Respiratory Review

33. A patient with COPD has meal-related dyspnea. To address this issue, which drug does the nurse offer the patient 30 minutes before the meal? A. Albuterol (Ventolin) B. Guaifenesin (Organidin) C. Fluticasone (Flovent) D. Pantoprazole sodium (Protonix)

A

42. A patient with a history of bronchitis for more than 20 years is hospitalized. With this patient's history, what is a potential complication? A. Right-sided heart failure B. Left-sided heart failure C. Renal disease D. Stroke

A

29. Patients with asthma are taught self-care activities and treatment modalities according to the "step method." Which symptoms and medication routines relate to step 3? A. Symptoms occur daily; daily use of inhaled corticosteroid, add a long-acting beta agonist. B. Symptoms occur more than once per week; daily use of antiiflammatory inhaler. C. Symptoms occur less than once per week; use of rescue inhalers once per week. D. Frequent exacerbations occur with limited physical activity; increased use of rescue inhalers.

A

45. A patient has returned several times to the clinic for treatment of respiratory problems. Which action does the nurse perform first? A. Obtain a history of the patient's previous problems and response to therapy. B. Ask the patient to describe his compliance with the prescribed therapies. C. Obtain a request for diagnostic testing, including a tuberculosis and human immunodeficiency virus (HIV) evaluation. D. Listen to the patient's lungs, obtain a pulse oximetry reading, and count the respiratory rate.

A

47. The patient with COPD is undergoing pulmonary rehabilitation by walking. What does the nurse teach this patient about when to increase his or her walking time? A. "You should increase your walking time when your rest periods decrease." B. "You should increase your walking time when your heart rate remains less than 80/minute." C. "You should increase your walking time when you are no longer short of breath." D. "You should increase your walking time when you do not need to use an inhaler."

A

54. The nurse has completed a community presentation about lung cancer. Which statement from a participant demonstrates an understanding of the information presented? A. "The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid secondhand smoke." B. "The overall 5-year survival rate for all patients with lung cancer is 85%." C. "The death rate for lung cancer is less than prostate, breast, and colon cancer combined." D. "Cures are most likely for patients who undergo treatment for stage III disease."

A

59. The nurse is caring for a patient with a chest tube. What is the correct nursing intervention for this patient? A. The patient is encouraged to cough and do deep-breathing exercises frequently. B. "Stripping" of the chest tubes is done routinely to prevent obstruction by blood clots. C. Water level in the suction chamber need not be monitored, just the collection chamber. D. Drainage containers are positioned upright or on the bed next to the patient.

A

69. A patient has developed pulmonary hypertension. What is the goal of drug therapy for this patient? A. Dilate pulmonary vessels and prevent clot formation. B. Decrease pain and make the patient comfortable. C. Improve or maintain gas exchange. D. Maintain and manage pulmonary exacerbation.

A

7. The nurse is helping a patient learn about managing her asthma. What does the nurse instruct the patient to do? A. Keep a symptom diary to identify what triggers the asthma attacks. B. Make an appointment with an allergist for allergy therapy. C. Take a low dose of aspirin every day for the anti-inflammatory action. D. Drinks large amounts of clear fluid to keep mucus thin and watery.

A

70. A patient is newly diagnosed with sarcoidosis. Which statement by the patient indicates an understanding of the disease? A. "Corticosteroids are the main type of therapy for sarcoidosis." B. "Sarcoidosis is a type of lung cancer that is treatable if diagnosed early." C. "My condition can be treated with antibiotics." D. "Sarcoidosis is a type of pneumonia that is highly contagious."

A

72. A patient with a history of asthma enters the emergency department with severe dyspnea, accessory muscle involvement, neck vein distention, and severe inspiratory/expiratory wheezing. The nurse is prepared to assist the provider with which emergency procedure if the patient does not respond to initial interventions? A. Intubation B. Needle thoracentesis C. Chest tube insertion D. Pleurodesis

A

74. The nurse is instructing a patient to use a flutter-valve mucus clearance device. What should the patient be taught to do? A. Inhale deeply and exhale forcefully through the device. B. Use an inhalation technique that is similar to the handheld inhaler. C. Use pursed-lip breathing before and after usage. D. Exhale slowly through the nose, and then inhale by sniffing.

A

What is the nurse's best first action to prevent harm for a client with chronic obstructive pulmonary disease (COPD) who is 1 day postoperative and now has an SpO2 of 83%? A. Apply oxygen. B. Raise the head of the bed. C. Recheck the SpO2 on a different body area. D. Instruct the client to use the incentive spirometer immediately.

A All actions are appropriate for the nurse to take to help this client. The SpO2 of 83% indicates hypoxemia and this must be corrected first with supplemental oxygen. Ideally, a client with COPD does not have an SpO2 of less than 88%. It is possible that the pulse oximeter is not working properly or is incorrectly positioned providing a falsely low SpO2 but applying oxygen to improve gas exchange is the priority before checking the accuracy of the reading.

Which client with a respiratory problem having a sudden onset of extreme shortness of breath causes the nurse to suspect primary pulmonary arterial hypertension (PAH) as a possible cause of the problem? A. 27-year-old woman whose mother dies of PAH B. 55-year-old man with a 70 pack-year smoking history C. 65-year-old woman with chronic obstructive pulmonary disease (COPD) D. 70-year-old man who had a pneumonectomy 1 year ago for lung cancer

A Although rare, primary PAH has a genetic component and is more common among women than men. Smoking does not contribute to the development of primary PAH but may play more of a role in secondary PAH. As COPD progresses, it does not increase pulmonary pressures but this is a type of secondary PAH, not primary. Lung removal does not cause primary PAH in the remaining lung.

Which symptom in a client with chronic obstructive pulmonary disease (COPD) does the nurse associate directly with chronic hypoxemia? A. Finger clubbing B. Barrel chest C. Pursed-lip breathing D. Increased mucous production

A Chronic hypoxemia from any pathologic condition (pulmonary or cardiovascular) causes finger clubbing. Barrel chest is caused by air trapping. Pursed-lip breathing is a change in breathing pattern taught to clients with COPD to prevent both airway and alveolar collapse. Increased mucous production is a result of the presence of airway inflammation and chronic bronchitis, not hypoxemia.

Which action will the nurse perform to promote comfort for a client with dyspnea from advanced lung cancer? A. Providing supplemental oxygen via cannula or mask B. Providing nonopioid pain medication when the client requests it C. Encouraging coughing, deep-breathing, and independent ambulation D. Placing the client in a supine position with a pillow under the knees and legs

A Only providing supplemental oxygen can reduce dyspnea. Nonopioids do not relieve dyspnea although opioids may. Coughing, deep-breathing, and independent ambulation may all make dyspnea worse as will being in a supine position.

Which symptom in a client having an acute asthma episode indicates to the nurse that the attack is becoming more severe? A. Loud wheezing is heard on inhalation as well as exhalation. B. The end-tidal carbon dioxide level is decreasing. C. The respiratory cycle is becoming shorter. D. The client's heart rate is decreasing.

A Respiratory effort is needed for inhalation to overcome elastic recoil of the lungs, whereas exhalation is a largely passive event not requiring muscle effort. Thus, when airflow is impaired, wheezing is heard first on exhalation. As the impairment becomes worse, the client has audible or even loud wheezing on inhalation as well as exhalation. With narrowed airways, air movement out and in is impeded and the actual respiratory cycle becomes longer. As the effectiveness of ventilation decreases, gas exchange decreases and carbon dioxide levels in exhaled air increases. Heart rate increases rather than decreases whenever gas exchange is impaired.

Which laboratory test will the nurse expect to be ordered as most appropriate for an adult client who has persistent pulmonary symptoms to determine whether cystic fibrosis (CF) is the cause? A. Sweat chloride level B. Alpha1-antitrypsin (AAT) levels C. Arterial blood gas (ABG) analysis D. Genetic analysis of the CFTR gene

A The defect in the CFTR gene that causes CF results in a high concentration of chloride ions being present in the affected client's sweat. It is a quick, noninvasive, and inexpensive way to determine whether or not the client has any form of CF. Genetic analysis of the CFTR gene to determine the exact mutation is performed later after the diagnosis is made to assess which therapy may be beneficial. Alpha1-antitrypsin (AAT) levels are normal in CF. ABGs are nonspecific and only indicate gas exchange adequacy or inadequacy (and whether the problem is chronic or acute), not CF.

Which activities will the nurse indicate are safe to perform without causing lung problems for a client with cystic fibrosis (CF) who had a bilateral lung transplant 6 months ago? Select all that apply. A. Bowling B. Hiking C. Playing chess with a friend with asthma D. Riding a bicycle E. Sledding F. Swimming

A, B, C, D, E, F After healing from lung transplantation surgery, there are no activity restrictions related to the new lungs.

