Comfort and Gas Exchange Quiz Questions
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 130 mEq/L would have a serum osmolality of: 300 mOsm/kg 280 mOsm/kg 250 mOsm/kg 260 mOsm/kg
260 mOsm/kg
Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation? a. Bronchitis b. Pneumonia c. Common cold d. Asthma
a. Bronchitis
A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does bloody fluid results indicate? a. Trauma b. Infection c. Malignancy d. Emphysema
a. Trauma
A victim of a motor vehicle accident has been brought to the emergency room. The patient is exhibiting paradoxical chest expansion and respiratory distress. Which of the following chest disorders should be suspected? a. Flail chest b. Cardiac tamponade c. Pulmonary contusion d. Simple pneumothorax
a. Flail chest
The nurse is educating the patient in the use of a mini-nebulizer. What should the nurse encourage the patient to do? (Select all that apply.) a. Hold the breath at the end of inspiration for a few seconds. b. Cough frequently. c. Take rapid, deep breaths. d. Frequently evaluate progress. e. Prolong the expiratory phase after using the nebulizer.
a. Hold the breath at the end of inspiration for a few seconds. b. Cough frequently. d. Frequently evaluate progress.
The nurse knows that what condition is associated with increased compliance of the lungs? a. Atelectasis b. Pulmonary edema c. Emphysema d. Pleural effusion
c. Emphysema
A client is receiving morphine sulfate intravenously (IV) every 4 hours as needed for the relief of pain related to a surgical procedure the client had 3 days previously. The physician is discontinuing the IV and will be starting the client on oral pain medication. What would provide the client with optimal pain relief when discontinuing the IV dose? Administer a higher dose of the medication by mouth. Administer an equianalgesic dose. Administer a lower dose so the client does not get addicted to the medication. The client should be ordered the medication to be administered intramuscularly (IM) instead of by mouth.
Administer an equianalgesic dose.
A mediastinal shift occurs in which type of chest disorder? a. Tension pneumothorax b. Traumatic pneumothorax c. Simple pneumothorax d. Cardiac tamponade
a. Tension pneumothorax
A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? a. "Raise your arms over your head." b. "Delay self-care activities for 1 hour." c. "Sit in a chair whenever doing an activity." d. "Drink fluids upon arising from bed."
b. "Delay self-care activities for 1 hour."
A patient's serum sodium concentration is within the normal range. What should the nurse estimate the serum osmolality to be? a. <136 mOsm/kg b. 275-300 mOsm/kg c. >408 mOsm/kg d. 350-544 mOsm/kg
b. 275-300 mOsm/kg
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. Teach the client to perform upper chest breaths. d. Increase the flow of oxygen.
b. Encourage the client to exhale slowly against pursed lips.
Which measure may increase complications for a client with COPD? a. Administration of antibiotics b. Increased oxygen supply c. Administration of antitussive agents d. Decreased oxygen supply
b. Increased oxygen supply
A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed? no IV fluids isotonic solution hypotonic solution hypertonic solution
hypertonic solution
An unlicensed assistive personnel (UAP) reports to the nurse that a postsurgical client has pain rated as 8 on a 0-to-10-point scale. The UAP tells the nurse that the client is exaggerating and does not need pain medication. What is the nurse's best response? "Unless there is strong evidence to the contrary, we should take the client's report at face value." "We need to provide pain medications because it is the law, and we must always follow the law." "Since pain often comes and goes with postsurgical clients, reassess the client's pain in 30 minutes." "It's not unusual for clients to misreport pain to get our attention when we are busy."
"Unless there is strong evidence to the contrary, we should take the client's report at face value."
