EXAM 3 Practice Questions

Pink, frothy sputum may be an indication of

pulmonary edema

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

respiratory acidosis

The classification of Stage III of COPD is defined as

severe COPD

The nurse auscultates crackles in a patient with a respiratory disorder. With what disorder would crackles be commonly heard?

Collapsed alveoli

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern?

Compromised gas exchange Decreased airflow Wheezes

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?"

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?

"I can't use a spacer or holding chamber with the MDI."

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.

60 mm Hg; 90%

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent?

90%

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

"I do not need to rinse my mouth with this type of inhaler."

A nurse is instructing the client on the normal sensations that can occur when contrast medium is infused during pulmonary angiography. Which client statement demonstrates an understanding of the teaching?

"I will feel warm and may have chest pain"

The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response?

"It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs."

Following a chest X-ray, a patient has been diagnosed with a pleural effusion. The care team has concluded that the quantity of fluid in the patient's intrapleural space necessitates thoracentesis. What patient education should the nurse provide in anticipation of this procedure?

"It's very important that you remain still while the doctor is performing the procedure."

A client newly diagnosed with COPD tells the nurse, "I can't believe I have COPD; I only had a cough. Are there other symptoms I should know about"? Which is the best response by the nurse?

"Other symptoms you may develop are shortness of breath upon exertion and sputum production."

The patient with hypothyroidism is preparing to go home. What important teaching points should the nurse include in discharge teaching?

"Report any difficulty with orientation to time, place, or person." "Note how many hours you sleep in a 24-hr period." "Be sure that you take your medication every day at the same time." "Call the provider if you develop an unsteady gait or tremors in your hands."

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb in 1 day."

Which patient statement indicates that further nursing teaching is needed about hypothyroidism?

"When I am feeling better in a few months, I will no longer need to take the Synthroid pills."

A student accepted into a nursing program must begin receiving the hepatitis B series of injections. The student asks when the next two injections should be administered. What is the best response by the instructor?

"You must have the second one in 1 month and the third in 6 months."

A client with a chronic lung disease is prescribed postural drainage. Place in order the nurse's actions to perform this procedure.

1. Plan to do the procedure before a meal. 2. Provide medication to loosen secretions before the procedure. 3. Obtain an emesis basin, sputum cup, and paper tissues. 4. Instruct client to breathe in through the nose and out through pursed lips. 5. Place client in position to drain the lower lobes for 10 to 15 minutes and then cough. 6. Place client in position to drain the middle lobe for 10 to 15 minutes and then cough. 7. Place client in position to drain the upper lobes for 10 to 15 minutes and then cough.

A client has recently been diagnosed with malignant lung cancer. The nurse is calculating the client's smoking history in pack-years. The client reports smoking two packs of cigarettes a day for the past 11 years. The nurse correctly documents the client's pack-years as

22 Smoking history is usually expressed in pack-years, which is the number of packs of cigarettes smoked per day times the number of years the patient smoked. In this situation, the client's pack-years is 22 (2 × 11). It is important to find out whether the client is still smoking or when the client quit smoking.

Inspection of a patient's skin color is part of the assessment of the integumentary system. Cyanosis, which is a late indicator of hypoxia, is present when the unoxygenated hemoglobin level is:

5 g/dL

Which statement describes emphysema?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

A client is being treated in the ED for respiratory distress coupled with bacterial pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs?

Administration of antibiotics Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia.

Which of the following are priority nursing interventions for Ms. Hoffman, who is in respiratory distress secondary to an asthma attack?

Administration of intravenous fluids Administration of bronchodilators Monitoring of arterial blood gases

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Albuterol

In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.

Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

The nurse should include which of the following as rescue medications to take at the beginning of an asthma attack?

Albuterol, Ipratropium, Levalbuterol

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:

An abnormal distention of the air spaces with destruction of the alveolar walls

The nurse is caring for a client diagnosed with pneumonia. The nurse assesses the client for tactile fremitus by completing which action?

Asking the client to repeat "ninety-nine" as the nurse's hands move down the client's thorax

The nurse is caring for a client with recurrent hemoptysis who has undergone a bronchoscopy. Immediately following the procedure, the nurse should complete which action?

Assess the client for a cough reflex.