71. The nurse is providing discharge instructions to a patient with pulmonary fibrosis and the family. What instructions are appropriate for this patient's diagnosis? (Select all that apply.) A. Using home oxygen B. Maintaining activity level as before C. Preventing respiratory infections D. Limiting fluid intake E. Energy conservation measures

A, C, E

A client has just been admitted to the intensive care unit after having a left lower lobectomy with a video-assisted thoracoscopic surgery. Which of these requests will the nurse implement first? A) Adjust oxygen flow rate to keep O2 saturation at 93% to 100%. B) Administer 2 g of cephalothin (Keflin) IV now. C) Give morphine sulfate 4 to 6 mg IV for pain. D) Infuse 1 unit of packed red blood cells (PRBCs) over the next 2 hours. (Chp. 30; elseview resources)

A) Adjust oxygen flow rate to keep O2 saturation at 93% to 100%. (Chp. 30; elseview resources)

A client with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? A) Albuterol (Proventil) 2 inhalations B) Fluticasone (Flovent) 2 inhalations C) Ipratropium (Atrovent) 2 inhalations D) Salmeterol (Serevent) 2 inhalations (Chp. 30; elseview resources)

A) Albuterol (Proventil) 2 inhalations (Chp. 30; elseview resources)

After surgery for placement of a chest tube, the client reports burning in the chest. What does the nurse do first? A) Assess the airway, breathing, and circulation. B) Call for the Rapid Response Team. C) Check the patency of the chest tubes. D) Listen for breath sounds. (Chp. 30; elseview resources)

A) Assess the airway, breathing, and circulation (Chp. 30; elseview resources)

Because clients with cystic fibrosis (CF) are at increased risk for infection, what will the nurse advise the client with CF who is infected with Burkholderia cepacia to do? A) Avoid Cystic Fibrosis Foundation-sponsored events. B) Avoid the hospital. C) Stay at home most of the time. D) Use an antiseptic hand gel. (Chp. 30; elseview resources)

A) Avoid Cystic Fibrosis Foundation-sponsored events. (Chp. 30; elseview resources)

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? A) Barrel chest B) Cough C) Dyspnea D) Reduced gas exchange(Chp. 30; elseview resources)

A) Barrel chest (Chp. 30; elseview resources)

While the nurse is talking with the postoperative thoracic surgery client, the client coughs and the chest tube collection water seal chamber bubbles. What does the nurse do? A) Calmly continues talking B) Checks the tube for blocks or kinks C) Immediately calls the health care provider D) Strips the chest tube (Chp. 30; elseview resources)

A) Calmly continues talking (Chp. 30; elseview resources)

All of these clients are being cared for on the intensive care stepdown unit. Which client should the charge nurse assign to an RN who has floated from the pediatric unit? A) Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask. B) Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour. C) Client with emphysema who requires instruction about correct use of oxygen at home. D) Client with lung cancer who has just been transferred from the intensive care unit after having a left lower lobectomy the previous day. (Chp. 30; elseview resources)

A) Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask. (Chp. 30; elseview resources)

Which factors or conditions that increase the risk for development of chronic obstructive pulmonary disease (COPD) will the nurse include in preparing client education materials? Select all that apply. A. Alpha1-antitrypsin (AAT) deficiency B. Chronic exposure to inhalation irritants C. Cigarette smoking D. History of asthma E. Mutations in the CFTR gene F. Pulmonary protease deficiency

A, B, C, D Well known factors or conditions associated with development of COPD include cigarette smoking, chronic exposure to inhalation, and AAT deficiency. A newer identified factor is asthma. The incidence of COPD is reported to be 12 times greater among adults with asthma than among adults without asthma. Mutations in the CFTR gene cause cystic fibrosis, not COPD. One of the pathologic mechanisms for the injury to elastic tissues leading to emphysema in an excess of pulmonary proteases.

Which instructions are most important for the nurse to teach a female client with pulmonary artery hypertension (PAH) who is prescribed an oral endothelin-receptor antagonist therapy at home? Select all that apply. A. Report any yellowing of the skin or whites of the eyes to your pulmonologist immediately. B. If you are sexually active, be sure to use two reliable methods of contraception. C. Get up slowly from a lying or sitting position. D. Do not break, chew, or crush the drug tablet. E. Take the drug with a full glass of water. F. Avoid drinking alcoholic beverages.

A, B, C, D, E, F Although the oral endothelin-receptor antagonist drugs are beneficial to clients with PAH, they are dangerous drugs with many side effects, including liver toxicity (so clients must avoid alcohol consumption and assess daily for indications of jaundice), postural hypotension, and inducing birth defects. These drugs are not to be crushed, chewed, or broken, and must be taken with a full glass of water.

23. In obtaining a history for a patient with chronic airflow limitation, which risk factors are related to potentially causing or triggering the disease process? (Select all that apply.) A. Cigarette smoking B. Occupational and air pollution C. Genetic tendencies D. Smokeless tobacco E. Occupation

A, B, C, E

After collaboration with the registered dietitian nutritionist, the nurse expects to reinforce which nutritional changes to the client with chronic obstructive pulmonary disease (COPD)? Select all that apply. A. Increasing protein intake B. Avoiding dry or crumbly food C. Eating all fruit and vegetables raw D. Eating six smaller meals instead of three larger ones daily E. Drinking as much fluid as possible during meals to reduce coughing F. Greatly increasing the percentage of carbohydrate consumed daily

A, B, D The client with COPD often has nausea, early satiety, poor appetite, and meal-related dyspnea. The work of breathing raises total calorie and protein needs, which can lead to protein-calorie malnutrition. Although all food groups are important, recommendations include increasing proteins and relying less on carbohydrates. To avoid early satiety, clients are instructed to avoid drinking liquids with meals and to eat smaller meals more frequently. Dry or crumbly food is avoided because these foods increase coughing, which may make the client too fatigues to eat. Foot that requires a lot of chewing also may make the client too fatigues to eat. Fruits and vegetables that are cooked and require less chewing are recommended.

34. The patient with COPD is taking systemic theophylline. What specific precautions must the nurse use when caring for this patient? (Select all that apply.) A. Monitor serum theophylline levels. B. Alert the healthcare provider for any abnormal values. C. Administer the drug using a metered-dose inhaler (MDI). D. Assess the patient for adverse reactions related to a toxic level. E. Monitor the patient's heart rate.

A, B, D, E

6. A patient with chronic obstructive pulmonary disease (COPD) is likely to have which findings on assessment? (Select all that apply.) A. Increased anteroposterior (AP) diameter of the chest B. Sitting in a chair leaning forward with elbows on knees C. Unintentional weight gain D. Decreased appetite E. Unexplained weight loss

A, B, D, E

Which assessment findings will the nurse associate with the possibility of lung cancer? Select all that apply. A. Dyspnea B. Persistent cough C. Abdominal pain D. Change in voice quality E. Use of accessory muscles F. Dark yellow-colored sputum

A, B, D, E Common symptoms of lung cancer include hoarseness, cough, sputum production, hemoptysis, shortness of breath, labored breathing, and reduced endurance. Abdominal pain is not associated with lung cancer. Although increased sputum production occurs, it is frequently blood-tinged. Dark yellow sputum is associated with respiratory infections, especially viral pneumonia.

2. Which are characteristics of asthma? (Select all that apply.) A. Narrowed airway lumen due to inflammation B. Increased eosinophils C. Decreased breathing cycle D. Intermittent bronchospasm E. Loss of elastic recoil F. Stimulation of disease process by allergies

A, B, D, F

Which assessment findings does the nurse expect to see in a client having an acute asthma attack? Select all that apply. A. Audible wheezing B. Breathlessness while speaking C. Clubbing of the fingers D. Cyanosis of the nail beds E. Use of pursed-lip respirations F. Sternal retractions

A, B, D, F Common symptoms during an asthma attack are an audible wheeze and increased respiratory rate making the client breathless and unable to speak more than a few words between breaths. If hypoxemia is present, cyanosis of the nail beds and oral mucous membranes may be present. Client may need to use accessory muscles to help breathe during an attack, which is seen as muscle retraction at the sternum. Clubbing of the fingers occurs only with disorders that are associated with chronic, continuous hypoxia, not an intermittent problem of asthma. Clients who have COPD use pursed-lip respirations, which are slow and deep, and those having an acute asthma attack do not use this form of respiration.

Which characteristics are most commonly associated with asthma? Select all that apply. A. Airway hyperresponsiveness B. Narrowed airway lumen C. Chronic bronchitis D. Dilated alveoli E. Excessive inflammation F. Leukocyte activation G. Reversible airway obstruction H. Bronchiolar smooth muscle constriction

A, B, E, F, G, H Asthma is a chronic disease in which reversible airway obstruction occurs intermittently, reducing airflow. Airway obstruction occurs by excessive inflammation and airway tissue sensitivity (hyperresponsiveness) with bronchoconstriction. Lumens are narrowed by inflammation and constriction of bronchiolar smooth muscle. Inflammation begins with leukocyte activation, especially of the eosinophils and the neutrophils. Airway hyperresponsiveness and constriction of bronchial smooth muscle narrow the tubular structure of the airways. Asthma is an airway disease and the alveoli are not directly affected. Infectious or inflammatory chronic bronchitis is not a feature or characteristic of asthma.

Which signs and symptoms in a client with long-standing chronic obstructive pulmonary disease (COPD) indicate to the nurse the possibility of cor pulmonale? Select all that apply. a. Dependent edema B. Distended neck veins C. Systemic high blood pressure D. Hypoxemia and acidosis E. Paralysis of airway cilia F. Swollen liver

A, B, F Cor pulmonale is right-sided heart failure that develops as a result of the right ventricle overworking to pump blood into the lungs that have a high vascular pressure from long-term COPD. Blood backs up into the venous vascular system, causing dependent edema, distended neck veins (even when the client is in the upright position), nausea and other GI problems, and a swollen and tender liver. Systemic blood pressure is actually low because not as much blood is getting to the left side of the heart, which is responsible for mean arterial pressure. Hypoxemia and acidosis to some degree are present in all clients with COPD, not just those who have cor pulmonale. Paralysis of cilia is common in anyone who smokes cigarettes and is not a specific sign or symptom of cor pulmonale.

