All of these clients are being cared for on the intensive care step down unit. Which client should the charge nurse assign to an RN who has floated from the pediatric unit?
A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-
Answer: A
Rational: Because asthma is a common pediatric diagnosis, the pediatric nurse would be familiar with the assessment and care needed for a client with this diagnosis. Although chronic pleural effusions can occur in the pediatric population, this
Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease?
A. Barrel chest
B. Cough
C. Dyspnea
D. Reduced gas exchange
Answer: A
Rational: Interstitial lung diseases are restrictive, not obstructive, so they do not cause barrel chest, which is the result of air trapping. Both types of pulmonary disease cause cough, dyspnea, and reduced gas exchange
A client with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first?
A. Albuterol (Proventil) 2 inhalations
Answer: A
Rational: Albuterol is a beta2 agonist that acts rapidly as a bronchodilator. Fluticasone is a corticosteroid; it is used to prevent asthma attacks and is not used as a rescue medication. Ipratropium is an anticholinergic drug that allows the sy
A client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client?
A. Mucolytics decrease secretion production.
B. Mucolytics increase gas exchange in the lower airways.
C. Mucol
Answer:D
Rational: The term mucolytic means "breaking down mucus." Mucolytics cause secretions to thin, making them easier to expectorate; this is important for a client with chronic bronchitis. Mucolytics do not decrease secretion production. Mucolytics
A client has asthma that gets worse during the summer. She tells the nurse that she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the client?
A. Albuterol (Prov
Answer: C
Rational: Montelukast is a leukotriene antagonist that works well for asthma that occurs during certain seasons. It is taken on a daily basis as a preventive medication. Albuterol inhalers are beta2 agonists that are rescue medications used on a
The client is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler?
A. Corticosteroids
B. Long-acting beta agonists
C. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Short-acting beta agonists
Answer: D
Rational: Short-acting beta agonist medications have a rapid onset and cause bronchodilation; they would be excellent for marathon running because some types of asthma may be exercise-induced. Corticosteroids disrupt production pathways of infla
A client has been diagnosed with asthma. Which statement below indicates that the client correctly understands how to use an inhaler with a spacer?
A. "I don't have to wait between the two puffs if I use a spacer."
B. "If the spacer makes a whistling soun
Answer: B
Rational:Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the client of which technique needs to be used. The client must wait 1 minute between puffs. The client shou
What does the nurse do first when setting up a safe environment for the new client on oxygen?
A. Ensures that staff members wear protective clothing
B. Ensures that no combustion hazards are present in the room
C. Sets the oxygen delivery to maintain no f
Answer: B
Rational:Oxygen is highly flammable. The nurse must ensure that no open flames or combustion hazards are present in a room where oxygen is in use. Protective clothing is not necessary for a client who requires oxygen therapy other than the use o
The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this client?
A. By nasal cannula at a rate of no more than 1 to 3 L/mi
Answer: D
Rational:In the past, a client with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels increased. However, recent evidence does not support this; this ide
An environmental assessment of a factory finds inhalation exposure with a high level of particulate matter. What does the factory nurse do to generate the quickest compliance?
A. Encourages proper building ventilation
B. Refers workers to a tobacco cessat
Answer: D
Rational:Teaching everyone to use a mask when working in areas with high levels of particulate matter can reduce individual exposure. Proper building ventilation often requires work orders, reconstruction, time, and money; this will need to be i
After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions?
A. "Asthma drugs help everybody breathe better."
B. "I must carry my emergency
Answer:C
Rational: Because asthma attacks cannot always be predicted, clients with asthma must always carry a rescue inhaler such as a short-acting beta agonist (e.g., albuterol [Proventil]). Asthma medications are specific to the disease and should never
The client says, "I hate this stupid COPD." What is the best response by the nurse?
A. "Then you need to stop smoking."
B. "What is bothering you?"
C. "Why do you feel this way?"
D. "You will get used to it.
Answer:B
Rational: Encourage the client, and the family, to express their feelings about limitations on their lifestyle and about disease progression. This is not the time to lecture the client regarding his smoking habits; the client is expressing a need
Which statement by a client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction?
A. "I don't need to use my oxygen all the time."
B. "I don't need to get a flu shot."
C. "I need to eat more protein."
D
Answer:B
Rational: An annual influenza vaccine (flu shot) is important for all clients with COPD. At the same time, a pneumonia vaccine could be offered, since pneumonia is one of the most common complications of COPD. The client who is hypoxemic and also
A client is admitted with asthma. How is this disease differentiated from other chronic lung disorders?
