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27 Cards in this Set

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In a presentation to a group of middle school students, the nurse identifies which of the following as the major risk factor for lung cancer?
A. Smoking marijuana
B. Cigarette smoking
C. Alcohol consumption
D. Asbestos exposure
B. Cigarette smoking
In assessing the client admitted with respiratory disease, the nurse correlates which finding to the client with emphysema?
A. Chronic, productive cough
B. Dyspnea at rest
C. Wheezing
D. Slow, deep respirations
B. Dyspnea at rest
In differentiating bronchospasm from asthma, the nurse notes that bronchospasm involves constricted airways without:
A. Change in work of breathing
B. Change respiratory rate
C. Airway resistance
D. Inflammation
D. Inflammation
In evaluating the client's response to treatment for restrictive breathing problems, which of the following would indicate a worsening of condition?
A. Increased sputum production
B. Change in color of sputum
C. Increasing rales and crackles
D. Increasing dyspnea at rest
D. Increasing dyspnea at rest
In evaluating the effectiveness of aminophylline in the client with asthma, the nurse expects:
A. Thinning of secretions
B. Increase in respiratory rate
C. Suppression of cough
D. Decrease in wheezing
D. Decrease in wheezing
In interpreting pulmonary function test results for the client with asthma, the nurse recognizes the need for intervention when:
A. Peak inspiratory pressure (PIP) decreases.
B. Peak expiratory rate flow (PERF) decreases.
C. Forced vital capacity (FVC) increases.
D. Forced expiratory volume in the first second (FEV1) increases.
B. Peak expiratory rate flow (PERF) decreases.
In preparing an inservice about COPD, the nurse includes which risk factors?
A. Lobectomy for cancer
B. Allergic reactions to pollen
C. Frequent bouts of pneumonia
D. Cigarette smoking
D. Cigarette smoking
In teaching the client about radiation therapy for lung cancer, the nurse explains that side effects may include:
A. Weight gain
B. Dyspnea
C. Oral bleeding
D. Taste changes
D. Taste changes
In teaching the client at step III of stepped therapy for asthma, the nurse stresses that:
A. Daily use of rescue inhalers may indicate worsening of condition.
B. Long-acting bronchodilators are not effective for this step.
C. Symptoms usually occur two times per month.
D. Inhaled corticosteroids are contraindicated at this step.
A. Daily use of rescue inhalers may indicate worsening of condition.
The nurse assesses the client receiving chronic oral steroids for which of the following complications?
A. Weight loss
B. Renal calculi
C. Hyperglycemia
D. Tachycardia
C. Hyperglycemia
The nurse recognizes that clients with COPD are at greatest risk for:
A. Protein malnutrition
B. Carbohydrate intolerance
C. Loss of body fat
D. Vitamin deficiency
A. Protein malnutrition
The nurse teaches the client being discharged after pneumonectomy to:
A. Always sleep with the operative side down.
B. Take temperature daily to monitor for signs of infection.
C. Avoid using arm on affected side.
D. Perform deep breathing exercises with the operative side up.
B. Take temperature daily to monitor for signs of infection.
The nurse teaches the client with COPD which of the following energy conservation measures?
A. "Hold your breath when doing an activity to decrease respiratory rate."
B. "Avoid talking when doing exercises to avoid exertion."
C. "Do not drink fluids before an activity involving ambulation."
D. "Increase oxygen setting when doing strenuous activities."
B. "Avoid talking when doing exercises to avoid exertion."
Which of the following findings in the client after lung reduction surgery would require an immediate intervention?
A. Pain on inspiration
B. Decreased cough
C. Absence of breath sounds
D. Drainage from operative site
C. Absence of breath sounds
Which statement by the client with COPD being discharged on home oxygen indicates the need for further teaching?
A. “It would be best if the oxygen was humidified.”
B. “If I get short of breath, I can increase the oxygen to 6 L/min.”
C. “I may not need to use the oxygen all the time, only when I feel short of breath.”
D. “If the oxygen setting is too high, I could stop breathing.”
B. “If I get short of breath, I can increase the oxygen to 6 L/min.”
While assisting a client in changing positions, the chest tube is pulled from the client's chest. What should the nurse do first?
A. Check breath sounds.
B. Place the end of the chest tube in a cup of water.
C. Place the client in a reverse Trendelenburg position.
D. Cover the opening in the chest with a dressing.
D. Cover the opening in the chest with a dressing.
The medical-surgical unit you are working on has one bed left that is negative airflow. There are four clients in the emergency department who need to be admitted to a bed. Of the following clients, which one should you accept on your unit?
A. The 92-year-old woman with bacterial lower lobe pneumonia and a blood pressure of 70/50
B. The 84-year-old man with respiratory distress and who is currently on 100% oxygen
C. The 65-year-old man with right empyema who has a chest tube and a fever of 103.2° F
D. The 45-year-old woman with suspected pulmonary tuberculosis who currently has hemoptysis
D. The 45-year-old woman with suspected pulmonary tuberculosis who currently has hemoptysis

