Med Surg Week 4 Study Guide Questions Flashcards


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1

A patient develops epistaxis upon removal of a nasogastric tube. What action should the nurse take?

A) Pinch the soft part of the nose.

B) Position the patient on the side.

C) Have the patient hyperextend the neck.

D) Apply an ice pack to the back of the neck.

Answer: A

2

The nurse receives an evening report on a patient who underwent posterior nasal packing for epistaxis earlier in the day. What is the first patient assessment the nurse should make?

A) Patient's temperature

B) Level of the patient's pain

C) Drainage on the nasal dressing

D) Oxygen saturation by pulse oximetry

Answer: D

3

What does the nurse teach the patient with intermittent allergic rhinitis is the most effective way to decrease allergic symptoms?

A) Undergo weekly immunotherapy.

B) Identify and avoid triggers of the allergic reaction.

C) Use cromolyn nasal spray prophylactically year round.

D) Use over-the-counter antihistamines and decongestants during an acute attack.

Answer: B

4

During assessment of the patient with a viral upper respiratory infection, the nurse recognizes that antibiotics may be indicated based on what finding?

A) Cough and sore throat

B) Copious nasal discharge

C) Temperature of 100° F (38° C)

D) Dyspnea and severe sinus pain

Answer: D

5

A 36-yr-old patient with type 1 diabetes mellitus asks the nurse whether an influenza vaccine is necessary every year. What is the best response by the nurse?

A) “You should get the inactivated influenza vaccine that is injected every year.”

B) “Only health care workers in contact with high-risk patients should be immunized each year.”

C) “An annual vaccination is not necessary because previous immunity will protect you for several years.”

D) “Antiviral drugs, such as zanamivir (Relenza), eliminate the need for vaccine except in the older adult.”

Answer: A

6

A patient with an acute pharyngitis is seen at the clinic with fever and severe throat pain that affects swallowing. On inspection, the throat is reddened and edematous with patchy yellow exudates. The nurse anticipates that interprofessional management will include

A) treatment with antibiotics.

B) treatment with antifungal agents.

C) a throat culture or rapid strep antigen test.

D) treatment with medication only if the pharyngitis does not resolve in 3 to 4 days.

Answer: C

7

What is an advantage of a tracheostomy over an endotracheal (ET) tube for long-term management of an upper airway obstruction?

A) A tracheostomy is safer to perform in an emergency.

B) An ET tube has a higher risk of tracheal pressure necrosis.

C) A tracheostomy tube allows for more comfort and mobility.

D) An ET tube is more likely to lead to lower respiratory tract infection.

Answer: C

8

During care of a patient with a cuffed tracheostomy, the nurse notes that the tracheostomy tube has an inner cannula. To care for the tracheostomy appropriately, what should the nurse do?

A) Deflate the cuff, then remove and suction the inner cannula.

B) Remove the inner cannula and replace it per institutional guidelines.

C) Remove the inner cannula if the patient shows signs of airway obstruction.

D) Keep the inner cannula in place at all times to prevent dislodging the tracheostomy tube.

Answer: B

9

What is included in the nursing care of the patient with a cuffed tracheostomy tube?

A) Change the tube every 3 days.

B) Monitor cuff pressure every 8 hours.

C) Perform mouth care every 12 hours.

D) Assess arterial blood gases every 8 hours.

Answer: B

10

A patient's tracheostomy tube becomes dislodged with vigorous coughing. What should be the nurse's first action?

A) Attempt to replace the tube.

B) Notify the health care provider.

C) Place the patient in high Fowler's position.

D) Ventilate the patient with a manual resuscitation bag until the health care provider arrives.

Answer: A

11

When obtaining a health history from a patient with possible cancer of the mouth, what would the nurse expect the patient to report?

A) Long-term denture use

B) Heavy tobacco and/or alcohol use

C) Persistent swelling of the neck and face

D) Chronic herpes simplex infections of the mouth and lips

Answer: B

12

The patient has been diagnosed with an early vocal cord malignancy. The nurse explains that usual treatment includes

A) radiation therapy that preserves the quality of the voice.

