Deck 28: Nursing Management: Lower Respiratory Problems

Question 1

During IV administration of amphotericin B ordered for treatment of coccidioidomycosis, the nurse increases the patient's tolerance of the drug by

A) cooling the solution to 80° F before administration.
B) keeping the patient flat in bed for 1 hour after the infusion is completed.
C) diluting the amphotericin B in 500 ml of sterile water.
D) giving diphenhydramine (Benadryl) 1 hour before starting the infusion.

Answer 1

giving diphenhydramine (Benadryl) 1 hour before starting the infusion.

Question 2

A patient who has active TB has just been started on drug therapy for TB. The nurse informs the patient that the disease can be transmitted to others until

A) the chest x-ray shows resolution of the tuberculosis.
B) three sputum smears for acid-fast bacilli are negative.
C) TB medications have been taken for 6 months.
D) sputum cultures on 3 consecutive days are negative.

Answer 2

three sputum smears for acid-fast bacilli are negative.

Question 3

An alcoholic and homeless patient is diagnosed with active TB. Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

A) Giving the patient written instructions about how to take the medications
B) Teaching the patient about the high risk for infecting others unless treatment is followed
C) Arranging for a daily noontime meal at a community center and give the medication then
D) Educating the patient about the long-term impact of TB on health

Answer 3

Arranging for a daily noontime meal at a community center and give the medication then

Question 4

A staff nurse has a TB skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about the

A) use and side effects of INH.
B) standard four-drug therapy for TB.
C) need for annual repeat TB skin testing.
D) recommendation guidelines for bacille Calmette-Guérin (BCG) vaccine.

Question 5

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which information best supports this diagnosis?

A) Resting pulse oximetry (SpO₂) of 85%
B) Respiratory rate of 28
C) Large amounts of greenish sputum
D) Weak, nonproductive cough effort

Question 6

To protect susceptible patients in the hospital from aspiration pneumonia, the nurse will plan to

A) turn and reposition immobile patients at least every 2 hours.
B) position patients with altered consciousness in lateral positions.
C) monitor frequently for respiratory symptoms in patients who are immunosuppressed.
D) provide for continuous subglottic aspiration in patients receiving enteral feedings.

Question 7

The nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB

A) demonstrates correct use of a nebulizer.
B) reports daily to the public health department.
C) washes dishes and personal items after use.
D) covers the mouth and nose when coughing.

Question 8

The nurse notes new-onset confusion in an 89-year-old patient in a long-term-care facility; the patient is normally alert and oriented. Which action should the nurse take next?

A) Check the patient's pulse rate.
B) Obtain an oxygen saturation.
C) Notify the health care provider.
D) Document the change.

Question 9

After 2 months of TB treatment with a standard four-drug regimen, a patient continues to have positive sputum smears for acid-fast bacilli (AFB). The nurse discusses the treatment regimen with the patient with the knowledge that

A) directly observed therapy (DOT) will be necessary if the medications have not been taken correctly.
B) the positive sputum smears indicate that the patient is experiencing toxic reactions to the medications.
C) twice-weekly administration may be used to improve compliance with the treatment regimen.
D) a regimen using only INH and rifampin (Rifadin) will be used for the last 4 months of drug therapy.

Question 10

A patient is receiving isoniazid (INH) after having a positive tuberculin skin test. Which information will the nurse include in the patient teaching plan?

A) "Take vitamin B₆ daily to prevent peripheral nerve damage."
B) "Read a newspaper daily to check for changes in vision."
C) "Schedule an audiometric examination to monitor for hearing loss."
D) "Avoid wearing soft contact lenses to avoid orange staining."

Question 11

The nurse observes a nursing assistant doing all the following activities when caring for a patient with right lower-lobe pneumonia. The nurse will need to intervene when the nursing assistant

A) turns the patient over to the right side.
B) splints the patient's chest during coughing.
C) elevates the patient's head to 45 degrees.
D) assists the patient to get up to the bathroom.

Question 12

A patient who was admitted to the hospital with pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of chest pain rated 7 on a 10-point scale with deep inspiration. Which of these ordered medications should the nurse give first?