This unit has a negative airflow bed, which is appropriate for the client with suspected tuberculosis and the other clients warrant admission to units with higher levels of care.
The RN is caring for a 55-year-old man with bilateral pneumonia resulting from aspiration after alcohol intoxication. Of the following orders, which would the nurse implement first?
A. Draw anaerobic and aerobic blood cultures.
B. Refer to social worker regarding alcohol treatment options.
C. Hang Levaquin 500 mg IV with normal saline at 100 mL/hr.
D. Give Ativan 1 mg PO at bedtime and as needed for agitation.
A. Draw anaerobic and aerobic blood cultures.

Obtaining the blood cultures before hanging the antibiotics is standard practice. This enables the result to not be altered by infusing antibiotics. Ativan and referral to social worker should follow, but are not appropriate to implement first.
Which of the following clients would you assign to a nurse who recently contracted an upper respiratory infection and is currently undergoing antibiotic therapy?
A. A 78-year-old client admitted for viral pneumonia
B. A 59-year-old postsurgical client who has undergone sinus surgery
C. A 23-year-old postsurgical client who has undergone tonsillectomy
D. A 19-year-old client admitted for neutropenia
A. A 78-year-old client admitted for viral pneumonia

Clients who are postoperative are at risk for acquiring infections from their caregivers. A client who is neutropenic should not be cared for by a nurse with a history of recent infection because of the client’s suppressed immune system. A client with an existing respiratory infection would be an appropriate assignment.
Which of the following clients would you not allow the nursing assistant to obtain an oral temperature from?
A. A 67-year-old client with type 2 diabetes who is suspected of having a sinus infection
B. A 43-year-old smoker with a history of elevated cholesterol diagnosed with pneumonia
C. A 37-year-old client with stridor and complaint of fever with sore throat for the past 2 hours
D. A 21-year-old client who complains of fever and is suspected of having viral pharyngitis.
C. A 37-year-old client with stridor and complaint of fever with sore throat for the past 2 hours

This client is exhibiting signs of epiglottis and obtaining an oral temperature is contraindicated because of the possibility of causing laryngospasm.
Which of the following tasks would be appropriate to delegate to the LPN working with you in the ICU?
A. Assessing lung sounds on a client with diagnosed SARS (severe acute respiratory syndrome)
B. Performing incision and drainage on a client with a left peritonsillar abscess
C. Administering zanamivir (Relenza) to a client with diagnosed influenza A and dehydration
D. Adjusting ventilator settings according to recent arterial blood gases for a client with bacterial pneumonia
C. Administering zanamivir (Relenza) to a client with diagnosed influenza A and dehydration.

The RN is legally responsible for the physical assessments of client within the unit. Incision and drainage of a peritonsillar abscess is the role of the physician. Adjusting ventilator settings is not within the scope of practice of an LPN.
An 81-year-old woman presents to your emergency department with a 2-day history of cough, pain on inspiration, and shortness of breath. She had symptoms of an upper respiratory illness (URI) last week. Over the past 2 days she has had increased dyspnea. She has never had a pneumococcal vaccine. Her pulse oximetry reading is 89% on room air. Her chest x-rays show density in both bases. You note wheezing upon auscultation of her lungs.
The client is admitted and her sputum culture is positive for Streptococcus. The client asks about the length of her treatment. You base your answer on the following. Check all that apply.
A. When the client is afebrile for 24 hours.
B. When she has completed 6 days of antibiotic therapy.
C. She may be switched from intravenous to oral therapy in 2 to 3 days.
D. Usually anti-infectives are used for 7 to 10 days.
C. She may be switched from intravenous to oral therapy in 2 to 3 days.
D. Usually anti-infectives are used for 7 to 10 days.

