HESI MED-SURG TEST BANK 18 LATEST VERSIONS  VERIFIED QUESTIONS AND ANSWERS AND STUDY SETSS  BEST DOCUMENT FOR EXAM PREPARATION  100% SATISFACTION GUARANTEED COMPLETE AND LATEST GUIDE FOR HESI MED-SURG 2022 1000+ Questions with answers Med Surg 1 HESI Final T2, Questions with accurate answers. Rated A. 2022/2023

HESI MED-SURG TEST BANK 18 LATEST VERSIONS  VERIFIED QUESTIONS AND ANSWERS AND STUDY SETSS  BEST DOCUMENT FOR EXAM PREPARATION  100% SATISFACTION GUARANTEED COMPLETE AND LATEST GUIDE FOR HESI MED-SURG 2022 1000 ...

HESI MED-SURG TEST BANK 18 LATEST VERSIONS  VERIFIED QUESTIONS AND ANSWERS AND STUDY SETSS  BEST DOCUMENT FOR EXAM PREPARATION  100% SATISFACTION GUARANTEED COMPLETE AND LATEST GUIDE FOR HESI MED-SURG 2022 1000+ Questions with answers Med Surg 1 HESI Final T2, Questions with accurate answers. Rated A. 2022/2023 1. A nurse is visiting a client who is receiving home health care, focusing on medication and dietary instructions and management of heart failure. The nurse should reinforce which instruction? A.) If you feel tired and short of breath, lie down flat and prop up your feet. B.) Eating liver several times a week will help build up your strength. C.) Your daily dose of furosemide should be taken first thing in the morning. D.) The dose of enalapril will help prevent vasodilation from occurring. - ✔✔Answer: C 2. A nurse planning care for a client who has undergone transurethral resection of the prostate (TURP) remembers that the most common cause of postoperative pain is which factor? A.) Bladder spasms B.) Bleeding within the bladder C.) The location of the incision D.) Tension on the Foley catheter - ✔✔Answer: A 3. A nurse assessing the skin of a client who is immobile notes this change in appearance of the skin in the sacral area: The nurse documents this finding in which way? A.) Stage I pressure ulcer B.) Stage II pressure ulcer C.) Stage III pressure ulcer D.) Stage IV pressure ulcer - ✔✔Answer: A 4. A nurse reinforces teaching given to a client with gastroesophageal reflux disease (GERD) about measures to manage the disease. What does the nurse encourage the client to do to obtain relief of the symptoms? A.) Limit intake of coffee and tea. B.) Eat three large, well-balanced meals per day. C.) Rest in a supine position for 30 minutes after each meal. D.) Elevate the head of the bed at least 6 to 8 inches for sleep. - ✔✔Answer: D 5. A nurse provides instructions to a client who is taking allopurinol for the treatment of gout. Which statements by the client indicate an understanding of the medication? A.) "I need to take the medication 1 hour before I eat." B.) "I need to drink at least 8 glasses of fluid every day." C. "I'll start taking a vitamin C supplement each morning." D.) "I can use an antihistamine lotion if I get an itchy rash." - ✔✔Answer: B 6. A client with phantom limb pain has decided to use transcutaneous electrical nerve stimulation (TENS) as prescribed by the health care provider. The nurse reinforces instructions regarding the use of the TENS unit. Which statements by the client indicate a need for further instruction regarding this painrelief measure? A.) "I'm so glad this will help relieve the pain." B.) "Now I won't need to take so many pain medications." C.) "I need to put the electrodes on the areas that you marked." D.) "I'm not sure I'm going to like having those electrodes attached to my skin." - ✔✔Answer: C 7. A hospitalized client has just been found to have acute renal failure (ARF). The laboratory calls the nursing unit and reports that the client has a serum potassium level of 6.4 mEq/L. On the basis of this laboratory finding, the nurse should first take which action? A.) Call the health care provider B.) Check the client's sodium level C.) Encourage the client to increase fluid intake D.) Have the client decrease intake of potassium-rich foods - ✔✔Answer: A 8. A nurse is caring for a client who has just had a plaster leg cast applied. Which measure does the nurse implement to prevent the development of compartment syndrome? A.) Elevating the limb and applying ice to the affected leg B.) Elevating the limb and covering the limb with bath blankets C.) Keeping the leg horizontal and applying ice to the affected leg D.) Placing the leg in a slightly dependent position and applying ice to the affected leg - ✔✔Answer: A 9. On the first day after undergoing total knee arthroplasty, the client tells the nurse that he is experiencing pain when he extends his leg. The nurse should take which action? A.) Notify the health care provider immediately B.) Administer an analgesic and evaluate the response C.) Immobilize the knee temporarily and contact the health care provider to report pain D.) Put the client's knee through full passive range of motion to assess tolerance - ✔✔Answer: B 10. A nurse in the emergency department is assisting with data collection from a client who sustained an open leg fracture in a fall from a ladder. Which question is most important for the nurse to ask the client? A.) "When was your last tetanus vaccine?" B.) "Have you ever had a tuberculin test?" C.) "Have you had a chest x-ray recently?" D.) "When was your last physical examination?" - ✔✔Answer: A 