Which suggestions will the nurse make to a client with asthma who is a runner to prevent an exercise-induced attack? Select all that apply. A. Use your reliever inhaler before starting your run. B. Dress in extra clothing during cold weather. C. Run on an indoor track during cold weather. D. Use pursed-lip breathing during the run. E. Exercise early in the morning before the day becomes too warm. F. Avoid eating solid foods before starting your run.

A, C Use of a reliever inhaler before exercise begins can help prevent an asthma attack by inducing or increasing bronchodilation. Exercising in cold, dry air is an airway irritant that usually exacerbates exercise-induced asthma. Changing the environment during cold weather by running on an indoor track can help prevent an attack. Dressing warmly does not affect the temperature of the inhaled air or reduce exercise-induced asthmas as a trigger. Using pursed-lip breathing does not contribute to bronchodilation. Exercising before the day becomes too warm is a good idea for other reasons, but does not help prevent exercise-induced asthma. Although eating solid food before running may cause discomfort during the run, it does not trigger exercise-induced asthma.

31. In assisting a patient with chronic airflow limitation to relive dyspnea, which sitting positions are beneficial to the patient for breathing? (Select all that apply.) A. On edge of chair, leaning forward with arms folded and resting on a small table B. In a low semi-reclining position with the shoulders back and knees apart C. Forward in a chair with feet spread apart and elbows placed on the knees D. Head slightly flexed, with feet spread apart and shoulders relaxed E. Low semi-Fowler's position with knees elevated

A, C, D

Which key elements will the nurse teach or reinforce to a client for self-management with a personal asthma action plan? Select all that apply. A. A schedule for prescribed daily controlled drug(s) and directions for prescribed reliever drug B. Daily assessment of symptom severity with a peak flow meter C. Client-specific daily asthma control assessment questions D. Directions for adjusting the daily controlled drug schedule E. Emergency actions to take when asthma is not responding to controller and reliever drugs F. When to contact the primary health care provider (in addition to regularly scheduled visits)

A, C, D, E, F All the above-listed elements are key parts of a personal asthma action plan except for option B. At one time, clients were instructed to assess their asthma severity at least daily with a peak flow meter. However, this process if now only recommended for those clients whose asthma is not well controlled.

3. The nurse is caring for an older adult patient with a chronic respiratory disorder. Which interventions are best to use in caring for this patient? (Select all that apply.) A. Provide rest periods between activities such as bathing, meals, and ambulation. B. Place the patient in a supine position after meals to allow fore rest. C. Schedule drug administration around routine activities to increase adherence to drug therapy. D. Arrange chairs in strategic locations to allow the patient to walk and rest. E. Teach the patient to avoid getting the pneumococcal vaccine. F. Encourage the patient to have an annual flu vaccination.

A, C, D, F

49. The nurse is caring for a patient who has CF. Which assessment findings indicate the need for exacerbation therapy? (Select all that apply.) A. New-onset crackles B. Increased activity tolerance C. Increased frequency of coughing D. Increased chest congestion E. Increased SaO2 F. At least a 10% decrease in FEV1

A, C, D, F

56. Which of the following may be warnings signs of lung cancer? (Select all that apply.) A. Dyspnea B. Dark yellow-colored sputum C. Persistent cough or change in cough D. Abdominal pain and frequent stools E. Recurring episodes of pleural effusion

A, C, E

The nurse will recognize which differences in common drug therapy for a client who has chronic obstructive pulmonary disease (COPD) from that prescribed for clients with asthma? Select all that apply. A. Addition of mucolytics B. Absence of reliever drugs C. Daily use of nebulizer delivery D. Addition of cholinergic antagonists E. Controllers in combinations of three drugs F. Increased use of immunoglobulin E (IgE) antagonists

A, C, E All drugs commonly used for asthma control and relief are also used for COPD. An additional drug category for COPD management is the mucolytics, some of which are delivered by nebulizer daily. The focus for COPD management is on long-term control therapy with longer-acting drugs in two- and three-drug combinations. These are not recommended (and some are contraindicated) for asthma managment. Although cholinergic antagonists are used more commonly for COPD, they are also prescribed for asthma control. IgE antagonists are not prescribed for COPD because disease symptoms are not caused by allergens.

10. A patient with asthma is repeatedly not compliant with the medication regimen, which has resulted in the patient being hospitalized for a severe asthma attack. Which interventions does the nurse suggest to help the patient manage asthma on a daily basis? (Select all that apply.) A. Encourage active participation in the plan of care. B. Help the patient develop a flexible plan of care. C. have the pharmacist establish a plan of care. D. Teach the patient about asthma and its treatment plan. E. Assess symptom severity using a peak flowmeter 1 to 2 times per week.

A, D

1. Which of the following are characteristics of pulmonary emphysema? (Select all that apply.) A. Decreased surface area of alveoli B. Chronic thickening of bronchial walls C. Decreased respiratory rate D. Hypercapnia E. Arterial blood gases (ABGs) show chronic respiratory acidosis F. Increased eosinophils

A, D, E

17. What are the goals of drug therapy in the treatment of asthma? (Select all that apply.) A. Drugs are used to reduce the asthma response. B. Weekly drugs are used to reduce the asthma response. C. Combination drugs are avoided in the treatment of asthma. D. Some patients only require drug therapy during an asthma episode. E. Drugs are used to change airway responsiveness.

A, D, E

What are the critical priority actions for the nurse to take to prevent harm when caring for a client with pulmonary artery hypertension who is receiving an infusion of a prostacyclin through a small portable IV pump? Select all that apply. A. Ensuring the infusion is never interrupted B. Monitoring arterial blood gas values (ABGs) C. Assessing for new-onset angina-like chest pain D. Teaching the client about anticoagulation therapy E. Avoiding the use of the pump line for delivery of other drugs F. Using strict aseptic technique when changing drug cassettes and site dressings

A, E, F The effectiveness of parenteral prostacyclin therapy for PAH depends on continuous infusion and interrupting the therapy even for a few minutes can have adverse effects. The line is dedicated to the use of the prostacyclin administration only to prevent disruption of therapy or the dilution of the drug concentration. A major cause of death in clients receiving this therapy is sepsis because the continuous IV infusion allows direct access of microorganisms to the blood stream. Strict asepsis is needed to prevent this potentially fatal complication. Monitoring ABGs, although important, is not a critical priority. Prostacyclin induces vasodilation and does not cause angina-like symptoms.

COMPLETION 1.A 242-pound client is being mechanically ventilated. To prevent lung injury, what setting should the nurse anticipate for tidal volume? (Record your answer using a whole number.) ___ mL .

ANS: 660 mL A low tidal volume of 6 mL/kg is used to prevent lung injury. 242 pounds = 110 kg. 110 kg × 6 mL/kg = 660 mL

20.A client has been diagnosed with a very large pulmonary embolism (PE) and has a dropping blood pressure. What medication should the nurse anticipate the client will need as the priority? a. Alteplase (Activase) b. Enoxaparin (Lovenox) c. Unfractionated heparin d. Warfarin sodium (Coumadin)

ANS: A a. Alteplase (Activase) Activase is a "clot-busting" agent indicated in large PEs in the setting of hemodynamic instability. The nurse knows this drug is the priority, although heparin may be started initially. Enoxaparin and warfarin are not indicated in this setting.

4.The nurse caring for mechanically ventilated clients uses best practices to prevent ventilator-associated pneumonia. What actions are included in this practice? (Select all that apply.) a. Adherence to proper hand hygiene b. Administering anti-ulcer medication c. Elevating the head of the bed d. Providing oral care per protocol e. Suctioning the client on a regular schedule

ANS: A, B, C, D a. Adherence to proper hand hygiene b. Administering anti-ulcer medication c. Elevating the head of the bed d. Providing oral care per protocol The "ventilator bundle" is a group of care measures to prevent ventilator-associated pneumonia. Actions in the bundle include using proper hand hygiene, giving anti-ulcer medications, elevating the head of the bed, providing frequent oral care per policy, preventing aspiration, and providing pulmonary hygiene measures. Suctioning is done as needed.

3.A client with a new pulmonary embolism (PE) is anxious. What nursing actions are most appropriate? (Select all that apply.) a. Acknowledge the frightening nature of the illness. b. Delegate a back rub to the unlicensed assistive personnel (UAP). c. Give simple explanations of what is happening. d. Request a prescription for antianxiety medication. e. Stay with the client and speak in a quiet, calm voice.

ANS: A, B, C, E a. Acknowledge the frightening nature of the illness. b. Delegate a back rub to the unlicensed assistive personnel (UAP). c. Give simple explanations of what is happening. e. Stay with the client and speak in a quiet, calm voice. Clients with PEs are often anxious. The nurse can acknowledge the client's fears, delegate comfort measures, give simple explanations the client will understand, and stay with the client. Using a calm, quiet voice is also reassuring. Sedatives and antianxiety medications are not used routinely because they can contribute to hypoxia. If the client's anxiety is interfering with diagnostic testing or treatment, they can be used, but there is no evidence that this is the case.