B) a hemilaryngectomy that prevents the need for a tracheostomy.

C) a radical neck dissection that removes possible sites of metastasis.

D) a total laryngectomy to prevent development of second primary cancers.

Answer: A

13

During preoperative teaching for the patient scheduled for a total laryngectomy, what should the nurse include?

A) The postoperative use of nonverbal communication techniques

B) Techniques that will be used to alleviate a dry mouth and prevent stomatitis

C) The need for frequent, vigorous coughing in the first 24 hours postoperatively

D) Self-help groups and community resources for patients with cancer of the larynx

Answer: A

14

When assessing the patient on return to the surgical unit following a total laryngectomy and radical neck dissection, what would the nurse expect to find?

A) A closed-wound drainage system

B) A nasal endotracheal tube in place

C) A nasogastric tube with orders for tube feedings

D) A tracheostomy tube and mechanical ventilation

Answer: A

15

What should the nurse include in discharge teaching for the patient with a total laryngectomy?

A) How to use esophageal speech to communicate

B) How to use a mirror to suction the tracheostomy

C) The necessity of never covering the laryngectomy stoma

D) The need to use baths instead of showers for personal hygiene

Answer: B

16

What is the most normal functioning method of speech restoration for the patient with a total laryngectomy?

A) Esophageal speech

B) A transesophageal puncture

C) An electrolarynx held to the neck

D) An electrolarynx placed in the mouth

Answer: B

17

Why is the classification of pneumonia as community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP) clinically useful?

A) Atypical pneumonia syndrome is more likely to occur in HAP.

B) Diagnostic testing does not have to be used to identify causative agents.

C) Causative agents can be predicted, and empiric treatment is often effective.

D) IV antibiotic therapy is necessary for HAP, but oral therapy is adequate for CAP.

Answer: C

18

The microorganisms Pneumocystis jiroveci (PJP) and cytomegalovirus (CMV) are associated with which type of pneumonia?

A) Necrotizing pneumonia

B) Opportunistic pneumonia

C) Hospital-associated pneumonia

D) Community-acquired pneumonia

Answer: B

19

When obtaining a health history from a 76-yr-old patient with suspected CAP, what does the nurse expect the patient or caregiver to report?

A) Confusion

B) A recent loss of consciousness

C) An abrupt onset of fever and chills

D) A gradual onset of headache and sore throat

Answer: A

20

What is the initial antibiotic treatment for pneumonia based on?

A) The severity of symptoms

B) The presence of characteristic leukocytes

C) Gram stains and cultures of sputum specimens

D) History and physical examination and characteristic chest x-ray findings

Answer: D

21

After the health care provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. Which order should the nurse implement first?

A) Anterior/posterior and lateral chest x-rays

B) Start IV levofloxacin (Levaquin) 500 mg every 24 hr

C) Sputum specimen for Gram stain and culture and sensitivity

D) Complete blood count (CBC) with white blood cell (WBC) count and differential

Answer: C

22

Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on which finding?

A) SpO2 of 86%

B) Crackles in both lower lobes

C) Temperature of 101.4° F (38.6° C)

D) Production of greenish purulent sputum

Answer: A

23

A patient with pneumonia has a nursing diagnosis of ineffective airway clearance related to pain, fatigue, and thick secretions. What is an expected outcome for this patient?

A) SpO2 is 90%

B) Lungs clear to auscultation

C) Patient tolerates walking in hallway

D) Patient takes three or four shallow breaths before coughing to minimize pain

Answer: B

24

During an annual health assessment of a 66-yr-old patient at the clinic, the patient tells the nurse he has not had the pneumonia vaccine. What should the nurse advise him about the best way for him to prevent pneumonia?

A) Obtain a pneumococcal vaccine now and get a booster 12 months later.