A. It affects only young people.
B. The client has dyspnea.
C. The client is coughing.
D. The client is symptom-free between exacerbations.
Answer:D
Rational: The client may be completely symptom-free between exacerbations. Asthma affects people of all ages. Dyspnea is a common symptom of many chronic lung diseases. Coughing occurs in many acute and chronic lung diseases.
The nurse has been teaching improved airflow techniques to the client, who has continued to have restrictive breathing problems. Which is the best indicator of success?
A. Peak flowmeter readings that are yellow after the third reading
B. Productive cough
Answer:C
Rational: Maintaining a baseline SpO2 of 92% after ambulating 50 feet is an excellent indicator that the client has achieved better airflow, and that the nurse's teaching has been effective. A yellow reading means "caution," which indicates narro
A newly diagnosed client with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do?
A. Nothing. This is in the green zone.
B. Provide the rescue drug and reassess.
C. Provide the rescue drug and seek emergency he
Answer:D
Rational:Since the client is newly diagnosed with asthma, this would be an excellent opportunity for the nurse to observe the client using the peak flowmeter to ensure that the client is using it properly, so readings are accurate and in the gree
After surgery for placement of a chest tube, the client reports burning in the chest. What does the nurse do first?
A. Assess the airway, breathing, and circulation.
B. Call for the Rapid Response Team.
C. Check the patency of the chest tubes.
D. Listen f
Answer:A
Rational: Assessing the "ABCs" is the priority to determine possible causes of burning in the client's chest. The client's situation does not require the Rapid Response Team to be called. The client's symptoms are not caused by a blockage of ches
Which of these clients should the charge nurse assign to the LPN/LVN working on the medical-surgical unit?
1. Client with group A beta-hemolytic streptococcal pharyngitis who has stridor
2. Client with pulmonary tuberculosis who is receiving multiple medi
Answer:2
Rational:The LPN/LVN scope of practice includes medication administration, so a client receiving multiple medications can be managed appropriately by an LPN/LVN. Stridor is an indication of respiratory distress; this client needs to be managed by
The nurse is caring for a client with severe acute respiratory syndrome. What is the most important precaution the nurse should take when preparing to suction this client?
1. Keeping the head of the bed elevated 30 to 45 degrees
2. Performing oral care af
Answer:4
Rational: To protect health care workers during procedures that induce coughing or promote aerosolization of particles, nurses should wear a particulate mask respirator and protective eyewear to prevent the spread of infectious organisms. Keeping
A client with pneumonia caused by aspiration after alcohol intoxication has just been admitted. The client is febrile and agitated. Which health care provider order should the nurse implement first?
1. Administer levofloxacin (Levaquin) 500 mg IV.
2. Draw
Answer:2
Rational:Obtaining aerobic and anaerobic cultures is the first action the nurse should perform and is standard procedure in a febrile client for whom antibiotics have been requested. Levofloxacin, an antibiotic, is important to administer, but bl
The medical-surgical unit has one negative-airflow room. Which of these four clients who have just arrived on the unit should the charge nurse admit to this room?
1. Client with bacterial pneumonia and a cough productive of green sputum
2. Client with neu
Answer:3
Rational:A client with possible tuberculosis should be admitted to the negative-airflow room to prevent airborne transmission of tuberculosis. A client with bacterial pneumonia does not require a negative-airflow room but should be placed in Drop
An older adult resident in a long-term-care facility becomes confused and agitated, telling the nurse, "Get out of here! You're going to kill me!" Which action will the nurse take first?
1. Check the resident's oxygen saturation.
2. Do a complete neurolog
Answer:1
Rational:A common reason for sudden confusion in older clients is hypoxemia caused by undiagnosed pneumonia. The nurse's first action should be to assess oxygenation by checking the pulse oximetry. Determining the cause of the confusion is the pr
The community health nurse is planning tuberculosis treatment for a client who is homeless and heroin-addicted. Which action will be most effective in ensuring that the client completes treatment?
