Nokea
The nurse is caring for a patient who has just had a thoracentesis. Which of the following information 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.
Correct Answer: B
Rationale: Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 89% indicates that a complication such as pneumothorax may be occurring. The other assessment data also indicate a need for ongoing assessment or intervention, but the low oxygen saturation is the priority.
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The nurse is caring for a patient who has a steering wheel injury as a result of an automobile accident. Which of the following findings should be of most concern to the nurse during the initial assessment?
- A. Paradoxical 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
Correct Answer: A
Rationale: Paradoxical chest movement indicates that the patient may have flail chest, which can severely compromise gas exchange and can rapidly lead to hypoxemia. Chest wall pain, a slightly elevated pulse rate, and chest bruising all require further assessment or intervention, but the priority concern is poor gas exchange.
The nurse is developing a teaching plan for a patient with a 12 pack-year history of cigarette smoking. Which of the following information should the nurse include in the plan of care?
- A. Computed tomography (CT) screening for lung cancer
- B. Options for smoking cessation
- C. Reasons for annual sputum cytology testing
- D. Erlotinib therapy to prevent tumour risk
Correct Answer: B
Rationale: Because smoking is the major cause of lung cancer, the most important role for the nurse is educating patients about the benefits of and means of smoking cessation. Early screening of at-risk patients using sputum cytology, chest x-ray, or CT scanning has not been effective in reducing mortality. Erlotinib may be used in patients who have lung cancer but not to reduce risk for developing tumours.
The nurse is caring for a patient with primary pulmonary hypertension (PPH) who is receiving nifedipine. Which of the following findings indicate that the treatment is effective?
- A. BP is less than 140/90 mm Hg
- B. Patient reports decreased exertional dyspnea.
- C. Heart rate is between 60 and 100 beats/minute.
- D. Patient's chest x-ray indicates clear lung fields.
Correct Answer: B
Rationale: Since a major symptom of PPH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective. Nifedipine will affect BP and heart rate, but these parameters would not be used to monitor effectiveness of therapy for a patient with PPH. The chest x-ray will show clear lung fields even if the therapy is not effective.
Which of the following actions by the occupational health nurse at a manufacturing plant where there is potential exposure to inhaled dust is most helpful in reducing incidence of lung disease?
- A. Teach about symptoms of lung disease.
- B. Treat workers who inhale dust particles
- C. Monitor workers for shortness of breath
- D. Require the use of protective equipment
Correct Answer: D
Rationale: Prevention of lung disease requires the use of appropriate protective equipment such as masks. The other actions will help in recognition or early treatment of lung disease, but will not be effective in prevention of lung damage.
The nurse is caring for a patient with primary pulmonary hypertension (PPH) who has been taking a calcium channel blocker with no effect. Which of the following medications should the nurse expect that the patient will receive next?
- A. Nifedipine
- B. Diltiazem
- C. Iloprost
- D. Bosentan
Correct Answer: C
Rationale: Iloprost has revolutionized care for PPH. It is now the treatment of choice for select patients unresponsive to calcium channel blockers. It is a long-acting chemically stable prostacyclin analogue, which is administered in an aerosolized form (100-150 mcg/day). Bosentan is an oral form of prostacyclin used to treat PPH. Nifedipine and diltiazem are calcium channel blockers.