Which action by the nurse indicates understanding of one basic principle of providing effective pain management? Administering pain medications on a PRN (as needed) basis Administering a dose of an analgesic agent via client-controlled analgesia (PCA) during rounds Awakening a new postoperative client to take pain medication Continuing to provide around-the-clock pain medications 72 hours after a surgical procedure
Awakening a new postoperative client to take pain medication
J.P. is a 67-year-old man, admitted to a medical floor for COPD exacerbation, emphysema. History includes pneumonia yearly for 4 years, 2 1/2 pack a day smoker for 45 years. He reports productive cough of thick yellow-green sputum. J.P. is irritable and anxious, complains of poor sleep and feels tired most of the time. He also experiences difficulty breathing at rest. Current Vital Signs: BP: 162/84 Pulse: 124 Respirations: 36 Temperature: 102 degrees F O2 Saturation: 88% on room air Physician orders: Diet as tolerated Out of bed with assistance O2 sats to maintain 90% IV of D5W at 50ml/hr EKG monitoring ABG's in morning (tomorrow morning) CBC with differential now BMP now Chest x-ray now sputum culture Albuterol 2.5mg plus Ipratropium 250 mcg nebulizer treatment STAT Which of the following explains emphysema? Select all that apply. The lungs have partial collapse resulting in a chest tube placement. Destruction of the alveolar membrane results in premature closure of the airway, trapping air during expiration. small airways undergo repeated cycles of inflammation and repair that increase collagen and scar tissue in the airway walls. Normally includes increased sputum production. The area affected is mainly in the upper airway.
Destruction of the alveolar membrane results in premature closure of the airway, trapping air during expiration. small airways undergo repeated cycles of inflammation and repair that increase collagen and scar tissue in the airway walls.
A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical clients' pain. What principle should guide the nurse's use of placebos in pain management? Placebos require the active participation of the client's family. Placebos are an acceptable, but unconventional, form of nonpharmacologic pain management. Placebos are never recommended in the treatment of pain. Placebos require a higher level of informed consent than conventional care.
Placebos are never recommended in the treatment of pain.
Your client, J.P. is improving, and the physician is discussing discharging the client to home. J.P's spouse confides in you (the nurse) and says "I don't know what to do. My husband used to be so active before he retired 6 months ago. Since then he's lost 35 pounds. He is afraid to take a bath, and it takes hi hours to dress- that's if he gets dressed at all. He has gone downhill so fast that it scares me. He's afraid to do anything for himself. He wants me in the room with him all the time, but if I try to talk with him he snarls and does things to irritate me. I have to keep working. His medical bills are draining all of our savings, and I have to be able to support myself when he's gone. You know. sometimes I go to work just to get away from the house and his constant demands. He calls me several times a dayu asking me to come home, but I can't go home. You may not think I'm much of a wife, but quite honestly, I don't want to come home anymore. I just don't know what to do." How would you respond to this statement? Select all that apply. Let her know that these feelings she has are normal but that she shouldn't be venting about them. Provide information about the American Lung Association which offers education and social support for COPD patients and their families. Contact social services, who can arrange respite care for the wife. Inform the physician that the wife cannot support the husband and that a nursing home is necessary. Suggest a home health aide to do light housekeeping and assist the patient in bathing.
Provide information about the American Lung Association which offers education and social support for COPD patients and their families. Contact social services, who can arrange respite care for the wife. Suggest a home health aide to do light housekeeping and assist the patient in bathing.
