Med-Surg2 Respiratory NCLEX

1. A patient is admitted to a respiratory unit with a diagnosis of left lower lobe pneumonia. The nursing assessment reveals the patient to be febrile and experiencing a weak, congested-sounding cough. The patient has moist crackles throughout the lung fields. Based on the data provided, which nursing diagnosis is most appropriate? a. Anxiety b. Impaired Gas Exchange c. Ineffective Breathing Pattern d. Ineffective Airway Clearance

1. ANS: D Data point to excessive secretions that the patient is not completely coughing up, so Ineffective Airway Clearance is the best choice. A. B. C. Although they may be concerns with pneumonia, there is no evidence of anxiety, impaired gas exchange, or ineffective breathing pattern.

10. A summer camp worker reports to the camp nurse with complaints of shortness of breath and audible wheezing. Which inhaled medication should the nurse provide? a. Albuterol (Proventil) b. Cromolyn sodium (Intal) c. Triamcinolone (Azmacort) d. Nedocromil sodium (Tilade)

10. ANS: A Albuterol is an adrenergic bronchodilator and would be used to help immediately relieve acute bronchospasm. B. D. Cromolyn and nedocromil are mast cell inhibitors. C. Triamcinolone is a corticosteroid.

11. While reinforcing discharge teaching for a patient with emphysema, which patient statement indicates that teaching was effective? a. There are bacteria in my lungs so my body is trying to wall off the infection. b. My disease is caused by spasm of the smooth muscles in my breathing pipes. c. Emphysema causes swelling in the airways and an increase in mucus production. d. Air gets trapped when damage to the air sacs makes it hard for air to move in and out.

11. ANS: D Emphysema affects the alveolar membranes, causing destruction of the alveolar walls, loss of elastic recoil, and air trapping. B. Smooth muscle spasm is associated with asthma. C. Inflammation and mucus production are associated with chronic bronchitis. A. Walled-off bacteria are characteristic of tuberculosis (TB).

12. A patient with chronic obstructive pulmonary disease is prescribed methylprednisolone (Solu-Medrol). For what reason should the nurse realize that corticosteroids are used in the treatment of this health problem? a. Dry secretions b. Treat infection c. Improve the oxygen-carrying capacity of hemoglobin d. Reduce airway inflammation

12. ANS: C Corticosteroids are potent anti-inflammatory agents. A. B. They do not dry secretions, and they may cause infection to worsen. C. They do not directly affect oxygenation.

13. A nurse is providing home care for a patient with chronic obstructive pulmonary disease (COPD). Which order should the nurse question? a. Low-sodium diet b. Increase activity as tolerated c. Oxygen 4 L/min per nasal cannula d. Tiotropium (Spiriva) inhalation once daily

13. ANS: C Oxygen is generally ordered at a flow rate of 1 to 2 L/min for patients with chronic lung disease. Higher flow rates may suppress the hypoxic drive in patients who are chronic CO2 retainers. B. D. Tiotropium and increasing activity as tolerated are common orders in COPD. A. A low-sodium diet is not contraindicated.

14. A patient prescribed theophylline for asthma has a theophylline level of 3 mcg/dL. What should the nurse do? a. Notify the physician. b. Double the next dose of theophylline. c. No action is necessary; this is a therapeutic level. d. Hold the next dose of theophylline until further orders are given.

14. ANS: A A therapeutic theophylline level is 10 to 20 mcg/mL. The physician should be notified. D. Holding the next dose will further lower the level. B. Doubling the dose is inappropriate without a physicians order. C. This is not a therapeutic level and action is necessary.

15. The nurse enters the room of a patient who is acutely short of breath. Which action should the nurse take first? a. Assist the patient into Sims position. b. Encourage use of pursed-lip breathing. c. Ask the patient what caused the dyspnea. d. Teach the patient use of accessory muscles.

15. ANS: B Pursed-lip breathing can help open alveoli and promote excretion of carbon dioxide. A. Fowlers, not Sims, position will help lung expansion. C. Asking the patient the cause is appropriate after the dyspnea is resolved. D. Accessory muscle use is a sign of respiratory distress, not a therapeutic measure.

16. The nurse is providing care for a patient prescribed tiotropium (Spiriva). Which statement should be included in the patient education? a. Do not swallow the capsules. b. This medication can cause blurred vision and anorexia. c. It is important to alert the doctor to any abdominal pain or bloating. d. You may experience a headache and sensitivity to light while taking this medication.

16. ANS: A Tiotropium (Spiriva) is a capsule that is placed in a device and activated before inhalation. The patient should be instructed to not swallow the capsules. B. This medication does not cause blurred vision and anorexia. C. Abdominal pain and bloating is not associated with this medication. D. A headache and sensitivity to light are not adverse effects of this medication.

17. The nurse is caring for a patient with end-stage chronic obstructive pulmonary disease. Which medication can help reduce acute dyspnea associated with this disease? a. PO cortisone b. IV morphine c. IV propranolol (Inderal) d. IM meperidine (Demerol)

17. ANS: B IV morphine helps acute dyspnea and anxiety in patients with end-stage disease. A. Cortisone may reduce inflammation, but the oral route is too slow for acute dyspnea. D. Meperidine has not been shown to reduce dyspnea. C. Propranolol is a beta blocker and may aggravate bronchoconstriction.

18. A patients arterial blood gas analysis shows a PaCO2 of 62 mm Hg. What action should the nurse take? a. Notify the RN; this is abnormally high. b. Have the patient breathe into a paper bag. c. Increase the flow rate of the patients nasal oxygen. d. No action is necessary; this is a normal PaCO2 level.

18. ANS: A Normal PaCO2 is 35 to 45 mm Hg. 62 mm Hg is evidence of hypoventilation and the inability to excrete carbon dioxide. The RN or physician should be notified. C. Increasing nasal oxygen will not help CO2 excretion. B. Breathing into a paper bag will increase the CO2 level. D. This is not a normal level and action must be taken immediately.

19. A patient with chronic obstructive pulmonary disease works with the nurse to set a goal of ambulating to the bathroom with oxygen. Which statement best documents progress toward this goal? a. Dyspnea is controlled with oxygen and rest. b. Arterial blood gases are within normal limits. c. Patient assisted to bathroom three times today. d. Ambulated to bathroom with oxygen, dyspnea level 3 on a 0-to-10 scale.

19. ANS: D Ambulated to bathroom with oxygen, dyspnea level 3 on a 0-to-10 scale directly addresses the goal. A. B. C. Normal arterial blood gases (ABGs), controlled dyspnea, and being assisted to the bathroom are all good outcomes, but they do not directly address the goal.

2. The nurse is caring for a patient with pneumonia. Which laboratory test would best help the nurse to monitor the condition of this patient? a. Electrolytes, serum creatinine b. Complete blood count (CBC), urinalysis c. Partial thromboplastin time (PTT), serum potassium d. White blood cell (WBC) count, arterial blood gases (ABGs)

2. ANS: D WBC is elevated in infection, and ABGs may be abnormal if gas exchange is impaired with pneumonia. CBC may be helpful, but WBC is more specific. A. B. Urinalysis, electrolytes, and creatinine are useful in kidney and bladder problems. C. PTT and potassium may be ordered for cardiovascular problems, among other disorders.

20. A patient with cystic fibrosis has ineffective airway clearance. What intervention would worsen this problem? a. Fluids b. Bedrest c. Mucolytics d. Percussion and postural drainage

20. ANS: B Movement helps mobilize secretions, so bedrest is not helpful. A. C. D. Percussion, postural drainage, fluids, and mucolytics will all help clear the airway.

21. The nurse is assisting in the preparation of content that focuses on respiratory health for a community health fair. What should the nurse include as a major risk factor for many respiratory problems? a. Smoking b. Eating spicy foods c. Eating a high-fat diet d. Excessive sun exposure

21. ANS: A Smoking is the most important risk factor for chronic obstructive pulmonary disease (COPD) and most other respiratory disorders. B. C. D. Spicy foods, sun, and diet are not risk factors

22. A patient has difficulty raising pulmonary secretions, and the nurse writes a nursing diagnosis of Ineffective Airway Clearance related to weak cough and fatigue. What would best help the patient maintain a clear airway? a. Teach relaxation exercises. b. Allow rest periods between activities. c. Encourage fluids; suction prn as ordered. d. Instruct in abdominal and pursed-lip breathing.

22. ANS: D Fluids help reduce viscosity of secretions, and suction can remove secretions in patients who are unable to cough effectively. A. B. Rest and relaxation can help with activity intolerance and anxiety. D. Breathing exercises help correct impaired gas exchange.

23. A patient with a lung infection has blood-tinged sputum. What term should the nurse use to document this finding? a. Hypoxemia b. Hemoptysis c. Hypercarbia d. Hematemesis

23. ANS: B Hemoptysis is blood-tinged sputum. D. Hematemesis is bloody emesis. A. Hypoxemia is low blood oxygen. C. Hypercarbia is high blood carbon dioxide.

24. A nurse performs purified protein derivative and Candida skin tests on a patient suspected of TB. After 48 hours, what finding at the injection sites should the nurse document as a positive result? a. Warmth b. Redness c. Induration d. Purulent discharge

24. ANS: C Induration is a raised area at the injection site and is considered positive. A. B. D. Redness, discharge, and warmth are not positive results.

25. A patient with suspected TB is prescribed a Candida skin test. What should the nurse explain as the purpose of this test? a. Provides a control test b. Tests for skin superinfection c. Potentiates the purified protein derivative (PPD) test d. Determines if the patient has a Candida albicans infection

25. ANS: A Candida is used to test a patient for anergy, or the inability of the immune system to react to an antigen. If the Candida or mumps test produce positive results, the TB results are considered to be reliable. B. D. It is not done to identify Candida infection or superinfection, as most patients are positive. C. It does not affect the PPD test.

