Following an acute asthma attack the patient may experience a second attack because Quizlet

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The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 <60 mm HG or SaO2 <88%) and hypercapnia (PaCO2 >45mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia intoxicating respiratory failure

a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg
b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg
c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg
d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg

1. A patient with a history of asthma is admitted to the hospital in acute respiratory distress. During the assessment of the patient, the nurse would notify the health care provider immediately about:

A) a pulse oximetry reading of 90%.

B) a peak expiratory flow rate of 240 ml/min.

C) decreased breath sounds and wheezing.

D) a respiratory rate of 30 breaths/minute.

D) a respiratory rate of 30 breaths/minute.

3. What is the priority nursing intervention in the postictal phase of a seizure?

A) Reorient the patient to time, person, and place.

B) Determine the client's level of sleepiness.

C) Assess the client's breathing pattern.

D) Position the patient comfortably.

C) Assess the client's breathing pattern.

4. The nurse will anticipate discharge today for which of these patients with community-acquired-pneumonia?

A) 24-year-old patient who has a temperature ranging from 100.6 F to 101 F.

B) 5 -year-old patient who has had 600 ml of oral fluids in the last 24 hours.

C) 50-year-old patient who has oxygen saturation of 91% on room air.

D) 72-year-old patient with a pulse of 102 and blood pressure of 90/56.

C) 50-year-old patient who has oxygen saturation of 91% on room air.

2. The nurse teaches a patient with chronic obstructive pulmonary disease (COPD) how to perform pursed lip breathing, explaining that this technique will assist respiration by

A) loosening secretions so that they may be coughed up more easily.

B) promoting maximal inhalation for better oxygenation of the lungs.

C) preventing airway collapse and air trapping in the lungs during expiration.

D) decreasing anxiety by giving the patient control of respiratory patterns.

C) preventing airway collapse and air trapping in the lungs during expiration.

5. When caring for a central line the nurse is aware of the differences between a valved versus not-valved, in that non-valved require which of the following:
Select all that apply.

A. no clamps

B. clamps

C. heparin or saline to maintain patency.

D. some are triple lumen.

E. some are PICC's

B,C,D

6. A patient is seen in the clinic with COPD, which information given by the patient would help most in confirming a diagnosis of chronic bronchitis??

A) The patient tells the nurse about a family history of bronchitis.

B) The patient denies having any respiratory problems until 6 months ago.

C) The patient's history indicates a 40 pack-year cigarette history.

D) The patient complains about having a productive cough every winter for 2 years in a row.

D) The patient complains about having a productive cough every winter for 2 years in a row.

7. The nurse is preparing to administer medication through a "power PICC," and knows that it requires irrigation:

A) of 3cc of normal saline with a 10cc syringe.

B) of 10cc of normal saline using 3cc increments until flush is complete.

C) of 10cc of normal saline using pulsate until finished.

D) no irrigation following medication administration.

C) of 10cc of normal saline using pulsate until finished.

8. The nurse recognizes that intubation and mechanical ventilation are indicated for a patient in status asthmaticus when

A) ventricular dysrhythmias and dyspnea occur.

B) loud wheezes are audible throughout the lungs.

C) pulsus paradoxus is greater than 40 mmHg.

D) fatigue and an O2 saturation of 88% develop.

D) fatigue and an O2 saturation of 88% develop.

9. When reading the medical record for a patient with COPD, the nurse notes that the patient has cor pulmonale. To assess for cor pulmonale, the nurse will monitor the patient for:

A) elevated temperature.

B) complaints of chest pain.

C) jugular vein distension.

D) clubbing of the fingers

C) jugular vein distension.

10.When administering IV push medication through a central line the nurse should be aware of
Select all that apply

A. specific action of drug being administered.

B. the peak action of the drug being administered.

C. the oral dosage of the medication being administered.

D. if the patient has allergies to shellfish.

E. the rate recommended for administration.

A,B,E

11. All of these orders are received for a patient having an acute asthma attack. Which one will the nurse administer first?

