HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success, Exams of Nursing

Download HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success and more Exams Nursing in PDF only on Docsity! HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 1. A patient is hospitalized with symptoms of tuberculosis (TB). The nurse recognizes that at least one of the sputum specimens for acid- fast bacilli (AFB) needs to be obtained at which time of the day? a. 6am i. Culture is the gold standard for diagnosing TB. Three consecutive sputum specimens are needed, each collected at 8- to 24-hour intervals, with at least one early-morning specimen. The initial test involves a microscopic examination of stained sputum smears for AFB. Early morning (6 a.m.) is the ideal time to collect sputum specimens for an AFB smear because secretions collect during the night. The times of 12 noon, 6 p.m., and 9 p.m. are not ideal times to collect the specimen because the amount of secretions for the specimen may not be optimal. • Which type of chest surgery is indicated for a patient with chest trauma? b. Exploratory thoracotomy i. An is an incision into the thorax to look for injured or bleeding tissues. It is indicated for a patient with chest trauma. Pneumonectomy is indicated for a patient with lung cancer. Segmental resection is indicated for a patient with bronchiectasis. Lung volume reduction surgery is indicated HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 3. When a patient is diagnosed with a lung abscess, which does the nurse teach the patient? a. Oral antibiotics will be used when the patient and x-ray show evidence of improvement. i. IV antibiotics are used until the patient and x-ray show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Lobectomy surgery is needed only when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic, as well as at the completion of the antibiotic therapy. 4. The nurse provides care for a patient who experienced chest trauma. When the nurse assesses the right lung, which finding suggests a right-sided pneumothorax? a. Absence of breath sounds i. A pneumothorax indicates that one of the lungs has collapsed and is not functioning. Manifestations of a pneumothorax include dyspnea, decreased movement of the involved chest wall, decreased or absent breath sounds HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 sputum. 7.A patient who is being treated at home for pneumonia reports fatigue to the home health nurse. Which instructions does the nurse provide for the patient? Select all that apply. a. Get adequate rest b. Restrict fluid intake c. Avoid alcohol and smoking d. Resume work to build strength e. Take every dose of the prescribed antibiotic i. oT ensure complete recovery after pneumonia, the patient should be advised to rest, avoid alcohol and smoking, and take every dose of the prescribed antibiotic. The patient should not resume work if feeling fatigued and should be encouraged to drink plenty of fluids during the recovery period. 8. The nurse reviews the medical record of a patient with a pneumothorax and notes that the patient has a minimal amount of fluid accumulated in the intrapleural space and that the patient is stable. Which does the nurse infer? a. No treatment may be needed i. Treatment of a pneumothorax depends on its severity, its HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 underlying cause, and the hemodynamic stability of the patient. If the patient is stable and has minimal air and/or fluid accumulated in the intrapleural space, no treatment may be needed because the condition may resolve spontaneously. Chest tube drainage is helpful to drain the fluid; however, this procedure is performed when the patient has severe complications. Aspiration with a large- bore needle is thoracentesis. This procedure is performed when the patient has fluid accumulation in the complete lung. Needle decompression helps to resolve pneumothorax when the patient has a medical emergency. 9. The nurse provides education for a group of nursing students about acute bronchitis and includes which information? a. Treatment is mainly supportive i. Acute bronchitis is usually self-limiting, and the treatment for acute bronchitis is supportive. Chest x- rays will differentiate acute bronchitis from pneumonia. With bronchitis, no consolidation or infiltrates will be seen on an x-ray as there is with pneumonia. If patients with acute bronchitis develop a fever, have difficulty breathing, or have symptoms last longer than four weeks, they should see their HCP. Because there is no consolidation, egophony would not HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 10. The health care provider prescribes IV vancomycin for a patient with pneumonia. Which action does the nurse perform first? a. Obtain sputum cultures for sensitivity i. The nurse should ensure that the sputum for culture and sensitivity has been sent to the laboratory before administering the antibiotic. It is important that the organisms be correctly identified (in the culture) before their numbers are affected by the antibiotic; the test also will determine whether the proper antibiotic has been prescribed (sensitivity testing). Vital signs, education, and white blood cell count measurement can be assessed following the obtainment of sputum cultures. 