Chapter 62: Management of Clients with Parenchymal and Pleural Disorders Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 62: Management of Clients with Parenchymal and Pleural Disorders

MULTIPLE CHOICE

1. The nurse administering influenza vaccinations to a group of office workers would not offer the vaccine to a client who

a.

has a history of asthma.

b.

is allergic to eggs.

c.

is allergic to sulfa drugs.

d.

takes amoxicillin for a bladder infection.

ANS: B

Clients allergic to eggs or who have a history of Guillain-Barr syndrome should not receive an influenza vaccine.

DIF: Comprehension/Understanding REF: p. 1599 OBJ: Assessment

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Immunizations

2. The nurse notes that a client in a long-term care facility has become increasingly confused in the last few days. The residents vital signs are temperature 97.7 F, pulse rate 80 beats/min, respirations 20 breaths/min, and blood pressure mm Hg. The nurse would suspect

a.

cancer of the lung.

b.

plural effusion.

c.

pneumonia.

d.

tuberculosis (TB).

ANS: C

The older adult with pneumonia may present not with fever or respiratory manifestations, but with altered mental status and volume depletion. Classic manifestations include fever, chills, sweats, fatigue, cough, sputum production, and dyspnea.

DIF: Analysis REF: p. 1599 OBJ: Assessment

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Aging Process/Age Related Changes

3. The nurse writing an infection control policy for a home health care agency would include the information that the rise in TB cases in recent years is related to the

a.

aging of the U.S. population.

b.

emergence of antibiotic-resistant bacteria.

c.

increase in HIV infection.

d.

rise in illegal drug use.

ANS: C

This increase in TB has been attributed to the emergence of the human immunodeficiency virus (HIV) epidemic, recent influxes of immigrants from developing third-world countries, and the deterioration of the U.S. health care infrastructure.

DIF: Comprehension/Understanding REF: p. 1604 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Infectious Diseases

4. The nurse would know that the client most likely to exhibit a false-negative Mantoux reaction is the client who is

a.

being treated for sickle cell disease.

b.

HIV-positive.

c.

malnourished.

d.

previously diagnosed with TB.

ANS: B

False-negative reactions are possible with the Mantoux test, especially in clients who are immunosuppressed or anergic. A 5-cm Mantoux reading is considered positive in a client who is immunosuppressed.

DIF: Comprehension/Understanding REF: pp. 1605, 1606

OBJ: Assessment

MSC: Health Promotion Prevention and/or Early Detection of Health Problems-Health Screening

5. The nurse caring for a client recently diagnosed with active TB would include in the teaching plan which information regarding medications?

a.

Clients must report daily to the health department to receive their medication.

b.

Clients are usually admitted to the hospital to initiate treatment for TB.

c.

Medications are generally given for 6 to 8 weeks.

d.

TB is treated with three or more medications to prevent organism resistance.

ANS: D

Clients who have not been treated for TB before are started on a four-drug regimen including isoniazid (INH), rifampin (RIF), pyrazinamide, and ethambutol. This induction treatment generally lasts about 2 months, and is followed by a continuation phase using 2 drugs for 4-7 months.

DIF: Application/Applying REF: pp. 1606, 1607

OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

6. The nurse caring for a client with cystic fibrosis would select as the highest priority the nursing diagnosis of

a.

Activity Intolerance.

b.

Anxiety.

c.

Risk for Deficient Fluid Volume.

d.

Risk for Ineffective Airway Clearance.

ANS: D

The disease process causes tracheobronchial secretions to become thick and viscous, leading to interference with normal ciliary action, plugging of airways, and creation of a reservoir for bacterial growth and infection.

DIF: Application/Applying REF: p. 1627 OBJ: Diagnosis

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

7. A client is noncompliant with the continuation phase of treatment for TB. The nurse assigns the diagnosis Ineffective Coping and plans interventions that will

a.

allow the client to continue to work from home.

b.

increase the clients sense of control.

c.

isolate the client from the family until the disease is under control.

d.

require the client to report medication use.

ANS: B

The treatment for TB is long and compliance is often a problem. Interventions that can help the client feel more personal control over the situation are likely to help the client remain compliant.