B) Seek medical care and antibiotic therapy for all upper respiratory infections.

C) Obtain the pneumococcal vaccine if he is exposed to individuals with pneumonia.

D) Obtain only the influenza vaccine every year because he should have immunity to the pneumococcus because of his age.

Answer: A

25

To what was the resurgence in tuberculosis (TB) resulting from the emergence of multidrug-resistant (MDR) strains of Mycobacterium tuberculosis related?

A) A lack of effective means to diagnose TB

B) Poor compliance with drug therapy in patients with TB

C) Indiscriminate use of antitubercular drugs in treatment of other infections

D) Increased population of immunosuppressed individuals with acquired immunodeficiency syndrome (AIDS)

Answer: B

26

A patient diagnosed with class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain and coughing. What nursing action has the highest priority?

A) Administering the patient's antitubercular drugs

B) Admitting the patient to an airborne infection isolation room

C) Preparing the patient's room with suction equipment and extra linens

D) Placing the patient in an intensive care unit, where he can be closely monitored

Answer: B

27

When obtaining a health history from a patient suspected of having early TB, the nurse should ask the patient about what manifestations?

A) Chest pain, hemoptysis, and weight loss

B) Fatigue, low-grade fever, and night sweats

C) Cough with purulent mucus and fever with chills

D) Pleuritic pain, nonproductive cough, and temperature elevation at night

Answer: B

28

A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the medication all the time. What is the best action for the nurse to take?

A) Arrange for directly observed therapy (DOT) by a public health nurse.

B) Schedule the patient to come to the clinic every day to take the medication.

C) Have a patient who has recovered from TB tell the patient about his successful treatment.

D) Schedule more teaching sessions so that the patient will understand the risks of noncompliance.

Answer: A

29

To reduce the risk for many occupational lung diseases, what is the most important measure the occupational nurse should promote?

A) Maintaining smoke-free work environments for all employees

B) Using masks and effective ventilation systems to reduce exposure to irritants

C) Inspection and monitoring of workplaces by national occupational safety agencies

D) Requiring periodic chest x-rays and pulmonary function tests for exposed employees

Answer: B

30

A patient with a 40 pack-year smoking history has recently stopped smoking because of the fear of developing lung cancer. The patient asks the nurse what he can do to learn about whether he develops lung cancer. What is the best response from the nurse?

A) “You should get a chest x-ray every 6 months to screen for any new growths.”

B) “It would be very rare for you to develop lung cancer now that you have stopped smoking.”

C) “You should monitor for any persistent cough, wheezing, or difficulty breathing,
which could indicate tumor growth.”

D) “Adults aged 55 to 80 with a history of heavy smoking who quit in the past 15 years should be screened yearly with low-dose computed tomography.”

Answer: D

31

A patient with a lung mass found on chest x-ray is undergoing further testing. The nurse explains that a definitive diagnosis of lung cancer can be confirmed using which diagnostic test?

A) Lung biopsy

B) Lung tomograms

C) Pulmonary angiography

D) Computed tomography (CT) scans

Answer: A

32

A patient with advanced lung cancer refuses pain medication, saying, “I deserve everything this cancer can give me.” What is the nurse's best response to this patient?

A) “Would talking to a counselor help you?”

B) “Can you tell me what the pain means to you?”

C) “Are you using the pain as a punishment for your smoking?”

D) “Pain control will help you to deal more effectively with your feelings.”

Answer: B

33

A male patient has chronic obstructive pulmonary disease (COPD) and is a smoker. The nurse notices respiratory distress and no breath sounds over the left chest. Which type of pneumothorax should the nurse suspect is occurring?

A) Tension pneumothorax

B) Iatrogenic pneumothorax

C) Traumatic pneumothorax

D) Spontaneous pneumothorax

Answer: D

34

To determine whether a tension pneumothorax is developing in a patient with chest trauma, for what does the nurse assess the patient?

