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Respiratory Nursing - Practice
Questions
A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of the med if the client states that he or she will perform which action? a) take an extra dose if fever develops b) take the medication with meals only c) take the tablet with a full glass of water d) decrease the amount of daily fluid intake - ansC Rationale Silvestri p 769 A client has been admitted with chest trauma after a motor vehicle crash and has undergone subsequent intubation. The nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has absensce of breath sounds in the right upper lobe of the lung. The nurse immediately assesses for the other signs of which condition? a) right pneumothorax b) pulmonary embolism c) displaced endotracheal tube d) acute respiratory distressed syndrome - ansA Rationale Silvestri p 750 A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the med? a) should always be taken with food or antacids b) should be double-dosed if one dose is forgotten c) causes orange discoloration of sweat, tears, urine, and feces d) may be discontinued independently if symptoms are gone in 3 months - ansC Rationale Silvestri p 770 A client has been taking isoniazid for 1.5 months. The client complains to the nurse about numbness, paresthesias, and tingling in the extremeties. The nurse interprets that the client is experiencing which problem? a) hypercalcemia b) peripheral neuritis
c) small blood vessel spasm d) impaired peripheral circulation - ansB Rationale Silvestri p 770 A client has begun therapy with theophyline (Theo-24). The nurse should plan to teach the client to limit the intake of which items while taking this medication? a) coffee, cola, and chocolate b) oysters, lobster, and shrimp c) melons, oranges, and pineapple d) cottage cheese, cream cheese, and dairy creamers - ansA Rationale Silvestri p 771 A client has experienced a pulmonary embolism. The nurse should assess for which symptom, which is most commonly reported? a) hot, flushed feeling b) sudden chills and fever c) chest pain that occurs suddenly d) dyspnea when deep breaths are taken - ansC Rationale Silvestri p 751 A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a) use alcohol in small amounts only b) report yellow eyes or skin immediately c) increase intake of Swiss or aged cheeses d) avoid vitamin supplements during therapy - ansB Rationale Silvestri p 770 A client undergoes nasal surgery. The nurse instructs the client to not blow the nose. What is the reason for this instruction? a) blowing increases intracranial pressure b) blowing decreases the client's O2 supply c) blowing encourages bruising and edema d) blowing may cause a nasal fracture - ansC *Clients undergoing nasal surgery are instructed not to blow their noses in the post-op period b/c it can cause bruising and edema
b) constipation c) hypotension d) bronchospasm - ansD Rationale Silvestri p 769 A patient with sleep apnea has a nursing Dx of sleep deprivation r/t disrupted sleep cycle. Which action should you delegate to the UAP? a) discussing weight-loss strategies such as diet and exercise with the pt b) teaching the pt how to set up the BiPAP machine b4 sleeping c) reminding the pt to sleep on his side instead of his back d) administering modafinil (Provigil) to promote daytime wakefulness - ansC A pt dX with COPD is drowsy and unable to expectorate secretions. The nurse should take which of the following actions? a) force fluids b) administer high-flow O2 via mask c) perform nasotracheal suction d) perform postural drainage - ansC *If pt unable to expectorate secretions, suctioning is appropriate; auscultate breath sounds to determine if suctioning is required A pt has COPD. Which intervention for airway management should you delegate to the UAP? a) assisting the pt to sit up on the side of the bed b) instructing the pt to cough effectively c) teaching the pt to use incentive spirometry d) auscultating breath sounds every 4 hrs - ansA A pt requires an emergency tracheostomy. When caring for the trach, the nurse should take which of the following actions? a) suction every hour b) clean the inner cannula after suctioning c) clean the site every 4 hours d) hyperextend the pt's neck to maintain patency - ansC *cleaning the site every 4 hours will help prevent infection A pt with a pulmonary embolus is receiving anticoagulation with IV heparin. What instructions would you give the UAP who will help the pt with ADLs? (Select all that apply)
