ATI Custom NUR 198 Exam 2 Summer ASN
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Free ATI Custom NUR 198 Exam 2 Summer ASN Questions
A nurse providing community education states, "The treatment of most cases of acute pharyngitis is through the management of symptoms." What rationale guides the nurse's teaching?
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Most cases of acute pharyngitis become chronic if not treated promptly with antibiotics.
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Most cases of acute pharyngitis are caused by a bacterial infection.
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Most cases of acute pharyngitis affect infants.
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Most cases of acute pharyngitis are caused by a viral infection.
Explanation
Viral pharyngitis is not responsive to antibiotic therapy, so treatment focuses on symptom management such as rest, hydration, and analgesics until the infection resolves on its own.
Why the other options are incorrect:
A. Acute pharyngitis becoming chronic without antibiotics is not the rationale for symptom-focused care, since most cases are self-limiting regardless of antibiotic use.
B. If most cases were bacterial, antibiotic treatment rather than symptom management would be the priority approach.
C. Acute pharyngitis is not primarily an infant-specific condition, and age is not the rationale behind symptom-based treatment.
A nurse is developing a teaching plan for an adult client with asthma. The nurse determines the teaching has been successful when the client makes which of the following statements?
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"I should use my cortisone inhaler followed by my albuterol inhaler."
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"I should closely monitor my symptoms using a peak expiratory flow (PEF) monitor."
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"I should expect to use my rescue inhaler daily."
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"I will avoid physical activity to prevent asthma attacks."
Explanation
Peak expiratory flow monitoring is a cornerstone of effective asthma self-management. It allows the client to objectively track lung function on a daily basis, identify early signs of airway narrowing before symptoms become severe, and recognize patterns or triggers that worsen their condition. Regular PEF monitoring empowers the client to adjust their action plan proactively, contact their provider when readings fall into the caution or danger zones, and prevent acute exacerbations through early intervention. This statement reflects a correct and successful understanding of asthma self-management.
Why the other options are incorrect:
A. "I should use my cortisone inhaler followed by my albuterol inhaler" — This statement reflects incorrect technique. The proper sequence is to use the short-acting bronchodilator, such as albuterol, first to open the airways, followed by the corticosteroid inhaler so that the anti-inflammatory medication can reach deeper into the now-dilated airways more effectively.
C. "I should expect to use my rescue inhaler daily" — Frequent or daily use of a rescue inhaler indicates poorly controlled asthma and signals the need for reassessment of the client's maintenance therapy regimen. This statement reflects a misunderstanding, as the goal of asthma management is to minimize rescue inhaler use, not normalize daily dependence on it.
D. "I will avoid physical activity to prevent asthma attacks" — This statement reflects a misunderstanding of asthma management. While exercise-induced bronchospasm can occur, the goal of treatment is to control asthma well enough that the client can safely participate in physical activity, often through prophylactic use of a bronchodilator prior to exercise, rather than avoiding activity altogether.
A nurse is caring for a surgical client who is prescribed bedrest. Which intervention should the nurse implement to prevent atelectasis?
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Consult the respiratory therapist to perform postural drainage each shift.
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Administer nebulized bronchodilators and corticosteroids as prescribed.
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Apply sequential compression devices.
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Encourage the client to use an incentive spirometer every hour while awake.
Explanation
Incentive spirometry is the standard and most effective nursing intervention to prevent atelectasis in clients on bedrest, particularly post-surgical clients. The device encourages slow, deep, sustained inspiration, which promotes maximal lung expansion, reinflates collapsed alveoli, and prevents the alveolar collapse that occurs with the shallow breathing patterns common in immobile or post-operative clients. Regular use every hour while awake maintains optimal lung volumes and significantly reduces the risk of atelectasis and subsequent pneumonia.
Why the other options are incorrect:
A. Consult the respiratory therapist to perform postural drainage each shift — Postural drainage is a technique used to mobilize and clear secretions in clients with excessive mucus production, such as those with cystic fibrosis or bronchiectasis. It is not the primary intervention for preventing atelectasis in a surgical client on bedrest, and prevention should be nurse-initiated and frequent, not dependent on therapist scheduling.
B. Administer nebulized bronchodilators and corticosteroids as prescribed — These medications are used to manage bronchospasm and airway inflammation in conditions such as asthma or COPD. They do not directly address the alveolar collapse mechanism responsible for atelectasis in an immobile surgical client.
C. Apply sequential compression devices — Sequential compression devices are used to prevent deep vein thrombosis in clients on bedrest by promoting venous return in the lower extremities. They have no role in preventing pulmonary atelectasis.
A nurse is suctioning the airway of a client with pneumonia when the suction catheter accidentally touches the bed rail. What is the nurse's priority action?