6.The nurse caring for mechanically ventilated clients knows that older adults are at higher risk for weaning failure. What age-related changes contribute to this? (Select all that apply.) a. Chest wall stiffness b. Decreased muscle strength c. Inability to cooperate d. Less lung elasticity e. Poor vision and hearing

ANS: A, B, D a. Chest wall stiffness b. Decreased muscle strength d. Less lung elasticity Age-related changes that increase the difficulty of weaning older adults from mechanical ventilation include increased stiffness of the chest wall, decreased muscle strength, and less elasticity of lung tissue. Not all older adults have an inability to cooperate or poor sensory acuity.

5.A nurse is caring for a client who is on mechanical ventilation. What actions will promote comfort in this client? (Select all that apply.) a. Allow visitors at the client's bedside. b. Ensure the client can communicate if awake. c. Keep the television tuned to a favorite channel. d. Provide back and hand massages when turning. e. Turn the client every 2 hours or more.

ANS: A, B, D, E a. Allow visitors at the client's bedside. b. Ensure the client can communicate if awake. d. Provide back and hand massages when turning. e. Turn the client every 2 hours or more. There are many basic care measures that can be employed for the client who is on a ventilator. Allowing visitation, providing a means of communication, massaging the client's skin, and routinely turning and repositioning the client are some of them. Keeping the TV on will interfere with sleep and rest.

23.A nurse is caring for a client on the medical stepdown unit. The following data are related to this client: Subjective Information Laboratory Analysis Physical Assessment Shortness of breath for 20 minutes Feels frightened "Can't catch my breath" pH: 7.12 PaCO2: 28 mm Hg PaO2: 58 mm Hg SaO2: 88% Pulse: 120 beats/min Respiratory rate: 34 breaths/min Blood pressure 158/92 mm Hg Lungs have crackles What action by the nurse is most appropriate? a. Call respiratory therapy for a breathing treatment. b. Facilitate a STAT pulmonary angiography. c. Prepare for immediate endotracheal intubation. d. Prepare to administer intravenous anticoagulants.

ANS: B b. Facilitate a STAT pulmonary angiography. This client has manifestations of pulmonary embolism (PE); however, many conditions can cause the client's presentation. The gold standard for diagnosing a PE is pulmonary angiography. The nurse should facilitate this test as soon as possible. The client does not have wheezing, so a respiratory treatment is not needed. The client is not unstable enough to need intubation and mechanical ventilation. IV anticoagulants are not given without a diagnosis of PE.

A nurse cares for a client who has a chest tube. When would this client be at highest risk for developing a pneumothorax? a. When the insertion site becomes red and warm to the touch b. When the tube drainage decreases and becomes sanguineous c. When the client experiences pain at the insertion site d. When the tube becomes disconnected from the drainage system

D

1.A nurse is caring for five clients. For which clients would the nurse assess a high risk for developing a pulmonary embolism (PE)? (Select all that apply.) a. Client who had a reaction to contrast dye yesterday b. Client with a new spinal cord injury on a rotating bed c. Middle-aged man with an exacerbation of asthma d. Older client who is 1-day post hip replacement surgery e. Young obese client with a fractured femur

ANS: B, D, E b. Client with a new spinal cord injury on a rotating bed d. Older client who is 1-day post hip replacement surgery e. Young obese client with a fractured femur Conditions that place clients at higher risk of developing PE include prolonged immobility, central venous catheters, surgery, obesity, advancing age, conditions that increase blood clotting, history of thromboembolism, smoking, pregnancy, estrogen therapy, heart failure, stroke, cancer (particularly lung or prostate), and trauma. A contrast dye reaction and asthma pose no risk for PE.

3.A client has a pulmonary embolism and is started on oxygen. The student nurse asks why the client's oxygen saturation has not significantly improved. What response by the nurse is best? a. "Breathing so rapidly interferes with oxygenation." b. "Maybe the client has respiratory distress syndrome." c. "The blood clot interferes with perfusion in the lungs." d. "The client needs immediate intubation and mechanical ventilation."

ANS: C c. "The blood clot interferes with perfusion in the lungs." A large blood clot in the lungs will significantly impair gas exchange and oxygenation. Unless the clot is dissolved, this process will continue unabated. Hyperventilation can interfere with oxygenation by shallow breathing, but there is no evidence that the client is hyperventilating, and this is also not the most precise physiologic answer. Respiratory distress syndrome can occur, but this is not as likely. The client may need to be mechanically ventilated, but without concrete data on FiO2 and SaO2, the nurse cannot make that judgment.

15.A client has been brought to the emergency department with a life-threatening chest injury. What action by the nurse takes priority? a. Apply oxygen at 100%. b. Assess the respiratory rate. c. Ensure a patent airway. d. Start two large-bore IV lines.

ANS: C c. Ensure a patent airway. The priority for any chest trauma client is airway, breathing, circulation. The nurse first ensures the client has a patent airway. Assessing respiratory rate and applying oxygen are next, followed by inserting IVs.

41. A family member of a patient with COPD asks the nurse, "What is the purpose of making him cough on a routine basis?" What is the nurse's best response? A. "We have to check the color and consistency of his sputum." B. "We don't want him to feel embarrassed when coughing in public, so we actively encourage it." C. "It improves air exchange by increasing airflow in the larger airways." D. "If he cannot cough, the provider may elect to do a tracheostomy."

C

44. A patient is admitted with asthma. Which assessment findings are most likely to indicate that the patient's asthma condition is deteriorating and progressing toward respiratory failure? A. Crackles, rhonchi, and productive cough with yellow sputum B. Tachypnea; thick, tenacious sputum; and hemoptysis C. Audible breath sounds, wheezing, and use of accessory muscles D. Respiratory alkalosis; slow, shallow respiratory rate

C

46. The nurse assesses a patient and finds a dusky appearance with bluish mucous membranes and production of lots of mucus. What illness does the nurse suspect? A. Asthma B. Emphysema C. Chronic bronchitis D. Acute bronchitis

C

52. The nurse is caring for a patient with bronchiolitis obliterans organizing pneumonia (BOOP) that has been confirmed by biopsy. What treatment does the nurse expect for this patient? A. A course of 10 to 14 days of antibiotics B. Use of chest physiotherapy to mobilize secretions C. A short course of corticosteroid drug therapy D. Bronchodilation by MDI

C

53. A patient has prolonged occupational exposure to petroleum distillates and subsequently developed a chronic lung disease. This patient is advised to seek frequent health examinations because there is high risk for developing which respiratory disease condition? A. Tuberculosis B. Cystic fibrosis C. Lung cancer D. Pulmonary hypertension

C

57. Which statement is true about radiation therapy for lung cancer patients? A. It is given daily in "cycles" over the course of several months. B. It causes hair loss, nausea, and vomiting for the duration of treatment. C. It causes dry skin at the radiation site, fatigue, and changes in appetite with nausea. D. It is the best method of treatment for systemic metastatic disease.

C

8. A nurse cares for a client who had a bronchoscopy 2 hours ago. The client asks for a drink of water. What action would the nurse take next? a. Call the primary health care provider and request food and water for the client. b. Provide the client with ice chips instead of a drink of water. c. Assess the client's gag reflex before giving any food or water. d. Let the client have a small sip to see whether he or she can swallow.

ANS: C The topical anesthetic used during the procedure will have affected the client's gag reflex. Before allowing the client anything to eat or drink, the nurse must check for the return of this reflex. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Respiratory assessment, Diagnostic testing MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2.When working with women who are taking hormonal birth control, what health promotion measures should the nurse teach to prevent possible pulmonary embolism (PE)? (Select all that apply.) a. Avoid drinking alcohol. b. Eat more omega-3 fatty acids. c. Exercise on a regular basis. d. Maintain a healthy weight. e. Stop smoking cigarettes.

ANS: C, D, E c. Exercise on a regular basis. d. Maintain a healthy weight. e. Stop smoking cigarettes. Health promotion measures for clients to prevent thromboembolic events such as PE include maintaining a healthy weight, exercising on a regular basis, and not smoking. Avoiding alcohol and eating more foods containing omega-3 fatty acids are heart-healthy actions but do not relate to the prevention of PE.

22.A student nurse asks for an explanation of "refractory hypoxemia." What answer by the nurse instructor is best? a. "It is chronic hypoxemia that accompanies restrictive airway disease." b. "It is hypoxemia from lung damage due to mechanical ventilation." c. "It is hypoxemia that continues even after the client is weaned from oxygen." d. "It is hypoxemia that persists even with 100% oxygen administration."

ANS: D d. "It is hypoxemia that persists even with 100% oxygen administration." Refractory hypoxemia is hypoxemia that persists even with the administration of 100% oxygen. It is a cardinal sign of acute respiratory distress syndrome. It does not accompany restrictive airway disease and is not caused by the use of mechanical ventilation or by being weaned from oxygen.

21.A client is brought to the emergency department after sustaining injuries in a severe car crash. The client's chest wall does not appear to be moving normally with respirations, oxygen saturation is 82%, and the client is cyanotic. What action by the nurse is the priority? a. Administer oxygen and reassess. b. Auscultate the client's lung sounds. c. Facilitate a portable chest x-ray. d. Prepare to assist with intubation.

