143 Module 2 - Chronic Respiratory Disorders (PRACTICE QUESTIONS)

A nurse is caring for a 6-year-old client with cystic fibrosis. To enhance the child's nutritional status, which priority intervention should be included in the plan of care? A. Pancreatic enzyme supplementation with meals B. Provision of five to six small meals per day rather than three larger meals C. Total parenteral nutrition (TPN) D. Magnesium, thiamine, and iron supplementation

ANS: A Rationale: Nearly 90% of clients with CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals. Frequent, small meals or TPN are not normally indicated. Vitamin supplements are required, but specific replacement of magnesium, thiamine, and iron is not typical.

A nurse is developing a teaching plan for a client with chronic obstructive pulmonary disease. What should the nurse include as the most important area of teaching? A. Avoiding extremes of heat and cold B. Setting and accepting realistic short- and long-term goals C. Adopting a lifestyle of moderate activity D. Avoiding emotional disturbances and stressful situations

ANS: B Rationale: A major area of teaching involves setting and accepting realistic short- and long-term goals. The other options should also be included in the teaching plan, but they are not areas that are as high a priority as setting and accepting realistic goals.

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse? A. Gives oral pancreatic enzymes with meals B. Provides nebulized tobramycin (TOBI) C. Collects sputum for culture and sensitivity D. Administers vancomycin intravenously

C. Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.

What is the rationale for using CPAP to treat sleep apnea? A) positive air pressure holds the airway open B) negative air pressure holds the airway closed C) delivery of oxygen facilitates respiratory effort D) alternating waves of air stimulate breathing

A) positive air pressure holds the airway open

A nurse is evaluating the diagnostic study data of a client with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? A. Elevated sweat chloride concentration B. Positive phenylketonuria C. Presence of protein in the urine D. Decreased tidal volume

A. Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and decreased tidal volume are not diagnostic for CF.

A nurse is preparing to perform an admission assessment on a client with chronic obstructive pulmonary disease (COPD). It is most important for the nurse to review which of the following? A. Social work assessment B. Finances C. Chloride levels D. Available diagnostic tests

ANS: D Rationale: In addition to the client's history, the nurse reviews the results of available diagnostic tests. Social work assessment is not a priority for the majority of clients. Chloride levels are relevant to cystic fibrosis, not COPD. Immediate physiological status would be more important than finances.

A patient tells the nurse that when he is exposed to cigarette smoke he begins to get short of breath, starts coughing, and gets a high-pitched noise in his lungs when he breathes. The nurse would ask additional assessment questions about which pulmonary disorder? 1. Chronic obstructive pulmonary disorder (COPD) 2. Asthma 3. Emphysema 4. Pneumonia

Answer: 2 Explanation: 1. COPD also is an obstructive disorder but does not typically become exacerbated with a trigger to cause the onset of symptoms. 2. The classic triad of asthma symptoms includes paroxysmal episodes of dyspnea, wheeze, and cough triggered by a stimulus. The stimulus, or trigger, for the patient is cigarette smoke. This patient most likely is describing the symptoms of asthma. 3. Emphysema also is an obstructive disorder but does not typically become exacerbated with a trigger to cause the onset of symptoms. 4. Pneumonia will not suddenly appear after exposure to cigarette smoke to cause the onset of the patient's symptoms.

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. A. Dry airways obstruct airflow. B. Overinflated alveoli impair gas exchange. C. Inflamed airways obstruct airflow. D. Mucus secretions block airways.

B, C, D. Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.

What are the primary causes for an acute exacerbation of COPD? Select all that apply. A. Change in season from spring to summer B. Tracheobronchial infection C. Hypertension D. Gastrointestinal viruses E. Air pollution

B, E. Common causes of an acute exacerbation include tracheobronchial infection and air pollution. However, the cause of approximately one third of severe exacerbations cannot be identified. Change in season from spring to summer, hypertension, and GI viruses are not causes of exacerbation of COPD. Winter is worse for COPD when viral and bacterial infections are more prevalent.

Which is the strongest predisposing factor for asthma? A. Congenital malformations B. Allergy C. Male gender D. Air pollution

B. Allergy is the strongest predisposing factor for asthma.

Which of the following is not a primary symptom of COPD? A. Dyspnea upon exertion B. Weight gain C. Sputum production D. Cough

B. COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Weight loss is common with COPD.

During assessment of a patient with OSA, the nurse documents which of the following characteristic signs that occurs because of repetitive apneic events? A. Systemic hypotension B. Increased smooth muscle contractility C. Pulmonary hypotension D. Hypercapnia

D. Repetitive apneic events result in hypoxia and hypercapnia, which triggers a sympathetic response (increased heart rate and decreased tone and contractility of smooth muscle).

The most effective treatments for sleep apnea include all of the following EXCEPT a. weight loss. b. the use of stimulant drugs. c. the use of a continuous positive airway pressure (CPAP) mask. d. surgery for breathing obstructions.

b. the use of stimulant drugs.