J.P. is a 67-year-old man, admitted to a medical floor for COPD exacerbation, emphysema. History includes pneumonia yearly for 4 years, 2 1/2 pack a day smoker for 45 years. He reports productive cough of thick yellow-green sputum. J.P. is irritable and anxious, complains of poor sleep and feels tired most of the time. He also experiences difficulty breathing at rest. Current Vital Signs: BP: 162/84 Pulse: 124 Respirations: 36 Temperature: 102 degrees F O2 Saturation: 88% on room air Physician orders: Diet as tolerated Out of bed with assistance O2 sats to maintain 90% IV of D5W at 50ml/hr EKG monitoring ABG's in morning (tomorrow morning) CBC with differential now BMP now Chest x-ray now sputum culture Albuterol 2.5mg plus Ipratropium 250 mcg nebulizer treatment STAT The following ABG is drawn. What state is the client currently in? pH: 7.34 C02: 48 HC03: 28 Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Respiratory acidosis
J.P. is a 67-year-old man, admitted to a medical floor for COPD exacerbation, emphysema. History includes pneumonia yearly for 4 years, 2 1/2 pack a day smoker for 45 years. He reports productive cough of thick yellow-green sputum. J.P. is irritable and anxious, complains of poor sleep and feels tired most of the time. He also experiences difficulty breathing at rest. Current Vital Signs: BP: 162/84 Pulse: 124 Respirations: 36 Temperature: 102 degrees F O2 Saturation: 88% on room air Physician orders: Diet as tolerated Out of bed with assistance O2 sats to maintain 90% IV of D5W at 50ml/hr EKG monitoring ABG's in morning (tomorrow morning) CBC with differential now BMP now Chest x-ray now sputum culture Albuterol 2.5mg plus Ipratropium 250 mcg nebulizer treatment STAT Your client is having difficulty breathing while lying down in bed. The nurse has placed the head of the bed higher, but the client still feels uncomfortable. The client has 2L of 02 via nasal cannula their 02 sats are 92%. What independent nursing action can the nurse do to improve the client's comfort? Select all that apply. Call a rapid response since the client is clearly in distress. Ask the physician for an anxiety medication to be used prn. Assist the client into the tripod position. Increase the 02 via nasal cannula to keep the 02 sats near 100%. Help the client to use pursed-lip breathing.
Assist the client into the tripod position. Ask the physician for an anxiety medication to be used prn. Help the client to use pursed-lip breathing.
A nurse is caring for a client after a thoracentesis. Which sign, if noted in the client, should be reported to the physician immediately? a. "Client is becoming agitated and complains of pleuritic pain." b. "Client is drowsy and complains of headache." c. "Client has subcutaneous emphysema around needle insertion site." d. "Client has oxygen saturation of 93%."
a. "Client is becoming agitated and complains of pleuritic pain."
A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client. a. "Inhale through your nose." b. "Slowly count to 3." c. "Exhale slowly through pursed lips." d. "Slowly count to 7."
a. "Inhale through your nose." b. "Slowly count to 3." c. "Exhale slowly through pursed lips." d. "Slowly count to 7."
A patient has an increase in blood osmolality when the nurse reviews the laboratory work. What can this increase indicate for the patient? a. ADH stimulation b. An increase in urine volume c. Diuresis d. Less reabsorption of water
a. ADH stimulation
A client with exacerbation of chronic obstructive pulmonary disease (COPD) is scheduled for a thoracentesis. Which nursing intervention would be appropriate for client safety? a. Administering a cough suppressant as needed b. Assisting the client to a prone position c. Obtaining arterial blood gas values immediately after the procedure d. Applying oxygen via nasal cannula
a. Administering a cough suppressant as needed
What are the primary causes for an acute exacerbation of COPD? Select all that apply. a. Air pollution b. Tracheobronchial infection c. Change in season from spring to summer d. Gastrointestinal viruses e. Hypertension
a. Air pollution b. Tracheobronchial infection
The nurse is completing a family history for a client who is admitted for exacerbation of chronic obstructive pulmonary disease (COPD). The nurse should include questions that address which health problem? Select all that apply. a. Allergies b. Alcohol use disorder c. Fractures d. Hypervitaminosis e. Obesity
a. Allergies b. Alcohol use disorder e. Obesity
A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: a. An abnormal distention of the air spaces with destruction of the alveolar walls b. Increased oxygen diffusion with inflammation of the bronchioles c. Inflammation of the bronchioles with a normal distention of the air spaces d. Decreased sputum production with dilation of bronchioles
a. An abnormal distention of the air spaces with destruction of the alveolar walls
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. Apply supplemental oxygen as ordered. b. Assess vital signs every 2 hours, including O2 saturations and ABG results. c. Educate the client about the importance of pursed lip breathing. d. Refer the client to respiratory therapy if breathing becomes labored.
a. Apply supplemental oxygen as ordered.
