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30 Cards in this Set
- Front
- Back
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ABG results for a patient with COPD would most likely indicate:
a. Respiratory alkalosis b. Metabolic alkalosis c. Respiratory acidosis d. Metabolic acidosis |
C. Respiratory acidosis
Gas exchange is affected by the increased work of breathing and the loss of alveolar tissue. Carbon dioxide is produced faster than it can be eliminated, resulting in carbon dioxide retention and respiratory acidosis |
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Type of drugs that help improve bronchial airflow by increasing bronchiolar smooth muscle relaxation
a. Corticosteroids b. Cholinergic antagonists c. Leukotriene antagonist d. NSAIDs |
B. Cholinergic antagonists
Cholinergic antagonist drugs (Ipratropium) causes bronchodilation by inhibiting the parasympathetic nervous system, allowing sympathetic nervous system to dominate, releasing norepinephrine that activates beta2 receptors Anti-inflammatories do not cause bronchodilation |
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A 45 year old patient in the unit who was diagnosed with chronic bronchitis is complaining to the nurse of chronic cough and thick, sticky mucous secretions. The nurse would administer which of the following drugs?
a. NSAID b. Mucolytic c. Anticoagulant d. Diuretic |
B. Mucolytics thin mucous secretions which makes them easier to expectorate
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Which of the following is true regarding the drug Albuterol?
a. It causes bronchodilation by inhibiting parasympathetic nervous system, releasing norepinephrine that activates beta2 receptors b. Onset of action is slow with a long duration c. Requires a specific blood level to work d. A fast-acting “rescue” drug |
D. Albuterol is a short-acting beta agonist (SABA) primarily used as a fast-acting “rescue” drug either during an attack or just before engaging in activity that usually triggers an attack
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A nurse in the acute care facility is about to teach a patient diagnosed with chronic bronchitis about the medication Prednisone. Which of the following teaching instructions by the nurse is not appropriate regarding administration of the drug?
a. Teach patient to avoid activities that can lead to injury b. Teach patient not to take drug with food c. Teach patient about numerous possible side effects d. Teach patient to not suddenly stop taking the drug for any reason |
B. Teach patient not to take drug with food
The drug should be taken with food to decrease the risk of GI ulceration |
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Which of the following are steps on how to do effective purse-lip breathing? [select all that apply]
a. Close mouth and breath in through the nose b. Puff cheeks while breathing out slowly through the mouth c. Use abdominal muscles to squeeze out air as you can d. Always inhale before beginning the activity and exhale while performing the activity e. When exhaling, spend at least twice the amount of time it took to breathe in |
a. Close mouth and breath in through the nose
c. Use abdominal muscles to squeeze out air as you can d. Always inhale before beginning the activity and exhale while performing the activity e. When exhaling, spend at least twice the amount of time it took to breathe in In purse-lip breathing, when exhaling, the person should breathe out slowly through the mouth without puffing the cheeks. Spend at least twice the amount of time it took to breathe in |
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A 65 year old patient in the acute care facility is presenting signs and symptoms of influenza. To confirm this diagnosis, the nurse would assess for all of the following signs or symptoms except:
a. Fatigue b. Weakness c. Night sweats d. Fever |
C. Night sweats
Night sweats is a classical symptom of TB |
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A nurse in the ICU is ordered to administer medication to a 55 year old patient who was diagnosed with influenza. Which of the following drugs would the nurse administer regarding the patient’s diagnosis?
a. Ceftriaxone (Rocephin) b. Levofloxacin (Levaquin) c. Linezolid (Zyvox) d. Amantadine (Symmetrel) |
D. Amantadine (Symmetrel)
Viral infections don’t respond to traditional antibiotic therapy. (Rocephin, Levaquin, Zyvox). Antiviral agents (Symmetrel) may be effective for prevention and treatment of some types of influenza. |
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When caring for patients who are suspected to have the flu, nurses should know that the condition is most contagious at what time period?
