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A patient is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis?
- A. Increased tactile fremitus, egophony, and a dull sound upon percussion of the chest wall
- B. Decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion of the chest wall
- C. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub
- D. Normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion of the chest wall
Correct Answer: C
Rationale: The correct answer is C. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub are consistent with pleural effusion. Dullness on percussion indicates fluid accumulation in the pleural space. Absent breath sounds suggest decreased air movement due to the fluid. A pleural friction rub may be heard due to inflammation of the pleura.
A is incorrect because increased tactile fremitus, egophony, and a dull sound upon percussion are more indicative of pneumonia.
B is incorrect because decreased tactile fremitus, wheezing, and a hyperresonant sound upon percussion are more indicative of COPD or emphysema.
D is incorrect because normal tactile fremitus, decreased breath sounds, and a resonant sound upon percussion are more indicative of asthma or atelectasis.
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When teaching a patient with heart failure on a 2000-mg sodium diet. Which foods should the nurse recommend limiting?
- A. Chicken
- B. Fresh spinach
- C. Eggs
- D. Milk
Correct Answer: D
Rationale: The correct answer is D: Milk. Milk is a high sodium food and can contribute significantly to a patient's daily sodium intake. For a patient on a 2000-mg sodium diet, it is crucial to limit high sodium foods like milk to prevent fluid retention and worsening of heart failure symptoms. Other choices (A, B, C) are lower in sodium compared to milk. Chicken, fresh spinach, and eggs are generally good protein sources with lower sodium content and can be included in moderation in a 2000-mg sodium diet for a heart failure patient.
A 64-year-old female is admitted to the hospital. She has smoked two packs per day for 30 years. While providing her history, she becomes dyspneic and appears very anxious. She has a cough with thick white sputum production. Her chest is barrel shaped. Based on these data, the nurse will need to develop a plan of care for a client with?
- A. Pneumonia.
- B. Chronic obstructive pulmonary disease.
- C. Tuberculosis.
- D. Asthma.
Correct Answer: B
Rationale: The correct answer is B: Chronic obstructive pulmonary disease (COPD). The patient's smoking history, dyspnea, anxiety, chronic cough with sputum production, and barrel-shaped chest are indicative of COPD. Smoking is the primary cause of COPD, leading to airway inflammation and airflow limitation. The dyspnea, cough, and sputum production are common symptoms of COPD due to air trapping and mucus hypersecretion. The barrel-shaped chest is a sign of hyperinflation of the lungs seen in COPD patients. Pneumonia (A) typically presents with symptoms like fever and productive cough, not necessarily dyspnea and barrel chest. Tuberculosis (C) commonly presents with weight loss, night sweats, and hemoptysis, not the symptoms described. Asthma (D) often presents with wheezing, chest tightness, and reversible airflow obstruction, not the chronic symptoms described in this case.
With respect to regional gas exchange in the upright lung
- A. Ventilation is greater at the top of the lungs
- B. Perfusion is much greater at the top of the lungs compared with the bases
- C. Ventilation/perfusion ratio is abnormally high at the top of the lungs
- D. PO2 is highest at the bases of the lungs
Correct Answer: C
Rationale: The correct answer is C because in the upright lung, the ventilation-perfusion ratio is higher at the top due to gravity causing increased perfusion at the bases. This results in a mismatch between ventilation and perfusion, leading to a higher V/Q ratio at the top. Choices A and B are incorrect because ventilation is actually greater at the bases due to the effect of gravity, leading to higher ventilation there. Choice D is incorrect because PO2 is higher at the apex of the lung due to decreased perfusion but not at the bases.
The nurse is caring for a patient who has been scheduled for a bronchoscopy. How should the nurse prepare the patient for this procedure?
- A. Administer a bolus of IV fluids.
- B. Arrange for the insertion of a peripherally inserted central catheter.
- C. Administer nebulized bronchodilators every 2 hours until the test.
- D. Withhold food and fluids for several hours before the test.
Correct Answer: D
Rationale: The correct answer is D because withholding food and fluids for several hours before a bronchoscopy is important to prevent aspiration during the procedure. When the patient is sedated for the bronchoscopy, there is an increased risk of vomiting, and having an empty stomach reduces this risk. Administering IV fluids (choice A) is not necessary unless clinically indicated. Inserting a peripherally inserted central catheter (choice B) is not typically required for a bronchoscopy. Administering nebulized bronchodilators (choice C) may not be needed for all patients and should be based on the individual's respiratory condition.
The nurse is caring for a 30-year-old American Indian female who is taking Rifater, a drug
containing rifampin, isoniazid, and pyrazinamide. The patient asks how long she will have to
take the medication. Which response explains when the patient may discontinue the
medication?
- A. When the sputum culture comes back negative.
- B. When the medication has been taken for 9 months
- C. When three consecutive sputum cultures are negative
- D. When the tuberculin skin test (TST) is no longer positive
Correct Answer: C
Rationale: The correct answer is C: When three consecutive sputum cultures are negative. This indicates successful treatment completion and eradication of the tuberculosis infection. A negative sputum culture confirms that the patient is no longer infectious and can safely discontinue the medication.
Choice A is incorrect because a single negative sputum culture does not guarantee complete eradication of the infection. Choice B is incorrect as the standard treatment duration for tuberculosis is typically 6-9 months, but discontinuation should be based on sputum culture results. Choice D is incorrect as the TST can remain positive even after successful treatment, as it reflects exposure to the tuberculosis bacteria, not active infection status.