Question 1

A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device.Which action by the nurse is most appropriate?

Accepted Answer

A)   Document the presence of a large air leak.
B)   Notify the surgeon of a possible pneumothorax.
C)   Take no further action with the collection device.
D)   Adjust the dial on the wall regulator to decrease suction. C

Question 2

The nurse receives change-of-shift report on the following four patients.Which patient should the nurse assess first?

Accepted Answer

A)   A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled
B)   A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath
C)   A 77-year-old patient with tuberculosis (T
B)   who has four antitubercular medications due in 15 minutes
D)   A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° 
C)   B

Question 3

When assessing a patient who has just arrived after an automobile accident,the emergency department nurse notes tachycardia and absent breath sounds over the right lung.For which intervention will the nurse prepare the patient?

Accepted Answer

A)   Emergency pericardiocentesis
B)   Stabilization of the chest wall with tape
C)   Administration of an inhaled bronchodilator
D)   Insertion of a chest tube with a chest drainage system D

Question 4

After change-of-shift report,which patient should the nurse assess first?

Accepted Answer

A)   72-year-old with cor pulmonale who has 4+ bilateral edema in his legs and feet
B)   28-year-old with a history of a lung transplant and a temperature of 101° F (38.3° 
C)  
C)   40-year-old with a pleural effusion who is complaining of severe stabbing chest pain
D)   64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion

Question 5

A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of severe pleuritic chest pain.Which prescribed medication should the nurse give first?

Accepted Answer

A)   Codeine
B)   Guaifenesin (Robitussin) 
C)   Acetaminophen (Tylenol) 
D)   Piperacillin/tazobactam (Zosyn)

Question 6

A patient is admitted to the emergency department with an open stab wound to the left chest.What is the first action that the nurse should take?

Accepted Answer

A)   Position the patient so that the left chest is dependent.
B)   Tape a nonporous dressing on three sides over the chest wound.
C)   Cover the sucking chest wound firmly with an occlusive dressing.
D)   Keep the head of the patient's bed at no more than 30 degrees elevation.

Question 7

Following assessment of a patient with pneumonia,the nurse identifies a nursing diagnosis of ineffective airway clearance.Which assessment data best supports this diagnosis?

Accepted Answer

A)   Weak, nonproductive cough effort
B)   Large amounts of greenish sputum
C)   Respiratory rate of 28 breaths/minute
D)   Resting pulse oximetry (SpO2)  of 85%

Question 8

An occupational health nurse works at a manufacturing plant where there is potential exposure to inhaled dust.Which action,if recommended by the nurse,will be most helpful in reducing the incidence of lung disease?

Accepted Answer

A)   Treat workers with pulmonary fibrosis.
B)   Teach about symptoms of lung disease.
C)   Require the use of protective equipment.
D)   Monitor workers for coughing and wheezing.

Question 9

After 2 months of tuberculosis (TB)treatment with isoniazid (INH),rifampin (Rifadin),pyrazinamide (PZA),and ethambutol,a patient continues to have positive sputum smears for acid-fast bacilli (AFB).Which action should the nurse take next?

Accepted Answer

A)   Teach about treatment for drug-resistant TB treatment.
B)   Ask the patient whether medications have been taken as directed.
C)   Schedule the patient for directly observed therapy three times weekly.
D)   Discuss with the health care provider the need for the patient to use an injectable antibiotic.

Question 10

The nurse assesses the chest of a patient with pneumococcal pneumonia.Which finding would the nurse expect?

Accepted Answer

A)   Increased tactile fremitus
B)   Dry, nonproductive cough
C)   Hyperresonance to percussion
D)   A grating sound on auscultation

Question 11

A lobectomy is scheduled for a patient with stage I non-small cell lung cancer.The patient tells the nurse,"I would rather have chemotherapy than surgery." Which response by the nurse is most appropriate?