A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse a. Asks the client, "What are your allergies?" b. Explains to the client not to eat or drink before the spirometry test c. States that various blood tests must also be done d. Tells the client that arterial blood gas is performed after spirometry testing
a. Asks the client, "What are your allergies?"
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. Compromised gas exchange b. Decreased airflow c. Wheezes d. Jugular vein distention e. Ascites
a. Compromised gas exchange b. Decreased airflow c. Wheezes
An emergency room nurse is assessing a client who is complaining of dyspnea. Which sign would indicate the presence of a pleural effusion? a. Decreased chest wall excursion upon palpation b. Wheezing upon auscultation c. Resonance upon percussion d. Mottled skin seen during inspection
a. Decreased chest wall excursion upon palpation
What is the reason for chest tubes after thoracic surgery? a. Draining secretions, air, and blood from the thoracic cavity is necessary. b. Chest tubes allow air into the pleural space. c. Chest tubes indicate when the lungs have re-expanded by ceasing to bubble. d. Draining secretions and blood while allowing air to remain in the thoracic cavity is necessary.
a. Draining secretions, air, and blood from the thoracic cavity is necessary.
The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)? a. Increased serum sodium b. Decreased serum potassium c. Decreased hemoglobin d. Increased platelets
a. Increased serum sodium
Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. a. Inflamed airways obstruct airflow. b. Mucus secretions block airways. c. Overinflated alveoli impair gas exchange. d. Dry airways obstruct airflow.
a. Inflamed airways obstruct airflow. b. Mucus secretions block airways. c. Overinflated alveoli impair gas exchange.
A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. a. Inflamed airways that obstruct airflow b. Mucus secretions that block airways c. Overinflated alveoli that impair gas exchanged. d. Dry airways that obstruct airflow e. Decreased numbers of goblet cells
a. Inflamed airways that obstruct airflow b. Mucus secretions that block airways c. Overinflated alveoli that impair gas exchanged.
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 prolongs exhalation. b. It increases the respiratory rate to improve oxygenation. c. It will assist with widening the airway. d. It will prevent the alveoli from overexpanding.
a. It prolongs exhalation.
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. Lung sounds b. Skin color c. Heart rate d. Respiratory rate
a. Lung sounds
The home health nurse is planning teaching for a client with COPD and a history of noncompliance to the medication regimen. Which factor does the nurse recognize as having the most influence on enabling complete adherence to a health regimen? a. Motivation b. Self-esteem c. Cost of medication d. Education level
a. Motivation
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. Providing sufficient oxygen to improve oxygenation b. Avoiding the use of oxygen to decrease the hypoxic drive c. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise d. Increasing pH
a. Providing sufficient oxygen to improve oxygenation
A client with chronic obstructive pulmonary disease (COPD) visits the health care center with breathing difficulties. Which part of the client profile relates to the client's view of himself or herself and the impact of COPD? a. Self-concept b. Chief complaint c. Stress and coping response d. Biographical information
a. Self-concept
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. Sharp, stabbing chest pain b. Dyspnea c. A dry, hacking cough d. Tachycardia
a. Sharp, stabbing chest pain
A client with COPD has been receiving oxygen therapy for an extended period. What symptoms would be indicators that the client is experiencing oxygen toxicity? Select all that apply. a. Substernal pain b. Dyspnea c. Fatigue d. Mood swings e. Bradycardia
a. Substernal pain b. Dyspnea c. Fatigue
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.
a. Teach the client strategies for promoting diaphragmatic breathing.
Why would a client with COPD report feeling fatigued? Select all that apply. a. The client is using all expendable energy just to breathe. b. Muscle function gradually decreases over time in clients with COPD. c. The client is using all expendable energy for activities of daily living (ADLs). d. Lung function gradually decreases over time in clients with COPD.
a. The client is using all expendable energy just to breathe. d. Lung function gradually decreases over time in clients with COPD.
