Valvular/Inflammatory/Respiratory
Because a client has mitral stenosis and is a prospective valve recipient, the nurse preoperatively assesses the client’s past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client?
A. Medication therapy
B. Diet modification
C. Activity restrictions
D. Dental care
What is A?
Preoperatively, anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. Post-op, all clients with mechanical valves and some with bioprostheses are maintained indefinitely on anticoagulation therapy. Adhering strictly to a dosage schedule and observing specific precautions are necessary to prevent hemorrhage or thromboembolism. Some clients are maintained on lifelong antibiotic prophylaxis to prevent recurrence from rheumatic fever. Episodic prophylaxis is required to prevent infective endocarditis after dental procedures or upper respiratory, GI, or GU surgery.
Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to:
A. Promote expectoration.
B. Suppress the cough.
C. Relax smooth muscles of the bronchial airway.
D. Prevent infection.
What is C?
Correct Answer: C. Relax smooth muscles of the bronchial airway.
Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. Theophylline causes non-selective inhibition of type III and type IV isoenzymes of phosphodiesterase, which leads to increased tissue cyclic adenosine monophosphate (cAMP) and cyclic 3?,5? guanosine monophosphate concentrations, resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS and cardiac stimulation.
Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?
A. To promote oxygen intake.
B. To strengthen the diaphragm.
C. To strengthen the intercostal muscles.
D. To promote carbon dioxide elimination.
Correct Answer: D. To promote carbon dioxide elimination.
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.
A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:
A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.
What is A?
This client’s serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau’s sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans’ sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar’s sign (softening of the uterine isthmus) and Goodell’s sign (cervical softening) are probable signs of pregnancy.
Insensible fluid losses include:
A. urine
B. gastric drainage
C. bleeding
D. perspiration
What is D?
Perspiration and the fluid lost via the lungs are termed insensible losses; normally, insensible losses equal about 1000 cc/day.
A 68-year-old woman is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation. Although the diagnosis was made during childhood, she did not have any symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the nice lady, the nurse would most likely learn that the client’s childhood health history included?
A. Chicken pox
B. poliomyelitis
C. Rheumatic fever
D. meningitis
What is C?
Most clients with mitral stenosis have a history of rheumatic fever or bacterial endocarditis.
A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?
A. Encouraging additional fluids for the next 24 hours
B. Ensuring the return of the gag reflex before offering foods or fluids
C. Administering atropine intravenously
D. Administering small doses of midazolam (Versed).
What is B?
Correct Answer: B. Ensuring the return of the gag reflex before offering foods or fluids
After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based on the clinician’s preference (e.g., benzodiazepines, opioids, dexmedetomidine).
Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?
A. Increased anteroposterior chest diameter.
B. Underdeveloped neck muscles.
C. Collapsed neck veins.
D. Increased chest excursions with respiration.
Correct Answer: A. Increased anteroposterior chest diameter.
Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. In addition, coarse crackles beginning with inspiration may be heard.
Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?
A. “Be sure to take glipizide 30 minutes before meals.”
B. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
C. “You won’t need to check your blood glucose level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent heartburn.”
What is A?
The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
When assessing a patient for signs of fluid overload, the nurse would expect to observe:
A. bounding pulse
B. flat neck veins
C. poor skin turgor
D. vesicular
What is A?
Bounding pulse is a sign of fluid overload as more volume in the vessels causes a stronger sensation against the blood vessel walls. Flat neck veins and vesicular breath sounds are normal findings. Poor skin turgor is consistent with dehydration.
Good dental care is an important measure in reducing the risk of endocarditis. A teaching plan to promote good dental care in a client with mitral stenosis should include a demonstration of the proper use of?
A. A manual toothbrush
B. An electric toothbrush
C. An irrigation device
D. Dental floss
What is A?
Daily dental care and frequent checkups by a dentist who is informed about the client’s condition are required to maintain good oral health. Use of an electric toothbrush, an irrigation device, or dental floss may cause gums to bleed and allow bacteria to enter mucous membranes and the bloodstream, increasing the risk of endocarditis.
A nurse is assessing a client with chronic airflow limitation and notes that the client has a “barrel chest.” The nurse interprets that this client has which of the following forms of chronic airflow limitation?
A. Chronic obstructive bronchitis
B. Emphysema
C. Bronchial asthma
D. Bronchial asthma and bronchitis
What is B?
Correct Answer: B. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as “barrel chest.” The client also has dyspnea with prolonged expiration and has hyper resonant lungs to percussion.
The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?
A. Clubbing of nail beds
B. Hypertension
C. Peripheral edema
D. Increased appetite
Correct Answer: C. Peripheral edema
Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling.
A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine would be most accurate in stating:
“The test needs to be repeated following a 12-hour fast.”
A. “It looks like you aren’t following the prescribed diabetic diet.”
B. “It tells us about your sugar control for the last 3 months.”
C. “Your insulin regimen needs to be altered significantly.”
“Your insulin regimen needs to be altered significantly"
What is C?