ANS: D d. Prepare to assist with intubation. This client has manifestations of flail chest and, with the other signs, needs to be intubated and mechanically ventilated immediately. The nurse does not have time to administer oxygen and wait to reassess, or to listen to lung sounds. A chest x-ray will be taken after the client is intubated.

What does the nurse do first when setting up a safe environment for the new client on oxygen? A) Ensures that staff members wear protective clothing B) Ensures that no combustion hazards are present in the room C) Sets the oxygen delivery to maintain no fewer than 16 breaths/min D) Uses a pulse oximetry unit (Chp. 30; elseview resources)

B) Ensures that no combustion hazards are present in the room (Chp. 30; elseview resources)

32. The nurse is developing a teaching plan for a patient with chronic airflow limitation using the priority patient problem of insufficient knowledge related to energy conservation. What does the nurse advise the patient to avoid? A. Performing activities at a relaxed pace throughout the day with rest periods B. Working on activities that require using arms at chest level or lower C. Eating three large meals per day D. Talking and performing activities separately

C

55. Which sites are commonly affected by lung cancer metastasis? (Select all that apply.) A. Heart B. Bone C. Liver D. Colon E. Brain

B, C, E

36. A patient with asthma has been prescribed a fluticasone (Flovent) inhaler. What is the purpose of this drug for the patient? A. Relaxes the smooth muscles of the airway B. Acts as a bronchodilator in severe episodes C. Reduces obstruction of airways by decreasing inflammation D. Reduces the histamine effect of the triggering agent

C

51. The nurse is working for a manufacturing company and is responsible for routine employee health issues. Which primary prevention is most important for those employees at high risk for occupational pulmonary disease? A. Screen all employees by use of chest x-ray films twice a year. B. Advise employees not to smoke, and to use masks and ventilation equipment. C. Perform pulmonary function tests once a year on all employees. D. Refer at-risk employees to a social worker for information about pensions.

B

Which new-onset problem in a client diagnosed with advanced lung cancer indicates to the nurse probably metastasis? A. Anorexia B. Bone pain C. Insomnia D. Dyspnea

B A common site for metastasis of lung cancer is the bone, which increases the pressure in the bone and causes pain. Anorexia and weight loss are common with advanced lung cancer as a result of increasing shortness of breath and the energy needed for the increased work of breathing. Dyspnea occurs as a result of the primary tumor in the lungs or airways and not metastasis.

Which arterial blood gas (ABG) value indicates to the nurse that a client with asthma demonstrating increased respiratory effort is in the early phase of the attack? A. PaCO2 of 60 mm Hg B. PaCO2 of 30 mm Hg C. pH of 7.40 D. PaO2 of 86 mm Hg

B ABG levels show the effectiveness of gas exchange. Early in the attack, the arterial carbon dioxide level (PaCO2) may be decreased as the client increases the breathing rate and depth. Later in an asthma episode, PaCO2 rises indicating carbon dioxide retention. The pH is in the normal range and the PaO2 is low, which usually occurs later in the attack as respiratory effort becomes less effective.

14. A patient who is allergic to dogs experiences a sudden "asthma attack." Which assessment findings does the nurse expect for this patient? A. Slow, deep, pursed-lip respirations B. Breathlessness and difficulty completing sentences C. Clubbing of the fingers and cyanosis of the nailbeds d. Bradycardia and irregular pulse

B

15. A patient is experiencing an asthma attack and shows an increased respiratory effort. Which arterial blood gas value is more associated with the early phase of the attack? A. PaCO2 of 60 mmHg B. PaCO2 of 30 mmHg C. pH of 7.40 D. PaCO2 of 98 mmHg

B

16. A patient who has well-controlled asthma has what kind of airway changes? A. Chronic, leading to hyperplasia B. Temporary and reversible C. Open alveoli D. Permanent and irreversible

B

20. The nurse is taking a history of a patient with chronic pulmonary disease. The patient reports often sleeping in a chair that allows his head to be elevated rather than sleeping in a chair that allows his head to be elevated rather than sleeping in a bed. The patient's behavior is a strategy to deal with which condition? A. Paroxysmal nocturnal dyspnea B. Orthopnea C. Tachypnea D. Cheyne-Stokes respirations

B

24. Which statement is true about the relationship of smoking cessation to the pathophysiology of COPD? A. Smoking cessation completely reverses the damage to the lungs. B. Smoking cessation slows the rate of disease progression. C. Smoking cessation is an important therapy for asthma but not for COPD. D. Smoking cessation reverses the effects on the airways but not the lungs.

B

25. A patient has a history of COPD but is admitted for a surgical procedure that is unrelated to the respiratory system. To prevent any complications related to the patient's COPD, what action does the nurse take? A. Assess the patient's respiratory system every 8 hours. B. Monitor for signs and symptoms of pneumonia. C. Give high-flow oxygen to maintain pulse oximetry readings. D. Instruct the patient to use a tissue if coughing or sneezing.

B

28. A patient with respiratory difficulty has completed a pulmonary function test before starting any treatment. The peak expiratory flow (PEF) is 15% to 20% below what is expected for this adult patient's age, gender, and size. The nurse anticipates this patient will need additional information about which topic? A. Further diagnostic tests to confirm pulmonary hypertension B. How to manage asthma medications and identify triggers C. Smoking cessation and its relationship to COPD D. How to manage the acute episode of respiratory infection

B

35. A patient is receiving ipratropium (Atrovent) and reports nausea, blurred vision, headache, and inability to sleep. What action does the nurse take? A. Administer a PRN medication for nausea and a milk PRN sedative. B. Report these symptoms to the provider as signs of overdose. C. Obtain a provider's request for an ipratropium level. D. Tell the patient that these side effects are normal and not to worry.

B

38. The nurse is teaching a patient with chronic airflow limitation about his medications. What is the correct sequence for administering aerosol treatment? A. Bronchodilator should be taken 5 to 10 minutes after the steroid. B. Bronchodilator should be taken at least 5 minutes before other inhaled drugs. C. Bronchodilator should be taken immediately after the steroid. D. Bronchodilator and steroid are two different classes of drugs, so sequence is irrelevant.

B

43. The nurse is caring for a patient with chronic bronchitis, and notes the following clinical findings: fatigue, dependent edema, distended neck veins, and cyanotic lips. What condition is the patient exhibiting? A. COPD B. Cor pulmonale C. Asthma D. Lung cancer

B

5. The nurse is presenting a community education lecture about respiratory disorders. Which statement by a participant indicates a correct understanding of the information? A. "Bronchitis is a genetic disease that affects many organs." B. "In bronchial asthma, an airway obstruction can be caused by inflammation." C. "In chronic bronchitis, the tissue damage is only temporary and reversible." D. "Smoking cessation reverses the tissue damage caused by emphysema."

B

63. The nurse has determined that a patient with COPD has the priority problem of impaired oxygenation related to reduced airway size, ventilator muscle fatigue, and excessive mucus production. Which action is best to delegate to the unlicensed assistive personnel (UAP)? A. Observe the patient for fatigue, shortness of breath, or change of breathing pattern during activities of daily living (ADLs). B. Report a respiratory rate of greater than 24/min at rest or 30/min after ambulating to the nurses' station. C. Encourage the patient to cough up sputum, and examine the color, consistency, and amount. D. Record and monitor the patient's intake and output, and give fluids to keep the secretions thin.

B

64. A patient is receiving a chemotherapy agent for lung cancer. The nurse anticipates that the patient is likely to have which common side effect? A. Diarrhea B. Nausea C. Flatulence D. Constipation

B

68. A patient is diagnosed with cor pulmonale secondary to pulmonary hypertension and is receiving an infusion of epoprostenol (Flolan) through a small portable IV pump. What is the critical priority for this patient? A. Strict aseptic technique must be used to prevent sepsis. B. Infusion must not be interrupted, even for a few minutes. C. The patient must have a daily dose of warfarin (Coumadin). D. The patient must be assessed for angina like chest pain and fatigue.

B

9. The nurse teaches a patient with asthma to monitor for which problem while exercising? A. Increased peak expiratory flow rates B. Wheezing from bronchospasm C. Swelling in the feet and ankles D. Respiratory muscle fatigue

B

What is the nurse's best response to a client with chronic pulmonary disease (COPD) who states that there is no reason to quite cigarette smoking now that the disease has already been diagnosed? A. If you stop smoking now, the damage to your lungs can be reversed. B. Smoking cessation can slow the rate of your disease progression. C. You are correct, nothing will change the course of the disease now. D. You can serve as a role model to others by quitting smoking.

B Nothing reverses the existing lung damage of COPD; however, reducing or eliminating the exposure to cigarette smoke can reduce the severity of the symptoms (especially the cough and mucous production) and slow the progression of the disorder.

Which parameter indicates to the nurse that the medication administered to the client 5 minutes ago for an acute asthma attack is effective? A. SpO2 decreased from 85% to 78% B. Peak expiratory flow increased from 50% to 70%. C. The obvious use of accessory muscles during inhalation. D. Active bubbling in the humidifier chamber of the oxygen delivery system.