A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care? a. To improve the client's and family's quality of life b. To support aggressive and innovative treatments for cure c. To provide physical support for the client d. To help the client develop a separate plan with each discipline of the health care team
a. To improve the client's and family's quality of life
A client is exhibiting signs of a pneumothorax following tracheostomy. The surgeon inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the primary purpose of this chest tube? a. To remove air from the pleural space b. To drain copious sputum secretions c. To monitor bleeding around the lungs d. To assist with mechanical ventilation
a. To remove air from the pleural space
A nurse evaluates a client's laboratory results. What is a factor that may be affecting an increase in serum osmolality? a. free water loss b. diuretic use c. overhydration d. hyponatremia
a. free water loss
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. instruct the client to drink at least 2 L of fluid daily. b. maintain the client on bed rest. c. administer anxiolytics, as ordered, to control anxiety. d. administer pain medication as ordered.
a. instruct the client to drink at least 2 L of fluid daily.
A client who underwent thoracic surgery to remove a lung tumor had a chest tube placed anteriorly. The surgical team places this catheter to: a. remove air from the pleural space. b. remove fluid from the lungs. c. administer IV medication. d. ventilate the client.
a. remove air from the pleural space.
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: a. "Nicotine patches would be appropriate for you." b. "Have you tried to quit smoking before?" c. "I can refer you to the American Lung Association." d. "Many options are available for you."
b. "Have you tried to quit smoking before?"
The nurse is assigned to care for a client with a chest tube. The nurse should ensure that which item is kept at the client's bedside? a. An Ambu bag b. A bottle of sterile water c. An incentive spirometer d. A set of hemostats
b. A bottle of sterile water
Which term refers to lung tissue that has become more solid in nature as a result of a collapse of alveoli or an infectious process? a. Atelectasis b. Consolidation c. Bronchiectasis d. Empyema
b. Consolidation
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find? a. Elevated serum sodium levels b. Decreased serum osmolarity c. Decreased urine sodium levels d. Elevated urine calcium levels
b. Decreased serum osmolarity
For a client with pleural effusion, what does chest percussion over the involved area reveal? a. Absent breath sounds b. Dullness over the involved area c. Friction rub d. Fluid presence
b. Dullness over the involved area
A client has suspected fluid accumulation in the pleural space of the lungs and is scheduled for a thoracentesis. The nurse will implement which of the following for this procedure? Select all that apply. a. Place the client in the prone position. b. Educate the client about the need to cleanse the thoracic area. c. Apply pressure to the puncture site after the procedure. d. Prepare the client for magnetic resonance imaging after the procedure to verify tube placement. e. Complete a respiratory assessment after the procedure.
b. Educate the client about the need to cleanse the thoracic area. c. Apply pressure to the puncture site after the procedure. e. Complete a respiratory assessment after the procedure.