Which statement is true about both lung transplant and bullectomy? A. Both procedures improve the overall quality of life of a client with COPD. B. Both procedures treat patients with bullous emphysema. C. Both procedures cure COPD. D. Both procedures treat end-stage emphysema.

A. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat clients with bullous emphysema.

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: A. uses the sternocleidomastoid muscles. B. wants the head of the bed raised to a 90-degree level. C. has a pulse oximetry reading of 93%. D. sits in tripod position.

A. Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. A. Respiratory failure B. Pertussis C. Atelectasis D. Thoracentesis E. Status asthmaticus

A, C, E. Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

The ED nurse is assessing the respiratory function of a client who presented with acute shortness of breath. Auscultation reveals continuous wheezes during inspiration and expiration. This finding is most suggestive of what condition? A. Pleurisy B. Emphysema C. Asthma D. Pneumonia

ANS: C Rationale: Wheezes are commonly associated with asthma. They do not normally accompany pleurisy, emphysema, or pneumonia.

The nurse caring for a client recently diagnosed with lung disease encourages the client not to smoke. What is the primary rationale behind this nursing action? A. Smoking decreases the amount of mucus production. B. Smoke particles compete for binding sites on hemoglobin. C. Smoking causes atrophy of the alveoli. D. Smoking damages the ciliary cleansing mechanism.

ANS: D Rationale: In addition to irritating the mucous cells of the bronchi and inhibiting the function of alveolar macrophage (scavenger) cells, smoking damages the ciliary cleansing mechanism of the respiratory tract. Smoking also increases the amount of mucus production and distends the alveoli in the lungs. It reduces the oxygen-carrying capacity of hemoglobin, but not by directly competing for binding sites.

A client's plan of care specifies postural drainage. Which action should the nurse perform when providing this noninvasive therapy? A. Administer the treatment with the client in a high Fowler or semi-Fowler position. B. Perform the procedure immediately following the client's meals. C. The client is instructed to avoid coughing during the therapy. D. Assist the client into a position that will allow gravity to move secretions.

ANS: D Rationale: In postural drainage, the client assumes a position that allows gravity to facilitate the draining of secretions from all areas of the lungs. Postural drainage is usually performed two to four times per day, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Because the client usually sits in an upright position (i.e., high- or semi-Fowler position), secretions are likely to accumulate in the lower parts of the lungs. Several other positions are used in postural drainage so that the force of gravity helps move secretions from the smaller bronchial airways to the main bronchi and trachea. The client is encouraged to cough and remove secretions during postural drainage.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? A. Low-fat B. High-protein C. 1,800-calorie ADA D. Full-liquid

B. Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

A school nurse is caring for a 10-year-old client who is having an asthma attack. What is the preferred intervention to alleviate this client's airflow obstruction? A. Administer corticosteroids by metered dose inhaler. B. Administer inhaled anticholinergics. C. Administer an inhaled beta-adrenergic agonist. D. Use a peak flow monitoring device.

ANS: C Rationale: Asthma exacerbations are best managed by early treatment and education of the client. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in clients who fail to respond to inhaled beta-adrenergic medication. A peak flow device will not resolve short-term shortness of breath.

A nurse's assessment reveals that a client with chronic obstructive pulmonary disease may be experiencing bronchospasm. Which assessment findings would suggest that the client is experiencing bronchospasm? Select all that apply. A. Fine or coarse crackles on auscultation B. Wheezes or diminished breath sounds on auscultation C. Reduced respiratory rate or lethargy D. Slow, deliberate respirations and diaphoresis E. Labored and rapid breathing

ANS: B, E Rationale: Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, labored breathing and agitation, not slow, deliberate respirations, reduced respiratory rate, or lethargy.

A nurse is developing a teaching plan for an adult client with asthma. Which teaching point should have the highest priority in the plan of care that the nurse is developing? A. Gradually increase levels of physical exertion. B. Change filters on heaters and air conditioners frequently. C. Take prescribed medications as scheduled. D. Avoid goose-down pillows.

ANS: C Rationale: Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.

In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply. A. Albuterol is a bronchodilator. B. Cotrimoxazole is a bronchodilator. C. Prednisone is a corticosteroid. D. Dexamethasone is an antibiotic. E. Ciprofloxacin is an antibiotic.

A, C, E. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics. All of these drugs could be prescribed to a client with COPD.

The nurse is admitting a patient with COPD. The decrease of what substance in the blood gas analysis would indicate to the nurse that the patient is experiencing hypoxemia? A. PaO2 B. PCO2 C. pH D. HCO3

A. Hypoxemic hypoxia, or hypoxemia, is a decreased oxygen level in the blood (PaO2) resulting in decreased oxygen diffusion into the tissues.

A pediatric nurse practitioner is caring for a 2-year-old client who has just been diagnosed with asthma. The nurse has provided the parents with information that includes potential causative agents for an asthmatic reaction. Which potential causative agent that may trigger an attack should the nurse describe? A. Household pets B. Inadequate sleep C. Psychosocial stress D. Bacteria

ANS: A Rationale: Common causative agents that may trigger an asthma attack are as follows: dust, dust mites, pets, soap, certain foods, molds, and pollens. Although some research links inadequate sleep to making asthma worse, it is not a common trigger for attacks. Psychosocial stress is anything that translates to a perceived threat to social status. Stress is listed as a trigger for asthma, but this type of stress is unlikely in a 2-year-old client. A viral, not bacterial, component is linked to asthma triggers.

The nurse is providing care for a client who has recently been diagnosed with chronic obstructive pulmonary disease. When educating the client about exacerbations, the nurse should prioritize which topic? A. Identifying specific causes of exacerbations B. Prompt administration of corticosteroids during exacerbations C. The importance of prone positioning during exacerbations D. The relationship between activity level and exacerbations

ANS: A Rationale: Prevention is key in the management of exacerbations, and it is important for the client to identify which factors cause exacerbations. Corticosteroids are not normally used as a rescue medication, and prone positioning does not enhance oxygenation. Activity in the morning may need to be delayed for an hour or two for bronchial secretions that have collected overnight in the lungs to clear. Therefore, the right amount of activity, at the right time, can impact exacerbations, but prevention is the priority.

A nurse has been asked to give a workshop on chronic obstructive pulmonary disease for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has which pathophysiologic effect? A. Increases the amount of mucus produced B. Destabilizes hemoglobin C. Shrinks the alveoli in the lungs D. Collapses the alveoli in the lungs

ANS: A Rationale: Smoking irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, which, in turn, produces more irritation, infection, and damage to the lung. Smoking is not known to destabilize hemoglobin, shrink the alveoli in the lungs, or collapse the alveoli in the lungs.

A nurse is admitting a new client who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the client achieve the goal of maintaining effective oxygenation? A. Teach the client strategies for promoting diaphragmatic breathing. B. Administer supplementary oxygen by simple face mask. C. Teach the client to perform airway suctioning. D. Assist the client in developing an appropriate exercise program.

ANS: A Rationale: The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in clients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.

A nurse is working with a 10-year-old client who is undergoing a diagnostic workup for suspected asthma. Which signs and symptoms are consistent with a diagnosis of asthma? Select all that apply. A. Chest tightness B. Crackles C. Bradypnea D. Wheezing E. Cough

ANS: A, D, E Rationale: Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Crackles and bradypnea are not typical symptoms of asthma.

An asthma nurse educator is working with a group of adolescent asthma clients. What intervention is most likely to prevent asthma exacerbations among these clients? A. Encouraging clients to carry a corticosteroid rescue inhaler at all times B. Educating clients about recognizing and avoiding asthma triggers C. Teaching clients to utilize alternative therapies in asthma management D. Ensuring that clients keep their immunizations up to date

ANS: B Rationale: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate clients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.

An asthma educator is teaching a client newly diagnosed with asthma and the family about the use of a peak flow meter. The educator should teach the client that a peak flow meter measures highest airflow during which type of breath? A. Forced inspiration B. Forced expiration C. Normal inspiration D. Normal expiration

ANS: B Rationale: Peak flow meters measure the highest airflow during a forced expiration.

A nurse is providing discharge teaching for a client with COPD. What should the nurse teach the client about breathing exercises? A. Lie supine to facilitate air entry. B. Avoid pursed-lip breathing unless absolutely necessary. C. Use diaphragmatic breathing. D. Use chest breathing.

ANS: C Rationale: Inspiratory muscle training and breathing retraining may help improve breathing patterns in clients with COPD. Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and helps expel as much air as possible during expiration. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration. Diaphragmatic breathing, not chest breathing, increases lung expansion. Supine positioning does not aid breathing.

A 45-year-old obese man arrives in a clinic reporting daytime sleepiness, difficulty going to sleep at night, and snoring. The nurse should recognize the manifestations of which health problem? A. Adenoiditis B. Chronic tonsillitis C. Obstructive sleep apnea D. Laryngeal cancer

ANS: C Rationale: Obstructive sleep apnea occurs in men, especially those who are older and overweight. Symptoms include excessive daytime sleepiness, insomnia, and snoring. Daytime sleepiness and difficulty going to sleep at night are not indications of tonsillitis or adenoiditis. This client's symptoms are not suggestive of laryngeal cancer.