a) use a lift sheet when moving and positioning the pt in bed b) use an electric razor when shaving the pt each day c) use a soft-bristled toothbrush or tooth sponge for oral care d) use a rectal thermometer to obtain a more accurate body temp e) be sure the pt's footwear has a firm sole when the pt ambulates - ansA, B, C, E A pt with acute respiratory distress syndrome is receiving O2 by nonrebreather mask, but arterial blood gas measurements still show poor oxygenation. As the nurse responsible for the patient's care, you would anticipate a physician order for what action? a) perform endotracheal intubation and initiate mechanical ventilation b) immediately begin continuous positive airway pressure (CPAP) via the patient's nose and mouth c) administer furosemide/Lasix 100 mg IV push STAT d) call a a code for respiratory arrest - ansA *A nonrebreather mask can deliver nearly 100% oxygen. When the pt's oxygenation status does not improve adequately in response to delivery of oxygen at this high concentration, refractory hypoxemia is present. *usually at this stage, the pt is working very hard to breathe and may go into respiratory arrest unless HCPs intervene by providing intubation and mechnical ventilation to decrease the pt's work of breathing After change of shift, you are assigned to care for the following pts. Which pt should you assess first? a) 68 yo on a ventilator for whom a sterile sputum specimen must be sent to the lab b) 57 yo with COPD and a pulse ox reading from the previous shift of 90% saturation c) 72 yo with pneumonia who needs to be started on IV antibiotics d) 51 yo with asthma who reports s.o.b. after using a bronchodilator inhaler - ansD After the respiratory therapist performs suctioning on a pt who is intubated, the UAP measures vital signs for the pt. Which vital sign value should the UAP report to the RN immediately? a) heart rate 98 bpm b) respiratory rate of 24 breaths per min c) BP of 168/ d) tympanic temp of 101.4 F - ansD *Infections are always a threat for the pt receiving mechanical ventilation. The endotracheal tube bypasses the body's normal air-filtering mechanisms and provides a direct access route for bacteria or viruses to the lower parts of the respiratory system
friction rubs are grating sounds that are usually heard during both inspiration and expiration. Rifabutin (Mycobutin) is prescribed for a client with active Mycobacterium avium complex (MAC) disease and TB. For which side/adverse effects of the med should the nurse monitor? (Select all that apply) a) signs of hepatitis b) flu-like symptoms c) low neutrophil count d) vitamin B6 deficiency e) ocular pain or blurred visioin f) tingling and numbness of the fingers - ansA, B, C, E Rationale Silvestri p 771 Terbutaline is prescribed for a client with bronchitis. The nurse understands that this medication should be used with caution if which medical condition is present in the client? a) osteoarthritis b) hypothyroidism c) diabetes mellitus d) polycystic disease - ansC Rationale Silvestri p 769- The charge nurse is making assignments for the next shift. Which pt should be assigned to the fairly new nurse (6 months experience) floated from the surgical unit to the medical unit? a) 58 yo on airborne precautions for TB b) 65 yo who just returned from bronchoscopy and biopsy c) 72 yo who needs teaching about the use of incentive spirometry d) 69 yo with COPD who is ventilator dependent - ansC The community health nurse is conducting an educational session with community members regarding the symptoms associated with tuberculosis. Which is one of the first manifestations associated with tuberculosis? a) dyspnea b) chest pain c) a bloody, productive cough d) a cough with the expectoration of mucoid sputum - ansD Rationale Silvestri p 752
The E.D. nurse is assessing a client who has sustained a blunt injury to the chest wall. Which finding would indicate the presence of a pneumothorax in this client? a) low respiratory rate b) diminished breath sounds c) the presence of a barrel chest d) a sucking sound at the site of injury - ansB Rationale Silvestri p 749 The high pressure alarm on a patient's ventilator goes off. When u enter the room to assess the pt who has ARDS, the O2 monitor reads 87% and the pt is struggling to sit up. Which action should you take next? a) reassure the pt that the ventilator will do the work of breathing for him b) manually ventilate the pt while assessing possible reasons for the high pressure alarm c) increase the fraction of inspired O2 on the ventilator to 100% in prep. for endotracheal suctioning d) insert an oral airway to prevent the pt from biting on the endotracheal tube - ansB The low-pressure alarm sounds on a ventilator. The nurse assesses the client and then attempts to determine the cause of the alarm. If unsuccessful in determining the cause of the alarm, the nurse should take what initial action? a) administer O b) check the client's vital signs c) ventilate the client manually d) start cardiopulmonary resuscitation - ansC The nurse cares for a pt receiving IV aminophylline. The nurse understands that the med is: a) an antimicrobial b) a mucolytic c) a bronchodilator d) an expectorant - ansC *Aminophyline is a xanthine derivative that acts as a bronchodilator by relaxing smooth muscles *xanthines also stimulate the CNS, dilate coronary arteries & pulmonary vessels, and cause diuresis *Side effects include anorexia, nause and vomiting, gastric pain, nervousness, dizziness, headache, tachycardia, and palpitations
