BINGO REVIEWER - medsurg.pdf
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BINGO REVIEWER of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: 1. Nurse Andrews is caring for Mr. Thompson, a 65-...
BINGO REVIEWER of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: 1. Nurse Andrews is caring for Mr. Thompson, a 65-year-old patient A. Promote oxygen intake. diagnosed with COPD. To ensure Mr. Thompson maintains adequate B. Strengthen the diaphragm. gas exchange, Nurse Andrews must choose the most effective nursing C. Strengthen the intercostal muscles. action. Which action should she prioritize? D. Promote carbon dioxide elimination. A. Positioning the patient in a semi-Fowler's position. B. Encouraging the patient to consume three glasses of fluid daily. 9. A nurse performs an admission assessment on a female client with C. Applying a high-flow Venturi mask to deliver prescribed a diagnosis of tuberculosis. The nurse reviews the results of which oxygen. diagnostic test that will confirm this diagnosis? D. Administering a prescribed sedative. A. Bronchoscopy B. Sputum culture 2. Nurse Patel is teaching Mrs. Wilson, a patient with emphysema, C. Chest x-ray the proper technique for pursed-lip breathing. Mrs. Wilson is D. Tuberculin skin test curious about the benefits of this breathing method and asks Nurse Patel to explain its purpose. What should Nurse Patel say? 10. A community health nurse is conducting an educational session A. It reduces the use of accessory breathing muscles. with community members regarding tuberculosis. The nurse tells the B. It prolongs the inspiratory phase of breathing. group that one of the first symptoms associated with tuberculosis is: C. It increases the strength of inspiratory muscles. A. Dyspnea D. It helps prevent early airway collapse. B. Chest pain C. A bloody, productive cough 3. A nurse is caring for a female client diagnosed with tuberculosis. D. A cough with the expectoration of mucoid sputum Which assessment, if made by the nurse, is inconsistent with the usual clinical presentation of tuberculosis and may indicate the 11. An emergency room nurse is assessing a female client who has development of a concurrent sustained a blunt injury to the chest wall. Which of these signs would problem? indicate the presence of a pneumothorax in this client? A. Cough A. A low respiratory B. High-grade fever B. Diminished breathe sounds C. Chills and night sweats C. The presence of a barrel chest D. Anorexia and weight loss D. A sucking sound at the site of injury 4. A nurse is assessing a male client with chronic airflow limitations 12. Nurse Kim is caring for a client with a pneumothorax and who and notes that the client has a “barrel chest.” The nurse interprets that has had a chest tube inserted notes continuous gentle bubbling in the this client has which of the following forms of chronic airflow suction control chamber. What action is appropriate? limitations? A. Do nothing, because this is an expected finding. A. Emphysema B. Immediately clamp the chest tube and notify the physician. B. Bronchial asthma C. Check for an air leak because the bubbling should be C. Chronic obstructive bronchitis intermittent. D. Bronchial asthma and bronchitis D. Increase the suction pressure so that bubbling becomes vigorous. 5. A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent intubation. A nurse 13. Nurse Joy is caring for a client after a bronchoscopy and biopsy. checks the client when the high-pressure alarm on the ventilator Which of the following signs, if noticed in the client, should be sounds, and notes that the client has absence of breathe sounds in reported immediately to the physician? right upper lobe of the lung. The nurse immediately assesses for other A. Dry cough signs of: B. Hermaturia A. Right pneumothorax C. Bronchospasm B. Pulmonary embolism D. Blood-streaked sputum C. Displaced endotracheal tube D. Acute respiratory distress syndrome 14. Considering the following respiratory terms, which one aligns with the definition: The maximum amount of air that can be 6. A nurse teaches a male client about the use of a respiratory inhaler. forcefully expelled after taking the deepest possible inhalation? Which action by the client indicates a need for further teaching? A. Inhales the mist and quickly exhales A. Inspiratory Reserve Volume B. Removes the cap and shakes the inhaler well before use B. Inspiratory Capacity C. Presses the canister down with the finger as he breathes in C. Expiratory Reserve Volume D. Waits 1 to 2 minutes between puffs if more than one puff has D. Vital Capacity been prescribed 7. A female client is suspected of having a pulmonary embolus. A 15. Among the following respiratory terms, which one fits the nurse assesses the client, knowing that which of the following is a description: The quantity of air that can be drawn in after the common clinical manifestation of pulmonary embolism? expiration of a normal tidal volume? A. Dyspnea B. Bradypnea A. Inspiratory Reserve Volume C. Bradycardia B. Inspiratory Capacity D. Decreased respiratory C. Vital Capacity D. Expiratory Reserve Volume 8. A nurse instructs a female client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type 16. Imagine a woman with a