medsurg exam 3 – Flashcards
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I just finished eating my lunch, I'm ready for my CPT now.
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The nurse is preparing to perform chest physiotherapy (CPT) on a patient. Which of the following patient statements would indicate the procedure is contraindicated. a) "I just changed into my running suit; we can do my CPT now." b) "I received my pain medication 10 minutes ago, let's do my CPT now." c) "I just finished eating my lunch, I'm ready for my CPT now." d) "I have been coughing all morning and am barely bringing anything up."
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Instruct the client to remain in each position of the postural drainage sequence for 10-15 minutes.
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The nurse is assisting a client with postural drainage. Which of the following demonstrates correct implementation of this technique? a) Use aerosol sprays to deodorize the client's environment after postural drainage. b) Administer bronchodilators and mucolytic agents following the sequence. c) Perform this measure with the client once a day. d) Instruct the client to remain in each position of the postural drainage sequence for 10 to 15 minutes.
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volume-controlled
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Which type of ventilator has a present volume of air to be delivered with each inspiration? a) Pressure-cycled b) Time-cycled c) Volume-controlled d) Negative-pressure
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kinking of the ventilator tubing
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A client suffers acute respiratory distress syndrome as a consequence of shock. The client's condition deteriorates rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? a) Kinking of the ventilator tubing b) A change in the oxygen concentration without resetting the oxygen level alarm c) A disconnected ventilator tube d) An ET cuff leak
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manual resuscitation bag
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A client with chronic obstructive pulmonary disease (COPD) is intubated and placed on continuous mechanical ventilation. Which equipment is most important for the nurse to keep at this client's bedside? a) Manual resuscitation bag b) Oxygen analyzer c) Water-seal chest drainage set-up d) Tracheostomy cleaning kit
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assist-control
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Which ventilator mode provides full ventilatory support by delivering a present tidal volume and respiratory rate? a) IMV b) SIMV c) Pressure support d) Assist-control
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by supplying a magic slate or similar device
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A nurse is assigned to care for a client with a tracheostomy tube. How can the nurse communicate with this client? a) By providing a tracheostomy plug to use for verbal communication b) By placing the call button under the client's pillow c) By suctioning the client frequently d) By supplying a magic slate or similar device
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Monitor pulmonary status as directed and needed. Regularly assess the client's vital signs every 2 to 4 hours. Encourage deep breathing exercises.
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A client who is undergoing thoracic surgery has a nursing diagnosis of "Impaired gas exchange related to lung impairment and surgery" on the nursing care plan. Which of the following nursing interventions would be appropriately aligned with this nursing diagnosis? Select all that apply. a) Regularly assess the client's vital signs every 2 to 4 hours. b) Maintain an open airway. c) Encourage deep breathing exercises. d) Monitor pulmonary status as directed and needed. e) Monitor and record hourly intake and output.
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When the tube is being removed, take a deep breath, exhale, and bear down.
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The nurse is preparing to assist the health care provider with the removal of a patient's chest tube. Which of the following instructions will the nurse correctly give the patient? a) "During the removal of the chest tube, do not move because it will make the removal more painful." b) "Exhale forcefully while the chest tube is being removed." c) "When the tube is being removed, take a deep breath, exhale, and bear down." d) "While the chest tube is being removed, raise your arms above your head."
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water seal chamber
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After lobectomy for lung cancer, a client receives a chest tube connected to a disposable chest drainage system. The nurse observes that the drainage system is functioning correctly when she notes tidal movements or fluctuations in which compartment of the system as the client breathes? a) Air-leak chamber b) Suction control chamber c) Water-seal chamber d) Collection chamber
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They help prevent cardiac arrhythmias.
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A client in acute respiratory distress is brought to the emergency department. After endotracheal (ET) intubation and initiation of mechanical ventilation, the client is transferred to the intensive care unit. Before suctioning the ET tube, the nurse hyperventilates and hyperoxygenates the client. What is the rationale for these interventions? a) They help prevent cardiac arrhythmias. b) They help prevent pulmonary edema. c) They help prevent pneumothorax. d) They help prevent subcutaneous emphysema.