11. Which type of procedure allows the health care provider to manipulate instruments passed into the pleural space? a. Video-assisted thoracoscopic surgery i. Video-assisted thoracoscopic surgery allows the surgeon to manipulate instruments passed into pleural space. Decortication, segmental resection, and exploratory thoracotomy do not allow the surgeon to manipulate instruments passed into pleural space. 12. A patient with a sudden onset of respiratory distress is scheduled HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 for a ventilation-perfusion scan. Which instruction does the nurse provide to the patient about the procedure? a. The test involves the injection of a radioisotope and the inhalation of a radioactive gas i. A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood, and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. Sedation is not required; magnetic imaging is not a component of the examination, so the patient can have the test even if there is metal in the body. Chest pressure may indicate an adverse reaction and is not normal. 13. A pediatric patient presents with a 2-week history of cough, clear sputum, headache, hoarseness, and myalgias. The patient has no significant medical history. The patient's parent asks why there is no plan to administer an antibiotic. How does the nurse respond? a. Explain that antibiotics are not required for the patient i. The symptoms and signs indicate that the patient may have acute bronchitis, which is a viral disorder. Therefore the nurse should explain to the parent that antibiotics will not help in viral infections. If they are prescribed, antibiotics may cause side effects and may also lead to antibiotic HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 associated with the rupture of small blebs. 15. A patient with no significant health history presents to the emergency department reporting a sudden onset of shortness of breath. The nurse auscultates the lungs and notes that there are no breath sounds in the right upper lobe. The nurse suspects which type of pneumothorax? a. Spontaneous i. A lack of breath sounds over a portion of the lung fields indicates the presence of a pneumothorax. A spontaneous pneumothorax typically occurs as a result of the rupture of small blebs (air-filled sacs) on the surface of the lung. These blebs can occur in healthy young people or from lung disease, such as chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis, and pneumonia. A tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. An iatrogenic pneumothorax can occur because of laceration or puncture of the lung during medical procedures. A traumatic pneumothorax can occur from either penetrating (open) or nonpenetrating (closed) chest trauma. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 16. A patient is hospitalized with a diagnosis of pneumonia. When reviewing the patient’s history, the nurse finds that the patient experienced a seizure with profuse vomiting four days prior to the hospital admission. Which type of pneumonia does the nurse suspect? a. Aspiration pneumonia i. Aspiration pneumonia results from the abnormal entry of material from the mouth or stomach into the trachea and lungs. Conditions that increase the risk for aspiration include decreased level of consciousness (e.g., seizure, anesthesia, head injury, stroke, alcohol intake), difficulty swallowing, and insertion of nasogastric (NG) tubes with or without enteral feeding. The aspirated material (food, water, vomitus, oropharyngeal secretions) triggers an inflammatory response. The history of the patient does not suggest any exposure to pneumonia in the community. The patient has never been in the hospital; therefore hospital-associated pneumonia is highly unlikely. The patient does not have a history of HIV, intake of immunosuppressive drugs, corticosteroids, or any disorders leading to immunosuppression; therefore opportunistic pneumonia did not occur in this patient. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 for a patient with pneumonia when the patient makes which statement? a. I should take antibiotics for all upper respiratory infections i. Antibiotics are not indicated for all upper respiratory tract infections, such as viral infections, because they have side effects and promote antibiotic resistance. It is important for the patient to continue with coughing and deep breathing exercises for at least six weeks, until all of the infection has cleared from the lungs. The patient should take all medications as prescribed and seek medical attention for signs or symptoms of a new infection. 