DIF: Application/Applying REF: p. 1608 OBJ: Application

MSC: Psychological Integrity Coping and Adaptation-Coping Mechanisms

8. To prevent the complication of atelectasis in an 82-year-old woman with a hip fracture, the nurse would

a.

ambulate the client frequently.

b.

frequently reposition the client.

c.

suction the upper airway.

d.

supply oxygen.

ANS: B

One of the primary goals of nursing intervention is to prevent atelectasis in the high-risk client. Clients who are elderly, obese, or bedridden, or who have a history of smoking are more susceptible to atelectasis. Frequent position changes and early ambulation help promote drainage of all lung segments.

DIF: Application/Applying REF: p. 1597 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications from Surgical Procedures and Health Alteration

9. The nurse has made the nursing diagnosis Ineffective Breathing Pattern related to tachypnea secondary to chest pain for a client with pneumonia. After administration of an analgesic, the nurse would

a.

encourage the use of an incentive spirometer.

b.

monitor the clients respiratory pattern.

c.

reposition the client flat in bed.

d.

request that the client cough.

ANS: B

The nurse should administer prescribed cough suppressants and analgesics but should be cautious because narcotics may depress respirations more than desired.

DIF: Application/Applying REF: p. 1602 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

10. To increase the level of comfort for a client with a lung abscess, the nurse would include which intervention in the care plan?

a.

Encourage activity before meals.

b.

Offer frequent oral hygiene.

c.

Provide easy-to-eat milk products.

d.

Restrict fluid intake.

ANS: B

The clients copious sputum may have a foul taste. The nurse should provide frequent opportunities for the client to use mouthwash and perform tooth brushing and flossing.

DIF: Application/Applying REF: p. 1603 OBJ: Intervention

MSC: Physiological Integrity Basic Care and Comfort-Personal Hygiene

11. A client has small cell carcinoma of the lung. The nurse should anticipate providing which intervention to the client?

a.

Educating the client and family about planned chemotherapy

b.

Instructing the client on home care of a chest tube system

c.

Preparing the client for lung resection

d.

Providing a referral to hospice

ANS: D

Small cell carcinoma (oat cell) does initially respond well to chemo, but the prognosis is very poor because it usually has metastasized when found. Also the high doses of chemotherapy needed for small cell carcinoma often produce toxicity that leads to discontinuation of the treatment. Surgical resection usually does not play a role in treatment because the tumor has usually metastasized by this point. Because of the poor prognosis of this kind of cancer, hospice referral may be the most appropriate option.

DIF: Knowledge REF: pp. 1611, 1614 OBJ: Intervention

MSC: Psychological Integrity Coping and Adaptation-End of Life Care

12. The nurse would know that a client who has just begun treatment for pulmonary TB with rifampin has a good understanding of this medication with the statement that

a.

I told my wife to throw away all our spoons and forks before I come home.

b.

I wont go to any family gatherings for 6 months.

c.

Its going to be important to remember to cover my nose when I sneeze.

d.

My urine will look orange because of the medication.

ANS: D

The client should understand that orange urine, feces, saliva, sputum, sweat, and tears may occur when taking rifampin.

DIF: Comprehension/Understanding REF: p. 1607 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

13. A client had chest surgery this morning and has a chest tube attached to a closed-chest drainage system. When the nurse notes no tidaling of fluid, the nurse would first

a.

attach the system to suction.

b.

milk the chest tube.

c.

notify the physician immediately.

d.

reposition the client.

ANS: D

Tidaling (rise of fluid with inspiration and fall of fluid with expiration) indicates that the drainage tubes are patent and the apparatus is functioning correctly. Tidaling stops when the lung has expanded or the tubes are kinked or obstructed. If tidaling does not occur, the nurse can reposition the client, check the tubing for kinks, or have the client deep breathe and cough. If these measures do not work and if there are no blood clots or tissue fragments visible, then notify the surgeon. If blood clots or tissue fragments are visible in the tubing, milking may help reestablish the flow from the chest to the collection bottle.

DIF: Application REF: pp. 1622, 1623 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

14. The nurse notes intermittent bubbling in the water-seal chamber of a chest tube in place for a client with pneumothorax. The nurses most appropriate action is to

a.

change the drainage unit.

b.

clamp the chest tube.

c.

encourage respiratory exercises.

d.

place petrolatum gauze around the chest tube.

