28 Flashcards
When developing a teaching plan for a patient with a 42 pack-year history of cigarette smoking, it will be most important for the nurse to include information about
a. computed tomography (CT) screening for lung cancer.
b. options for smoking cessation.
c. reasons for annual sputum cytology testing.
d. erlotinib (Tarceva) therapy to prevent tumor risk.
b. options for smoking cessation.
A lobectomy is scheduled for a patient with stage I non–small cell lung cancer. The patient tells the nurse, “I would rather have radiation 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.”
d. “Tell me what you know about the various treatments available.”
An hour after a thoracotomy, a patient complains of incisional pain at a level 7 out of 10 and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which action is best for the nurse to take next?
a. Administer the prescribed PRN morphine.
b. Assist the patient to deep breathe and cough.
c. Milk the chest tube gently to remove any clots.
d. Tape the area around the insertion site of the chest tube.
a. Administer the prescribed PRN morphine.
The health care provider inserts a chest tube in a patient with a hemopneumothorax. When monitoring the patient after the chest tube placement, the nurse will be most concerned about
a. a large air leak in the water-seal chamber.
b. 400 mL of blood in the collection chamber.
c. complaint of pain with each deep inspiration.
d. subcutaneous emphysema at the insertion site.
b. 400 mL of blood in the collection chamber.
A patient experiences a steering wheel injury as a result of an automobile accident. During the initial assessment, the emergency department nurse would be most concerned about
a. paradoxic chest movement.
b. the complaint of chest wall pain.
c. a heart rate of 110 beats/minute.
d. a large bruised area on the chest.
a. paradoxic chest movement.
When assessing a 24-year-old patient who has just arrived after an automobile accident, the emergency department nurse notes that the breath sounds are absent on the right side. The nurse will anticipate the need for
a. emergency pericardiocentesis.
b. stabilization of the chest wall with tape.
c. administration of an inhaled bronchodilator.
d. insertion of a chest tube with a chest drainage system.
d. insertion of a chest tube with a chest drainage system.
A patient who has a right-sided chest tube following a thoracotomy has continuous bubbling in the suction-control chamber of the collection device. The most appropriate action by the nurse is to
a. document the presence of a large air leak.
b. obtain and attach a new collection device.
c. notify the surgeon of a possible pneumothorax.
d. take no further action with the collection device.
d. take no further action with the collection device.
When providing preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung, the nurse informs the patient that the postoperative care includes
a. positioning on the right side.
b. bed rest for the first 24 hours.
c. frequent use of an incentive spirometer.
d. chest tubes to water-seal chest drainage.
c. frequent use of an incentive spirometer
To determine the effectiveness of prescribed therapies for a patient with cor pulmonale and right-sided heart failure, which assessment will the nurse make?
a. Lung sounds
b. Heart sounds
c. Blood pressure
d. Peripheral edema
d. Peripheral edema
A patient with primary pulmonary hypertension (PPH) is receiving nifedipine (Procardia). The nurse will evaluate that the treatment is effective if
a. the BP is less than 140/90 mm Hg.
b. the patient reports decreased exertional dyspnea.
c. the heart rate is between 60 and 100 beats/minute.
d. the patient’s chest x-ray indicates clear lung fields.
b. the patient reports decreased exertional dyspnea.
A patient with a pleural effusion is scheduled for a thoracentesis. Before the procedure, the nurse will plan to
a. start a peripheral intravenous line to administer the necessary sedative drugs.
b. position the patient sitting upright on the edge of the bed and leaning forward.
c. remove the water pitcher and remind the patient not to eat or drink anything for 6 hours.
d. instruct the patient about the importance of incentive spirometer use after the procedure.
b. position the patient sitting upright on the edge of the bed and leaning forward.
After discharge teaching has been completed for a patient who has had a lung transplant, the nurse will evaluate that the teaching has been effective if the patient states
a. “I will make an appointment to see the doctor every year.”
b. “I will not turn the home oxygen up higher than 2 L/minute.”
c. “I will not worry if I feel a little short of breath with exercise.”
d. “I will call the health care provider right away if I develop a fever.”
d. “I will call the health care provider right away if I develop a fever.”
Which assessment information obtained by the nurse when caring for a patient who has just had a thoracentesis is most important to communicate to the health care provider?
a. BP is 150/90 mm Hg.
b. Oxygen saturation is 89%.
c. Pain level is 5/10 with a deep breath.
d. Respiratory rate is 24 when lying flat.
b. Oxygen saturation is 89%.
A patient with a possible pulmonary embolism complains of chest pain and difficulty breathing. The nurse finds a heart rate of 142, BP reading of 100/60, and respirations of 42. The nurse’s first action should be to
a. elevate the head of the bed to 45 to 60 degrees.
b. administer the ordered pain medication.
c. notify the patient’s health care provider.
d. offer emotional support and reassurance.
a. elevate the head of the bed to 45 to 60 degrees.
After the nurse has received change-of-shift report about the following four patients, which patient should be assessed first?
a. A 77-year-old patient with tuberculosis (TB) who has four antitubercular medications due in 15 minutes
b. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled
c. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath.
d. A 35-year-old patient who was admitted the previous day with pneumonia and has a temperature of 100.2° F (37.8° C)
c. A 46-year-old patient who has a deep vein thrombosis and is complaining of sudden onset shortness of breath.
