Question 1

The nurse would know that a client who has just begun treatment for pulmonary TB with rifampin has a good understanding of this medication with the statement that
A) "I told my wife to throw away all our spoons and forks before I come home."
B) "I won't go to any family gatherings for 6 months."
C) "It's going to be important to remember to cover my nose when I sneeze."
D) "My urine will look orange because of the medication."

Accepted Answer

The client should understand that orange urine, feces, saliva, sputum, sweat, and tears may occur when taking rifampin.

Question 2

The nurse caring for a client with cystic fibrosis would select as the highest priority the nursing diagnosis of
A) Activity Intolerance.
B) Anxiety.
C) Risk for Deficient Fluid Volume.
D) Risk for Ineffective Airway Clearance.

Accepted Answer

The disease process causes tracheobronchial secretions to become thick and viscous, leading to interference with normal ciliary action, plugging of airways, and creation of a reservoir for bacterial growth and infection.

Question 3

On physical examination of a client with pneumonia, the nurse would expect
A) absence of whispered pectoriloquy over the affected area.
B) increased tactile fremitus over the affected area.
C) tympanic percussion notes over the affected area.
D) vesicular breath sounds over the affected area.

Accepted Answer

Consolidated lung tissue transmits bronchial sound waves to outer lung fields. Crackling sounds and whispered pectoriloquy may be heard over the affected areas. Tactile fremitus is usually increased over areas of pneumonia, whereas percussion notes are dulled.

Question 4

In caring for a client scheduled to have chest tubes removed, the nurse's most appropriate action would be to
A) assist the client to a prone position.
B) empty the collection chambers before removal.
C) encourage deep breathing during removal.
D) medicate for pain 1/2 hour before removal.

Accepted Answer

Removal of chest catheters can be moderately to severely painful. The prescribed premedication should be administered about 1/2 hour before the procedure.

Question 5

The nurse caring for a client recently diagnosed with active TB would include in the teaching plan which information regarding medications?
A) Clients must report daily to the health department to receive their medication.
B) Clients are usually admitted to the hospital to initiate treatment for TB.
C) Medications are generally given for 6 to 8 weeks.
D) TB is treated with three or more medications to prevent organism resistance.

Accepted Answer

Clients who have not been treated for TB before are started on a four-drug regimen including isoniazid (INH), rifampin (RIF), pyrazinamide, and ethambutol. This induction treatment generally lasts about 2 months, and is followed by a continuation phase using 2 drugs for 4-7 months.

Question 6

The nurse writing an infection control policy for a home health care agency would include the information that the rise in TB cases in recent years is related to the
A) aging of the U.S. population.
B) emergence of antibiotic-resistant bacteria.
C) increase in HIV infection.
D) rise in illegal drug use.

Accepted Answer

This increase in TB has been attributed to the emergence of the human immunodeficiency virus (HIV) epidemic, recent influxes of immigrants from developing third-world countries, and the deterioration of the U.S. health care infrastructure.

Question 7

The nurse would assess a client with severe acute respiratory syndrome (SARS) for the major clinical manifestation indicating the onset of the lower respiratory phase, which is
A) dry, nonproductive cough.
B) hemoptysis.
C) pleuritic pain.
D) rapid temperature elevation.

Accepted Answer

A dry, nonproductive cough signals the onset of the lower respiratory phase of SARS.

Question 8

To prevent the complication of atelectasis in an 82-year-old woman with a hip fracture, the nurse would
A) ambulate the client frequently.
B) frequently reposition the client.
C) suction the upper airway.
D) supply oxygen.

Accepted Answer

One of the primary goals of nursing intervention is to prevent atelectasis in the high-risk client. Clients who are elderly, obese, or bedridden, or who have a history of smoking are more susceptible to atelectasis. Frequent position changes and early ambulation help promote drainage of all lung segments.

Question 9

A client had chest surgery this morning and has a chest tube attached to a closed-chest drainage system. When the nurse notes no tidaling of fluid, the nurse would first
A) attach the system to suction.
B) milk the chest tube.
C) notify the physician immediately.
D) reposition the client.