ANS: C

Bubbling in the water-seal compartment is caused by air passing out of the pleural space into the fluid in the bottle. Intermittent bubbling is normal when the lung is still expanding. Respiratory exercises will hasten the lungs reexpansion.

DIF: Application/Applying REF: p. 1623 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

15. A client has accidentally disconnected a chest tube while turning over in bed. The suction tubing is on the floor. The most appropriate action by the nurse is to

a.

call the physician immediately and prepare the client for reinsertion.

b.

clamp the chest tube just proximal to the open end.

c.

reattach the drainage tube to the suction tubing.

d.

submerge the end of the drainage tube in a bottle of sterile saline.

ANS: D

When a chest tube becomes disconnected to the suction tubing, the best action is to reattach it. However, since this suction tubing was on the floor, it is contaminated and reattaching the drainage tube to the suction tubing will place the client at an even higher risk of infection than already present. The next best action is to submerge the drainage tube into a bottle of sterile water or saline kept at the bedside for just such an occasion. If there is no fluid available, leave the tubing open rather than clamp it because clamping the tubing creates a risk for tension pneumothorax. The nurse will need to replace the contaminated suction tubing with new tubing.

DIF: Application/Applying REF: p. 1624 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Safe Use of Equipment

16. In caring for a client scheduled to have chest tubes removed, the nurses most appropriate action would be to

a.

assist the client to a prone position.

b.

empty the collection chambers before removal.

c.

encourage deep breathing during removal.

d.

medicate for pain hour before removal.

ANS: D

Removal of chest catheters can be moderately to severely painful. The prescribed premedication should be administered about hour before the procedure.

DIF: Application/Applying REF: p. 1624 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Pain Management

17. On physical examination of a client with pneumonia, the nurse would expect

a.

absence of whispered pectoriloquy over the affected area.

b.

increased tactile fremitus over the affected area.

c.

tympanic percussion notes over the affected area.

d.

vesicular breath sounds over the affected area.

ANS: B

Consolidated lung tissue transmits bronchial sound waves to outer lung fields. Crackling sounds and whispered pectoriloquy may be heard over the affected areas. Tactile fremitus is usually increased over areas of pneumonia, whereas percussion notes are dulled.

DIF: Comprehension/Understanding REF: p. 1599 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

18. A young female client with cystic fibrosis (CF) wishes to become pregnant but is concerned about the effect of CF on fertility. The nurse bases a response with the understanding that

a.

breastfeeding will not be possible because of plugged milk glands.

b.

only about 20% of women with CF are infertile.

c.

pregnancy carries a high risk of spontaneous abortion (miscarriage).

d.

women with CF are unlikely to become pregnant.

ANS: B

CF does affect reproduction. Most men are azoospermic because of obliteration of the vas deferens; 20% of women are infertile. Thick tenacious cervical mucus can block sperm migration. More than 90% of completed pregnancies produce viable infants, and breastfeeding is not affected.

DIF: Analysis/Analyzing REF: p. 1627 OBJ: Intervention

MSC: Health Promotion Growth and Development Through the Lifespan-Family Planning

19. The nurse would assess a client with severe acute respiratory syndrome (SARS) for the major clinical manifestation indicating the onset of the lower respiratory phase, which is

a.

dry, nonproductive cough.

b.

hemoptysis.

c.

pleuritic pain.

d.

rapid temperature elevation.

ANS: A

A dry, nonproductive cough signals the onset of the lower respiratory phase of SARS.

DIF: Comprehension/Understanding REF: p. 1609 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

20. The nurse would become concerned about the risk of hemorrhage if, in the first 2 hours after surgery, the thoracotomy clients drainage exceeded

a.

50 ml.

b.

100 ml.

c.

300 ml.

d.

750 ml.

ANS: C

As much as 500 to 1000 ml of drainage may occur in the first 24 hours after chest surgery. Between 100 and 300 ml of drainage may accumulate during the first 2 hours; after this time, the drainage should lessen.

DIF: Application REF: p. 1617 OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-System Specific Assessments

21. After the physician tells a client that pneumonia has caused the clients bilateral lobar atelectasis, the client anxiously asks the nurse, Does that mean my lungs have collapsed? The most informative response by the nurse would be the following:

a.

