Lewis & Potter Review Questions

Question 1

A patient who started smoking in adolescence and continues to smoke 40 years later comes to the clinic. The nurse under- stands that this patient has an increased risk for being diagnosed with which disorder:

1. Alcoholism and hypertension
2. Obesity and diabetes
3. Stress-related illnesses
4. Cardiopulmonary disease and lung cancer

Answer 1

Answer: 4.
Effects of nicotine on blood vessels and lung tissue have been proven to increase pathological changes, leading to heart disease and lung cancer.

Question 2

. A patient has been diagnosed with severe iron deficiency anemia. During physical assessment for which of the following symptoms would the nurse assess to determine the patient’s oxygen status?

1. Increased breathlessness but increased activity tolerance
2. Decreased breathlessness and decreased activity tolerance
3. Increased activity tolerance and decreased breathlessness
4. decreased activity tolerance and increased breathlessness

Answer 2

Answer: 4.
Hypoxia occurs because of decreased circulating blood volume, which leads to decreased oxygen to muscles, causing fatigue, decreased activity tolerance, and a feeling of shortness of breath.

Question 3

A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient’s color is ruddy, not cyanotic, the nurse understands that the patient is at a risk for decreased oxygen-carrying capacity of blood because carbon monoxide does which of the following:

1. Stimulates hyperventilation, causing respiratory alkalosis
2. Forms a strong bond with hemoglobin, creating a functional anemia.
3. Stimulates hypoventilation, causing respiratory acidosis
4. Causes alveoli to overinflate, leading to atelectasis

Answer 3

Answer: 2.

Carbon monoxide strongly binds to hemoglobin, making it unavailable for oxygen binding and transport.

Question 4

A 6-year-old boy is admitted to the pediatric unit with chills and a fever of 104° F (40° C). What physiological process explains why the child is at risk for developing dyspnea?

1. Fever increases metabolic demands, requiring increased oxygen need.
2. Blood glucose stores are depleted, and the cells do not have energy to use oxygen.
3. Carbon dioxide production increases as result of hyperventilation.
4. Carbon dioxide production decreases as a result of hypoventilation.

Answer 4

Answer: 1.
When the body cannot meet the increased oxygenation need, the increased metabolic rate causes breakdown of protein and wasting of respiratory muscles, increasing the work of breathing.

Question 5

A patient is admitted with the diagnosis of severe left-sided heart failure. The nurse expects to auscultate which adventitious lung sounds?

1. Sonorous wheezes in the left lower lung
2. Rhonchi midsternum
3. Crackles only in apex of lungs
4. Inspiratory crackles in lung bases

Answer 5

Answer: 4.
Decreased effective contraction of left side of heart leads to back up of fluid in the lungs, increasing hydrostatic pressure and causing pulmonary edema, resulting in crackles in lung bases.

Question 6

The nurse is caring for a patient who has decreased mobility. Which intervention is a simple and cost-effective method for reducing the risks of stasis of pulmonary secretions and decreased chest wall expansion?

1. Antibiotics
2. Frequent change of position
3. Oxygen humidification
4. Chest physiotherapy

Answer 6

Answer: 2.
Movement not only mobilizes secretions but helps strengthen respiratory muscles by impacting the effectiveness of gas exchange processes.

Question 7

A patient is admitted with severe lobar pneumonia. Which of the following assessment findings would indicate that the patient needs airway suctioning?

1. Coughing up thick sputum only occasionally
2. Coughing up thin, watery sputum easily after nebulization
3. Decreased independent ability to cough
4. Lung sounds clear only after coughing

Answer 7

Answer: 3.
Impaired ability to cough up mucus caused by weakness or very thick secretions indicates a need for suctioning when you know the patient has pneumonia.

Question 8

A patient was admitted after a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/ symptoms of secondary pneumothorax, which includes which of the following?

1. Sharp pleuritic pain that worsens on inspiration
2. Crackles over lung bases of affected lung
3. Tracheal deviation toward the affected lung
4. Increased diaphragmatic excursion on side of rib fractures

Answer 8

Answer: 1.
When the lung collapses, the thoracic space fills with air on each inspiration, and the atmospheric air irritates the parietal pleura, causing pain.

Question 9

A patient has been newly diagnosed with emphysema. In dis- cussing his condition with the nurse, which of his statements would indicate a need for further education?

1. “I’ll make sure that I rest between activities so I don’t get so short of breath.”
2. “I’ll rest for 30 minutes before I eat my meal.”
3. “If I have trouble breathing at night, I’ll use two to three pillows to prop up.”
4. “If I get short of breath, I’ll turn up my oxygen level to 6 L/min.”

Answer 9

Answer: 4.
Hypoxia is the drive to breathe in a patient with chronic obstructive pulmonary disease who has become used to acidic pH and elevated CO2 levels. Turning up to 6 L/min increases the oxygen level, which turns off the drive to breathe.

Question 10

The nurse goes to assess a new patient and finds him lying supine in bed. The patient tells the nurse that he feels short of breath. Which nursing action should the nurse perform first?

1. Raise the head of the bed to 45 degrees.
2. Take his oxygen saturation with a pulse oximeter.
3. Take his blood pressure and respiratory rate.
4. Notify the health care provider of his shortness of breath.

Answer 10

Answer: 1.

Raising the head of the bed brings the diaphragm down and allows for better chest expansion, thus improving ventilation.

Question 11

The nurse is caring for a patient who exhibits labored breathing and uses accessory muscles. The patient has crackles in both lung bases and diminished breath sounds. Which would be priority assessments for the nurse to perform? (Select all that apply.)

1. SpO2 levels
2. Amount of sputum production
3. Change in respiratory rate and pattern
4. Pain in lower calf area

Answer 11

Answer: 1, 2, 3.

Answer 4 indicates vascular, not respiratory, status.

Question 12

Which of the following statements made by a student nurse indicates the need for further teaching about suctioning a patient with an endotracheal tube?

1. “Suctioning the patient requires sterile technique.”
2. “I’ll apply suction while rotating and withdrawing the suction catheter.”
3. “I’ll suction the mouth after I suction the endotracheal tube.”
4. “I’ll instill 5 mL of normal saline into the tube before hyper oxygenating the patient.”

Answer 12

Answer: 4.

Saline has been found to cause more side effects when suctioning and does not increase the amount of secretions removed.