The nurse is assessing a client whose respiratory disease is characterized by chronic hyperinflation of the lungs. Which physical characteristic would the nurse most likely observe in this client? A. Signs of oxygen toxicity B. A moon face C. A barrel chest D. Long, thin fingers

ANS: C Rationale: In chronic obstructive pulmonary disease (COPD) clients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The client with COPD is more likely to have finger clubbing, which is an abnormal rounded appearance of the fingertips, rather than long, thin fingers. Clubbed fingers are the result of chronically low blood levels of oxygen. A moon face is swelling of the face due to increased fat deposits. This may be a sign of Cushing syndrome or a side effect of steroid use. Signs of oxygen toxicity, such as facial pallor or behavioral changes, may be possible but are not the most likely physical findings for this client.

A patient is diagnosed with cystic fibrosis. The nurse will anticipate providing care for a patient with which change in lung function? 1. Decreased total lung capacity 2. Progressive respiratory alkalosis 3. Increased PaCO2 4. Increased forced expiratory volume (FEV)

Answer: 3 Explanation: 1. The air trapping associated with obstructive lung disorders such as cystic fibrosis results in increase in total lung capacity. 2. Obstructive pulmonary disorders such as cystic fibrosis tend to produce progressive respiratory acidosis. 3. In obstructive lung disorders such as cystic fibrosis, PaCO2 levels increase because of air trapping. 4. Obstructive disorders such as cystic fibrosis cause inability to exhale trapped air. This results in a decreased FEV.

The caregivers of a child who was diagnosed with cystic fibrosis 5 months ago report that they have been following all of the suggested guidelines for nutrition, fluid intake, and exercise, but the child has been having bouts of constipation and diarrhea. The nurse tells the caregiver to increase the amount of which substance in the child's diet? A. Saturated fat B. Pancreatic enzymes C. Iodized salt D. Calories from protein

B. Adequate nutrition helps the child resist infections. Pancreatic enzymes must be administered with all meals and snacks. If the child has bouts of diarrhea or constipation, the dosage of enzymes may need to be adjusted. The child's diet should be high in carbohydrates and protein with no restriction of fats. The child may need 1.5 to 2 times the normal caloric intake to promote growth. Low-fat products can be selected if desired. The child also may require additional salt in the diet. Increased caloric intake compensates for impaired absorption.

A client with chronic lung disease is prescribed chest percussion. For which reason will the nurse question this treatment for the client? A. Left hip replaced 5 years ago B. Age 75 years C. Receiving intravenous fluid therapy D. Diagnosed with bacterial pneumonia

B. Chest percussion is used to help dislodge mucus adhering to the bronchioles and bronchi. It is carried out by cupping the hands and lightly striking the chest wall in a rhythmic fashion over the lung segment to be drained. The wrists are alternately flexed and extended so that the chest is cupped or clapped in a painless manner. Percussion is performed for 3 to 5 minutes for each position while the client uses diaphragmatic breathing. As a precaution, percussion over chest drainage tubes and the sternum, spine, liver, kidneys, spleen, or breasts (in women) is avoided. Percussion is performed cautiously in older adult clients because of the increased incidence of osteoporosis and risk of rib fracture. Percussion is not contraindicated after hip replacement surgery. It is not contraindicated while receiving intravenous fluid therapy. It would be an appropriate treatment for a client with bacterial pneumonia.

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: A. administer pain medication as ordered. B. instruct the client to drink at least 2 L of fluid daily. C. maintain the client on bed rest. D. administer anxiolytics, as ordered, to control anxiety.

B. Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first? A. "Have him use his low-dose steroid inhaler now and again in 15 minutes." B. "Have him use his short-acting bronchodilator right away." C. "You

B. The child's symptoms and drop in PEFR suggest a medical alert or red situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? A. Vancomycin 1 gram intravenously over 1 hour B. Oxygen through nasal cannula at 2 L/minute C. Intravenous methylprednisolone (Solu-Medrol) 120 mg D. Ipratropium bromide (Alupent) by metered-dose inhaler

B. When a client presents in the emergency department with an exacerbation of COPD, the nurse should first administer oxygen therapy and perform a rapid assessment of whether the exacerbation is potentially life threatening.

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? A. Respiratory rate B. Heart rate C. Lung sounds D. Skin color

C. A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? A. Metabolic acidosis B. Respiratory alkalosis C. Respiratory acidosis D. Metabolic alkalosis

C. In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: A. high sodium chloride concentration in the sweat. B. decreased respiratory capacity. C. chronic lack of oxygen. D. impaired digestive activity.

C. In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed? A. After meals and at bedtime B. Before meals C. With meals D. Three times a day regardless of meal time

C. Nearly 90% of clients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals.

The nurse is caring for a 10-year-old girl with cystic fibrosis who receives pancreatic enzymes. Which comment by a parent demonstrates understanding of the instructions regarding the medication? A. Between meals is the best time to give the enzymes. B. I should stop the enzymes if my child is taking antibiotics. C. I should give the enzymes before each meal or snack. D. I should reduce the dose if she has large, malodorous stools.