11. A client who sustained an extensive full-thickness burn injury is being admitted to the nursing unit. Which prescription by the health care provider would the nurse question? A.) Insert Foley catheter and check urine output each hour. B.) Maintain nasogastric tube with low intermittent suction. C.) Assess vital signs, oxygen saturation, and level of consciousness each hour. D. Administer morphine sulfate 6 mg intramuscularly every 3 hours as needed. - ✔✔Answer: D 12. A nurse reinforces dietary instructions to a client with viral hepatitis whose laboratory results indicate liver impairment. The nurse provides the client with which information? A.) To increase intake of foods high in protein to promote healing B.) To consume mainly high-fat foods because they are better tolerated C.) That most calorie intake should consist of foods high in carbohydrates D.) That snacks, particularly those that are salty, are an important part of the diet - ✔✔Answer: C 13. A nurse is checking a client's closed chest drainage system and notes rapid bubbling in the water seal chamber. The nurse checks the system for an air leak but does not find one. The nurse interprets this in which way? A.) The pneumothorax is resolving. B.) The degree of suction needs to be decreased. C.) There is an incision or tear in the pulmonary pleura. D.) The suction applied to the system is not working correctly. - ✔✔Answer: C 14. A nurse has taught a client with chronic obstructive pulmonary disease (COPD) about positions that will ease breathing during dyspneic episodes. Which statement by the client indicates a need for further instruction? A.) "I should sit up and lean on a table." B.) "I should stand and lean against a wall." C.) "I should lie flat on my side in a fetal position." D.) "I should sit up with my elbows resting on my knees." - ✔✔Answer: C 15. A nurse caring for a client with a diagnosis of peptic ulcer is monitoring the client for signs of perforation. Which findings would cause the nurse to suspect perforation? A.) Bradycardia B.) Abdominal rigidity C.) A sudden bout of diarrhea D.) Projectile vomiting of bile - ✔✔Answer: B 16. A nurse is caring for a client with a diagnosis of chronic renal failure (CRF). Which early sign of CRF does the nurse expect to note during data collection? A.) Restlessness B.) Temperature of 99.8°F C.) Pulse of 110 beats/min D.) Blood pressure of 168/94 mm Hg - ✔✔Answer: D 17. A nurse is assisting with data collection of a client with angina pectoris. The client reports that the anginal pain is triggered by exercise and relieved by rest or nitroglycerin. In the client's record, the nurse notes that the client is experiencing which situation? A.) Stable angina B.) Variant angina C.) Unstable angina D.) Nonanginal pain - ✔✔Answer: A 18. A client who was exposed to cold for a prolonged period is brought to the emergency department. The nurse, conducting an assessment of the client, notes acute frostbite of the fingers of the left hand. Which action should the nurse take immediately? A.) Placing the client's fingers in cold water for 15 to 20 minutes B.) Placing the client's fingers in warm water for 15 to 20 minutes C.) Placing the client's fingers in warm water for 5 minutes, then debriding any obvious blisters D.) Placing the client's fingers in cold water for 10 minutes and then warm water for 10 minutes and continuing this pattern for 1 hour - ✔✔Answer: B 19. A client who is experiencing chest pain is brought to the emergency department by a family member. Assessing the client, the nurse obtains a description of the client's chest pain. Which information from the client causes the nurse to determine that the client's pain is most likely angina? A.) The pain is unrelieved by rest. B.) The pain is unrelieved by nitroglycerin. C.) The pain was precipitated by a stressful event. D.) The pain is accompanied by nausea, vomiting, diaphoresis, and dyspnea - ✔✔Answer: C 20. A nurse provides home care instructions to a client with bacterial infective endocarditis. Which statement by the client indicates a need for further instruction? A.) "I need to let my dentist know that I had this infection." B.) "I need to take antibiotics before I have any invasive procedures." C.) "I should check my temperature every day and call the doctor if I have a fever." D.) "I need to be sure to floss my teeth and use an electric toothbrush." - ✔✔Answer: D 21. The nurse provides discharge instructions to a client who has undergone mechanical valve replacement. Which statement by the client indicates an understanding of the instructions? A.) "I'll have to take a blood thinner for the rest of my life." B.) "If I hear a clicking sound I need to call the surgeon immediately." C.) "I need to avoid lifting anything heavier than 30 lb for at least 6 weeks." D.) "I shouldn't worry if I see redness at the incision site or clear drainage, because it's normal - ✔✔Answer: A 22. A nurse provides self-care instructions to a client with hypertension who will be taking an antihypertensive medication daily. Which statement by the client indicates a need for further instruction? A.) "I need to cut down on my smoking." B.) "I'm going to have to take this medicine for the