Nursing Exam 6 - Oxygenation | Answered with Rationales

Nursing Exam 6 - Oxygenation | Answered with Rationales A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases s ...

Nursing Exam 6 - Oxygenation | Answered with Rationales A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD? A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax ***The answer is C. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters". A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia ***The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels). The term" blue bloaters" is used to describe patients with? A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema ***The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema. A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels. An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be: A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following: A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm. A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation? A. Spiriva B. Salmeterol C. Symbicort D. Albuterol The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator. Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply: A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms." The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually). A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication? A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation. In regards to previous question, which action by the patient demonstrates they know how to properly use this medication? A. The patient rinses their mouth after using the Spiriva inhaler. B. The patient rinses their mouth after using the Pulmicort inhaler. C. The patient dispenses of the inhalers. D. The patient coughs 2 times after using the Pulmicort inhaler. The patient should rinse the mouth after using any type of corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the medication from the mouth. If left in the mouth, the patient can develop thrush. A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect: A. Atrovent B. Prednisone C. Roflumilast D. Theophylline Roflumilast is a phosphodiestrace-4 inhibitor that is used in the treatment of patients with severe COPD due to chronic bronchitis. This medication can caused increased suicidal thoughts, and the patient should be monitored for this while taking Roflumilast. A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to? A. Administer the dose at 1400 as ordered B. Notify the physician for further orders C. Hold the 1400 dose D. Collect another blood sample to confirm the level A normal Theophylline level is 10-20 mcg/mL...therefore the level is normal and the nurse should administer the dose at 1400 as ordered. You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising? A. Prednisone B. Atrovent C. Flagyl D. Levaquin Prednisone is a corticosterioid and can cause hyperglycemia and brusing. True or False: Tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis and it only affects the lungs. True False tuberculosis is a contagious bacterial infection caused by mycobacterium tuberculosis that affects the lungs AND other systems of the body like the joints, kidneys, brain, spine, liver etc. A 55-year old male patient is admitted with an active tuberculosis infection. The nurse will place the patient in ___________________ precautions and will always wear _____________________ when providing patient care? A. droplet, respirator B. airborne, respirator C. contact and airborne, surgical mask D. droplet, surgical mask A patient with ACTIVE TB is contagious. The bacterium, mycobacterium tuberculosis which causes TB, is so small that it can stay suspended in the air for hours to days. Therefore, the nurse will place the patient in AIRBORNE precautions. In addition, a special mask must be worn called a respirator (also referred to as an N95 mask.....a surgical mask does NOT work with this condition). Which statement is correct regarding mycobacterium tuberculosis? A. This bacterium is an anaerobic type of bacteria. B. It is an alkali bacterium that stains bright red during an acid-fast smear test. C. It is known as being an aerobic type of bacteria. D. It's an acid-fact bacterium that stains bright green during an acid-fast smear test. Mycobacterium tuberculosis is AEROBIC (it thrives in conditions that are high in oxygen), and it is an ACID-FAST bacterium, which means when it is stained during an acid-fast smear it will turn BRIGHT RED Your patient with a diagnosis of latent tuberculosis infection needs a bronchoscopy. During transport to endoscopy, the patient will need to wear? A. N95 mask B. Surgical mask C. No special PPE is needed D. Face mask with shield Patients with a latent tuberculosis infection are NOT contagious. Therefore, no special PPE is needed for the patient during transport. HOWEVER, if the patient had ACTIVE tuberculosis they would need to wear a surgical mask during transport. You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis: A. Diabetes B. Liver failure C. Long-term care resident D. Inmate E. IV drug user F. HIV G. U.S. resident Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors. Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition: A. "The patient will not need treatment unless it progresses to an active tuberculosis infection." B. "The patient is not contagious and will have no signs and symptoms." C. "The patient will have a positive tuberculin skin test or IGRA test. D. "The patient will have an abnormal chest x-ray." E. "The patient's sputum will test positive for mycobacterium tuberculosis." The patient WILL need medical treatment to prevent this case of LBTI from developing into an active TB infection later on. The patient will NOT have an abnormal chest x-ray or a positive sputum test. This is only in active TB. A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew-up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification? A. PPD (Mantoux test) B. Chest X-ray C. QuantiFERON-TB Gold (QFT) D. Sputum culture Patients who have received the BCG vaccine will have a false positive on a PPD (Mantoux test), which is the tuberculin skin test. The BCG vaccine is a vaccine to prevent TB. It is given in foreign countries to children to prevent TB. Therefore, the person has already been exposed to the bacteria via vaccine and will have a false positive. A QuantiFERON-TB Gold test is a better option for this patient. It is a blood test. You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education? A. Cough for a minimum of 6 weeks B. Night sweats C. Weight gain D. Hemoptysis E. Chills F. Fever G. Chest pain Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain). A patient has a positive PPD skin test that shows an 8 mm induration. As the nurse you know that: A. The patient will need to immediately be placed in droplet precautions and started on a medication regime. B. The patient will need a chest x-ray and sputum culture to confirm the test results before treatment is provided. C. The patient will need an IGRA test to help differentiate between a latent tuberculosis infection versus an active tuberculosis infection. D. The patient will need to repeat the skin test in 48-72 hours to confirm the results. A positive PPD result does NOT necessarily mean the patient has an active infection of TB. The patient will need a chest x-ray and sputum culture to determine if mycobacterium tuberculosis is present and then treatment will be based on those results. The IGRA test does NOT differentiate between LTBI or an active TB infection. Patients are placed in airborne precautions (NOT droplet) if they have ACTIVE TB. A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in _________ so the results can be interpreted? A. 24-48 hours B. 12-24 hours C. 48-72 hours D. 24-72 hours A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result? A. 5 mm induration B. 15 mm induration C. 9 mm induration D. 10 mm induration 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive. The physician orders an acid-fast bacilli sputum culture smear on a patient with possible tuberculosis. How will you collect this? A. Collect 2 different sputum specimens 12 hours apart B. Collect 3 different sputum specimens (one in the morning, afternoon, and at night) C. Collect 3 different sputum specimens on 3 different days D. Collect 2 different sputum specimens on 2 different days This is how an AFB sputum culture is collected. A patient receiving medical treatment for an active tuberculosis infection asks when she can starting going out in public again. You respond that she is no longer contagious when: select all that apply A. She has 3 negative sputum cultures B. Her signs and symptoms improve C. She has completed the full medication regime D. Her chest x-ray is normal E. She has been on tuberculosis medications for about 3 weeks These are all criteria for when a patient with active TB can return to public life (school, work, running errands). Until then they are still contagious and must stay home in isolation. As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is: A. Incorrect medication ordered B. Increase in tuberculosis cases nationwide C. Incorrect route of drug ordered D. Noncompliance due to duration of medication treatment needed Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete. Your patient, who is receiving Pyrazinamide, report stiffness and extreme pain in the right big toe. The site is extremely red, swollen, and warm. You notify the physician and as the nurse you anticipated the doctor will order? A. Calcium level B. Vitamin B6 level C. Uric acid level D. Amylase level This medication can increase uric acid levels which can lead to gout. The patient's signs and symptoms are classic findings in a gout attack. You note your patient's sweat and urine is orange. You reassure the patient and educate him that which medication below is causing this finding? A. Ethambutol B. Streptomycin C. Isoniazid D. Rifampin This medication will cause body fluids to turn orange. A patient with active tuberculosis is taking Ethambutol. As the nurse you make it priority to assess the patient's? A. hearing B. mental status C. vitamin B6 level D. vision This medication can cause inflammation of the optic nerve. Therefore, it is very important the nurse asks the patient about their vision. If the patient has blurred vision or reports a change in colors, the MD must be notified immediately. A patient taking Isoniazid (INH) should be monitored for what deficiency? A. Vitamin C B. Calcium C. Vitamin B6 D. Potassium This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication. A patient is taking Streptomycin. Which finding below requires the nurse to notify the physician? A. Patient reports a change in vision. B. Patient reports a metallic taste in the mouth. C. The patient has ringing in their ears. D. The patient has a persistent dry cough. The answer is C. This medication can be very toxic to the ears (cranial nerve 8). Therefore, it is alarming if the patient reports ringing in their ears, which could represent ototoxicity. A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications? A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. D. The patient inhales the Fluticasone and immediately inhales the Salmeterol. The bronchodilator inhaler (Salmeterol) is administered first to open up the airways. Then the patient is to wait five minutes and then administer the corticosteroid (Fluticasone). The bronchodilator will open the airways