slight weight problem, a background of allergy-triggered asthma, high blood pressure, and an issue with her mitral valve, presenting herself for a planned surgical procedure in a diagnoses would be most appropriate when planning nutritional hospital. As a nurse, you meticulously collect her health history and interventions for this client? perform an exhaustive physical examination, focusing particularly on A. Altered nutrition: Less than body requirements related her heart and lung systems. During the percussion of the patient’s to fatigue. chest wall, what kind of sound would you anticipate to hear? B. Activity intolerance related to dyspnea. A. Muted, flat-like sounds. C. Weight loss related to COPD. B. Clear and hollow, resonant sounds. D. Ineffective breathing pattern related to alveolar C. Dense, dull-like sounds. hypoventilation. D. Extraordinarily clear and booming, hyperresonant sounds. 25. When developing a discharge plan to manage the care of a client 17. Which of the following pathophysiological mechanisms that with COPD, the nurse should anticipate that the client will do which occurs in the lung parenchyma allows pneumonia to develop? of the following? A. Atelectasis A. Develop infections easily B. Bronchiectasis B. Maintain current status C. Effusion C. Require less supplemental oxygen D. Inflammation D. Show permanent improvement. 18. A nurse is caring for a client hospitalized with acute exacerbation 26. Which of the following outcomes would be appropriate for a of COPD. Which of the following would the nurse expect to note on client with COPD who has been discharged to home? The client: assessment of this client? A. Promises to do pursed lip breathing at home. A. Increased oxygen saturation with exercise B. States actions to reduce pain. B. Hypocapnia C. States that he will use oxygen via a nasal cannula at 5 C. A hyperinflated chest on x-ray film L/minute. D. A widened diaphragm noted on chest x-ray film D. Agrees to call the physician if dyspnea on exertion increases. 19. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the 27. Which of the following physical assessment findings would the following types of oxygen delivery systems would the nurse nurse expect to find in a client with advanced COPD? anticipate to be prescribed? A. Increased anteroposterior chest diameter A. Venturi mask B. Underdeveloped neck muscles B. Aerosol mask C. Collapsed neck veins C. Face tent D. Increased chest excursions with respiration D. Tracheostomy collar 20. Aminophylline (theophylline) is prescribed for a client with acute 28. Which of the following is the primary reason to teach pursed-lip bronchitis. A nurse administers the medication, knowing that the breathing to clients with emphysema? primary action of this medication is to: A. To promote oxygen intake A. Promote expectoration B. To strengthen the diaphragm B. Suppress the cough C. To strengthen the intercostal muscles C. Relax smooth muscles of the bronchial airway D. To promote carbon dioxide elimination D. Prevent infection 29. Which of the following is a priority goal for the client with 21. A female client is scheduled to have a chest radiograph. Which of COPD? the following questions is of most importance to the nurse assessing A. Maintaining functional ability this client? B. Minimizing chest pain A. “Is there any possibility that you could be pregnant?” C. Increasing carbon dioxide levels in the blood B. “Are you wearing any metal chains or jewelry?” D. Treating infectious agents C. “Can you hold your breath easily?” D. “Are you able to hold your arms above your head?” 30. A client’s arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3– 36 mEq/L. Which of the 22. Which of the following would be an expected outcome for a following signs or symptoms would the nurse expect? client recovering from an upper respiratory tract infection? The client A. Cyanosis will: B. Flushed skin A. Maintain a fluid intake of 800ml every 24 hours. C. Irritability B. Experience chills only once a day D. Anxiety C. Cough productively without chest discomfort. D. Experience less nasal obstruction and discharge. 31. When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects: 23. Guaifenesin 300 mg four times daily has been ordered as an A. While inhaling through an open mouth. expectorant. The dosage strength of the liquid is 200mg/5ml. How B. While exhaling through pursed lips many mL should the nurse administer each dose? C. After exhaling but before inhaling. A. 5.0 ml D. While taking a deep breath and holding it. B. 7.5 ml C. 9.5 ml 32. The nurse teaches a client with COPD to assess for s/s of right- D. 10 ml sided heart failure. Which of the following s/s would be included in the teaching plan? 24. A client with COPD reports steady weight loss and being “too A. Clubbing of nail beds tired from just breathing to eat.” Which of the following nursing B. Hypertension C. Peripheral edema D. Increased appetite client actions indicates that he us using the MDI correctly? Select all that apply. 