1. Arrange for a health care worker to watch the client ta
Answer:1
Rational:Because this client is unlikely to adhere to long-term treatment unless directly supervised while taking medications, the best option is to arrange for directly observed therapy. Giving a client who is homeless and addicted to heroin wri
An older client presents to the emergency department with a 2-day history of cough, pain on inspiration, shortness of breath, and dyspnea. The client never had a pneumococcal vaccine. The client's chest x-ray shows density in both bases. The client has wh
Answer:2
Rational:A bronchodilator would help decrease bronchospasm and would open up the airways, so it would be beneficial for this client. It would decrease dyspnea and feelings of shortness of breath. A bronchodilator would not be able to clear up the
A client who has been homeless and has spent the past 6 months living in shelters has been diagnosed with confirmed tuberculosis (TB). Which medications does the nurse expect to be ordered for the client?
1. Isoniazid (INH), rifampin (Rifadin), pyrazinami
Answer:1
Rational: The combination of isoniazid, rifampin, pyrazinamide, and ethambutol is used to treat TB. Metronidazole is used to treat anaerobic bacteria and some parasites, but is not effective against TB. Acyclovir is used to treat viral infection.
A client is taking isoniazid, rifampin, pyrazinamide, and ethambutol for tuberculosis. The client calls to report visual changes, including blurred vision and reduced visual fields. Which medication may be causing these changes?
1. Ethambutol
2. Isoniazid
Answer:1
Rational: Ethambutol can cause optic neuritis, leading to blindness at high doses. When discovered early and the drug is stopped, problems can usually be reversed. Both isoniazid and pyrazinamide may cause liver failure; side effects of major con
A client is being admitted for pneumonia. The sputum culture is positive for streptococcus, and the client asks about the length of the treatment. On what does the nurse base the answer?
1. The client will be treated for 5 to 7 days.
2. The client will re
Answer:1
Rational: Anti-infectives usually are used for 5 to 7 days in uncomplicated community-acquired pneumonia, and for up to 21 days in an immunocompromised client or one with hospital-acquired pneumonia. A client may become afebrile early in the cour
The nurse notices a visitor walking into the room of a client on airborne isolation with no protective gear. What does the nurse do?
1. Ensures that the client is wearing a mask
2. Tells the visitor that the client cannot receive visitors at this time
3.
Answer:4
Rational:Because the visitor is entering the client's isolation environment, the visitor must wear a mask. The client typically must wear a mask only when he or she is outside of an isolation environment. Turning the visitor away is inappropriate
A client is being discharged home with active tuberculosis. Which information does the nurse include in the discharge teaching plan?
1. "You are not contagious unless you stop taking your medication."
2. "You will not be contagious to the people you have
Answer:2
Rational: The people the client has been living with have already been exposed and need to be tested. They cannot be re-exposed simply because the diagnosis has now been confirmed. The client with active tuberculosis is contagious, even while tak
Community health nurses are tasked with providing education on prevention of respiratory infection for diseases such as the flu. Which target audience is given the highest priority?
1. Homeless people
2. Hospital staff
3. Politicians
4. Prison staff and i
Answer:4
Rational: High-risk groups for respiratory infection include those who live in crowded areas such as long-term care facilities, prisons, and mental health facilities. Although homeless people are a high priority, they are not the group at greates
A 70-year-old client has a complicated medical history, including chronic obstructive pulmonary disease. Which client statement indicates the need for further teaching about the disease?
1. "I am here to receive the yearly pneumonia shot again."
2. "I am
Answer:1
Rational: Clients 65 years and older, as well as those who have chronic health problems, should be encouraged to receive the pneumonia vaccine, which is not given annually but only once. Older clients are encouraged to receive a flu shot annually
A client who has recently traveled to Vietnam comes to the emergency department with fatigue, lethargy, night sweats, and a low-grade fever. What is the nurse's first action?
1. Contact the health care provider for tuberculosis (TB) medications.
2. Perfor
Answer:3
Rational: The concern is that this client has TB. A respiratory mask should be placed on the client immediately. Requesting medications for TB is not appropriate until the client has been evaluated and a diagnosis has been made. Performing a TB t
A client comes to the emergency department with a sore throat. Examination reveals redness and swelling of the pharyngeal mucous membranes. Which diagnostic test does the nurse expect will be requested first?
1. Chest x-ray
2. Complete blood count (CBC)
3
Answer:4
Rational: A throat culture is important for distinguishing a viral infection from a group A beta-hemolytic streptococcal infection. A chest x-ray or TB skin test is not indicated by the symptoms given. A CBC might be indicated to evaluate infecti
Which symptom of pneumonia may present differently in the older adult than in the younger adult?
