Question 1

When caring for a pt w/acute bronchitis, the nurse will prioritize interventions by...?

Accepted Answer

Auscultating lung sounds
Rational:
Assessing lung sounds is a priority nursing intervention for patients with bronchitis. Evidence of consolidation would indicate progression of bronchitis to pneumonia.

Question 2

Which pt's have the greatest r/o aspiration pneumonia?

Accepted Answer

a) pt w/seizures
b) pt w/head injury
e) pt receiving NG tube feeds
Rational
Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., due to seizures, anesthesia, head injury, stroke, oralcohol intake), difficulty swallowing, and nasogastric tubes with or without tube feeding.

Question 3

An appropriate NI to assist a pt w/pneumonia manage thick secretions and fatigue would be to...

Accepted Answer

Teach pt to cough effectively & expectorate secretions
A forced expiratory technique (i.e., huff coughing) clears secretions with less change in pleural pressure and less risk of bronchial collapse.
 Before the patient attempts coughing, the nurse should ensure the patient is breathing deeply from the diaphragm by placing hands on the patient’s lower lateral chest wall then ask the patient to breathe deeply through the nose. Nurse’s hands should move outward, which represents a breath from the diaphragm.

Question 4

A pt w/TB is admitted & placed on airborne precautions & placed in isolation room.  What should the nurse teach the pt?

Accepted Answer

c) Adherence to precautions includes coughing into kleenex
d) take meds for full length of time to avoid MDR-TB
e) wear standard isolation mask if leaving the room
To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for a minimum of 3 months. If pt needs 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.

Question 5

A pt has been receiving high-dose cortiosteroids & broad spectrum antbx to treat an infection following a traumatic injury.  The nurse plans care for the pt knowing that they are most susceptible to...

Accepted Answer

a) candidiasis
Pulmonary fungal infections occur most often in seriously ill patients being treated with corticosteroids, chemotherapy, and immunosuppressive drugs or with multiple antibiotics and in patients with human immunodeficiency virus (HIV) infection and cystic fibrosis. Candida albicansis the leading cause of fungal infections.

Question 6

When caring for a pt w/a lung abscess, what is the nurses priority intervention?

Accepted Answer

b) antibiotic administration
IV antibiotic therapy should be started as soon as possible. Postural drainage is not recommended because it may spread infection into other bronchi.

Question 7

You are caring for a pt exposed to a chlorine leak from a local factory.  The nurse monitors the pt closely for....

Accepted Answer

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

Question 8

The nurse receives an order for a pt w/lung cancer to receive influenza & pneumococcal vaccine.  The nurse will...?

Accepted Answer

b) give both vaccines at same time in different arms.

Patients at risk for pneumonia (e.g., patients with lung cancer) should have influenza and pneumococcal vaccines. The vaccines may be given at the same time in different arms

Question 9

The nurse identifies a flail chest in a trauma pt when...

Accepted Answer

c) paradoxical chest movement occurs during respiration
Flail chest causes paradoxical 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 10

The nurse notes tidaling of water level in the water seal chamber in a pt w/ closed chest tube drainage. The nurse should

Accepted Answer

a) continue to monitor pt

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 11

After a pneumonectomy, an appropriate NI is...

Accepted Answer

c) doing range-of-motion exercises on the affected upper limb
Teach a patient who has had a pneumonectomy (removal of 1 whole lung) to perform range-of-motion exercises on the surgical side that are similar to those for patients who have undergone mastectomy

Question 12

A priority NI for a pt who has just undergone a chemical pleurodesis for recurrent pleural effusion is...

Accepted Answer

a) giving ordered analgesics

Chemical pleurodesis involves 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 given.

Question 13

When planning care for a pt at r/f PE, the nurse prioritizes what ?

Accepted Answer

b) using intermittent pneumatic compression devices (SCD's)

Deep vein thrombosis (DVT) is the main cause of pulmonary embolism. Preventing VTE with the use of intermittent pneumatic compression devices, early ambulation, and prophylactic anticoagulant agents would be priority nursing interventions

Question 14

Which statement describes the management of a pt following lung transplantation?

Accepted Answer

b) Use home spirometer to monitor lung fx
c) Immunosuppressant therapy is usually a 3 drug regimen
e) a lung biopsy is done via trans-tracheal method if rejection is suspected
Acute rejection after lung transplantation is common. Accurate diagnosis is achieved by transtracheal biopsy. Home spirometry has been useful in monitoring trends in lung function. Teach patients to keep medication logs, document labs & spirometer reads. Immunosuppressive therapy usually includes a 3 drug regimen

Question 15

While ambulating a patient with metastatic lung cancer, the nurse observes a decrease in oxygen saturation from 93% to 86%. Which nursing action is most appropriate?