33. The nurse assesses the respiratory status of a client who is A. The inhaler is held upright. experiencing an exacerbation of COPD secondary to an upper B. Head is tilted down while inhaling the medication respiratory tract infection. Which of the following findings would be C. Client waits 5 minutes between puffs. expected? D. Mouth is rinsed with water following administration A. Normal breath sounds E. Client lies supine for 15 minutes following administration. B. Prolonged inspiration C. Normal chest movement 41. A client is prescribed metaproterenol (Alupent) via a metered D. Coarse crackles and rhonchi dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side 34. Which of the following ABG abnormalities should the nurse effects of metaproterenol? anticipate in a client with advanced COPD? A. Irregular heartbeat A. Increased PaCO2 B. Constipation B. Increased PaO2 C. Petal edema C. Increased pH. D. Decreased heart rate. D. Increased oxygen saturation 42. A client has been taking flunisolide (Aerobid), two inhalations a 35. Which of the following diets would be most appropriate for a day, for treatment of asthma. He tells the nurse that he has painful, client with COPD? white patches in his mouth. Which response by the nurse would be A. Low fat, low cholesterol the most appropriate? B. Bland, soft diet A. “This is an anticipated side-effect of your medication. It C. Low-Sodium diet should go away in a couple of weeks.” D. High calorie, high-protein diet B. “You are using your inhaler too much and it has irritated your mouth.” 36. The nurse is planning to teach a client with COPD how to cough C. “You have developed a fungal infection from your effectively. Which of the following instructions should be included? medication. It will need to be treated with an A. Take a deep abdominal breath, bend forward, and antibiotic.” cough 3 to 4 times on exhalation. D. “Be sure to brush your teeth and floss daily. Good oral B. Lie flat on back, splint the thorax, take two deep breaths hygiene will treat this problem.” and cough. C. Take several rapid, shallow breaths and then cough 43. Which of the following health promotion activities should the forcefully. nurse include in the discharge teaching plan for a client with asthma? D. Assume a side-lying position, extend the arm over the head, A. Incorporate physical exercise as tolerated into the and alternate deep breathing with coughing. treatment plan. B. Monitor peak flow numbers after meals and at bedtime. 37. A 34-year-old woman with a history of asthma is admitted to the C. Eliminate stressors in the work and home environment emergency department. The nurse notes that the client is dyspneic, D. Use sedatives to ensure uninterrupted sleep at night. with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly 44. The client with asthma should be taught that which of the diminished breath sounds. Based on these findings, what action following is one of the most common precipitating factors of an acute should the nurse take to initiate care of the client? asthma attack? A. Initiate oxygen therapy and reassess the client in 10 A. Occupational exposure to toxins minutes. B. Viral respiratory infections B. Draw blood for an ABG analysis and send the client for a C. Exposure to cigarette smoke chest x-ray. D. Exercising in cold temperatures C. Encourage the client to relax and breathe slowly through the mouth 45. A female client comes into the emergency room complaining of D. Administer bronchodilators SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 38. The nurse would anticipate which of the following ABG results 110, R 40. The physician orders ABG’s, results are as follows: pH: in a client experiencing a prolonged, severe asthma attack? 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3– 24 mEq/L; A. Decreased PaCO2, increased PaO2, and decreased pH. SaO2 86%. Considering these results, the first intervention is to: B. Increased PaCO2, decreased PaO2, and decreased pH. A. Begin mechanical ventilation C. Increased PaCO2, increased PaO2, and increased pH. B. Place the client on oxygen D. Decreased PaCO2, decreased PaO2, and increased pH. C. Give the client sodium bicarbonate D. Monitor for pulmonary embolism. 39. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in 46. A cyanotic client with an unknown diagnosis is admitted to the clients with asthma? E.R. In relation to oxygen, the first nursing action would be to: A. Corticosteroids promote bronchodilation A. Wait until the client’s lab work is done. B. Corticosteroids act as an expectorant B. Not administer oxygen unless ordered by the physician. C. Corticosteroids have an anti-inflammatory effect C. Administer oxygen at 2 L flow per minute. D. Corticosteroids prevent development of respiratory D. Administer oxygen at 10 L flow per minute and check the infections. client’s nailbeds. 40. The nurse is teaching the client how to use a metered dose inhaler 47. Auscultation of a client’s lungs reveals crackles in the left (MDI) to administer a Corticosteroid drug. Which of the following posterior base. The nursing intervention is to: A. Repeat auscultation after asking the client to deep 56. An elderly client with pneumonia may appear with which of the breathe and cough. following symptoms first? B. Instruct the client to limit fluid intake to less than 2000 A. Altered mental status and dehydration ml/day. B. Fever and chills C. Inspect the client’s ankles and sacrum for the presence of C. Hemoptysis and dyspnea edema D. Pleuritic chest pain and cough D. Place the client on bedrest in a semi-Fowlers position. 