26. The nurse is reviewing the health histories for an assigned group of patients. Which patient should the nurse identify as being the most at risk for TB? a. The patient with lung cancer b. The patient with a history of alcohol abuse c. The patient with chronic airflow limitation d. The patient with acquired immunodeficiency syndrome

26. ANS: D Patients with immune dysfunction are most at risk for becoming ill with TB. A. B. C. Patients with cancer, airflow limitation, or alcohol abuse are only at risk if their immune function is compromised.

27. The nurse is reviewing medication orders for a patient with TB. Which drugs should the nurse expect to have prescribed for this patient? a. Isoniazid and rifampin b. Claforan and penicillin c. Aspirin and guaifenesin d. Alupent and theophylline

27. ANS: A Isoniazid and rifampin are antibiotics effective against TB. B. C. D. These medications may be used for respiratory disorders, but they are not specific to TB

28. A patient with TB who is in respiratory isolation must go to the x-ray department. Which action should the nurse take? a. Place a gown and gloves on the patient. b. Place a mask over the patients nose and mouth. c. Notify the x-ray department that the test must be cancelled. d. Call the x-ray department to make sure the waiting room is empty.

28. ANS: B The patient should be in respiratory isolation, so a mask over the nose and mouth is essential. A. Gown and gloves are not necessary. C. D. Ideally, traveling outside the room should be kept to a minimum, but not all x-rays can be done at the bedside.

29. The nurse teaches a patient with TB about drug therapy. Which patient statement indicates that teaching has been effective? a. I will have to take the antibiotics for 10 days. b. I will get a prescription for 2 weeks of antibiotics. c. I will have to take antibiotics for the rest of my life. d. I will probably need to be on antibiotic therapy for 6 months to 2 years.

29. ANS: D Drugs for TB must be taken for 6 months, or up to 2 years for multidrug-resistant TB (MDR-TB). A. B. C. The medications must be taken longer than 10 days to 2 weeks however do not need to be taken for the rest of the patients life.

3. A patient is unable to maintain a clear airway effectively with coughing and has a respiratory rate of 22/min with coarse crackles bilaterally. Which intervention should the nurse provide first? a. Encourage fluids. b. Encourage bedrest. c. Perform tracheal suctioning. d. Assess the patients coughing technique.

3. ANS: D Assessment is the first step before providing care, and effective coughing is important to clear the airway. A. Fluids may be helpful once assessment is complete. B. Bedrest will reduce mobilization of secretions. C. Suctioning is only necessary in patients who are unable to cough.

0. A patient with TB takes the prescribed drugs until the bottle runs out and then feels better and does not refill the prescription. The home health nurse explains that continuing the drugs is important for which reason? a. If taken consistently, your drugs will prevent hemoptysis. b. If you dont take all your drugs you can develop a superinfection. c. The drugs will keep you pain free so you can cough more effectively. d. You must take all the drugs to prevent development of resistant bacteria.

30. ANS: D Unfinished antibiotic prescriptions allow stronger bacteria to survive and become resistant. A. C. Antibiotics do not directly prevent hemoptysis or pain. B. Superinfection can occur even if all the drugs are taken as prescribed.

31. The nurse is beginning morning care after receiving report. Which patient should the nurse monitor most closely for symptoms of a pulmonary embolism (PE)? a. A patient who smokes b. A patient with a deep vein thrombosis in the leg c. A patient with a history of radiation therapy for lung cancer d. A patient with chronic obstructive pulmonary disease (COPD)

31. ANS: B Clots in the legs can mobilize and move to the lungs. D. COPD is not associated with blood clots. A. Smoking causes many lung disorders but does not directly cause PE. C. History of radiation therapy is not a risk factor for PE.

32. The nurse answers a call light and finds the patient gasping for breath and looking very anxious. Based on the patients history, the nurse believes the patient may be experiencing a pulmonary embolism (PE). Which action should the nurse take first? a. Contact the physician. b. Call for help and start oxygen. c. Check the patients vital signs. d. Place the patient in a left lateral position.

32. ANS: B Be alert to the presence of risk factors, and obtain immediate assistance if the cause of dyspnea might be PE. Death can occur if treatment is not quick and effective. D. Left lateral position will not help. A. Leaving the patient to call the physician is not appropriatesomeone else can contact the physician. C. Checking vital signs is important but is not more important than oxygen.

33. A patient is diagnosed with a pulmonary embolism. Which medication should the nurse anticipate administering to this patient? a. Heparin b. Expectorant c. Theophylline d. Corticosteroid

33. ANS: A If a thrombolytic agent is not used, treatment is aimed at preventing extension of the clot and the formation of additional clots. Heparin will prevent clot extension. C. Theophylline is a bronchodilator. D. Corticosteroids are anti-inflammatory. B. An expectorant will help raise secretions.

34. A patient with a pneumothorax has a chest drainage system. The family asks when the chest tube will be removed. What should the nurse respond to the family? a. The tube is removed when serous drainage has stopped collecting in the system. b. The tube is taken out when the patient is able to cough and deep breathe effectively. c. When the adventitious lung sounds are resolved, it is usually safe to remove the tube. d. When tidaling stops and lung sounds are equal on both sides, the tube can be removed.

34. ANS: D Absence of tidaling and bilateral breath sounds are signs that the lung is reinflated and the chest tube can be safely removed. A. Drainage will generally have stopped at this time also, but it is not the primary determinant for removal. B. C. Coughing and deep breathing and clear lung sounds are not signs that the lung is reinflated.

35. The nurse auscultates the lung sounds of a patient with a pneumothorax every 4 hours. What is the nurse listening for during this auscultation? a. Evidence of obstruction b. Presence of crackles or wheezes c. Evidence of bilateral lung sounds d. Presence of secretions in the lungs

35. ANS: C Lung sounds are absent over a pneumothorax. Return of bilateral sounds signifies that the lung is reinflated. A. B. D. Crackles, wheezes, secretions, or obstruction are concerning but do not provide direct information about pneumothorax.

36. A patient is diagnosed with respiratory failure. Which acid-base abnormality should the nurse expect the patient to demonstrate? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

36. ANS: C Arterial blood gases in respiratory failure show decreasing PaO2 and pH and increasing PaCO2, which lead to respiratory acidosis. D. Respiratory alkalosis is associated with hyperventilation. A. B. Metabolic imbalances are not caused by respiratory dysfunction.

37. An LPN is collecting data on a patient recovering from thoracic surgery. Vital signs following surgery were: blood pressure 156/94 mm Hg, pulse 100 beats/min, respirations 14/min, and temperature 97.4F (approximately 36.3C). Which new finding should the nurse report immediately to the physician? a. Pulse 88 beats/min b. Respirations 18/min c. Blood pressure 110/76 mm Hg d. Temperature 98.4F (approximately 36.9C)

37. ANS: C Although the blood pressure is still normal, it has dropped significantly and could signify bleeding or impending shock. A. B. D. The other vital signs are not as remarkable.

38. The nurse develops a plan for impaired gas exchange for a patient with end-stage chronic obstructive pulmonary disease (COPD). Which finding best helps the nurse to know when the goal has been reached? a. The patient is alert and oriented. b. The patients oxygen saturation is 92%. c. The patient is able to clear the airway with coughing. d. The patient correctly demonstrates pursed lip breathing.

38. ANS: B Oxygen saturation of 92% is desirable in a patient with COPD. It reflects adequate oxygenation. A, C, and D are all important but are not as objective as oxygen saturation.

39. A patient asks the nurse what can be done to prevent the development of lung cancer. What measure should the nurse explain as the most effective way to prevent this disease? a. Avoid smoking. b. Eat a balanced diet. c. Avoid excessive sun exposure. d. Avoid exposure to air pollution.

39. ANS: A Smoking causes lung cancer. B, C, and D can help prevent a variety of cancers.

4. The nurse is reviewing data collected on a patient with a respiratory disorder. Which factor should the nurse identify that places the patient at risk for lung cancer? a. Smoking and exposure to radon gas b. Living in a cold climate and having pets c. Eating foods high in beta carotene and fiber d. Living in crowded conditions and lack of sunlight

4. ANS: A Smoking is the biggest risk factor for lung cancer. Radon exposure is also a significant factor. B. C. D. Living in a cold climate, having pets, eating foods high in beta carotene and fiber, living in crowded conditions, and lack of sunlight are not identified risk factors for the development of lung cancer.

40. The nurse is assisting in the preparation of an inservice on infections. What should the nurse include as being the most common cause of death from infection? a. AIDS b. Influenza c. Pneumonia d. TB

40. ANS: C Pneumonia is the cause of more than 10% of hospital admissions each year and is the most common cause of death from infection. A. B. D. AIDS, TB, and influenza are also deadly diseases, but they are not the most common cause of death from an infection.

41. A patient has a positive response to a Candida test, in addition to a positive purified protein derivative (PPD) skin test. Which interpretation of these results is correct? a. The patient is anergic. b. The patients PPD test is reliable. c. The patient has a Candida infection. d. The patient has active TB infection.

41. ANS: B The positive Candida reaction means the patients immune system is intact and that the PPD test is reliable. A. Two negative results would indicate anergy. C. All patients react to Candida. D. Active infection is possible but must be confirmed with a culture.

42. The nurse is reviewing the health statuses for assigned patients to determine the risk for pneumonia. Which type of pneumonia occurs most often as a nosocomial infection in hospitalized patients, very young patients, and older patients? a. Viral pneumonia b. Lobar pneumonia c. Fungal pneumonia d. Bronchopneumonia

42. ANS: D Generalized pneumonia is very serious and is called bronchopneumonia. Bronchopneumonia occurs more often as a nosocomial (hospital-acquired) infection in hospitalized patients, the very young, and the very old. B. Lobar pneumonia is localized. A. C. Fungal and viral pneumonias refer to specific causes but are not necessarily more frequent in the populations listed.