Which statement is true about both lung transplant and bullectomy?

Both procedures improve the overall quality of life of a client with COPD.

In the patient experiencing an asthma exacerbation, which of the following changes occur?

Bronchoconstriction, Airway edema, Airway narrowing

What finding by the nurse may indicate that the client has chronic hypoxia?

Clubbing of the fingers

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations?

Cromolyn sodium

For air to enter the lungs (process of ventilation), the intrapulmonary pressure must be less than atmospheric pressure so air can be pulled inward. Select the movement of respiratory muscles that makes this happen during inspiration.

Diaphragm contracts and elongates the chest cavity.

Which of the following clinical manifestations should a nurse monitor for during a pulmonary angiography, which indicates an allergic reaction to the contrast medium?

Difficulty in breathing

Which exposure accounts for most cases of COPD?

Exposure to tobacco smoke

A nurse is preparing a presentation for a local community group about hepatitis. Which of the following would the nurse include?

Hepatitis C increases a person's risk for liver cancer.

After educating Ms. Hoffman on appropriate self-care for a client with asthma, the nurse knows she understands the instructions when she states which of the following?

I should take a peak flow reading daily. In the red zone, if quick-relief medication doesn't work, I should call my provider. If I have trouble talking due to shortness of breath, I should call my provider.

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in?

II

In which grade of COPD is the forced expiratory volume (FEV) less than 30%?

IV Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 30% predicted.

Asthma is cause by which type of response?

IgE-mediated Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.

A pediatrician diagnosed a child with swollen and inflamed adenoids. The nurse practitioner confirmed the diagnosis by:

Inspecting the roof of the nasopharynx.

A client has a nursing diagnosis of "ineffective airway clearance" as a result of excessive secretions. An appropriate outcome for this client would be which of the following?

Lungs are clear on auscultation.

A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. What is the reason the client with suspected lung cancer would undergo magnetic resonance imaging (MRI)?

MRI can view soft tissues and can help stage cancers.

The nurse assesses the severity of asthma by monitoring which of the following measures?

Peak flow, Severity of symptoms, Auscultation of lungs

The nurse is taking a respiratory history for a patient who has come into the clinic with a chronic cough. What information should the nurse obtain from this patient? (Select all that apply.)

Previous history of lung disease in the patient or family Occupational and environmental influences Previous history of smoking

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?

Providing sufficient oxygen to improve oxygenation

Which diagnostic test is most accurate in assessing acute airway obstruction?

Pulmonary function studies

In the patient experiencing asthma, the nurse can expect to find which of the following sounds on percussion of the chest?

Resonant to hyper-resonant

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

Respiratory rate of 22 breaths/minute

A client with chronic bronchitis is admitted to the health facility. Auscultation of the lungs reveals low-pitched, rumbling sounds. What breath sound should the nurse document?

Rhonchi

In which position should the client be placed for a thoracentesis?

Sitting on the edge of the bed

How will you know that a patient is improving from an asthma attack?

SpO2 92-99%, respiratory rate 12-20, increased air movement upon auscultation

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and a productive cough

A nurse assesses a patient diagnosed with hepatic encephalopathy. She observes a number of clinical signs, including asterixis and fetor hepaticus; the patient's electroencephalogram (EEG) is abnormal. The nurse documents that the patient is exhibiting signs of which stage of hepatic encephalopathy?

Stage 2

The nurse is admitting a client who just had a bronchoscopy. Which assessment should be the nurse's priority?

Swallow reflex

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply.

Take a slow, deep inhalation from the device. Activate the MDI once. The device may increase delivery of the MDI medication.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Take ordered medications as scheduled.

The client is returning from the operating room following a bronchoscopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment?

The nursing assistant is pouring a glass of water to wet the client's mouth.

Perfusion refers to blood supply to the lungs, through which the lungs receive nutrients and oxygen. What are the two methods of perfusion?

The two methods of perfusion are the bronchial and pulmonary circulation.

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply.

Tobacco smoke Occupational dust Air pollution Infection Second-hand smoke

The nurse is providing discharge teaching to Ms. Hoffman, who has suffered an asthma attack. It is essential for the nurse to include which of the following topics in the discharge instructions?