rest of my life." C.) "I can use relaxation techniques to help control my blood pressure." D.) "I need to check food labels for the sodium content when I'm shopping." - ✔✔Answer: A 23. A client undergoes transplantation of a kidney from her brother. Which information should the nurse, in home care instructions to the client about graft rejection, provide to the client? A.) Rejection always occurs during the 48 hours after surgery. B.) Rejection is not a problem when the donor is a direct family member. C.) The client should contact the healthcare provider if she notices weight gain or edema. D.) The client should not be concerned about rejection, because immunosuppressive medications prevent its occurrence. - ✔✔Answer: C 24. The nurse provides information to a client treated for cystitis about measures to prevent its recurrence. Which statement by the client indicates a need for further instruction? A.) "I should wear cotton underpants." B.) "I should urinate and drink a glass of water after sex." C.) "I need to wipe from front to back when I use the bathroom." D.) "I can soak in a bathtub to relieve the pain and prevent infections in the future." - ✔✔Answer: D 25. A client is brought to the emergency department after sustaining a fall, complaining of severe pain in the right arm. The nurse carefully cuts off the clothing that is covering the arm and notes an open wound with bone protruding from it. Which action should the nurse take immediately? A.) Covering the open area with a sterile dressing B.) Obtaining a prescription for pain medication C.) Placing the cut-off shirt sleeve over the open area D.) Irrigating the open area with half strength hydrogen peroxide - ✔✔Answer: A 26. Which action would the nurse take when caring for a client who just returned from a cardiac catheterization and reports that the pressure bandage on the right groin is tight? A.) Loosen the dressing slightly. B.) Notify the health care provider. C.) Assess the pulses distal to the dressing. D.) Have the client flex the joints of the right leg. - ✔✔Answer: C 27. Which statement by a client with hypertension prescribed a 2-g sodium diet provides evidence that the nurse's dietary instructions are understood? A.) "My fluid intake should be restricted." B.) "I should limit the number of daily food servings." C.) "Salt should not be used during cooking but can be used at the table." D.) "Labels on prepackaged food products should be evaluated before purchase." - ✔✔Answer: D 28. Which is the priority nursing intervention when providing postprocedure care to a client who had a cardiac catheterization via a brachial artery in the first hour after the procedure? A.) Monitor vital signs every 15 minutes. B.) Maintain the client in the supine position. C.) Keep the client's lower extremities in extension. D.) Administer the prescribed oxygen at 4 L/min via nasal cannula. - ✔✔Answer: A 29. Which preoperative teaching is most important for the nurse to include when completing laryngectomy education? A.) Establishing a means for communicating postoperatively B.) Explaining that there will be a feeding tube postoperatively C.) Demonstrating how to care for a permanent laryngeal stoma D.) Teaching how to cough to expectorate bronchial secretions effectively - ✔✔Answer: A 30. Which intervention would the nurse implement to help prevent atelectasis in a client with fractured ribs as a result of chest trauma? A.) Apply a thoracic binder for support. B.) Encourage coughing and deep breathing. C.) Defer pain medication the first day after injury. D.) Position the client face down on a soft mattress. - ✔✔Answer: B 31. Which action would the nurse determine is needed for a client who has undergone gastric bypass surgery? A.) Ensure that the client eats three large meals a day. B.) Teach the client how to avoid dumping syndrome. C.) Weigh the client twice daily. D.) Encourage a full glass of water with every meal. - ✔✔Answer: B 32. Which definition relates to steatorrhea? A.) Fatty stools B.) Loose, watery stools C.) Hard, formed stools D.) Stools that are red in color - ✔✔Answer: A 33. Which symptom would the nurse observe on a client who sustained a superficial partial-thickness burn? A.) Painful, pink to red skin B.) Large blisters and exposed dermis C.) Blistered, weepy, pale to red skin D.) Dry, leathery, and red, brown, or black patches - ✔✔Answer: C 34. A hospitalized client develops an infection at a catheter insertion site. The nurse uses the term iatrogenic when describing this infection because it resulted from what? A.) Poor personal hygiene B.) A procedure performed at the hospital C.) Inadequate dietary intake D.) The client's developmental level - ✔✔Answer: B 35. Which intervention by the nurse promotes perfusion and healing of the surgical wound in an older adult? A.) Minimizing the use of tape on the skin B.) Keeping the client adequately hydrated C.) Changing the dressings as soon as they get wet D.) Providing rest for the client throughout the day - ✔✔Answer: B 36. Which statement regarding rheumatoid arthritis (RA) is true? A.) "It is a systemic condition." B.) "It affects only the hips and hands." . C.) "It involves bone spur formation." D.) "It affects