The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps identify trends or practices that impair glycemic control, and it doesn’t require a fasting period before blood is drawn. The nurse can’t conclude that the result occurs from poor dietary management or inadequate insulin coverage.
You’re planning your medication teaching for your patient with a UTI prescribed phenazopyridine (Pyridium). What do you include?
A. “Your urine might turn bright orange.”
B. “You need to take this antibiotic for 7 days.”
C. “Take this drug between meals and at bedtime.”
D. “Don’t take this drug if you’re allergic to penicillin.”
What is A?
The drug turns the urine orange. It may be prescribed for longer than 7 days and is usually ordered three times a day after meals. Phenazopyridine is an azo (nitrogenous) analgesic; not an antibiotic.
Which of the following diets would be most appropriate for a client with COPD?
A. Low fat, low cholesterol
B. Bland, soft diet
C. Low-Sodium diet
D. High calorie, high-protein diet
Correct Answer: D. High-calorie, high-protein diet
The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of protein at least twice a day to help maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat, fish, poultry, nuts and dried beans or peas.
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?
A. It is likely that the client is developing a secondary bacterial pneumonia.
B. The assessment findings are consistent with influenza and are to be expected.
C. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions
D. The client has not been taking her decongestants and bronchodilators as prescribed.
Correct Answer: A. It is likely that the client is developing a secondary bacterial pneumonia.
Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza.
The best method of oxygen administration for client with COPD uses:
A. Cannula
B. Simple Face mask
C. Non-rebreather mask
D. Venturi mask
Correct Answer: D. Venturi mask
Venturi delivers controlled oxygen. An air-entrainment (also known as venturi) mask can provide a pre-set oxygen to the patient using jet mixing. As the percent of inspired oxygen increases using such a mask, the air-to-oxygen ratio decreases, causing the maximum concentration of oxygen provided by an air-entrainment mask to be around 40%.
Lab tests revealed that patient Z’s [Na+] is 170 mEq/L. Which clinical manifestation would nurse Natty expect to assess?
A. Tented skin turgor and thirst
B. Muscle twitching and tetany
C.Fruity breath and Kussmaul’s respirations
D. Muscle weakness and paresthesia
What is A?
Hypernatremia refers to elevated serum sodium levels, usually above 145 mEq/L. Typically, the client exhibits tented skin turgor and thirst in conjunction with dry, sticky mucous membranes, lethargy, and restlessness. Muscle weakness and paresthesia are associated with hypokalemia; fruity breath and Kussmaul’s respirations are associated with diabetic ketoacidosis. Muscle twitching and tetany may be seen with hypercalcemia or hyperphosphatemia.
A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important?
A. Strain all urine
B. Limit fluid intake
C. Enforce strict bed rest
D. Encourage a high calcium diet
What is A?
Urine should be strained for calculi and sent to the lab for analysis. Fluid intake of 3 to 4 L is encouraged to flush the urinary tract and prevent further calculi formation. A low-calcium diet is recommended to help prevent the formation of calcium calculi. Ambulation is encouraged to help pass the calculi through gravity.
The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.
A. The inhaler is held upright.
B. Head is tilted down while inhaling the medication.
C. Client waits 5 minutes between puffs.
D. Mouth is rinsed with water following administration.
E. Client lies supine for 15 minutes following administration.
Correct Answers: A & D.
Inhaled respiratory medications are often taken by using a device called a metered-dose inhaler, or MDI. The MDI is a pressurized canister of medicine in a plastic holder with a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication.
When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?
A. Develop infections easily.
B. Maintain current status.
C. Require less supplemental oxygen.
D. Show permanent improvement.
Correct Answer: A. Develop infections easily.
A client with COPD is at high risk for the development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation.
To determine if a patient’s respiratory system is functioning, the nurse would assess which of the following parameters:
A. respiratory rate
B. pulse
C. arterial blood gas
D. pulse oximetry
What is C?
Arterial blood gases will indicate CO2 and O2 levels. This is an indication that the respiratory system is functioning. Respiratory rate can reveal data about other systems, such as the brain, making letter c a better choice. Pulse rate is not measure of respiratory status. Pulse oximetry yields oxygen saturation levels, which is not a measure of acid-base balance.
Jon has a potassium level of 6.5 mEq/L, which medication would nurse Wilma anticipate?
A. Potassium supplements
B. Kayexalate
C. Calcium gluconate
D. Sodium tablets
What is 2?
The client’s potassium level is elevated; therefore, Kayexalate would be ordered to help reduce the potassium level. Kayexalate is a cation-exchange resin, which can be given orally, by nasogastric tube, or by retention enema. Potassium is drawn from the bowel and excreted through the feces. Because the client’s potassium level is already elevated, potassium supplements would not be given. Neither calcium gluconate nor sodium tablets would address the client’s elevated potassium level.
The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms?
A. Urge incontinence
B. Nocturia
C. Decreased force in the stream of urine
D. Urinary retention
What is C?
Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur.