Respiratory Nursing

Pain Management

100

You are the nurse caring for a patient with a patient-controlled analgesia (PCA) pump, but you notice that he has not used it very often and is denying pain. Despite these findings, you still suspect that he is having pain because: A. his temperature is 104 F (40 C), and you are having a hard time keeping him awake. B. his color is flushed, his pulse is 100 beats/min, and his blood pressure is 90/54. C. he shows facial grimacing, his pulse is 120 beats/min, and his blood pressure is 170/92. Correct D. his speech is slurred, his respiratory rate is 12 breaths/min, and his blood pressure is 120/64.

C. he shows facial grimacing, his pulse is 120 beats/min, and his blood pressure is 170/92. Correct

200

You are caring for a postoperative patient who is complaining of incisional pain. You ask the patient to rate the pain on a scale of 1-10. What is the rationale for rating the patient's pain level? A. To determine if your interventions are effective B. To decide if the subjective data are accurate C. To ascertain the effective use of therapeutic communication D. To determine the behavioral pain experience

A. To determine if your interventions are effective

300

Your patient reports increased amounts of pain at the site of his chest tube. The physician has ordered IV morphine 2-4 mg every 3 hours. What is your major concern when monitoring your patient’s condition after administering morphine intravenously? A. Respiratory depression B. Rebound pain sequence C. Nausea and vomiting D. Constipation

A. Respiratory depression

400

Your patient has received IV morphine, and you note that he is difficult to arouse and his respiratory rate has fallen to 8 breaths/min. The physician orders naloxone. Which nursing intervention is appropriate when administering this medication? A. Continuing to monitor respiratory rate for 2 to 3 hours after administering naloxone B. Setting up a patient to controlled analgesia (PCA) pump with naloxone to continue its effect "on demand" C. Administering diphenhydramine to prevent pruritus as a side effect D. Monitoring intake and output for urinary retention

A. Continuing to monitor respiratory rate for 2 to 3 hours after administering naloxone

500

Your patient has decreased levels of pain relief during the nighttime despite being ordered PCA with morphine. You do not feel that your patient is receiving effective control with "on-demand" PCA only. What would be the most effective alternative for this PCA order? A. Adding a basal infusion with the self-administration B. Increasing the frequency of the on-demand dose C. Increasing the dosage of the on-demand dose D. Administering the PCA by an epidural route

A. Adding a basal infusion with the self-administration

Assessment

100

You are assessing a patient with a chest tube to Pleurovac suction. You note his vital signs as T 100.4 F, BP 158/90, P 92, RR 22. When auscultating breath sounds, you note bilateral scattered rales and rhonchi that do not clear with coughing. What is your priority nursing intervention? A. Assessing the oxygen saturation level B. Calling the appropriate health care provider for an antibiotic C. Collecting sputum for culture and sensitivity D. Increasing oxygen to 4 L via nasal cannula

A. Assessing the oxygen saturation level

200

A student nurse attends a program to review adventitious breath sounds. After completion of the program, which statement by the student indicates understanding? A. "Wheezes are musical sounds that I may hear on inspiration or expiration." B. "Crackles are high-pitched sounds which are heard primarily with inspiration." C. "I can expect to hear crackles when I am caring for a child with a mild cold." D. "Pleural friction rubs are high-pitched vibrating sounds heard on inspiration."

A. "Wheezes are musical sounds that I may hear on inspiration or expiration."

300

When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action? A. Weak cough effort B. Barrel-shaped chest C. Dry mucous membranes D. Bilateral crackles at lung bases

D. Bilateral crackles at lung bases

400

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.

C. The patient's white blood cell (WBC) count is 9000/µL

500

he clinic nurse is assisting to perform a focused data collection process on a client who is complaining of symptoms of a cold, a cough, and lung congestion. Which of the following would the nurse include for this type of data collection? Select all that apply. A. Checking the strength of peripheral pulses B. Performing a musculoskeletal and neurological examination C. Obtaining information about the client's respirations D. Obtaining the client's temperature E. Asking the client about a family history of any illness or disease F. Auscultating lung sounds

C, D, F

Prioritization

100

A patient has been admitted to the intensive care unit with a diagnosis of pulmonary edema. The patient is anxious and has shortness of breath. The admitting team has performed a baseline weight and lung assessment. When developing the plan of care, which nursing diagnosis is of the highest priority? A. Fluid volume deficit B. Impaired gas exchange C. Alteration in comfort D. Anxiety

B. Impaired gas exchange

200

Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? A. Notify the health care provider. B. Offer reassurance to the patient. C. Auscultate the patient's breath sounds. D. Give the prescribed PRN morphine sulfate IV.

C. Auscultate the patient's breath sounds.

300

The oxygen saturation (SpO2) for a patient with left lower lobe pneumonia is 90%. The patient has rhonchi, a weak cough effort, and complains of fatigue. Which action is a priority for the nurse to take? A. Position the patient on the left side. B. Assist the patient with staged coughing. C. Place a humidifier in the patient's room. D. Schedule a 2-hour rest period for the patient.