Question 13

Two hours after surgery the nurse assesses a patient who had a chest tube inserted during surgery. There is 200 mL of dark-red drainage in the chest tube at this time. What is the appropriate action for the nurse to perform?

1. Record the amount and continue to monitor drainage
2. Notify the health care provider
3. Strip the chest tube starting at the chest
4. Increase the suction by 10 mm Hg

Answer 13

Answer: 1.
Dark-red drainage after surgery (50 to 200 mL per hour in first 3 hours) is expected, but be aware of sudden increases greater than 100 mL per hour after the first 3 hours, especially if it becomes bright red in color.

Question 14

Which nursing intervention is appropriate for preventing atelectasis in the postoperative patient?

1. Postural drainage
2. Chest percussion
3. Incentive spirometer
4. Suctioning

Answer 14

Answer: 3.
An incentive spirometer is used to encourage deep breathing to inflate alveoli and open pores of Kohn. The rest are used to treat atelectasis and increased mucus production.

Question 15

15. The nurse needs to apply oxygen to a patient who has a precise oxygen level prescribed. Which of the following oxygen- delivery systems should the nurse select to administer the oxygen to the patient?
16. Nasal cannula
17. Venturi mask
18. Simple face mask without inflated reservoir bag
19. Plastic face mask with inflated reservoir bag

Answer 15

Answer: 1.

A nasal cannula delivers precise, high-flow rates of oxygen.

Question 16

A patient who is comatose is admitted to the hospital with an unknown history. Respirations are deep and rapid. Arterial blood gas levels on admission are pH, 7.20; PaCO2, 21 mm Hg; PaO2, 92 mm Hg; and HCO3−, 8. You interpret these laboratory values to indicate: 1. Metabolic acidosis

2. Metabolic alkalosis
3. Respiratory acidosis
4. Respiratory alkalosis

Answer 16

Answer: 1.
The low pH indicates acidosis. The low PaCO2 is caused by the hyperventilation, either from primary respiratory alkalosis (not compatible with the measured pH) or as a compensation for metabolic acidosis. The low HCO3− indicates metabolic acidosis or compensation for respiratory alkalosis (again, not compatible with the measured pH). Thus metabolic acidosis is the correct interpretation.

Question 17

A patient with a cardiac history is taking the diuretic furosemide (Lasix) and is seen in the emergency department for muscle weakness. Which laboratory value do you assess first?

1. Serum albumin
2. Serum sodium
3. Hematocrit
4. Serum potassium

Answer 17

Answer: 4.
Potassium-wasting diuretics such as furosemide increase potassium urinary output and can cause hypokalemia unless potassium intake also increases. Hypokalemia causes muscle weakness.

Question 18

Which of these patients do you expect will need teaching regarding dietary sodium restriction?

1. An 88-year-old with a fractured femur scheduled for surgery
2. A 65-year-old recently diagnosed with heart failure
3. A 50-year-old recently diagnosed with asthma and diabetes
4. A 20-year-old with vomiting and diarrhea from gastroenteritis

Answer 18

Answer: 2.
Heart failure commonly causes extracellular fluid volume (ECV) excess because diminished cardiac output reduces kidney perfusion and activates the renin-angiotensin-aldosterone system, causing the kidneys to retain Na+ and water. Dietary sodium restriction is important with heart failure because Na+ holds water in the extracellular fluid, making the ECV excess worse.

Question 19

You teach patients to replace sweat, vomiting, or diarrhea fluid losses with which type of fluid?

1. Tap water or bottled water
2. Fluid that has sodium (salt) in it
3. Fluid that has K+ and HCO3− in it
4. Coffee or tea, whichever they prefer

Answer 19

Answer: 2.
Body fluid losses remove sodium-containing fluid from the body and can cause extracellular fluid volume deficit unless both the sodium and the water are replaced.

Question 20

You assess four patients. Which patient is at greatest risk for the development of hypocalcemia?

1. 56-year-old with acute kidney renal failure
2. 40-year-old with appendicitis
3. 28-year-old who has acute pancreatitis
4. 65-year-old with hypertension and asthma

Answer 20

Answer: 3.
People who have acute pancreatitis frequently develop hypocalcemia because calcium binds to undigested fat in their feces and is excreted. This is called steatorrhea. This process decreases absorption of dietary calcium and also increases calcium output by preventing resorption of calcium contained in gastrointestinal fluids.

Question 21

Which of the following activities can you delegate to nursing assistive personnel (NAP)? (Select all that apply.)

1. Measuring oral intake and urine output
2. Preparing intravenous (IV) tubing for routine change
3. Reporting an IV container that is low in fluid
4. Changing an IV fluid container

Answer 21

Answer: 1, 3.

The registered nurse cannot delegate working with IV tubing or changing an IV infusion to NAP.

Question 22

Place the following steps for intravenous (IV) catheter insertion in the correct order:

1. Perform hand hygiene.
2. Open and prepare infusion set.
3. Select appropriate vein and insert catheter.
4. Use two identifiers to ensure correct patient.
5. Assess for risk factors such as age or platelet count.
6. Carefully check the health care provider’s order for the IV therapy.

Answer 22

Answer: 6, 5, 4, 1, 2, 3.

See Skill 41-1.

Question 23

Assessment findings consistent with intravenous (IV) fluid infiltration include: (Select all that apply.)

1. Edema and pain
2. Streak formation
3. Pain and erythema
4. Pallor and coolness
5. Numbness and pain

Answer 23

Answer: 1, 4.
Inadvertent fluid leakage into the interstitial compartment around an IV site can cause swelling, pain from the pressure, pale color, and coolness of the infiltrated area.

Question 24

Which of the following defining characteristics is consistent with fluid volume deficit?

1. A 1-lb (0.5 kg) weight loss, pale yellow urine
2. Engorged neck veins when upright, bradycardia
3. Dry mucous membranes, thready pulse, tachycardia
4. Bounding radial pulse, flat neck veins when supine

Answer 24

Answer: 3.
The nursing diagnosis fluid volume deficit includes extracellular fluid volume (ECV) deficit, hypernatremia, and clinical dehydration. ECV deficit is characterized by dry mucous membranes, thready pulse, and tachycardia, among other indicators. Weight loss of 1 lb (0.5 kg) in 1 week could indicate fat loss instead of fluid loss. ECV deficit causes dark yellow urine rather than pale yellow, which is normal.