43. The nurse is caring for a patient with long-standing bronchiectasis. Which manifestation should the nurse report immediately? a. Copious sputum b. Periodic episodes of harsh coughing c. Distended neck veins and dependent edema d. Fever of 100.6F (approximately 38C) and dyspnea

43. ANS: C Distended neck veins and dependent edema are signs of cor pulmonale and should be reported immediately. A. B. D. Fever, sputum, and cough are expected in patients with bronchiectasis.

44. The nurse is assisting with the development of content on lung diseases to be provided during an upcoming health fair. What should the nurse include as being the disease that one-third of the worlds population is currently infected? a. AIDS b. Cancer c. Pneumonia d. TB

44. ANS: D One-third of the worlds population is currently infected with TB. A. B. C. One third of the worlds population is not currently infected with AIDS or pneumonia or has cancer.

45. An older adult patient who reports difficulty breathing and a productive cough and has a low-grade fever is admitted to the hospital for diagnosis and treatment. Which new-onset symptom should take priority? a. Fatigue b. Confusion c. Blood-tinged sputum d. Crackles on lung auscultation

45. ANS: B New onset confusion in a patient with respiratory symptoms is a sign of impaired gas exchange. It must be corrected immediately. A. C. D. Crackles, blood-tinged sputum, and fatigue are all important but are not the first priority.

46. The nurse is concerned that a patient with a chronic low oxygen saturation level should be wearing home oxygen. Which oxygenation level should be used to make this decision? a. 95% b. 90% c. 88% d. 72%

46. ANS: C Patients with chronic oxygen saturation levels of less than or equal to 88% should be placed on home oxygen. A. B. Oxygenation levels greater than 88% do not need to be prescribed home oxygen. D. The patient may need additional intervention if the oxygen level is 72%

47. A patient is having a therapeutic thoracentesis to remove pleural fluid. What volume of pleural fluid should the nurse recognize as being abnormal? a. 5 mL b. 7 mL c. 13 mL d. 30 mL

47. ANS: D More than 25 mL of fluid is considered abnormal. A. B. C. A normal amount of pleural fluid around each lung is 1 to 15 mL.

48. A patient is diagnosed with a pulmonary embolism. To be effective, how soon should thrombolytic agents be administered? a. 4 to 6 hours b. 7 to 9 hours c. 10 to 12 hours d. 14 to 24 hours

48. ANS: A Thrombolytic agents such as alteplase (Activase) or reteplase (Retavase) may be used in life-threatening emergencies to dissolve the clot Thrombolytics must be administered within 4 to 6 hours of the clots occurrence. B. C. D. Administering the medication after 6 hours would be ineffective to dissolve the clot.

9. The nurse observes a newly admitted patient in the hospital room and determines that data collection should be focused on chronic obstructive pulmonary disease. What did the nurse observe to make this decision? a. The patient is coughing. b. The patient is lying supine in bed. c. The patient is walking around the room. d. The patient is sitting in the tripod position. Multiple Response

49. ANS: D In chronic obstructive pulmonary disease patients use accessory muscles to breathe and tend to assume the classic tripod position to aid breathing. A. B. C. Coughing, lying supine in bed and walking around the room do not necessarily indication that the patient has chronic obstructive pulmonary disease.

56. A patient is prescribed long-term anticoagulant therapy as treatment for pulmonary emboli. What should the nurse ensure the patient is instructed before being discharged home? (Select all that apply.) a. Wear shoes at home. b. Use an electric razor. c. Use a soft toothbrush. d. Expect bruising to occur. e. Restrict the intake of citrus fruits.

56. ANS: A, B, C The patient on long-term anticoagulant therapy needs to be instructed to avoid accidental injury and bleeding. The patient should be instructed to wear shoes at home, use an electric razor, and use a soft toothbrush. D. Bruising is not expected and should be reported to the health care provider. E. There is no reason to restrict the intake of citrus fruits.

5. A patient with lung cancer who is scheduled to begin a course of radiation therapy asks the nurse, How will they know if Im cured? The nurses best response is based on which understanding of the disease process? a. Lung cancer is never a curable disease; prolonged life is the goal. b. Eighty percent of lung cancers are curable with radiation therapy. c. Radiation in lung cancer is most often used to increase comfort, not cure disease. d. Radiation therapy reduces inflammation; chemotherapy is used to shrink the tumor.

5. ANS: C Radiation may be used to shrink a tumor to reduce symptoms in patients who are unable to undergo surgery. D. It generally is not curative, and it will not reduce inflammation. A. B. Lung cancer is curable in some cases but not usually with radiation alone.

50. According to Centers for Disease Control and Prevention (CDC) guidelines, which individuals should the nurse consider as being positive for the TB skin test? (Select all that apply.) a. A 5-mm induration in a foreign-born individual b. A 5-mm induration in an HIV-infected individual c. A 10-mm induration in a child younger than 4 years old d. A 5-mm induration in an individual from a low-income group e. A 10-mm induration in an individual with no risk factors for TB f. A 10-mm induration in an HIV-negative individual who uses illicit injected drugs

50. ANS: B, C, F 5 mm or more is positive in patients with HIV, close contacts with TB, a history of TB, or IV drug abuse and unknown HIV status. A. D. 10 mm or more is positive in persons who are foreign-born, are IV drug abusers and HIV-negative, are low income, reside in residential facilities, or are children younger than age 4. E. A 15-mm result is positive in a person with no TB risk factors

51. The nurse is caring for a patient with a suspected pulmonary embolism. Which diagnostic tests or procedures should the nurse expect to be prescribed for this patient? (Select all that apply.) a. D-dimer b. Spirometry c. Angiogram d. Bronchoscopy e. Ventilation-perfusion lung scan f. Spiral computed tomography (CT) scan

51. ANS: A, C, E, F A spiral CT scan is a new and fast type of CT scan that is noninvasive and can diagnose PE quickly. If this is not available, a lung scan (ventilation-perfusion scan) is done to assess the extent of ventilation of lung tissue and the areas of blood perfusion. A pulmonary angiogram can outline the pulmonary vessels with a radiopaque dye injected via a cardiac catheter. D-dimer is a fibrin fragment that is found in the blood after any thrombus formation. It can be present in a number of disorders, but if it is negative, PE can be eliminated as a possible cause of the patients symptoms. D. Bronchoscopy is not used to determine PE. B. Spirometry is not a diagnostic test.

52. A nurse is providing care for a patient with Ineffective Airway Clearance. Which are appropriate interventions to address this problem? (Select all that apply.) a. Weigh patient every day. b. Teach patient proper use of an incentive spirometer. c. Place patient in supine position and turn every 2 hours. d. Assess respiratory rate and pattern every 4 hours and prn. e. Encourage patient to deep breathe and cough every 2 hours. f. Administer guaifenesin (Mucinex) every 4 to 6 hours prn as ordered.

52. ANS: A, B, C, D, E, F Interventions to help with ineffective airway clearance include teaching the use of incentive spirometry, assessing respiratory rate and pattern every 4 hours and as needed, encouraging the patient to deep breathe and cough every 2 hours, and administering medication to thin secretions as prescribed. A. Daily weights may be done for other reasons but are not directly related to the problem of ineffective airway clearance.

53. The nurse needs to collect a sputum specimen for culture from a patient with a chronic cough. What actions should the nurse take when collecting this specimen? (Select all that apply.) a. Obtain the specimen first thing in the morning b. Obtain the specimen before the patient eats breakfast c. Administer an antibiotic before collecting the specimen d. Provide the patient with warm water to drink before obtaining the specimen e. Have the patient rinse the mouth with warm water before collecting the specimen

53. ANS: A, B A specimen for culture should be obtained first thing in the morning before the patient eats breakfast. C. The culture specimen should be obtained before antibiotics are started to avoid altering culture results. D. The patient does not need to drink warm water before obtaining the specimen. E. If the patient has eaten, the mouth should be rinsed with water to keep food particles out of the specimen

54. The nurse is assisting in the planning of care for a patient with chronic obstructive pulmonary disease. What should be the goals of care for this patient? (Select all that apply.) a. Smoking cessation b. Improve activity tolerance c. Prevent disease progression d. Complete an advance directive e. Prevent and treat exacerbations

54. ANS: A, B, C, E The goals of COPD treatment include cessation of cigarette smoking, improve activity tolerance, prevent disease progression, and prevent and treat exacerbations. D. Completing an advance directive is not a goal for treatment.

55. A young adult is admitted with manifestations associated with cystic fibrosis. What should the nurse expect to find when collecting data from this patient? (Select all that apply.) a. Extreme thirst b. Finger clubbing c. Body mass index 16 d. Thick sputum production e. Complaints of frequent foul-smelling stool

55. ANS: B, C, D, E Symptoms of cystic fibrosis usually first appear in infancy or childhood, although a few individuals are not diagnosed until adulthood. Manifestations include finger clubbing, malnutrition, thick sputum production, and frequent foul-smelling stools. A. Extreme thirst is not a manifestation of cystic fibrosis.

6. A patient with lung cancer develops pleural effusion. Which explanation by the nurse would help the patient understand this problem? a. Pus has developed in your alveoli that must be removed to improve your breathing. b. You have large amounts of fluid collecting in your airways because of the lung cancer. c. Fluid has collected in the space between your lungs and the sac surrounding your lungs. d. Fluid in your pericardial sac places pressure on your lungs, making it difficult to breathe.