A)IV methylprednisolone (Solu-Medrol) 60mg.

B) Triamcinolone (Azmacort) 2 puffs per MDI

C) Salmeterol (Serevent) 50mcg per DPI

D) Albuterol (Ventolin) 2.5mg per nebulizer.

D) Albuterol (Ventolin) 2.5mg per nebulizer.

13. An asthmatic patient who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse will explain that

A) Advair is a combination of long-acting and slow-acting bronchodialators

B) the two drugs work together to block the effects of histamine on the bronchioles.

C) one drug is a bronchodilator and the other decreases inflammation.

D) the combination of the two drugs works quickly in an acute asthma attack.

B) the two drugs work together to block the effects of histamine on the bronchioles.

12. While teaching a patient with asthma the appropriate use of a peak flow meter, the nurse instructs the patient to

A) take and record peak and flow readings when having asthma symptoms or an attack.

B) increase the doses of long-term control mediction for peak and flow in the red zone.

C) use the flow meter each morning after taking asthma medications.

D) empty the lungs and then inhale rapidly through the mouthpiece.

A) take and record peak and flow readings when having asthma symptoms or an attack.

14. When teaching the patient with COPD about exercise, which information should the nurse include?

A) "Stop exercising if you start to feel short of breath."
Correct!

B) "Use the bronchodilator before you start to exercise."

C) "Breathe in and out through the mouth while you exercise."

D)"Upper body exercise should be avoided to prevent dyspnea."

B) "Use the bronchodilator before you start to exercise."

16. A nurse is accessing a central line, what factors are considered during assessment?
Select all that apply.

A) Insertion site, tenderness at site of insertion.

B) Last dressing change.

C) What the patient knows about central catheters.

D) Discharge care of central catheters.

E) Looking for excessive redness, pain at site, tenderness at distal end of catheter.

A,B,E

15. A client is taking albuterol sulfate (Ventolin Diskus) by inhalation but cannot cough up secretions. The nurse teaches the patient to do which of the following to best help clear the bronchial secretions?

A) Get more exercise each day.

B)Use a dehumidifier in the home.

C)Administer an extra dose before bedtime.

D)Increase the amount of fluids consumed every day.

D)Increase the amount of fluids consumed every day.

17. Which finding would be an indication to the nurse that the patient having an acute asthma attack was responding to the prescribed treatment?

A)Wheezes are more easily heard.

B)The oxygen saturation is 89%.

C)Vesicular breath sounds resolve.

D)The respiratory effort decreases.

A)Wheezes are more easily heard.

18. What nursing assessments should be documented at the beginning of the ictal phase of a seizure?

A)heart rate, respirations, pulse oximeter, and blood pressure.

B)last dose of anticonvulsant and circumstances at the time.

C)type of visual, auditory, and olfactory aura the patient experienced.

D)movement of the head and eyes and muscle rigidity.

D)movement of the head and eyes and muscle rigidity.

19. During assessment of a patient with a history of asthma, the nurse notes wheezing and dyspnea. The nurse will anticipate giving medications to reduce

A) laryngospasm.

B) pulmonary edema.

C)airway narrowing.

D) alveolar distention.

C)airway narrowing.

20. The nurse is assessing a client in the postictal phase of generalized tonic-clonic seizure. The nurse should determine if the patient has:

A) drowsiness.

B) inability to move.

C) parenthesis.

D) hypotension.

A) drowsiness.

21. Which nursing action is the first priority during a generalized tonic-clonic seizure episode?

A) Observe and record all events that occur before, during, and after the seizure.

B)Maintain a patent airway by turning the head to the side.

C)Protect the patient from injury.

D) Monitor vital signs. with special attention directed to respiratory status.

C)Protect the patient from injury.

22. Which of these prescribed interventions will the nurse implement first for a hospitalized patient who is experiencing continuous tonic-clonic seizures?