d) I should not be contagious after 2 to 3 weeks of medication therapy - ansD Rationale Silvestri p 751 The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will immediately report which finding? a) impaired sense of hearing b) gastrointestinal side effects c) orange-red discoloration of body secretions d) difficulty in discriminating the color red from green - ansD Rationale Silvestri p 770 The nurse has just administered the first dose of omalizumab (Xolair) to a client. Which statement by the client would alert the nurse that the client may be experiencing a life- threatening effect? a) I have a severe headache b) My feet are quite swollen c) I am nauseated and may vomit d) My lips and tongue are swollen - ansD Rationale Silvestri p 771 The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds that the primary purpose of pursed-lip breathing is to promote which outcome? a) promote oxygen intake b) strengthen the diaphragm c) strengthen intercostal muscles d) promote carbon dioxide elimination - ansD Rationale Silvestri p 749 The nurse is assessing a client with multiple trauma who is at risk for developing acute respiratory distress syndrome. The nurse should assess for which earliest sign of ARDS? a) bilateral wheezing b) inspiratory crackles c) intercostal retractions d) increased respiratory rate - ansD
Rationale Silvestri p 750 The nurse is assessing respiratory status of a client who has suffered a fractured rib. The nurse should expect to note which finding? a) slow deep respirations b) rapid deep respirations c) paradoxical respirations d) pain, especially with inspiration - ansD Rationale Silvestri p 750 The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in the client, should be reported immediately to the health care provider? a) dry cough b) hematuria c) bronchospasm d) blood-streaked sputum - ansC Rationale Silvestri p 749 The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? (Select all that apply) a) hypocapnia b) a hyperinflated chest noted on the chest x-ray c)decreased oxygen saturation with mild exercise d) a widened diaphragm noted on the chest x-ray e) pulmonary function tests that demonstrate increased vital capacity - ansB, C Rationale Silvestri p 749 The nurse is caring for a client with a dX of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an UNDERSTANDING of the instruction? a) I must take the medication exactly as prescribed b) Once I start the medication, I will no longer be contagious c) I will not get any colds or infections while taking this medication d) this medication has minimal side effects and I can return to normal activities - ansA Rationale Silvestri p 771-
Rationale Silvestri p 749 The nurse is preparing to administer a dose of naloxone hydrochloride intravenously to a client with an IV opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? a) nasogastric tube b) paracentesis tray c) resuscitation equipment d) central line insertion tray - ansC Rationale Silvestri p 769 The nurse is preparing to give a bed bath to an immobilized client with TB. The nurse should wear which item when performing this care? a) surgical mask and gloves b) particulate respirator, gown, and gloves c) particulate respirator and protective eyewear d) surgical mask, gown, and protective eyewear - ansB Rationale Silvestri p 751 The nurse is preparing to suction a client via a tracheostomy tube. The nurse should plan to limit the suctioning time to a maximum of which time period? a) 1 minute b) 5 seconds c) 10 seconds d) 30 seconds - ansC Rationale Silvestri p 750 The nurse is suctioning a client via an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate is decreasing. Which nursing intervention is most appropriate? a) continue to suction b) notify the health care provider immediately c) stop the procedure and reoxygenate the client d) ensure that the suction is limited to 15 seconds - ansC Rationale Silvestri p 750