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Intermittent mandatory ventilation (IMV)
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Which of the following ventilator modes provides a combination of mechanically assisted breaths and spontaneous breaths? a) Pressure support b) Intermittent mandatory ventilation (IMV) c) Assist control d) Synchronized intermittent mandatory ventilation (SIMV)
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Continues assessing the client's respiratory status frequently
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A client is on a positive-pressure ventilator with a synchronized intermittent mandatory ventilation (SIMV) setting. The ventilator is set for 8 breaths per minute. The client is taking 6 breaths per minute independently. The nurse a) Consults with the physician about removing the client from the ventilator b) Changes the setting on the ventilator to increase breaths to 14 per minute c) Contacts the respiratory therapy department to report the ventilator is malfunctioning d) Continues assessing the client's respiratory status frequently
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pneumonectomy
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In general, chest drainage tubes are not indicated for a patient undergoing which of the following procedures? a) Lobectomy b) Segmentectomy c) Pneumonectomy d) Wedge resection
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aspiration pneumonia
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Which of the following is a potential complication of a low pressure in the endotracheal tube (ET) cuff? a) Tracheal bleeding b) Tracheal ischemia c) Pressure necrosis d) Aspiration pneumonia
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the patient will have an insertion of a tracheostomy
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A patient in the ICU has been orally intubated and on mechanical ventilation for 2 weeks after having a severe stroke. What action does the nurse anticipate the physician will take now that the patient has been intubated for this length of time? a) The patient will have an insertion of a tracheostomy tube. b) The patient will begin the weaning process. c) The patient will be extubated and a nasotracheal tube will be inserted. d) The patient will be extubated and another endotracheal tube will be inserted.
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patient is hypoxic from suctioning
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The nurse suctions a patient through the endotracheal tube for 20 seconds and observes dysrhythmias on the monitor. What does the nurse determine is occurring with the patient? a) The patient is having a myocardial infarction. b) The patient is hypoxic from suctioning. c) The patient is in a hypermetabolic state. d) The patient is having a stress reaction.
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routine cuff deflation is recommended
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Which of the following statements would not be considered an appropriate intervention for a patient with an ET tube? a) Cuff is deflated prior to tube removal b) Routine cuff deflation is recommended c) Humidified oxygen should always be introduced through the tube d) Cuff pressures should be checked every 6 to 8 hours
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auscultation
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A nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the lungs? a) Arterial blood gas (ABG) levels b) Auscultation c) Chest X-ray d) Inspection
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The vaccine is an inactivated virus, but may cause some mild cold-like symptoms.
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The healthcare provider understands that teaching has been effective when the patient verbalizes the following regarding influenza vaccinations: Please choose from one of the following options. "Since the vaccine is the live virus, I can expect to be ill for 444-777 days after receiving my shot." "Influenza vaccines are a cure for the flu." "The vaccine is an inactivated virus, but may cause some mild cold-like symptoms." "If I have already had the vaccine last year, it is not recommended that I get it again this year."
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40 year old yoga instructor
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Which of the following individuals is at the least risk for developing pneumonitis? Please choose from one of the following options. 40-year-old yoga instructor 22-year-old poultry handler 37-year-old housekeeper 57-year-old corn farmer
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impaired gas exchange related to pulmonary abscess
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A 32-year-old man has been admitted to the emergency department with complaints of chest pain, shortness of breath and a fever for the last 3 days. Upon assessment, the healthcare provider notes the patient has a productive cough with pus-like sputum. What is the most appropriate conclusion a healthcare provider can infer from this data? Please choose from one of the following options. Chest pain related to pneumonitis Ineffective breathing related pleural effusion Decreased appetite related to pneumonia Impaired gas exchanged related to pulmonary abscess
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Cyanosis is the blue coloring of the skin and mucous membranes in the presence of poorly oxygenated blood.
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A new healthcare provider is working on the medical surgical unit of a hospital and notes in a patient's chart that he has cyanosis. When asking the department manager what cyanosis means, the manager's best response would be: Please choose from one of the following options. "Cyanosis is the blue coloring of skin and mucous membranes in the presence of highly oxygenated blood." "Cyanosis indicates that the patient has pneumonia." "Cyanosis means the patient's skin was cold due to his illness." "Cyanosis is the blue coloring of the skin and mucous membranes in the presence of poorly oxygenated blood."