Question 25

Which of the following assessments do you perform routinely when an older adult patient is receiving intravenous 0.9% NaCl? 1. Auscultate dependent portions of lungs 2. Check color of urine 3. Assess muscle strength 4. Check skin turgor over sternum or shin

Answer 25

Answer: 1. Excessive or too-rapid infusion of 0.9% NaCl (normal saline) causes extracellular fluid volume (ECV) excess with pulmonary vessel congestion and potential pulmonary edema, especially in older adults, who cannot adapt as rapidly to increased vascular volume. Overload of intravenous normal saline eventually increases urine volume if kidneys are functioning but may not change urine color. Assessment of muscle strength is appropriate for potassium imbalances, not ECV imbalances. Skin turgor is not a reliable assessment of ECV deficit in older adults.

Question 26

While receiving a blood transfusion, your patient develops chills, tachycardia, and flushing. What is your priority action? 1. Notify a health care provider 2. Insert an indwelling catheter 3. Alert the blood bank 4. Stop the transfusion

Answer 26

Answer: 4. Development of chills, tachycardia, and flushing during a blood transfusion is an indication of an acute hemolytic reaction. You stop the transfusion immediately so no more of the incompatible blood reaches the patient.

Question 27

The health care provider’s order is 1000 mL 0.9% NaCl with 20 mEq K+ intravenously over 8 hours. Which assessment finding causes you to clarify the order with the health care provider before hanging this fluid? 1. Flat neck veins 2. Tachycardia 3. Hypotension 4. Oliguria

Answer 27

Answer: 4. | Administration of KCl (increased K+ intake) to a person who has oliguria (decreased K+ output) can cause hyperkalemia.

Question 28

Your patient who has diabetic ketoacidosis is breathing rapidly and deeply. Intravenous (IV) fluids and other treatments have just been started. What should you do about this patient’s breathing? 1. Notify her health care provider that she is hyperventilating 2. Provide frequent oral care to keep her mucous membranes moist 3. Ask her to breathe slower and help her to calm down and relax 4. Assess her for pain and request an order for a sedative

Answer 28

Answer: 2. Hyperventilation is a compensatory mechanism for metabolic acidosis and should be allowed to continue. Rapid breathing can make oral mucous membranes dry and cracked.

Question 29

Your patient had 200 mL of ice chips and 900 mL intravenous (IV) fluid during your shift. Which total intake should you record? 1. 700 mL 2. 900 mL 3. 1000 mL 4. 1100 mL

Answer 29

Answer: 3. | Add one half the volume of ice chips to other intake to calculate total intake.

Question 30

The health care provider’s order is 1000 mL 0.9% NaCl IV over 6 hours. Which rate do you program into the infusion pump? 1. 125 mL/hr 2. 167 mL/hr 3. 200 mL/hr 4. 1000 mL/hr

Answer 30

Answer: 2. 1000 mL divided by 6 hours is 166.7 mL/hr, which rounds to 167 mL/hr (if infusion pump accepts decimals, program it to 166.7 mL/hr).

Question 31

``` Pain is best described as: [L 9] a creation of a person’s imagination. b. an unpleasant, subjective experience c. a maladaptive response to a stimulus. d. a neurologic event resulting from activation of nociceptors. ```

Answer 31

Correct answer: b Rationale: The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Question 32

. A patient is receiving a PCA infusion after surgery to repair a hip fracture. She is sleeping soundly but awakens when the nurse speaks to her in a normal tone of voice. Her respirations are 8 breaths/minute. The most appropriate nursing action in this situation is to: [L9] a. stop the PCA infusion. b. obtain an oxygen saturation level. c. continue to closely monitor the patient. d. administer naloxone and contact the physician

Answer 32

Correct answer: c Rationale: Close monitoring is indicated for this patient with a sedation score of 3 and a respiratory rate of 8 breaths/minute. If the respiration rate falls below 8 breaths/minute and the sedation level is 5 or greater, the nurse should vigorously stimulate the patient and try to keep the patient awake.

Question 33

Which words are most likely to be used to describe neuropathic pain (select all that apply)? [L9] a. Dull b. Mild c. Burning d. Shooting e. Shock-like

Answer 33

Correct answers: c, d, e Rationale: Neuropathic pain is caused by damage to peripheral nerves or structures in the central nervous system (CNS). Typically described as numbing, hot or burning, shooting, stabbing, sharp, or electric shock–like in nature, neuropathic pain can be sudden, intense, shortlived, or lingering.

Question 34

Unrelieved pain is: [9] a. expected after major surgery. b. expected in a person with cancer. c. dangerous and can lead to many physical and psychologic complications. d. an annoying sensation, but it is not as important as other physical care needs.

Answer 34

Correct answer: c Rationale: Consequences of untreated pain include unnecessary suffering, physical and psychosocial dysfunction, impaired recovery from acute illness and surgery, immunosuppression, and sleep disturbances. In the acutely ill patient, unrelieved pain can result in increased morbidity as a result of respiratory dysfunction, increased heart rate and cardiac workload, increased muscular contraction and spasm, decreased gastrointestinal motility and transit, and increased breakdown of body energy stores (i.e., catabolism).

Question 35

A cancer patient who reports ongoing, constant moderate pain with short periods of severe pain during dressing changes is: [L9] a. probably exaggerating his pain. b. best treated by referral for surgical treatment of his pain. c. best treated by receiving both a long-acting and a short-acting opioid. d. best treated by regularly scheduled short-acting opioids plus acetaminophen.

Answer 35

Correct answer: c Rationale: Moderate to severe pain usually necessitates an opioid analgesic. Constant, moderate pain is treated with a long-acting opioid; procedural severe pain is treated with a short-acting opioid.

Question 36

An example of distraction to provide pain relief is: [L9] a. TENS. b. music. c. exercise. d. biofeedback.

Answer 36

Correct answer: b Rationale: Distraction involves redirection of attention away from the pain and to something else. Distraction can be achieved by engaging the patient in any activity that can hold his or her attention (e.g., watching TV or a movie, conversing, listening to music, playing a game).

Question 37

Appropriate nonopioid analgesics for mild pain include (select all that apply) [L9] a. oxycodone. b. ibuprofen (Advil). c. lorazepam (Ativan). d. acetaminophen (Tylenol). e. codeine with acetaminophen (Tylenol #3).

Answer 37

Correct answers: b, d Rationale: Nonopioid analgesics include acetaminophen, aspirin and other salicylates, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Question 38

An important nursing responsibility related to pain is to: [L9] a. leave the patient alone to rest. b. help the patient appear to not be in pain. c. believe what the patient says about the pain. d. assume responsibility for eliminating the patient’s pain.

Answer 38

Correct answer: c Rationale: Pain is a subjective experience, and patients need to feel confident that the nurse will believe their reports of pain.

Question 39

Providing opioids to a dying patient who is experiencing moderate to severe pain: [L9] a. may cause addiction. b. will probably be ineffective. c. is an appropriate nursing action. d. will likely hasten the person’s death.

Answer 39

Correct answer: c Rationale: Opioid therapy is an appropriate intervention for moderate to severe pain experienced by a dying patient, and the drugs may be titrated upward many times over the course of therapy to maintain adequate pain control.

Question 40

A nurse believes that patients with the same type of tissue injury should have the same amount of pain. This statement reflects: [L9] a belief that will contribute to appropriate pain management. b. an accurate statement about pain mechanisms and an expected goal of pain therapy. c. a belief that will have no effect on the type of care provided to people in pain. d. a lack of knowledge about pain mechanisms, which is likely to contribute to poor pain management

Answer 40

Correct answer: d Rationale: Genetic makeup and variability among individuals affects the plasticity of the central nervous system; this phenomenon helps explain individual differences in responses to pain. Poor knowledge of pain mechanisms often leads to poor pain management.

Question 41

During the postoperative care of a 76-year-old patient, the nurse monitors the patient’s intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because: [L17] a. older adults have an impaired thirst mechanism and need reminding to drink fluids. b. water accounts for a greater percentage of body weight in the older adult than in younger adults. c. older adults are more likely than younger adults to lose extra-cellular fluid during surgical procedures. d. small losses of fluid are more significant because body fluids account for only about 50% of body weight in older adults

Answer 41

Correct answer: d | Rationale: In the older adult, body water content averages 45% to 55% of body weight.

Question 42

During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is: [L17] a. osmosis. b. diffusion. c. active transport. d. facilitated diffusion.

Answer 42

. Correct answer: a Rationale: Osmosis is the movement of water between two compartments separated by a semipermeable membrane. Water moves through the membrane from an area of low solute concentration to an area of high solute concentration

Question 43

An older woman was admitted to the medical unit with dehydration. Clinical indications of this problem are (select all that apply) [L17] a. weight loss. b. dry oral mucosa. c. full bounding pulse. d. engorged neck veins. e. decreased central venous pressure.

Answer 43

Correct answers: a, b, e Rationale: Body weight loss, especially sudden change, is an excellent indicator of overall fluid volume loss. Other clinical manifestations of dehydration include dry mucous membranes and a decreased central venous pressure, which reflect fluid volume loss.

Question 44

The nursing care for a patient with hyponatremia includes: [L17] a. fluid restriction. b. administration of hypotonic IV fluids. c. administration of a cation-exchange resin. d. increased water intake for patients on nasogastric suction

Answer 44

Correct answer: a Rationale: In hyponatremia that is caused by water excess, fluid restriction often is all that is needed to treat the problem.

Question 45

The nurse should be alert for which manifestations in a patient receiving a loop diuretic? [L17] a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms

Answer 45

Correct answer: c Rationale: Loop diuretics may result in renal loss of potassium (i.e., hypokalemia). Clinical manifestations of hypokalemia include fatigue, muscle weakness, leg cramps, nausea, vomiting, paralytic ileus, soft, muscle flab, paresthesias, decreased reflexes, weak, irregular pulse, polyuria, hyperglycemia, and electrocardiographic changes.

