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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

454

Chapter23:ManagementofPatientswithChestandLowerRespiratory TractDisorders  1.

Aperioperativenurseiscaringforapostoperativepatient.Thepatienthasashallowrespiratorypattern andisreluctanttocoughortobeginmobilizing.Thenurseshouldaddressthepatientsincreasedriskfor whatcomplication?

A)

Acuterespiratorydistresssyndrome(ARDS)

B)

Atelectasis

C)

Aspiration

D)

Pulmonaryembolism

Ans:

B Feedback: Ashallow,monotonousrespiratorypatterncoupledwithimmobilityplacesthepatientatanincreased riskofdevelopingatelectasis.Thesespecificfactorsarelesslikelytoresultinpulmonaryembolismor aspiration.ARDSinvolvesanexaggeratedinflammatoryresponseanddoesnotnormallyresultfrom factorssuchasimmobilityandshallowbreathing.

2.

Acritical-carenurseiscaringforapatientdiagnosedwithpneumoniaasasurgicalcomplication.The nursesassessmentrevealsthatthepatienthasanincreasedworkofbreathingduetocopious tracheobronchialsecretions.Whatshouldthenurseencouragethepatienttodo?

A)

Increaseoralfluidsunlesscontraindicated.

B)

Callthenursefororalsuctioning,asneeded.

C)

LieinalowFowlersorsupineposition.

D)

Increaseactivity.

Ans:

A Feedback: Thenurseshouldencouragehydrationbecauseadequatehydrationthinsandloosenspulmonary secretions.Oralsuctioningisnotsufficientlydeeptoremovetracheobronchialsecretions.Thepatient shouldhavetheheadofthebedraised,andrestshouldbepromotedtoavoidexacerbationofsymptoms.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

3.

455

ThepublichealthnurseisadministeringMantouxteststochildrenwhoarebeingregisteredfor kindergarteninthecommunity.Howshouldthenurseadministerthistest?

A)

Administerintradermalinjectionsintothechildrensinnerforearms.

B)

Administerintramuscularinjectionsintoeachchildsvastuslateralis.

C)

Administerasubcutaneousinjectionintoeachchildsumbilicalarea.

D)

Administerasubcutaneousinjectionata45-degreeangleintoeachchildsdeltoid.

Ans:

A Feedback: Thepurifiedproteinderivative(PPD)isalwaysinjectedintotheintradermallayeroftheinneraspectof theforearm.Thesubcutaneousandintramuscularroutesarenotutilized.

4.

Thenurseiscaringforapatientwhohasbeeninamotorvehicleaccidentandthecareteamsuspects thatthepatienthasdevelopedpleurisy.Whichofthenursesassessmentfindingswouldbestcorroborate thisdiagnosis?

A)

Thepatientisexperiencingpainlesshemoptysis.

B)

Thepatientsarterialbloodgases(ABGs)arenormal,buthedemonstratesincreasedworkof breathing.

C)

Thepatientsoxygensaturationlevelisbelow88%,buthedeniesshortnessofbreath.

D)

Thepatientspainintensifieswhenhecoughsortakesadeepbreath.

Ans:

D Feedback: Thekeycharacteristicofpleuriticpainisitsrelationshiptorespiratorymovement.Takingadeepbreath, coughing,orsneezingworsensthepain.ThepatientsABGswouldmostlikelybeabnormaland shortnessofbreathwouldbeexpected.

5.

Thenursecaringforapatientrecentlydiagnosedwithlungdiseaseencouragesthepatientnottosmoke. Whatistheprimaryrationalebehindthisnursingaction?

A)

Smokingdecreasestheamountofmucusproduction.

B)

Smokeparticlescompeteforbindingsitesonhemoglobin.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Smokingcausesatrophyofthealveoli.

D)

Smokingdamagestheciliarycleansingmechanism.

Ans:

D

456

Feedback: Inadditiontoirritatingthemucouscellsofthebronchiandinhibitingthefunctionofalveolar macrophage(scavenger)cells,smokingdamagestheciliarycleansingmechanismoftherespiratory tract.Smokingalsoincreasestheamountofmucusproductionanddistendsthealveoliinthelungs.It reducestheoxygen-carryingcapacityofhemoglobin,butnotbydirectlycompetingforbindingsites. 6.

ApatienthasbeenbroughttotheEDbytheparamedics.ThepatientissuspectedofhavingARDS.Wha interventionshouldthenursefirstanticipate?