a. 24 hours after the symptoms occur b. 24 hours before the symptoms occur c. 3 – 5 days before the symptoms occur d. 2 – 3 days before the symptoms occur |
B. 24 hours before symptoms occur
The condition is most contagious from 24 hours before the symptoms occur and up to 5 days after they begin |
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A nurse is caring for a 65 year old patient in the emergency department, assessment findings are T= 100.1F, R= 34, B/P= 136/88, P= 70, pulse ox= 88%. Past medical history includes COPD, and chronic cough. Further assessment shows presence of fluid in the lungs. The patient would most likely be diagnosed with:
a. Influenza b. Lung cancer c. Pneumonia d. Tuberculosis |
C. Pneumonia
Pneumonia is a condition where there is excess fluid in the lungs resulting from an inflammatory process |
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An ICU nurse is caring for a 65 year old patient diagnosed with COPD who had a recent aspiration event. Once the patient is in a stable condition, the primary healthcare provider ordered the nurse to administer medications to the patient. Which of the following medications should the nurse question?
a. Cimetidine (Tagamet) b. Guaifenesin (Robitussin) c. Salmeterol (Serevent) d. Fluticasone (Flovent) |
A. Cimetidine (Tagamet)
Older adult patients who have a chronic lung disease, has had a recent aspiration event, and uses drugs that increase gastric pH (histamine [H2] blockers – Cimetidine, or antacids) are at a high risk for acquiring pneumonia (hospital-acquired) |
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The nurse is providing care to a client who is receiving mechanical ventilation. Which nursing action should be implemented to prevent ventilator-acquired pneumonia (VAP) for this client?
a. Position the client on his side b. Verifying the client has received pneumonia vaccination c. Ensuring oxygen delivered is humidified d. Provide oral care every 8 hours |
D. Provide oral care every 8 hours
Oral care, in particular, can help reduce the risk because many of the most common organisms causing VAP are translocated from the client’s mouth into the respiratory tract. The client should be maintained with the head of the bed elevated to at least 30 degrees to prevent reflux and aspiration of stomach contents. The pneumonia vaccination is effective only against certain respiratory organisms and not against the organisms that colonize the oral cavity or digestive tract. Lack of humidification is not associated with pneumonia. |
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The most common manifestation of pneumonia in the older adult patient is ____
a. Fever b. Persistent cough c. Night sweats d. Confusion |
D. Confusion
The most common manifestation of pneumonia in the older adult is acute confusion from hypoxia rather than fever or cough. |
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A nurse is tasked to do an initial assessment of a patient in the emergency department who is showing symptoms of pneumonia. When observing the general appearance of the patient with pneumonia, the nurse should note that the patient is most likely:
a. Withdrawn b. Anxious c. Calm d. Unconscious |
B. Anxious
Patients with pneumonia often have pain, fatigue, and dyspnea, all of which promote anxiety. Assess anxiety by looking at facial expression and general tenseness of facial and shoulder muscles. |
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All of the following are common complications of pneumonia except:
a. CO2 retention b. Atelectasis c. Hypoxemia d. Cyanosis |
A. CO2 retention
In pneumonia, oxygen is the gas exchange affected most; therefore hypoxemia is the primary problem. Carbon dioxide retention is not common in pneumonia. |
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A patient diagnosed with TB is put in what type of isolation / precautions?