males and females equally." - ✔✔Answer: A 37. Which action of a client with ankylosing spondylitis would be beneficial in treatment? A.) Turning every 15 minutes B.) Avoiding breathing exercises C.) Avoiding lying on the abdomen D.) Applying heat to the back and hips - ✔✔Answer: D 38. Which intervention would a nurse implement when initially caring for an older bedridden client who is incontinent of urine? A.) Restricting fluid intake B.) Offering the urinal regularly . C.) Applying incontinence pants D.) Inserting an indwelling urinary catheter - ✔✔Answer: B 39. Which statement would cause the nurse to conclude that teaching was effective after providing discharge instructions to a client who received a prescription for digoxin after a myocardial infarction? A.) "I should avoid foods high in potassium." B.) "I should check my radial pulse rate daily." C.) "I should increase my intake of vitamin K." D.) "I should adjust the dosage according to my activities." - ✔✔Answer: B 40. Which blood type is considered a universal blood recipient? A.) A B.) B C.) AB D.) O - ✔✔Answer: C 41. Which explanation about the mechanism of action would the nurse give to a client who is prescribed enoxaparin 40 mg subcutaneously daily after abdominal surgery? A.) "It controls expected postoperative fever." B.) "It provides a constant source of mild analgesia." C.) "It limits the inflammatory response associated with surgery." D.) "It provides prophylaxis against postoperative thrombus formation." - ✔✔Answer: D 42. Who is experiencing a loss of appetite and complains of feeling "too full to eat." What does the nurse encourage the client to do? Select all that apply. A.) Avoid drinking fluids before and during meals. B.) Eat a variety of dark-green vegetables, such as broccoli. C.) Have snacks, such as crackers and cheese, between meals. D.) Select foods that are easy to chew and are not gas forming. - ✔✔Answer: A, D 43. A client who sustained a major burn injury is beginning to take an oral diet again. Which betweenmeal menu selections meet the client's needs for wound healing and tissue repair? Select all that apply. A.) Apple slices and skim milk B.) Whole-milk shake and granola C.) Baked potato topped with cheese D.) Cheese and whole-wheat crackers E.) Cauliflower with low-fat ranch dip - ✔✔Answer: B, C, D 44. A nurse is preparing a list of instructions regarding stoma and laryngectomy care to a client who has undergone laryngectomy. Which instructions should be included in the list? Select all that apply. A.) Keep humidity in the home low. B.) Avoid wearing high-collared clothing. C.) Prevent debris from entering the stoma. D.) Avoid swimming and use care when showering. - ✔✔Answer: C, D 45. Which of the following risk factors for MI are modifiable? Select all that apply. A.) The client smokes four or five cigarettes a day B.) The client reports a sedentary lifestyle. C.) The client is 5 feet 1 inch tall and weighs 232 lb. D.) The client's blood pressure consistently ranges between 148/88 and 170/96 mm Hg. E.) The client reports that her mother has a history of severely increased cholesterol levels that cannot be controlled with diet or medication. - ✔✔Answer: A, B, C, D 46. Which of the following findings are specific characteristics of right-sided heart failure? Select all that apply. A.) Cough B.) Allow sips of clear fluids only. C.) Crackles on auscultation D.) Pitting dependent edema E.) Abdominal pain and bloating - ✔✔Answer: B, D, E 47. Which of the following clients are at risk for venous thrombosis? Select all that apply. A.) A client with a diagnosis of hypothyroidism B.) A client who reports that he is a marathon runner C.) A client who sustained a pelvic fracture after falling from a horse D.) A client with a seizure disorder who is taking phenytoin (Dilantin) E.) A client who reports using oral contraceptives as a means of birth control - ✔✔Answer: C, E 48. The nurse provides self-care instructions to a client with a venous disorder. Which of these statements by the client indicate the need for further instruction? Select all that apply. A.) "I need to order a MedicAlert bracelet." B.) "I should watch my legs and ankles for swelling." C.) "I can massage my leg gently when it's sore." D.) "I can put pillows under my knees if it's more comfortable." E.) "I should elevate my legs above the level of my heart when I'm in bed." - ✔✔Answer: C, D 49. A nurse is preparing a list of home care instructions for a client with peripheral artery disease (PAD). Which instructions should the nurse include on the list? Select all that apply. A.) Avoid crossing the legs. B.) Report signs of skin breakdown. C.) Avoid ambulation to help prevent pain. D.) Inspect the skin of the extremities daily. E.) Elevate the legs above the level of the heart when in bed or in a chair. F.) Avoid exposure to cold and place a heating pad on the legs to improve blood flow. - ✔✔Answer: A, B, D 50. A client with sepsis has been receiving intravenous antibiotics, and acute kidney injury has developed as a result. The nurse assesses the client and reviews the laboratory results. Which findings should the nurse expect to note during the oliguric stage of acute kidney injury? Select