A)

Preparingtoassistwithintubatingthepatient

B)

Settingupoxygenat5L/minutebynasalcannula

C)

Performingdeepsuctioning

D)

Settingupanebulizertoadministercorticosteroids

Ans:

A Feedback: ApatientwhohasARDSusuallyrequiresintubationandmechanicalventilation.Oxygenbynasal cannulawouldlikelybeinsufficient.Deepsuctioningandnebulizersmaybeindicated,butthepriorityis tosecuretheairway.

7.

Thenurseiscaringforapatientwhoisscheduledforalobectomyforadiagnosisoflungcancer.While assistingwithasubclavianveincentrallineinsertion,thenursenotestheclientsoxygensaturation rapidlydropping.Thepatientcomplainsofshortnessofbreathandbecomestachypneic.Thenurse suspectsapneumothoraxhasdeveloped.Furtherassessmentfindingssupportingthepresenceofa pneumothoraxincludewhat?

A)

Diminishedorabsentbreathsoundsontheaffectedside

B)

Paradoxicalchestwallmovementwithrespirations

C)

Suddenlossofconsciousness

D)

Muffledheartsounds

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

457

A Feedback: Inthecaseofasimplepneumothorax,auscultatingthebreathsoundswillrevealabsentordiminished breathsoundsontheaffectedside.Paradoxicalchestwallmovementsoccurinflailchestconditions. Suddenlossofconsciousnessdoesnottypicallyoccur.Muffledordistantheartsoundsoccurin pericardialtamponade.

8.

Thenurseisprovidingdischargeteachingforapatientwhodevelopedapulmonaryembolismaftertotal kneesurgery.Thepatienthasbeenconvertedfromheparintosodiumwarfarin(Coumadin) anticoagulanttherapy.Whatshouldthenurseteachtheclient?

A)

Coumadinwillcontinuetobreakuptheclotoveraperiodofweeks

B)

CoumadinmustbetakenconcurrentwithASAtoachieveanticoagulation.

C)

Anticoagulanttherapyusuallylastsbetween3and6months.

D)

HeshouldtakeavitaminsupplementcontainingvitaminK

Ans:

C Feedback: Anticoagulanttherapypreventsfurtherclotformation,butcannotbeusedtodissolveaclot.Thetherapy continuesforapproximately3to6monthsandisnotcombinedwithASA.VitaminKreversestheeffect ofanticoagulanttherapyandnormallyshouldnotbetaken.

9.

Anewemployeeaskstheoccupationalhealthnurseaboutmeasurestopreventinhalationexposureofthe substances.Whichstatementbythenursewilldecreasethepatientsexposurerisktotoxicsubstances?

A)

Positionafanblowingonthetoxicsubstancestopreventthesubstancefrombecomingstagnantin theair.

B)

Wearprotectiveattireanddeviceswhenworkingwithatoxicsubstance.

C)

Makesurethatyoukeepyourimmunizationsuptodatetopreventrespiratorydiseasesresulting fromtoxins.

D)

Alwayswearadisposablepaperfacemaskwhenyouareworkingwithinhalabletoxins.

Ans:

B

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

458

Feedback: Whenworkingwithtoxicsubstances,theemployeemustwearoruseprotectivedevicessuchasface masks,hoods,orindustrialrespirators.Immunizationsdonotconferprotectionfromtoxinsandapaper maskisnormallyinsufficientprotection.Neverpositionafandirectlyblowingonthetoxicsubstanceas itwilldispersethefumesthroughoutthearea. 10. Anx-rayofatraumapatientrevealsribfracturesandthepatientisdiagnosedwithasmallflailchest injury.Whichinterventionshouldthenurseincludeinthepatientsplanofcare? A)

Suctionthepatientsairwaysecretions.

B)

Immobilizetheribswithanabdominalbinder.

C)

Preparethepatientforsurgery.

D)

Immediatelysedateandintubatethepatient.

Ans:

A Feedback: Aswithribfracture,treatmentofflailchestisusuallysupportive.Managementincludesclearing secretionsfromthelungs,andcontrollingpain.Ifonlyasmallsegmentofthechestisinvolved,itis importanttocleartheairwaythroughpositioning,coughing,deepbreathing,andsuctioning.Intubation isrequiredforsevereflailchestinjuries,andsurgeryisrequiredonlyinrarecircumstancestostabilize theflailsegment.

11. Thenurseiscaringforapatientwhoisreceivingoxygentherapyforpneumonia.Howshouldthenurse bestassesswhetherthepatientishypoxemic? A)

Assessthepatientslevelofconsciousness(LOC).

B)

Assessthepatientsextremitiesforsignsofcyanosis.

C)

Assessthepatientsoxygensaturationlevel.

