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The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patients symptoms from those of a cardiac etiology?
- A. Carboxyhemoglobin level
- B. Brain natriuretic peptide (BNP) level
- C. C-reactive protein (CRP) level
- D. Complete blood count
Correct Answer: B
Rationale: Common diagnostic tests performed for patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema. The carboxyhemoglobin level will be increased in a client with an inhalation injury, which commonly progresses into ARDS. CRP and CBC levels do not help differentiate from a cardiac problem.
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The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?
- A. Administer intradermal injections into the childrens inner forearms
- B. Administer intramuscular injections into each childs vastus lateralis
- C. Administer a subcutaneous injection into each childs umbilical area
- D. Administer a subcutaneous injection at a 45-degree angle into each childs deltoid
Correct Answer: A
Rationale: The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.
A 54-year-old man has just been diagnosed with small cell lung cancer. The patient asks the nurse why the doctor is not offering surgery as a treatment for his cancer. What fact about lung cancer treatment should inform the nurses response?
- A. The cells in small cell cancer of the lung are not large enough to visualize in surgery
- B. Small cell lung cancer is self-limiting in many patients and surgery should be delayed
- C. Patients with small cell lung cancer are not normally stable enough to survive surgery
- D. Small cell cancer of the lung grows rapidly and metastasizes early and extensively
Correct Answer: D
Rationale: Surgery is primarily used for NSCLCs, because small cell cancer of the lung grows rapidly and metastasizes early and extensively. Difficult visualization and a patients medical instability are not the limiting factors. Lung cancer is not a self-limiting disease.
The home care nurse is monitoring a patient discharged home after resolution of a pulmonary embolus. For what potential complication would the home care nurse be most closely monitoring this patient?
- A. Signs and symptoms of pulmonary infection
- B. Swallowing ability and signs of aspiration
- C. Activity level and role performance
- D. Residual effects of compromised oxygenation
Correct Answer: D
Rationale: The home care nurse should monitor the patient for residual effects of the PE, which involved a severe disruption in respiration and oxygenation. PE has a noninfectious etiology; pneumonia is not impossible, but it is a less likely sequela. Swallowing ability is unlikely to be affected; activity level is important, but secondary to the effects of deoxygenation.
When assessing for substances that are known to harm workers lungs, the occupational health nurse should assess their potential exposure to which of the following?
- A. Organic acids
- B. Propane
- C. Asbestos
- D. Gypsum
Correct Answer: C
Rationale: Asbestos is among the more common causes of pneumoconiosis. Organic acids, propane, and gypsum do not have this effect.
A patient is brought to the ED by ambulance after a motor vehicle accident in which the patient received blunt trauma to the chest. The patient is in acute respiratory failure, is intubated, and is transferred to the ICU. What parameters of care should the nurse monitor most closely? Select all that apply.
- A. Coping
- B. Level of consciousness
- C. Oral intake
- D. Arterial blood gases
- E. Vital signs
Correct Answer: B,D,E
Rationale: Patients are usually treated in the ICU. The nurse assesses the patients respiratory status by monitoring the level of responsiveness, ABGs, pulse oximetry, and vital signs. Oral intake and coping are not immediate priorities during the acute stage of treatment, but would become more important later during recovery.