A) Dull percussion sounds on the injured side

B) Severe respiratory distress and tracheal deviation

C) Muffled and distant heart sounds with decreasing blood pressure

D) Decreased movement and diminished breath sounds on the affected side

Answer: B

35

Following a motor vehicle accident, the nurse assesses the driver for which distinctive sign of flail chest?

A) Severe hypotension

B) Chest pain over ribs

C) Absence of breath sounds

D) Paradoxical chest movement

Answer: D

36

When should the nurse check for leaks in the chest tube and pleural drainage system?

A) There is continuous bubbling in the water-seal chamber.

B) There is constant bubbling of water in the suction control chamber.

C) Fluid in the water-seal chamber fluctuates with the patient's breathing.

D) The water levels in the water-seal and suction control chambers are decreased.

Answer: A

37

An unlicensed assistive personnel (UAP) is taking care of a patient with a chest tube. The nurse should intervene when she observes the UAP

A) looping the drainage tubing on the bed.

B) securing the drainage container in an upright position.

C) stripping or milking the chest tube to promote drainage.

D) reminding the patient to cough and deep breathe every 2 hours.

Answer: C

38

Which chest surgery is used for the stripping of a fibrous membrane?

A) Lobectomy

B) Decortication

C) Thoracotomy

D) Wedge resection

Answer: B

39

How should the nurse explain to the patient and family what the purpose of video assisted thoracic surgery (VATS) is?

A) Removal of a lung

B) Removal of one or more lung segments

C) Removal of lung tissue by multiple wedge excisions

D) Inspection, diagnosis, and management of intrathoracic injuries

Answer: D

40

Following a thoracotomy, the patient has a nursing diagnosis of ineffective breathing pattern related to inability to cough as a result of pain and positioning. What is the best nursing intervention for this patient?

A) Have the patient drink 16 oz of water before attempting to deep breathe.

B) Auscultate the lungs before and after deep-breathing and coughing regimens.

C) Place the patient in the Trendelenburg position for 30 minutes before the coughing
exercises.

D) Medicate the patient with analgesics 20 to 30 minutes before assisting to cough
and deep breathe.

Answer: D

41

Two days after undergoing pelvic surgery, a patient develops marked dyspnea and anxiety. What is the first action that the nurse should take?

A) Raise the head of the bed.

B) Notify the health care provider.

C) Take the patient's pulse and blood pressure.

D) Determine the patient's SpO2 with an oximeter.

Answer: A

42

A pulmonary embolism is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about?

A) D-dimer

B) Chest x-ray

C) Spiral (helical) CT scan

D) Ventilation-perfusion lung scan

Answer: C

43

Which condition contributes to secondary pulmonary arterial hypertension by causing pulmonary capillary and alveolar damage?

A) COPD

B) Sarcoidosis

C) Pulmonary fibrosis

D) Pulmonary embolism

Answer: A

44

While caring for a patient with idiopathic pulmonary arterial hypertension (IPAH), the nurse observes that the patient has exertional dyspnea and chest pain in addition to fatigue. To what are these symptoms related?

A) Decreased left ventricular output

B) Right ventricular hypertrophy and failure

C) Increased systemic arterial blood pressure

D) Development of alveolar interstitial edema

Answer: B

45

What is a primary treatment goal for cor pulmonale?

A) Controlling dysrhythmias

B) Dilating the pulmonary arteries

C) Strengthening the cardiac muscle

D) Treating the underlying pulmonary condition

Answer: D

46

Six days after a heart-lung transplant, the patient develops a low-grade fever, dyspnea, and decreased SpO2. What should the nurse recognize that this may indicate?

A) A normal response to extensive surgery

B) A frequently fatal cytomegalovirus infection

C) Acute rejection that will be treated with corticosteroids

D) Bronchiolitis obliterans, which plugs terminal bronchioles

Answer: C

47

While assisting a patient with intermittent asthma to identify specific triggers of asthma, what should the nurse explain?

A) Food and drug allergies do not manifest in respiratory symptoms.