A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? a. Disturbed sleep pattern related to cough b. Ineffective coping related to anxiety c. High risk for ineffective therapeutic regimen management related to lack of knowledge d. Activity intolerance related to fatigue
b. Ineffective coping related to anxiety
A new nurse auscultates adventitious breath sounds but is not sure what to document and confers with an experienced nurse. This experienced nurse documents a pleural friction rub. Which of the following did the experienced nurse do during her assessment to identify the rub? a. Instructed the client to cough b. Instructed the client to hold the breath c. Listened over the upper posterior lung surface d. Used percussion to verify the sounds
b. Instructed the client to hold the breath
A physician orders an isotonic I.V. solution for a client. Which solution should the nurse plan to administer? a. 5% dextrose and normal saline solution b. Lactated Ringer's solution c. Half-normal saline solution d. 10% dextrose in water
b. Lactated Ringer's solution
A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described with which terms? a. Hydrostatic pressure b. Osmosis and osmolality c. Diffusion d. Active transport
b. Osmosis and osmolality
A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. a. Strengthen the diaphragm b. Prevent airway collapse c. Control the rate and depth of respirations d. Condition the inspiratory muscles e. Release air trapped in the lungs
b. Prevent airway collapse c. Control the rate and depth of respirations e. Release air trapped in the lungs
Which diagnostic test is most accurate in assessing acute airway obstruction? a. Arterial blood gases (ABGs) b. Pulmonary function studies c. Pulse oximetry d. Spirometry
b. Pulmonary function studies
The nurse is caring for a client who has a pleural effusion and who underwent a thoracoscopic procedure earlier in the morning. The nurse should prioritize assessment for which of the following? a. Sputum production b. Shortness of breath c. Throat discomfort d. Epistaxis
b. Shortness of breath
The nurse is providing preoperative teaching to a client scheduled for surgery. The nurse is instructing the client on the use of deep breathing, coughing, and the use of incentive spirometry when the client states, "I don't know why you're focusing on my breathing. My surgery is on my hip, not my chest." What rationale for these instructions should the nurse provide? a. To prevent chronic obstructive pulmonary disease (COPD) b. To promote optimal lung expansion c. To enhance peripheral circulation d. To prevent pneumothorax
b. To promote optimal lung expansion
In general, chest drainage tubes are not used for a patient undergoing a. lobectomy. b. pneumonectomy. c. wedge resection. d. segmentectomy.
b. pneumonectomy.
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
c. A barrel chest
A client presents to the emergency department after being in a boating accident about 3 hours ago. Now the client reports headache, fatigue, and the feeling of not being able to breathe enough. The nurse notes that the client is restless and tachycardic with an elevated blood pressure. This client may be in the early stages of which respiratory problem? a. Pneumoconiosis b. Pleural effusion c. Acute respiratory failure d. Pneumonia
c. Acute respiratory failure
The nurse is caring for a client being treated with isotonic IV fluid for hypernatremia. What complication of hypernatremia should the nurse continuously monitor for? a. Red blood cell crenation b. Red blood cell hydrolysis c. Cerebral edema d. Renal failure
c. Cerebral edema
A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type? a. Wheezes b. Rhonchi c. Crackles d. Pleural rub
c. Crackles
A client with lung cancer develops pleural effusion. During chest auscultation, which breath sound should the nurse expect to hear? a. Crackles b. Rhonchi c. Decreased breath sounds d. Wheezes
c. Decreased breath sounds
A patient has a serum osmolality of 250 mOsm/kg. The nurse knows to assess further for: a. Dehydration. b. Hyperglycemia. c. Hyponatremia. d. Acidosis.
c. Hyponatremia.
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. Maintain activity level of walking to the mailbox. b. Continue with current level of mobility at home. c. Increase walking distance around a city block without shortness of breath. d. Relieve shortness of breath to a level as close as possible to tolerable.
c. Increase walking distance around a city block without shortness of breath.
With which condition should the nurse expect that a decrease in serum osmolality will occur? a. Influenza b. Hyperglycemia c. Kidney failure d. Uremia
c. Kidney failure
A client is undergoing testing to assess for a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis? a. Increased tactile fremitus, egophony, and the chest wall dull on percussion b. Decreased tactile fremitus, wheezing, and the chest wall hyperresonant on percussion c. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub d. Normal tactile fremitus, decreased breath sounds, and the chest wall resonant on percussion
c. Lung fields dull to percussion, absent breath sounds, and a pleural friction rub
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.
c. Minor respiratory infections are considered to be self-limited and are not treated with medication.
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. Emphysema b. Asthma c. Polycythemia d. Bronchitis
c. Polycythemia
A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. Which term should the nurse document? a. Crackles b. Pleural friction rub c. Rhonchi d. Bronchial
c. Rhonchi
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a. Encouraging the client to drink three glasses of fluid daily b. Keeping the client in semi-Fowler's position c. Using a Venturi mask to deliver oxygen as ordered d. Administering a sedative as ordered
c. Using a Venturi mask to deliver oxygen as ordered
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
c. Venturi mask
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. pleural effusion. b. pulmonary edema. c. atelectasis. d. oxygen toxicity.
c. atelectasis.