all that apply. A.) A calcium level of 8.0 mg/dL B.) A creatinine level of 2.0 mg/dL C.) A serum sodium level of 159 mEq/L D.) A serum potassium level of 3.1 mEq/L - ✔✔Answer: A, B 51. The nurse is educating a group of older adults regarding osteoporosis. The nurse should mention which factors that increase the risk of osteoporosis? Select all that apply. A.) Obesity B. Late menopause C.) Cigarette smoking D.) Sedentary lifestyle E.) African heritage F.) Family history of osteoporosis - ✔✔Answer: C, D, F 52. Which assessment finding would the nurse assess for that could suggest a pulmonary embolus? Select all that apply. One, some, or all responses may be correct. A.) Apathy B.) Dyspnea C.) Hemoptysis D.) Bronchial wheezes E.) Feeling of impending doom - ✔✔Answer: B, C, E 53. Which sign or symptom is expected with advanced cirrhosis? Select all that apply. One, some, or all responses may be correct A.) Ascites B.) Jaundice C.) Esophageal varices D.) Decreased consciousness E.) Numbness and tingling in extremities - ✔✔Answer: A, B, C, D, E 54. Which statement made by a client with rheumatoid arthritis about precautions to be taken during the intake of methotrexate indicates understanding? Select all that apply. One, some, or all responses may be correct A.) "I need to drink lots of water." B.) "I will take the drug with food." C.) "I should not plan to become pregnant." D.) "I need to get an eye test every 6 months." E.) "I will rinse out my mouth thoroughly after eating." - ✔✔Answer: A, C Test bank Med/Surg HESI Practice Questions with accurate answers. Latest Update 2022/2023 The nurse notices clear nasal drainage in a patient newly admitted with facial trauma, including a nasal fracture. The nurse should: A. test the drainage for the presence of glucose. B. suction the nose to maintain airway clearance. C. document the findings and continue monitoring. D. apply a drip pad and reassure the patient this is normal. - ✔✔A. test the drainage for the presence of glucose. Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be tested for the presence of glucose, which would indicate the presence of CSF. When caring for a patient who is 3 hours postoperative laryngectomy, the nurse's highest priority assessment would be: A. Airway patency B. Patient comfort C. Incisional drainage D. Blood pressure and heart rate - ✔✔A. Airway patency Remember ABCs with prioritization. Airway patency is always the highest priority and is essential for a patient undergoing surgery surrounding the upper respiratory system. When initially teaching a patient the supraglottic swallow following a radical neck dissection, with which of the following foods should the nurse begin? A. Cola B. Applesauce C. French fries D. White grape juice - ✔✔A. ColaWhen learning the supraglottic swallow, it may be helpful to start with carbonated beverages because the effervescence provides clues about the liquid's position. Thin, watery fluids should be avoided because they are difficult to swallow and increase the risk of aspiration. Nonpourable pureed foods, such as applesauce, would decrease the risk of aspiration, but carbonated beverages are the better choice to start with. The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment, the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum and a respiratory rate of 20. Which of the following nursing diagnosis is most appropriate based upon this assessment? A. Hyperthermia related to infectious illness B. Ineffective thermoregulation related to chilling C. Ineffective breathing pattern related to pneumonia D. Ineffective airway clearance related to thick secretions - ✔✔A. Hyperthermia related to infectious illness Because the patient has spiked a temperature and has a diagnosis of pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill, and her breathing pattern is within normal limits at 20 breaths per minute. There is no evidence of ineffective airway clearance from the information given because the patient is expectorating sputum. Which of the following physical assessment findings in a patient with pneumonia best supports the nursing diagnosis of ineffective airway clearance? A. Oxygen saturation of 85% B. Respiratory rate of 28 C. Presence of greenish sputum D. Basilar crackles - ✔✔D. Basilar crackles The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. Which of the following clinical manifestations would the nurse expect to find during assessment of a patient admitted with pneumococcal pneumonia? A. Hyperresonance on percussion B. Fine crackles in all lobes on auscultation C. Increased vocal fremitus on palpation D. Vesicular breath sounds in all lobes - ✔✔C. Increased vocal fremitus on palpation. A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include dullness to percussion, bronchial breath sounds, and crackles in the affected area. Which of the following nursing interventions is of the highest priority in helping a patient expectorate thick secretions related to pneumonia? A. Humidify the oxygen as able B. Increase fluid intake to 3L/day if tolerated. C. Administer cough suppressant q4hr. D. Teach patient to splint the affected area. - ✔✔B. Increase fluid intake to 3L/day if tolerated. Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen is also helpful, but is not the primary intervention. Teaching the patient to splint the affected area may also be helpful, but does not liquefy the secretions so that they can be removed. During discharge teaching for a 65-year-old patient with emphysema and pneumonia, which of the following vaccines should the nurse recommend the patient receive? A. S. aureus B. H. influenzae C. Pneumococcal D. Bacille Calmette-Guérin (BCG) - ✔✔C. Pneumococcal The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 or over, or living in a long-term care facility. The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been most effective when the patient states which of the following measures to prevent a relapse? A. "I will increase my food intake to 2400 calories a day to keep my immune system well." B. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to reevaluate." C. "I will seek immediate medical treatment for any upper respiratory infections." D. "I should continue to do deep-breathing and coughing exercises for at least 6 weeks." - ✔✔D. "I should continue to do deep-breathing and coughing exercises for at least 6 weeks." It is important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks until all of the infection has cleared from the lungs. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. Increased fluid intake, not caloric intake, is required to liquefy secretions. Home O2 is not a requirement unless the patient's oxygenation saturation is below normal. After admitting a patient to the medical unit with a diagnosis of pneumonia, the nurse will verify that which of the following physician orders have been completed before administering a dose of cefotetan (Cefotan) to the patient? A. Serum laboratory studies ordered for AM B. Pulmonary function evaluation C. Orthostatic blood pressures D. Sputum culture and sensitivity - ✔✔D. Sputum culture and sensitivityThe nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefotetan. It is important that the organisms are correctly identified (by the culture) before their numbers are affected by the antibiotic; the test will also determine whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, all of the other options will not be affected by the administration of antibiotics. Which of the following nursing interventions is most appropriate to enhance oxygenation in a patient with unilateral malignant lung disease? A. Positioning patient on right side. B. Maintaining adequate fluid intake C. Performing postural drainage every 4 hours D. Positioning patient with "good lung down" - ✔✔D. Positioning patient with "good lung down" Therapeutic positioning identifies the best position for the patient assuring stable oxygenation status. Research indicates that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation in patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation. A 71-year-old patient is admitted with acute respiratory distress related to cor pulmonale. Which of the following nursing interventions is most appropriate during admission of this patient? A. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. B. Perform a comprehensive health history with the patient to review prior respiratory problems. C. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress. D. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. - ✔✔C. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed once the patient's acute respiratory distress is being managed. When planning appropriate nursing interventions for a patient with metastatic lung cancer and a 60- pack-year history of cigarette smoking, the nurse recognizes that the smoking has most likely decreased the patient's underlying respiratory defenses because of impairment of which of the following? A. Reflex bronchoconstriction B. Ability to filter particles from the air C. Cough reflex D. Mucociliary clearance - ✔✔D. Mucociliary clearance Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions, chronic cough, and frequent respiratory infections. While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which of the following nursing interventions is most appropriate based upon these findings? A. Continue with ambulation as this is a normal response to activity. B. Move the oximetry probe from the finger to the earlobe for more accurate monitoring during activity. C. Obtain a physician's order for supplemental oxygen to be used during ambulation and other activity. D. Obtain a physician's order for arterial blood gas determinations to verify the oxygen saturation. - ✔✔C. Obtain a physician's order for supplemental oxygen to be used during ambulation and other activity. An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to have supplemental oxygen applied. The nurse is caring for a 73-year-old patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient complains of shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4o F, blood pressure 130/88, respirations 36, and oxygen saturation 91% on room air. Which of the following should the nurse first suspect as the etiology of this episode? A. Septic embolus from the knee joint B. Pulmonary embolus from deep vein thrombosis C. New