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Discard the catheter and obtain a new sterile one.
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Flush the catheter with normal saline and proceed.
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Continue suctioning since it briefly touched a clean surface.
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Wipe the catheter with an alcohol swab and continue.
Explanation
Suctioning requires strict sterile technique because the catheter is introduced directly into the lower airway, which is normally sterile. Once a suction catheter contacts any non-sterile surface, such as a bed rail, it becomes contaminated and is no longer safe to use. Continuing to use a contaminated catheter introduces pathogens directly into the client's airway, significantly increasing the risk of hospital-acquired infection, particularly concerning in a client already diagnosed with pneumonia. The only safe and appropriate action is to discard the contaminated catheter immediately and obtain a new sterile one before continuing the procedure.
Why the other options are incorrect:
B. Flush the catheter with normal saline and proceed — Flushing the catheter with saline does not sterilize it. Normal saline is not an antiseptic or sterilizing agent and will not remove or kill pathogens that have contaminated the catheter surface.
C. Continue suctioning since it briefly touched a clean surface — A bed rail is not a sterile or even clean surface in the clinical sense required for airway suctioning; it is a high-touch surface known to harbor significant numbers of microorganisms. Brief contact still constitutes contamination.
D. Wipe the catheter with an alcohol swab and continue — Wiping the catheter with an alcohol swab does not restore sterility. Alcohol swabs are not capable of achieving the level of sterilization required for a device being introduced into the sterile lower airway, and residual alcohol could also cause airway irritation.
A nurse is developing a teaching plan for a client with asthma. Which teaching point should have the priority in the plan of care for this client?
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Gradually increase levels of physical exertion.
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Take prescribed medications as scheduled.
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Avoid goose-down pillows.
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Change filters on heaters and air conditioners frequently.
Explanation
Consistent adherence to prescribed asthma medications, including controller medications, is essential for managing airway inflammation and preventing exacerbations, making it the priority teaching point over environmental or activity-related recommendations.
Why the other options are incorrect:
A. Gradually increasing physical exertion is a reasonable health-promoting recommendation but is not the priority compared to consistent medication adherence for controlling the underlying disease process.
C. Avoiding goose-down pillows addresses an environmental trigger, which is important but secondary to ensuring proper medication use.
D. Changing filters on heaters and air conditioners is also an environmental control measure that is helpful but not the priority over medication adherence.
The nurse is providing teaching for a client regarding the purified protein derivative (PPD) test for tuberculosis. Which statement by the client indicates an understanding of the teaching?
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"Because I had a previous reaction to this test, this time I need to get a chest x-ray."
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"I will come back in 7-10 days to have the test read."
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"I will isolate myself from my family until I get my test results."
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"If the test area gets hard and swollen, that means I have active tuberculosis."
Explanation
Clients with a documented history of a prior positive PPD reaction should not be retested with the PPD, as repeat testing in someone already sensitized can cause a severe local reaction; instead, a chest x-ray is the appropriate follow-up to evaluate for active disease, showing correct understanding of the teaching.
Why the other options are incorrect:
B. The PPD test must be read within 48 to 72 hours after placement, not 7 to 10 days, as induration measured outside this window is not reliable.
C. A positive PPD result alone does not require isolation, since it only indicates exposure or latent infection and further testing such as a chest x-ray and sputum culture is needed to determine if active disease is present.
D. Induration at the test site indicates a positive reaction suggestive of exposure or latent infection, not necessarily active tuberculosis, which requires further diagnostic evaluation to confirm.
This is a drag-and-drop clinical judgment item rather than a multiple-choice question, so let me work through it using all the data provided (nurses notes, physical exam, diagnostic results) to identify the most likely condition, the two actions to take, and the two parameters to monitor.
A nurse is caring for a client who is 1 day postoperative following a right-sided thoracotomy with a chest tube insertion. A nurse prioritizes care after completing the assessment and initiates the following action. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
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Condition: Air leak; Actions: Check the drainage system and tubing, Assess for subcutaneous emphysema; Parameters: Respiratory status, Chest tube drainage
Explanation
Continuous bubbling in the water-seal chamber, as documented in the nurses' notes, is a hallmark sign of an air leak in the chest drainage system rather than the intermittent bubbling expected during expiration or coughing. Checking the drainage system and tubing helps the nurse locate the source of the leak, whether at the insertion site, tubing connections, or within the system itself, while assessing for subcutaneous emphysema evaluates for air escaping into the subcutaneous tissue, a common complication of an air leak. Monitoring respiratory status is essential because an unresolved air leak can compromise lung re-expansion and oxygenation, and monitoring chest tube drainage helps the nurse track the resolution of the leak and ensure the system continues to function properly.