A client is experiencing edema in the tissue. What type of intravenous fluid would the nurse expect to be prescribed? a. isotonic fluid b. no intravenous solution c. hypertonic solution d. hypotonic solution
c. hypertonic solution
The nurse is caring for a client with an exacerbation of COPD and scheduled for pulmonary function studies using a spirometer. Which client statement would the nurse clarify? a. "My study is scheduled for 10 AM, several hours after I eat." b. "I brought comfortable clothes and shoes for the test." c. "I am ordered a bronchodilator to note lung improvement following use." d. "I will breathe in through my mouth and out through my nose."
d. "I will breathe in through my mouth and out through my nose."
The client asks the nurse to explain the reason for a chest tube insertion in treating a pneumothorax. Which is the best response by the nurse? a. "The tube will allow air to be restored to the lung." b. "The tube will drain secretions from the lung." c. "The tube will provide a route for medication instillation to the lung." d. "The tube will drain air from the space around the lung."
d. "The tube will drain air from the space around the lung."
A client who is semiconscious presents with restlessness and weakness. The nurse assesses a dry, swollen tongue; body temperature of 99.3 °F; and a urine specific gravity of 1.020. What is the most likely serum sodium value for this client? a. 110 mEq/L b. 130 mEq/L c. 145 mEq/L d. 165 mEq/L
d. 165 mEq/L
A nurse can estimate serum osmolality at the bedside by using a formula. A patient who has a serum sodium level of 140 mEq/L would have a serum osmolality of: a. 210 mOsm/kg. b. 230 mOsm/kg. c. 250 mOsm/kg. d. 280 mOsm/kg.
d. 280 mOsm/kg.
The nurse at the beginning of the evening shift in the emergency department receives a report at 1900 on the following clients. Which client would the nurse assess first? a. An 85-year-old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen b. A 62-year-old with emphysema who has 300 mL of intravenous fluid remaining c. A 74-year-old with chronic bronchitis who has BP 128/58, HR 104, and R 26 d. An 86-year-old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
d. An 86-year-old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions? a. BP 122/82, HR 102, R 24, noted barrel chest, temperature 98.4 °F (36.9 °C) b. Client states, "It always seems like I just can't catch my breath." c. Pale, paper-thin skin, O2 at 2L/min via nasal cannula d. BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)
d. BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)
A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important risk factor for emphysema? a. Air pollution b. Allergens c. Infectious agents d. Cigarette smoking
d. Cigarette smoking
The nurse is assessing a client who has a chest tube in place for the treatment of a pneumothorax. The nurse observes that the water level in the water seal rises and falls in rhythm with the client's respirations. How should the nurse best respond to this assessment finding? a. Gently reinsert the chest tube 1 to 2 cm and observe if the water level stabilizes. b. Inform the physician promptly that there is in imminent leak in the drainage system. c. Encourage the client to do deep breathing and coughing exercises. d. Document that the chest drainage system is operating as it is intended.
d. Document that the chest drainage system is operating as it is intended.
A client is scheduled to have excess pleural fluid aspirated with a needle to relieve dyspnea. The client inquires about the normal function of pleural fluid. What should the nurse describe? a. It allows for full expansion of the lungs within the thoracic cavity. b. It prevents the lungs from collapsing within the thoracic cavity. c. It limits lung expansion within the thoracic cavity. d. It lubricates the movement of the thorax and lungs.
d. It lubricates the movement of the thorax and lungs.