a. Solitary confinement b. Droplet isolation c. Contact isolation d. Airborne isolation |
D. Airborne isolation
TB is a highly communicable disease that is transmitted via aerosolization (airborne route). When a person with active TB sneezes, coughs, laughs, whistles, droplets become airborne and may be inhaled by others |
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Which of the following is true regarding TB? [select all that apply]
a. It has a fast, and acute onset b. Many patients aren’t aware of symptoms until disease is advanced c. Anyone who has received the BCG vaccine within the previous 10 years will have a positive skin test d. BCG vaccine is the only preferred vaccine for TB in the United States |
B. Many patients aren’t aware of symptoms until disease is advanced
C. Anyone who has received the BCG vaccine within the previous 10 years will have a positive skin test TB has a slow, gradual onset and the effectiveness of BCG vaccine in preventing TB is controversial and it isn’t used for this purpose in the United States |
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A 45 year old patient in the local health clinic got a tuberculin (Mantoux) skin test. The nurse ordered the patient to come back in 2 – 3 days to read the results. The nurse would know that an indication of exposure to and infection with TB would be:
a. An area of induration on the injection site measuring 10mm or greater in diameter b. An area of induration on the injection site less than 10mm in diameter c. Blue / cyanotic area around the injection site d. No skin response |
A. An area of induration on the injection site measuring 10mm or greater in diameter
The tuberculin (Mantoux) test is the most commonly used reliable test of TB infection. It is given intradermally and an area of induration (not just redness) on injection site measuring 10mm or greater in diameter 48 – 72 hours after injection indicates exposure to and infection with TB |
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A 45 year old patient in the local community hospital is diagnosed with TB. Which of the following drugs would the nurse anticipate to give the patient as part of the first-line therapy?
a. Vancomycin b. Tamiflu c. Albuterol d. Isoniazid |
D. Isoniazid
Combination drug therapy is the most effective method of treating TB and preventing transmission. Current first-line therapy uses Isoniazid (INH) and Rifampin throughout therapy. |
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The charge nurse in a local community hospital is teaching her patient diagnosed with TB about the medications, Isoniazid (INH) and Rifampin. Which of the following would be considered the nurse’s top priority in patient teaching regarding the drugs?
a. Social support b. Patient compliance c. Patient’s financial resources d. Other healthcare resources |
B. Patient compliance
For TB, nursing interventions focus on patient teaching for drug therapy adherence and infection control – stressing the importance of taking each drug regularly, exactly as prescribed, for as long as it is prescribed. |
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The charge nurse in a local community hospital is teaching her patient diagnosed with TB about the medications, Isoniazid (INH) and Rifampin. Which of the following patient statements would indicate a need for more teaching by the nurse?
a. “I can take the drugs at bedtime” b. “I’ll eat foods rich in iron, protein, and vitamin B complex” c. “My urine may have a red-orange color” d. “I can stop taking the drugs after 2 – 3 weeks” |
D. “I can stop taking the drugs aftger 2 – 3 weeks”
Strict adherence to the prescribed drug regimen is crucial for suppressing the disease. Although the disease is usually no longer contagious after drugs have been taken for 2 – 3 consecutive weeks and clinical improvement has been seen, the patient must still continue taking the drugs as prescribed. TB drugs may cause nausea. Taking the daily dose at bedtime may prevent nausea Patients taking Rifampin may expect their urine to have a red-orange tinge |
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The charge nurse in a local community hospital is teaching her patient diagnosed with TB about the medications, Isoniazid (INH) and Rifampin. All of the following are appropriate nursing interventions for the patient except:
a. Teach patient to take multivitamins while taking the drugs b. Teach patient to expect the drug Rifampin to stain skin and soft contact lenses to become permanently stained c. Teach patient to take the drug Isoniazid (INH) with food d. Tell the patient that sputum specimens are needed once drug therapy is initiated |
C. Teach patient to take drugs with food
Food and antacids slow or prevent absorption of the drug from the GI tract |
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A patient in the ICU is diagnosed with TB. One of the medications prescribed to the patient is Pyrazinamide (PZA). One of the nursing interventions is to teach the patient to drink at least 8 ounces of water and to increase fluid intake. The appropriate rationale for the nursing intervention is:
a. Increasing fluid intake will help the body absorb the medication quickly b. It helps prevent uric acid from precipitating c. It helps prevent severe nausea and vomiting when taking the drug d. Increasing fluid intake helps the body retain the vitamins supposedly depleted by the drug |
B. It helps prevent uric acid from precipitating
The drug increases uric acid formation and for patients diagnosed with TB that have a history of gout, more fluids help prevent uric acid from precipitating and causing gout or kidney problems |
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A 55 year old woman who was diagnosed with TB 4 months ago called her niece who is a nursing student at Harper. She complains to her niece that she has been experiencing blurred vision and states “sometimes I don’t see colors”. Which of the following is the most appropriate response by the niece?