B) Exercise-induced asthma is seen only in individuals with sensitivity to cold air.

C) Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques.

D) Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.

Answer: D

48

A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse?

A) The presence of a pulsus paradoxus

B) Markedly diminished breath sounds with no wheezing

C) A respiratory rate of 34 and increased pulse and blood pressure

D) Use of accessory muscles of respiration and a feeling of suffocation

Answer: B

49

A patient with asthma has the following arterial blood gas (ABG) results early in an acute asthma attack: pH 7.48, PaCO2 30 mm Hg, PaO2 78 mm Hg. What is the most appropriate action by the nurse?

A) Prepare the patient for mechanical ventilation.

B) Have the patient breathe in a paper bag to raise the PaCO2.

C) Document the findings and monitor the ABGs for a trend toward acidosis.

D) Reduce the patient's oxygen flow rate to keep the PaO2 at the current level.

Answer: C

50

What is an indication of marked bronchoconstriction with air trapping and hyperinflation of the lungs in a patient with asthma?

A) SaO2 of 85%

B) PEF rate of <150 L/min

C) FEV1 of 85% of predicted

D) Chest x-ray showing a flattened diaphragm

Answer: B

51

Which medication should the nurse anticipate being used first in the emergency department for relief of severe respiratory distress related to asthma?

A) Prednisone orally

B) Tiotropium inhaler

C) Fluticasone inhaler

D) Albuterol nebulizer

Answer: D

52

When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which statement by the patient shows the nurse that the patient needs more teaching?

A) “I do not need to use the spacer like I used to.”

B) “I will hold my breath for 10 seconds or longer if I can.”

C) “I will not shake this inhaler like I did with my old inhaler.”

D) “I will store it in the bathroom so I will be able to clean it when I need to.”

Answer: D

53

To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do?

A) Leave the patient alone to rest in a quiet, calm environment.

B) Stay with the patient and encourage slow, pursed lip breathing.

C) Reassure the patient that the attack can be controlled with treatment.

D) Let the patient know that frequent monitoring is being done using measurement of vital signs and SpO2.

Answer: B

54

When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse instruct the patient to do?

A) Carry the flowmeter with the patient at all times in case an asthma attack occurs.

B) Use the flowmeter to check the status of the patient's asthma every time the patient takes quick-relief medication.

C) Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone.

D) Use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible.

Answer: C

55

The nurse recognizes that additional teaching is needed when the patient with asthma says

A) “I should exercise every day if my symptoms are controlled.”

B) “I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness.”

C) “I should inform my spouse about my medications and how to get help if I have a
severe asthma attack.”

D) “A diary to record my medication use, symptoms, peak expiratory flow rates, and
activity levels will help in adjusting my therapy.”

Answer: B

56

Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking?

A) Bronchospasm and hoarseness

B) Decreased mucus secretions and cough

C) Increased function of alveolar macrophages

D) Increased risk of infection and hyperplasia of mucous glands

Answer: D

57

What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD?

A) Increased viscosity of the blood

B) Alveolar hypoxia and hypercapnia

C) Long-term low-flow oxygen therapy

D) Administration of high concentrations of oxygen

Answer: B

58

In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease?

A) Use of bronchodilator drugs

B) Use of inhaled corticosteroids

C) Lung volume–reduction surgery

D) Prevention of respiratory tract infections

Answer: D

59

Which method of oxygen administration is the safest system to use for a patient with COPD exacerbation?

A) Venturi mask

B) Nasal cannula

C) Simple face mask

D) Non-rebreather mask

Answer: A

60

What is characteristic of a partial rebreather mask?

A) Used for long-term O2 therapy

B) Reservoir bag conserves oxygen

C) Provides highest oxygen concentrations

D) Most comfortable and causes the least restriction on activities

Answer: B

61

A patient is being discharged with plans for home O2 therapy provided by an O2 concentrator with a portable O2-concentrator unit. In preparing the patient to use the equipment, what should the nurse teach the patient?