The nurse is taking the history of a client with occupational lung disease (silicosis). The nurse should assess whether the client wears which item during periods of exposure to silica particles? a) mask b) gown c) gloves d) eye protection - ansA Rationale Silvestri p 752 The nurse observes a student nurse suction the right bronchus of a pt via the tracheostomy. The nurse determines care is appropriate if the student nurse places the pt's head in which position? a) the pt's head turned to the left b) the pt's head turned to the right c) the pt's head tilted forward toward the ches d) the pt's head tilted backward even with the shoulders - ansA *When a trach is suctioned, the head should be positioned to the side opposite from that of the bronchus being suctioned *clearing the right bronchus is therefore best accomplished by turning pt's head to the left The nurse performs an admission assessment on a client with a diagnosis of TB. The nurse should check the results of which diagnostic test that will confirm this diagnosis? a) chest x-ray b) bronchoscopy c) sputum culture d) TBT - ansC Rationale Silvestri p 752 The nurse performs nutritional counseling for a pt who is dX with COPD. It is most important for the nurse to advise the pt to avoid consuming which nutrient in high amounts? a) carbs b) calories c) protein d) fats - ansA *excessive carb loads can increase CO2 production since they are broken down into glucose, CO2, and water when metabolized
a) I will take the medication on an empty stomach b) I won't drink alcohol while taking this medication c) I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth d) I won't do activities that require mental alertness while taking this medication - ansA Rationale Silvestri p 769 The nurse understands which of the following is the cause of respiratory alkalosis? a) hyperglycemia b) hyperventilation c) fluid loss d) airway compromise - ansB *Hyperventilation from acute anxiety, improper settings on mechanical ventilators, CNS lesions, or stimulant drugs is the cause of respiratory alkalosis from excessive loss of CO *hypoxemia, such as from being in high altitudes can also cause hyperventilation The pediatric nurse cares for a 3 yo child diagnosed with acute laryngotracheobronchitis in a croupette. The nurse is MOST concerned if which of the following is observed? a) the air inside the croupette is cool b) the grandmother gives the child a teddy bear c) the child has a cap on the head d) the child appears frightened unless someone is nearby - ansB *croupette is a humidified oxygen tent *a teddy bear can present a breeding ground for microorganisms by its absorption of moisture *depending on the materials used in the bear-- wool, polyester, rayon-- it could present a fire hazard *vinyl or plastic are the best materials for toys in a croupette; metal and electrical ones could cause sparks *attention should also be given to buttons or other choking hazards The pt with COPD has a nursing Dx of inneffective breathing pattern. Which is an appropriate action to delegate to the experienced LPN? a) observing how well the pt performs pused-lip breathing b) planning a nursing care regimen that gradually increases activity tolerance c) assisting the pt with basic activities of ADLs d) consulting with the physical therapy dept. about reconditioning exercises - ansA *Experienced LPNs can use observation of pts to gather data regarding how well pts perform interventions that have already been taught
*Assisting pts with positioning and activities of ADLs (C) is more appropriately delegated to UAPs *Planning and consulting require additional education and skills appropriate to the RN's scope The pt with COPD tells the UAP that he did not get his annual flu shot this year and has not had a pneumonia vaccination. You would be sure to instruct the UAP to report which vital sign value? a) BP of 152/ b) respiratory rate of 27 breaths/min c) HR of 92 bpm d) Oral temp of 101.2 F (38.4 C) - ansD The UAP tells you that a pt. who is receiving O2 at a flow rate of 6L/min by nasal cannula is reporting nasal passage discomfort. What intervention should you suggest to improve the pt's comfort for this problem? a) humidify the pt's O b) use a simple face mask instead of a nasal cannula c) provide the pt with an extra pillow d) have the pt sit up in a chair at the bedside - ansA To facilitate communication with a pt who has a tracheostomy, which of these nursing approaches is best? a) tell the pt to nod his head "yes" or shake his head "no" b) tell the pt to mouth words so that the nurse can lip=read c) have someone who knows the pt stay at the bedside to act as interpreter d) ask the pt to anticipate needs and write them down - ansA *Important for nurse to establish a way that pt can communicate *asking yes/no questions and instructing the pt to nod his head to indicate yes and shake his head to indicate no is a practical way for the pt to communicate w/ the nurse When a pt with TB is being prepared for discharge, which statement by the pt indicates a NEED FOR FURTHER teaching? a) Everyone in my family needs to go and see the doctor for TB testing b) I will continue to take my ioniazid until I am feeling completely well c) I will cover my mouth and nose when I sneeze or cough and put my used tissues in a plastic bag d) I will change my diet to include more foods rich in iron, protein, and vitamin C - ansB When assessing a 22 yo pt who required emergency surgery and multiple transfusions 3 days ago, you find that the pt looks anxious and has labored respirations at a rate of