A) Azithromycin (Zithromax)
B) Acetaminophen (Tylenol)
C) Guaifenesin (Robitussin)
D) Codeine phosphate (Codeine)

Question 13

To promote airway clearance in a patient with pneumonia, the nurse instructs the patient to

A) splint the chest when coughing.
B) maintain fluid restrictions.
C) wear the nasal oxygen cannula.
D) try the pursed-lip breathing technique.

Question 14

The nurse will anticipate discharge today for which of these patients with community-acquired-pneumonia?

A) 24-year-old patient who has had temperatures ranging from 100.6° to 101° F
B) 35-year-old patient who has had 600 ml of oral fluids in the last 24 hours
C) 50-year-old patient who has an oxygen saturation of 91% on room air
D) 72-year-old patient with a pulse of 102 and a blood pressure (BP) of 90/56

Question 15

After a patient with right lower-lobe pneumonia has been treated with intravenous (IV) antibiotics for 2 days, which assessment data obtained by the nurse indicates that the treatment has been effective?

A) Bronchial breath sounds are heard at the right base.
B) Increased vocal fremitus is palpable over the right chest.
C) The patient coughs up small amounts of green mucous.
D) The patient's white blood cell (WBC) count is 9000/µl.

Question 16

When teaching the patient who is receiving standard multidrug therapy for TB about possible toxic effects of the antitubercular medications, the nurse will give instructions to notify the health care provider if the patient develops

A) yellow-tinged skin.
B) changes in hearing.
C) orange-colored urine.
D) thickening of the nails.

Question 17

A 77-year-old patient with pneumonia has a fever of 101.2° F (38.5° C), a nonproductive cough, and an oxygen saturation of 89%. The patient is very weak and needs assistance to get out of bed. The priority nursing diagnosis for the patient is

A) hyperthermia related to infectious illness.
B) ineffective airway clearance related to thick secretions.
C) impaired transfer ability related to weakness.
D) impaired gas exchange related to respiratory congestion.

Question 18

A hospitalized patient who may have tuberculosis (TB) has an order for a sputum specimen. When will be the best time for the nurse to collect the specimen?

A) After the patient rinses the mouth with mouthwash
B) As soon as the order is received from the health care provider
C) Right after the patient gets up in the morning
D) After the skin test is administered

Question 19

Following discharge teaching, the nurse evaluates that the patient who was admitted with pneumonia understands measures to prevent a reoccurrence of the pneumonia when the patient states,

A) "I will increase my food intake to 3000 calories a day."
B) "I will need to use home oxygen therapy for 3 months."
C) "I will seek medical treatment for any upper respiratory infections."
D) "I will do deep-breathing and coughing exercises for the next 6 weeks."

Question 20

During assessment of the chest in a patient with pneumococcal pneumonia, the nurse would expect to find

A) hyperresonance on percussion.
B) increased vocal fremitus on palpation.
C) fine crackles in all lobes on auscultation.
D) asymmetric chest expansion on inspection.

Question 21

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The patient tells the nurse, "I would rather have radiation than surgery." Which response by the nurse is most appropriate?

A) "Are you afraid that the surgery will be very painful?"
B) "Tell me what you know about the various treatments available."
C) "Surgery is the treatment of choice for stage I lung cancer."
D) "Did you have bad experiences with previous surgeries?"

Question 22

When providing preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung, the nurse informs the patient that the postoperative care includes

A) positioning on the right side.
B) chest tubes to water-seal chest drainage.
C) bedrest for the first 24 hours.
D) frequent use of an incentive spirometer.

Question 23

An hour after a left upper lobectomy, a patient complains of incisional pain at a level 7 out of 10 and has decreased left-sided breath sounds. The pleural drainage system has 100 ml of bloody drainage and a large air leak. Which action should the nurse take first?

A) Assist the patient to deep breathe and cough.
B) Milk the chest tube gently to remove any clots.
C) Medicate the patient with the ordered morphine.
D) Notify the surgeon about the large air leak.