Question 46

Which patient would be at greatest risk for the potential development of hypermagnesemia? [L17] a. 83-year-old man with lung cancer and hypertension b. 65-year-old woman with hypertension taking β-adrenergic blockers c. 42-year-old woman with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection

Answer 46

Correct answer: c Rationale: Causes of hypermagnesemia include renal failure (especially if the patient is given magnesium products), excessive administration of magnesium for treatment of eclampsia, and adrenal insufficiency

Question 47

It is especially important for the nurse to assess for which clinical manifestation(s) in a patient who has just undergone a total thyroidectomy (select all that apply)? [L17] a. Confusion b. Weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek’s sign

Answer 47

Correct answers: a, d, e Rationale: Inadvertent removal of a portion of or injury to the parathyroid glands during thyroid or neck surgery can result in a lack of parathyroid hormone, leading to hypocalcemia. A positive Chvostek sign, confusion, and circumoral numbness are manifestations of low serum calcium levels

Question 48

The nurse anticipates that treatment of the patient with hyperphosphatemia secondary to renal failure will include: [L17] a. fluid restriction. b. calcium supplements. c. loop diuretic therapy. d. magnesium supplements

Answer 48

Correct answer: b Rationale: The major conditions that can lead to hyperphosphatemia are acute kidney injury and chronic kidney disease that alter the ability of the kidneys to excrete phosphate. For the patient with renal failure, measures to reduce serum phosphate levels include calcium supplements, phosphate-binding agents or gels, fluid replacement therapy, and dietary phosphate restrictions.

Question 49

The lungs act as an acid-base buffer by: [L17] a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.

Answer 49

Correct answer: a Rationale: As a compensatory mechanism, the respiratory system acts on the CO2 + H2O side of the reaction by altering the rate and depth of breathing to “blow off” (through hyperventilation) or “retain” (through hypoventilation) CO2.

Question 50

A patient has the following arterial blood gas results: pH 7.52; PaCO2 30 mm Hg; HCO3− 24 mEq/L. The nurse determines that these results indicate: [L17] a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.

Answer 50

Correct answer: d Rationale: Respiratory alkalosis (carbonic acid deficit) occurs with hyperventilation. The primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders. Anxiety, central nervous system (CNS) disorders, and mechanical overventilation also increase ventilation rate and decrease the partial pressure of arterial carbon dioxide (PaCO2). This leads to a decrease in carbonic acid level and to alkalosis.

Question 51

The typical fluid replacement for the patient with a fluid volume deficit is: [L17] a. dextran. b. 0.45% saline. c. lactated Ringer’s. d. 5% dextrose in 0.45% saline

Answer 51

Correct answer: c Rationale: Administration of an isotonic solution expands only the extracellular fluid (ECF). There is no net loss or gain from the intracellular fluid (ICF). An isotonic solution is the ideal fluid replacement for a patient with an ECF volume deficit. Examples of isotonic solutions include lactated Ringer’s solution and 0.9% NaCl.

Question 52

The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to: [L17] a. apply warm moist compresses to the insertion site. b. attempt to force 10 mL of normal saline into the device. c. place the patient on the left side with head-down position. d. instruct the patient to change positions, raise arm, and cough

Answer 52

Correct answer: d Rationale: Interventions for catheter occlusion include instructing the patient to change position, raise an arm, and cough; assessing for and alleviating clamping or kinking of the tube; flushing the catheter with normal saline through a 10-mL syringe (do not force flush); using fluoroscopy to determine cause and site of occlusion; and instilling anticoagulant or thrombolytic agents.

Question 53

To promote the release of surfactant, the nurse encourages the patient to: [L26] a. take deep breaths. b. cough five times per hour to prevent alveolar collapse. c. decrease fluid intake to reduce fluid accumulation in the alveoli. d. sit with head of bed elevated to promote air movement through the pores of Kohn

Answer 53

Correct answer: a Rationale: Surfactant is a lipoprotein that lowers the surface tension in the alveoli. It reduces the amount of pressure needed to inflate the alveoli and decreases the tendency of the alveoli to collapse. Deep breaths stretch the alveoli and promote surfactant secretion.

Question 54

A patient with a respiratory condition asks “How does air get into my lungs?” The nurse bases her answer on her knowledge that air moves into the lungs because of: [L26] a. contraction of the accessory abdominal muscles. b. increased carbon dioxide and decreased oxygen in the blood. c. stimulation of the respiratory muscles by the chemoreceptors. d. decrease in intrathoracic pressure relative to pressure at the airway

Answer 54

Correct answer: d Rationale: During inspiration, the diaphragm contracts, increasing intrathoracic volume and pushing the abdominal contents downward. At the same time, the external intercostal muscles and scalene muscles contract, increasing the lateral and anteroposterior dimension of the chest. This causes the size of the thoracic cavity to increase and intrathoracic pressure to decrease, which enables air to enter the lungs.

Question 55

The nurse can best determine adequate arterial oxygenation of the blood by assessing: [L26] a. heart rate. b. hemoglobin level. c. arterial oxygen tension. d. arterial carbon dioxide tension.

Answer 55

Correct answer: c Rationale: The ability of the lungs to oxygenate arterial blood adequately is determined by examination of the partial pressure of oxygen in arterial blood (PaO2) and arterial oxygen saturation (SaO2).

Question 56

When teaching a patient about the most important respiratory defense mechanism distal to the respiratory bronchioles, which topic would the nurse discuss? [L26] a. Alveolar macrophages b. Impaction of particles c. Reflex bronchoconstriction d. Mucociliary clearance mechanism

Answer 56

Correct answer: a Rationale: Respiratory defense mechanisms are efficient in protecting the lungs from inhaled particles, microorganisms, and toxic gases. Because ciliated cells are not found below the level of the respiratory bronchioles, the primary defense mechanism at the alveolar level is alveolar macrophages.

Question 57

A student nurse asks the RN what can be measured by arterial blood gases (ABGs). The RN tells the student that the ABGs can measure (select all that apply) [L26] a. acid-base balance. b. oxygenation status. c. acidity of the blood. d. glucose bound to hemoglobin. e. bicarbonate (HCO3−) in arterial blood.

Answer 57

Correct answers: a, b, c, e Rationale: Arterial blood gases (ABGs) are measured to determine oxygenation status and acid-base balance. ABG analysis includes measurement of the PaO2, the partial pressure of carbon dioxide in arterial blood (PaCO2), acidity (pH), and bicarbonate (HCO3–) in arterial blood.

Question 58

To detect early signs or symptoms of inadequate oxygenation, the nurse would examine the patient for: [L26] a. dyspnea and hypotension. b. apprehension and restlessness. c. cyanosis and cool, clammy skin. d. increased urine output and diaphoresis.

Answer 58

Correct answer: b | Rationale: Early symptoms of inadequate oxygenation include unexplained restlessness, apprehension, and irritability.

Question 59

During the respiratory assessment of the older adult, the nurse would expect to find (select all that apply) [L26] a vigorous cough. b. increased chest expansion. c. increased residual volume. d. increased breath sounds in the lung apices. e. increased anteroposterior (AP) chest diameter

Answer 59