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human papillomavirus
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The healthcare provider is conducting teaching during a health fair about the causes of pneumonia. The healthcare provider demonstrates understanding of the causes when she states that community acquired pneumonia (CAP) can be caused by all of the following except: Please choose from one of the following options. Mycoplasma Human papillomavirus Influenza Streptococcus pneumoniae
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provide oral care and suctioning to the patient
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In order to prevent ventilator associated/ acquired pneumonia (VAP) in an intubated patient, the healthcare provider should: Please choose from one of the following options. Provide oral care and suctioning to the patient Maintain intubation for no more than 72 hours Give prophylactic antibiotics Discourage patient visitors
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crackles
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A pediatric patient has been diagnosed with right lower lobe pneumonia. Upon auscultation of this lung field, the healthcare provider would expect to hear which breath sound? Please choose from one of the following options. Rhonchi Stridor Crackles Wheezes
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the vaccine is not recommended for older adults
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The healthcare provider understands that further teaching on the Influenza vaccine is needed when the patient states: Please choose from one of the following options. The vaccine is not recommended for older adults. The vaccine effectiveness depends on the characteristics of the individual and how close the vaccine matches the current strain. The vaccine can reduce the incidence of influenza by 60, percent. The vaccine does not protect against other viruses.
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Smoking is highly discouraged after suffering a pulmonary abscess; can I help you seek out some smoking cessation resources?
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A 45-year-old female patient has recently been diagnosed with a pulmonary abscess. She asks if she can still smoke cigarettes after her treatment is complete. What is the healthcare provider's best response? Please choose from one of the following options. "You should stop smoking; that's probably what caused your abscess. Have you considered nicotine skin patches?" "Smoking will not impact your pulmonary abscess because it is isolated within a hard, fibrotic shell." "Smoking is highly discouraged after suffering a pulmonary abscess; can I help you seek out some smoking cessation resources?" "You can smoke a maximum of 2 times per day."
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corticosteroid administration
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The healthcare provider would anticipate which of the following as a treatment option for pneumonitis? Please choose from one of the following options. Emergency thoracotomy Albuterol nebulization Corticosteroid administration Chest tube insertion
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a 13 year old boy with an allergy to eggs
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The healthcare provider working in an immunization clinic is supervising the medical assistant during an influenza vaccine administration. The healthcare provider should question the immunization of which of the following patients scheduled to receive the vaccine? Please choose from one of the following options. A 65-year-old man with a history of emphysema. A 32-year-old man with a allergy to latex. A 13-year-old boy with an allergy to eggs. A 76-year-old woman with a history of congestive heart failure.
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Glucose 200
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Which lab value alteration is likely a result of corticosteroid treatment in a Type 1 diabetic patient diagnosed with pneumonitis? Please choose from one of the following options. Potassium 5.1 Glucose 200 Albumin 3.5 Sodium 138
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A 50-year-old woman with human immunodeficiency virus (HIV).
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The healthcare provider understands that which of the following patients is most at risk for developing pneumocystis carinii pneumonia (PCP)? Please choose from one of the following options. A 45-year-old man who smokes 2 packs of cigarettes a day. A 50-year-old woman with human immunodeficiency virus (HIV). A 22-year-old man with a history of asthma. A 36-year-old who works in a coal mine.
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the patient who is complaining of shortness of breath
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The day-shift healthcare provider is receiving report on her patient assignments for the day. It would be most important for the her to see which patient first? Please choose from one of the following options. The patient who is complaining of shortness of breath. The patient with serosanguinous chest tube drainage. The patient complaining of pain 7 on a 10 point scale. The patient who with documented bilateral wheezes.
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Mycoplasmas share characteristics of both viruses and bacteria. Mycoplasmas have no cell wall.
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A patient has been diagnosed with pneumonia secondary to a mycoplasma infection. The healthcare provider knows the following is true about mycoplasmas. Select all that apply. Mycoplasmas are easily treated with penicillins. Mycoplasmas have no cell wall. Mycoplasmas are the largest pathogen identified to affect humans. Mycoplasmas cause "whooping cough". Mycoplasmas share characteristics of both viruses and bacteria.
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The vaccine provides protection against up to 23 different serotypes. The vaccine assists the individual in forming an immunity to the pathogen. The body creates antibodies against the bacterium.
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The healthcare provider understands that pneumococcal vaccines work in the following ways: Select all that apply. The vaccine causes the illness in the individual so an immunity is formed. The vaccine provides protection against up to 23 different serotypes. The vaccine assists the individual in forming an immunity to the pathogen. The vaccine provide protection for up to 2 years from the pneumococci bacteria. The body creates antibodies against the bacterium.
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dry cough tachypnea chest pain shortness of breath
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A patient diagnosed with pneumonitis would be likely to have all of the following symptoms. Select all that apply. Dry cough Tachypnea Chest pain Bloody sputum Shortness of breath
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a pleural effusion is an accumulation of fluid in the pleural cavity
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The healthcare provider is providing teaching on pleural effusions. The healthcare provider understands that teaching has been effective when the patient states: Please choose from one of the following options. "A pleural effusion is accumulation of fluid in the airways of the lungs." "A pleural effusion is an accumulation of fluid in the pleural cavity." "A pleural effusion is an accumulation of blood in the airspace." "A pleural effusion is an accumulation of fluid in the alveoli."