Accepted Answer

Tidaling (rise of fluid with inspiration and fall of fluid with expiration) indicates that the drainage tubes are patent and the apparatus is functioning correctly. Tidaling stops when the lung has expanded or the tubes are kinked or obstructed. If tidaling does not occur, the nurse can reposition the client, check the tubing for kinks, or have the client deep breathe and cough. If these measures do not work and if there are no blood clots or tissue fragments visible, then notify the surgeon. If blood clots or tissue fragments are visible in the tubing, milking may help reestablish the flow from the chest to the collection bottle.

Question 10

The nurse notes that a client in a long-term care facility has become increasingly confused in the last few days. The resident's vital signs are temperature 97.7° F, pulse rate 80 beats/min, respirations 20 breaths/min, and blood pressure (90/62) mm Hg. The nurse would suspect
A) cancer of the lung.
B) plural effusion.
C) pneumonia.
D) tuberculosis (TB).

Accepted Answer

The older adult with pneumonia may present not with fever or respiratory manifestations, but with altered mental status and volume depletion. Classic manifestations include fever, chills, sweats, fatigue, cough, sputum production, and dyspnea.

Question 11

A client is noncompliant with the continuation phase of treatment for TB. The nurse assigns the diagnosis Ineffective Coping and plans interventions that will
A) allow the client to continue to work from home.
B) increase the client's sense of control.
C) isolate the client from the family until the disease is under control.
D) require the client to report medication use.

Accepted Answer

The treatment for TB is long and compliance is often a problem. Interventions that can help the client feel more personal control over the situation are likely to help the client remain compliant.

Question 12

The nurse notes intermittent bubbling in the water-seal chamber of a chest tube in place for a client with pneumothorax. The nurse's most appropriate action is to
A) change the drainage unit.
B) clamp the chest tube.
C) encourage respiratory exercises.
D) place petrolatum gauze around the chest tube.

Accepted Answer

Bubbling in the water-seal compartment is caused by air passing out of the pleural space into the fluid in the bottle. Intermittent bubbling is normal when the lung is still expanding. Respiratory exercises will hasten the lung's reexpansion.

Question 13

The nurse would become concerned about the risk of hemorrhage if, in the first 2 hours after surgery, the thoracotomy client's drainage exceeded
A) 50 ml.
B) 100 ml.
C) 300 ml.
D) 750 ml.

Accepted Answer

As much as 500 to 1000 ml of drainage may occur in the first 24 hours after chest surgery. Between 100 and 300 ml of drainage may accumulate during the first 2 hours; after this time, the drainage should lessen.

Question 14

The nurse has made the nursing diagnosis Ineffective Breathing Pattern related to tachypnea secondary to chest pain for a client with pneumonia. After administration of an analgesic, the nurse would
A) encourage the use of an incentive spirometer.
B) monitor the client's respiratory pattern.
C) reposition the client flat in bed.
D) request that the client cough.

Accepted Answer

The nurse should administer prescribed cough suppressants and analgesics but should be cautious because narcotics may depress respirations more than desired.

Question 15

A young female client with cystic fibrosis (CF) wishes to become pregnant but is concerned about the effect of CF on fertility. The nurse bases a response with the understanding that
A) breastfeeding will not be possible because of plugged milk glands.
B) only about 20% of women with CF are infertile.
C) pregnancy carries a high risk of spontaneous abortion (miscarriage).
D) women with CF are unlikely to become pregnant.

Accepted Answer

CF does affect reproduction. Most men are azoospermic because of obliteration of the vas deferens; 20% of women are infertile. Thick tenacious cervical mucus can block sperm migration. More than 90% of completed pregnancies produce viable infants, and breastfeeding is not affected.

Question 16

A client has small cell carcinoma of the lung. The nurse should anticipate providing which intervention to the client?
A) Educating the client and family about planned chemotherapy
B) Instructing the client on home care of a chest tube system
C) Preparing the client for lung resection
D) Providing a referral to hospice

Accepted Answer

Small cell carcinoma ("oat cell") does initially respond well to chemo, but the prognosis is very poor because it usually has metastasized when found. Also the high doses of chemotherapy needed for small cell carcinoma often produce toxicity that leads to discontinuation of the treatment. Surgical resection usually does not play a role in treatment because the tumor has usually metastasized by this point. Because of the poor prognosis of this kind of cancer, hospice referral may be the most appropriate option.

Question 17

The nurse would know that the client most likely to exhibit a false-negative Mantoux reaction is the client who is
A) being treated for sickle cell disease.
B) HIV-positive.
C) malnourished.
D) previously diagnosed with TB.