B Peak flow measures the effectiveness of expiratory efforts. An increased peak flow rate indicates less obstruction and greater movement of air with expiratory effort. Decreased SpO2 would indicate a worsening of the condition, not effectiveness of the therapy. The use of accessory muscles indicates that the work of breathing has increased. The active bubbling in the humidification chamber is not related to the client's respiratory effort or the drug therapy's effectiveness.

Using the GOLD classification system, how will the nurse categorize the severity of respiratory impairment for a client with chronic obstructive pulmonary disease (COPD) whose FEV1 now consistently measures 60% of the predicted value for the client's age? A. Mild B. Moderate C. Severe D. Very severe

B The GOLD classification identifies a consistent FEV1 between 50% to 79% of predicted in a client with COPD as moderate severity. Mild severity has an FEV1 equal to or greater than 80%, severe between 30% to 49%, and very severe less than 30% of predicted.

Which subjective assessment findings will the nurse expect in a client who has just been diagnosed with early-stage pulmonary arterial hypertension (PAH)? A. Difficulty concentrating and anorexia B. Dyspnea and fatigue C. Cyanosis and finger clubbing D. Hypotension and headache

B The most common early symptoms are dyspnea and fatigue in an otherwise healthy adult. At this time, gas exchange and oxygenation remain adequate as a result of increased respiratory rate. Cyanosis occurs later and finger clubbing takes months of hypoxemia to develop. Pulmonary vessels are constricted as are systemic vessels, leading to hypertension.

39. A patient has been prescribed cromolyn sodium (Intal) for the treatment of asthma. Which statement by the patient indicates a correct understanding of this drug? A. "It opens my airways and provides short-term relief." B. "It is the medication that should be used 30 minutes before exercise." C. "It is not intended for use during acute episodes of asthma attacks." D. "It is a steroid medication, so there are severe side effects."

C

Which statement by a client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction? A) "I don't need to use my oxygen all the time." B) "I don't need to get a flu shot." C) "I need to eat more protein." D) "It is normal to feel more tired than I used to." (Chp. 30; elseview resources)

B) "I don't need to get a flu shot." (Chp. 30; elseview resources)

A client has been diagnosed with asthma. Which statement below indicates that the client correctly understands how to use an inhaler with a spacer? A) "I don't have to wait between the two puffs if I use a spacer." B) "If the spacer makes a whistling sound, I am breathing in too rapidly." C) "I should rinse my mouth and then swallow the water to get all of the medicine." D) "I should shake the inhaler only if I want to see whether it is empty." (Chp. 30; elseview resources)

B) "If the spacer makes a whistling sound, I am breathing in too rapidly." (Chp. 30; elseview resources)

The client says, "I hate this stupid COPD." What is the best response by the nurse? A) "Then you need to stop smoking." B) "What is bothering you?" C) "Why do you feel this way?" D) "You will get used to it." (Chp. 30; elseview resources)

B) "What is bothering you?" (Chp. 30; elseview resources)

The change-of-shift report has just been completed on the medical-surgical unit. Which client will the oncoming nurse plan to assess first? A) Client with chronic obstructive pulmonary disease (COPD) who is ready for discharge, but is not able to pay for prescribed home medications. B) Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min. C) Hospice client with terminal pulmonary fibrosis and an oxygen saturation level of 89%. D) Client with lung cancer who needs an IV antibiotic administered before going to surgery. (Chp. 30; elseview resources)

B) Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min. (Chp. 30; elseview resources)

The nurse is teaching a client who has been newly diagnosed with cancer. For which side effect specific to radiation does the nurse teach prevention techniques? A) Hair loss B) Increased risk for sunburn C) Loss of appetite D) Pain at site of treatment (Chp. 30; elseview resources)

B) Increased risk for sunburn (Chp. 30; elseview resources)

Which parameter indicates to the nurse that the short-acting beta-adrenergic agonist the client took 5 minutes ago for an acute asthma attack is effective? A) SpO2 decrease from 85% to 78% B) Peak expiratory flow rate increase from 50% to 70% C) The obvious use of accessory muscles during inhalation and exhalation D) Active bubbling in the humidifier chamber of the oxygen delivery system (Chp. 30; p. 557)

B) Peak expiratory flow rate increase from 50% to 70% (Chp. 30; p. 557)

4. The nurse is caring for an older adult patient with a history of chronic asthma. Which problem related to aging can influence the care and treatment of this patient? A. Asthma usually resolves with age, so the condition is less severe in older adult patients. B. It is more difficult to teach older adult patients about asthma than to teach younger patients. C. With aging, the beta-adrenergic drugs do not work as quickly or strongly. D. Older adult patients have difficulty manipulating handheld inhalers.

C

Which common features of chronic obstructive pulmonary disease COPD does the nurse recognize as increasing a client's risk for respiratory infection? Select all that apply. A. Acidosis B. Ineffective cough C. Poor ciliary function D. Inadequate nutrition E. Excessive thick mucus F. Right-sided heart failure

B, C, D, E A major factor that increases the risk for respiratory infection in a client with COPD is the presence of excessive thick mucus. It is a fertile medium for the growth of microorganisms. Thus, any problem that reduces the client's ability to cough up the mucus increases the risk, such as an ineffective cough and poor ciliary function. Clients with inadequate nutrition have weaker muscles, which also reduce coughing effectiveness. Acidosis does not directly increase the risk for respiratory infection. Right-sided heart failure results in systemic edema, which has little if any effect on risk for infection. (Left-sided failure would cause pulmonary edema and increase infection risk.)

12. Which are main purposes of asthma treatment? (Select all that apply.) A. Avoid secondhand smoke B. Improve airflow C. Relieve symptoms D. Improve exercise tolerance E. Prevent asthma episodes

B, C, E

48. A patient is undergoing diagnostic testing for possible cystic fibrosis (CF). Which nonpulmonary assessment findings does the nurse expect to observe in a patient with CF? (Select all that apply.) A. Peripheral edema B. Abdominal distention C. Steatorrhea D. Constipation E. Gastroesophageal reflux

B, C, E

Which assessment findings will the nurse expect to find in a 32-year-old client who was diagnosed with cystic fibrosis (CF) at age 6 months? Select all that apply. A. Arterial blood gases with a higher than normal pH B. History of frequent respiratory infections C. Cough and sputum production D. Chest muscle weakness E. Decreased exercise tolerance F. Barrel-shaped chest

B, C, E, F Pulmonary symptoms are usually the most obvious problems caused by CF and are progressive. Respiratory infections are frequent or chronic with exacerbations. Clients usually have chest congestion, limited exercise tolerance, cough, sputum production, use of accessory muscles, and decreased pulmonary function (especially forced vital capacity [FVC] and forced expiratory volume in the first second of exhalation [FEV1]). Chest x-rays show infiltrate and an increased anteroposterior diameter leading to a barrel chest. Clients with long-standing CF do not have chest muscle weakness because of the constant increased respiratory effort needed to breathe. A higher than normal ABG pH indicates alkalosis, not the acidosis most commonly present in these clients.

40. After the nurse has instructed a patient with COPD in the proper coughing technique, which action the next day by the patient indicates the need for additional teaching or intervention? A. Coughing upon rising in the morning B. Coughing before meals C. Coughing after meals D. Coughing at bedtime

C

13. For a patient that is a nonsmoker, which classic assessment finding of chronic airflow limitation is particularly important in diagnosing asthma? A. Cyanosis B. Dyspnea C. Audible wheezing D. Tachypnea

C

18. The nurse is teaching a patient how to interpret peak expiratory flow readings and use this information to manage drug therapy at home. Which statement by the patient indicates a need for additional teaching? A. "If the reading is in the green zone, there is no need to increase the drug therapy." B. "Red is 50% below my 'personal best'; I should try a rescue drug and seek help." C. "If the reading is in the yellow zone, I should increase my use of my inhalers." D. "If frequent yellow readings occur, I should see my provider for a change in medications."

C

19. A patient with chronic bronchitis often shows signs of hypoxia. Which clinical manifestation is the priority to look out for in this patient? A. Chronic, nonproductive, dry cough B. Clubbing of fingers C. Large amounts of thick mucus D. Barrel chest

C

22. A patient has COPD with chronic difficult breathing. In planning this patient's care, what condition must the nurse acknowledge is present in this patient? A. Decreased need for calories and protein requirements since dyspnea causes activity intolerance B. COPD has no effect on calorie and protein needs, meal tolerance, satiety, appetite, and weight C. Increased metabolism and the need for additional calories and protein supplements D. Anabolic state, which creates conditions for building body strength and muscle mass

C

26. The nurse is instructing a patient regarding complications of COPD. Which statement by the patient indicates the need for additional teaching? A. "I have to be careful because I am susceptible to respiratory infections." B. "I could develop heart failure, which could be fatal if untreated." C. "My COPD is serious, but it can be reversed if I follow my doctor's orders." D. "The lack of oxygen could cause my heart to beat in an irregular pattern."