20. Which is the reason that the nurse, while assisting with insertion of a chest tube, positions the patient with the arm raised above the head on the affected side? a. To expose the midaxillary area i. The midaxillary area is the standard site for the insertion of a chest tube. Therefore the nurse will position the patient with the arm raised above the head on the affected side to expose the midaxillary area. Analgesics will be given to the patient to minimize pain. The patient’s head will be elevated to reduce the risk of injury. The chest tube will be advanced up over the top of the rib to avoid the intercostal nerves. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 21. When caring for a patient with pertussis, which intervention does the nurse prioritize? a. Administering antibiotic therapy i. The treatment is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. For the patient who cannot take macrolides, trimethoprim/sulfamethoxazole is used. Cough suppressants and antihistamines should not be used because they are ineffective and may induce coughing episodes. Corticosteroids and bronchodilators are not useful in reducing symptoms. 22. The nurse provides which information about the water-seal chamber on a chest drainage unit (CDU) when educating a group of nursing students? a. It contains 2 cm of water i. The water-seal chamber is the second chamber of the chest drainage system. It contains 2 cm of water, which acts as a one-way valve. The first chamber of the drainage system receives fluid and air from the pleural space. The third chamber applies suction to the chest drainage system. 23. The nurse provides teaching for a patient who is scheduled for a HS MISC Elsevier – Respiratory Exam Questions and HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 intake, is recommended to liquefy secretions. 25. Which condition in a patient with chest trauma requires treatment with positive pressure ventilation? a. Flail chest i. Flail chest results in a loss of chest stability as a result of fracture of the ribs. The nurse should stabilize the flail segment with positive pressure ventilation (intubation and mechanical ventilation as needed). The nurse performs needle decompression to treat cardiac tamponade. The patient with a hemopneumothorax or tension pneumothorax requires treatment with chest tube drainage, and positive pressure ventilation aggravates the patient’s condition. 26. A patient has a chest tube inserted to treat a pneumothorax. Which observation causes the nurse to conclude that the water- seal chamber of the chest drainage unit (CDU) is functioning properly? a. The level in the water-seal chamber fluctuates with respirations i. The water-seal chamber level fluctuates with respirations as a result of the restoration of negative pressure within the thoracic cavity. If there is no bubbling in the suction control chamber, (1) there is no suction, (2) the suction is not high HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 the risk of complications. If the drainage system is found to be broken, then the distal end of the chest tubing connection should be placed in a sterile water container at a 2-cm level as an emergency water seal. Milking and stripping the drainage tubes are done only when there is an order from the physician. The collection chamber should never be emptied but should be replaced. 29. Forty-eight hours after a patient received an intradermal tuberculin skin test (Mantoux), the nurse assesses the injection site and notes a 12-mm area of palpable induration. How does the nurse interpret this result? a. A significant indication that the patient has been exposed to tuberculosis i. The test is read by inspection and palpation 48 to 72 hours later for the presence or absence of induration. Induration, a palpable, raised, hardened area or swelling (not redness) at the injection site, means the person has been exposed to tuberculosis and has developed antibodies. The other answer options are incorrect conclusions related to the findings.3 30. The registered nurse is evaluating the actions of a nursing student HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 who is maintaining a chest drainage unit (CDU) for a patient with chest trauma. The nurse intervenes when the student performs which actions? Select all that apply. a. Coils the tubing above the chest level b. Expects air fluctuations in the water-seal chamber c. Verifies the presence of an air- occlusive dressing over the insertion site d. Connects the chest tube to wall suction to check for tidaling e. Positions the tubing so that the drainage flows freely from the insertion site to the collection chamber i. Coiling of the tubing above the chest level may cause fluid to drain back into the pleural cavity. Therefore the tubing of the drainage system should be coiled below the chest level. The chest tube should be disconnected from wall suction to check the tidaling because the suction will be increased. An absence of air fluctuations in the water-seal chamber indicates blockage of the tubing. The dressing of the drainage system should be air-occlusive to prevent leakage. The tubing should be dropped straight from the bed or chair to the drainage unit for easy flow. 31. A patient experiences a chest injury as a result of a motor HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. There is not enough information to conclude that ARDS has developed. The risk for ARDS is greater after the initial injury, not at the time of the injury. 