57. When auscultating the chest of a client with pneumonia, the 48. The most reliable index to determine the respiratory status of a nurse would expect to hear which of the following sounds over areas client is to: of consolidation? A. Observe the chest rising and falling A. Bronchial B. Observe the skin and mucous membrane color. B. Bronchovestibular C. Listen and feel the air movement. C. Tubular D. Determine the presence of a femoral pulse. D. Vesicular 49. A client with COPD has developed secondary polycythemia. 58. A diagnosis of pneumonia is typically achieved by which of the Which nursing diagnosis would be included in the plan of care following diagnostic tests? because of the polycythemia? A. ABG analysis A. Fluid volume deficit related to blood loss. B. Chest x-ray B. Impaired tissue perfusion related to thrombosis C. Blood cultures C. Activity intolerance related to dyspnea D. sputum culture and sensitivity D. Risk for infection related to suppressed immune response. 59. A client with pneumonia develops dyspnea with a respiratory 50. Assessing a client who has developed atelectasis postoperatively, rate of 32 breaths/minute and difficulty expelling his secretions. The the nurse will most likely find: nurse auscultates his lung fields and hears bronchial sounds in the left A. A flushed face lower lobe. The nurse determines that the client requires which of the B. Dyspnea and pain following treatments first? C. Decreased temperature A. Antibiotics D. Severe cough and no pain. B. Bed rest C. Oxygen 51. A client states that the physician said the tidal volume is slightly D. Nutritional intake diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air: 60. A client has active TB. Which of the following symptoms will A. Exhaled forcibly after a normal expiration he exhibit? B. Exhaled after there is a normal inspiration A. Chest and lower back pain C. Trapped in the alveoli that cannot be exhaled B. Chills, fever, night sweats, and hemoptysis D. Forcibly inspired over and above a normal respiration. C. Fever of more than 104*F and nausea D. Headache and photophobia 52. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by: 61. Which of the following diagnostic tests is definitive for TB? A. A decreasing oxygen pressure in the blood A. Chest x-ray B. An increasing carbon dioxide pressure in the blood B. Mantoux test C. A decreasing oxygen pressure and/or an increasing C. Sputum culture carbon dioxide pressure in the blood. D. Tuberculin test D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood. 62. A 24-year-old client comes into the clinic complaining of right- sided chest pain and shortness of breath. He reports that it started 53. Clients with chronic illnesses are more likely to get pneumonia suddenly. The assessment should include which of the following when which of the following situations is present? interventions? A. Dehydration A. Auscultation of breath sounds B. Group living B. Chest x-ray C. Malnutrition C. Echocardiogram D. Severe periodontal disease D. Electrocardiogram (ECG) 54. Which of the following pathophysiological mechanisms that 63. A client with shortness of breath has decreased to absent breath occurs in the lung parenchyma allows pneumonia to develop? sounds on the right side, from the apex to the base. Which of the A. Atelectasis following conditions would best explain this? B. Bronchiectasis A. Acute asthma C. Effusion B. Chronic bronchitis D. Inflammation C. Pneumonia D. Spontaneous pneumothorax 55. Which of the following organisms most commonly causes community-acquired pneumonia in adults? 64. Which of the following treatments would the nurse expect for a A. Haemiphilus influenzae client with a spontaneous pneumothorax? B. Klebsiella pneumoniae A. Antibiotics C. Steptococcus pneumoniae B. Bronchodilators D. Staphylococcus aureus C. Chest tube placement D. Hyperbaric chamber 65. Which of the following methods is the best way to confirm the diagnosis of a pneumothorax? A. Auscultate breath sounds B. Have the client use an incentive spirometer C. Take a chest x-ray D. stick a needle in the area of decreased breath sounds 66. Which of the following statements best explains how opening up collapsed alveoli improves oxygenation? A. Alveoli need oxygen to live B. Alveoli have no effect on oxygenation C. Collapsed alveoli increase oxygen demand D. Gaseous exchange occurs in the alveolar membrane. 67. Which of the following best describes pleural effusion? A. The collapse of alveoli B. The collapse of bronchiole C. The fluid in the alveolar space D. The accumulation of fluid between the linings of the pleural space. 68. If a pleural effusion develops, which of the following actions best describes how the fluid can be removed from the pleural space and proper lung status restored? A. Inserting a chest tube B. Performing thoracentesis C. Performing paracentesis D. Allowing the pleural effusion to drain by itself. 69. A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the group that one of the first symptoms associated with TB is: A. A bloody, productive cough B. A cough with the expectoration of mucoid sputum C. Chest pain D. Dyspnea