No, but your pneumonia has permanently damaged your lungs to the point they may never fully inflate.

b.

No; only a lobe in each side has collapsed, but they will inflate as the pneumonia resolves.

c.

Yes; both lungs have collapsed, but they are presently reinflating as your health improves.

d.

Yes; large portions of your lungs have collapsed, but the unaffected portions of your lungs will accommodate your oxygen needs.

ANS: B

Atelectasis can occur throughout the lung or in portions of it (lobar). The lung reinflates after the condition that caused the obstruction has been treated.

DIF: Comprehension/Understanding REF: p. 1600 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

22. The nurse would explain that the clients diagnosis of interstitial pneumonia means

a.

pus has accumulated in the major bronchi.

b.

the alveoli are filled with fluid.

c.

the small bronchioles are inflamed.

d.

there is an inflammatory response in the tissue surrounding the air space.

ANS: D

Interstitial pneumonia occurs when the parenchymal tissue surrounding the air space is inflamed.

DIF: Comprehension/Understanding REF: p. 1600 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

23. A client is admitted with flu-like symptoms that developed after hunting rabbits. The nurse anticipates which of the following initial orders for this client?

a.

Intubation and mechanical ventilation

b.

Mantoux TB testing

c.

Rapid infusion of IV fluids

d.

Respiratory isolation room

ANS: D

Pneumonic plague, which is a type of bubonic plague, can develop after exposure to infected rodents, rabbits, and fleas. Clinical manifestations start with flu-like symptoms, then progress to rapidly developing pneumonia with shortness of breath, cough, and blood or watery sputum. Clients need immediate respiratory isolation and caregivers need to wear tight-fitting, disposable surgical masks.

DIF: Application/Applying REF: pp. 1600, 1605

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

24. A client has undergone a pleurodesis. The priority nursing action after the procedure is to assess the clients

a.

respiratory status.

b.

urine output.

c.

vital signs.

d.

wound site.

ANS: A

Pleural space obliteration creates permanent changes and can create compromised respiratory function. Therefore the priority assessment in this case is of respiratory status.

DIF: Application/Applying REF: pp. 1631-1632

OBJ: Assessment

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

25. A client is being discharged after treatment for a bronchopleural fistula. Important self-care measures the nurse should teach include

a.

improving the clients nutrition.

b.

management of the chest tube system.

c.

preventing a recurrence.

d.

smoking cessation resources.

ANS: B

Because these fistulas are slow to heal, clients may be sent home with closed-chest drainage systems. Teaching the client how to manage the chest tubes and drainage apparatus and what to report are important self-care measures.

DIF: Comprehension/Understanding REF: p. 1632 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

26. A spinal cordinjured client complains of severe dyspnea in the side-lying position. The nurse anticipates diagnostic testing to reveal

a.

a pleural abscess.

b.

a tension pneumothorax.

c.

bilateral diaphragmatic paralysis.

d.

pneumonia.

ANS: C

The most common causes of bilateral diaphragmatic paralysis include spinal cord injury, thoracic trauma, multiple sclerosis, nerve compression from tumors, anterior horn disease, and muscular dystrophy. Classic manifestations include dyspnea and hypoxemia in the side-lying position. There is generally no treatment for this condition unless the phrenic nerve is still intact, in which case a phrenic nerve pacemaker can be implanted.

DIF: Analysis/Analyzing REF: pp. 1632, 1633

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

27. A client comes to the clinic complaining of shortness of breath with activity that has gradually gotten worse over several years. An important finding from the nursing history would be the clients

a.

family history of lung cancer.

b.

occupation as a coal miner.

c.

previous treatment for walking pneumonia.

d.

recent move from the mountains.

ANS: B

Pneumoconioses (dust diseases) are an occupational hazard for people who are coal miners, construction workers, sandblasters, potters, or who work in foundries and rock quarries. Manifestations develop gradually over a period of years and the decreased lung capacity is due to diffuse pulmonary fibrosis.

DIF: Comprehension/Understanding REF: p. 1625 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

28. A nurse is planning care for a client who has an intrapulmonary restrictive lung disorder. The nurse chooses interventions with the understanding that treatment for this disease

a.

can assist lung tissue in regenerating.

b.

is best attained through surgery.

c.

requires a long course of antibiotics.

d.

will not reverse the disease process.