6. ANS: C When excess fluid collects in the pleural space, it is called a pleural effusion. Fluid normally enters the pleural space from surrounding capillaries and is reabsorbed by the lymphatic system. When a pathological condition causes an increase in fluid production or inadequate reabsorption of fluid, excess fluid collects. A. B. D. The fluid is not in the airways or alveoli or around the heart.

7. A patient diagnosed with a pleural effusion is very dyspneic. With which procedure should the nurse anticipate assisting? a. Tracheostomy b. Thoracentesis c. Bronchoscopy d. Pericardiocentesis

7. ANS: B Thoracentesis can be done by the physician to remove some of the fluid that has collected and is compressing lung tissue. A. Tracheostomy creates a stoma for the placement of an artificial airway. C. Bronchoscopy visualizes the major airways with an endoscope. D. Pericardiocentesis removes fluid from around the heart.

8. The nurse is providing discharge teaching for a patient with newly diagnosed asthma. What should be included in the discharge teaching? a. Fluid fills the tiny sacs in the lungs and makes breathing difficult. b. Symptoms are caused by inflammation in the lining of your airways. c. You may notice large amounts of pus-like sputum that has a foul odor. d. The chest wall becomes stiff and air movement is restricted in individuals with asthma.

8. ANS: B Asthma is characterized by inflammation of the mucosal lining of the bronchial tree and spasm of the bronchial smooth muscles (bronchospasm). A. Alveoli are not generally affected in asthma. C. Some sputum may be present, but purulent sputum suggests infection, not asthma. D. Noncompliance of the chest wall occurs in restrictive, not obstructive, disorders.

9. The nurse is providing routine follow-up care for a young adult with asthma who has been on a 3-month course of maintenance therapy. Which activity would best help the nurse to determine if the patients treatment plan was effective? a. Obtain an ABG analysis. b. Determine the patients pulse oximeter reading. c. Evaluate the patients use of an incentive spirometer. d. Examine daily tracking records of the peak expiratory flow rate.

9. ANS: D Many patients with asthma monitor their peak expiratory flow rate at home. This is a measure of the amount of air the patient can blow into a peak flowmeter from fully inflated lungs and is measured in liters per minute. Daily tracking records will indicate respiratory status over time. C. An incentive spirometer encourages deep breathing; correct use will not help evaluate asthmatic control. B. Current pulse oximetry will only provide a measure of current oxygenation and will not indicate long-term efficacy of the treatment plan. A. ABGs may be helpful in severe cases but are invasive and not routine and will only give a current measurement.

6.The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease. Which of the following interventions require extra care by the nurse? 1. Administering pain medications 2. Applying a cardiac monitor 3. Encouraging fluids 4. Teaching the client diaphragmatic breathing

ANS: 1 Administering pain medications (narcotics) requires extra care by the nurse because these medications can depress respiratory status and worsen hypercapnia. Increasing fluids helps thin the clients secretions and is encouraged. Applying a cardiac monitor and monitoring the rhythm is part of a normal assessment. Teaching diaphragmatic breathing does not require extra care.

8.The nurse is assessing a client diagnosed with emphysema. Which of the following will most likely be assessed during the clients physical examination? 1. Barrel chest 2. Pectus carinatum 3. Pectus excavatum 4. Scoliosis

ANS: 1 Barrel chest is often seen in chronic emphysema as a result of long-term air trapping. Pectus carinatum is an abnormal protuberance of the sternum, and pectus excavatum is an abnormal depression of the sternum. PTS:1DIF:ApplyREF:Skeletal Deformities

11.A client is demonstrating a crescendo-decrescendo pattern of breathing with periods of apnea. The nurse would document this breathing pattern as being: 1. Cheyne-Stokes. 2. apnea. 3. bradypnea. 4. Kussmaul.

ANS: 1 Cheyne-Stokes breathing is a pattern of crescendo-decrescendo breathing. Apnea is the absence of breathing. Bradypnea is a breathing rate of less than 12 respirations per minute. Kussmaul breathing is rapid and deep and often associated with diabetic ketoacidosis. PTS: 1 DIF: Apply REF: Figure 30-14 Rhythms of Breathing

5.A client is demonstrating signs of respiratory alkalosis. The nurse realizes that this alteration is least likely caused by which of the following? 1. Diarrhea 2. Fever 3. Pain 4. Severe anemia

ANS: 1 Diarrhea is a cause of metabolic acidosis. Causes of the respiratory alkalosis are hypoxia, increased minute ventilation, hyperventilation, pregnancy, fever, pain, and severe anemia. PTS: 1 DIF: Analyze REF: Table 30-1 Causes of Acid-Base Imbalances

3.A client is being treated for exacerbation of chronic obstructive pulmonary disease. Which of the following nursing interventions will the nurse expect to be completed? 1. Initiate oxygen at 1 L/min via nasal cannula. 2. Limit fluids. 3. Place on respiratory isolation. 4. Schedule all activities at one time.

ANS: 1 Oxygen for a client diagnosed with COPD should be low flow so as not to diminish the clients drive to breath. Fluids are encouraged, and activities should be interspersed with rest periods so the client will not become overtired. Isolation is not necessary at this time. PTS:1DIF:Apply

14.A client is experiencing a sudden onset of headache, nausea, cough, fever, myalgia, and fatigue. The nurse suspects this client is experiencing: 1. seasonal influenza. 2. chronic obstructive pulmonary disease. 3. asthma. 4. cystic fibrosis.

ANS: 1 Seasonal influenza has a sudden onset with a headache, nausea, cough, chills, fever, rhinitis, myalgia, and extreme fatigue. These symptoms are not seen in chronic obstructive pulmonary disease, asthma, or cystic fibrosis.

9.A client diagnosed with a hemothorax has had a chest tube inserted and attached to a portable water-seal drainage system. Which of the following interventions would be inappropriate for this client? 1. Clamp the tubing when ambulating. 2. Date and mark the amount of drainage in the collection chamber every shift. 3. Monitor the suction chamber for continuous bubbling. 4. Watch the water-seal chamber for fluctuation.

ANS: 1 The chest tube should not be clamped or raised above the chest when ambulating. All other options are appropriate. PTS: 1 DIF: Apply REF: Pneumothorax: Planning and Implementation

11.The nurse is assessing a client diagnosed with asthma. The clients breath sounds initially had wheezing but are diminishing until no audible sounds are heard. This has occurred because: 1. swelling has increased, and it has blocked airways. 2. the attack has passed. 3. the client used an inhaler. 4. no mucus is present.

ANS: 1 This client needs to be evaluated immediately and receive prompt treatment to reduce the airway obstruction and reverse inflammation. Lack of audible breath sounds does not mean that the attack has passed, the client has used an inhaler, or there is no mucus present.

5.The nurse is instructing a client on ways to reduce the transmission of tuberculosis. Which of the following should be included in these instructions? 1. The disease is transmitted by inhaling droplets exhaled by an infected person. 2. The disease is transmitted by not fully cooking foods. 3. The disease is transmitted by not washing hands. 4. The disease is transmitted by sexual contact.

ANS: 1 Tuberculosis is transmitted by inhaling the bacillus present in the air. The bacillus is present in the air after an infected person has coughed, sneezed, or expectorated.Tuberculosis is not transmitted through poorly cooked foods, poor handwashing, or sexual contact. PTS: 1 DIF: Apply REF: Tuberculosis: Patient and Family Teaching

4.A client diagnosed with chronic obstructive pulmonary disease is scheduled for diagnostic tests. Which of the following are used to aid in the diagnosis of this disorder? (Select all that apply.) 1. Pulmonary function spirometry tests 2. Chest x-ray 3. Electrocardiogram 4. Medication levels 5. Sputum samples 6. Electrolyte levels

ANS: 1, 2, 3, 4 Tests used to aid in the diagnosis of chronic obstructive pulmonary disease include pulmonary function spirometry tests, chest x-ray, electrocardiogram, and medication levels. Sputum samples are not useful and are not recommended in the diagnosis of chronic obstructive pulmonary disease. Electrolyte levels are not indicated.

1.The nurse is caring for a client diagnosed with pneumonia. Which of the following signs and symptoms would the nurse most likely assess in this client? (Select all that apply.) 1. Abdominal pain 2. Anorexia 3. Cough 4. Dyspnea 5. Fever 6. Frequent wiping of the nose

ANS: 1, 2, 3, 4, 5 Specific symptoms suggestive of pneumonia include fever, chills or rigor, sweats, new cough (with or without sputum), pleuritic chest pain, and dyspnea. Nonspecific symptoms include malaise, fatigue, abdominal pain, headaches, anorexia, and worsening of an underlying illness. Frequent wiping of the nose is a sign of allergic rhinitis.

5.Which of these instructions are for a client diagnosed with a pneumothorax? (Select all that apply.) 1. Remove air from the pleural space. 2. Correct acid-base imbalances. 3. Treat infection. 4. Minimize damage. 5. Reexpand the lung. 6. Improve fluid balance.