32. A patient with a diagnosis of chylothorax is prescribed octreotide. Which outcome does the nurse expect after the treatment a. Reduced flow of lymphatic fluid i. Chylothorax is a type of chest injury that is associated with the accumulation of fluid in the pleural space. Octreotide acts like the natural hormone somatostatin, which behaves as a vasoconstrictor and reduces the flow of lymphatic fluid into the pleural space. The patient with chylothorax will not need hydration and IV fluids. The nurse administers analgesia for adequate pain control. Octreotide does not reduce the risk of hypoxemia. 33. Which instructions does the nurse provide to a patient with acute bronchitis? Select all that apply. a. Increase oral fluid intake b. Avoid secondhand smoke HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 c. Maintain a 30-degree head elevation when in bed d. Avoid throat lozenges because they may induce coughing e. Eat a spoonful of honey to help relieve cough i. The goal of treatment is to relieve symptoms and prevent pneumonia. Treatment is supportive. It includes encouraging oral fluid intake. Honey may help relieve cough. The nurse should encourage patients not to smoke, to avoid secondhand smoke, and to wash their hands often. The patient should be positioned in an upright sitting position (high Fowler's) with the head slightly flexed. Throat lozenges may help relieve cough. 34. Following a thoracotomy, a patient uses patient- controlled analgesia (PCA). Which related outcomes does the nurse expect? Select all that apply. a. The patient will have an effective cough b. The patient will be able to take deep breaths. c. The patient will have reexpansion of the lungs d. The patient will have reduced pulmonary edema e. The patient will be able to move the arm on the operative side i. Thoracotomy is a painful procedure and involves cutting HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 contraceptives, hormone therapy, cigarette smoking, prolonged air travel, heart failure, pregnancy, and clotting disorders. Pneumonia is not a risk factor. 36. The treatment plan for a patient with tuberculosis includes isoniazid and rifampin. Which data found in the patient's health history cause the nurse to question the medication prescriptions? a. Hepatitis i. Isoniazid (INH) and rifampin are tuberculosis medications that are metabolized in the liver and are extremely toxic. Hepatotoxicity is a common side effect. A history of asthma, rheumatic fever, or allergy to penicillin is not a contraindication to the administration of INH and rifampin. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 37. A patient’s initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed? a. Isoniazid (INH) i. The standard treatment regimen for latent tuberculosis infection (LTBI) is nine months of daily isoniazid. It is an effective and inexpensive drug that the patient can take orally. Penicillin and theophylline would not be prescribed for the treatment of TB exposure. INH plus an antibiotic would not likely be prescribed for this scenario. 38. A patient with a pneumothorax has a chest tube in place. The nurse verifies that there are no leaks in the tubing or at the insertion site. The nurse notes that there is no bubbling in the suction control chamber of the chest drainage unit (CDU). Which are the most probable reasons for the absence of bubbling? Select all that apply. a. There is no suctioning being applied b. The CDU is not working properly. c. The suction pressure is very low d. The pleural air leak is so large that the suction is not high 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 40. A patient presents to the emergency department with a temperature of 101.4°F (38.6°C) and a productive cough with rust- colored sputum. The nurse suspects which diagnosis? a. Pneumonia i. Sputum associated with pneumonia may be green, yellow, or even rust colored (bloody). Tuberculosis frequently presents with a dry cough. With acute bronchitis, clear sputum is often present, although some patients have purulent sputum. Pink, frothy sputum would be present in CHF and pulmonary edema. 