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transudative
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A 53-year-old patient with a history of heart failure has been recently diagnosed with a right pleural effusion. Based on the patient's history of heart failure, the healthcare provider expects that the patient's pleural effusion is: Please choose from one of the following options. Consolidated Transudative Infiltrative Exudative
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Chest X-ray
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Which of the following diagnostic tests would be contraindicated for a pregnant patient who is being evaluated for a pleural effusion? Please choose from one of the following options. Chest x-ray Blood culture Thoracic ultrasound Pleural biopsy
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The 17-year-old with a left pleural effusion complaining of chest pain 9 on a 0 -10 scale.
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The healthcare provider on pediatric unit has received her assignments for the day. Which of the following patients should the healthcare provider assess first? Please choose from one of the following options. The 17-year-old with a left pleural effusion complaining of chest pain 9 on a 0 - 10 scale. The 11-year-old with pneumonia being discharged today. The 6-year-old with bronchitis with an intravenous (IV) antibiotic infusing at 30mL/hour The 3-year-old with asthma who has an oxygen saturation of 94%, percent on room air.
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leukocytes
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A patient with a suspected empyema has a thoracentesis, and pleural fluid has been sent to the laboratory for examination. Which of the following constituents of the pleural fluid would best support a diagnosis of empyema? Please choose from one of the following options. Leukocytes Epithelial cells Plasma proteins Erythrocytes
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fluid collection is outside of the airways and alveoli
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Several family members of a patient diagnosed with a pleural effusion are concerned that the patient has not been "coughing up any of the fluid." The healthcare provider understands that nonproductive cough is expected because the: Please choose from one of the following options. Fluid collection is excreted through circulation. Effusion has most likely resolved. Pressure of the fluid is restricting the airway. Fluid collection is outside of the airways and alveoli.
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pneumonthorax
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The patient is undergoing a thoracentesis for a pleural effusion. After the procedure, the healthcare provider will monitor the patient for which of the following possible complications of the procedure? Please choose from one of the following options. Respiratory acidosis Pulmonary fibrosis Pneumothorax Coagulopathy
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decreased plasma proteins allow excess fluid to move into the pleural space
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A patient with nephrotic syndrome has developed a pleural effusion and has been admitted for treatment. The healthcare provider understands that the a pleural effusion can be caused by nephrotic syndrome because: Please choose from one of the following options. Decreased hydrostatic pressure has caused stasis of fluid in the lungs. Decreased plasma proteins allow excess fluid to move into the pleural space. Inflammation has caused increased capillary permeability and pulmonary edema. Urinary retention has cause fluid volume overload and hypertension.
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you can discontinue you antibiotics once you begin to feel better
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A patient is being treated for an empyema is being discharged home. Which of the following statements should the healthcare provider NOT include in the discharge teaching? Please choose from one of the following options. "Antibiotics are required to treat the underlying infection." "It is important to refrain from smoking." "You can discontinue your antibiotics once you begin to feel better." "Seek medical attention right away if you develop a sudden, increased fever."
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Dizziness BUN levels Hearing changes
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A patient with a pleural effusion is receiving an aminoglycoside. For which of the following should the healthcare provider monitor? Select all that apply. Hemoglobin levels Dizziness BUN levels Hearing changes Serum potassium levels
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Chest pain Dyspnea Dry Cough
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Which of the following symptoms would the healthcare provider expect to see in a patient with a pleural effusion? Select all that apply. Chest pain Dyspnea Dry cough Vomiting Purulent sputum
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Take prescribed albuterol before performing postural drainage.
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A client is prescribed postural drainage because secretions are accumulating in the upper lobes of the lungs. The nurse instructs the client to: a) Hold each position for 5 minutes. b) Lay in bed with the head on a pillow. c) Take prescribed albuterol (Ventolin) before performing postural drainage. d) Perform drainage 1 hour after meals.
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20 minutes
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Arterial blood gases should be obtained at which timeframe following the initiation of continuous mechanical ventilation? a) 25 minutes b) 20 minutes c) 15 minutes d) 10 minutes
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suction the client' artificial airway
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A client with myasthenia gravis is receiving continuous mechanical ventilation. When the high-pressure alarm on the ventilator sounds, what should the nurse do? a) Check for an apical pulse. b) Suction the client's artificial airway. c) Increase the oxygen percentage. d) Ventilate the client with a handheld mechanical ventilator.
