Nokea
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.
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The nurse is caring for a patient in the emergency department who has an open stab wound to the right chest. Which of the following actions should the nurse implement first?
- A. Position the patient so that the right chest is dependent.
- B. Keep the head of the patient's bed at no more than 30 degrees elevation.
- C. Tape a nonporous dressing on three sides over the chest wound.
- D. Cover the sucking chest wound firmly with an occlusive dressing.
Correct Answer: C
Rationale: The dressing taped on three sides will allow air to escape when intrapleural pressure increases during expiration, but it will prevent air from moving into the pleural space during inspiration. Placing the patient on the right side or covering the chest wound with an occlusive dressing will allow trapped air in the pleural space and cause tension pneumothorax. The head of the bed should be elevated to 30-45 degrees to facilitate breathing.
The nurse is caring for patients with active tuberculosis (TB) who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
- A. Educating the patient about the long-term impact of TB on health
- B. Giving the patient written instructions about how to take the medications
- C. Teaching the patient about the high risk for infecting others unless treatment is followed
- D. Arranging for a daily noontime meal at a community centre and giving the medication then
Correct Answer: D
Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help to ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate for some patients, but are not likely to be as helpful with this patient.
Which of the following information about a patient who has a recent history of tuberculosis (TB) indicates that the nurse can discontinue airborne isolation precautions?
- A. Chest x-ray shows no upper lobe infiltrates.
- B. TB medications have been taken for 6 months.
- C. Mantoux testing shows an induration of 10 mm.
- D. Three sputum smears for acid-fast bacilli are negative.
Correct Answer: D
Rationale: Negative sputum smears indicate that M. tuberculosis is not present in the sputum, and the patient cannot transmit the bacteria by the airborne route. Chest x-rays are not used to determine whether treatment has been successful. Taking medications for 6 months is necessary, but the multidrug-resistant forms of the disease might not be eradicated after 6 months of therapy. Repeat Mantoux testing would not be done since it will not change even with effective treatment.
The nurse is performing tuberculosis (TB) screening in a clinic that has many patients who have immigrated to Canada. Before doing a TB skin test on a patient, which of the following questions is most important for the nurse to ask?
- A. Is there any family history of TB?
- B. Have you received the bacille Calmette-Guérin (BCG) vaccine for TB?
- C. How long have you lived in the Canada?
- D. Do you take any over-the-counter (OTC) medications?
Correct Answer: B
Rationale: Patients who have received the BCG vaccine will have a positive Mantoux test. Another method for screening (such as a chest x-ray) will need to be used in determining whether the patient has a TB infection. The other information also may be valuable but is not as pertinent to the decision about doing TB skin testing.
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.