A) The portable unit will last about 6 to 8 hours.

B) The unit is strictly for portable and emergency use.

C) The unit concentrates O2 from the air, providing a continuous O2 supply.

D) Weekly delivery of one large cylinder of O2 will be necessary for a 7- to 10-day supply of O2.

Answer: C

62

Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation?

A) Huff coughing

B) Thoracic breathing

C) Pursed lip breathing

D) Diaphragmatic breathing

Answer: C

63

What does the nurse include when planning for postural drainage for the patient with COPD?

A) Schedules the procedure 1 hour before and after meals

B) Has the patient cough before positioning to clear the lungs

C) Assesses the patient's tolerance for dependent (head-down) positions

D) Ensures that percussion and vibration are performed before positioning the patient

Answer: C

64

Which dietary modification helps to meet the nutritional needs of patients with COPD?

A) Eating a high-carbohydrate, low-fat diet

B) Avoiding foods that require a lot of chewing

C) Preparing most foods of the diet to be eaten hot

D)Drinking fluids with meals to promote digestion

Answer: B

65

The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)?

A) Assist the patient to get out of bed.

B) Auscultate breath sounds every 4 hours.

C) Plan patient activities to minimize exertion.

D) Teach the patient pursed lip breathing technique.

Answer: A

66

Which medication is a long-acting β2-adrenergic agonist and DPI that is used only for COPD?

A) Roflumilast (Daliresp)

B) Salmeterol (Serevent)

C) Ipratropium (Atrovent HFA)

D) Indacaterol (Arcapta Neohaler)

Answer: D

67

During an acute exacerbation of mild COPD, the patient is severely short of breath, and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to alveolar hypoventilation and anxiety. What is the best nursing action?

A) Prepare and administer routine bronchodilator medications.

B) Perform chest physiotherapy to promote removal of secretions.

C) Administer oxygen at 5 L/min until the shortness of breath is relieved.

D) Position the patient upright with the elbows resting on the over-the-bed table.

Answer: D

68

The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurse's best response?

A) “You need to discuss your feelings and needs with your wife so that she knows what you expect of her.”

B) “There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath.”

C) “You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity.”

D) “Would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?”

Answer: D

69

What should the nurse include when teaching the patient with COPD about the need for physical exercise?

A) All patients with COPD should be able to increase walking gradually up to 20 minutes per day.

B) A bronchodilator inhaler should be used to relieve exercise-induced dyspnea immediately after exercise.

C) Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise.

D) Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.

Answer: C

70

The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 <60 mm Hg or SaO2 <88%) and hypercapnia (PaCO2 >45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure?

A) pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg

B) pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg

C) pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg

D) pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg

Answer: B

71

What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease?

A) Fibrosis of mucous glands and destruction of bronchial walls

B) Destruction of lung parenchyma from inflammation and scarring

C) Production of secretions low in sodium chloride and resulting thickened mucus

D) Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa

Answer: C

72

What is the most effective treatment for cystic fibrosis?

A) Heart-lung transplant

B) Administration of prophylactic antibiotics

C) Administration of nebulized bronchodilators

D) Vigorous and consistent airway clearance techniques

Answer: D

73

Meeting the developmental tasks of young adults with cystic fibrosis becomes a major problem primarily because

A) they eventually need a lung transplant.

B) they must also adapt to a chronic disease.

C) any children they have will develop cystic fibrosis.

D) their illness keeps them from becoming financially independent.

Answer: B

74

In an adult patient with bronchiectasis, what is a nursing assessment likely to reveal?

A) Chest trauma

B) Childhood asthma

C) Smoking or oral tobacco use

D) Recurrent lower respiratory tract infections

Answer: D

75

In planning care for the patient with bronchiectasis, which nursing intervention is the priority?

A) Relieve or reduce pain

B) Prevent paroxysmal coughing

C) Prevent spread of the disease to others

D) Promote drainage and removal of mucus

Answer: D

76

Which obstructive pulmonary disease would a 30-yr-old white female patient with a parent with the disease be most likely to be diagnosed with?