41. A patient presents with a pneumonia score of 5 on the Expanded CURB-65 scale. Which action does the nurse take? a. Consider admission to an intensive care unit i. The Expanded CURB-65 scale may be used as a supplement to clinical judgment to determine the severity of pneumonia and if patients need to be hospitalized. A patient score of 5 on the scale means the perceived risk is high and that placement in the intensive care unit is warranted. If the patient has symptoms of pneumonia, advising no treatment is not appropriate. Treatment in an outpatient setting is advised when the scores are 0 to 2 on the scale. Hospital HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 a. Enoxaparin i. Subcutaneous administration of low-molecular-weight heparin (LMWH) (e.g., enoxaparin [Lovenox], fragmin [Dalteparin], or fondaparinux) is the recommended treatment for patients with acute PE. LMWH is safer and more effective than unfractionated heparin. Warfarin (Coumadin) is an oral anticoagulant; it is started at the time of diagnosis. Warfarin should be given for at least three months and then reevaluated. Direct thrombin inhibitors are given IV; some health care providers use them in the treatment of PE. The fibrinolytic agents, such as tissue plasminogen activator (tPA) or alteplase (Activase), may help dissolve the PE and the source of the thrombus in the pelvis or deep leg veins, thereby decreasing the risk for recurrent emboli. 44. A patient reports shortness of breath one day after a cholecystectomy. The nurse assesses the right lung sounds and notes dullness to percussion and decreased breath sounds. Which is the most probable reason for the assessment findings? a. Atelectasis i. Atelectasis is a lung condition characterized by collapsed, airless alveoli. There may be decreased or absent breath HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 sounds and dullness to percussion over the affected area. The most common cause of atelectasis is obstruction of the small airways with secretions. This is common in bedridden patients and in postoperative abdominal and chest surgery patients. Pneumonia can have similar findings, but it is highly unlikely to occur one day after surgery. In both pneumothorax and tension pneumothorax, the affected area is hyperresonant. 45. The nurse provides education for a patient about reducing the risk of atelectasis while undergoing chest tube drainage. Which statements made by the patient indicate effective learning? Select all that apply. a. I should change positions slowly b. I should cough at regular intervals c. I should use my incentive spirometer d. I should reduce the intake of protein in my diet e. I should perform range-of- motion exercises i. Nursing care and patient teaching can minimize the risk of atelectasis. The nurse should encourage coughing, deep HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 46. The nurse cares for a patient who is immunocompetent and presents with pulmonary tuberculosis (TB). Which clinical manifestation does the nurse expect? a. Mucopurulent sputum i. A cough that progresses in frequency and produces mucoid or mucopurulent sputum is the most common symptom of pulmonary TB. Diarrhea, lymph node enlargement, and dehydration are manifestations not directly associated with pulmonary TB in a patient who is immunocompetent. 47. A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential for which reason? a. It discourages the development of resistant strains of the TB organism i. Because of the growing prevalence of multidrug- resistant tuberculosis (MDR-TB), it is important to manage the patient with active TB aggressively. Drug therapy is divided into two phases: initial and continuation. In most circumstances, the treatment regimen for patients with previously untreated TB consists of a three-month initial phase with four drugs (isoniazid, rifampin, pyrazinamide, and ethambutol). The dosage, side effects, and duration of the regimen are not HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 reasons for combination drug therapy in a patient with TB. 48. An unconscious patient who was brought to the emergency department responded well to cardiopulmonary resuscitation (CPR). After several hours in stable condition, the patient experiences dyspnea, tachycardia, cyanosis, and neck vein distention. The nurse prepares for which immediate intervention? a. Needle decompression i. The symptoms and signs indicate that the patient has a tension pneumothorax. Tension pneumothorax occurs when air enters the pleural space but cannot escape. The continued accumulation of air in the pleural space causes increasingly elevated intrapleural pressures. This results in compression of the lung on the affected side and pressure on the heart and great vessels, pushing them away from the affected side. If the tension in the pleural space is not relieved, the patient is likely to die from inadequate cardiac output or severe hypoxemia. Therefore the patient requires immediate needle decompression followed by chest tube insertion with a chest drainage system. Pericardiocentesis is the treatment for cardiac tamponade. Insertion of a CVAD is not the priority. The patient will likely be placed in the semi- Fowler’s position to facilitate breathing. HS MISC Elsevier – Respiratory Exam Questions and HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 50. A patient is admitted to an intensive care unit in stable condition with suspected acute pulmonary embolism (PE). The nurse prepares for the administration of which medication? a. Subcutaneous enoxaparin i. Immediate anticoagulation is required for patients with PE. Subcutaneous administration of low- molecular- weight heparin (LMWH) (e.g., enoxaparin [Lovenox]) or fragmin [Dalteparin] or fondaparinux) is the recommended treatment for patients with acute PE. Subcutaneous administration of LMWH has been found to be safer and more effective than the use of unfractionated heparin. Oral warfarin (vs. apixaban) is the most widely used oral anticoagulant. Warfarin should be given for at least three months and then reevaluated. Thrombolytic therapy HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 (e.g., alteplase) to treat PE is prescribed in cases of hemodynamic instability and right ventricular dysfunction. 51. A 70-year-old patient presents to the emergency department with symptoms that indicate pneumonia. Assessment findings include a new onset of confusion, a respiratory rate of 42 breaths/minute, a blood urea nitrogen (BUN) of 24 mg/dL, and a BP of 80/50 mm Hg. The nurse expects which treatment plan? a. Admit the patient to the intensive care unit i. According to the Expanded CURB-65 scale, which is used as a supplement to clinical judgment to determine the severity of pneumonia, the patient’s score is a 5; placement in the intensive care unit is recommended. The patient receives 1 point for each criterion: confusion (compared to baseline); BUN greater than 20 mg/dL; respiratory rate greater than or equal to 30 breaths/min; systolic BP of less than 90 mm Hg; and age greater than or equal to 65 yrs. With severe pneumonia, the patient needs a higher level of care than general medical-surgical. Discharging the patient is unsafe. Pulmonary embolism does not manifest in this way, and assessing for it is not required in this case. 52. The nurse cares for a patient with a diagnosis of tuberculosis. Which HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hours. There is no need to notify the health care provider or decrease the amount of water in the water-seal chamber because the chest tube system is functioning normally. The chest tube should not be clamped; doing so could cause a tension pneumothorax. 54. A patient has a chest tube with a chest drainage unit (CDU) in place. The nurse notes that the tidaling in the water-seal chamber has stopped. Which action does the nurse take? a. Assess the drainage system for occlusion i. Normal fluctuation of the water within the water-seal chamber is called tidaling. This up-and- down movement of water in concert with respiration reflects the intrapleural pressure changes during inspiration and expiration. If tidaling (rising with inspiration and falling with expiration in the spontaneously breathing patient) is not seen, the drainage system is blocked, the lungs are reexpanded, or the system is attached to suction. If tidaling is not seen, the nurse needs to determine the cause rather than simply continuing to monitor the patient. The nurse could check all connections for a leak, but the most common cause is occlusion. The collection unit is likely already in a low HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 position. 55. The nurse collaborates with the health care team to arrange for home care for a patient with pulmonary tuberculosis (TB). Of the family members who live with the patient, which one is at the greatest risk for contracting the disease? a. A 75-year-old parent who takes prednisone HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 H2O) may be used for frail HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 57. The nurse is assessing patients who are undergoing the process of chest drainage using a chest drainage unit (CDU). Which patient requires -10 cm H2O? a. Patient C i. High pressure may cause tissue damage in Patient A, who is very frail. Lower pressure (-10 cm and older patients at risk for tissue damage with higher pressures. The suction pressure is usually ordered to be -20 cm H2O, which is appropriate for Patient B. Patient C HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 requires evacuation of the pleural thorax; therefore the patient requires high-pressure drainage, such as -30 to -40 cm H2O. Patient D has a pneumothorax, so the patient will require high pressure, such as -30 to - 40 cm H2O, to evacuate the pleural space. 