A client's burns are estimated at 36% of total body surface area; fluid resuscitation has been ordered in the emergency department. After establishing intravenous access, the nurse should anticipate the administration of what fluid? a. 0.45% NaCl with 20 mEq/L KCl b. 0.45% NaCl with 40 mEq/L KCl c. Normal saline d. Lactated Ringer's
d. Lactated Ringer's
A client who has just had a triple-lumen catheter placed in his right subclavian vein complains of chest pain and shortness of breath. His blood pressure is decreased from baseline and, on auscultation of his chest, the nurse notes unequal breath sounds. A chest X-ray is immediately ordered by the physician. What diagnosis should the nurse suspect? a. Pulmonary embolism b. Myocardial infarction (MI) c. Heart failure d. Pneumothorax
d. Pneumothorax
The nurse is caring for a patient with pleurisy. What symptoms does the nurse recognize are significant for this patient's diagnosis? a. Dullness or flatness on percussion over areas of collected fluid b. Dyspnea and coughing c. Fever and chills d. Stabbing pain during respiratory movement
d. Stabbing pain during respiratory movement
The most diagnostic clinical symptom of pleurisy is: a. Dullness or flatness on percussion over areas of collected fluid. b. Dyspnea and coughing. c. Fever and chills. d. Stabbing pain during respiratory movements.
d. Stabbing pain during respiratory movements.
The nurse is caring for a client with COPD who was recently admitted to the hospital with an acute exacerbation of the illness. What indicates to the nurse that the client is in the comeback phase of the Trajectory Model of Chronic Illness? a. Unrelieved symptoms of the illness results in the interruption of the client's everyday life activities. b. The illness course and symptoms are under control and the client's everyday life activities are managed. c. The client begins to cope with implications of the illness. d. The client gradually returns back to an acceptable way of life within the limits imposed by the illness.
d. The client gradually returns back to an acceptable way of life within the limits imposed by the illness.
The nurse is caring for a client who has been diagnosed with chronic obstructive pulmonary disease (COPD) and is experiencing respiratory acidosis. The client asks what is making the acidotic state. What does the nurse identify as the result of the disease process that causes the fall in pH? a. The lungs are unable to breathe in sufficient oxygen. b. The lungs are unable to exchange oxygen and carbon dioxide. c. The lungs have ineffective cilia from years of smoking. d. The lungs are not able to regulate carbonic acid levels.
d. The lungs are not able to regulate carbonic acid levels.
A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that: a. inserting a Foley catheter can decrease fluid retention. b. administering I.V. antibiotics can prevent pneumonia. c. this client may need intubation. d. it may be necessary to raise the head of this client's bed.
d. it may be necessary to raise the head of this client's bed.
The classification of Stage IV of COPD is defined as a. at risk for COPD. b. mild COPD. c. severe COPD. d. very severe COPD. e. moderate COPD.
d. very severe COPD.
J.P. is a 67-year-old man, admitted to a medical floor for COPD exacerbation, emphysema. History includes pneumonia yearly for 4 years, 2 1/2 pack a day smoker for 45 years. He reports productive cough of thick yellow-green sputum. J.P. is irritable and anxious, complains of poor sleep and feels tired most of the time. He also experiences difficulty breathing at rest. Current Vital Signs: BP: 162/84 Pulse: 124 Respirations: 36 Temperature: 102 degrees F O2 Saturation: 88% on room air Physician orders: Diet as tolerated Out of bed with assistance O2 sats to maintain 90% IV of D5W at 50ml/hr EKG monitoring ABG's in morning (tomorrow morning) CBC with differential now BMP now Chest x-ray now sputum culture Albuterol 2.5mg plus Ipratropium 250 mcg nebulizer treatment STAT Place the following orders in order of implementation: at the nurses discretion, allow client out of bed and order a diet tray. obtain sputum culture as soon as the patient can provide a specimen. obtain chest xray and blood work. place the client on an EKG monitor and initiate fluids. initiate oxygen at 2L per nasal cannula and administer the albuterol treatment.
initiate oxygen at 2L per nasal cannula and administer the albuterol treatment. place the client on an EKG monitor and initiate fluids. obtain chest xray and blood work. obtain sputum culture as soon as the patient can provide a specimen. at the nurses discretion, allow client out of bed and order a diet tray.
