Ch. 27

Question 1

A nurse obtains the health history of a client who is recently diagnosed with lung cancer and identifies that the client has a 60–pack-year smoking history. Which action is most important for the nurse to take when interviewing this client?
a.
Tell the client that he needs to quit smoking to stop further cancer development.
b.
Encourage the client to be completely honest about both tobacco and marijuana use.
c.
Maintain a nonjudgmental attitude to avoid causing the client to feel guilty.
d.
Avoid giving the client false hope regarding cancer treatment and prognosis.

Answer 1

c.
Maintain a nonjudgmental attitude to avoid causing the client to feel guilty.

ref. 494

Question 2

A nurse assesses a client after an open lung biopsy. Which assessment finding is matched with the correct intervention?
a.
Client states he is dizzy. – Nurse applies oxygen and pulse oximetry.
b.
Client’s heart rate is 55 beats/min. – Nurse withholds pain medication.
c.
Client has reduced breath sounds. – Nurse calls physician immediately.
d.
Client’s respiratory rate is 18 breaths/min. – Nurse decreases oxygen flow rate.

Answer 2

c.
Client has reduced breath sounds. – Nurse calls physician immediately.

ref. 512

Question 3

A nurse assesses a client’s respiratory status. Which information is of highest priority for the nurse to obtain?
a.
Average daily fluid intake
b.
Neck circumference
c.
Height and weight
d.
Occupation and hobbies

Answer 3

d.
Occupation and hobbies

ref. 496

Question 4

A nurse is caring for an older adult client who has a pulmonary infection. Which action should the nurse take first?
a.
Encourage the client to increase fluid intake.
b.
Assess the client’s level of consciousness.
c.
Raise the head of the bed to at least 45 degrees.
d.
Provide the client with humidified oxygen.

Answer 4

b.
Assess the client’s level of consciousness.

ref. 501

Question 5

A nurse is providing care after auscultating clients’ breath sounds. Which assessment finding is correctly matched to the nurse’s primary intervention?
a.
Hollow sounds are heard over the trachea. – The nurse increases the oxygen flow rate.
b.
Crackles are heard in bases. – The nurse encourages the client to cough forcefully.
c.
Wheezes are heard in central areas. – The nurse administers an inhaled bronchodilator.
d.
Vesicular sounds are heard over the periphery. – The nurse has the client breathe deeply.

Answer 5

c.
Wheezes are heard in central areas. – The nurse administers an inhaled bronchodilator.

ref. 506

Question 6

A nurse observes that a client’s anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question should the nurse ask the client in response to this finding?
a.
“Are you taking any medications or herbal supplements?”
b.
“Do you have any chronic breathing problems?”
c.
“How often do you perform aerobic exercise?”
d.
“What is your occupation and what are your hobbies?”

Answer 6

b.
“Do you have any chronic breathing problems?”

ref. 503

Question 7

A nurse is assessing a client who is recovering from a lung biopsy. Which assessment finding requires immediate action?
a.
Increased temperature
b.
Absent breath sounds
c.
Productive cough
d.
Incisional discomfort

Answer 7

b.
Absent breath sounds

ref. 512

Question 8

A nurse is caring for a client who is scheduled to undergo a thoracentesis. Which intervention should the nurse complete prior to the procedure?
a.
Measure oxygen saturation before and after a 12-minute walk.
b.
Verify that the client understands all possible complications.
c.
Explain the procedure in detail to the client and the family.
d.
Validate that informed consent has been given by the client.

Answer 8

d.
Validate that informed consent has been given by the client.

ref. 511

Question 9

A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action?
a.
The client rates pain as a 5/10 at the site of the procedure.
b.
A small amount of drainage from the site is noted.
c.
Pulse oximetry is 93% on 2 liters of oxygen.
d.
The trachea is deviated toward the opposite side of the neck.

Answer 9

d.
The trachea is deviated toward the opposite side of the neck.

ref. 511

Question 10

A nurse cares for a client who had a bronchoscopy 2 hours ago. The client asks for a drink of water. Which action should the nurse take next?
a.
Call the physician and request a prescription for food and water.
b.
Provide the client with ice chips instead of a drink of water.
c.
Assess the client’s gag reflex before giving any food or water.
d.
Let the client have a small sip to see whether he or she can swallow.