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non-rebreather mask
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Of the following oxygen administration devices, which has the advantage of providing high oxygen concentration? a) Non-rebreather mask b) Venturi mask c) Face tent d) Catheter
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hyperbaric
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Which type of oxygen therapy includes the administration of oxygen at pressure greater than 1 atmosphere? a) Hyperbaric b) Low-flow systems c) Transtracheal d) High-flow systems
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auscultating the lungs for bilateral breath sounds
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For a client with an endotracheal (ET) tube, which nursing action is the most important? a) Providing frequent oral hygiene b) Monitoring serial blood gas values every 4 hours c) Turning the client from side to side every 2 hours d) Auscultating the lungs for bilateral breath sounds
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Vital capacity of 13 mL/kg Tidal volume of 8.5 mL/kg PaO2 of 64 mm Hg
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Which of the following are indicators that a client is ready to be weaned from a ventilator? Select all that apply. a) Tidal volume of 8.5 mL/kg b) Vital capacity of 13 mL/kg c) PaO2 of 64 mm Hg d) Rapid/shallow breathing index of 112 breaths/min e) FiO2 45%
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reduced cardiac output
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Positive end-expiratory pressure (PEEP) therapy has which effect on the heart? a) Tachycardia b) Increased blood pressure c) Bradycardia d) Reduced cardiac output
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84 mm Hg
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A client with a respiratory condition is receiving oxygen therapy. While assessing the client's PaO2, the nurse knows that the therapy has been effective based on which of the following readings? a) 84 mm Hg b) 45 mm Hg c) 58 mm Hg d) 120 mm Hg
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exposure and no evidence of infection
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A Class 1 with regards to TB indicates a) no exposure and no infection. b) latent infection with no disease. c) exposure and no evidence of infection. d) disease that is not clinically active.
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acute respiratory distress syndrome
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The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication? a) Acute respiratory distress syndrome b) Atelectasis c) Respiratory acidosis d) Metabolic alkalosis
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ineffective airway clearance
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The client, with a lower respiratory airway infection, is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse? a) Ineffective Airway Clearance b) Ineffective Breathing Pattern c) Risk for Infection d) Impaired Gas Exchange
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Daily doses of isoniazid, 300 mg for 6 months to 1 year
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A physician determines that a client has been exposed to someone with tuberculosis. The nurse expects the physician to order which treatment? a) Daily doses of isoniazid, 300 mg for 6 months to 1 year b) Isolation until 24 hours after antitubercular therapy begins c) Daily oral doses of isoniazid (Nydrazid) and rifampin (Rifadin) for 6 months to 2 years d) Nothing, until signs of active disease arise
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tension pneumothorax
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A mediastinal shift occurs in which type of chest disorder? a) Tension pneumothorax b) Simple pneumothorax c) Traumatic pneumothorax d) Cardiac tamponade
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The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.
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A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? a) The client has a partial pressure of arterial carbon dioxide (PaCO2) value of 65 mm Hg or higher. b) The client exhibits restlessness and confusion. c) The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher. d) The client exhibits bronchial breath sounds over the affected area.
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turn onto the affected side
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Which of the following techniques does a nurse suggest to a patient with pleurisy while teaching about splinting the chest wall? a) Use a heat or cold application b) Use a prescribed analgesic c) Turn onto the affected side d) Avoid using a pillow while splinting
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apply a compression dressing to the area
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Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Apply a compression dressing to the area. b) Measure the patient's pulse oximetry. c) Report the finding to the physician immediately. d) Record the observation.
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the mucus secreting glands are abnormal
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Which statement would indicate that the parents of child with cystic fibrosis understand the disorder? a) "Early treatment can stop the progression of the disease." b) "The mucus-secreting glands are abnormal." c) "There are fibrous cysts in the lungs." d) "Allergic reactions cause inflammation in the lungs."
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15-mm induration
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A nurse is assessing the injection site of a client who has received a purified protein derivative test. Which finding indicates a need for further evaluation? a) A blister b) 5-mm induration c) 15-mm induration d) Reddened area
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Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.
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The nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension? a) Bronchial thickening causes increased resistance and pressure in the pulmonary vascular bed. b) Chronic lung disease causes scaring in the bronchioles raising pressure in the pulmonary vascular bed. c) Left-sided heart failure causes increased resistance and pressure in the pulmonary vascular bed. d) Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.