B. Assist the patient with staged coughing.

400

A patient with acute respiratory distress syndrome (ARDS) who is intubated and receiving mechanical ventilation develops a right pneumothorax. Which action will the nurse anticipate taking next? A. Increase the tidal volume and respiratory rate. B. Increase the fraction of inspired oxygen (FIO2). C. Perform endotracheal suctioning more frequently. D. Lower the positive end-expiratory pressure (PEEP).

D. Lower the positive end-expiratory pressure (PEEP).

500

Which actions should the nurse initiate to reduce the risk for ventilator-associated pneumonia (VAP) (select all that apply)? A. Obtain arterial blood gases daily. B. Provide a "sedation holiday" daily. C. Elevate the head of the bed to at least 30°. D. Give prescribed pantoprazole (Protonix). E. Provide oral care with chlorhexidine (0.12%) solution daily.

B. Provide a "sedation holiday" daily. C. Elevate the head of the bed to at least 30°. D. Give prescribed pantoprazole (Protonix). E. Provide oral care with chlorhexidine (0.12%) solution daily.

Labs and Diagnostics

100

An older patient receiving iso-osmolar continuous tube feedings develops restlessness, agitation, and weakness. Which laboratory result should the nurse report to the health care provider immediately? A. K+ 3.4 mEq/L (3.4 mmol/L) B. Ca+2 7.8 mg/dL (1.95 mmol/L) C. Na+ 154 mEq/L (154 mmol/L) D. PO4-3 4.8 mg/dL (1.55 mmol/L)

C. Na+ 154 mEq/L (154 mmol/L)

200

A patient is being managed for septic shock. The physician has ordered a series of laboratory studies. When the nurse reviews the results, which finding supports the diagnosis? A. Elevated serum glucose levels B. Increased creatinine levels C. Reduced levels of urea nitrogen D. Increased hemoglobin levels

B. Increased creatinine levels

300

What might a nurse expect to see on an ECG if the patient has been experiencing hypokalemia? A. Tall, peaked T wave B. Loss of P wave C. Ventricular dysrhythmias such as PVCs D. Ventricular fibrillation

C. Ventricular dysrhythmias such as PVCs

400

Your patient has ABGs drawn. The results are reported to you by the lab. You should notify the appropriate health care provider regarding which level? A. pH = 7.37 B. PaO2 = 85 C. PaCO2 = 80 D. SaO2 = 98%

C. PaCO2 = 80

500

During report, a nurse notes that a patient had serum electrolytes drawn. Which electrolyte levels should the nurse note as being abnormal? Select all that apply. A. Potassium: 3.9 mEq/L B. Sodium: 157 mEq/L C. Magnesium: 3.1 mEq/L D. Calcium: 6.8 mEq/L E. Chloride: 73 mEq/L

B. Sodium: 157 mEq/L C. Magnesium: 3.1 mEq/L D. Calcium: 6.8 mEq/L E. Chloride: 73 mEq/L

Education

100

The physician has recommended that the patient be sent home and a palliative care plan be implemented. Hospice is notified, and the family is called. The nurse should explain to the family that: A. the focus will be on quality of life. B. no more medications will be given. C. symptom management will be avoided. D. death will be prolonged as far as possible.

A. the focus will be on quality of life.

200

During preoperative teaching, you tell your patient that he will not be able to have anything to eat or drink (NPO) after midnight the night before surgery. What is the rationale you should give the patient? A. reduces the chance for vomiting and aspirating stomach content. B. It prevents damage to the bladder during surgery. C. It allows accurate intake of electrolytes from the IV infusion. D. helps absorption of general anesthetics.

A. reduces the chance for vomiting and aspirating stomach content.

300

A speaker has come to discuss lung transplantation with a class of nursing students. After the session, the students discuss the presentation. Which response by a participant indicates the need for further education? A. "Rejection is a common occurrence that is seen after the first 30 to 45 days." B. "Transplantation is a therapy considered for the management of cystic fibrosis." C. "Infections make up the leading cause of death in the postoperative period." D. "Cytomegalovirus is a leading cause of infection for the patient with a lung transplant."

A. "Rejection is a common occurrence that is seen after the first 30 to 45 days."

400

A patient with COPD asks if there is anything she can do to help when she has difficulty breathing. Which is the nurse's best response? A. "Trying to take slow, deep breaths is the best way to control dyspnea." B. "There is not a lot you can do to help your dyspnea since you have COPD." C. "We should speak with your doctor to ask what is best in your particular case." D. "Pursed-lip breathing is often helpful for dyspnea. Let me teach you how to perform it."

"Pursed-lip breathing is often helpful for dyspnea. Let me teach you how to perform it."

500

The nurse teaches a patient about pulmonary function testing (PFT). Which statement, if made by the patient, indicates teaching was effective? A. "I will use my inhaler right before the test." B. "I won't eat or drink anything 8 hours before the test." C. "I should inhale deeply and blow out as hard as I can during the test." D. "My blood pressure and pulse will be checked every 15 minutes after the test."

C. "I should inhale deeply and blow out as hard as I can during the test."