ANS: D

Intrapulmonary restrictive disorders are not reversible. Management of the client revolves around maintaining a functional status and good quality of life as long as possible. Disorders that are extrapulmonary, for instance caused by obesity, can be helped by treating the underlying cause.

DIF: Comprehension/Understanding REF: p. 1627 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

29. A client is hospitalized for an exacerbation of sarcoidosis. The nurse anticipates an order to administer

a.

antipyretics.

b.

corticosteroids.

c.

high-dose antibiotics.

d.

rifampin.

ANS: B

Sarcoidosis consists of an immune response at the site of involvement. Corticosteroids are used to blunt this response. Antibiotics and antipyretics are usually not a major part of the treatment plan. Rifampin is for TB.

DIF: Comprehension/Understanding REF: p. 1630 OBJ: Intervention

MSC: Physiological Adaptation Pharmacological and Parenteral Therapies-Pharmacological Agents and Actions

30. A client has an interstitial lung disease (ILD) and has questions related to the disease process. The best explanation by the nurse is that ILD

a.

causes alveolar walls to thicken and become nonfunctional.

b.

is a highly contagious disease and close contacts need treatment.

c.

is caused by a recurrent fungal infection in the lung parenchyma.

d.

leads to diffuse intrapulmonary cavity formation.

ANS: A

In ILD the interstitium of the alveolar walls thickens and becomes fibrotic because of an accumulation of inflammatory cells. The thickened alveoli become nonfunctional.

DIF: Comprehension/Understanding REF: p. 1630 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

31. A client has been diagnosed with histoplasmosis lung infection. The nurse would anticipate treatment to include

a.

amphotericin B.

b.

corticosteroids.

c.

isoniazid.

d.

morphine.

ANS: A

Amphotericin B or itraconazole are the treatments of choice for fungal lung infections.

DIF: Comprehension/Understanding REF: p. 1610 OBJ: Intervention

MSC: Physiological Adaptation Pharmacological and Parenteral Therapies-Pharmacological Agents and Actions

MULTIPLE RESPONSE

1. A client with HIV infection has a history of close exposure to someone with active pulmonary tuberculosis and has developed a cough and low-grade fever. The clients Mantoux is negative but the client has been admitted to the hospital for further testing. The most appropriate action by the nurse is to (Select all that apply)

a.

admit the client to a private room.

b.

anticipate orders for AFB testing.

c.

place the client in respiratory isolation.

d.

screen potential roommates carefully.

e.

select a room close to the nurses station.

ANS: B, C

The client should understand that a negative test result does not always mean that TB is absent, particularly in HIV-positive clients, who are immunosuppressed. Until TB has been ruled out, the client needs to be in respiratory isolation in a negative airflow room. These rooms should send room air directly to the outside and have at least six air exchanges per hour. Putting the client in a private room is not enough. The client should not have a roommate. The location of the room is less important than having negative airflow capability. Definitive testing for tuberculosis includes chest x-ray, AFB smears from sputum, and culture.

DIF: Application/Applying REF: pp. 1605, 1606, 1607-1608

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

2. Nurses caring for clients being treated for active pulmonary tuberculosis in the hospital are required to have (Select all that apply)

a.

an annual chest x-ray.

b.

an annual skin test for TB.

c.

no allergies to anti-TB medications.

d.

properly-fitting particulate respirators.

ANS: B, D

Personal protective equipment called a particulate respirator is required for all health care providers who enter the room of a client with active TB. Skin testing should be performed annually for all health care workers.

DIF: Knowledge/Remembering REF: pp. 1607-1608

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

3. A client is being evaluated for a lung transplant. The nurse assists the client to understand that the psychological assessment includes which of the following? (Select all that apply.)

a.

Ability to cope with stress and coping mechanisms

b.

History of compliance with medical regimen

c.

History of substance abuse

d.

Occupational and financial resources

ANS: A, B, C

Options a, b, and c all relate to the extensive psychosocial assessment done before listing a client for transplantation.

DIF: Comprehension/Understanding REF: p. 1628 OBJ: Assessment

MSC: Psychological Integrity Coping and Adaptation-Coping Mechanisms

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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