Question

A nurse is reinforcing teaching with a client who is having difficulty using an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

Answer 1

Correct Answers:

Start slowly and increase volume over several sessions.

Rationale :

🌬️An incentive spirometer is used to promote deep lung expansion, prevent atelectasis, and improve oxygenation, especially after surgery or during immobility.

📈If the client is struggling, it is important to encourage gradual progress, starting with small efforts and slowly increasing the inhaled volume with practice to avoid frustration or fatigue.

🔁Suggesting vigorous use or abrupt increases may cause dizziness, hyperventilation, or ineffective technique.

🚫Abandoning the device or switching to another method like general deep breathing exercises misses the goal of visual feedback and structured lung expansion that the incentive spirometer provides.

📌Core message

Clients should begin incentive spirometry slowly, focusing on gradual improvement in inhaled volume to ensure safe and effective lung expansion.

Answer 2

Correct Answers:

Wear a mask while out or around crowds of people.

Rationale :

🌬️Clients with pulmonary tuberculosis (TB) can spread Mycobacterium tuberculosis through airborne droplets, especially in crowded or poorly ventilated areas.

🧼Wearing a mask in public or crowded settings helps reduce the transmission risk until the client is no longer considered infectious (typically after several weeks of effective treatment).

🚫Clients should avoid alcohol entirely during treatment due to the hepatotoxicity risk of TB medications like isoniazid and rifampin.

🧪Sputum cultures are usually required monthly (every 4 weeks), not every 6 weeks, until three consecutive negative samples confirm non-infectivity.

🚯Tissues with secretions should be disposed of in a sealed plastic bag, not a paper bag, to minimize contamination risk.

📌Core message

Clients with pulmonary TB should wear a mask in public to prevent airborne transmission until noninfectious status is confirmed.

Answer 3

Correct Answers:

Frequent oral hygiene is necessary
Rinse and spit after inhalation of the medication
When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first
Hold your breath for 10 seconds during inhalation of the medication

Rationale :

🦷Frequent oral hygiene and rinsing the mouth after using a steroid inhaler help prevent oral candidiasis (thrush), a common side effect of inhaled corticosteroids due to local immune suppression.

💨Holding the breath for about 10 seconds after inhaling allows more of the medication to reach deep into the lungs, enhancing absorption and therapeutic effect.

⏱️When using both a bronchodilator and a steroid, the bronchodilator should be used first to open the airways, enabling better delivery of the steroid medication.

🚫Using the inhaler on a PRN basis only is incorrect, as steroid inhalers are maintenance medications intended for daily use to prevent inflammation, not to relieve acute symptoms.

📌Core message

Teaching should emphasize oral hygiene, mouth rinsing, correct inhalation technique, and bronchodilator-first sequencing when using a steroid inhaler for optimal safety and effectiveness.

Answer 4

Correct Answers:

70 year old woman with glaucoma
64 year old woman with a history of heart disease

Rationale :

🧑‍⚕️Alpha-adrenergic decongestants such as phenylephrine or pseudoephedrine work by vasoconstricting nasal blood vessels, relieving nasal congestion effectively in young, healthy individuals without chronic conditions.

🚫These medications are contraindicated in glaucoma, as they can increase intraocular pressure, worsening the condition.

❤️They are also not safe in heart disease, since they may cause increased blood pressure and heart rate, stressing the cardiovascular system.

🚻In men with prostatic hypertrophy, alpha agonists can worsen urinary retention, due to smooth muscle contraction around the bladder neck and prostate.

🌿Thus, only the young individuals without underlying medical risks are considered safe candidates for these medications.

📌Core message

Alpha-adrenergic decongestants are safe for young, healthy individuals, but should be avoided in patients with glaucoma, heart disease, or prostatic hypertrophy due to serious potential complications.

Answer 5

Correct Answers:

"I'll take this medication once a day in the evening."

Rationale :

🫁Montelukast is a leukotriene receptor antagonist used for the long-term control of asthma, especially effective in preventing nocturnal symptoms and exercise-induced bronchospasm.

🕘It is prescribed to be taken once daily in the evening, which aligns with the body’s natural inflammatory rhythm and enhances its preventive effects overnight.