ANS: 1, 2, 4, 5 Treatment goals for pneumothorax include removing the air and fluid from the pleural space, correcting acid-base imbalance, minimizing further damage, and reexpanding the lung. Treating infection and improving fluid balance are not treatment goals for a pneumothorax. PTS: 1 DIF: Apply REF: Pneumothorax: Planning and Implementation

3.The nurse is assessing the thorax of an elderly client. Which of the following would be considered normal age-related changes in this clients respiratory system? (Select all that apply.) 1. Hyperresonance 2. Pain with inspiration 3. Vital capacity reduced 4. Hemoptysis 5. Productive cough 6. Wheezes

ANS: 1, 3 Normal age-related changes seen in the elderly include hyperresonance with palpation and a reduction in the vital capacity. Pain with inspiration, hemoptysis, productive cough, and wheezes are not normal age-related changes of the respiratory system. PTS: 1 DIF: Analyze REF: Age-Related Changes in the Respiratory System

4.A client is scheduled for a ventilation-perfusion scan. The nurse realizes that this diagnostic test is used to diagnose which of the following? (Select all that apply.) 1. Pulmonary emboli 2. Congestive heart failure 3. Bronchitis 4. Asthma 5. Pneumonia 6. COPD

ANS: 1, 3, 4, 5, 6 The purpose of the ventilation-perfusion scan is to diagnose and locate pulmonary emboli. It is also helpful in diagnosing bronchitis, asthma, pneumonia, COPD, and cancer. This scan is not used to diagnose congestive heart failure. PTS: 1 DIF: Analyze REF: Ventilation-Perfusion Scan

2.The nurse is documenting that a client has adventitious breath sounds. Which of the following would be considered this type of sound? (Select all that apply.) 1. Rales 2. Vesicular 3. Rhonchi 4. Wheeze 5. Bronchovesicular 6. Pleural friction rub

ANS: 1, 3, 4, 6 Adventitious breath sounds include rales, rhonchi, wheezes, and pleural friction rubs. Vesicular and bronchovesicular are considered normal breath sounds. PTS: 1 DIF: Analyze REF: Table 30-5 Adventitious Breath Sounds

2.The nurse is planning to administer the pneumococcus vaccination to a client. Which of the following would indicate that a client is a candidate for this vaccination? (Select all that apply.) 1. Age 70 2. Age 55 3. Diagnosis of heart failure 4. Recovering from knee replacement surgery 5. Diagnosis of asthma 6. Recovering from an appendectomy

ANS: 1, 3, 5 Criteria for the pneumococcus vaccination include high-risk groups such as people over age 65, diagnosed with chronic heart disease, and diagnosed with asthma. Age 55, recovering from knee replacement surgery; and recovering from an appendectomy are not criteria for the pneumococcus vaccination.

1.The nurse is caring for a client diagnosed with cystic fibrosis. Which of the following medications does the nurse realize are commonly used to help treat this disorder? (Select all that apply.) 1. N-acetylcysteine (Mucomyst) 2. Acetaminophen (Tylenol) 3. Dornase alfa (Pulmozyme) 4. Furosemide (Lasix) 5. Ibuprofen (Motrin) 6. Digitalis (Digoxin)

ANS: 1, 3, 5 Medications commonly used to treat cystic fibrosis include N-acetylcysteine (Mucomyst), Dornase alfa (Pulmozyme), and Ibuprofen (Motrin). Acetaminophen, furosemide, and digitalis are not routinely prescribed in the treatment of cystic fibrosis

5.A client is prescribed a bedside diagnostic test to assess pulmonary status. The nurse will prepare to administer which of the following to the client? (Select all that apply.) 1. Capnography 2. Thoracentesis 3. Oximetry 4. Bronchoscopy 5. Polysomnography 6. Lung biopsy

ANS: 1, 3, 5 The three diagnostic tests that can be administered at the bedside include capnography, which measures exhaled carbon dioxide; oximetry, which measures oxygenation; and polysomnography, which measures breathing while asleep. Thoracentesis, bronchoscopy, and lung biopsy are all invasive procedures and cannot be administered at the bedside. PTS: 1 DIF: Apply REF: Bedside Monitoring Diagnostic Tests

1.The nurse is assessing a client for decreased fremitus. Which of the following conditions are associated with decreased fremitus? (Select all that apply.) 1. Atelectasis 2. Emphysema 3. Pneumonia 4. Pneumothorax 5. Pulmonary fibrosis 6. Pulmonary infarction

ANS: 1, 3, 5, 6 Atelectasis, pneumonia, pulmonary fibrosis, and pulmonary infarction cause decreased fremitus. Pneumothorax and emphysema would cause increased fremitus. PTS: 1 DIF: Analyze REF: Fremitus

4.The nurse, planning care for a client diagnosed with a pneumothorax, identifies which types of pneumothorax? (Select all that apply.) 1. Spontaneous 2. Radical 3. Traumatic 4. Incomplete 5. Iatrogenic 6. Tension

ANS: 1, 3, 5, 6 The four types of pneumothorax are spontaneous, traumatic, iatrogenic, and tension. Radical and incomplete are not types of pneumothorax. PTS: 1 DIF: Analyze REF: Pneumothorax: Etiology

3.The nurse is planning care for a client diagnosed with bronchiolectasis. Which of the following would be goals for this clients care? (Select all that apply.) 1. Treat the infection. 2. Reduce the heart rate. 3. Minimize further damage. 4. Improve urine output. 5. Promote breathing. 6. Remove secretions.

ANS: 1, 3, 5, 6 Treatment goals for the client diagnosed with bronchiolectasis include treat the infection, minimize further damage, promote effective airway breathing, and remove secretions. Treatment goals do not include reducing heart rate and improving urine output. PTS: 1 DIF: Apply REF: Bronchiolectasis: Planning and Implementation

4.A client with a nasogastric tube connected to low continuous suction has the following arterial blood gas (ABG) results: pH 7.49, PaO2 91, PaCO2 42, and HCO3 31. Interpreting these result, the nurse concludes that the client is in: 1. metabolic acidosis. 2. metabolic alkalosis. 3. respiratory acidosis. 4. respiratory alkalosis.

ANS: 2 Because the pH is greater than 7.45, this is not an acidosis. The PaCO2 is within normal limits. The HCO3 is elevated. An elevated pH and HCO3 indicates metabolic alkalosis. PTS: 1 DIF: Analyze REF: Arterial Blood Gas Analysis

12.The nurse, assessing a clients breath sounds, has the stethoscope placed over the second intercostal space next to the sternum. The sound the nurse is most likely going to hear would be: 1. vesicular. 2. bronchovesicular. 3. bronchial. 4. absent.

ANS: 2 Bronchovesicular breath sounds are loud and harsh and are most likely heard over the trachea. Vesicular breath sounds can be heard anywhere over the lung fields. Bronchial sounds are only normally heard over the trachea. They are loud and harsh in quality, high-pitched, and sound hollow. Absent breath sounds can also be heard throughout the lung fields. PTS: 1 DIF: Analyze REF: Table 30-4 Normal Breath Sounds

13.The nurse is to collect a stool specimen from a client diagnosed with cystic fibrosis. The nurse would expect to see: 1. black, tarry stool. 2. bulky, foul-smelling stool. 3. clay-colored stool. 4. green stool.

ANS: 2 Bulky, foul-smelling stool is characteristic of clients diagnosed with cystic fibrosis as a result of malabsorption. Black, tarry stool can be observed in a client with upper gastrointestinal bleeding. Clay-colored stool can indicate bile obstruction. Green stool may indicate gastrointestinal infection.

8.A client diagnosed with a lung abscess is being prescribed antibiotic therapy. Which of the following medications would be indicated if this client has a history of penicillin allergy? 1. Metronidazole 2. Clindamycin 3. Ampicillin 4. Steroid

ANS: 2 Clients allergic to penicillin are often given clindamycin since this medication is not part of the penicillin family. Metronidazole and ampicillin should not be administered to this client. Steroid is not an antibiotic. PTS: 1 DIF: Analyze REF: Lung Abscess: Pharmacology

9.The nurse is assessing an adult patient experiencing hypoxia. Which of the following findings would be considered a late sign of hypoxia? 1. Confusion 2. Cyanosis 3. Drowsiness 4. Headache

ANS: 2 Cyanosis is a late sign of hypoxia. Confusion, drowsiness, and headache are early signs. PTS: 1 DIF: Analyze REF: Signs of Respiratory Distress

10.A clients chest tube has been accidentally dislodged while the client was being transferred from the bed to a stretcher. Which of the following should the nurse do to help this client? 1. Cover the site with occlusive petroleum jelly gauze and tape to four sides. 2. Cover the site with occlusive petroleum jelly gauze and tape to three sides. 3. Cover the site with occlusive petroleum jelly gauze and tape to two sides. 4. Cover the site with occlusive petroleum jelly gauze and tape to one side.

ANS: 2 In the case of accidental dislodging of the chest tube, the site should be covered with occlusive petroleum jelly gauze and taped on three sides to prevent the development of a tension pneumothorax. If the gauze is taped on all four sides, the client can develop a tension pneumothorax. Taping the gauze on one or two sides will not be effective to support this client and should not be done. PTS: 1 DIF: Apply REF: Red Flag: Ensuring Chest Tube Connections

11.A client is diagnosed with fractured ribs. Which of the following should the nurse instruct this client? 1. Engage in routine activities of daily living after taking pain medication. 2. Splint the rib cage when deep breathing and coughing. 3. Restrict fluids. 4. Stay on bed rest until the ribs heal.

ANS: 2 Nursing care for a client recovering from fractured ribs include splinting the rib cage when deep breathing and coughing. The client should be encouraged to avoid dangerous activities when taking pain medication. Fluids should not be restricted. Bed rest would not be necessary for fractured ribs. PTS:1DIF:Apply

2.A client diagnosed with chronic obstructive pulmonary disease is experiencing pneumonia. The nurse applies oxygen at 2 L/min via nasal cannula. When the nurse leaves the room, a family member increases the oxygen to 5 L. Which complication may occur? 1. Angina 2. Apnea 3. Metabolic acidosis 4. Respiratory alkalosis

ANS: 2 The COPD clients drive to breathe is hypoxia. Increasing the oxygen removes this drive and leads to apnea. Angina occurs because of decreased oxygen to the myocardial tissues. Neither respiratory alkalosis nor metabolic acidosis would occur with the increased oxygen level. PTS: 1 DIF: Analyze REF: Safety First: Oxygen Therapy

6.A client has a productive cough that produces green sputum with a musty odor. The nurse realizes that the client may be experiencing: 1. emphysema. 2. pneumococcal pneumonia. 3. Pseudomonas infection. 4. pulmonary edema.