C

61. The provider's prescriptions indicate an increase in the suction to -20cm for a patient with a chest tube. To implement this, the nurse performs which intervention? A. Increases the wall suction to the medium setting, and observes gentle bubbling in the suction chamber. B. Adds water to the suction and drainage chambers to the level of -20cm C. Stops the suction, adds sterile water to level of -20cm to the water seal chamber, and resumes the wall suction D. has the patient cough and deep-breathe, and monitors level of fluctuation to achieve -20cm

C

62. A patient is fearful that she might develop lung cancer because her father and grandfather died of cancer. She seeks advice about how to modify lifestyle factors that contribute to cancer. How does the nurse advise the patient? A. Not to worry about air pollution unless there is hydrocarbon exposure. B. Quit her job if she has continuous exposure to lead or other heavy metals C. Avoid situations where she would be exposed to "secondhand" smoke D. Not to be concerned because there are no genetic factors associated with lung cancer

C

65. A patient is having pain resulting from bone metastases caused by lung cancer. What is the most effective intervention for relieving the patient's pain? A. Support the patient through chemotherapy. B. Handle and move the patient very gently. C. Administer analgesics around the clock. D. Reposition the patient, and use distraction.

C

66. A patient has a chest tube in place. What does the water in the water seal chamber do when the system is functioning correctly? A. Bubbles vigorously and continuously B. Bubbles gently and continuously C. Fluctuates with the patient's respirations D. Stops fluctuation, and bubbling is not observed

C

73. A patient presents to the walk-in clinic with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers or medications. What is the priority nursing action? A. Establish IV access to give emergency medications. B. Obtain the equipment and prepare the patient for intubation. C. Place the patient in a high Fowler's position, and start oxygen. D. Call 911 and report that the patient has probable status asthmaticus.

C

Which arterial blood gas (ABG) value in a client with COPD does the nurse interpret as hypercarbia? A. pH= 7.19 B. HCO3-= 33 mEq/L C. PaCO2= 72 mm Hg D. PaO2= 92 mm Hg

C All of the ABG values are abnormal. Hypercapnia is an elevated arterial carbon dioxide level (also known as hypercarbia). The pH is low, indicating acidosis; however, it does not indicate that hypercapnia is the cause. The bicarbonate level is elevated but only indicates that the acidosis is chronic, not that hypercapnia is present. The carbon dioxide is very high, indicating hypercapnia (normal is 35 to 45 mm Hg). The oxygen level is low, indicating hypoxemia but not hypercapnia.

Which problem has the highest priority for the nurse to help the wife of a client with late-stage small cell lung cancer to provide symptom management in the home? A. Continuing weight loss B. Constipation C. Severe pain D. Fatigue

C Although all the listed problems are important, effective pain management is the most important issue for this client and family.

Which observation of a client's chest tube setup indicates to the nurse a leak is present in the system? A. Cessation of fluctuation in the water-seal chamber B. Increase of bubbling in the suction chamber C. Continuous bubbling in the water-seal chamber D. Decreased drainage in the collection chamber

C Bubbling of the water in the water-seal chamber indicates air drainage form the client whenever he or she exhales, coughs, or sneezes. Continuous or excessive bubbling in the water-seal chamber indicates an air leak.

With clients from which racial or ethnic group will the nurse make sure to ask about family members with cystic fibrosis when performing a pulmonary assessment? A. Asian Americans B. African Americans C. European Americans D. Hispanic or Latino Americans

C CF is most common among whites, especially European Americans from northern Europe, and about 4% (1 in 29) are carriers.

Which statement by a client with chronic obstructive pulmonary disease (COPD) does the nurse suspect that chronic bronchitis is more of a problem than emphysema? A. 52-year-old with an alpha1-antitrypsin (AAT) deficiency B. 60-year-old with a 60 pack-year cigarette smoking history C. 66-year-old with chronic hypoxia, PaCO2 of 40 mm Hg, and cyanosis D. 70-year-old with PaCO2 of 65 mm Hg, dependent edema, and SpO2 of 93%

C Clients with COPD whose pathology is chronic bronchitis rather than emphysema do not retain CO2 because the alveoli are not affected and have no difficulty eliminating this gas. The bronchitis narrows the upper airways reducing oxygenation leading to chronic hypoxia and hypoxemia, resulting in a cyanotic appearance. Cigarette smoking and an AAT deficiency are associated with development of emphysema and CO2 retention.

For which side effects of therapy will the nurse prepare a client who is about to begin external beam radiation for lung cancer? A. Constipation B. Scalp alopecia C. Chest skin redness and peeling D. Persistent abdominal pain and vomiting

C Radiation therapy is local and only the tissues in the path of the radiation beam are affected directly, in this case the chest. The skin of the chest will develop irritation, redness, peeling, and loss of chest hair. Scalp hair is unaffected. The abdomen is not in the radiation path, thus constipation is not an expected side effect of the therapy and neither are abdominal pain and persistent vomiting.

Which statement by a client with chronic obstructive pulmonary disease (COPD) indicates to the nurse a need for additional teaching about the disorder? A. "I have to be careful because I am susceptible to respiratory infections." B. "If the disease becomes more severe, I might develop serious heart failure." C. "My COPD is serious, but it can be reversed if I follow my treatment plan." D. "The lack of oxygen could cause my heart to beat in an irregular pattern."

C The tissue damage to the pulmonary system caused by COPD is not reversible; however, progression may be delayed when a client is adherent to the prescribed treatment plan. Complications of COPD include increased susceptibility to respiratory infection, hypoxia-induced cardiac dysrhythmias, and heart failure.

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse's instructions? A) "Asthma drugs help everybody breathe better." B) "I must carry my emergency inhaler only when activity is anticipated." C) "I must have my emergency inhaler with me at all times." D) "Preventive drugs can stop an attack." (Chp. 30; elseview resources)

C) "I must have my emergency inhaler with me at all times." (Chp. 30; elseview resources)

What is the greatest risk factor for lung cancer? A) Alcohol consumption B) Asbestos exposure C) Cigarette smoking D) Smoking marijuana (Chp. 30; elseview resources)

C) Cigarette smoking (Chp. 30; elseview resources)

The chest tube of a client 16 hours postoperative from a lobectomy is accidentally pulled out by a portable x-ray machine. What is the nurse's best first action? A) Clamp the tubing with padded clamps as close as possible to the insertion site. B) Reposition the client on the nonoperative side and support the tube(s) with pillows. C) Cover the insertion site with a sterile occlusive dressing and tape down on three sides. D) Don sterile gloves and attempt to reinsert the chest tube at the original insertion site. (Chp. 30; p. 579)

C) Cover the insertion site with a sterile occlusive dressing and tape down on three sides. (Chp. 30; p. 579)

A client has asthma that gets worse during the summer. She tells the nurse that she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the client? A) Albuterol (Proventil) inhaler B) Guaifenesin (Organidin) C) Montelukast (Singulair) D) Omalizumab (Xolair) (Chp. 30; elseview resources)

C) Montelukast (Singulair) (Chp. 30; elseview resources)

The nurse has been teaching improved airflow techniques to the client, who has continued to have restrictive breathing problems. Which is the best indicator of success? A) Peak flowmeter readings that are yellow after the third reading B) Productive cough C) SpO2 level of 92% after ambulating 50 feet D) Stable arterial blood gases (ABGs) (Chp. 30; elseview resources)

C) SpO2 level of 92% after ambulating 50 feet (Chp. 30; elseview resources)

Which statement(s) regarding drug therapy for asthma is (are) true? Select all that apply. A. A nursing priority for clients prescribed interleukin-5 antagonists is teaching them the correct subcutaneous technique for self-injection. B. Increases in a client's forced expiratory volume in the first second (FEV1) is a positive indicator for asthma diagnosis. C. Inhaled anti-inflammatory drugs are always used for asthma control and never for acute asthma rescue. D. Reliever drugs are delivered by inhaler and controller drugs are taken orally. E. Metered does inhalers are most effective with the use of a spacer. F. Oxygen is considered a type of asthma control drug. G. Daily magnesium sulfate prevents asthma attacks.

C, E Inhaled anti-inflammatory drugs help prevent asthma attacks from occurring but their actions are too slow to help stop an actual attack. Without a spacer, drug doses delivered by metered dose are more likely to stick to oral mucus membranes or to be exhaled through the nose instead of reaching the lower airways, which are the sites of action. Although some interleukin-5 antagonists are injected subcutaneously, the drug is associated with a relatively high risk for inducing anaphylaxis and must be administered by a health care professional in a setting prepared to handle emergency management of anaphylaxis. Narrowing of the airways during an asthma attack causes a decrease in forced expiratory volume in the first second (FEV1), not an increase. Both asthma reliever and control drugs may be delivered by inhaler. Oxygen is a drug but its use does not prevent or control an asthma attack, it only supports gas exchange during an attack. Magnesium sulfate may be used during status asthmaticus but is not a controller drug. Its use in status asthmaticus is controversial.

Which drugs or drug classes will the nurse expect to be prescribed to slow disease progression for a client who has early-stage idiopathic pulmonary fibrosis? Select all that apply. A. Antibiotics B. Bronchodilators C. Corticosteroids D. Morphine E. Nintedanib F. Pirfenidone

C, E, F Pulmonary fibrosis is an example of excessive wound healing. Once lung injury occurs, inflammation begins tissue repair and continues beyond normal healing time, causing fibrosis and scarring, which thicken alveolar tissues and make gas exchange difficult. Drug therapy for slowing disease progression includes anti-inflammatory/immunosuppressants (corticosteroids) and drugs that inhibit fibrous growth (nintedanib, pirfenidone). Antibiotics and morphine are prescribed as needed during the course of the disease but do not slow disease progression. Because the disorder affects the lung tissue and not the airways, bronchodilators are not part of therapy for idiopathic pulmonary fibrosis.