Accepted Answer

Obtain a provider’s order for supplemental oxygen.
Rationale:
An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen.

Question 16

A patient with a persistent cough is diagnosed with pertussis. What medication does the nurse anticipate administering to this patient?

Accepted Answer

Antibiotic
Rationale:
Pertussis, unlike acute bronchitis, is caused by a gram-negative bacillus, Bordetella pertussis, which must be treated with antibiotics.

Question 17

The nurse teaches a pt w/a PE how to admin enoxaparin after discharge.  What statement shows that the teaching was understood?

Accepted Answer

“The medicine will be prescribed for 10 days.”
Rationale:
Enoxaparin is a low-molecular-weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots.

Question 18

An older adult patient living alone is admitted to the hospital with pneumococcal pneumonia. Which clinical manifestation is consistent with the patient being hypoxic?

Accepted Answer

Sudden onset of confusion
Rationale:
Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient.

Question 19

The nurse is caring for a patient with a fever due to pneumonia. What assessment data does the nurse obtain that correlates with the patient having a fever? (Select all that apply.)

Accepted Answer

A temperature of 101.4° F
Heart rate of 120 beats/min
A productive cough with yellow sputum

Rationale:
A fever is an inflammatory response related to the infectious process. A productive cough with discolored sputum (which should be clear) is an indication that the patient has pneumonia.

Question 20

The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse understand is the reason for using this type of surgery?

Accepted Answer

Less discomfort and faster return to normal activity.
Rationale:
The VATS procedure uses minimally invasive incisions that cause less discomfort and allow faster healing and return to normal activity as well as lower morbidity risk and fewer complications. A chest tube will be needed postoperatively for VATS.

Question 21

The nurse is caring for a postoperative patient with impaired airway clearance. What nursing actions would promote airway clearance? (Select all that apply.)

Accepted Answer

Maintain adequate fluid intake.

Splint the chest when coughing.

Teach the patient to cough at end of exhalation.
Rationale:
Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should teach the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. Incentive spirometry promotes lung expansion.

Question 22

An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action is most appropriate during admission of this patient?

Accepted Answer

Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.
Rationale:
Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system.

Question 23

The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic?

Accepted Answer

Obtain a sputum specimen for culture and Gram stain.
Rationale:
A sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks.

Question 24

The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. What should the nurse assess this patient for?

Accepted Answer

Mucociliary clearance
Rationale:
Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.

Question 25

After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which provider orders must the nurse verify have been completed before administering a dose of cefuroxime?

Accepted Answer

Sputum culture and sensitivity
Rationale:
The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime because this is community-acquired pneumonia. It is important that the organisms are correctly identified (by the culture) before the antibiotic takes effect. The test will also determine whether the proper antibiotic has been ordered (sensitivity testing).

Question 26

The nurse is caring for a group of patients. Which patient is at risk of aspiration?

Accepted Answer

A 26-yr-old patient with continuous enteral feedings through a nasogastric tube
Rationale:
Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without enteral nutrition. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur.

Question 27

A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and now has exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient?

Accepted Answer

Bronchiolitis obliterans (BOS)
Rationale:
BOS is a manifestation of chronic rejection and is characterized by airflow obstruction progressing over time with a gradual onset of exertional dyspnea, nonproductive cough, wheezing, and/or low-grade fever.

Question 28

The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of a fungal lung infection with Candida albicans. What patient statement indicates to the nurse that further teaching is required?

Accepted Answer

“I need to be isolated from my family and friends so they won’t get it.”
Rationale:
The patient with an opportunistic fungal infection does not need to be isolated because it is not transmitted from person to person.

Question 29

The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that “something is wrong.” Temperature is 98.4° F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action?

Accepted Answer

Sit the patient up in bed as tolerated and apply oxygen.
Rationale:
The patient’s clinical picture is most likely pulmonary embolus, and the first action the nurse takes should be to assist with the patient’s respirations. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the health care provider.

Question 30

The nurse is admitting a patient with a diagnosis of pulmonary embolism. Which risk factors are a priority for the nurse to assess? (Select all that apply.)

Accepted Answer

Cancer
Obesity
Cigarette smoking
Prolonged air travel
Rationale:
An increased risk of pulmonary embolism is associated with obesity, cancer, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, and surgery within the previous 3 months, oral contraceptives and hormone therapy, heart failure, pregnancy, and clotting disorders.