ANS: 3 A client with a Pseudomonas infection can have a cough that produces green sputum with a musty odor. The sputum from emphysema is gray-white and mucoid. The sputum from pneumococcal pneumonia and pulmonary edema are rust colored and pink, frothy, respectively. PTS: 1 DIF: Analyze REF: Table 30-2 Sputum in Pulmonary Conditions

4.A client undergoes a purified protein derivative (PPD) test. The test should be read: 1. immediately after the test. 2. 24 to 48 hours after the test. 3. 48 to 72 hours after the test. 4. anytime after 72 hours

ANS: 3 A small amount of tuberculin is injected directly under the skin at the site and is read 48 to 72 hours after the test. The test should not be read immediately afterwards or within 24 to 48 hours. If the test is read after 72 hours, the test may need to be repeated. PTS: 1 DIF: Apply REF: Tuberculosis: Diagnostic Tests

4.A client has been diagnosed with chronic obstructive pulmonary disease. Which of the following nursing diagnoses would be the most important at this time? 1. Activity intolerance 2. Anxiety 3. Impaired gas exchange 4. Nutrition, imbalance

ANS: 3 Airway and breathing are always a top priority for a client. Once gas exchange is ensured for the client, the other diagnoses of activity intolerance and nutrition imbalance can be addressed. Anxiety would be addressed last for this client. PTS:1DIF:Apply

12.The parents of a child diagnosed with cystic fibrosis ask the nurse how their child developed the disease. Which of the following should the nurse explain to these parents? 1. Cystic fibrosis is a disease that has an extra chromosome. 2. Cystic fibrosis is an X-linked disorder. 3. Cystic fibrosis is passed on by a defective gene from both parents. 4. Cystic fibrosis is passed on by one defective gene from one parent.

ANS: 3 Cystic fibrosis is an inherited, autosomal recessive disease that is passed on by a defective gene from both parents and not one parent. This disease does not occur because of an extra chromosome. This disease is not an X-linked disorder. Cystic fibrosis is a chronic, progressive, and frequently fatal disease of the bodys exocrine mucus-producing glands that primarily affects the respiratory, digestive, intestinal systems, and the pancreas.

12.A client is prescribed a diuretic for treatment of pulmonary hypertension. Which of the following should the nurse instruct the client regarding this medication? 1. This medication expands the blood vessels. 2. This medication causes smooth muscle relaxation to reduce pulmonary engorgement. 3. This medication reduces the amount of water in the body. 4. This medication keeps the blood from clotting.

ANS: 3 Diuretics in the treatment of pulmonary hypertension are used to reduce the amount of water in the body. Vasodilators expand the blood vessels. Sildenafil causes smooth muscle relaxation to reduce pulmonary engorgement. Anticoagulants keep the blood from clotting.

1.The nurse is reviewing clients for risk factors in the development of pneumonia. Which of the following clients would be at the highest risk for developing this disorder? 1. A 48-year-old client experiencing menopause 2. An 18-year-old client with abdominal pain 3. A 23-year-old client diagnosed with sickle-cell anemia and a cough 4. A 3-year-old client with fever

ANS: 3 High-risk groups for acquiring pneumonia are people with diabetes, infants 6- to 23-months old, and those with a chronic illness such as sickle-cell anemia. Menopause and abdominal pain are not symptoms associated with pneumonia. Fever in a 3-year-old client could be caused by many disorders and not necessarily pneumonia. PTS:1DIF:Analyze REF: Box 32-1 High-Risk Indicators for Acquiring Pneumonia

3.The nurse has a positive PPD during the last testing cycle for tuberculosis. Which of the following is indicated for this nurse? 1. Nothing 2. Chest x-rays every 2 months 3. Pharmacological treatment 4. Admission for inpatient treatment

ANS: 3 Latent tuberculosis infection occurs when a person exposed to the mycobacterium has a positive PPD test. This person is without an active clinical picture and has a 10% chance of developing TB if preventive pharmacological treatment is not initiated. The nurse needs pharmacological treatment. Doing nothing could result in active disease. The nurse does not need chest x-rays every 2 months or admission for inpatient treatment. PTS: 1 DIF: Apply REF: Tuberculosis: Pathophysiology

13.The nurse is assessing a client experiencing manifestations of cor pulmonale. Which of the following will the nurse most likely assess in this client? 1. Low blood pressure 2. Low heart rate 3. Hoarseness 4. Lumbar pain

ANS: 3 Manifestations of cor pulmonale include hoarseness, chest pain, distended neck veins, liver enlargement, peripheral edema, abnormal heart sounds. Low blood pressure, low heart rate, and lumbar pain are not manifestations of cor pulmonale.

8.A client is being admitted with the diagnosis of asthma. To facilitate breathing, in what position would the nurse place the client? 1. Lateral 2. Prone 3. High-Fowlers 4. Supine

ANS: 3 Only the high-Fowlers position facilitates breathing. The other positions could make breathing more difficult.

9.A client diagnosed with asthma is having an acute episode at home. Which of the following medications should the client be instructed not to use during this episode? 1. Albuterol 2. Proventil 3. Serevent 4. Ventolin

ANS: 3 Serevent is a long-acting agent and is not to be used as rescue medication during acute episodes. Albuterol (also sold under the brand names Proventil and Ventolin) is a short-acting agent used as a rescue medication.

2.A client has been smoking for the last 40 years and has a history of emphysema. Which of the following findings would the nurse not expect to find? 1. Decreased forced vital capacity (FVC) 2. Increased anterior-posterior chest diameter 3. Increased forced expiratory volume (FEV1) 4. Pursed lip breathing

ANS: 3 The FEV1 does not increase; it decreases. The FVC does decrease, and the client can exhibit increased anterior-posterior chest diameter and pursed lip breathing. PTS:1DIF:Apply

5.The nurse is caring for a client who has completed pulmonary function testing. Which of the following indicates the amount of air inhaled or exhaled with each breath during normal breathing? 1. Expiratory reserve volume 2. Minute volume 3. Tidal volume 4. Vital capacity

ANS: 3 Tidal volume is the amount of air inhaled or exhaled with each breath during normal breathing. The expiratory reserve volume is the maximum amount of air exhaled forcefully after a normal exhalation. Minute volume is the amount of air breathed per minute. Vital capacity is the maximum amount of air exhaled after maximum inspiration.

3.A client is diagnosed with stage I mild, chronic obstructive pulmonary disease. Which of the following assessment findings will support this diagnosis? (Select all that apply.) 1. Chronic cough 2. Sputum production 3. Forced expiratory volume in 1 second of greater than 80% 4. Mild airflow limitations 5. Extreme dyspnea on exertion 6. Right-sided heart failure

ANS: 3, 4 In stage I mild chronic obstructive pulmonary disease, the client will demonstrate mild airflow limitations and have a forced expiratory volume in 1 second of greater than 80%. Chronic cough and sputum production are signs of stage 0 of the disease. Extreme dyspnea on exertion and right-sided heart failure are indications of stage III severe chronic obstructive pulmonary disease.

7.A client is experiencing a gradual increase of pleuritic pain. In which of the following pulmonary conditions would the nurse expect to see this type of pain? 1. Pneumococcal pneumonia 2. Pneumothorax 3. Pulmonary embolism 4. Tuberculosis

ANS: 4 A more gradual onset of pleuritic pain is seen in tuberculosis and malignancy. Acute pleuritic pain is associated with pneumococcal pneumonia, pneumothorax, and pulmonary embolism. PTS: 1 DIF: Analyze REF: Assessment: History Taking

7.A client diagnosed with chronic obstructive pulmonary disease has the complication of cor pulmonale. Which of the following instructions will be included in the clients discharge teaching? 1. Adjust oxygen higher depending on activity level. 2. Increase sodium in the diet. 3. Maintain bed rest. 4. Weigh self daily, and call the physician with a weight gain of 2 pounds

ANS: 4 A weight gain of greater than 2 pounds would indicate fluid retention and need to be reported to the physician. Oxygen would not be increased past the prescribed level because this may eliminate the clients drive to breathe. Increasing sodium will encourage fluid retention. Moderate activity is desired to maintain a level of cardiovascular health.

10.A client is diagnosed with a large pneumothorax. The percussion note the nurse would expect to find is: 1. dullness. 2. flatness. 3. resonant. 4. tympany.

ANS: 4 Air-filled areas have a percussion note of tympany. A resonant note can be elicited by percussing a patient with normal lungs. Flatness is heard over bone and dullness is heard over the organs. PTS:1DIF:Apply REF: Table 30-3 Percussion Notes and Associated Conditions

10.A client diagnosed with asthma is receiving instructions about the use of albuterol. The client should be aware that albuterol may cause: 1. bradycardia. 2. drowsiness. 3. nasal congestion. 4. nervousness.

ANS: 4 Albuterol causes nervousness, tachycardia, insomnia, dizziness, tremors, hypertension, headache, and irritation to the nasal and throat passages. Albuterol does not cause bradycardia, drowsiness, or nasal congestion.

2.A client has a slight shift to the left on the oxygen-hemoglobin dissociation curve. Which of the following assessment findings will support this curve configuration? 1. Arterial pH less than 7.35 2. Increased levels of 2,3-diphosphoglycerate 3. Hyperthermia 4. Hypothermia

ANS: 4 Factors that cause increased affinity of oxygen for hemoglobin will shift the oxyhemoglobin dissociation curve to the left. These factors include alkalemia and hypothermia. Arterial pH less than 7.35, increased leaves of 2,3-diphosphoglycerate, and hyperthermia indicate a shift to the right, not the left. PTS: 1 DIF: Analyze REF: Oxygen-Hemoglobin Dissociation Curve

7.The spouse of a client diagnosed with tuberculosis is to begin isoniazid prophylactic therapy. Which of the following should the nurse instruct the spouse regarding length of time to take this medication? The medication should be taken for: 1. 10 to 24 days. 2. 1 to 3 months. 3. 4 to 7 months. 4. 6 to 12 months.