1. Crackles on auscultation
2. Fever
3. Headache
4. Wheezing
Answer:2
Rational: Older adults may not have fever and may have a lower-than-normal temperature with pneumonia. Crackles on auscultation may be present in all age groups as the result of fluid in the lungs. All age ranges may have a headache with pneumoni
The nurse is preparing to admit an adult client with pertussis. Which symptom does the nurse anticipate finding in this client?
1. "Whooping" after a cough
2. Hemoptysis
3. Mild cold-like symptoms
4. Post-cough emesis
Answer:4
Rational: Clients with pertussis will have paroxysms of coughing often followed by changes in color and/or vomiting. Adults do not usually have the characteristic whooping sound associated with coughing that children with pertussis exhibit. Hemop
A client with tuberculosis (TB) who is homeless and has been living in shelters for the past 6 months asks the nurse why he must take so many medications. What information will the nurse provide in answering this question? (Select all that apply.)
1. Comb
Answer:1,2,4,5
Rational: Combination drug therapy is the most effective method for treating TB and preventing transmission. Multiple drug regimens are able to destroy organisms as quickly as possible and reduce the emergence of drug-resistant organisms. A
Which parameter indicates to the nurse that the short-acting beta-adrenergic agonist the client used 5 minutes ago for an acute asthma attack is effective?
A. SpO2 decreased from 85% to 78%
B. Peak expiratory flow increase from 50% to 70%
C. The obvious u
Answer: B
Rationale: Peak flow measures the effectiveness of expiratory efforts. An increased peak flow rate indicates less obstruction and greater movement of air with expiratory effort. Decreased SpO2 would indicate a worsening of the condition, not eff
A client with chronic obstructive pulmonary disease (COPD) prescribed a long-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can't be taken as a pill. What is the nurse's best response?
A. "Drugs taken by inhaler work more sl
Answer: D
Rationale: When used as prescribed, inhaler drugs go more to the site where the intended responses are needed (the airways), and less drug is absorbed systemically. Thus, inhaled drugs have fewer side effects (but still have side effects). Oral
Which precaution is most important for the nurse to teach a client who has cystic fibrosis?
A. Report a weight change of 2 pounds to your health care provider immediately.
B. Use supplemental oxygen whenever your oxygen saturation is less than 95%.
C. Eat
Answer: D
Rationale: The most common cause of death for a client with CF is respiratory failure from a respiratory infection. Avoiding infection in this population is critical for survival. Although many clients who have CF are underweight and need to mai
The chest tube of a client 16 hours postoperative from a lobectomy is accidentally pulled out by a portable x-ray machine. What is the nurse's best first action?
A. Clamp the tubing with padded clamps as close as possible to the insertion site.
B. Reposit
Answer: C
Rationale: Although the client had a pneumonectomy and sometimes chest tubes are not even used, the insertion site should be covered immediately to prevent infection. If this were a chest tube placed for any other reason, the action of covering
The charge nurse at an assisted living facility receives report from an emergency department (ED) nurse about one of the resident clients. The client was sent to the ED with a fever, chills, muscle aches, and headache. The ED nurse reports the client's ra
Answer: B
Rationale: This client is most likely going to be managed at the assisted living facility. Influenza is highly contagious. Keeping the client in his room rather than having him go to the dining room and eat with other residents helps prevent inf
A nurse is caring for an 89-year-old client admitted with pneumonia. He has an IV of normal saline running at 100 mL/hr and antibiotics that were initiated in the emergency department 3 hours ago. He has oxygen at 2 liters/nasal cannula. What assessment f
Answer: A
Rationale: One of the first manifestations of pneumonia in an older adult is acute confusion as a result of impaired gas exchange. A client with pneumonia who is alert and oriented to person, place, and time is responding well to appropriate the
A client has been admitted to the hospital with suspected TB. What drugs should the nurse plan to teach the client about before discharge? Select all that apply.
A. Rifampin (Rifadin); contact lenses can become stained orange
B. Isoniazid (INH); report ye
Answer: A, B, D
Rationale: Amoxicillin is not prescribed for TB. Pyrazinamide, although prescribed for TB, calls for an increase in fluids, not fluid restriction. Rifampin, isoniazid, and ethambutol are first-line drugs for TB therapy and have side effect