Correct answers: c, e Rationale: The anterior-posterior diameter of the thoracic cage and the residual volume increase in older adults. An older adult has a less forceful cough. The costal cartilages calcify with aging and interfere with chest expansion. Small airways in the lung bases close earlier during expiration. As a consequence, more inspired air is distributed to the lung apices, ventilation is less well matched to perfusion, and the PaO2 is lowered.

Question 60

When assessing activity-exercise patterns related to respiratory health, the nurse inquires about: [L26] a. dyspnea during rest or exercise. b. recent weight loss or weight gain. c. ability to sleep through the entire night. d. willingness to wear oxygen equipment in public.

Answer 60

Correct answer: a Rationale: In this functional health pattern, determine whether the patient’s activity is limited by dyspnea at rest or during exercise.

Question 61

When auscultating the chest of an older patient in respiratory distress, it is best to: [L26] a. begin listening at the apices. b. begin listening at the lung bases. c. begin listening on the anterior chest. d. ask the patient to breathe through the nose with the mouth closed.

Answer 61

. Correct answer: b Rationale: Normally, auscultation should proceed from the lung apices to the bases, so that opposite areas of the chest are compared. If the patient is likely to tire easily or has respiratory distress, start at the bases.

Question 62

Which assessment finding of the respiratory system does the nurse interpret as abnormal? [L26] a. Inspiratory chest expansion of 1 in b. Percussion resonance over the lung bases c. Symmetric chest expansion and contraction d. Bronchial breath sounds in the lower lung fields

Answer 62

Correct answer: d | Rationale: Bronchial or bronchovesicular sounds heard in the peripheral lung fields are abnormal breath sounds.

Question 63

The nurse is preparing the patient for a diagnostic procedure to remove pleural fluid for analysis. The nurse would prepare the patient for which test? [L26] a. Thoracentesis b. Bronchoscopy c. Pulmonary angiography d. Sputum culture and sensitivity

Answer 63

Correct answer: a Rationale: Thoracentesis is the insertion of a large-bore needle through the chest wall into the pleural space to obtain specimens for diagnostic evaluation, remove pleural fluid, or instill medication into the pleural space.

Question 64

A patient was seen in the clinic for an episode of epistaxis, which was controlled by placement of anterior nasal packing. During discharge teaching, the nurse instructs the patient to: [L27] a. use aspirin for pain relief. b. remove the packing later that day. c. skip the next dose of antihypertensive medication. d. avoid vigorous nose blowing and strenuous activity.

Answer 64

Correct answer: d Rationale: The nurse should teach the patient about home care before discharge: to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 to 6 weeks; to sneeze with the mouth open; and to avoid the use of aspirin-containing products or nonsteroidal anti-inflammatory drugs (NSAIDs).

Question 65

A patient with allergic rhinitis reports severe nasal congestion; sneezing; and watery, itchy eyes and nose at various times of the year. To teach the patient to control these symptoms, the nurse advises the patient to: [L27] a. avoid all intranasal sprays and oral antihistamines. b. limit the usage of nasal decongestant spray to 10 days. c. use oral decongestants at bedtime to prevent symptoms during the night. d. keep a diary of when the allergic reaction occurs and what precipitates it.

Answer 65

Correct answer: d Rationale: An important intervention involves identifying and avoiding triggers of allergic reactions. The nurse should instruct the patient to keep a diary of times when the allergic reaction occurs and of the activities that precipitate the reaction. To prevent rebound nasal congestion, decongestant sprays should not be used for more than 3 days.

Question 66

A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudate, and headache. The nurse anticipates that the collaborative management will include (select all that apply) [L27] a. antiviral agents to treat influenza. b. treatment with antibiotics starting ASAP . c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible etiology.

Answer 66

Correct answers: c, d, e Rationale: The goals of nursing management are infection control, symptom relief, and prevention of secondary complications. Medications are not prescribed until the etiology is known. Unnecessary use of antibiotics leads to the development of antibiotic-resistant organisms. A thorough history and a throat culture help identify the cause. The nurse should encourage the patient with pharyngitis to increase fluid intake. Cool, bland liquids and gelatin do not irritate the pharynx; citrus juices are often irritating.

Question 67

The best method for determining the risk of aspiration in a patient with a tracheostomy is to: [L27] a. consult a speech therapist for swallowing assessment. b. have the patient drink plain water and assess for coughing. c. assess for change of sputum color 48 hours after patient drinks small amount of blue dye. d. suction above the cuff after the patient eats or drinks to determine presence of food in trachea.

Answer 67

Correct answer: a Rationale: The ability to swallow secretions without aspiration has traditionally been evaluated with the use of blue dye. A teaspoon of water colored with blue dye is swallowed by the patient. Respiratory secretions are then monitored for 24 hours for appearance of the dye, which would indicate aspiration. Recent studies, however, do not support the sensitivity of this test. It is therefore no longer recommended. Instead, clinical assessment by a speech therapist, video fluoroscopy, or fiberoptic endoscopic evaluations of swallow are recommended. Patients should begin swallowing with thickened liquids, not plain water. Ability to swallow should be assessed with the cuff deflated, inasmuch as cuff inflation may interfere with swallowing ability.

Question 68

Which nursing action would be of highest priority when suctioning a patient with a tracheostomy? [L27] a. Auscultating lung sounds after suctioning is complete b. Providing a means of communication for the patient during the procedure c. Assessing the patient’s oxygenation saturation before, during, and after suctioning d. Administering pain and/or anti-anxiety medication 30 minutes before suctioning

Answer 68

Correct answer: c Rationale: A patient with a tracheostomy is at risk for hypoxemia after suctioning. Therefore, it is imperative to monitor the patient’s oxygen status before, during, and after suctioning. Remember the protocol for airway, breathing, and circulation (ABCs) when prioritizing.

Question 69

When planning health care teaching to prevent or detect early head and neck cancer, which people would be the priority to target (select all that apply)? [L27] a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 78-year-old woman who has been drinking hard liquor since her husband died 15 years ago d. 21-year-old college student who drinks beer on weekends with his fraternity brothers e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix

Answer 69

Correct answers: a, b, c, e Rationale: Eighty-five percent of head and neck cancers are caused by tobacco use. Excessive alcohol consumption is also a major risk factor. Head and neck cancers in people younger than 50 years of age have been associated with human papillomavirus (HPV) infection. Sun exposure, especially to the oral cavity, is also a risk factor.

Question 70

While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? [L27] a. Notify the physician immediately. b. Place the patient in the prone position to facilitate drainage. c. Instill 3 mL of normal saline into the tracheostomy tube to loosen secretions. d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds

Answer 70

Correct answer: d Rationale: Immediately after surgery, the patient with a laryngectomy requires frequent suctioning by means of the laryngectomy tube. Secretions typically change in amount and consistency over time. Secretions may initially be copious and blood-tinged secretions and then diminish and thicken. Normal saline bolus through the tracheostomy tube is not recommended to assist with removal of thickened secretions because it causes hypoxia and damage to the epithelial cells.