C. The enzymes are necessary for appropriate digestion and absorption of food and nutrients. There is no interaction between enzymes and antibiotics. Large, malodorous stools are a sign of no pancreatic enzyme activity. Pancreatic enzymes must be given each time the child eats, usually in smaller doses for snacks than for meals.

A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: A. Dyspnea B. A dry, hacking cough C. Sharp, stabbing chest pain D. Tachycardia

C. The initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? A. Limit yourself to smoking only 2 cigarettes per day. B. Maintain bed rest. C. Weigh yourself daily and report a gain of 2 lb in 1 day. D. Eat a high-sodium diet.

C. The nurse should instruct the client to weigh himself daily and report a gain of 2 lb in 1 day. COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy. The client shouldn't smoke at all.

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

A. Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

The nurse is caring for a patient with obstructive pulmonary disease who had tachycardia, tachypnea, and restlessness. The patient has become very lethargic, but has a normal respiratory rate. The nurse should evaluate this change as indicating which condition? 1. The patient is now able to rest and sleep. 2. The patient's condition has significantly deteriorated. 3. The patient's condition shows some slight improvement. 4. The patient's condition has stabilized significantly.

Answer: 2 Explanation: 1. These findings do not indicate that the patient is resting and now able to sleep. 2. The patient's condition has deteriorated as evidenced by lethargy and decreased respiratory rate. The elevated carbon dioxide levels have affected the central nervous system causing lethargy, which may progress to coma. The patient has become exhausted and is unable to maintain the compensatory mechanisms needed to maintain acid-base balance. 3. These findings do not indicate that the patient's condition is improving. 4. These findings do not indicate significant stabilization of the patient's condition.

A patient has inability to clear thick secretions from her airway. Which nursing interventions are appropriate to address this problem? Select all that apply. 1. Encourage bedrest to conserve energy. 2. Administer pain medications as needed. 3. Position the patient on the unaffected side. 4. Encourage the patient to provide as much self-care as possible. 5. Encourage slow, deep breaths.

Answer: 2, 4 Explanation: 1. Bedrest will impair the patient's ability to mobilize secretions. Activity as tolerated will help mobilize secretions. 2. The nurse should treat the patient's pain but avoid oversedation. 3. Positioning the patient on the unaffected side is an intervention to improve gas exchange. Ineffective airway clearance generally involves both lungs and the trachea. 4. Providing care for self encourages the patient to move within the environment even if it is limited to the bed or bedside. Movement encourages mobilization of secretions. 5. Slow, deep breaths will support a healthier breathing pattern, but is not necessarily indicated to help clear the airway.

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? A. An oral corticosteroid B. An inhaled corticosteroid C. An I.V. beta2-adrenergic agonist D. An inhaled beta2-adrenergic agonist

D. An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.

Which type of sleep apnea is characterized by lack of airflow due to pharyngeal occlusion? A. Simple B. Central C. Mixed D. Obstructive

D. Obstructive sleep apnea occurs usually in men, especially men who are older and overweight. Types of sleep apnea do not include a simple classification. Mixed sleep apnea is a combination of central and obstructive apnea, with one apneic episode. In central sleep apnea, the client demonstrates simultaneous cessation of both airflow and respiratory movements.

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? A. Asthma B. Emphysema C. Bronchitis D. Polycythemia

D. Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

The nurse has instructed a client on how to perform pursed-lip breathing. The nurse recognizes the purpose of this type of breathing is to accomplish which result? A. Promote the strengthening of the client's diaphragm B. Promote more efficient and controlled ventilation and to decrease the work of breathing C. Promote the client's ability to take in oxygen D. Improve oxygen transport; induce a slow, deep breathing pattern; and assist the client to control breathing

D. Pursed-lip breathing, which improves oxygen transport, helps induce a slow, deep breathing pattern and assists the client to control breathing, even during periods of stress. This type of breathing helps prevent airway collapse secondary to loss of lung elasticity in emphysema.

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. A. Wheezes B. Jugular vein distention C. Ascites D. Compromised gas exchange E. Decreased airflow

A, D, E. Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2015).

The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed? A. It is okay for our child to do chores such as sweeping the floor. B. We will both enroll in smoking cessation classes. C. Our family dog will need to go live with a grandparent. D. We will keep an albuterol inhaler with our child at all times.

A. Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.

The nurse assessed a 28-year-old woman who was experiencing dyspnea severe enough to make her seek medical attention. The history revealed no prior cardiac problems and the presence of symptoms for 6 months' duration. On assessment, the nurse noted the presence of both inspiratory and expiratory wheezing. Based on this data, which of the following diagnoses is likely? A. Asthma B. Pneumothorax C. Acute respiratory obstruction D. Adult respiratory distress syndrome

A. The presence of both inspiratory and expiratory wheezing usually signifies asthma if the individual does not have heart failure. Sudden dyspnea is an indicator of the other choices.

