Question 1

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.Which assessment data obtained by the nurse indicates that the treatment has been effective?

Accepted Answer

A)  Bronchial breath sounds are heard at the right base. 
B)  The patient coughs up small amounts of green mucus. 
C)  The patient's white blood cell (WB
C)  count is 9000/µL. 
D)  Increased tactile fremitus is palpable over the right chest.

Question 2

The nurse notes new onset confusion in an older patient who is normally alert and oriented.In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A,B,C,D].)

Accepted Answer

A)  Obtain the oxygen saturation. 
B)  Check the patient's pulse rate. 
C)  Document the change in status. 
D)  Notify the health care provider.

Question 3

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 4

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test.Which action should the nurse take?

Accepted Answer

A)  Teach about the reason for the blood tests. 
B)  Schedule an appointment for a chest x-ray. 
C)  Teach about the need to get sputum specimens for 2 to 3 consecutive days. 
D)  Instruct the patient to expectorate three specimens as soon as possible.

Question 5

A patient has just been admitted with probable bacterial pneumonia and sepsis.Which order should the nurse implement first?

Accepted Answer

A)  Chest x-ray via stretcher 
B)  Blood cultures from two sites 
C)  Ciprofloxacin (Cipro) 400 mg IV 
D)  Acetaminophen (Tylenol) rectal suppository

Question 6

A patient is admitted with active tuberculosis (TB).The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented?

Accepted Answer

A)  Chest x-ray shows no upper lobe infiltrates. 
B)  TB medications have been taken for 6 months. 
C)  Mantoux testing shows an induration of 10 mm. 
D)  Three sputum smears for acid-fast bacilli are negative.

Question 7

A patient with bacterial pneumonia has rhonchi and thick sputum.What is the nurse's most appropriate action to promote airway clearance?

Accepted Answer

A)  Assist the patient to splint the chest when coughing. 
B)  Teach the patient about the need for fluid restrictions. 
C)  Encourage the patient to wear the nasal oxygen cannula. 
D)  Instruct the patient on the pursed lip breathing technique.

Question 8

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 9

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.

Question 10

A patient with idiopathic pulmonary arterial hypertension (IPAH)is receiving nifedipine (Procardia).Which assessment would best indicate to the nurse that the patient's condition is improving?

Accepted Answer

A)  Blood pressure (BP) is less than 140/90 mm Hg. 
B)  Patient reports decreased exertional dyspnea. 
C)  Heart rate is between 60 and 100 beats/minute. 
D)  Patient's chest x-ray indicates clear lung fields.

Question 11

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB).Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

Accepted Answer

A)  Arrange for a friend to administer the medication on schedule. 
B)  Give the patient written instructions about how to take the medications. 
C)  Teach the patient about the high risk for infecting others unless treatment is followed. 
D)  Arrange for a daily noon meal at a community center where the drug will be administered.

Question 12

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 13

An hour after a thoracotomy,a patient complains of incisional pain at a level 7 (based on 0 to 10 scale)and has decreased left-sided breath sounds.The pleural drainage system has 100 mL of bloody drainage and a large air leak.Which action is best for the nurse to take next?

Accepted Answer

A)  Milk the chest tube gently to remove any clots. 
B)  Clamp the chest tube momentarily to check for the origin of the air leak. 
C)  Assist the patient to deep breathe, cough, and use the incentive spirometer. 
D)  Set up the patient controlled analgesia (PC
A)  and administer the loading dose of morphine.

Question 14

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 15

The nurse cares for a patient who has just had a thoracentesis.Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

Accepted Answer

A)  Oxygen saturation is 88%. 
B)  Blood pressure is 145/90 mm Hg. 
C)  Respiratory rate is 22 breaths/minute when lying flat. 
D)  Pain level is 5 (on 0 to 10 scale) with a deep breath.

Question 16

The nurse completes discharge teaching for a patient who has had a lung transplant.The nurse evaluates that the teaching has been effective if the patient makes which statement?

Accepted Answer

A)  "I will make an appointment to see the doctor every year." 
B)  "I will stop taking the prednisone if I experience a dry cough." 
C)  "I will not worry if I feel a little short of breath with exercise." 
D)  "I will call the health care provider right away if I develop a fever."

Question 17

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 18

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH)who is receiving epoprostenol (Flolan).Which assessment information requires the most immediate action by the nurse?

Accepted Answer

A)  The oxygen saturation is 94%. 
B)  The blood pressure is 98/56 mm Hg. 
C)  The patient's central IV line is disconnected. 
D)  The international normalized ratio (INR) is prolonged.

Question 19

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 20

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy.Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)?

Accepted Answer

A)  Document the amount of drainage every eight hours. 
B)  Obtain samples of drainage for culture from the system. 
C)  Assess patient pain level associated with the chest tube. 
D)  Check the water-seal chamber for the correct fluid level.

Exam 24: Nursing Management: Lower Respiratory Problems

A patient with right lower-lobe pneumonia has been treated with IV antibiotics for 3 days.Which assessment data obtained by the nurse indicates that the treatment has been effective?

The nurse notes new onset confusion in an older patient who is normally alert and oriented.In which order should the nurse take the following actions? (Put a comma and a space between each answer choice [A,B,C,D].)

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?

The health care provider writes an order for bacteriologic testing for a patient who has a positive tuberculosis skin test.Which action should the nurse take?

A patient has just been admitted with probable bacterial pneumonia and sepsis.Which order should the nurse implement first?

A patient is admitted with active tuberculosis (TB) .The nurse should question a health care provider's order to discontinue airborne precautions unless which assessment finding is documented?

A patient with bacterial pneumonia has rhonchi and thick sputum.What is the nurse's most appropriate action to promote airway clearance?

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?

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?

A patient with idiopathic pulmonary arterial hypertension (IPAH) is receiving nifedipine (Procardia) .Which assessment would best indicate to the nurse that the patient's condition is improving?

An alcoholic and homeless patient is diagnosed with active tuberculosis (TB) .Which intervention by the nurse will be most effective in ensuring adherence with the treatment regimen?

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

An hour after a thoracotomy,a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds.The pleural drainage system has 100 mL of bloody drainage and a large air leak.Which action is best for the nurse to take next?

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?

The nurse cares for a patient who has just had a thoracentesis.Which assessment information obtained by the nurse is a priority to communicate to the health care provider?

The nurse completes discharge teaching for a patient who has had a lung transplant.The nurse evaluates that the teaching has been effective if the patient makes which statement?

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?

The nurse is caring for a patient with idiopathic pulmonary arterial hypertension (IPAH) who is receiving epoprostenol (Flolan) .Which assessment information requires the most immediate action by the nurse?

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

The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy.Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP) ?