Nokea
Which statement would indicate that the parents of child with cystic fibrosis understand the disorder?
- A. Early treatment can stop the progression of the disease
- B. The mucus-secreting glands are abnormal
- C. There are fibrous cysts in the lungs
- D. Allergic reactions cause inflammation in the lungs
Correct Answer: B
Rationale: Cystic fibrosis is caused by dysfunction of the exocrine glands with no cystic lesions present in the lungs. Early treatment can improve symptoms and extend the life of clients, but a cure for this disorder is presently not available. Allergens are responsible for allergic asthma and not associated with cystic fibrosis.
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The nurse knows the mortality rate is high in lung cancer clients due to which factor?
- A. Increase in women smokers
- B. Increased incidence among the elderly
- C. Increased exposure to industrial pollutants
- D. Few early symptoms
Correct Answer: D
Rationale: Because lung cancer produces few early symptoms, its mortality rate is high. Lung cancer has increased in incidence due to an increase in the number of women smokers, a growing aging population, and exposure to pollutants but these are not directly related to the incidence of mortality rates.
The ICU nurse is caring for a client who was admitted with a diagnosis of smoke inhalation. The nurse knows that this client is at increased risk for which of the following?
- A. Acute respiratory distress syndrome
- B. Lung cancer
- C. Bronchitis
- D. Tracheobronchitis
Correct Answer: A
Rationale: Factors associated with the development of ARDS include aspiration related to near drowning or vomiting; drug ingestion/overdose; hematologic disorders such as disseminated intravascular coagulation or massive transfusions; direct damage to the lungs through prolonged smoke inhalation or other corrosive substances; localized lung infection; metabolic disorders such as pancreatitis or uremia; shock; trauma such as chest contusions, multiple fractures, or head injury; any major surgery; embolism; and septicemia. Smoke inhalation does not increase the risk for lung cancer, bronchitis, and tracheobronchitis.
When the nurse monitors the water-sealed drainage system, which finding suggests the system is working properly?
- A. Fluid rises and falls with respirations
- B. Level of fluid is lowered in suction chamber
- C. Fluid is bubbling vigorously
- D. Fluid appears white and frothy
Correct Answer: A
Rationale: Fluctuation of fluid in the water-sealed chamber is initially present with each respiration. The level of fluid in the suction chamber should be maintained to initial level. Excessive or vigorous bubbling can indicate a leak in the system. The fluid in the chamber is clear.
The nurse is caring for a client with a chest tube. Which nursing assessment would alert the nurse to a possible complication?
- A. Skin around tube is pink
- B. Bloody drainage is observed in the collection chamber
- C. Absence of bloody drainage in the anterior/upper tube
- D. The tissues give a crackling sensation when palpated
Correct Answer: D
Rationale: Subcutaneous emphysema is the result of air leaking between the subcutaneous layers. It is not a serious complication but is notable and reportable. Pink skin and blood in the collection chamber are normal findings. When two tubes are inserted, the posterior or lower tube drains fluid, whereas the anterior or upper tube is for air removal.
The nurse is caring for a client who has just been diagnosed with lung cancer. What is a cardinal sign of lung cancer?
- A. Mucopurulent sputum
- B. Pain on inspiration
- C. Obvious trauma
- D. Shortness of breath
Correct Answer: A
Rationale: For a client with lung cancer, a cough productive of mucopurulent or blood-streaked sputum is a cardinal sign of lung cancer. Symptoms of fractured ribs consist primarily of severe pain on inspiration and expiration, obvious trauma, and shortness of breath. These symptoms may also be caused by other disorders but are not considered indicative of lung cancer.