onset of angina pectoris D. Pleural effusion related to positioning in the operating room - ✔✔B. Pulmonary embolus from deep vein thrombosis The patient presents the classic symptoms of pulmonary embolus: acute onset of symptoms, tachypnea, shortness of breath, and chest pain. In the case of pulmonary embolus from deep vein thrombosis, which of the following actions should the nurse take first? A. Notify the physician. B. Administer a nitroglycerin tablet sublingually. C. Conduct a thorough assessment of the chest pain. D. Sit the patient up in bed as tolerated and apply oxygen. - ✔✔D. Sit the patient up in bed as tolerated and apply oxygen.The patient's clinical picture is consistent with pulmonary embolus, and the first action the nurse takes should be to assist the patient. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the physician. The nurse is caring for a postoperative patient with sudden onset of respiratory distress. The physician orders a STAT ventilation-perfusion scan. Which of the following explanations should the nurse provide to the patient about the procedure? A. This test involves injection of a radioisotope to outline the blood vessels in the lungs, followed by inhalation of a radioisotope gas. B. This test will use special technology to examine cross sections of the chest with use of a contrast dye. C. This test will use magnetic fields to produce images of the lungs and chest. D. This test involves injecting contrast dye into a blood vessel to outline the blood vessels of the lungs. - ✔✔A. This test involves injection of a radioisotope to outline the blood vessels in the lungs, followed by inhalation of a radioisotope gas.A ventilation-perfusion scan has two parts. In the perfusion portion, a radioisotope is injected into the blood and the pulmonary vasculature is outlined. In the ventilation part, the patient inhales a radioactive gas that outlines the alveoli. During assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to which of the following pathophysiologic changes? A. Laryngospasm B. Overdistention of the alveoli C. Narrowing of the airway D. Pulmonary edema - ✔✔C. Narrowing of the airwayNarrowing of the airway leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which of the following clinical manifestations might be present as an early symptom during an exacerbation of asthma? A. Anxiety B. Cyanosis C. Hypercapnia D. Bradycardia - ✔✔A. Anxiety An early symptom during an asthma attack is anxiety because he is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating. The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. Which of the following is the primary reason for the nurse to carefully inspect the chest wall of this patient? A. Observe for signs of diaphoresis B. Allow time to calm the patient C. Monitor the patient for bilateral chest expansion D. Evaluate the use of intercostal muscles - ✔✔D. Evaluate the use of intercostal muscles The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Which of the following positions is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? A. Supine B. Lithotomy C. High-Fowler's D. Reverse Trendelenburg - ✔✔C. High-Fowler'sThe patient experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the patient's respiratory status is improving? A. Wheezing becomes louder B. Vesicular breath sounds decrease C. Aerosol bronchodilators stimulate coughing D. The cough remains nonproductive - ✔✔A. Wheezing becomes louder The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. The nurse assesses for which of the following etiologic factor for this nursing diagnosis in patients with asthma? A. Anxiety and restlessness B. Effects of medications C. Fear of suffocation D. Work of breathing - ✔✔D. Work of breathingWhen the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate which of the following is likely to be the next step in treatment? A. Pulmonary function testing B. Systemic corticosteroids C. Biofeedback therapy D. Intravenous fluids - ✔✔B. Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. A patient with acute exacerbation of COPD needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use? A. Venturi mask B. Partial non-rebreather mask C. Oxygen tent D. Nasal cannula - ✔✔A. Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered. While teaching a patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to do which of the following? A. Use the flow meter each morning after taking medications to evaluate their effectiveness. B. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled. C. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. D. Increase the doses of the long-term control medication if the peak flow numbers decrease. - ✔✔C. Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. It is important to keep track of peak flow readings daily and when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the physician based on personal peak flow numbers. Peak flow is measured by exhaling into the meters and should be assessed before and after medications to evaluate their effectiveness. The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, the nurse should provide which of the following instructions? A. "Close lips tightly around the mouthpiece and breathe in deeply and quickly." B. "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." C. "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible." D. "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." - ✔✔A. "Close lips tightly around the mouthpiece and breathe in deeply and quickly." Dry powder inhalers do not require spacer devices. The patient should be instructed to breathe in deeply and quickly to ensure medicine moves down deeply into lungs. The patient may not taste or sense the medicine going into the lungs. The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after noting which of the following? A. Adrenocortical dysfunction and hyperglycemia B. Elevation of blood glucose and calcium levels C. Oropharyngeal candidiasis and hoarseness D. Hypertension and pulmonary edema - ✔✔C. Oropharyngeal candidiasis and hoarseness Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose. The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state which of the following as the primary benefit? A. "Now I will not need to breathe in as deeply when taking the inhaler medications." B. "This device will make it so much easier and faster to take my inhaled medications." C. "I will pay less for medication because it will last longer." D. "More of the medication will get down into my lungs to help my breathing." - ✔✔D. "More of the medication will get down into my lungs to help my breathing." A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. Which of the following test results identify that a patient with an asthma attack is responding to treatment? A. A decreased exhaled nitric oxide B. An increase in CO2 levels C. A decrease in white blood cell count D. An increase in serum bicarbonate levels - ✔✔A. A decreased exhaled nitric oxide. Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma. The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which of the following patient vital signs? A. Oxygen saturation 96% B. Respiratory rate of 18 C. Temperature of 98.4° F D. Pulse rate of 76 - ✔✔D. Pulse rate of 76 Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 76 indicates that the patient did not experience tachycardia as an adverse effect. The patient has an order for each of the following inhalers. Which of the following should the nurse offer to the patient at the onset of an asthma attack? A. Albuterol (Proventil) B. Beclomethasone (Beclovent) C. Ipratropium bromide (Atrovent) D. Salmeterol (Serevent) - ✔✔A. Albuterol (Proventil) Albuterol is a short-acting bronchodilator that should initially be given when the patient experiences an asthma attack. The nurse who has administered a first dose of oral prednisone (Deltasone) to the patient with asthma writes on the care plan to begin monitoring which of the following patient parameters? A. Intake and output B. Bowel sounds C. Apical pulse D. Deep tendon reflexes - ✔✔A. Intake and output Corticosteroids such as prednisone can lead to fluid retention. For this reason, it is important to monitor the patient's intake and output. The nurse is assisting a patient to learn self-administration of beclomethasone two puffs inhalation q6hr. The nurse explains that the best way to prevent oral infection while taking this medication is to do which of the following as part of the self-administration techniques? A. Chew a hard candy before the first puff of medication. B. Ask for a breath mint following the second puff of medication. C. Rinse the mouth with water before each puff of medication. D. Rinse the mouth with water following the second puff of medication. - ✔✔D. Rinse the mouth with water following the second puff of medication. The patient should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection. The nurse is scheduled to give a dose of salmeterol by metered dose inhaler (MDI). The nurse would administer the right drug by selecting the inhaler with which of the following trade names? A. Vanceril B. Serevent C. AeroBid D. Atrovent - ✔✔B. Serevent The trade or brand name for salmeterol, an adrenergic bronchodilator, is Serevent. The nurse is evaluating whether a patient understands how to safely determine whether a metered dose inhaler is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler? A. Place it in water to see if it floats. B. Shake the canister while holding it next to the ear. C. Check the indicator line on the side of the canister. D. Keep track of the number of inhalations used. - ✔✔D. Keep track of the number of inhalations used. It is no longer appropriate to see if a canister floats in water or not as research has demonstrated this is not accurate. The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing when those inhalations have been used. The nurse is scheduled to give a dose of ipratropium bromide by metered dose inhaler. The nurse would administer the right drug by selecting the inhaler with which of the following trade names? A. Vanceril B. Pulmicort C. AeroBid D. Atrovent - ✔✔D. Atrovent The trade or brand name for ipratropium bromide, an anticholinergic medication, is Atrovent. The patient has an order for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/ml. How many milliliters should the nurse use to prepare the patient