The nurse identifies a nursing diagnosis of Ineffective airway clearance related to inflammation and copious thick secretions. What action is the priority? A. suctioning secretions from the airway B. administering oxygen as ordered C. administering analgesics as ordered D. monitoring oxygen saturation by pulse oximeter

A. The priority intervention is suctioning secretions to provide a patent airway. Administering oxygen as ordered, monitoring oxygen saturation by pulse oximeter, and administering analgesics as ordered would be secondary interventions.

A nurse is developing the teaching portion of a care plan for a client with COPD. What would be the most important component for the nurse to emphasize? A. Smoking up to three cigarettes weekly is generally allowable. B. Chronic inhalation of indoor toxins can cause lung damage. C. Minor respiratory infections are considered to be self-limited and are not treated with medication. D. Activities of daily living (ADLs) should be clustered in the early morning hours.

ANS: B Rationale: Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all clients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. ADLs should be paced throughout the day to permit clients to perform these without excessive distress.

A client's severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the client's statements suggests a correct understanding of this medication? A. This drug may make my heart beat slower. B. This drug is particularly good at preventing asthma attacks during exercise. C. I'll make sure to use this each time I feel an asthma attack coming on. D. I understand that this drug is less effective at controlling night-time symptoms.

ANS: B Rationale: LABAs are effective in the prevention of exercise-induced asthma. They are also used with anti-inflammatory medications to control asthma symptoms, particularly those that occur during the night. LABAs are not indicated for immediate relief of symptoms. are not used for management of acute asthma symptoms. Tachycardia, not bradycardia, is a potential adverse effect of this medication.

A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF? A. Alveolar mucus plugging, infection, and eventual bronchiectasis B. Bronchial mucus plugging, inflammation, and eventual bronchiectasis C. Atelectasis, infection, and eventual COPD D. Bronchial mucus plugging, infection, and eventual COPD

ANS: B Rationale: The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath after a prolonged episode of coughing. On assessment, the nurse notes an oxygen saturation of 84%, asymmetrical chest movement, and decreased breath sounds on the right side. Which condition should the nurse suspect and which interventions should the nurse implement based on these signs and symptoms? A. Expected response to coughing; give supplemental oxygen and encourage deep breathing exercises B.

ANS: B Rationale: Development of a pneumothorax, a potentially life-threatening complication of COPD, may be spontaneous or related to severe coughing or large intrathoracic pressure changes. The combination of asymmetry of chest movement, differences in breath sounds, and a decreased pulse oximetry are indications of pneumothorax. In response, the nurse should administer supplemental oxygen and continue close bedside monitoring of this client. The signs and symptoms described are not normal findings after coughing or due to chronic atelectasis (alveolar collapse). While a decrease in saturation is expected after coughing, due to irritation of airways and decreased ability to fully oxygenate, the saturation was lower than expected. Oxygen toxicity occurs when too high of a concentration of oxygen is given over a period of time, which triggers a severe inflammatory response. Because no specific duration or amount of oxygen was listed and a hallmark of this condition is substernal discom

A client with a severe exacerbation of chronic obstructive pulmonary disease requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? A. Nonrebreathing mask B. Tracheostomy collar C. Venturi mask D. Face tent

ANS: C Rationale: The Venturi mask is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. It is used primarily for clients with COPD because it can accurately provide appropriate levels of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The Venturi mask uses the Bernoulli principle of air entrainment (trapping the air like a vacuum), which provides a high airflow with controlled oxygen enrichment. For each liter of oxygen that passes through a jet orifice, a fixed proportion of room air is entrained. Varying the size of the jet orifice and adjusting the flow of oxygen can deliver a precise volume of oxygen. The other methods of oxygen delivery listed, the nonrebreathing mask, tracheostomy collar, and face tent, do not use the Bernoulli principle and thus lack the precision of a Venturi mask.

The nurse is assessing the respiratory status of a client who is experiencing an exacerbation of emphysema symptoms. When preparing to auscultate, what breath sounds should the nurse anticipate? A. Rhonchi during expiration B. Wheezing with discontinuous breath sounds C. Faint breath sounds with prolonged expiration D. Faint breath sounds with fine crackles

ANS: C Rationale: The breath sounds of the client with emphysema are faint or often completely inaudible. When they are heard, the expiratory phase is prolonged. Fine crackles are soft, high-pitched, discontinuous popping sounds heard in mid to late inspiration that are associated with interstitial pneumonia, restrictive pulmonary disease, or bronchitis. Wheezing is a continuous, musical, high-pitched, shrill sound associated with chronic bronchitis or bronchiectasis. Rhonchi are deep, lower-pitched rumbling sounds, with a snoring quality, that are associated with secretions or a tumor.