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the nurse asks the patient to put both hands on the abdomen and breathe in and out while keeping the chest still.
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You have a blind patient. In preparation for surgery, the nurse teaches the patient diaphragmatic breathing. Which is the most effective teaching method for the nurse to use? a) the nurse demonstrates diaphragmatic breathing and asks the patient to do a return demonstration. b)the nurse discuss the rationale behind the postoperative abdominal breathing, outlines the steps and answers any questions. c) the nurse asks the patient to put both hands on the abdomen and breathe in and out while keeping the chest still. d) the nurse asks the patient to tighten and release muscles, progressuing from toes to the head.
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the patient has a nonproductive cough.
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The nurse monitors a patient receiving oxygen via face mask. The nurse is most concerned if which is observed? a)there is condensation in the tubing of the humidifer. b)the pulse ox reading is 92% c) the patient has a nonproductive cough. d) the skin under the elastic band is reddened.
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abnormal gas values
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Which sign or symptom, if observed by the nurse, is most important to determine if a patient is hypoxic? a) cool, bluish skin b) abnormal gas values c) elevated temperature d) sputum production
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hepatitis
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the nurses assess a patient receiving INH. It is most important to observe for which? a) hepatitis b) glomerulonephis c) photosensitivity d)deafness
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diminished breath sounds
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The emergency department 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) a low respiratory rate b) diminished breath sounds c) the presence of a barrel chest d) a sucking sound a the site of injury
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hyperinflated chest noted on the chest x ray decreased oxygen saturation with mild exercise
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The nurse is caring for a client hospitalized with acute excarebation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on the assessment of this client? a) hypocapnia b) 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
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activities should be resumed gradually. a sputum culture is needed every 2 to 4 weeks once medication therapy is initiated. cover the mouth and nose when coughing or sneezing and put used tissues in plastic bags.
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The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for tuberculosis. Which instructions should the nurse include on the list. Select all that apply. a) activities should be resumed gradually. b) avoid contact with other individuals, except family members, for at least 6 months. c) a sputum culture is needed every 2-4 weeks once medication therapy is initiated. d) respiratory isolation is not necessary because family members have already been exposed. e) cover the mouth and nose when coughing or sneezing and put used tissue in plastic bags. f) when one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment.
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10 seconds
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The nurse is preparing to suction a client via tacheostomy 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
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stop the procedure and reoxygenate the client
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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 healthcare provider immediately c) stop the procedure and reoxygenate the client d) ensure the suction is limited to 15 seconds
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increased respiratory rate
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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 signs of acute respiratory distress syndrome? a) bilateral wheezing b) inspiratory crackles c) intercostal retratction d) increased respiratory rate
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percussion and vibration
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the nurse is discussing the techniques of chest physiotherapy and postural drainage t a client having expectoration problems because of a chronic thick, tenacious mucus production int he lower airway. The nurse explains that after the client is positionied for postural draining the nurse will perform which action to help loosen secretions? a) palpation and clubbing 2) percussion and vibration 3) hyperoxygenation and suctioning 4) administer a bronchodilator and monitor peak flow
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i should not be contagious after 2 to 3 weeks of therapy
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The nurse has conducted discharge teaching with a client diagnosed with tuberculosis, who has been receiving medication for 1.5 weeks. The nurse determines that the client has understood the information if the client makes which statement? a) i need to continue drug therapy for 2 months b) i can't stop at the mall for the next 6 months c) i can return back to work if a sputum culture is negative d) i should not be contagious after 2 to 3 weeks of therapy
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particulate respiratory, gown, and gloves
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The nurse is preparing to give a bed bath to an immobilized client with tuberculosis. The nurse should wear which item when performing care? a) surgical mask and gloves b) particulate respirator, gown and gloves c) particulate respiratory and protective eyewear d) surgical mask, gown, and protective eyewear
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chest pain that occurs suddenly
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A client has experienced 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
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a cough with the expectoration of muccoid sputum
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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) bloody, productive cough d) a cough with the expectoration of muccoid sputum
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sputum culture
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the nurse performs an admission assessment on a client with a diagnosis of tuberculosis. The nurse should check the results of which diagnsotic test that will confirm this diagnosis? a) chest x ray b) bronchoscopy c) sputum culture d) tuberculin skin test
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ventilate the client manually
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the low pressure alarms sounds on a ventilator. The nurse asses the client and then attempts to determine the cause of the alarm. If unsuccessful in determing the cause of the alarm, the nurse should take what initial action? a) administer oxygen b) check the client's vital signs c) ventilate the client manually d) start cardiopulmonary resuscitation
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pH 7.28, PaO2 50 mm Hg
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A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which of the following results are consistent with this disorder? a) pH 7.36, PaCO2 32 mm Hg b) pH 7.35, PaCO2 48 mm Hg c) pH 7.46, PaO2 80 mm Hg d) pH 7.28, PaO2 50 mm Hg
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Mucopurulent sputum
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You are caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer? a) Mucopurulent sputum b) Pain on inspiration c) Shortness of breath d) Obvious trauma
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Ineffective Airway Clearance
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The client, with a lower respiratory airway infection, is presenting with the following symptoms: fever, chills, dry hacking cough, and wheezing. Which nursing diagnosis best supports the assessment by the nurse? a) Impaired Gas Exchange b) Ineffective Airway Clearance c) Risk for Infection d) Ineffective Breathing Pattern
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exposure and no evidence of infection
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A Class 1 with regards to TB indicates a) no exposure and no infection. b) exposure and no evidence of infection. c) disease that is not clinically active. d) latent infection with no disease.