Triggers to avoid Proper inhalation technique How to initiate an asthma action plan Always carry a quick relief medication

A nurse is discussing squamous epithelial cells lining each alveolus, which consist of different types of cells. Which type of alveolar cells produce surfactant?

Type II cells

A nurse assesses a client's respiratory status. Which observation indicates that the client is having difficulty breathing?

Use of accessory muscles

A client with chronic bronchitis is admitted with an exacerbation of symptoms. During the nursing assessment, the nurse will expect which of the following findings? Select all that apply.

Use of accessory muscles to breathe Purulent sputum with frequent coughing

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient?

Ventilation exceeds perfusion.

What is the difference between respiration and ventilation?

Ventilation is the movement of air in and out of the respiratory tract.

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-Medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

albuterol (Proventil).

The nurse is aware that which of the following represents the strongest predisposing factor for asthma?

allergy

Which is the strongest predisposing factor for asthma?

allergy

Understanding pulmonary physiology, what characteristic would the nurse expect to result in decreased gas exchange in older adults?

alveolar walls containing fewer capillaries

A client has just been diagnosed with hepatitis A. On assessment, the nurse expects to note:

anorexia, nausea, and vomiting.

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?

anxiety

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

asthma

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as

atelectasis

The nurse is assessing a patient in respiratory failure. What finding is a late indicator of hypoxia?

cyanosis

The provider orders laboratory work that includes thyroid function tests. Which results does the nurse expect to see for hypothyroidism?

decreased T3 and T4 levels

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side.

A client arrives at the physician's office stating dyspnea; a productive cough for thick, green sputum; respirations of 28 breaths/minute, and a temperature of 102.8° F. The nurse auscultates the lung fields, which reveal poor air exchange in the right middle lobe. The nurse suspects a right middle lobe pneumonia. To be consistent with this anticipated diagnosis, which sound, heard over the chest wall when percussing, is anticipated?

dull

A client with chronic lung disease is prescribed 40% oxygen via face mask. Which finding indicates to the nurse that the client is experiencing oxygen toxicity? Select all that apply.

dyspnea, restlessness, substernal discomfort

The nurse understands that a patient with asthma is likely to exhibit which three most common symptoms?

dyspnea, wheezing, cough

In a patient with asthma, the nurse hears wheezing initially during which part of the respiration cycle?

expiration

A 45-year-old woman who is seeing her health care provider states that she is tired all the time and has muscle aches and pains. Assessment reveals a heart rate of 56/min and a BP of 96/58. She has non-pitting edema of her face, especially around her eyes, and in her hands and feet. Her health history includes radioactive iodine (RAI) for hyperthyroidism. What diagnosis does the nurse expect for this patient?

hypothyroidism

A nurse is concerned that a client may develop postoperative atelectasis. Which nursing diagnosis would be most appropriate if this complication occurs?

impaired gas exchange

What would the instructor tell the students purulent fluid indicates?

infection

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive?

influenza

As you care for your patient, which assessment findings would you expect to see that are consistent with asthma exacerbation?

inspiratory and expiratory wheezing, low SpO2 less than 92%, difficulty speaking in full sentences

The nurse is in the radiology unit of the hospital. The nurse is caring for a client who is scheduled for a lung scan. The nurse knows that lung scans need the use of radioisotopes and a scanning machine. Before the perfusion scan, what must the client be assessed for?

iodine allergy

The nurse understands that the first medication that will be administered to decrease respiratory distress is ________________; if the client's condition does not immediately improve, the next likely drug that will be administered is ______________.

ipratropium/albuterol, methylprednisolone

A client has just undergone bronchoscopy. Which nursing assessment is most important at this time?

level of consciousness

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?

lung sounds

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?

mast cells

The nurse is performing an assessment for a patient with congestive heart failure. The nurse asks if the patient has difficulty breathing in any position other than upright. What is the nurse referring to?

orthopnea

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process?

polycythemia

What is the primary function of the larynx?

producing sound

The amount of air inspired and expired with each breath is called:

tidal volume.

The classification of Stage IV of COPD is defined as

very severe COPD

The nurse is performing chest auscultation for a patient with asthma. How does the nurse describe the high-pitched, sibilant, musical sounds that are heard?

wheezes