Question 31

One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions?

Accepted Answer

Chest tube with a loose-fitting dressing
Rationale:
If the dressing at the CT insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water. Having more water will not contribute to an air leak, and it should not be drained from the CDS. No new drainage does not indicate an air leak but may indicate the CT is no longer needed

Question 32

During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive?

Accepted Answer

Pneumococcal
Rationale:
The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 years or older, or living in a long-term care facility.

Question 33

The nurse determines that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse?

Accepted Answer

“I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia’s resolution.”
Rationale:
The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. It may be important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks,

Question 34

The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation would the nurse expect to find?

Accepted Answer

Increased vocal fremitus on palpation
Rationale:
A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area

Question 35

During admission of a patient diagnosed with non–small cell lung cancer, the nurse questions the patient related to a history of which risk factors for this type of cancer? (Select all that apply.)

Accepted Answer

Asbestos exposure
Exposure to uranium
History of cigarette smoking
Rationale:
Non–small cell cancer is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium.

Question 36

The nurse is caring for a patient with impaired airway clearance. What is the priority nursing action to assist this patient to expectorate thick lung secretions?

Accepted Answer

Increase fluid intake to 3 L/day if tolerated.
Rationale:
Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily.

Question 37

A patient with a gunshot wound to the right side of the chest arrives in the emergency department with severe shortness of breath and decreased breath sounds on the right side of the chest. Which action should the nurse take immediately?

Accepted Answer

Cover the chest wound with a nonporous dressing taped on three sides.
Rationale:
The pt has a sucking chest wound (open pneumothorax). Air enters  pleural space through the chest wall during inspiration. Emergency treatment is covering the wound w/occlusive dressing that is secured on three sides. On inspiration, the dressing pulls against the wound, preventing air from entering the pleural space. During expiration, the dressing is pushed out and air escapes through the wound and from under the dressing.

Question 38

A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis?

Accepted Answer

IV antibiotic therapy will be started as soon as possible.
Rationale:
IV antibiotics are used until the patient and radiographs show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic as well as at the completion of the antibiotic therapy.

Question 39

The nurse is caring for a patient with unilateral lung cancer. What is the priority nursing action to enhance oxygenation in this patient?

Accepted Answer

Positioning patient with “good lung” down
Rationale:
Therapeutic positioning identifies the best position for the patient, thus assuring stable oxygenation status. Research indicates that positioning the pt w/unaffected lung (good) dependent best promotes oxygenation in patients w/unilateral lung disease. For bilateral lung disease, right lung down has best ventilation/perfusion. Inc fluids intake and  postural drainage will help airway clearance, but positioning is most best to enhance oxygenation.

Question 40

The nurse is performing a respiratory assessment.  Which finding best supports presence of ineffective airway clearance?

Accepted Answer

Basilar crackles
Rationale:
The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with impaired airway clearance because the patient is retaining secretions.