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Viruses, like influenza, are the most common cause of pneumonia
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A client, who is at risk for pneumonia, has been ordered influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine? a) "Getting the flu can complicate pneumonia." b) "Influenza vaccine will prevent typical pneumonias." c) "Influenza is the major cause of death in the United States." d) "Viruses, like influenza, are the most common cause of pneumonia."
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apply a compression dressing to the area
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Which of the following actions is most appropriate for the nurse to take when the patient demonstrates subcutaneous emphysema along the suture line or chest dressing 2 hours after chest surgery? a) Record the observation b) Apply a compression dressing to the area c) Measure the patient's pulse oximetry d) Report the finding to the physician immediately
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Encourage breathing exercises.
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A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema? a) Encourage breathing exercises. b) Do not allow visitors with respiratory infection. c) Institute droplet precautions. d) Place suspected patients together.
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hand antisepsis techniques for incentive spirometry receiving vaccinations
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You've been invited to speak to the Hospital Guild of the hospital where you practice nursing. You've been asked to address "Communicable Diseases of Winter" and are speaking to a large group of volunteer women, most of whom are older than 60 years. What practices should you encourage in these women, who are at the risk of pneumococcal and influenza infections? Select all that apply. a) Hand antisepsis b) Techniques for incentive spirometry c) Using prescribed opioids d) Receiving vaccinations
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tension pneumothorax
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The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation? a) Pulmonary contusion b) Tension pneumothorax c) Flail chest d) Cardiac tamponade
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few early symptoms
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The nurse knows the mortality rate is high in lung cancer clients due to which factor? a) Increase in women smokers b) Few early symptoms c) Increased exposure to industrial pollutants d) Increased incidence among the elderly
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Encouraging a liberal fluid intake Assisting the patient to do leg elevations above the level of the heart Using elastic stockings, especially when decreased mobility would promote venous stasis Applying a sequential compression device
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The nurse is planning the care for a patient at risk of developing pulmonary embolism. What nursing interventions should be included in the care plan? (Select all that apply.) a) Instructing the patient to dangle the legs over the side of the bed for 30 minutes, four times a day b) Using elastic stockings, especially when decreased mobility would promote venous stasis c) Assisting the patient to do leg elevations above the level of the heart d) Applying a sequential compression device e) Encouraging a liberal fluid intake
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empyema
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A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is: a) Pneumocystis carinii pneumonia. b) lobar pneumonia. c) empyema. d) infected chest tube wound site.
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pain
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Which of the following is a key characteristic of pleurisy? a) Anxiety b) Pain c) Blood-tinged secretions d) Dyspnea
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crackling is heard when skin around is touched
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While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication? a) Skin around tube is pink. b) Absence of bloody drainage in the anterior/upper tube c) Crackling is heard when skin around tube is touched. d) Bloody drainage is seemed in the collection chamber.
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Airborne and contact precautions
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A client with severe shortness of breath comes to the emergency department. He tells the emergency department staff that he recently traveled to China for business. Based on his travel history and presentation, the staff suspects severe acute respiratory syndrome (SARS). Which isolation precautions should the staff institute? a) Contact and droplet precautions b) Contact precautions c) Droplet precautions d) Airborne and contact precautions
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Patient is becoming agitated and complains of pleuritic pain.