so the corticosteroid can easily enter the airways to decrease inflammation. Your assisting your patient who has asthma to bed. The patient is experiencing a frequent cough and chest tightness. You auscultate the patient's lung fields and note expiratory wheezes. The patient's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the patient with the fastest relief from these signs and symptoms of an asthma attack? A. Theophylline B. Tiotropium C. Albuterol D. Cromolyn During an asthma attack, the patient needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators, such as Albuterol, short-acting beta agonists. Another type of short-acting bronchodilator is an anticholinergic bronchodilator called Ipratropium (this is given if a patient can't tolerated short-acting beta agonists like Albuterol). Theophylline is a bronchodilator but given orally and is NOT for quick relief. Tiotropium is a bronchodilator, as well, but is a LONG-ACTING anticholinergic bronchodilator. Cromolyn is an inhaled nonsteroidal anti-allergy medication that doesn't provide quick relief. You assist your patient with using their inhaler. The inhaler contains the medication Budesonide. Before administering the inhaler, you will want to connect what device to the inhaler to help decrease the patient from developing ________? A. Peak flow meter; pneumonia B. Incentive spirometer; thrush C. Spacer; thrush D. Peak flow meter; mouth sores Budesonide is a corticosteroid. Inhaled corticosteroids can cause thrush. Therefore, it is important to connect a spacer to the inhaler before usage to help prevent the patient from developing thrush and for the patient to gargle and rinse the mouth with water. A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will? A. Immediately stop the nebulizer B. Re-adjust the nebulizer C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication. D. Reassure the patient this is a temporary side effect of this medication. Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the patient that these are temporary side effects of this medication. Your patient's asthma is poorly controlled. The patient reports using their rescue inhaler 4 times a week. In addition, the patient's asthma is not responding to other treatments. The physician orders the patient to take a medication that works by blocking the role of the immunoglobulin IgE. This describes which medication below? A. Montelukast B. Omalizumab C. Cromolyn D. Salmeterol Omalizumab blocks the role of the immunoglobulin IgE, which will decrease the allergic response...hence asthma attacks. It is given subcutaneously and used when a patient's asthma is poorly controlled and other treatments are not working. It is NOT used for quick relief. It is important the patient receives NO LIVE vaccines while receiving this medication You're providing discharge teaching to a patient who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the patient to list some of them. Select all the correct early warning signs verbalized by the patient: A. Easily fatigued with physical activity B. Reduced peak flow meter reading C. Chest retractions D. Cyanosis E. Wheezing with activity F. Nighttime coughing G. No relief with short-acting bronchodilator inhaler These are all early warning signs an asthma attack is imminent. Options C, D, and G are signs and symptoms of an active asthma attack that requires medical treatment. Select all the correct options that represent the pathophysiology of an asthma attack. A. The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B. The mucosa lining experiences severe inflammation. C. The goblet cells within the mucosa lining produce excessive amounts of mucous. D. Too much carbon dioxide is exhaled due to hyperventilation and the patient experiences respiratory alkalosis. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic. Your educating a patient how to use a peak flow meter to help monitor the status of their asthma. Which statement by the patient demonstrates they understand how to use the device? A. "This device will help keep my lungs strong so I don't have another asthma attack." B. "I will inhale as hard as I can while using the device." C. "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading." D. "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow." This option is correct. Option A is wrong because this device monitors how controlled a patient's asthma is and if it is getting worst. It doesn't make the lung stronger. Option B is wrong because the patient exhales as hard as they can onto the device. Option D is wrong because a flow rate of 90% of the personal best peak flow is a good reading. Select all the following that can trigger an asthma attack: A. Sulfites B. Smoke C. Caffeine D. GERD E. Cold, windy weather F. Beta agonist G. Cockroaches Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack. A patient has exercise-induced asthma. Which of the following actions can the patient perform to help prevent an attack during exercise. Select all that apply: A. Avoid warming up before exercise. B. Administer a short-acting beta agonist before exercise. C. Administer a short-acting beta agonist after exercise. D. Avoid exercising when experiencing a respiratory illness. Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after). Your patient with asthma is taking Theophylline. Which product below should the patient avoid consuming? A. Caffeine B. Dairy C. Wheat D. Shellfish Caffeine has the same properties as Theophylline and can increase the effects the drug. Which medication below blocks the function of Leukotriene for the treatment of asthma? A. Salmeterol B. Theophylline C. Tiotropim D. Montelukast The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse? A. Intravenous B. Intramuscular