Ch 27

Lower Respiratory Problems

Question	Answer
When caring for a pt w/acute bronchitis, the nurse will prioritize interventions by...?	Auscultating lung sounds Rational: Assessing lung sounds is a priority nursing intervention for patients with bronchitis. Evidence of consolidation would indicate progression of bronchitis to pneumonia.
Which pt's have the greatest r/o aspiration pneumonia?	a) pt w/seizures b) pt w/head injury e) pt receiving NG tube feeds Rational Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., due to seizures, anesthesia, head injury, stroke, oralcohol intake), difficulty swallowing, and nasogastric tubes with or without tube feeding.
An appropriate NI to assist a pt w/pneumonia manage thick secretions and fatigue would be to...	Teach pt to cough effectively & expectorate secretions A forced expiratory technique (i.e., huff coughing) clears secretions with less change in pleural pressure and less risk of bronchial collapse. Before the patient attempts coughing, the nurse should ensure the patient is breathing deeply from the diaphragm by placing hands on the patient’s lower lateral chest wall then ask the patient to breathe deeply through the nose. Nurse’s hands should move outward, which represents a breath from the diaphragm.
A pt w/TB is admitted & placed on airborne precautions & placed in isolation room. What should the nurse teach the pt?	c) Adherence to precautions includes coughing into kleenex d) take meds for full length of time to avoid MDR-TB e) wear standard isolation mask if leaving the room To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for a minimum of 3 months. If pt needs 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.
A pt has been receiving high-dose cortiosteroids & broad spectrum antbx to treat an infection following a traumatic injury. The nurse plans care for the pt knowing that they are most susceptible to...	a) candidiasis Pulmonary fungal infections occur most often in seriously ill patients being treated with corticosteroids, chemotherapy, and immunosuppressive drugs or with multiple antibiotics and in patients with human immunodeficiency virus (HIV) infection and cystic fibrosis. Candida albicansis the leading cause of fungal infections.
When caring for a pt w/a lung abscess, what is the nurses priority intervention?	b) antibiotic administration IV antibiotic therapy should be started as soon as possible. Postural drainage is not recommended because it may spread infection into other bronchi.
You are caring for a pt exposed to a chlorine leak from a local factory. The nurse monitors the pt closely for....	a) Pulmonary edema Chemical pneumonitis results from exposure to toxic chemical fumes. In the acute scenario, lung injury is diffuse and characterized as pulmonary edema.
The nurse receives an order for a pt w/lung cancer to receive influenza & pneumococcal vaccine. The nurse will...?	b) give both vaccines at same time in different arms. Patients at risk for pneumonia (e.g., patients with lung cancer) should have influenza and pneumococcal vaccines. The vaccines may be given at the same time in different arms
The nurse identifies a flail chest in a trauma pt when...	c) paradoxical chest movement occurs during respiration Flail chest causes paradoxical 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
The nurse notes tidaling of water level in the water seal chamber in a pt w/ closed chest tube drainage. The nurse should	a) continue to monitor pt 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
After a pneumonectomy, an appropriate NI is...	c) doing range-of-motion exercises on the affected upper limb Teach a patient who has had a pneumonectomy (removal of 1 whole lung) to perform range-of-motion exercises on the surgical side that are similar to those for patients who have undergone mastectomy
A priority NI for a pt who has just undergone a chemical pleurodesis for recurrent pleural effusion is...	a) giving ordered analgesics Chemical pleurodesis involves 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 given.
When planning care for a pt at r/f PE, the nurse prioritizes what ?	b) using intermittent pneumatic compression devices (SCD's) Deep vein thrombosis (DVT) is the main cause of pulmonary embolism. Preventing VTE with the use of intermittent pneumatic compression devices, early ambulation, and prophylactic anticoagulant agents would be priority nursing interventions
Which statement describes the management of a pt following lung transplantation?	b) Use home spirometer to monitor lung fx c) Immunosuppressant therapy is usually a 3 drug regimen e) a lung biopsy is done via trans-tracheal method if rejection is suspected Acute rejection after lung transplantation is common. Accurate diagnosis is achieved by transtracheal biopsy. Home spirometry has been useful in monitoring trends in lung function. Teach patients to keep medication logs, document labs & spirometer reads. Immunosuppressive therapy usually includes a 3 drug regimen
While ambulating a patient with metastatic lung cancer, the nurse observes a decrease in oxygen saturation from 93% to 86%. Which nursing action is most appropriate?	Obtain a provider’s order for supplemental oxygen. Rationale: An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen.
A patient with a persistent cough is diagnosed with pertussis. What medication does the nurse anticipate administering to this patient?	Antibiotic Rationale: Pertussis, unlike acute bronchitis, is caused by a gram-negative bacillus, Bordetella pertussis, which must be treated with antibiotics.
The nurse teaches a pt w/a PE how to admin enoxaparin after discharge. What statement shows that the teaching was understood?	“The medicine will be prescribed for 10 days.” Rationale: Enoxaparin is a low-molecular-weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots.
An older adult patient living alone is admitted to the hospital with pneumococcal pneumonia. Which clinical manifestation is consistent with the patient being hypoxic?	Sudden onset of confusion Rationale: Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient.
The nurse is caring for a patient with a fever due to pneumonia. What assessment data does the nurse obtain that correlates with the patient having a fever? (Select all that apply.)	A temperature of 101.4° F Heart rate of 120 beats/min A productive cough with yellow sputum Rationale: A fever is an inflammatory response related to the infectious process. A productive cough with discolored sputum (which should be clear) is an indication that the patient has pneumonia.
The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse understand is the reason for using this type of surgery?	Less discomfort and faster return to normal activity. Rationale: The VATS procedure uses minimally invasive incisions that cause less discomfort and allow faster healing and return to normal activity as well as lower morbidity risk and fewer complications. A chest tube will be needed postoperatively for VATS.