Why the other options are incorrect:
Pneumonia is not supported by the data, as the client's WBC count of 9,500/mm3 is within normal limits, there is no fever mentioned, and lung sounds are simply diminished at the bases bilaterally rather than presenting with crackles or rhonchi typically associated with pneumonia.
Pulmonary edema is not supported, as there are no adventitious breath sounds noted, and the client does not exhibit signs such as frothy sputum, severe dyspnea, or jugular venous distension consistent with this condition.
Bleeding is not the priority concern, as the hemoglobin of 15 g/dL and hematocrit of 35% are within normal limits, and the 50 mL of sanguineous drainage since 0700 is an expected and unremarkable amount following a thoracotomy.
Obtaining blood cultures is not indicated, as there is no evidence of infection such as fever or elevated WBC count.
Administering prescribed blood products is not appropriate, as the client's hemoglobin and hematocrit values do not indicate a need for transfusion.
Observing the surgical dressing, while a reasonable general nursing action, is not specific to identifying or managing an air leak.
Client's ability to perform lung expansion exercises, blood pressure, and sputum are not the priority parameters for monitoring an air leak specifically, though they remain part of overall postoperative care.
A client with small cell lung cancer is receiving chemotherapy and is admitted with serum sodium of 118 mEq/L (nl. 136-146 mEq/L). Which intervention should the nurse anticipate?
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Restrict sodium intake.
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Encourage oral fluid intake.
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Administer intravenous (IV) hypertonic saline.
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Administer potassium supplements.
Explanation
Small cell lung cancer is commonly associated with syndrome of inappropriate antidiuretic hormone (SIADH), and a severely low serum sodium level of 118 mEq/L represents a critical, symptomatic hyponatremia that requires IV hypertonic saline to safely and gradually correct the sodium level and prevent serious neurological complications.
Why the other options are incorrect:
A. Restricting sodium intake would worsen the client's hyponatremia rather than correct it, as the client needs additional sodium, not less.
B. Encouraging oral fluid intake would further dilute the serum sodium and worsen the hyponatremia, as fluid restriction, not increased intake, is typically indicated in SIADH.
D. Potassium supplements address a different electrolyte imbalance and would not correct this client's critically low sodium level.
A client who was admitted to the hospital one day ago with a diagnosis of thrombophlebitis suddenly reports chest pain and shortness of breath and is visibly anxious. The nurse should immediately assess the client for additional manifestations of which disease process?
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Tension pneumothorax
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Pulmonary edema
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Pneumonia
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Pulmonary embolism
Explanation
A client with thrombophlebitis is at high risk for a deep vein thrombus dislodging and traveling to the lungs, and the sudden onset of chest pain, shortness of breath, and anxiety are classic manifestations of a pulmonary embolism, making this the priority concern for immediate assessment.
Why the other options are incorrect:
A. Tension pneumothorax is typically associated with trauma or invasive procedures rather than thrombophlebitis, making it an unlikely cause of these symptoms in this client.
B. Pulmonary edema is most often associated with heart failure or fluid overload rather than a history of thrombophlebitis.
C. Pneumonia would typically present with a more gradual onset of symptoms, often accompanied by fever and productive cough, rather than the sudden onset described in this scenario.
A nurse's assessment reveals that a client with asthma has a rapid, labored breathing pattern and expiratory wheezes. Which of the following complications will the nurse determine the client is most likely experiencing?
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Bronchospasm
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Fluid volume overload
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Oxygen toxicity
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Pleural effusion
Explanation
Bronchospasm is the sudden constriction of the smooth muscles lining the bronchi and bronchioles, which is the hallmark pathophysiological event in an asthma exacerbation. This airway narrowing produces the classic findings of rapid, labored breathing as the client struggles to move air through constricted passages, and expiratory wheezing as air is forced through the narrowed airways during exhalation. These findings are the direct and expected clinical manifestation of bronchospasm in a client with asthma.
Why the other options are incorrect:
B. Fluid volume overload — Fluid volume overload typically presents with crackles, edema, jugular venous distension, and signs of heart failure rather than wheezing and labored breathing specifically associated with airway constriction. This is not a typical asthma-related complication.
C. Oxygen toxicity — Oxygen toxicity results from prolonged exposure to high concentrations of supplemental oxygen and presents with symptoms such as substernal discomfort and nonproductive cough due to damage to lung tissue. It is unrelated to the bronchoconstrictive process occurring in this asthma exacerbation.
D. Pleural effusion — Pleural effusion involves fluid accumulation in the pleural space and typically presents with decreased or absent breath sounds over the affected area, dullness to percussion, and dyspnea, rather than the wheezing characteristic of bronchospasm in asthma.
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