Question 24

The nurse identifies a nursing diagnosis of ineffective airway clearance for a patient who has incisional pain, a poor cough effort, and scattered rhonchi after having a pneumonectomy. To promote airway clearance, the nurse's first action should be to

A) have the patient use the incentive spirometer.
B) medicate the patient with the ordered morphine.
C) splint the patient's chest during coughing.
D) assist the patient to sit up at the bedside.

Question 25

A patient with primary pulmonary hypertension is receiving nifedipine (Procardia). The nurse will evaluate that the treatment is effective if

A) the patient reports decreased exertional dyspnea.
B) the blood pressure is less than 140/90 mm Hg.
C) the heart rate is between 60 and 100 beats/minute.
D) the patient's chest x-ray indicates clear lung fields.

Question 26

When caring for a patient who is hospitalized with active TB, the nurse observes a family member who is visiting the patient. The nurse will need to intervene if the family member

A) washes the hands before entering the patient's room.
B) puts on a surgical face mask before visiting the patient.
C) brings food from a "fast-food" restaurant to the patient.
D) hands the patient a tissue from the box at the bedside.

Question 27

A patient experiences a steering wheel injury as a result of an automobile accident. During the initial assessment, the emergency department nurse would be most concerned about

A) complaints of severe pain.
B) heart rate of 110 beats/min.
C) a large bruised area on the chest.
D) paradoxic chest movement.

Question 28

A patient is admitted to the emergency department with a stab wound to the right chest. Air can be heard entering his chest with each inspiration. To decrease the possibility of a tension pneumothorax in the patient, the nurse should

A) position the patient so that the right chest is dependent.
B) administer high-flow oxygen using a non-rebreathing mask.
C) cover the sucking chest wound with an occlusive dressing.
D) tape a nonporous dressing on three sides over the chest wound.

Question 29

A 68-year-old man has a long history of COPD and is admitted to the hospital with cor pulmonale. Which clinical manifestation noted by the nurse is consistent with the cor pulmonale diagnosis?

A) Audible crackles at both lung bases
B) 3+ edema in the lower extremities
C) Loud murmur at the mitral area
D) High systemic BP

Question 30

The nurse is caring for a patient with primary pulmonary hypertension who is receiving epoprostenol (Flolan). Which assessment information requires the most immediate action?

A) The international normalized ratio (INR) is prolonged.
B) The central line is disconnected.
C) The oxygen saturation is 90%.
D) The BP is 88/56.

Question 31

The nurse is performing TB screening in a clinic that has many patients who have immigrated to the United States. Before doing a TB skin test on a patient, which question is most important for the nurse to ask?

A) "How long have you lived in the United States?"
B) "Is there any family history of TB?"
C) "Have you received the BCG vaccine for TB?"
D) "Do you take any over-the-counter (OTC) medications?"

Question 32

The occupational nurse at a manufacturing plant where there is high worker exposure to beryllium dust will monitor workers for

A) shortness of breath.
B) chest pain.
C) elevated temperature.
D) barrel-chest.

Question 33

After discharge teaching has been completed for a patient who has had a lung transplant, the nurse will evaluate that the teaching has been effective if the patient states

A) "I will make an appointment to see the doctor every year."
B) "I will not turn the home oxygen up higher than 2 L/minute."
C) "I will be careful to use sterile technique with my central line."
D) "I will write down my medications and spirometry in a journal."

Question 34

The health carre provider inserts two chest tubes connected with a Y-connecter in a patient with a hemopneumothorax. When monitoring the patient after the chest tube placement, the nurse will be most concerned about

A) a large air leak in the water-seal chamber.
B) 400 ml of blood in the collection chamber.
C) severe pain with each deep patient inspiration.
D) subcutaneous emphysema at the insertion site.

Question 35

A patient with newly diagnosed lung cancer tells the nurse, "I think I am going to die pretty soon, maybe this week." The best response by the nurse is

A) "Are you afraid that the treatment for your cancer will not be effective?"
B) "Can you tell me what it is that makes you think you will die so soon?"
C) "Would you like to talk to the hospital chaplain about your feelings?"
D) "Do you think that taking an antidepressant medication would be helpful?"

