Question 1

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing.The nurse finds a heart rate of 142 beats/minute,blood pressure of 100/60 mmHg,and respirations of 42 breaths/minute.Which action should the nurse take first?

Accepted Answer

The patient has symptoms consistent with a pulmonary embolism (PE).Elevating the head of the bed will improve ventilation and gas exchange.The other actions can be accomplished after the head is elevated (and oxygen is started).A spiral CT may be ordered by the health care provider to identify PE.Anticoagulants may be ordered after confirmation of the diagnosis of PE.

Question 2

A patient is diagnosed with both human immunodeficiency virus (HIV)and active tuberculosis (TB)disease.Which information obtained by the nurse is most important to communicate to the health care provider?

Accepted Answer

Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat TB.The other data are expected in a patient with HIV and TB.

Question 3

The nurse cares for a patient who has just had a thoracentesis.Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

Accepted Answer

Oxygen saturation would be expected to improve after a thoracentesis.A saturation of 88% indicates that a complication such as pneumothorax may be occurring.The other assessment data also indicate a need for ongoing assessment or intervention,but the low oxygen saturation is the priority.

Question 4

When assessing a patient who has just arrived after an automobile accident,the emergency department nurse notes tachycardia and absent breath sounds over the right lung.For which intervention will the nurse prepare the patient?

Accepted Answer

The patient's history and absent breath sounds suggest a right-sided pneumothorax or hemothorax,which will require treatment with a chest tube and drainage.The other therapies would be appropriate for an acute asthma attack,flail chest,or cardiac tamponade,but the patient's clinical manifestations are not consistent with these problems.

Question 5

A patient has just been admitted with probable bacterial pneumonia and sepsis.Which order should the nurse implement first?

Accepted Answer

Initiating antibiotic therapy rapidly is essential,but it is important that the cultures be obtained before antibiotic administration.The chest x-ray and acetaminophen administration can be done last.

Question 6

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung.Which information should the nurse include about the patient's postoperative care?

Accepted Answer

Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis.To promote gas exchange,patients after pneumonectomy are positioned on the surgical side.Early mobilization decreases the risk for postoperative complications such as pneumonia and deep vein thrombosis.In a pneumonectomy,chest tubes may or may not be placed in the space from which the lung was removed.If a chest tube is used,it is clamped and only released by the surgeon to adjust the volume of serosanguineous fluid that will fill the space vacated by the lung.If the cavity overfills,it could compress the remaining lung and compromise the cardiovascular and pulmonary function.Daily chest x-rays can be used to assess the volume and space.

Question 7

The nurse is performing tuberculosis (TB)skin tests in a clinic that has many patients who have immigrated to the United States.Which question is most important for the nurse to ask before the skin test?

Accepted Answer

Patients who have received the BCG vaccine will have a positive Mantoux test.Another method for screening (such as a chest x-ray)will need to be used in determining whether the patient has a TB infection.The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.

Question 8

The nurse receives change-of-shift report on the following four patients.Which patient should the nurse assess first?

Accepted Answer

Patients on bed rest who are immobile are at high risk for deep vein thrombosis (DVT).Sudden onset of shortness of breath in a patient with a DVT suggests a pulmonary embolism and requires immediate assessment and action such as oxygen administration.The other patients should also be assessed as soon as possible,but there is no indication that they may need immediate action to prevent clinical deterioration.

Question 9

The nurse supervises unlicensed assistive personnel (UAP)who are providing care for a patient with right lower lobe pneumonia.The nurse should intervene if which action by UAP is observed?

Accepted Answer

Positioning the patient with the head of the bed lowered will decrease ventilation.The other actions are appropriate for a patient with pneumonia.

Question 10

A patient is admitted to the emergency department with an open stab wound to the left chest.What is the first action that the nurse should take?

Accepted Answer

The dressing taped on three sides will allow air to escape when intrapleural pressure increases during expiration,but it will prevent air from moving into the pleural space during inspiration.Placing the patient on the left side or covering the chest wound with an occlusive dressing will allow trapped air in the pleural space and cause tension pneumothorax.The head of the bed should be elevated to 30 to 45 degrees to facilitate breathing.

Question 11

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic chest pain.Which prescribed medication should the nurse give first?

Accepted Answer

Early initiation of antibiotic therapy has been demonstrated to reduce mortality.The other medications are also appropriate and should be given as soon as possible,but the priority is to start antibiotic therapy.

Question 12

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat.The emergency department nurse would be most concerned if which finding is observed during the initial assessment?