🚫This medication is not a rescue therapy and should not be used during an asthma attack—short-acting bronchodilators like albuterol are used for that purpose.

🧼Rinsing the mouth is a teaching point for inhaled corticosteroids, not for montelukast, which is an oral tablet, and sodium intake is not affected by this medication.

📌Core message

Montelukast is a preventive asthma medication that should be taken once daily in the evening to control symptoms and reduce inflammation over time.

Answer 6

Correct Answers:

Barrel chest
Bradycardia
Dyspnea
Shallow respirations

Rationale :

🏐A barrel chest is common in clients with emphysema due to chronic lung hyperinflation, which increases the anteroposterior diameter of the chest.

☁️Clubbing of the fingers develops over time from chronic hypoxemia, a hallmark of long-standing emphysema and other pulmonary disorders.

😮‍💨Dyspnea (shortness of breath) is a primary symptom caused by air trapping and reduced gas exchange in damaged alveoli.

🌬️Shallow respirations occur as clients attempt to minimize respiratory effort while still struggling to maintain oxygenation due to lung stiffness and loss of recoil.

❌Bradycardia is not typically associated with emphysema; patients more often experience tachycardia in response to hypoxia and respiratory distress.

📌Core message

Emphysema commonly presents with barrel chest, finger clubbing, dyspnea, and shallow respirations due to chronic hypoxia and air trapping in damaged lungs.

Answer 7

Correct Answers:

"It delivers the low concentration of oxygen you need."

Rationale :

💨A nasal cannula is used to provide a low concentration of oxygen, typically ranging from 1 to 6 L/min, delivering about 24% to 44% oxygen, depending on flow rate and client’s breathing pattern.

🧑‍⚕️It is ideal for clients who need mild to moderate oxygen supplementation and can breathe adequately on their own, as it does not provide precise or high oxygen delivery.

🚫The nasal cannula does not deliver a constant or fixed concentration like a Venturi mask, nor is it suitable for high-concentration oxygen therapy, which requires masks like non-rebreathers.

⚠️Patients should not remove the cannula at will because even short interruptions can cause oxygen desaturation, especially in clients with chronic respiratory disease.

📌Core message

A nasal cannula provides a low concentration of oxygen, suitable for patients who need supplemental oxygen but do not require high-flow or precise delivery.

Answer 8

Correct Answers:

3

Rationale :

📏The ordered dose is 7.5 mg and the available dose is 2.5 mg per tablet.

➗To calculate the correct number of tablets:

7.5 mg ÷ 2.5 mg/tablet = 3 tablets

📋This ensures the client receives the exact prescribed amount of prednisone at each administration time.

🧠Administering the correct dose is essential to prevent under-treatment or corticosteroid-related side effects due to improper dosing.

📌Core message

To give 7.5 mg of prednisone using 2.5 mg tablets, administer 3 tablets per dose.

Answer 9

Correct Answers:

A chest tube

Rationale :

🩺After a lobectomy, which involves the surgical removal of a lobe of the lung, it is standard postoperative care to insert a chest tube to drain air, blood, or fluid from the pleural space.

🌬️This helps re-expand the remaining lung tissue, prevents pneumothorax, and facilitates adequate breathing.

🧠EEG monitoring is used for neurological assessments, not respiratory procedures.

🦵A CPM machine is associated with orthopedic surgeries, particularly knee replacement, and has no role in thoracic surgery.

💦A three-way urethral catheter is typically used for bladder irrigation, such as after urologic procedures, not after pulmonary surgery.

📌Core message

Following a lobectomy, a chest tube is expected to aid in draining the pleural space and supporting lung re-expansion during recovery.

Answer 10

Correct Answers:

The CPAP device should be placed over the nose-

Rationale :

💨Continuous Positive Airway Pressure (CPAP) device is a non-invasive therapy used to treat obstructive sleep apnea (OSA) by keeping the airway open during sleep through continuous airflow.

👃The most common configuration is a nasal mask, which fits snugly over the nose and delivers a constant stream of pressurized air to prevent airway collapse.