Answer 10

c.
Assess the client’s gag reflex before giving any food or water.

ref. 511

Question 11

A nurse plans care for a client who is experiencing dyspnea and must stop multiple times when climbing a flight of stairs. Which intervention should the nurse include in this client’s plan of care?
a.
Assistance with activities of daily living
b.
Physical therapy activities every day
c.
Oxygen therapy at 2 liters per nasal cannula
d.
Complete bedrest with frequent repositioning

Answer 11

a.
Assistance with activities of daily living

ref. 503

Question 12

A nurse teaches a client who is prescribed nicotine replacement therapy. Which statement should the nurse include in this client’s teaching?
a.
“Make a list of reasons why smoking is a bad habit.”
b.
“Rise slowly when getting out of bed in the morning.”
c.
“Smoking while taking this medication will increase your risk of a stroke.”
d.
“Stopping this medication suddenly increases your risk for a heart attack.”

Answer 12

c.
“Smoking while taking this medication will increase your risk of a stroke.”

ref. 495

Question 13

A nurse is caring for a client who received benzocaine spray prior to a recent bronchoscopy. The client presents with continuous cyanosis even with oxygen therapy. Which action should the nurse take next?
a.
Administer an albuterol treatment.
b.
Notify the Rapid Response Team.
c.
Assess the client’s peripheral pulses.
d.
Obtain blood and sputum cultures.

Answer 13

b.
Notify the Rapid Response Team.

ref. 510

Question 14

A nurse auscultates a harsh hollow sound over a client’s trachea and larynx. Which action should the nurse take first?
a.
Document the findings.
b.
Administer oxygen therapy.
c.
Position the client in high-Fowler’s position.
d.
Administer prescribed albuterol.

Answer 14

a.
Document the findings.

ref. 506

Question 15

A nurse assesses a client who is prescribed varenicline (Chantix) for smoking cessation. Which manifestations should the nurse identify as adverse effects of this medication? (Select all that apply.)
a.
Visual hallucinations
b.
Tachycardia
c.
Decreased cravings
d.
Impaired judgment
e.
Increased thirst

Answer 15

a.

Visual hallucinations

d.

Impaired judgment

ref. 496

Question 16

A nurse plans care for a client who is at high risk for a pulmonary infection. Which interventions should the nurse include in this client’s plan of care? (Select all that apply.)
a.
Encourage deep breathing and coughing.
b.
Implement an air mattress overlay.
c.
Ambulate the client three times each day.
d.
Provide a diet high in protein and vitamins.
e.
Administer acetaminophen (Tylenol) twice daily.

Answer 16

a.
Encourage deep breathing and coughing.

c.
Ambulate the client three times each day.
d.
Provide a diet high in protein and vitamins.

ref. 501

Question 17

A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements should the nurse include in communications with the respiratory therapist prior to the tests? (Select all that apply.)
a.
“I held the client’s morning bronchodilator medication.”
b.
“The client is ready to go down to radiology for this examination.”
c.
“Physical therapy states the client can run on a treadmill.”
d.
“I advised the client not to smoke for 6 hours prior to the test.”
e.
“The client is alert and can follow your commands.”

Answer 17

a.
“I held the client’s morning bronchodilator medication.”

d.
“I advised the client not to smoke for 6 hours prior to the test.”
e.
“The client is alert and can follow your commands.”

ref. 509

Question 18

While obtaining a client’s health history, the client states, “I am allergic to avocados.” Which responses by the nurse are best? (Select all that apply.)
a.
“What response do you have when you eat avocados?”
b.
“I will remove any avocados that are on your lunch tray.”
c.
“When was the last time you ate foods containing avocados?”
d.
“I will document this in your record so all of your providers will know.”
e.
“Have you ever been treated for this allergic reaction?”

Answer 18

a.
“What response do you have when you eat avocados?”

d.
“I will document this in your record so all of your providers will know.”
e.
“Have you ever been treated for this allergic reaction?”

ref. 502

Question 19

A nurse teaches a client who is interested in smoking cessation. Which statements should the nurse include in this client’s teaching? (Select all that apply.)
a.
“Find an activity that you enjoy and will keep your hands busy.”
b.
“Keep snacks like potato chips on hand to nibble on.”
c.
“Identify a punishment for yourself in case you backslide.”
d.
“Drink at least eight glasses of water each day.”
e.
“Make a list of reasons you want to stop smoking.”

Answer 19

a.
“Find an activity that you enjoy and will keep your hands busy.”

d.
“Drink at least eight glasses of water each day.”
e.
“Make a list of reasons you want to stop smoking.”

ref. 496

Question 20

A nurse assesses a 66-year-old client who is attempting to quit smoking. The client states, “I started smoking at age 16, and smoked one pack each day until 10 years ago. Then I decreased to a half of a pack per day.” How many pack-years should the nurse document for this client? (Record your answer using a whole number.) ___ pack-years

Answer 20

45 pack-years
66 (current age) – 16 (year started smoking) = 50 years of smoking.
(40 years × 1 pack per day) + (10 years × 0.5 pack per day) = 45 pack-years.

ref. 495