ANS: 4 Isoniazid therapy lasts 6 to 12 months. Taking the medication less than 6 months can be ineffective. The spouse should not be instructed to take the medication for 10 to 24 hours, 1 to 3 months, or 4 to 7 months. PTS:1DIF:Apply

13.A client is determined to be a candidate for a low-flow oxygen delivery system. Which of the following will the nurse most likely assess in this client? 1. Active bleeding 2. Change in level of consciousness 3. Cardiac arrhythmias 4. Respiratory rate of 16, unlabored breathing

ANS: 4 Low-flow oxygen systems are used for clients who are clinically stable and have a normal ventilatory pattern such as the client with a respiratory rate of 16 and unlabored breathing. A high-flow oxygen system would be indicated for a client who is not clinically stable such as bleeding, change in level of consciousness, or who is experiencing cardiac arrhythmias. PTS: 1 DIF: Apply REF: Oxygen Delivery Systems MULTIPLE RESPONSE

1.A client is experiencing the ventilation-perfusion mismatch termed shunting. The nurse realizes that the client most likely is not experiencing which of the following disorders? 1. Hemothorax 2. Intrapulmonary fistulas 3. Pneumothorax 4. Pulmonary embolus

ANS: 4 Shunting is the portion of the cardiac output that does not exchange with alveolar air. Examples of shunting include hemothorax, pneumothorax, and intrapulmonary fistulas. Pulmonary embolus is the other type of ventilation-perfusion mismatch called dead space. PTS: 1 DIF: Analyze REF: Ventilation-Perfusion Dysfunction

6.A client receiving oral medications for the treatment of tuberculosis develops hepatitis. Which of the following medications would be indicated for the client at this time? 1. Ethambutol 2. Isoniazid 3. Rifampin 4. Streptomycin

ANS: 4 Streptomycin is a medication that can be used until the cause of hepatitis is identified or the liver tissue heals. It is also given for those who have a first-line drug intolerance. First-line drugs are isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA). PTS: 1 DIF: Apply REF: Tuberculosis: Pharmacology

1.A client states, I dont know why I should quit smoking. It cant improve anything. The nurse responds by informing the client about the decrease in lung cancer rates over time after a person quits smoking. Which of the following is correct? 1. The lung cancer rate corresponds to that of nonsmokers 1 year after quitting smoking. 2. The lung cancer rate corresponds to that of nonsmokers 2 years after quitting smoking. 3. The lung cancer rate corresponds to that of nonsmokers 5 years after quitting smoking. 4. The lung cancer rate corresponds to that of nonsmokers 10 years after quitting smoking.

ANS: 4 Ten years after quitting smoking, the clients lung cancer rate will correspond to a nonsmokers rate. After 1 year of no smoking, the risk of coronary heart disease decreases to half that of a smoker. After 2 years of no smoking, the risk of coronary heart disease equals that of a nonsmoker. After 5 years of no smoking, the lung cancer rate drops by half. PTS:1DIF:Apply

3.A client, experiencing an acid-base imbalance, demonstrates signs of full compensation within 3 days. The nurse realizes that the full compensation was accomplished by which of the following systems? 1. Extracellular buffer 2. Intracellular buffer 3. Pulmonary 4. Renal

ANS: 4 The extracellular and intracellular buffer systems act immediately, the pulmonary system acts within 2 to 3 hours, and the renal system responds within 2 to 3 days. PTS: 1 DIF: Analyze REF: Compensatory Mechanisms

2.The nurse suspects a client is experiencing chronic obstructive pulmonary disease when which of the following is assessed? (Select all that apply.) 1. Peripheral edema 2. Jugular vein distention 3. High blood pressure 4. Dyspnea on exertion 5. Sputum production 6. Cough

ANS: 4, 5, 6 Chronic obstructive pulmonary disease is characterized by a history of three primary symptoms: 1) cough, 2) sputum production, and 3) dyspnea on exertion. Peripheral edema, jugular vein distention, and high blood pressure are not symptoms of chronic obstructive pulmonary disease.

12. An adult patient is admitted for an asthma attack. Which assessment obtained by the nurse would support that albuterol (Proventil) was effective? a. Decrease in wheezing present on auscultation b. Less dyspnea while positioned in a high Fowlers position c. Sputum production is clear and watery d. Respiratory rate decreased to 38 breaths/min

ANS: A A bronchodilator would open the airways and result in a reduction of wheezing. Less dyspnea while positioned in a high Fowlers position, clear and watery sputum, and a respiratory rate decreased to 38 breaths/min would not indicate that the medication was effective.

9. From where do the fluids of the respiratory tract originate? a. Specialized mucous glands called goblet cells b. Lymph fluid drawn across nasal membranes by osmosis c. Specialized beta cells in the islets of Langerhans d. Cells that produce aqueous humor

ANS: A The fluids of the respiratory tract originate from specialized mucous glands (goblet cells) and serous glands that line the respiratory tract. The goblet cells produce gelatinous mucus that forms a thin layer over the interior surfaces of the trachea, bronchi, and bronchioles. Lymph does not make up fluid in the respiratory tract. The beta cells in the islets of Langerhans are located in the pancreas. Cells that produce aqueous humor are located in the interior of the eye.

8. What is albuterol (Proventil) used to treat? a. Acute bronchospasm b. Acute allergies c. Nasal congestion d. Dyspnea on exertion

ANS: A The short-acting beta agonists have a rapid onset (few minutes) and are used to treat acute bronchospasm. Beta agonists are not used to treat allergies. Decongestants are used for nasal congestion. Long-acting beta agonists are used for exertional dyspnea.

21. The nurse is completing the admission of an older adult patient with a history of COPD whose diagnosis is pneumonia. Which assessments would be most important to include in obtaining the history? (Select all that apply.) a. Smoking history and exposure to second hand smoke b. Current medications c. Chief complaint and onset of symptoms d. Support system e. Home oxygen use f. Liver function

ANS: A, B, C, D, E It is important to assess present and past respiratory history (including smoking history and exposure to second hand smoke), obtain thorough medication history, ascertain the chief complaint and current pulmonary symptoms (including cough and sputum color), determine the patients support system, and ask about any home treatments when obtaining information from a patient with acute and chronic lung disease. Liver function testing is not necessary for the assessment of this patient.

22. Which physical assessment(s) would be pertinent to the patient with asthma? (Select all that apply.) a. Lung sounds b. Patient color c. Respiratory rate and effort d. Peak expiratory flow e. Pulse oximetry reading f. Bowel sounds

ANS: A, B, C, D, E Lung sounds, pallor and color, respiratory rate and effort, peak expiratory flow, and pulse oximetry should be assessed in the patient with asthma. Assessment of bowel sounds is not pertinent.

20. What is true about arterial blood gases (ABGs)? (Select all that apply.) a. They are measured from an arterial sample. b. They measure partial pressures of carbon dioxide. c. They measure blood pH. d. They measure partial pressures of sodium e. They measure partial pressures of oxygen.

ANS: A, B, C, E ABGs are taken from samples from arterial blood, which must be drawn and analyzed immediately. ABGs measure partial pressures of carbon dioxide and bicarbonate, pH, and partial pressures of oxygen. ABGs do not measure partial pressures of sodium.

24. Which statement(s) about acetylcysteine is/are true? (Select all that apply.) a. It reduces viscosity of secretions. b. It treats acetaminophen toxicity. c. It is stored at room temperature. d. It is given to improve airway flow. e. It is odorless. f. It is administered by inhalation.

ANS: A, B, D, F Acetylcysteine is given to reduce the viscosity of secretions, used to treat acetaminophen toxicity, used to improve airway flow, and is a mucolytic given by inhalation. Acetylcysteine should be refrigerated after opening and has an odor similar to that of rotten eggs.

23. Which principle(s) would be when teaching a patient to use a steroid inhaler? (Select all that apply.) a. Frequent oral hygiene is necessary. b. The inhaler should be used on a PRN basis only. c. Rinse and spit after inhalation of the medication. d. When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first. e. Hold the breath for 10 seconds during inhalation of the medication.

ANS: A, C, D, E Steroid medications may predispose patients to secondary fungal infections in the mouth. To prevent this, patients should be instructed on good oral hygiene technique and told to gargle and rinse the mouth with a hydrogen peroxide mouthwash after each aerosol treatment. In addition to good oral hygiene, patients should rinse and spit after inhalation of the medication. When a bronchodilator and steroid are prescribed, the bronchodilator should be administered as the first puff of medication and, after waiting a few minutes, the steroid medication should be administered. This procedure facilitates bronchodilation so that the second medication will have a better chance of reaching lower parts of the lungs. Patients should hold their breath for 10 seconds during inhalation of the medication so that the medication is fully inhaled. Steroid inhalers should be used on a regular basis to prevent symptoms.

25. Which statement(s) about ipratropium bromide (Atrovent) is/are true? (Select all that apply.) a. It is administered by aerosol inhalation. b. It relieves nasal congestion. c. It decreases mucus secretion. d. It has minimal effect on ciliary activity. e. It is used for short term treatment of bronchospasm. f. It may cause tachycardia or urinary retention.

ANS: A, D, F Ipratropium bromide is administered by aerosol inhalation, has minimal effect on ciliary activity, and may cause tachycardia, urinary retention, or exacerbation of pulmonary symptoms. Ipratropium bromide does not relieve nasal congestion; has minimal effect on mucous secretion, sputum volume, and viscosity; and is used as a bronchodilator for long term treatment of reversible bronchospasm associated with COPD.