a. “That’s just a minor side effect of the drug you are taking” b. “You are experiencing the side effects because you might have missed a dose” c. “You should immediately report that to your primary healthcare provider” d. “You should increase your fluid intake so you won’t experience any side effects” |
C. “You should immediately report that to your primary healthcare provider”
The TB drug Ethambutol (EMB) can cause optic neuritis, especially at high doses, and can lead to blindness. When the problem is discovered early, the eye problems are usually reversed when the drug is stopped |
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In assessing a patient with COPD, the nurse would anticipate that the patient will show all these signs and symptoms except:
a. Decreased chest vibration (fremitus) b. Decreased weight c. Rapid, shallow respirations d. “pigeon chest” |
D. “Pigeon chest”
Chest vibrations (fremitus) is often decreased and chest sounds hyperresonant on percussion because of trapped air. Patients with COPD breathe with rapid, shallow respirations or use accessory muscles in the abdomen and neck. COPD increases metabolic needs as a result of increased work of breathing |
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Which of the following nursing interventions is most appropriate for a 75 year old COPD patient who is experiencing dyspnea, confusion and has a pulse ox reading of 86%?
a. Administer O2 at 5 – 6 L/min via nasal cannula b. Administer O2 at 1 – 2 L/min via nasal cannula c. Administer a dose of albuterol d. Call a code and get the crash cart ready |
B. administer O2 at 1 – 2L/min via nasal cannula
The patient who is hypoxemic requires lower dose of oxygen delivery (usually 1 – 2 L/min via nasal cannula). A low arterial oxygen level is the patient’s primary drive to breathe. Don’t increase oxygen flow rate because this may lower their respiration rate or even make them stop breathing simultaneously. |
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A patient with COPD complains to his nurse a sudden shortness of breath and states having a “tight chest”. Which of the following medications of the patient would the nurse administer first?
a. Guaifenesin (Robitussin) b. Albuterol (Proventil) c. Salmeterol (Serevent) d. Fluticasone (Flovent) |
B. Albuterol (Proventil)
Albuterol is a short-acting beta antagonist primarily used as a “rescue” drug either during symptomatic attacks or just before engaging in activity that usually triggers an attack |
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A nurse is doing a patient-discharge teaching with a patient diagnosed with COPD about his medication Theophylline (Theo-Dur). Which of the following restrictions should the nurse teach the patient regarding the drug?
a. Avoid caffeine b. Avoid foods that contain tyramine c. Avoid high-carb foods d. Avoid any dairy products |
A. Avoid caffeine
The drug is acts like caffeine to cause bronchodilation by relaxing bronchiolar smooth muscles. Taking the drug with caffeine increases the risk for toxicity |
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Which of the following nursing diagnosis is appropriate for a patient with COPD taking Corticosteroids?
a. Anxiety b. Risk for infection c. Risk for falls d. Risk for disturbed sleep pattern |
B. Risk for infection
COPD patients taking anti-inflammatory corticosteroids are at risk for developing an infection (Fluticasone [Flovent] – reduces local immunity and increases risk for local infections) (Prednisone [Deltasone] – reduces all protective inflammatory process, increasing the risk for infection) |
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Which assessment is most important for the nurse to perform on a patient with COPD receiving Albuterol (Ventolin)?
a. Measure intake and output b. Monitor pulse and BP c. Monitor temperature d. Assess for mental status |
B. Monitor pulse and BP
Albuterol (Ventolin) is a beta adrenergic agonist with a bronchodilating effect. Because adrenergic agonists mimic sympathetic stimulation, the patient must be monitored carefully for cardiac arrhythmias, hypertension, nervousness, and restlessness. |