D)

Reviewthepatientshemoglobin,hematocrit,andredbloodcelllevels.

Ans:

C Feedback: TheeffectivenessofthepatientsoxygentherapyisassessedbytheABGanalysisorpulseoximetry. ABGresultsmaynotbereadilyavailable.Presenceorabsenceofcyanosisisnotanaccurateindicatorof oxygeneffectiveness.ThepatientsLOCmaybeaffectedbyhypoxia,butnoteverychangeinLOCis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

459

relatedtooxygenation.Hemoglobin,hematocrit,andredbloodcelllevelsdonotdirectlyreflectcurrent oxygenationstatus. 12. Anadultpatienthastestedpositivefortuberculosis(TB).Whileprovidingpatientteaching,what informationshouldthenurseprioritize? A)

Theimportanceofadheringcloselytotheprescribedmedicationregimen

B)

Thefactthatthediseaseisalifelong,chronicconditionthatwillaffectADLs

C)

ThefactthatTBisself-limiting,butcantakeupto2yearstoresolve

D)

Theneedtoworkcloselywiththeoccupationalandphysicaltherapists

Ans:

A Feedback: SuccessfultreatmentofTBishighlydependentoncarefuladherencetothemedicationregimen.The diseaseisnotself-limiting;occupationalandphysicaltherapyarenotnecessarilyindicated.TBis curable.

13. Thenurseisassessinganadultpatientfollowingamotorvehicleaccident.Thenurseobservesthatthe patienthasanincreaseduseofaccessorymusclesandiscomplainingofchestpainandshortnessof breath.Thenurseshouldrecognizethepossibilityofwhatcondition? A)

Pneumothorax

B)

Anxiety

C)

Acutebronchitis

D)

Aspiration

Ans:

A Feedback: Ifthepneumothoraxislargeandthelungcollapsestotally,acuterespiratorydistressoccurs.Thepatient isanxious,hasdyspneaandairhunger,hasincreaseduseoftheaccessorymuscles,andmaydevelop centralcyanosisfromseverehypoxemia.Thesesymptomsarenotdefinitiveofpneumothorax,but becauseofthepatientsrecenttraumatheyareinconsistentwithanxiety,bronchitis,oraspiration.

14. Thenurseatalong-termcarefacilityisassessingeachoftheresidents.Whichresidentmostlikelyfaces thegreatestriskforaspiration?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Aresidentwhosufferedaseverestrokeseveralweeksago

B)

Aresidentwithmid-stageAlzheimersdisease

C)

A92-year-oldresidentwhoneedsextensivehelpwithADLs

D)

Aresidentwithsevereanddeformingrheumatoidarthritis

Ans:

A

460

Feedback: Aspirationmayoccurifthepatientcannotadequatelycoordinateprotectiveglottic,laryngeal,andcough reflexes.Thesereflexesareoftenaffectedbystroke.Apatientwithmid-stageAlzheimersdiseasedoes notlikelyhavethevoluntarymuscleproblemsthatoccurlaterinthedisease.Clientsthatneedhelpwith ADLsorhaveseverearthritisshouldnothavedifficultyswallowingunlessitexistssecondarytoanother problem. 15. ThenurseiscaringforapatientsuspectedofhavingARDS.Whatisthemostlikelydiagnostictest orderedintheearlystagesofthisdiseasetodifferentiatethepatientssymptomsfromthoseofacardiac etiology? A)

Carboxyhemoglobinlevel

B)

Brainnatriureticpeptide(BNP)level

C)

C-reactiveprotein(CRP)level

D)

Completebloodcount

Ans:

B Feedback: CommondiagnostictestsperformedforpatientswithpotentialARDSincludeplasmabrainnatriuretic peptide(BNP)levels,echocardiography,andpulmonaryarterycatheterization.TheBNPlevelishelpful indistinguishingARDSfromcardiogenicpulmonaryedema.Thecarboxyhemoglobinlevelwillbe increasedinaclientwithaninhalationinjury,whichcommonlyprogressesintoARDS.CRPandCBC levelsdonothelpdifferentiatefromacardiacproblem.