58. The nurse identifies a nursing diagnosis of impaired gas exchange for a patient with pneumonia based on which physical assessment findings? Select all that apply. a. SpO2 of 85% b. PaCO2 of 65 mm Hg HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 c. Thick yellow mucus expectorant d. Respiratory rate of 24 breaths/minute e. Dullness to percussion over the affected area i. Indications of impaired gas exchange for this patient include a decreased oxygen saturation level (SpO2 less than 90%) and an increased partial pressure of carbon dioxide level (PaCO2 greater than 45 mm Hg). PaCO2 is the partial pressure of carbon dioxide in arterial blood. Dullness to percussion over the affected area indicates a pleural effusion, which is associated with pneumonia. Yellow mucus would indicate clearance of secretions. An increased respiratory rate does not imply impaired gas exchange. 59. The nurse provides care for a patient who sustained multiple injuries as a result of a motor vehicle accident. Which assessment finding requires immediate intervention? a. Tracheal deviation i. The nurse must check the patient’s airway, breathing, and circulation. The clinical manifestation of tracheal deviation indicates that the patient is experiencing a tension pneumothorax, which is a medical emergency. It affects both the respiratory and cardiovascular systems. If the tension in HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 10,000/mm3. The presence of leukocytosis (WBC count >15,000/μL) indicates that the infection persists despite treatment with an antibiotic. Lung sounds and respiratory rate are not indicators of the efficacy of antibiotic treatment. A low-grade fever also may signify that the infection is persisting; however, the WBC count is the most reliable indicator of active infection. 62. The nurse is preparing a community education session related to the increased incidence of tuberculosis (TB) among the city’s residents. The nurse identifies that which populations are most at risk for the disease? Select all that apply. a. Workers at a nearby prison b. Elderly adults who attend activities at a local senior center c. Adults who are homeless d. Children who attend a preschool three days a week e. Middle-aged adults who live in the inner-city neighborhood f. Immigrants from an underdeveloped country who live in temporary housing in the city i. TB occurs disproportionately in the poor, underserved, and minorities. People most at risk include the homeless, residents of inner-city neighborhoods, foreign-born people, HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 those living or working in institutions (long-term care facilities, prisons, shelters, hospitals), IV-injecting drug users, those with overcrowded living conditions and less- than-optimal sanitation, and those with poor access to health care. Immunosuppression from any cause (e.g., HIV infection, cancer, long-term corticosteroid use) increases the risk for active TB infection. Elderly adults who attend activities at a local senior center and children who attend a preschool three days a week do not have an increased risk of the disease. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 64. The nurse notes that a patient’s treatment plan for chylothorax includes chemical pleurodesis. The nurse expects that which medication will be prescribed? a. Chylothorax is the presence of lymphatic fluid in the pleural space. The thoracic duct is disrupted either traumatically or from cancer, allowing lymphatic fluid to fill the pleural space. Chemical pleurodesis is done to obliterate the pleural space and prevent reaccumulation of effusion fluid. This procedure first requires chest tube drainage of the effusion. Once the fluid is drained, a chemical slurry is instilled into the pleural space. Talc is the most effective agent for pleurodesis. Other agents that can be used include doxycycline and bleomycin. Octreotide is a hormone-like drug that acts as a vasoconstrictor and reduces lymphatic flow; however, this medication is not used after pleurodesis. Prednisone is a corticosteroid used to reduce the progression of chronic pulmonary fibrosis. Cyclosporine is an immunosuppressive drug that treats pulmonary fibrosis. 65. The nurse assesses a patient following a transthoracic needle aspiration and notes excess air in the pleural space. How does the nurse interpret the finding? a. The patient has an iatrogenic pneumothorax i. An iatrogenic pneumothorax can occur as a result of a HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 laceration or puncture of the lung during medical procedures. For example, transthoracic needle aspiration, subclavian catheter insertion, pleural biopsy, and transbronchial lung biopsy all have the potential to injure the lung. A hemothorax is a complication that is characterized by the presence of blood in the pleural space. Cardiac tamponade is a type of lung injury that is manifested by the presence of blood in the pericardial space and compression of the myocardium. Spontaneous pneumothorax is a type of lung trauma that occurs as a result of the rupture of blebs at the apex of the lung. 66. After connecting a patient’s chest tube to a dry suction system, which action does the nurse take next? a. Turn the suction dial on the CDU to -20 cm H2O pressure i. After connecting the patient to the system, the nurse should turn the dial on the chest drainage system to the amount ordered (generally -20 cm H2O pressure). The nurse then should connect the suction tubing to the wall suction source and increase the suction until the float appears in the window of the CDU. If ordered to decrease the suction, the nurse would turn the dial down, depress the high-negativity vent, and assess for a rise in the water level of the water- HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 seal chamber. Brief and methodical clamping should take place if an air leak is suspected; there is no information given that warrants this action. 