Accepted Answer

False-negative reactions are possible with the Mantoux test, especially in clients who are immunosuppressed or anergic. A 5-cm Mantoux reading is considered positive in a client who is immunosuppressed.

Question 18

A client has accidentally disconnected a chest tube while turning over in bed. The suction tubing is on the floor. The most appropriate action by the nurse is to
A) call the physician immediately and prepare the client for reinsertion.
B) clamp the chest tube just proximal to the open end.
C) reattach the drainage tube to the suction tubing.
D) submerge the end of the drainage tube in a bottle of sterile saline.

Accepted Answer

When a chest tube becomes disconnected to the suction tubing, the best action is to reattach it. However, since this suction tubing was on the floor, it is contaminated and reattaching the drainage tube to the suction tubing will place the client at an even higher risk of infection than already present. The next best action is to submerge the drainage tube into a bottle of sterile water or saline kept at the bedside for just such an occasion. If there is no fluid available, leave the tubing open rather than clamp it because clamping the tubing creates a risk for tension pneumothorax. The nurse will need to replace the contaminated suction tubing with new tubing.

Question 19

The nurse administering influenza vaccinations to a group of office workers would not offer the vaccine to a client who
A) has a history of asthma.
B) is allergic to eggs.
C) is allergic to sulfa drugs.
D) takes amoxicillin for a bladder infection.

Accepted Answer

Clients allergic to eggs or who have a history of Guillain-Barré syndrome should not receive an influenza vaccine.

Question 20

To increase the level of comfort for a client with a lung abscess, the nurse would include which intervention in the care plan?
A) Encourage activity before meals.
B) Offer frequent oral hygiene.
C) Provide easy-to-eat milk products.
D) Restrict fluid intake.

Accepted Answer

The client's copious sputum may have a foul taste. The nurse should provide frequent opportunities for the client to use mouthwash and perform tooth brushing and flossing.

Quiz 62: Management of Clients with Parenchymal and Pleural Disorders

The nurse would know that a client who has just begun treatment for pulmonary TB with rifampin has a good understanding of this medication with the statement that

The nurse caring for a client with cystic fibrosis would select as the highest priority the nursing diagnosis of

On physical examination of a client with pneumonia, the nurse would expect

In caring for a client scheduled to have chest tubes removed, the nurse's most appropriate action would be to

The nurse caring for a client recently diagnosed with active TB would include in the teaching plan which information regarding medications?

The nurse writing an infection control policy for a home health care agency would include the information that the rise in TB cases in recent years is related to the

The nurse would assess a client with severe acute respiratory syndrome (SARS) for the major clinical manifestation indicating the onset of the lower respiratory phase, which is

To prevent the complication of atelectasis in an 82-year-old woman with a hip fracture, the nurse would

A client had chest surgery this morning and has a chest tube attached to a closed-chest drainage system. When the nurse notes no tidaling of fluid, the nurse would first

The nurse notes that a client in a long-term care facility has become increasingly confused in the last few days. The resident's vital signs are temperature 97.7° F, pulse rate 80 beats/min, respirations 20 breaths/min, and blood pressure (90/62) mm Hg. The nurse would suspect

A client is noncompliant with the continuation phase of treatment for TB. The nurse assigns the diagnosis Ineffective Coping and plans interventions that will

The nurse notes intermittent bubbling in the water-seal chamber of a chest tube in place for a client with pneumothorax. The nurse's most appropriate action is to

The nurse would become concerned about the risk of hemorrhage if, in the first 2 hours after surgery, the thoracotomy client's drainage exceeded

The nurse has made the nursing diagnosis Ineffective Breathing Pattern related to tachypnea secondary to chest pain for a client with pneumonia. After administration of an analgesic, the nurse would

A young female client with cystic fibrosis (CF) wishes to become pregnant but is concerned about the effect of CF on fertility. The nurse bases a response with the understanding that

A client has small cell carcinoma of the lung. The nurse should anticipate providing which intervention to the client?

The nurse would know that the client most likely to exhibit a false-negative Mantoux reaction is the client who is

A client has accidentally disconnected a chest tube while turning over in bed. The suction tubing is on the floor. The most appropriate action by the nurse is to

The nurse administering influenza vaccinations to a group of office workers would not offer the vaccine to a client who

To increase the level of comfort for a client with a lung abscess, the nurse would include which intervention in the care plan?