Accepted Answer

Paradoxic chest movement indicates that the patient may have flail chest,which can severely compromise gas exchange and can rapidly lead to hypoxemia.Chest wall pain,a slightly elevated pulse rate,and chest bruising all require further assessment or intervention,but the priority concern is poor gas exchange.

Question 13

The nurse notes that a patient has incisional pain,a poor cough effort,and scattered rhonchi after a thoracotomy.Which action should the nurse take first?

Accepted Answer

A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain (which increases with deep breathing and coughing).The first action by the nurse should be to medicate the patient to minimize incisional pain.The other actions are all appropriate ways to improve airway clearance but should be done after the morphine is given.

Question 14

A patient with a pleural effusion is scheduled for a thoracentesis.Which action should the nurse take to prepare the patient for the procedure?

Accepted Answer

When the patient is sitting up,fluid accumulates in the pleural space at the lung bases and can more easily be located and removed.The patient does not usually require sedation for the procedure,and there are no restrictions on oral intake because the patient is not sedated or unconscious.Usually only 1000 to 1200 mL of pleural fluid is removed at one time.Rapid removal of a large volume can result in hypotension,hypoxemia,or pulmonary edema.

Question 15

A patient with idiopathic pulmonary arterial hypertension (IPAH)is receiving nifedipine (Procardia).Which assessment would best indicate to the nurse that the patient's condition is improving?

Accepted Answer

Because a major symptom of IPAH is exertional dyspnea,an improvement in this symptom would indicate that the medication was effective.Nifedipine will affect BP and heart rate,but these parameters would not be used to monitor the effectiveness of therapy for a patient with IPAH.The chest x-ray will show clear lung fields even if the therapy is not effective.

Question 16

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device.Which action by the nurse is most appropriate?

Accepted Answer

Continuous bubbling is expected in the suction-control chamber and indicates that the suction-control chamber is connected to suction.An air leak would be detected in the water-seal chamber.There is no evidence of pneumothorax.Increasing or decreasing the vacuum source will not adjust the suction pressure.The amount of suction applied is regulated by the amount of water in this chamber and not by the amount of suction applied to the system.

Question 17

A patient with pneumonia has a fever of 101.4° F (38.6° C),a nonproductive cough,and an oxygen saturation of 88%.The patient complains of weakness,fatigue,and needs assistance to get out of bed.Which nursing diagnosis should the nurse assign as the highest priority?

Accepted Answer

All these nursing diagnoses are appropriate for the patient,but the patient's oxygen saturation indicates that all body tissues are at risk for hypoxia unless the gas exchange is improved.

Question 18

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure.Which assessment would best evaluate the effectiveness of the therapies?

Accepted Answer

Cor pulmonale is right ventricular failure caused by pulmonary hypertension,so clinical manifestations of right ventricular failure such as peripheral edema,jugular venous distention,and right upper-quadrant abdominal tenderness would be expected.Crackles in the lungs are likely to be heard with left-sided heart failure.Findings in cor pulmonale include evidence of right ventricular hypertrophy on electrocardiogram ECG and an increase in intensity of the second heart sound.Heaves or thrills are not common with cor pulmonale.Chronic hypoxemia leads to polycythemia and increased total blood volume and viscosity of the blood.The hemoglobin and hematocrit values are more likely to be elevated with cor pulmonale than decreased.

Question 19

The nurse monitors a patient after chest tube placement for a hemopneumothorax.The nurse is most concerned if which assessment finding is observed?

Accepted Answer

The large amount of blood may indicate that the patient is in danger of developing hypovolemic shock.An air leak would be expected immediately after chest tube placement for a pneumothorax.Initially,brisk bubbling of air occurs in this chamber when a pneumothorax is evacuated.The pain should be treated but is not as urgent a concern as the possibility of continued hemorrhage.Subcutaneous emphysema should be monitored but is not unusual in a patient with pneumothorax.A small amount of subcutaneous air is harmless and will be reabsorbed.

Question 20

The nurse completes discharge teaching for a patient who has had a lung transplant.The nurse evaluates that the teaching has been effective if the patient makes which statement?

Accepted Answer

Low-grade fever may indicate infection or acute rejection so the patient should notify the health care provider immediately if the temperature is elevated.Patients require frequent follow-up visits with the transplant team.Annual health care provider visits would not be sufficient.Home oxygen use is not an expectation after lung transplant.Shortness of breath should be reported.Low-grade fever,fatigue,dyspnea,dry cough,and oxygen desaturation are signs of rejection.Immunosuppressive therapy,including prednisone,needs to be continued to prevent rejection.

Quiz 24: Nursing Management: Lower Respiratory Problems