. A patient has questions regarding a recently prescribed antitussive agent. Which response by the nurse is the best? a. It will eliminate your cough at night. b. It will reduce the frequency of your cough. c. It should be used in the morning. d. It should be taken before sleep.

ANS: B Antitussive agents act by suppressing the cough center in the brain. The expected therapeutic outcome is reduced frequency of nonproductive cough to promote rest. Antitussive agents should be taken as prescribed by the health care provider. Antitussives are not likely to eliminate a cough. Antitussives should be taken throughout the day.

14. The nurse is providing nutrition information to a patient diagnosed with a lower respiratory tract disease. What is the rationale for limiting caffeine? a. Caffeine increases the respiratory rate. b. Caffeine can result in thicker lung secretions. c. Caffeine will increase the anxiety response associated with dyspnea. d. Caffeine can cause bronchospasm.

ANS: B Avoid caffeine containing beverages because caffeine is a weak diuretic. Diuresis promotes thickening of lung secretions, making it more difficult to expectorate them

11. The nurse is providing instruction about ipratropium (Atrovent) to a patient with chronic obstructive pulmonary disease (COPD). Which is a common adverse effect that tends to resolve with therapy? a. Anxiety b. Dry mouth c. Tachycardia d. Urine retention

ANS: B Dry mouth is usually mild and tends to resolve with continued therapy. Anxiety, tachycardia, and urine retention are not common adverse effects.

7. What is the action of zafirlukast (Accolate), a leukotriene receptor antagonist? a. Dilates the alveolar sacs b. Decreases leukotriene release c. Inhibits histamine release d. Increases viscosity of secretions

ANS: B Leukotrienes are a class of anti inflammatory agents that block leukotriene formation, and they are part of the inflammatory pathway that causes bronchoconstriction. Leukotrienes work to reduce bronchoconstriction, and they do not inhibit histamine release or affect viscosity of secretions.

13. A child has been diagnosed with asthma and the nurse is providing education to the family. Which statement by the mother indicates a need for further teaching? a. I will place the stuffed animals in the freezer overnight. b. We will confine our dog to the kitchen area. c. I should wash bedding in hot water. d. A damp cloth should be used when I dust.

ANS: B Pets should be removed from the home or kept outside if at all possible.

3. What is the reason for administering potassium iodide to a patient with emphysema? a. To increase blood iodide levels b. To decrease mucus viscosity c. To reduce metabolic needs of the body d. To decrease bronchial irritation

ANS: B Potassium iodide acts as an expectorant by stimulating the bronchial glands to secrete. This will decrease the viscosity of mucous plugs, which makes it easier for patients to cough up the dry hardened plugs blocking the bronchial tubes. Potassium iodide is not given to increase serum potassium iodide levels. Potassium does not reduce metabolic needs of the body or bronchial irritation.

16. The health care provider in an outpatient clinic has prescribed omalizumab (Xolair) to a patient. Which primary outcome will the nurse teach the patient to expect? a. Easier expectoration of phlegm b. Less frequent asthma exacerbations c. Increased moisture of the mucous membranes d. Liquefaction of thick secretions

ANS: B The primary therapeutic outcome associated with omalizumab therapy is reduced frequency of acute asthmatic exacerbations. Easier expectoration of phlegm, increased moisture of the mucous membranes, and liquefaction of thick secretions are not outcomes of omalizumab.

19. Which statement(s) is/are true regarding the nursing assessment of a patient with a respiratory disorder? (Select all that apply.) a. Central cyanosis typically is observed on the fingers and earlobes. b. Clubbing of the fingernails is a sign of hypoxia. c. As oxygen levels diminish, mental alertness will progressively deteriorate. d. The normal respiratory rate in an adult is 10 breaths/min. e. Episodes of apnea are present in Cheyne-Stokes.

ANS: B, C, E Fingernail clubbing is a sign of hypoxia. Mental status will deteriorate as the oxygen level in the body diminishes. Apnea is present in Cheyne-Stokes respirations. Central cyanosis is not observed on the fingers and earlobes. The normal respiratory rate in an adult is more than 10 breaths/min.

26. The nurse is preparing to administer two inhalations of ipratropium bromide (Atrovent). When providing this medication, the nurse will instruct the patient to: (Select all that apply.) a. hold the canister horizontally. b. keep the eyes closed. c. exhale through the mouthpiece. d. wait 15 seconds before the second inhalation. e. shake the canister thoroughly prior to use.

ANS: B, D, E The eyes should be kept closed because temporary blurred vision may result if the aerosol is sprayed into the eyes. The patient should wait approximately 15 seconds, and repeat the second inhalation. The canister should be shaken thoroughly prior to use. The base of the canister should be held vertically. The patient should inhale through the mouthpiece. DIF: Cognitive Level: Application REF: p. 500 OBJ: 5 | 9 TOP: Nursing Process Step: Implementation

2. Which is a common expectorant in over-the-counter medications? a. Dextromethorphan b. Diphenhydramine c. Guaifenesin d. Codeine

ANS: C Guaifenesin is used for symptomatic relief of conditions characterized by a dry, nonproductive cough such as the common cold, bronchitis, laryngitis, pharyngitis, and sinusitis. Guaifenesin is also used to remove mucous plugs from the respiratory tract. Dextromethorphan is an antitussive. Diphenhydramine is an anticholinergic agent with antihistaminic and antitussive properties. Codeine is an antitussive.

10. What structures in the respiratory tract assist in removing foreign bodies such as smoke and bacteria? a. Villi b. Golgi bodies c. Ciliary hairs d. Erector pili

ANS: C Normally, respiratory tract fluid forms a protective layer over the trachea, bronchi, and bronchioles. Foreign bodies, such as smoke particles and bacteria, are caught in the respiratory tract fluid and are swept upward by ciliary hairs that line the bronchi and trachea to the larynx, where they are removed by the cough reflex. The villi are hair like protrusions into the intestine emanating from the wall of the intestine. The purpose of the villi is to slow the passage of food and allow food particles to be captured among these finger like villi, so that the blood inside the villi can absorb the nutrients in the food. The primary function of the Golgi apparatus, an organelle found in most eukaryotic cells, is to process proteins targeted to the plasma membrane, lysosomes, or endosomes and those that will be formed from the cell and to sort them within vesicles. Thus, it functions as a central delivery system for the cell. Erector pili are small muscles that cause hairs on the skin to rise when contracted.

18. A resident in a long term care facility diagnosed with COPD has a new medication order for indacaterol. When the nurse is providing education to the resident regarding this medication, information will include that: a. it is a short-acting beta antagonist. b. the patient should wait approximately 5 minutes between inhalations. c. onset of action is within 5 minutes. d. duration of action is about 12 hours.

ANS: C Onset of action is within 5 minutes. Indacaterol is an ultra-long-acting beta 2 agonist. Patients using inhaled bronchodilators should wait approximately 10 minutes. Duration of action is about 24 hours.

17. The nurse is obtaining a history of respiratory symptoms on a patient with the diagnosis of COPD. The patient reports smoking one pack of cigarettes per day for the past 20 years. The nurse calculates the pack years as: a. 5. b. 10. c. 20. d. 40.

ANS: C Pack years is defined as number of packs of cigarettes smoked per day times the number of years of smoking; 1 20 = 20.

6. A patient is seen in the emergency department. The patient had been maintained on theophylline (Theo Dur), and a blood sample reveals the serum theophylline level is subtherapeutic. Which may cause a subtherapeutic serum level? a. Cimetidine use b. Drug tolerance c. Smoking d. Overuse of the inhaler

ANS: C The patient is not tolerant to the drug if the serum theophylline levels are too low. Cimetidine would enhance the effects of theophylline, not decrease the effects. Smoking reduces the therapeutic effects of xanthine derivatives, including theophylline. Overuse of the inhaler would cause a high level of serum theophylline.

15. The nurse is teaching a patient with a history of COPD to self administer tiotropium (Spiriva) by dry powder inhalation. Which information provided by the nurse is accurate? a. The medication capsules can be used multiple times. b. Press on the canister while inhaling. c. Avoid breathing into the mouthpiece. d. Wash the device with cold water.

ANS: C The patient should not breathe into the mouthpiece at any time. Capsules are meant to be used as a single dose and should be disposed of after taking the daily dose. The HandiHaler uses capsules of medication that should be pierced before the patient inhales. The inhaler should be washed with hot water.

5. Premedication assessments before the use of anticholinergic bronchodilating agents should verify that the patient has no history of which condition? a. Diabetes b. Hypertension c. Liver disease d. Glaucoma

ANS: D Anticholinergic bronchodilating agents cause mydriasis (dilation of the pupils) and cycloplegia (loss of power in the ciliary muscle); therefore, they should not be used in patients with a history of closed angle glaucoma. Diabetes, hypertension, and liver disease are not affected by the use of anticholinergic bronchodilating agents.

4. Within minutes of the initiation of a nebulizer treatment with a sympathomimetic bronchodilator, the patient turns on his call light and states that he feels panicky and his heart is racing. Which action will the nurse take? a. Reassure the patient this is expected. b. Add more diluents to the nebulizer. c. Administer a sedative. d. Stop treatment and notify the health care provider.

ANS: D Sympathomimetic drugs increase sympathetic nervous stimulation. Symptoms such as nervousness, palpitations, tremors, tachycardia, and anxiety typically are dose related. These symptoms should be reported to the health care provider immediately because the patient may require a decreased dosage. These symptoms could lead to further complications if allowed to persist and are not common adverse effects. Although this may be a common result, it is not an expected outcome. Diluting the medication would not decrease the dose. Although a sedative might be appropriate for the patient, this is not the intervention of choice.