Question 71

When using a prosthesis for transesophageal speech, the patient: [L27] a. places a vibrating device in the mouth. b. blocks the stoma entrance with a finger. c. swallows air using a Valsalva maneuver. d. places a speaking valve next to the stoma.

Answer 71

Correct answer: b Rationale: To use a prosthesis for transesophageal speech, the patient manually blocks the stoma with a finger. Air moves from the lungs through the prosthesis, into the esophagus, and out the mouth. Speech is produced by the air vibrating against the esophagus and is formed into words by movement of the tongue and lips.

Question 72

When caring for a patient with acute bronchitis, the nurse will prioritize: [L28] a. auscultating lung sounds. b. encouraging fluid restriction. c. administering antibiotic therapy. d. teaching the patient to avoid cough suppressants.

Answer 72

Correct answer: a Rationale: Assessment of lung sounds is a priority nursing intervention for patients with bronchitis. Evidence of consolidation would indicate progression of bronchitis to pneumonia, which would necessitate a change in treatment. Fluid intake and use of cough suppressants should be encouraged. Antibiotic treatment is generally not indicated.

Question 73

For which patients with pneumonia would the nurse suspect aspiration as the likely cause of pneumonia (select all that apply)? [L28] a. Patient with seizures b. Patient with head injury c. Patient who had thoracic surgery d. Patient who had a myocardial infarction e. Patient who is receiving nasogastric tube feedings

Answer 73

Correct answers: a, b, e Rationale: Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., as a result of seizure, anesthesia, head injury, stroke, or alcohol intake), difficulty swallowing, and nasogastric intubation with or without tube feeding.

Question 74

An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to: [L28] a. perform postural drainage every hour. b. provide analgesics as ordered to promote patient comfort. c. administer O2 as prescribed to maintain optimal oxygen levels. d. teach the patient how to cough effectively to bring secretions to the mouth.

Answer 74

Correct answer: d Rationale: A forced expiratory technique (i.e., huff coughing) clears secretions with less change in pleural pressure and less likelihood of bronchial collapse. Before the patient attempts coughing, the nurse should ensure the patient is breathing deeply from the diaphragm. The nurse should place hands on the patient’s lower lateral chest wall and then ask the patient to breathe deeply through the nose. The nurse’s hands should move outward, which represents a breath from the diaphragm.

Question 75

A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? [L28] a. Expect routine TST to evaluate infection. b. Visitors will not be allowed while in airborne isolation. c. Take all medications for full length of time to prevent multidrug-resistant TB. d. Wear a standard isolation mask if leaving the airborne infection isolation room. e. Maintain precautions in airborne infection isolation room by coughing into a paper tissue.

Answer 75

Correct answers: c, d, e Rationale: To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for 2 to 6 months or longer. If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Teach patients to cover the nose and mouth with paper tissue every time they cough, sneeze, or produce sputum. If a person has a positive reaction to the tuberculin skin test, he or she need not be tested again because the sensitivity to tuberculin persists throughout life. Nurses and visitors must wear high-efficiency particulate air (HEPA) masks when entering the patient’s room.

Question 76

A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment secondary to a traumatic injury and infection. The nurse plans care for the patient knowing that the patient is most susceptible to: [L28] a. candidiasis. b. aspergillosis. c. histoplasmosis. d. coccidioidomycosis.

Answer 76

Correct answer: a Rationale: Pulmonary fungal infections occur most commonly in seriously ill patients being treated with corticosteroids, antineoplastic, and immunosuppressive drugs or with multiple antibiotics and in patients with human immunodeficiency virus (HIV) infection and cystic fibrosis. Candida albicans is the leading cause of fungal infections.

Question 77

When caring for a patient with a lung abscess, what is the nurse’s priority intervention? [L28] a. Postural drainage b. Antibiotic administration c. Obtaining a sputum specimen d. Patient teaching regarding home care

Answer 77

Correct answer: b Rationale: IV antibiotic therapy should be started as soon as possible. Postural drainage is not recommended because it may cause spillage of infection into other bronchi. Findings in a sputum specimen are not diagnostic for a lung abscess. Patient teaching regarding home care is important but not the priority.

Question 78

The emergency department nurse is caring for patients exposed to a chlorine leak from a local factory. The nurse would closely monitor these patients for: [L28] a. pulmonary edema. b. anaphylactic shock. c. respiratory alkalosis. d. acute tubular necrosis.

Answer 78

Correct answer: a Rationale: Chemical pneumonitis results from exposure to toxic chemical fumes. In the acute scenario, lung injury is diffuse and characterized as pulmonary edema.

Question 79

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will: [L28] a. call the health care provider to question the order. b. administer both vaccines at the same time in different arms. c. administer the flu shot and tell the patient to come back 1 week later to receive the pneumococcal vaccine. d. administer the pneumococcal vaccine and suggest FluMist (nasal vaccine) instead of the influenza injection

Answer 79

Correct answer: b Rationale: Patients at risk for pneumonia (e.g., patients with lung cancer) should obtain influenza and pneumococcal vaccines. The vaccines may be administered at the same time in different arms.

Question 80

The nurse identifies a flail chest in a trauma patient when: [L28] a. multiple rib fractures are determined by x-ray. b. a tracheal deviation to the unaffected side is present. c. paradoxic chest movement occurs during respiration. d. there is decreased movement of the involved chest wall.

Answer 80

Correct answer: c Rationale: Flail chest produces paradoxic respiration. On inspiration, the flail section sinks in, with a mediastinal shift to the uninjured side. On expiration, the flail section bulges outward, with a mediastinal shift to the injured side.

Question 81

The nurse notes tidaling of the water level in the tube submerged in the water-seal chamber in a patient with closed chest tube drainage. The nurse should: [L28] a. continue to monitor the patient. b. check all connections for a leak in the system. c. lower the drainage collector further from the chest. d. clamp the tubing at progressively distal points away from the patient until the tidaling stops.

Answer 81

Correct answer: a Rationale: Tidaling is a normal fluctuation of the water in the water-seal chamber of a chest tube. Tidaling reflects the intrapleural pressure during inspiration and expiration.

Question 82

An appropriate nursing intervention for a patient post-pneumonectomy is: [L28] a. monitoring chest tube drainage and functioning. b. positioning the patient on the unaffected side or back. c. doing range-of-motion exercises on the affected upper limb. d. auscultating frequently for lung sounds on the affected side.

Answer 82

Correct answer: c Rationale: Teach a patient who has had a pneumonectomy (i.e., removal of one whole lung) to perform range-of-motion exercises on the surgical side that are similar to those for patients who have undergone mastectomy. The patient will not have chest tube drainage, should not be positioned on the unoperative tube, and will not have lung sounds on the operative side because the entire lung has been removed.

Question 83