pp. 637-638. The course of therapy varies with the drug and the organism. The key to effective treatment of pneumonia is eradication of the organism causing the infection. The client may be switched from intravenous to oral therapy in 2 to 3 days depending on the response (e.g., stable clinical condition, afebrile).
Your client is a 47-year-old homeless man who has spent the last 6 months living in shelters. He has confirmed tuberculosis (TB). You are performing your medication teaching with this client.
The client asks why he must take so many medications. Your answer should include the following information. Check all that apply.
A. The use of multiple drugs reduces the emergence of drug-resistant organisms.
B. Combination drug therapy is the most effective method of treating TB.
C. Combination drug therapy is effective in preventing transmission.
D. Multiple drug regimens destroy organisms as quickly as possible.
All of the above (See answers on p. 642-644.)
Your client is a 47-year-old homeless man who has spent the last 6 months living in shelters. He has confirmed tuberculosis (TB). You are performing your medication teaching with this client.
What teaching points do you want to stress about his medications? Check all that apply.
A. The medications may cause nausea; the client should take them at bedtime.
B. Not taking the medication could lead to an infection that is difficult to treat or has total drug resistance.
C. These medications must be taken for 2 years.
D. The client is generally not contagious after 2 to 3 consecutive weeks on the medication regimen.
A. The medications may cause nausea; the client should take them at bedtime.
D. The client is generally not contagious after 2 to 3 consecutive weeks on the medication regimen.

pp.644-645. TB drugs may cause nausea. Taking them at bedtime may prevent nausea. Drugs must be taken for 2 to 3 weeks and improvement must be seen.
An 81-year-old woman presents to your emergency department with a 2-day history of cough, pain on inspiration, and shortness of breath. She had symptoms of an upper respiratory illness (URI) last week. Over the past 2 days she has had increased dyspnea. She has never had a pneumococcal vaccine. Her pulse oximetry reading is 89% on room air. Her chest x-rays show density in both bases. You note wheezing upon auscultation of her lungs.
Why would a bronchodilator be beneficial to this client?
A. It would not be beneficial.
B. It is given when bronchospasm is part of the disease process.
C. It will resolve the areas of density.
D. It can prevent areas of hypoperfusion.
B. It is given when bronchospasm is part of the disease process.

pp. 633, 637. The inflammation occurs in the interstitial spaces, the alveoli, and often the bronchioles.
An 81-year-old woman presents to your emergency department with a 2-day history of cough, pain on inspiration, and shortness of breath. She had symptoms of an upper respiratory illness (URI) last week. Over the past 2 days she has had increased dyspnea. She has never had a pneumococcal vaccine. Her pulse oximetry reading is 89% on room air. Her chest x-rays show density in both bases. You note wheezing upon auscultation of her lungs.
Why would anti-infectives NOT be prescribed immediately for this client?
A. Her age puts her at increased risk.
B. She needs to have a renal clearance test.
C. Her white cell count has not elevated.
D. Anti-infectives are given for all types of pneumonias except those caused by viruses.
D. Anti-infectives are given for all types of pneumonias except those caused by viruses.

pp. 637-638
Your client is a 47-year-old homeless man who has spent the last 6 months living in shelters. He has confirmed tuberculosis (TB). You are performing your medication teaching with this client.
What medications will be prescribed for your client?
A. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Tebrazid).
B. Prednisone (Prednisone), guaifenesin (Organidin), ketorolac (Toradol).
C. Metronidazole (Flagyl), acyclovir (Zovirax), flunisolide (AeroBid).
D. Salmeterol (Serevent), cromolyn sodium (Intal), dexamethasone (Decadron).
A. Isoniazid (INH), rifampin (Rifadin), pyrazinamide (Tebrazid).

p. 642-644. Current therapy uses these medications. This protocol shortens the therapy from 6 to 12 months to only 6 months.