Question 36

When developing a teaching plan for a patient with a 42 pack-year history of cigarette smoking, it will be most important for the nurse to include information about

A) reasons for annual sputum cytology testing.
B) CT screening for lung cancer.
C) erlotinib (Tarceva) therapy to prevent tumor risk.
D) options for smoking cessation.

Question 37

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

A) document the presence of a large air leak.
B) obtain and attach a new collection device.
C) notify the health care provider of a possible pneumothorax.
D) take no further action with the collection device.

Question 38

A patient who was admitted the previous day with pneumonia complains of a sharp pain "whenever I take a deep breath." Which action will the nurse take next?

A) Listen to the patient's lungs.
B) Check the patient's O₂ saturation.
C) Have the patient cough forcefully.
D) Notify the patient's health care provider.

Question 39

A patient with a pleural effusion is scheduled for a thoracentesis. Prior to the procedure, the nurse will plan to

A) position the patient sitting upright on the edge of the bed and leaning forward.
B) instruct the patient about the importance of incentive spirometer use after the procedure.
C) start a peripheral intravenous line to administer the necessary sedative drugs.
D) remove the water pitcher and remind the patient not to eat or drink anything for 8 hours.

Question 40

The emergency department nurse will suspect a tension pneumothorax in a patient who has been in an automobile accident if

A) the breath sounds on one side are decreased.
B) there are wheezes audible throughout both lungs.
C) there is a sucking sound with each patient breath.
D) paradoxic movement of the chest is noted.

Question 41

In developing a teaching plan for a patient who is being discharged with a warfarin (Coumadin) prescription after having a pulmonary embolus, the nurse will include information about

A) where to schedule activated partial thromboplastin time testing.
B) avoidance of a high protein diet.
C) how to obtain enteric-coated aspirin.
D) foods that are high in vitamin K.

Question 42

A patient with a chronic productive cough and weight loss is receiving a tuberculosis skin test and asks the nurse the reason for the test. Which response should the nurse give?

A) The skin test will determine if you have a tuberculosis infection.
B) The skin test will indicate whether you have active tuberculosis.
C) The skin test is used to decide which antibiotic therapy will work best.
D) The skin test is done prior to notification of the public health department.

Question 43

Which assessment information obtained by the nurse when caring for a patient who has just had a thoracentesis is most important to communicate to the health care provider?

A) BP is 150/90.
B) Pain level is 5/10 with a deep breath.
C) Oxygen saturation is 89%.
D) Respiratory rate is 24 when lying flat.

Question 44

All of the following orders are received for a patient who has just been admitted with probable bacterial pneumonia and sepsis. Which one will the nurse accomplish first?

A) Obtain blood cultures from two sites.
B) Give ciprofloxin (Cipro) 400 mg IV.
C) Send to radiology for chest radiograph.
D) Administer aspirin suppository.

Question 45

All of the following information is obtained by the nurse who is caring for a patient receiving subcutaneous heparin injections to treat a pulmonary embolus. Which assessment data is most important to communicate to the health care provider?

A) The patient has many abdominal bruises.
B) The patient's BP is 90/46.
C) The activated partial thromboplastin time is 2 times the patient baseline.
D) The patient's stool is dark green and liquid.

Question 46

The nurse has received change-of-shift report about these four patients. Which one will the nurse plan to assess first?

A) A 23-year-year-old patient with cystic fibrosis who has pulmonary function testing scheduled in 30 minutes
B) A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 100.2° F
C) A 46-year-old patient who is complaining of dyspnea after having a thoracentesis an hour previously
D) A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes

Question 47

A patient with a deep vein thrombophlebitis complains of sudden chest pain and difficulty breathing. The nurse finds a heart rate of 142, BP of 100/60, and respirations of 42. The nurse's first action should be to

A) elevate the head of the bed.
B) administer the ordered pain medication.
C) notify the patient's health care provider.
D) offer emotional support and reassurance.