A priority nursing intervention for a patient who has just under-gone a chemical pleurodesis for recurrent pleural effusion is: [L28] a. administering ordered analgesia. b. monitoring chest tube drainage. c. sending pleural fluid for laboratory analysis. d. monitoring the patient’s level of consciousness.

Answer 83

Correct answer: a Rationale: Chemical pleurodesis involves the instillation of a chemical slurry after the pleural effusion is drained. The chest tubes are clamped while the patient is turned in different positions. Pain is common, and thus analgesic agents should be administered.

Question 84

When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes: [L28] a. maintaining the patient on bed rest. b. using sequential compression devices. c. encouraging the patient to cough and deep breathe. d. teaching the patient how to use the incentive spirometer.

Answer 84

Correct answer: b Rationale: Deep vein thrombosis (DVT) is the primary cause of pulmonary embolism. Preventing DVT with the use of sequential compression devices, early ambulation, and prophylactic use of anticoagulant medications would thus be a priority nursing intervention.

Question 85

Which statement(s) describe(s) the management of a patient following lung transplantation (select all that apply)? [L28] a. The lung is biopsied using a transtracheal method if rejection is suspected. b. High doses of oxygen are administered around the clock c. The use of a home spirometer will help to monitor lung function. d. Immunosuppressant therapy usually involves a three-drug regimen. e. Most patients experience an acute rejection episode in the first 3 days

Answer 85

Correct answers: a, c, d Rationale: Acute rejection after lung transplantation is common and can happen as soon as 5 to 7 days after surgery. Accurate diagnosis is achieved by transtracheal biopsy. Home spirometry has been useful in monitoring trends in lung function. Teach patients to keep medication logs, documentation of laboratory results, and spirometry records. Immunosuppressive therapy usually includes a three-drug regimen of cyclosporine or tacrolimus, mycophenolate mofetil (CellCept), and prednisone.

Question 86

A patient is concerned that he may have asthma. Of the symptoms that he relates to the nurse, which ones suggest asthma or risk factors for asthma (select all that apply)? [L29] a. Allergic rhinitis b. Prolonged inhalation c. History of skin allergies d. Cough, especially at night e. Gastric reflux or heartburn

Answer 86

Correct answers: a, c, d, e Rationale: Allergic rhinitis is a major predictor of adult asthma. Allergy skin testing may enable the clinician to determine sensitivity to specific allergens. However, a positive skin test result does not necessarily mean that the allergen is causing the asthma attack, and a negative allergy test result does not mean that the asthma is not allergy related. A radioallergosorbent test (RAST), which is a blood test, is sometimes used to identify allergic causes in certain patients who have negative skin test results and in those who should not be skin tested (e.g., patients with severe eczema). The chronic inflammation of asthma leads to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning. The exact mechanism by which gastroesophageal reflux disease (GERD) triggers asthma is unknown.

Question 87

In evaluating an asthmatic patient’s knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient says: [L29] a. “I use my corticosteroid inhaler when I feel short of breath.” b. “I get a flu shot every year and see my health care provider if I have an upper respiratory tract infection” c. “I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies” d. “I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath”

Answer 87

Correct answer: a Rationale: A rescue plan for patients with asthma includes taking two to four puffs of a short-acting bronchodilator every 20 minutes three times to obtain rapid control of symptoms. Corticosteroids cannot abort an acute asthma attack.

Question 88

A plan of care for the patient with COPD could include (select all that apply) [L29] a. exercise such as walking. b. high flow rate of O2 administration. c. low-dose chronic oral corticosteroid therapy. d. use of peak flow meter to monitor the progression of COPD. e. breathing exercises such as pursed-lip breathing that focus on exhalation.

Answer 88

Correct answers: a, e Rationale: Breathing exercises may assist the patient during rest and activity (e.g., lifting, walking, stair climbing) by decreasing dyspnea, improving oxygenation, and slowing the respiratory rate. The main type of breathing exercise commonly taught is pursed-lip breathing. Walking or other endurance exercises (e.g., cycling) combined with strength training is probably the best intervention to strengthen muscles and improve the endurance of a patient with chronic obstructive pulmonary disease (COPD).

Question 89

The effects of cigarette smoking on the respiratory system include: [L29] a. hypertrophy of capillaries causing hemoptysis. b. hyperplasia of goblet cells and increased production of mucus. c. increased proliferation of cilia and decreased clearance of mucus. d. proliferation of alveolar macrophages to decrease the risk for infection.

Answer 89

Correct answer: b Rationale: The irritating effect of the smoke causes hyperplasia of cells, including goblet cells, which results in increased production of mucus. Smoking reduces the ciliary activity and may cause actual loss of cilia.

Question 90

The major advantage of a Venturi mask is that it can: [L29] a. deliver up to 80% O2. b. provide continuous 100% humidity. c. deliver a precise concentration of O2. d. be used while a patient eats and sleeps.

Answer 90

Correct answer: c Rationale: The Venturi mask is a high-flow device that delivers fixed concentrations of oxygen (e.g., 24% or 28%, independent of the patient’s respiratory pattern).

Question 91

Which guideline would be a part of teaching patients how to use a metered-dose inhaler (MDI)? [L29] a. After activating the MDI, breathe in as quickly as you can. b. Estimate the amount of remaining medicine in the MDI by floating the canister in water. c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week. d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day.

Answer 91

Correct answer: d Rationale: The patient needs to know the correct way to determine if the metered-dose inhaler (MDI) is empty (see Fig. 29-6). The patient should divide the total number of puffs in the canister by the puffs needed per day.

Question 92

Which treatments in CF would the nurse expect to implement in the management plan of patients with CF (select all that apply)? [L29] a. Sperm banking b. IV corticosteroids on a chronic basis c. Airway clearance techniques (e.g., Acapella) d. GoLYTELY given PRN for severe constipation e. Inhaled tobramycin to combat Pseudomonas infection

Answer 92

Correct answers: a, c, d, e Rationale: Nearly all men with cystic fibrosis (CF) have congenital absence of the vas deferens, which transports the sperm from the storage in the testes to the penile urethra. However, sperm may be made normally, and with assisted reproductive technology, they are able to father children. Airway clearance techniques include chest physiotherapy, positive expiratory pressure devices (e.g., Flutter device [eFig. 29-2], Acapella [see Fig. 29-15]), breathing exercises, and high-frequency chest wall oscillation systems. Severe constipation can be treated with ingestion of a balanced polyethylene glycol (PEG) electrolyte solution (MiraLax, Go-LYTELY), which is used to thin bowel contents. Inhaled tobramycin is effective in patients with CF who have Pseudomonas aeruginosa infections.

Question 93

A patient who has bronchiectasis asks the nurse, “What conditions would warrant a call to the clinic?” [L29] a. Blood clots in the sputum b. Sticky sputum on a hot day c. Increased shortness of breath after eating a large meal d. Production of large amounts of sputum on a daily basis

Answer 93

Correct answer: a Rationale: If hemoptysis occurs, patients should know when they should contact the health care provider. In some patients, a spot of blood is usual. The health care provider should give explicit instructions about when emergency contact is needed.