You are acting as a preceptor for a newly-graduated RN during her second week of orientation. You would assign the new RN under your supervision to provide nursing care to which pts? (Select all that apply) a) 38-yo with moderate persistent asthma awaiting d/c b) 63 yo w/ trach needing trach care every shift c) 56 yo with lung cancer who has just undergone left lower lobectomy d) 49 yo just admitted with a new Dx of esophageal cancer e) 76 yo newly Dx with type 2 diabetes - ansA, B *The new RN is at an early point in her orientation so the most appropriate pt's to assign are those in stable condition who require routine care. *The pt with the lobectomy (C) will require the care of an experienced nurse who will perform freq. assessments & monitor for post-op complications *The pt w/ esophageal cancer (D) will also benefit from a more experienced nurse (may have questions and need a comprehensive admission assessment) *The newly diagnosed diabetic (E) will need much teaching and careful monitoring You are admitting a pt for whom a dX of pulmonary embolus must be ruled out. The pt's history and assessment reveal all of these findings. Which finding supports the dX of pulmonary embolus? a) the pt was recently in a motor vehicle crash b) the pt participated in an aerobic exercise program for 6 months c) the pt gave birth to her youngest child 1 year ago d) the pt was on bed rest for 6 hrs after a diagnostic procedure - ansA You are assigned to provide nursing care for a pt receiving mechanical ventilation. Which action should you delegate to an experienced UAP? a) assessing the pts respiratory status every 4 hrs b) taking vitals and pulse ox readings every 4 hrs c) checking the ventilator settings to make sure they are as prescribed d) observing whether the pt's tube needs suctioning every 2 hrs - ansB You are caring for a pt with emphysema and respiratory failure who is receiving mechanical ventilation thru an endotracheal tube. To prevent ventilator-associated pneumonia (VAP), which action is most important to include in the plan of care? a) administer ordered antibiotics as scheduled b) hyperoxygenate the pt before suctioning c) maintain the head of bed at a 30-45 degree angle d) suction the airway when coarse crackles are audible - ansC *Research indicates that nursing actions such as maintaining the head of the bed at 30 to 45 degrees to decrease the incidence of VAP
*These actions are part of the standard of care for pts who require mechanical ventilation. The other actions are also appropriate for the pt but will not decrease the incidence of VAP You are evaluating and assessing a patient with a diagnosis of chronic emphysema. The patient is receiving O2 at a flow rate of 5L/min by nasal cannula. Which finding concerns you immediately? a) fine bibasilar crackles b) respiratory rate of 8 breaths/min c) the patient sitting up and leaning over the nightstand d) a large barrel chest - ansB You are initiating a nursing care plan for a patient with pneumonia. Which intervention for cough enhancement should you delegate to the UAP? a) teaching the pt about the importance of adequate fluid intake and hydration b) assisting the pt to a sitting position with the neck flexed, shoulders relaxed, and knees flexed c) reminding the pt to use an incentive spirometer every 1 to 2 hours while awake d) encouraging the pt to take a deep breath, hold it for 2 seconds, then cough two or three times in succession - ansC *UAPs can remind the pat to perform actions that are already part of the plan of care *Assisting the pt into the best position to facilitate coughing requires specialized knowledge and understanding that is beyond the scope of practice of the basic UAP (however, an experienced UAP could assist the pt with positioning after the UAP and the pt had been taught the proper technique You are making a home visit to a 50 yo pt who was recently hospitalized w/ a right leg DVT and a pulmonary embolism. The patient's only med is enoxaparin (Lovenox) sub- cu. Which assessment information will u need to communicate to the physician? a) The pt says that her right leg aches all night b) the right calf is warm to the touch and is larger than the left calf c) the pt is unable to remember her husband's first name d) ther are multiple ecchymotic areas on the pt's arms - ansC *Confusion in a pt this age is unusual and may be an indication of intracerebral bleeding associated with enoxaparin use. *The right leg symptoms are consistent with resolving DVT; the pt may need teaching about keeping the right leg elevated above the heart to reduce swelling and pain. *The presence of ecchymoses may point to a need to do more patient teaching about avoiding injury while taking anticoagulants but does not indicate that the physician needs to be called