16. Thenurseiscaringforapatientatriskforatelectasis.Thenurseimplementsafirst-linemeasureto preventatelectasisdevelopmentinthepatient.Whatisanexampleofafirst-linemeasuretominimize atelectasis? A)

Incentivespirometry

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

Intermittentpositive-pressurebreathing(IPPB)

C)

Positiveend-expiratorypressure(PEEP)

D)

Bronchoscopy

Ans:

A

461

Feedback: Strategiestopreventatelectasis,whichincludefrequentturning,earlyambulation,lung-volume expansionmaneuvers(deepbreathingexercises,incentivespirometry),andcoughing,serveasthefirstlinemeasurestominimizeortreatatelectasisbyimprovingventilation.Inpatientswhodonotrespond tofirst-linemeasuresorwhocannotperformdeep-breathingexercises,othertreatmentssuchaspositive end-expiratorypressure(PEEP),continuousorintermittentpositive-pressurebreathing(IPPB),or bronchoscopymaybeused. 17. Whileplanningapatientscare,thenurseidentifiesnursingactionstominimizethepatientspleuritic pain.Whichinterventionshouldthenurseincludeintheplanofcare? A)

Avoidactionsthatwillcausethepatienttobreathedeeply.

B)

Ambulatethepatientatleastthreetimesdaily.

C)

Arrangeforasoft-textureddietandincreasedfluidintake.

D)

Encouragethepatienttospeakaslittleaspossible

Ans:

A Feedback: Thekeycharacteristicofpleuriticpainisitsrelationshiptorespiratorymovement.Takingadeepbreath, coughing,orsneezingworsensthepain.Asoftdietisnotnecessarilyindicatedandthereisnoneedfor thepatienttoavoidspeaking.Ambulationhasmultiplebenefits,butpainmanagementisnotamong them.

18. Theperioperativenurseiswritingacareplanforapatientwhohasreturnedfromsurgery2hoursprior. Whichmeasureshouldthenurseimplementtomostdecreasethepatientsriskofdevelopingpulmonary emboli(PE)? A)

Earlyambulation

B)

Increaseddietaryintakeofprotein

C)

Maintainingthepatientinasupineposition

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

D)

Administeringaspirinwithwarfarin

Ans:

A

462

Feedback: ForpatientsatriskforPE,themosteffectiveapproachforpreventionistopreventdeepvein thrombosis.Activelegexercisestoavoidvenousstasis,earlyambulation,anduseofelasticcompression stockingaregeneralpreventivemeasures.Thepatientdoesnotrequireincreaseddietaryintakeof proteindirectlyrelatedtopreventionofPE,althoughitwillassistinwoundhealingduringthe postoperativeperiod.Thepatientshouldnotbemaintainedinoneposition,butfrequentlyrepositioned, unlesscontraindicatedbythesurgicalprocedure.Aspirinshouldneverbeadministeredwithwarfarin becauseitwillincreasethepatientsriskforbleeding. 19. Theschoolnurseispresentingaclassonsmokingcessationatthelocalhighschool.Aparticipantinthe classasksthenurseabouttheriskoflungcancerinthosewhosmoke.Whatresponserelatedtoriskfor lungcancerinsmokersismostaccurate? A)

Theyoungeryouarewhenyoustartsmoking,thehigheryourriskoflungcancer.

B)

Theriskforlungcancerneverdecreasesonceyouhavesmoked,whichiswhysmokersneed annualchestx-rays.

C)

Theriskforlungcancerisdeterminedmostlybywhattypeofcigarettesyousmoke.

D)

Theriskforlungcancerdependsprimarilyontheotherriskfactorsforcancerthatyouhave.

Ans:

A Feedback: Riskisdeterminedbythepack-yearhistory(numberofpacksofcigarettesusedeachday,multipliedby thenumberofyearssmoked),theageofinitiationofsmoking,thedepthofinhalation,andthetarand nicotinelevelsinthecigarettessmoked.Theyoungerapersoniswhenheorshestartssmoking,the greatertheriskofdevelopinglungcancer.Riskdeclinesaftersmokingcessation.Thetypeofcigarettes isasignificantvariable,butthisisnotthemostimportantfactor.

20. Thenurseisassessingapatientwhohasa35pack-yearhistoryofcigarettesmoking.Inlightofthis knownriskfactorforlungcancer,whatstatementshouldpromptthenursetoreferthepatientforfurther assessment? A)

Lately,Ihavethiscoughthatjustneverseemstogoaway.

B)

IfindthatIdonthavenearlythestaminathatIusedto.

C)

Iseemtogetnearlyeverycoldandfluthatgoesaroundmyworkplace.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

463

D)

Ineverusedtohaveanyallergies,butnowIthinkImdevelopingallergiestodustandpethair.

Ans:

A Feedback: Themostfrequentsymptomoflungcanceriscoughorchangeinachroniccough.Peoplefrequently ignorethissymptomandattributeittosmokingorarespiratoryinfection.Anewonsetofallergies, frequentrespiratoryinfectio...