The nurse is caring for a postoperative patient with impaired airway clearance. What nursing actions would promote airway clearance? (Select all that apply.)	Maintain adequate fluid intake. Splint the chest when coughing. Teach the patient to cough at end of exhalation. Rationale: Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should teach the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. Incentive spirometry promotes lung expansion.
An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action is most appropriate during admission of this patient?	Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress. Rationale: Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system.
The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic?	Obtain a sputum specimen for culture and Gram stain. Rationale: A sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks.
The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. What should the nurse assess this patient for?	Mucociliary clearance Rationale: Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.
After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which provider orders must the nurse verify have been completed before administering a dose of cefuroxime?	Sputum culture and sensitivity Rationale: The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime because this is community-acquired pneumonia. It is important that the organisms are correctly identified (by the culture) before the antibiotic takes effect. The test will also determine whether the proper antibiotic has been ordered (sensitivity testing).
The nurse is caring for a group of patients. Which patient is at risk of aspiration?	A 26-yr-old patient with continuous enteral feedings through a nasogastric tube Rationale: Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without enteral nutrition. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur.
A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and now has exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient?	Bronchiolitis obliterans (BOS) Rationale: BOS is a manifestation of chronic rejection and is characterized by airflow obstruction progressing over time with a gradual onset of exertional dyspnea, nonproductive cough, wheezing, and/or low-grade fever.
The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of a fungal lung infection with Candida albicans. What patient statement indicates to the nurse that further teaching is required?	“I need to be isolated from my family and friends so they won’t get it.” Rationale: The patient with an opportunistic fungal infection does not need to be isolated because it is not transmitted from person to person.
The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that “something is wrong.” Temperature is 98.4° F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action?	Sit the patient up in bed as tolerated and apply oxygen. Rationale: The patient’s clinical picture is most likely pulmonary embolus, and the first action the nurse takes should be to assist with the patient’s respirations. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the health care provider.
The nurse is admitting a patient with a diagnosis of pulmonary embolism. Which risk factors are a priority for the nurse to assess? (Select all that apply.)	Cancer Obesity Cigarette smoking Prolonged air travel Rationale: An increased risk of pulmonary embolism is associated with obesity, cancer, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, and surgery within the previous 3 months, oral contraceptives and hormone therapy, heart failure, pregnancy, and clotting disorders.
One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions?	Chest tube with a loose-fitting dressing Rationale: If the dressing at the CT insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water. Having more water will not contribute to an air leak, and it should not be drained from the CDS. No new drainage does not indicate an air leak but may indicate the CT is no longer needed
During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive?	Pneumococcal Rationale: The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 years or older, or living in a long-term care facility.
The nurse determines that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse?	“I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia’s resolution.” Rationale: The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. It may be important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks,
The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation would the nurse expect to find?	Increased vocal fremitus on palpation Rationale: A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area
During admission of a patient diagnosed with non–small cell lung cancer, the nurse questions the patient related to a history of which risk factors for this type of cancer? (Select all that apply.)	Asbestos exposure Exposure to uranium History of cigarette smoking Rationale: Non–small cell cancer is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium.
The nurse is caring for a patient with impaired airway clearance. What is the priority nursing action to assist this patient to expectorate thick lung secretions?	Increase fluid intake to 3 L/day if tolerated. Rationale: Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily.
A patient with a gunshot wound to the right side of the chest arrives in the emergency department with severe shortness of breath and decreased breath sounds on the right side of the chest. Which action should the nurse take immediately?	Cover the chest wound with a nonporous dressing taped on three sides. Rationale: The pt has a sucking chest wound (open pneumothorax). Air enters pleural space through the chest wall during inspiration. Emergency treatment is covering the wound w/occlusive dressing that is secured on three sides. On inspiration, the dressing pulls against the wound, preventing air from entering the pleural space. During expiration, the dressing is pushed out and air escapes through the wound and from under the dressing.
A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis?	IV antibiotic therapy will be started as soon as possible. Rationale: IV antibiotics are used until the patient and radiographs show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic as well as at the completion of the antibiotic therapy.
The nurse is caring for a patient with unilateral lung cancer. What is the priority nursing action to enhance oxygenation in this patient?	Positioning patient with “good lung” down Rationale: Therapeutic positioning identifies the best position for the patient, thus assuring stable oxygenation status. Research indicates that positioning the pt w/unaffected lung (good) dependent best promotes oxygenation in patients w/unilateral lung disease. For bilateral lung disease, right lung down has best ventilation/perfusion. Inc fluids intake and postural drainage will help airway clearance, but positioning is most best to enhance oxygenation.
The nurse is performing a respiratory assessment. Which finding best supports presence of ineffective airway clearance?	Basilar crackles Rationale: The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with impaired airway clearance because the patient is retaining secretions.

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