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Med-Surg Lewis Chapter 28 NCLEX Lower Respiratory Problems
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Med-Surg Lewis Chapter 28 NCLEX LowerRespiratory Problems
A lobectomy is scheduled for a patient with stage I non-small cell lung cancer. The
patient tells the nurse, "I would rather have chemotherapy than surgery." Which
response by the nurse is most appropriate?
a. "Are you afraid that the surgery will be very painful?"
b. "Did you have bad experiences with previous surgeries?"
c. "Surgery is the treatment of choice for stage I lung cancer."
d. "Tell me what you know about the various treatments available." - ANS-ANS: D
More assessment of the patient's concerns about surgery is indicated. An open-ended
response will elicit the most information from the patient. The answer beginning,
"Surgery is the treatment of choice" is accurate, but it discourages the patient from
sharing concerns about surgery. The remaining two answers indicate that the nurse has
jumped to conclusions about the patient's reasons for not wanting surgery.
Chemotherapy is the primary treatment for small cell lung cancer. In non-small cell lung
cancer, chemotherapy may be used in the treatment of nonresectable tumors or as
adjuvant therapy to surgery
A patient experiences a chest wall contusion as a result of being struck in the chest with
a baseball bat. The emergency department nurse would be most concerned if which
finding is observed during the initial assessment?
a. Paradoxic chest movement
b. Complaint of chest wall pain
c. Heart rate of 110 beats/minute
d. Large bruised area on the chest - ANS-ANS: A
Paradoxic chest movement indicates that the patient may have flail chest, which can
severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall
pain, a slightly elevated pulse rate, and chest bruising all require further assessment or
intervention, but the priority concern is poor gas exchange.
A patient has acute bronchitis with a nonproductive cough and wheezes. Which topic
should the nurse plan to include in the teaching plan?
a. Purpose of antibiotic therapy
b. Ways to limit oral fluid intake
c. Appropriate use of cough suppressants
d. Safety concerns with home oxygen therapy - ANS-ANS: C
,Cough suppressants are frequently prescribed for acute bronchitis. Because most acute
bronchitis is viral in origin, antibiotics are not prescribed unless there are systemic
symptoms. Fluid intake is encouraged. Home oxygen is not prescribed for acute
bronchitis, although it may be used for chronic bronchitis.
A patient has just been admitted with probable bacterial pneumonia and sepsis. Which
order should the nurse implement first?
a. Chest x-ray via stretcher
b. Blood cultures from two sites
c. Ciprofloxacin (Cipro) 400 mg IV
d. Acetaminophen (Tylenol) rectal suppository - ANS-ANS: B
Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be
obtained before antibiotic administration. The chest x-ray and acetaminophen
administration can be done last.
A patient is admitted to the emergency department with an open stab wound to the left
chest. What is the first action that the nurse should take?
a. Position the patient so that the left chest is dependent.
b. Tape a nonporous dressing on three sides over the chest wound.
c. Cover the sucking chest wound firmly with an occlusive dressing.
d. Keep the head of the patient's bed at no more than 30 degrees elevation. -
ANS-ANS: B
The dressing taped on three sides will allow air to escape when intrapleural pressure
increases during expiration, but it will prevent air from moving into the pleural space
during inspiration. Placing the patient on the left side or covering the chest wound with
an occlusive dressing will allow trapped air in the pleural space and cause tension
pneumothorax. The head of the bed should be elevated to 30 to 45 degrees to facilitate
breathing
A patient is admitted with active tuberculosis (TB). The nurse should question a health
care provider's order to discontinue airborne precautions unless which assessment
finding is documented?
a. Chest x-ray shows no upper lobe infiltrates.
b. TB medications have been taken for 6 months.
c. Mantoux testing shows an induration of 10 mm.
d. Three sputum smears for acid-fast bacilli are negative. - ANS-ANS: D
Negative sputum smears indicate that Mycobacterium tuberculosis is not present in the
sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays
are not used to determine whether treatment has been successful. Taking medications
for 6 months is necessary, but the multidrug-resistant forms of the disease might not be
, eradicated after 6 months of therapy. Repeat Mantoux testing would not be done
because the result will not change even with effective treatment.
A patient is diagnosed with both human immunodeficiency virus (HIV) and active
tuberculosis (TB) disease. Which information obtained by the nurse is most important to
communicate to the health care provider?
a. The Mantoux test had an induration of 7 mm.
b. The chest-x-ray showed infiltrates in the lower lobes.
c. The patient is being treated with antiretrovirals for HIV infection.
d. The patient has a cough that is productive of blood-tinged mucus. - ANS-ANS: C
Drug interactions can occur between the antiretrovirals used to treat HIV infection and
the medications used to treat TB. The other data are expected in a patient with HIV and
TB.
A patient who has a right-sided chest tube following a thoracotomy has continuous
bubbling in the suction-control chamber of the collection device. Which action by the
nurse is most appropriate?
a. Document the presence of a large air leak.
b. Notify the surgeon of a possible pneumothorax.
c. Take no further action with the collection device.
d. Adjust the dial on the wall regulator to decrease suction. - ANS-ANS: C
Continuous bubbling is expected in the suction-control chamber and indicates that the
suction-control chamber is connected to suction. An air leak would be detected in the
water-seal chamber. There is no evidence of pneumothorax. Increasing or decreasing
the vacuum source will not adjust the suction pressure. The amount of suction applied is
regulated by the amount of water in this chamber and not by the amount of suction
applied to the system.
A patient who has just been admitted with community-acquired pneumococcal
pneumonia has a temperature of 101.6° F with a frequent cough and is complaining of
severe pleuritic chest pain. Which prescribed medication should the nurse give first?
a. Codeine
b. Guaifenesin (Robitussin)
c. Acetaminophen (Tylenol)
d. Piperacillin/tazobactam (Zosyn) - ANS-ANS: D
Early initiation of antibiotic therapy has been demonstrated to reduce mortality. The
other medications are also appropriate and should be given as soon as possible, but the
priority is to start antibiotic therapy.
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