The nurse in the intensive care unit is caring for a client with pulmonary hypertension. Which finding should the nurse expect to assess? A. Pulmonary artery pressure greater than 20 mm Hg B. Flat neck veins C. Dyspnea at rest D. Enlarged spleen

ANS: C Rationale: The main symptom in pulmonary hypertension is dyspnea. At first dyspnea occurs with exertion, then eventually at rest. A client with pulmonary hypertension will have a pulmonary artery pressure greater than 25 mm Hg at rest and distended neck veins secondary to right-sided heart failure. The nurse would expect the liver, not the spleen, to be enlarged secondary to engorgement in pulmonary hypertension.

A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? A. Shallow respirations B. Increased anterior-posterior (AP) diameter C. Bilateral wheezes D. Bradypnea

ANS: C Rationale: The three most common symptoms of asthma are cough, dyspnea, and wheezing. There may be generalized wheezing (the sound of airflow through narrowed airways), first on expiration and then, possibly, during inspiration as well. Respirations are not usually slow and the child's AP diameter does not normally change.

The home care nurse is assessing a client who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the client in the home environment? A. The client desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min. B. The client requires a high-flow system for use with a tracheostomy collar. C. The client desires a portable oxygen delivery system that can deliver 2 L/min. D. The client's respiratory status re

ANS: C Rationale: The use of oxygen concentrators is another means of providing varying amounts of oxygen, especially in the home setting. They can deliver oxygen flows from 1 to 10 L/min and provide an FiO2 of about 40%. They require regular maintenance and are not used for high-flow applications. The client desiring a portable oxygen delivery system of 2 L/min will benefit from the use of an oxygen concentrator.

A nurse is developing a care plan for a client with chronic obstructive pulmonary disease (COPD) admitted to the hospital for the second time this year with pneumonia. Which nursing diagnoses would be appropriate for this client? Select all that apply. A. Ineffective airway clearance related to inhalation of toxins B. Activity intolerance related to oxygen supply and demand C. Impaired gas exchange related to ventilation-perfusion inequality D. Ineffective health management related to fatigue E.

ANS: C, E Rationale: Impaired gas exchange and deficient knowledge are the appropriate diagnoses for this client based on the information provided. Pneumonia is an acute infection of the parenchyma whose pathophysiology typically triggers an inflammatory response in the lung. In a client with COPD who already has chronic inflammation, gas exchange becomes further compromised. Areas of the lung receive either oxygen but no blood flow or blood flow but no oxygen (ventilation/perfusion inequality). Because this was the second admission for the same diagnosis, deficient knowledge of prevention strategies should be included for this client. Although ineffective airway clearance is a possibility, not enough information is provided to conclude that it was a result of toxins such as cigarette smoke. Activity intolerance and health management should be addressed as a risk because pneumonia and COPD impact activity and cause fatigue, but not enough information was provided to make these a proble

A nurse is planning the care of a client with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care? A. Taking prophylactic antibiotics as prescribed B. Adhering to the treatment regimen in order to cure the disease C. Avoiding airplanes, buses, and other crowded public places D. Setting realistic short- and long-term goals

ANS: D Rationale: A major area of teaching involves setting and accepting realistic short-term and long-term goals. Emphysema is not considered curable and antibiotics are not used on a preventative basis. The client does not normally need to avoid public places.

The hospital case manager for a group of recently discharged clients with asthma is providing health education. Which aspect of client teaching would have the greatest impact on preventing readmissions? A. Alternative treatment modalities B. Family participation in care C. Pathophysiology of the disease process D. Self-care and the therapeutic regimen

ANS: D Rationale: Knowledge about self-care and the therapeutic regimen would have the greatest impact on preventing admissions. For clients, the ability to understand the complex therapies of inhalers, anti-allergy and anti-reflux medications, and avoidance measures are essential for long-term control. Knowledge of alternative treatment modalities, such herbs, vitamins, or yoga, may help but is usually most effective as a complementary measure to an existing plan. Involving the family in care is important and can help the client with compliance, support, and encouragement, but ultimately the client is responsible for their own health. Understanding the pathophysiology of the disease process is important to include in education as it provides a better understanding in regards to causation and how it affects the body. However, how to physically manage asthma takes precedence over understanding in terms of readmission strategies.

A client with chronic obstructive pulmonary disease has recently begun a new bronchodilator. Which therapeutic effect(s) should the nurse expect from this medication? Select all that apply. A. Negative sputum culture B. Increased viscosity of lung secretions C. Increased respiratory rate D. Increased expiratory flow rate E. Relief of dyspnea

ANS: D, E Rationale: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the client's respiratory status. Bronchodilators would not have a direct result on the client's infectious process.

The student nurse is collecting data on a child diagnosed with cystic fibrosis and notes the child has a barrel chest and clubbing of the fingers. In explaining this manifestation of the disease, the staff nurse explains the cause of this symptom to be: A. decreased respiratory capacity. B. chronic lack of oxygen. C. impaired digestive activity. D. high sodium chloride concentration in the sweat.