A) Give phenytoin (Dilantin) 100 mg IV

B) Monitor level of consciousness (LOC)

C) Obtain computed tomography (CT) scan

D) Administer lorazepam (Ativan) 4 mg IV

D) Administer lorazepam (Ativan) 4 mg IV

23. A 23 year-old patient with a recent history of encephalitis is admitted to the medical unit with new onset generalized tonic-clonic seizures. Which nursing activities included in the patient's care will be best to delegate to an LPN (licensed practical nurse)/LVN (licensed vocational nurse) Select all that apply?

A) Observing and documenting the onset and duration of any seizure activity
B) Administering phenytoin (Dilantin) 200mg PO TID
C) Teaching the client about the need for frequent tooth brushing and flossing
D Developing a discharge plan that includes referral to Epilepsy Foundation
E) Assessing for adverse effects caused by new anti-seizure medications

A) Observing and documenting the onset and duration of any seizure activity

B) Administering phenytoin (Dilantin) 200mg PO TID

24. A patient has a tonic-clonic seizure while the nurse is in the patient's room. During the seizure, it is important for the nurse to:

A)insert an oral airway during the seizure to maintain a patient airway.

B)restrain the patient's arms and legs to prevent injury during the seizure.

C)avoid touching the patient to prevent further nervous system stimulation.

D)time, observe, and record the details of the seizure and postictal state.

D)time, observe, and record the details of the seizure and postictal state.

25. When the home health RN if planning care for a patient with epilepsy, which nursing action can be delegated to a LPN (licensed practical nurse) or LVN (licensed vocational nurse)?

A)Make referrals to appropriate community agencies.

B)Place medications in the home medication organizer.

C)Teach the patient and family how to manage seizures.

D)Assess for use of medications that may precipitate seizures.

B)Place medications in the home medication organizer.

26. When preparing a patient with possible asthma for pulmonary function testing, the nurse will teach the patient to

A)avoid eating or drinking for 4 hours before the forced expiratory volume in 1 second (FEV1)/forced expiratory volume (FEV) test.

B)take oral corticosteroids at least 2 hours before the examination.

C)withhold bronchodilators for 6-12 hours before the examination.

D)use rescue medications immediately before the FEV1/FEV testing.

C)withhold bronchodilators for 6-12 hours before the examination.

27. When preparing to teach a patient about phenytoin sodium (Dilantin) therapy, the nurse should urge the patient not to stop the drug suddenly because:

A)physical dependency on the drug develops over time.

B)status epilepticus may develop.

C)a hypoglycemic reaction develops.

D)heart block is likely to develop.

B)status epilepticus may develop.

28. The nurse is teaching a patient to recognize an aura. The nurse should instruct the patient to note:

A)a postictal state of amnesia.

B)a hallucination that occurs during a seizure.

C)a symptom that occurs just before a seizure.

D)a feeling of relaxation as the seizure begins to subside.

C)a symptom that occurs just before a seizure.

29. All of the following orders are received for a patient who has been admitted with probable bacterial pneumonia and sepsis. Which order will the nurse complete first?

A)Obtain blood cultures from two sites.

B)Give ciprofloxin (Cipro) 400 mg IVPB.

C)Send the patient to radiology for a chest x-ray.

D)Administer aspirin suppository.

A)Obtain blood cultures from two sites.

30. Which clinical manifestation is a typical reaction to long-term phenytoin sodium therapy?

A)weight gain.

B)insomnia.

C)excessive growth of gum tissue.

D)deteriorating eyesight.

C)excessive growth of gum tissue.

31. When a patient with COPD is receiving oxygen, the best action by the nurse is to

A)avoid administration of oxygen at a rate of more than 2L/min.

B)minimize oxygen use to avoid oxygen dependency.

C)administer oxygen according to the patient's level of dyspnea.

D)maintain the pulse oximetry level at 90% or greater.

A)avoid administration of oxygen at a rate of more than 2L/min.