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NURS 3300 Quiz 2questions with Correct Answers
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NURS 3300 Quiz 2questions with Correct Answers
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NURS 3300 Quiz 2questions with CorrectAnswers
1. Which finding by the nurse most specifically indicates that a patient is
not able to effectively clear the airway?
a. Weak cough effort
b. Profuse green sputum
c. Respiratory rate of 28 breaths/min
d. Resting pulse oximetry (SpO2) of 85% Correct Answer ✓✓ ANS: A
The weak cough effort indicates that the patient is unable to clear the
airway effectively. The other data suggest problems with gas exchange
and breathing pattern.
2. The nurse assesses the chest of a patient with pneumococcal
pneumonia. Which finding would the nurse expect?
a. Increased tactile fremitus
b. Dry, nonproductive cough
c. Hyperresonance to percussion
d. A grating sound on auscultation Correct Answer ✓✓ ANS: A
Increased tactile fremitus over the area of pulmonary consolidation is
expected with bacterial pneumonias. Dullness to percussion would be
expected. Pneumococcal pneumonia typically presents with a loose,
,productive cough. Adventitious breath sounds such as crackles and
wheezes are typical. A grating sound is more representative of a pleural
friction rub rather than pneumonia.
3. A patient with bacterial pneumonia has coarse crackles and thick
sputum. Which action should the nurse plan to promote airway
clearance?
a. Restrict oral fluids during the day.
b. Encourage pursed-lip breathing technique.
c. Help the patient to splint the chest when coughing.
d. Encourage the patient to wear the nasal O2 cannula. Correct Answer
✓✓ ANS: C
Coughing is less painful and more likely to be effective when the patient
splints the chest during coughing. Fluids should be encouraged to help
liquefy secretions. Nasal O2 will improve gas exchange but will not
improve airway clearance. Pursed-lip breathing can improve gas
exchange in patients with chronic obstructive pulmonary disease but will
not improve airway clearance.
4. The nurse provides discharge instructions to a patient who was
hospitalized for pneumonia. Which statement by the patient indicates a
good understanding of the instructions?
a. "I will call my health care provider if I still feel tired after a week."
,b. "I will continue to do deep breathing and coughing exercises at
home."
c. "I will schedule two appointments for the pneumonia and influenza
vaccines."
d. "I will cancel my follow-up chest x-ray appointment if I feel better
next week." Correct Answer ✓✓ ANS: B
Patients should continue to cough and deep breathe after discharge.
Fatigue is expected for several weeks. The pneumococcal and influenza
vaccines can be given at the same time in different arms. A follow-up
chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of
pneumonia.
5. Which action should the nurse plan to prevent aspiration in a high-risk
patient?
a. Turn and reposition an immobile patient at least every 2 hours.
b. Place a patient with altered consciousness in a side-lying position.
c. Insert a nasogastric tube for feeding a patient with high-calorie needs.
d. Monitor respiratory symptoms in a patient who is immunosuppressed.
Correct Answer ✓✓ ANS: B
With loss of consciousness, the gag and cough reflexes are depressed,
and aspiration is more likely to occur. The risk for aspiration is
decreased when patients with a decreased level of consciousness are
placed in a side-lying or upright position. Frequent turning prevents
pooling of secretions in immobilized patients but will not decrease the
, risk for aspiration in patients at risk. Monitoring of parameters such as
breath sounds and O2 saturation will help detect pneumonia in
immunocompromised patients, but it will not decrease the risk for
aspiration. Conditions that increase the risk of aspiration include
decreased level of consciousness (e.g., seizure, anesthesia, head injury,
stroke, alcohol intake), difficulty swallowing, and nasogastric intubation
with or without tube feeding.
6. 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 is 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 6000/µL.
d. Increased tactile fremitus is palpable over the right chest. Correct
Answer ✓✓ ANS: C
The normal WBC count indicates that the antibiotics have been
effective. All the other data suggest that a change in treatment is needed.
7. The health care provider writes an order for bacteriologic testing for a
patient who has a positive tuberculosis skin test. Which action should
the nurse take?
a. Teach about the reason for the blood tests.
b. Schedule an appointment for a chest x-ray.
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