Accepted Answer

A)   "Are you afraid that the surgery will be very painful?"
B)   "Did you have bad experiences with previous surgeries?"
C)   "Surgery is the treatment of choice for stage I lung cancer."
D)   "Tell me what you know about the various treatments available."

Question 12

A patient is diagnosed with both human immunodeficiency virus (HIV)and active tuberculosis (TB)disease.Which information obtained by the nurse is most important to communicate to the health care provider?

Accepted Answer

A)   The Mantoux test had an induration of 7 mm.
B)   The chest-x-ray showed infiltrates in the lower lobes.
C)   The patient is being treated with antiretrovirals for HIV infection.
D)   The patient has a cough that is productive of blood-tinged mucus.

Question 13

Which factors will the nurse consider when calculating the CURB-65 score for a patient with pneumonia ?

Accepted Answer

A)   Age
B)   Blood pressure
C)   Respiratory rate
D)   Oxygen saturation
E)   Presence of confusionF)  Blood urea nitrogen (BUN)  level

Question 14

The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure.Which assessment would best evaluate the effectiveness of the therapies?

Accepted Answer

A)   Observe for distended neck veins.
B)   Auscultate for crackles in the lungs.
C)   Palpate for heaves or thrills over the heart.
D)   Review hemoglobin and hematocrit values.

Question 15

A patient with pneumonia has a fever of 101.4° F (38.6° C),a nonproductive cough,and an oxygen saturation of 88%.The patient complains of weakness,fatigue,and needs assistance to get out of bed.Which nursing diagnosis should the nurse assign as the highest priority?

Accepted Answer

A)   Hyperthermia related to infectious illness
B)   Impaired transfer ability related to weakness
C)   Ineffective airway clearance related to thick secretions
D)   Impaired gas exchange related to respiratory congestion

Question 16

An experienced nurse instructs a new nurse about how to care for a patient with dyspnea caused by a pulmonary fungal infection.Which action by the new nurse indicates a need for further teaching?

Accepted Answer

A)   Listening to the patient's lung sounds several times during the shift
B)   Placing the patient on droplet precautions and in a private hospital room
C)   Increasing the oxygen flow rate to keep the oxygen saturation above 90%
D)   Monitoring patient serology results to identify the specific infecting organism

Question 17

The nurse provides discharge instructions to a patient who was hospitalized for pneumonia.Which statement,if made by the patient,indicates a good understanding of the instructions?

Accepted Answer

A)   "I will call the doctor if I still feel tired after a week."
B)   "I will continue to do the deep breathing and coughing exercises at home."
C)   "I will schedule two appointments for the pneumonia and influenza vaccines."
D)   "I'll cancel my chest x-ray appointment if I'm feeling better in a couple weeks."

Question 18

The nurse teaches a patient about the transmission of pulmonary tuberculosis (TB).Which statement,if made by the patient,indicates that teaching was effective?

Accepted Answer

A)   "I will avoid being outdoors whenever possible."
B)   "My husband will be sleeping in the guest bedroom."
C)   "I will take the bus instead of driving to visit my friends."
D)   "I will keep the windows closed at home to contain the germs."

Question 19

A patient who was admitted the previous day with pneumonia complains of a sharp pain of 7 (based on 0 to 10 scale)"whenever I take a deep breath." Which action will the nurse take next?

Accepted Answer

A)   Auscultate breath sounds.
B)   Administer the PRN morphine.
C)   Have the patient cough forcefully.
D)   Notify the patient's health care provider.

Question 20

When caring for a patient who is hospitalized with active tuberculosis (TB),the nurse observes a student nurse who is assigned to take care of a patient.Which action,if performed by the student nurse,would require an intervention by the nurse?

Accepted Answer

A)   The patient is offered a tissue from the box at the bedside.
B)   A surgical face mask is applied before visiting the patient.
C)   A snack is brought to the patient from the unit refrigerator.
D)   Hand washing is performed before entering the patient's room.

Exam 28: Nursing Management: Lower Respiratory Problems