🔄Unlike BiPAP, CPAP delivers the same pressure during inhalation and exhalation, making the statement about differing pressures incorrect.

🛌The mask must fit securely, not loosely, to maintain effective seal and pressure, ensuring that the therapy is efficient and comfortable.

📌Core message

CPAP therapy involves a nasal mask that fits snugly over the nose to provide continuous airway pressure, preventing airway collapse in obstructive sleep apnea.

1 :
A nurse is reinforcing teaching with a client who is having difficulty using an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

2 :
A nurse is preparing to review discharge instructions with a client who has pulmonary tuberculosis. Which of the following information should the nurse include?

3 :
Which principle(s) would be important to teach a patient about the use of a steroid inhaler? (SELECT ALL THAT APPLY)

4 :
Which patient(s) would be able to take an alpha-adrenergic decongestant safely? (SELECT ALL THAT APPLY)

5 :
A nurse is reinforcing teaching with a client who is to start taking montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching?

6 :
A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

7 :
A client is receiving oxygen therapy via a nasal cannula. When the client asks the nurse why he needs to have oxygen tubing in his nose, which of the following explanations about the cannula should the nurse give him?

8 :
Order: Prednisone 7.5 mg PO QID Available: Prednisone 2.5 mg tabs How much will you administer?

9 :
A nurse is assisting with the care of a client who has lung cancer and is scheduled for a lobectomy. The nurse should instruct the client to expect the use of which of the following equipment postoperatively?

10 :
A nurse is assisting with teaching a client who has obstructive sleep apnea (OSA) about continuous positive airway pressure (CPAP). Which of the following instructions should the nurse include?

1 : A nurse is reinforcing teaching with a client who is having difficulty using an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

2 : A nurse is preparing to review discharge instructions with a client who has pulmonary tuberculosis. Which of the following information should the nurse include?

3 : Which principle(s) would be important to teach a patient about the use of a steroid inhaler? (SELECT ALL THAT APPLY)

4 : Which patient(s) would be able to take an alpha-adrenergic decongestant safely? (SELECT ALL THAT APPLY)

5 : A nurse is reinforcing teaching with a client who is to start taking montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching?

6 : A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

7 : A client is receiving oxygen therapy via a nasal cannula. When the client asks the nurse why he needs to have oxygen tubing in his nose, which of the following explanations about the cannula should the nurse give him?

8 : Order: Prednisone 7.5 mg PO QID Available: Prednisone 2.5 mg tabs How much will you administer?

9 : A nurse is assisting with the care of a client who has lung cancer and is scheduled for a lobectomy. The nurse should instruct the client to expect the use of which of the following equipment postoperatively?

10 : A nurse is assisting with teaching a client who has obstructive sleep apnea (OSA) about continuous positive airway pressure (CPAP). Which of the following instructions should the nurse include?

1 :
A nurse is reinforcing teaching with a client who is having difficulty using an incentive spirometer. Which of the following instructions should the nurse include in the teaching?

2 :
A nurse is preparing to review discharge instructions with a client who has pulmonary tuberculosis. Which of the following information should the nurse include?

3 :
Which principle(s) would be important to teach a patient about the use of a steroid inhaler? (SELECT ALL THAT APPLY)

4 :
Which patient(s) would be able to take an alpha-adrenergic decongestant safely? (SELECT ALL THAT APPLY)

5 :
A nurse is reinforcing teaching with a client who is to start taking montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching?

6 :
A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

7 :
A client is receiving oxygen therapy via a nasal cannula. When the client asks the nurse why he needs to have oxygen tubing in his nose, which of the following explanations about the cannula should the nurse give him?

8 :
Order: Prednisone 7.5 mg PO QID Available: Prednisone 2.5 mg tabs How much will you administer?

9 :
A nurse is assisting with the care of a client who has lung cancer and is scheduled for a lobectomy. The nurse should instruct the client to expect the use of which of the following equipment postoperatively?

10 :
A nurse is assisting with teaching a client who has obstructive sleep apnea (OSA) about continuous positive airway pressure (CPAP). Which of the following instructions should the nurse include?