Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders

22 March 2023
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question
A client with suspected severe acute respiratory syndrome (SARS) comes to the emergency department. Which physician order should the nurse implement first?
answer
Institute isolation precautions.
question
During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must:
answer
Continue to take antibiotics for the entire 10 days.
question
Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections?
answer
Receiving vaccinations
question
What dietary recommendations should a nurse provide a client with a lung abscess?
answer
A diet rich in protein
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Which interventions does a nurse implement for clients with empyema?
answer
Encourage breathing exercises
question
You are assessing a client's potential for pulmonary emboli. What finding indicates possible deep vein thrombosis?
answer
Pain in the calf
question
You are an occupational health nurse in a large ceramic manufacturing company. How would you intervene to prevent occupational lung disease in the employees of the company?
answer
Fit all employees with protective masks.
question
The nurse is collaborating with a community group to develop plans to reduce the incidence of lung cancer in the community. Which of the following would be most effective?
answer
Classes at community centers to teach about smoking cessation strategies
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Which action should the nurse take first in caring for a client during an acute asthma attack?
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Administer bronchodilator as ordered.
question
After 48 hours, a Mantoux test is evaluated. At the site, there is a 10 mm induration. This finding would be considered:
answer
Significant
question
A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first?
answer
Administer oxygen by nasal cannula as ordered.
question
A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition?
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The client has a partial pressure of arterial oxygen (PaO2) value of 90 mm Hg or higher.
question
On auscultation, which finding suggests a right pneumothorax?
answer
Absence of breath sounds in the right thorax
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A recent immigrant is diagnosed with pulmonary tuberculosis (TB). Which intervention is the most important for the nurse to implement with this client?
answer
Developing a list of people with whom the client has had contact
question
When caring for a client with acute respiratory failure, the nurse should expect to focus on resolving which set of problems?
answer
Hypercapnia, hypoventilation, and hypoxemia
question
The occupational nurse is completing routine assessments on the employees where you work. What might be revealed by a chest radiograph for a client with occupational lung diseases?
answer
Fibrotic changes in lungs
question
The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?
answer
Acute respiratory distress syndrome
question
A nurse is preparing dietary recommendations for a client with a lung abscess. Which statement would be included in the plan of care?
answer
"You must consume a diet rich in protein, such as chicken, fish, and beans."
question
The nurse is providing discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client correctly mentions which early sign of exacerbation?
answer
Shortness of breath
question
A patient comes to the clinic with fever, cough, and chest discomfort. The nurse auscultates crackles in the left lower base of the lung and suspects that the patient may have pneumonia. What does the nurse know is the most common organism that causes community-acquired pneumonia?
answer
Streptococcus pneumoniae
question
A physician stated to the nurse that the client has fluid in the pleural space and will need a thoracentesis. The nurse expects the physician to document this fluid as ...
answer
pleural effusion.
question
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?
answer
See if there are leaks in the system.
question
You are caring for a client with chronic respiratory failure. What are the signs and symptoms of chronic respiratory failure?
answer
Progressive loss of lung function associated with chronic disease
question
A nurse is caring for a patient diagnosed with empyema. Which of the following interventions does a nurse implement for patients with empyema?
answer
Encourage breathing exercises.
question
A victim has sustained a blunt force trauma to the chest. A pulmonary contusion is suspected. Which of the following clinical manifestations correlate with a moderate pulmonary contusion?
answer
Blood-tinged sputum
question
A client who has recently started working in a coal mine is concerned the effects on long-term health. How does the nurse advise the client to prevent occupational lung disease? Select all that apply.
answer
- Do not smoke, or quit smoking if currently smoking. - Wear appropriate protective equipment when around airborne irritants and dusts.
question
The nurse is planning for the care of a patient with acute tracheobronchitis. What nursing interventions should be included in the plan of care? (Select all that apply.)
answer
- Increasing fluid intake to remove secretions - Encouraging the patient to remain in bed - Using cool-vapor therapy to relieve laryngeal and tracheal irritation
question
A patient has a Mantoux skin test prior to being placed on an immunosuppressant for the treatment of Crohn's disease. What results would the nurse determine is not significant for holding the medication?
answer
0 to 4 mm
question
The nurse is educating a patient who will be started on an antituberculosis medication regimen. The patient asks the nurse, "How long will I have to be on these medications?" What should the nurse tell the patient?
answer
6 to 12 months
question
A patient arrives in the emergency department after being involved in a motor vehicle accident. The nurse observes paradoxical chest movement when removing the patient's shirt. What does the nurse know that this finding indicates?
answer
Flail chest
question
After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH [Laniazid]) as prophylaxis against tuberculosis. The client's daughter asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy?
answer
6 to 12 months
question
Which is a true statement regarding severe acute respiratory syndrome (SARS)?
answer
It is most contagious during the second week of illness.
question
What is the reason for chest tubes after thoracic surgery?
answer
Draining secretions, air, and blood from the thoracic cavity is necessary.
question
You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia?
answer
Encourage increased fluid intake.
question
The patient with a chest tube is being transported to X-ray. Which complication may occur if the chest tube is clamped during transportation?
answer
Tension pneumothorax
question
A client who is diagnosed with chronic respiratory failure will have which symptom?
answer
dyspnea
question
A nurse assesses arterial blood gas results for a patient in acute respiratory failure (ARF). Which results are consistent with this disorder?
answer
pH 7.28, PaO2 50 mm Hg
question
The nurse is assessing a client who, after an extensive surgical procedure, is at risk for developing acute respiratory distress syndrome (ARDS). The nurse assesses for which most common early sign of ARDS?
answer
Rapid onset of severe dyspnea
question
A client diagnosed with acute respiratory distress syndrome (ARDS) is restless and has a low oxygen saturation level. If the client's condition does not improve and the oxygen saturation level continues to decrease, what procedure will the nurse expect to assist with in order to help the client breathe more easily?
answer
Intubate the client and control breathing with mechanical ventilation
question
The ICU nurse caring for a 2-year-old near drowning victim monitors for what possible complication?
answer
Acute respiratory distress syndrome
question
Which of the following is a potential complication of a low pressure in the endotracheal cuff?
answer
Aspiration pneumonia
question
The clinic nurse is caring for a client with acute bronchitis. The client asks what may have caused the infection. What may induce acute bronchitis?
answer
Chemical irritation
question
The nurse knows the mortality rate is high in lung cancer clients due to which factor?
answer
Few early symptoms
question
While caring for a client with a chest tube, which nursing assessment would alert the nurse to a possible complication?
answer
Crackling is heard when skin around tube is touched.
question
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis?
answer
Stabbing pain during respiratory movement
question
A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?
answer
"You should switch to wearing your glasses while taking this medication."
question
A patient is admitted to the hospital with pulmonary arterial hypertension. What assessment finding by the nurse is a significant finding for this patient?
answer
Dyspnea
question
A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia?
answer
A client with a nasogastric tube
question
A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan?
answer
Using strict hand hygiene
question
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?
answer
15-mm induration
question
A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia?
answer
Dyspnea and wheezing
question
A positive Mantoux test indicates that a client:
answer
has produced an immune response.
question
A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be:
answer
Ineffective airway clearance.
question
A mediastinal shift occurs in which type of chest disorder?
answer
Tension pneumothorax
question
A client at risk for pneumonia has been ordered an influenza vaccine. Which statement from the nurse best explains the rationale for this vaccine?
answer
"Viruses like influenza are the most common cause of pneumonia."
question
The nurse identifies which finding to be most consistent prior to the onset of acute respiratory distress?
answer
Normal lung function
question
The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse?
answer
"The tube will drain air from the space around the lung."