67. A patient is transported to the emergency department by the emergency response system (ERS) with a sudden change in mental status and a feeling of impending doom. The nurse reviews the patient’s medical history and notes recent international air travel. The nurse suspects that the patient is experiencing which condition? a. Pulmonary embolism (PE) i. The symptoms and history are indicative of massive PE . Massive PE may cause a sudden change in mental status, hypotension, and feelings of impending doom. Risk factors include HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 hemoptysis, crackles, wheezing, fever, accentuation of pulmonic heart sound, tachycardia, and syncope. Immediate assessment should focus on the patient’s cardiopulmonary status. O2 should be given by mask or cannula when hypoxemia is present. Notifying the HCP, obtaining an ECG, and calling the rapid response team can occur after the patient’s respiratory status is addressed. 69. A patient receives a prescription for amphotericin B. The nurse identifies that the medication is being given to treat which respiratory condition? a. Pulmonary fungal infection i. Amphotericin B is the standard therapy for treating serious systemic fungal infections. It must be given IV to achieve adequate blood and tissue levels because the gastrointestinal tract does not absorb it well. For a lung abscess, clindamycin is the first-line therapy because of its effectiveness against Staphylococcus and anaerobic organisms. The treatment for necrotizing pneumonia includes long-term antibiotic therapy. The treatment for pertussis is macrolide (erythromycin, azithromycin [Zithromax]) antibiotics to minimize symptoms and prevent the spread of the disease. HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 70. The nurse finds that a patient with chest trauma exhibits cyanosis, air hunger, neck vein distention, and an increase in intrathoracic pressure. The nurse prepares for which procedure? a. Needle decompression i. Cyanosis, air hunger, extreme agitation, subcutaneous emphysema, neck vein distention, hyperresonance to percussion, and tracheal deviation away from affected side (late sign) are manifestations of a tension pneumothorax in a patient with chest trauma. A tension pneumothorax is a complication associated with the presence of excess air in the pleural thorax that cannot escape and is treated with needle decompression. Pericardiocentesis is helpful in aspirating fluid from the pleural space, which is more useful in cases of cardiac tamponade. Insertion of a chest tube with a flutter valve or a chest tube with drainage are techniques that help to drain air from the lung. However, these techniques are performed after needle decompression. 71. The nurse reviews the process for setting up a wet suction system that is attached to a chest tube and questions which step that is listed in the procedure? a. Keep the suction control chamber uncovered HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 2022/2023 HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023 is sucked in, and during expiration, it bulges out. This paradoxical chest movement prevents adequate ventilation and increases the work of breathing. 73. A patient presents for a follow-up office visit one week after sustaining rib fractures that resulted in flail chest. Which instructions does the nurse provide to the patient? Select all that apply. a. You should take a shower instead of a bath for one more week b. You may want to sleep in the semi-Fowler’s position to make your breathing easier c. You should apply a binder over your chest during the day while performing activities d. You should wear compression hose throughout the day e. You may experience intercostal pain for several more weeks, so pain medication may still be needed i. The semi-Fowler’s position facilitates lung expansion, so the patient will be able to breathe easily. The lung parenchyma and fractured ribs heal with time. Some patients continue to have intercostal pain several weeks after the flail chest has resolved. Bathing will not complicate the patient’s condition. Applying a binder will reduce chest expansion, so the nurse does not instruct the patient to apply a binder over his or her chest. There is no indication that compression hose are HS MISC Elsevier – Respiratory Exam Questions and Answers Best Rated A+ Guaranteed Success Latest Update 2022/2023