28MD

Question 1

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

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%

Answer 1

a. Weak, nonproductive cough effort

Question 2

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

a. Increased tactile fremitus
b. Dry, nonproductive cough
c. Hyperresonance to percussion
d. A grating sound on auscultation

Answer 2

a. Increased tactile fremitus

Question 3

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

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.

Answer 3

a. Assist the patient to splint the chest when coughing.

Question 4

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?

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.”

Answer 4

b. “I will continue to do the deep breathing and coughing exercises at home.”

Question 5

The nurse develops a plan of care to prevent aspiration in a high-risk patient. Which nursing action will be most effective?

a. Turn and reposition immobile patients at least every 2 hours.
b. Place patients with altered consciousness in side-lying positions.
c. Monitor for respiratory symptoms in patients who are immunosuppressed.
d. Insert nasogastric tube for feedings for patients with swallowing problems.

Answer 5

b. Place patients with altered consciousness in side-lying positions.

Question 6

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?

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 (WBC) count is 9000/µL.
d. Increased tactile fremitus is palpable over the right chest.

Answer 6

c. The patient’s white blood cell (WBC) count is 9000/µL.

Question 7

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. 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.

Answer 7

c. Teach about the need to get sputum specimens for 2 to 3 consecutive days.

Question 8

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. 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.

Answer 8

d. Three sputum smears for acid-fast bacilli are negative.

Question 9

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

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.”

Answer 9

b. “My husband will be sleeping in the guest bedroom.”

Question 10

A patient who is taking rifampin (Rifadin) for tuberculosis calls the clinic and reports having orange discolored urine and tears. Which is the best response by the nurse?

a. Ask if the patient is experiencing shortness of breath, hives, or itching.
b. Ask the patient about any visual abnormalities such as red-green color discrimination.
c. Explain that orange discolored urine and tears are normal while taking this medication.
d. Advise the patient to stop the drug and report the symptoms to the health care provider.

Answer 10

c. Explain that orange discolored urine and tears are normal while taking this medication.

Question 11

An older patient is receiving standard multidrug therapy for tuberculosis (TB). The nurse should notify the health care provider if the patient exhibits which finding?

a. Yellow-tinged skin
b. Orange-colored sputum
c. Thickening of the fingernails
d. Difficulty hearing high-pitched voices

Answer 11

a. Yellow-tinged skin

Question 12

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?

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.

Answer 12

d. Arrange for a daily noon meal at a community center where the drug will be administered.

Question 13

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?

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.

Answer 13

b. Ask the patient whether medications have been taken as directed.

Question 14

Employee health test results reveal a tuberculosis (TB) skin test of 16-mm induration and a negative chest x-ray for a staff nurse working on the pulmonary unit. The nurse has no symptoms of TB. Which information should the occupational health nurse plan to teach the staff nurse?

a. Standard four-drug therapy for TB
b. Need for annual repeat TB skin testing
c. Use and side effects of isoniazid (INH)
d. Bacille Calmette-Guérin (BCG) vaccine

Answer 14

c. Use and side effects of isoniazid (INH)

Question 15

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?

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.

Answer 15

b. A surgical face mask is applied before visiting the patient.

Question 16

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?

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.

Answer 16

c. Require the use of protective equipment.

Question 17

The clinic nurse teaches a patient with a 42 pack-year history of cigarette smoking about lung disease. Which information will be most important for the nurse to include?

a. Options for smoking cessation
b. Reasons for annual sputum cytology testing
c. Erlotinib (Tarceva) therapy to prevent tumor risk
d. Computed tomography (CT) screening for lung cancer

Answer 17

a. Options for smoking cessation

Question 18

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?

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.”

Answer 18

d. “Tell me what you know about the various treatments available.”

Question 19

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?

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 (PCA) and administer the loading dose of morphine.

Answer 19

d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

Question 20

A patient with newly diagnosed lung cancer tells the nurse, “I don’t think I’m going to live to see my next birthday.” Which response by the nurse is best?

a. “Would you like to talk to the hospital chaplain about your feelings?”
b. “Can you tell me what it is that makes you think you will die so soon?”
c. “Are you afraid that the treatment for your cancer will not be effective?”
d. “Do you think that taking an antidepressant medication would be helpful?”

Answer 20

b. “Can you tell me what it is that makes you think you will die so soon?”

Question 21

The nurse monitors a patient after chest tube placement for a hemopneumothorax. The nurse is most concerned if which assessment finding is observed?

a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Complaint of pain with each deep inspiration
d. Subcutaneous emphysema at the insertion site

Answer 21

b. 400 mL of blood in the collection chamber

Question 22

A patient experiences a chest wall contusion as a result of being struck in the chest with a baseball bat. The emergency department nurse would be most concerned if which finding is observed during the initial assessment?

a. Paradoxic chest movement
b. Complaint of chest wall pain
c. Heart rate of 110 beats/minute
d. Large bruised area on the chest

Answer 22

a. Paradoxic chest movement

Question 23

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?

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

Answer 23

d. Insertion of a chest tube with a chest drainage system

Question 24

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. 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.

Answer 24

c. Take no further action with the collection device.

Question 25

The nurse provides preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung. Which information should the nurse include about the patient’s postoperative care? a. Positioning on the right side b. Bed rest for the first 24 hours c. Frequent use of an incentive spirometer d. Chest tube placement with continuous drainage

Answer 25

c. Frequent use of an incentive spirometer

Question 26

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? 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.