B. In the child with cystic fibrosis the development of a barrel chest and clubbing of fingers indicate chronic lack of oxygen. Impaired digestive activity may occur due to a lack of pancreatic enzymes. The high sodium concentration makes the child taste salty, but is not related to the barrel chest and clubbing of the fingers. Respiratory issues are a concern, but the barrel chest and clubbing of the fingers are not because of the child's respiratory capacity.

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute and a pulse oximetry of 93% despite receiving nasal oxygen at 2 L/minute. What action should the nurse take? A. Encourage the client to take deep breaths. B. Encourage the client to exhale slowly against pursed lips. C. Increase the flow of oxygen. D. Teach the client to perform upper chest breaths.

B. When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly against pursed lips. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the client control the rate and depth of respiration. It also promotes relaxation, enabling the client to gain control of dyspnea and reduce feelings of panic. Taking deep breaths and upper chest breathing are inefficient breathing techniques; the client with COPD should be encouraged to practice diaphragmatic breathing. Increasing oxygen flow is not necessary because the pulse oximetry is 93%.

Which measure may increase complications for a client with COPD? A. Decreased oxygen supply B. Administration of antibiotics C. Administration of antitussive agents D. Increased oxygen supply

D. Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications.

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? A. Fluticasone propionate B. Ipratropium bromide C. Ipratropium bromide and albuterol sulfate D. Albuterol

D. Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A. Metabolic alkalosis B. Respiratory alkalosis C. Metabolic acidosis D. Respiratory acidosis

D. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? A. Administering ordered sedatives regularly and in large amounts B. Enforcing absolute bed rest C. Restricting fluid intake to 1,000 ml/day D. Teaching the client how to perform controlled coughing

D. Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? A. Passive smoking B. Ambient air pollution C. Occupational exposure D. Exposure to tobacco smoke

D. Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors but do not account for the majority.

High or increased compliance occurs in which condition? A. Pleural effusion B. ARDS C. Pneumothorax D. Emphysema

D. High or increased compliance occurs if the lungs have lost their elasticity and the thorax is overdistended, as in emphysema. Conditions associated with decreased compliance include pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? A. Relieve shortness of breath to a level as close as possible to tolerable. B. Continue with current level of mobility at home. C. Maintain activity level of walking to the mailbox. D. Increase walking distance around a city block without shortness of breath.

D. If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. oxygen toxicity. B. pulmonary edema. C. pleural effusion. D. atelectasis.

D. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

Which of the following is the key underlying feature of asthma? A. Chest tightness B. Shortness of breath C. Productive cough D. Inflammation

D. Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? A. Restricting oral intake to 1,000 mL/day B. Providing the client a low-sodium diet C. Discussing palliative care and end-of-life issues with the client D. Performing chest physiotherapy as ordered

D. Nursing care includes helping clients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

A nurse is caring for a client who has a history of sleep apnea. The client understands the disease process when he says: A. I should eat a high-protein diet. B. I should sleep on my side all night long. C. I need to keep my inhaler at the bedside. D. I should become involved in a weight loss program.

D. Obesity and decreased pharyngeal muscle tone commonly contribute to sleep apnea; the client may need to become involved in a weight loss program. Using an inhaler won't alleviate sleep apnea, and the physician probably wouldn't order an inhaler unless the client had other respiratory complications. A high-protein diet and sleeping on the side aren't treatment factors associated with sleep apnea.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. It decreases use of accessory breathing muscles. B. It prolongs the inspiratory phase of respiration. C. It increases inspiratory muscle strength. D. It helps prevent early airway collapse.

D. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

The nurse is educating a patient with COPD about the technique for performing pursed-lip breathing. What does the nurse inform the patient is the importance of using this technique? A. It will prevent the alveoli from overexpanding. B. It increases the respiratory rate to improve oxygenation. C. It will assist with widening the airway. D. It prolongs exhalation.

D. The goal of pursed-lip breathing is to prolong exhalation and increase airway pressure during expiration, thus reducing the amount of trapped air and the amount of airway resistance.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? A. Increasing pH B. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise C. Avoiding the use of oxygen to decrease the hypoxic drive D. Providing sufficient oxygen to improve oxygenation

D. The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? A. Refer the client to respiratory therapy if breathing becomes labored. B. Educate the client about the importance of pursed lip breathing. C. Assess vital signs every 2 hours, including O2 saturations and ABG results. D. Apply supplemental oxygen as ordered.

D. When the client arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment. Oxygen will correct the hypoxemia. Careful observation of the liter flow or the percentage administered and its effect on the patient is important. These clients generally require low-flow oxygen rates of 1-2 L/min. Monitor and titrate to achieve desired PaO2. Periodic arterial blood gases and pulse oximetry help evaluate the adequacy of oxygenation.