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A nurse is caring for a patient after a thoracentesis. Which of the following signs if noted in the patient should be reported to the physician immediately? a) "Patient is drowsy and complains of headache." b) "Patient has an oxygen saturation level of 93%." c) "Patient has subcutaneous emphysema around needle insertion site." d) "Patient is becoming agitated and complains of pleuritic pain."
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Chemical irritation
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You are a clinic nurse caring for a client with acute tracheobronchitis. The client asks what may have caused the infection. Which of the following responses from the nurse would be most accurate? a) Drug ingestion b) Chemical irritation c) Direct lung damage d) Aspiration
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Partial pressure of arterial oxygen (PaO2)
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A client has hypoxemia of pulmonary origin. What portion of arterial blood gas results is most useful in distinguishing between acute respiratory distress syndrome and acute respiratory failure? a) Partial pressure of arterial oxygen (PaO2) b) Bicarbonate (HCO3-) c) Partial pressure of arterial carbon dioxide (PaCO2) d) pH
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2.0 to 2.5
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The nurse is administering anticoagulant therapy with heparin. What International Normalized Ratio (INR) would the nurse know is within therapeutic range? a) 2.0 to 2.5 b) 0.5 to 1.0 c) 1.5 to 2.5 d) 3.0 to 3.5
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black-streaked sputum
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The nurse is obtaining data from a client with a respiratory disorder. Which information would be considered a part of the functional assessment and assist in the diagnosis of an occupational lung disease? a) Tenacious secretions b) Cough and dyspnea c) Black-streaked sputum d) Barrel chest
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apply airtight dressing
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A client is admitted to the emergency department with a stab wound and is now presenting dyspnea, tachypnea, and sucking noise heard on inspiration and expiration. The nurse should care for the wound in which manner? a) Clean the wound and leave open to the air. b) Apply direct pressure to the wound. c) Apply vented dressing. d) Apply airtight dressing.
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Staphylococcal pneumonia
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Influenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an increase in the death rates of pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza? a) Tracheobronchitis b) Viral pneumonia c) Staphylococcal pneumonia d) Cardiovascular disease
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dyspnea
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A client who is diagnosed with chronic respiratory failure will have which of the following symptoms? a) Hypercapnia b) Dyspnea c) Ventilatory failure d) Hypoxemia
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I'll stop being contagious when I have a negative acid-fast bacilli test.
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A client who has started therapy for drug-resistant tuberculosis demonstrates understanding of tuberculosis transmission when he says: a) "I'll stop being contagious when I have a negative acid-fast bacilli test." b) "I'm contagious as long as I have night sweats." c) "My tuberculosis isn't contagious after I take the medication for 24 hours." d) "I'm clear when my chest X-ray is negative."
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Pulmonary hypertension
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A client presents to a physician's office complaining of dyspnea with exertion, weakness, and coughing up blood. Further examination reveals peripheral edema, crackles, and jugular vein distention. The nurse anticipates the physician will make which diagnosis? a) Pulmonary tuberculosis b) Pulmonary hypertension c) Chronic obstructive pulmonary disease (COPD) d) Empyema
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Pneumocystis
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Which type of pneumonia has the highest incidence in AIDS patients and patients receiving immunosuppressive therapy for cancer? a) Streptococcal b) Pneumocystis c) Fungal d) TB
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Large cell carcinoma
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The nursing instructor is teaching students about the types of lung cancer. Which type of lung cancer is characterized as fast growing and can arise peripherally? a) Bronchoalveolar carcinoma b) Squamous cell carcinoma c) Adenocarcinoma d) Large cell carcinoma
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See if there are leaks in the system.
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You are caring for a client status post lung resection. When assessing your client you find that the bubbling in the water-seal chamber for the chest tubes is more than you expected. What should you check when bubbling in the water-seal chamber is excessive? a) See if a kink has developed in the tubing. b) See if there are leaks in the system. c) See if the chest tube is clogged. d) See if the wall suction unit has malfunctioned.
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Legionnaires' disease
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Which of the following community-acquired pneumonias demonstrates the highest occurrence during summer and fall? a) Streptococcal (pneumococcal) pneumonia b) Mycoplasmata pneumonia c) Legionnaires' disease d) Viral pneumonia
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"It is all right if I have a grilled cheese sandwich with American cheese."
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A patient taking isoniazid (INH) therapy for tuberculosis demonstrates understanding when making which statement? a) "I am going to have a tuna fish sandwich for lunch." b) "It is all right if I have a grilled cheese sandwich with American cheese." c) "It is fine if I eat sushi with a little bit of soy sauce." d) "It is all right if I drink a glass of red wine with my dinner."