A) COPD

B) Asthma

C) Cystic fibrosis

D) α1-Antitrypsin (AAT) deficiency

Answer: D

77

What is the primary principle involved in the various airway clearance devices used for mobilizing secretions?

A) Vibration

B) Inhalation therapy

C) Chest physiotherapy

D) Positive expiratory pressure

Answer: D

78

Which statement about sleep is accurate?

A) Lack of sleep causes medical and psychiatric disorders.

B) Adults generally require at least 5 hours of sleep every 24 hours.

C) During sleep an individual is not consciously aware of his or her environment.

D) Less than 10% of adults report at least one sleep problem, such as difficulty falling asleep.

Answer: C

79

What is a typical parasomnia?

A) Cataplexy

B) Hypopnea

C) Sleep apnea

D) Sleep terrors

Answer: D

80

What controls the cyclic changes between waking and sleep?

A) Fluctuating levels of melatonin

B) The environmental light-dark cycles

C) Suprachiasmatic nucleus in hypothalamus

D) A variety of neurotransmitters released from the nervous system

Answer: C

81

What is the best therapy to try first for insomnia?

A) Complementary therapies such as melatonin

B) Cognitive-behavioral therapies such as relaxation therapy

C) Benzodiazepine-receptor agents (e.g., zolpidem [Ambien])

D) Over-the-counter medications such as diphenhydramine

Answer: B

82

The nurse knows that a patient taught sleep hygiene practices needs further instruction when he says

A) “Once I go to bed, I should get up if I am not asleep after 20 minutes.”

B) “It's okay to have my usual two glasses of wine in the evening before bed.”

C) “A couple of crackers with cheese and a glass of milk may help to relax before
bed.”

D) “I should go to the gym earlier in the day so that I'm done at least 6 hours before bedtime.”

Answer: B

83

The patient is complaining of insomnia and daytime fatigue. Which beverage would be the best option for this patient with an afternoon snack?

A) Diet Coke

B) Dr. Pepper

C) Decaffeinated coffee

D) A&W root beer float

Answer: D

84

A nurse caring for a patient in the intensive care unit (ICU) implements strategies to create an environment conducive to sleep. Which strategy would be most effective?

A) Turning off the lights in the room during the night

B) Having the television on at all times for background noise

C) Silencing the alarms on the bedside monitor and infusion pumps

D) Administering ordered analgesics around the clock, even if the patient denies pain

Answer: A

85

Which medication is a nonamphetamine wake-promotion drug that may be used for
narcolepsy?

A) Modafinil (Provigil)

B) Suvorexant (Belsomra)

C) Protriptyline (Vivactil)

D) Desipramine (Norpramin)

Answer: A

86

he health care provider has ordered continuous positive airway pressure (CPAP) for a patient with serious obstructive sleep apnea. How will CPAP help the patient?

A) Prevent airway occlusion by bringing the tongue forward

B) Be easily tolerated by both the patient and patient's bed partner

C) Provide enough positive pressure in the airway to prevent airway collapse

D) Deliver a high inspiratory pressure and a low expiratory pressure to prevent airway collapse

Answer: C

87

While caring for a patient following an uvulopalatopharyngoplasty (UPPP), the nurse monitors the patient for which complications in the immediate postoperative period?

A) Snoring and foul-smelling breath

B) Infection and electrolyte imbalance

C) Loss of voice and severe sore throat

D) Airway obstruction and hemorrhage

Answer: D

88

An older patient asks the nurse why she has so much trouble sleeping. What is the most appropriate response by the nurse?

A) “Disturbed sleep is a normal result of aging.”

B) “Have you tried any over-the-counter medications to help you sleep?”

C) “Don't worry. You don't need as much sleep as you did when you were younger.”

D) “Tell me more about the trouble you are having. There may be some things we can
do to help.”

Answer: D