Answer 26

a. Observe for distended neck veins

Question 27

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? 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.

Answer 27

b. Patient reports decreased exertional dyspnea.

Question 28

A patient with a pleural effusion is scheduled for a thoracentesis. Which action should the nurse take to prepare the patient for the procedure? a. Start a peripheral IV line to administer the necessary sedative drugs. b. Position the patient sitting upright on the edge of the bed and leaning forward. c. Obtain a large collection device to hold 2 to 3 liters of pleural fluid at one time. d. Remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.

Answer 28

b. Position the patient sitting upright on the edge of the bed and leaning forward.

Question 29

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. “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.”

Answer 29

d. “I will call the health care provider right away if I develop a fever.”

Question 30

A patient has just been admitted with probable bacterial pneumonia and sepsis. Which order should the nurse implement first? a. Chest x-ray via stretcher b. Blood cultures from two sites c. Ciprofloxacin (Cipro) 400 mg IV d. Acetaminophen (Tylenol) rectal suppository

Answer 30

b. Blood cultures from two sites

Question 31

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? 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.

Answer 31

a. Oxygen saturation is 88%.

Question 32

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. Codeine b. Guaifenesin (Robitussin) c. Acetaminophen (Tylenol) d. Piperacillin/tazobactam (Zosyn)

Answer 32

d. Piperacillin/tazobactam (Zosyn)

Question 33

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? 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.

Answer 33

c. The patient is being treated with antiretrovirals for HIV infection.

Question 34

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? 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

Answer 34

d. Impaired gas exchange related to respiratory congestion

Question 35

The nurse supervises unlicensed assistive personnel (UAP) who are providing care for a patient with right lower lobe pneumonia. The nurse should intervene if which action by UAP is observed? a. UAP splint the patient’s chest during coughing. b. UAP assist the patient to ambulate to the bathroom. c. UAP help the patient to a bedside chair for meals. d. UAP lower the head of the patient’s bed to 15 degrees.

Answer 35

d. UAP lower the head of the patient’s bed to 15 degrees.

Question 36

A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/minute, blood pressure of 100/60 mmHg, and respirations of 42 breaths/minute. Which action should the nurse take first? a. Administer anticoagulant drug therapy. b. Notify the patient’s health care provider. c. Prepare patient for a spiral computed tomography (CT). d. Elevate the head of the bed to a semi-Fowler’s position.

Answer 36

d. Elevate the head of the bed to a semi-Fowler’s position.

Question 37

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

Answer 37

b. A 46-year-old patient on bed rest who is complaining of sudden onset of shortness of breath

Question 38

The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test? a. “Is there any family history of TB?” b. “How long have you lived in the United States?” c. “Do you take any over-the-counter (OTC) medications?” d. “Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?”

Answer 38

d. “Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?”

Question 39

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? 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.

Answer 39

b. Tape a nonporous dressing on three sides over the chest wound.

Question 40

The nurse notes that a patient has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which action should the nurse take first? a. Assist the patient to sit upright in a chair. b. Splint the patient’s chest during coughing. c. Medicate the patient with prescribed morphine. d. Observe the patient use the incentive spirometer.

Answer 40

c. Medicate the patient with prescribed morphine.

Question 41

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? 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.

Answer 41

c. The patient’s central IV line is disconnected.

Question 42

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? a. Auscultate breath sounds. b. Administer the PRN morphine. c. Have the patient cough forcefully. d. Notify the patient’s health care provider.

Answer 42

a. Auscultate breath sounds.

Question 43

A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic should the nurse plan to include in the teaching plan? a. Purpose of antibiotic therapy b. Ways to limit oral fluid intake c. Appropriate use of cough suppressants d. Safety concerns with home oxygen therapy

Answer 43

c. Appropriate use of cough suppressants

Question 44

Which action by the nurse will be most effective in decreasing the spread of pertussis in a community setting? a. Providing supportive care to patients diagnosed with pertussis b. Teaching family members about the need for careful hand washing c. Teaching patients about the need for adult pertussis immunizations d. Encouraging patients to complete the prescribed course of antibiotics

Answer 44

c. Teaching patients about the need for adult pertussis immunizations

Question 45

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? 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

Answer 45

b. Placing the patient on droplet precautions and in a private hospital room

Question 46

Which intervention will the nurse include in the plan of care for a patient who is diagnosed with a lung abscess? a. Teach the patient to avoid the use of over-the-counter expectorants. b. Assist the patient with chest physiotherapy and postural drainage. c. Notify the health care provider immediately about any bloody or foul-smelling sputum. d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

Answer 46

d. Teach about the need for prolonged antibiotic therapy after discharge from the hospital.

Question 47

The nurse provides discharge teaching for a patient who has two fractured ribs from an automobile accident. Which statement, if made by the patient, would indicate that teaching has been effective? a. “I am going to buy a rib binder to wear during the day.” b. “I can take shallow breaths to prevent my chest from hurting.” c. “I should plan on taking the pain pills only at bedtime so I can sleep.” d. “I will use the incentive spirometer every hour or two during the day.”

Answer 47

d. “I will use the incentive spirometer every hour or two during the day.”

Question 48

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)? 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.

Answer 48

a. Document the amount of drainage every eight hours.

Question 49

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

Answer 49

d. 64-year-old with lung cancer and tracheal deviation after subclavian catheter insertion