ATI LPN
Perioperative Nursing Care Questions Questions
Question 1 of 5
The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?
Correct Answer: A
Rationale: The Mantoux test, used to screen for tuberculosis exposure, requires precise administration to ensure accurate results. It involves injecting purified protein derivative (PPD) intradermally into the inner forearm, creating a small wheal just under the skin surface. This method targets the dermal layer where immune cells can react to the antigen, producing a measurable induration if the child has been exposed to TB. Intramuscular injections into the vastus lateralis or subcutaneous injections into the umbilical area or deltoid are inappropriate because they deliver the substance too deeply or into fatty tissue, preventing the localized skin reaction needed for interpretation. The intradermal technique, typically at a 5-15 degree angle with a fine needle, ensures the PPD remains in the dermis, maximizing sensitivity and specificity of the test, which is critical for early detection in a pediatric population.
Question 2 of 5
The nurse is caring for an 82-year-old patient with a diagnosis of tracheobronchitis. The patient begins complaining of right-sided chest pain that gets worse when he coughs or breathes deeply. Vital signs are within normal limits. What would you suspect this patient is experiencing?
Correct Answer: C
Rationale: Right-sided chest pain worsening with coughing or deep breathing in an 82-year-old with tracheobronchitis suggests pleuritic pain, likely from pleural inflammation secondary to the airway infection. Pleurisy's hallmark is sharp, movement-exacerbated pain due to irritated pleural surfaces rubbing together, often unilateral, and may decrease as fluid accumulates later. Stable vital signs rule out severe systemic issues. Traumatic pneumothorax requires injury, absent here, and would show respiratory distress or absent breath sounds. Empyema, a pleural infection, typically involves fever and systemic signs, not just pain, and isn't indicated without infection escalation. Myocardial infarction causes central, pressure-like pain, often with vital sign changes (e.g., tachycardia, hypotension), not pleuritic features. The nurse's suspicion of pleuritic pain prompts pain management and monitoring for progression, aligning with tracheobronchitis complications.
Question 3 of 5
A patient with emphysema is experiencing shortness of breath. To relieve this patients symptoms, the nurse should assist her into what position?
Correct Answer: A
Rationale: For an emphysema patient with shortness of breath, sitting upright and leaning forward slightly optimizes respiratory mechanics. This position, often instinctive in COPD, elevates the diaphragm, reducing its flattening from hyperinflation, and engages accessory muscles (e.g., pectoralis) to aid expiration, easing dyspnea. Leaning forward may also reduce abdominal pressure on the thorax, enhancing lung expansion. Low Fowler's with neck hyperextension strains breathing by misaligning the airway and limiting diaphragm movement. Prone positioning, face-down, restricts chest expansion, worsening air trapping. Trendelenburg, head-down, elevates abdominal contents against the diaphragm, intensifying dyspnea. The nurse's assistance into this upright, forward-leaning posture often with arms supported maximizes ventilation, aligning with COPD management to relieve acute respiratory distress effectively.
Question 4 of 5
A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has what pathophysiologic effect?
Correct Answer: A
Rationale: Smoking cessation is vital in COPD because smoking increases mucus production, a key pathophysiologic effect. Cigarette smoke irritates goblet cells and mucous glands, overproducing thick mucus that clogs airways, impairs ciliary clearance, and fosters inflammation and infection central to COPD's chronic bronchitis component. Hemoglobin isn't destabilized; smoking forms carboxyhemoglobin, reducing oxygen capacity, but this is secondary. Alveoli don't shrink or collapse acutely emphysema involves their distention and destruction from elastase imbalance. The nurse's emphasis on mucus production educates the group on how smoking drives obstruction and symptoms (e.g., cough, dyspnea), reinforcing cessation's role in halting this cascade, per COPD pathogenesis and public health campaigns.
Question 5 of 5
A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma?
Correct Answer: B
Rationale: For an acute asthma exacerbation with persistent symptoms, the nurse expects anti-inflammatory drugs, primarily inhaled corticosteroids (e.g., budesonide), to gain underlying control. Asthma's root is airway inflammation corticosteroids reduce mucosal edema, mucus production, and hyperresponsiveness, preventing recurrent attacks and stabilizing lung function long-term. Rescue inhalers (e.g., albuterol) provide quick relief for acute bronchospasm but don't address inflammation, serving as short-term adjuncts. Antibiotics treat bacterial infections, irrelevant unless pneumonia complicates the case, which isn't typical in asthma. Antitussives suppress cough, counterproductive when cough clears mucus in asthma. The nurse anticipates corticosteroids often paired with beta-agonists per asthma guidelines (e.g., NHLBI), monitoring for delivery (e.g., MDI with spacer) and side effects (e.g., thrush), ensuring control of this chronic inflammatory state post-exacerbation.