11. An older adult patient experiences an asthma attack that is severe enough to warrant the use of a rescue drug. Which medication is best to use for the acute symptoms? A. Omalizumab (Xolair) B. Fluticasone (Flovent) C. Salmeterol (Severent) D. Albuterol (Proventil)

D

21. A patient has chronic bronchitis. The nurse plans interventions for inadequate oxygenation based on which set of clinical manifestations? A. Chronic cough, thin secretions, and chronic infection B. Respiratory alkalosis, decreased PaCO2, and increased PaO2 C. Areas of chest tenderness and sputum production (often with hemoptysis) D. Large amounts of thick secretions and repeated infections

D

27. What is the purpose of pulmonary function testing? A. Determines the oxygen liter flow rates required by the patient B. Measures blood gas levels before bronchodilators are administered C. Evaluates the movement of oxygenated blood from the lung to the heart D. Distinguishes airway disease from restrictive lung disease

D

30. What principle guides the nurse when providing oxygen therapy for a patient with COPD? A. The patient depends on a high serum carbon dioxide level to stimulate the drive to breathe. B. The patient requires a low serum oxygen level for the stimulus to breathe to work. C. The patient who receives oxygen therapy at a high flow rate is at risk for a respiratory arrest. D. The patient should receive oxygen therapy at rates to reduce hypoxia and bring SpO2 levels up between 88% and 92%.

D

37. What is the advantage of using the aerosol route for administering short-acting beta2 agonists? A. Achieves a rapid and effective anti-inflammatory action. B. Reduces risk for fungal infections C. Increases patient compliance because it is easy to use D. Provides rapid therapy with fewer systemic side effects

D

50. A patient with CF is admitted to the medical-surgical unit for an elective surgery. Which infection control measure is best for this patient? A. It is best to put two patients with CF in the same room. B. Standard precautions including handwashing are sufficient. C. The patient is to be placed on contact isolation. D. Measures that limit close contact between people with CF are needed.

D

58. The nurse is taking a report on a patient who had a pneumonectomy 4 days ago. Which question is the best to ask during the shift report? A. "Does the provider want us to continue encouraging use of the spirometer?" B. "How much drainage did you see in the Pleur-Evac during your shift?" C. "Do we have to request to 'milk' the patient's chest tube? D. "Does the surgeon want the patient placed on the nonoperative side?"

D

60. Upon observation of a chest tube setup, the nurse reports to the provider that there is a leak in the chest tube and system. How has the nurse identified this problem? A. Drainage in the collection chamber has decreased. B. The bubbling in the suction chamber has suddenly increased. C. Fluctuation in the water seal chamber has stopped. D. There was onset of continuous vigorous bubbling in the water seal chamber.

D

67. Which intervention promotes comfort in dyspnea management for a patient with lung cancer? A. Administer morphine only when the patient requests it. B. Place the patient in a supine position with a pillow under the knees and legs C. Encourage coughing and deep-breathing and independent ambulation. D. Provide supplemental oxygen via cannula or mask.

D

8. The nurse is taking a medical history on a new patient who has come to the office for a check up. The patient states that he was supposed to take a medication called montelukast (Singulair), but that he never got the prescription filled. What is the best response by the nurse? A. "When did you first get diagnosed with a respiratory disorder?" B. "Why didn't you get the prescription filled?" C. "Tell me how you feel about your decision to not fill the prescription." D. "Tell me about how your asthma has been recently?"

D

Which client with asthma does the nurse consider to have the highest risk for a fatal outcome of an acute attack? A. 24-year-old with exercise-induced wheezing B. 45-year-old recovering from pneumonia C. 58-year-old who has type 2 diabetes mellitus D. 76-year-old with hypertension

D Although asthma can be fatal at any age, asthma-related deaths are highest in adults aged over 65 years. Lung and airway changes as a part of the aging process make breathing problems more serious in the older adult. Also, older adults have a decreased sensitivity of beta-adrenergic receptors, which then no longer respond as quickly or as strongly to agonists and beta-adrenergic drugs, which are often used as rescue therapy during an acute asthma attack.

What is the nurse's best action to prevent harm when caring with a chest tube in place that has drained 110 mL during the past hour? A. Gently "milk" the tubing using a hang-over-hand technique. B. Reposition the client to the operative side. C. Check the chest tube system for leaks. D. Notify the surgeon immediately.

D Chest tube drainage of more than 70 mL/hr at any time after surgery is excessive and may indicate internal bleeding. This finding is reported immediately to the surgeon.

How will the nurse categorize the level of asthma control for a client who reports usually waking at night with wheezing at least three times weekly and needing to use the prescribed reliever inhaler to stop the episodes? A. Controlled B. Partly controlled C. Minimally controlled D. Uncontrolled

D The client meets the criteria for uncontrolled asthma, which are that any of these symptoms occur three or more times per week: Daytime symptoms of wheezing, dyspnea, coughing Waking from night sleep with symptoms of wheezing, dyspnea, coughing Reliever (rescue) drug needed more than twice weekly

Which precaution is most important for the nurse to teach a client who has cystic fibrosis? A. Report a weight change of 2 pounds to your health care provider immediately. B. Use supplemental oxygen whenever your oxygen saturation is less than 95%. C. Eat six small meals each day instead of only three larger ones. D. Avoid crowds and people who are ill.

D The most common cause of death for a client with cystic fibrosis is respiratory failure from a respiratory infection. Avoiding infection in this population is critical for survival. While many clients who have CF are underweight and need to maintain good nutrition, changes in weight and foot intake patterns are not as critical as avoiding infection. Supplemental oxygen use is based on client manifestations. Its use is not as critical as avoiding infection.

The chest tube of a client who is 12 hours postoperative from a lobectomy separates from the drainage system. What is the nurse's best first action? A. Immediately call the surgeon or Rapid Response Team. B. Notify respiratory therapy to set up a new drainage system. C. Cover the insertion site with a sterile occlusive dressing and tape down on three sides. D. Place the end of the disconnected tube into a container of sterile water positioned below the chest.

D This soon after surgery an open chest drainage tube can have air suck through it back into the client's chest and collapse the lung. This is an emergency. Although the surgeon or Rapid Response Team should be called, the nurse first prevents the situation from becoming worse by sealing the tube with water. Because the chest tube is still in place in the client, using an occlusive dressing will not help prevent a lung collapse. Setting up a new drainage system can wait until after the tube is secured.

Which nonpulmonary change in a client with chronic obstructive pulmonary disease (COPD) indicates to the nurse that the disorder may becoming more serious? A. Abdominal muscles contract on exhalation B. Increased urinary output at night C. Morning sputum production D. Weight loss of 11 lb (5 kg)

D Unplanned weight loss is likely when COPD severity increases because the work of breathing increases metabolic needs. In addition, increasing dyspnea and mucus production often result in poor food intake and inadequate nutrition, which also contribute to weight loss.

What is the nurse's best response to a client with chronic obstructive pulmonary disease (COPD) who is prescribed an inhaled long-acting beta2 agonist and asks why the drug can't be taken as a pill? A. "Drugs taken by inhaler work more slowly and remain in the system longer." B. "Drugs taken by inhaler have no side effects and are less expensive." C. "Drugs taken by mouth are more expensive because they must be sterile." D. "Drugs taken by mouth have systemic side effects and are harder to control."

D When used as prescribed, inhaler drugs go more to the site where the intended responses are needed (the airways) and less drug is absorbed systemically. Thus, inhaled drugs have fewer side effects (but still have side effects). Oral drugs always have systemic side effects.

A client with chronic obstructive pulmonary disease (COPD) prescribed a long-acting inhaled beta2 agonist reports hating the inhaler and asks why the drug can't be taken as a pill. What is the nurse's best response? A) "Drugs taken by inhaler work more slowly and remain in the system longer." B) "Drugs taken by inhaler have no side effects and are less expensive." C) "Drugs taken by mouth are more expensive because they must be sterile." D) "Drugs taken by mouth have systemic side effects and are harder to control." (Chp. 30; p. 564)

D) "Drugs taken by mouth have systemic side effects and are harder to control." (Chp. 30; p. 564)

Which precaution is most important for the nurse to teach a client who has cystic fibrosis? A) Report a weight change of 2 pounds to your health care provider immediately. B) Use supplemental oxygen whenever your oxygen saturation is less than 95%. C) Eat six small meals each day instead of only three larger ones. D) Avoid crowds and people who are ill. (Chp. 30; p. 569)

D) Avoid crowds and people who are ill. (Chp. 30; p. 569)

The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this client? A) By nasal cannula at a rate of no more than 1 to 3 L/min B) By nasal cannula at a rate of no more than 2 to 4 L/min C) By Venturi mask at a rate of at least 60% D) By maintaining oxygen saturations greater than 88% (Chp. 30; elseview resources)

D) By maintaining oxygen saturations greater than 88% (Chp. 30; elseview resources)

A client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client? A) Mucolytics decrease secretion production. B) Mucolytics increase gas exchange in the lower airways. C) Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease. D) Mucolytics thin secretions, making them easier to expectorate. (Chp. 30; elseview resources)

D) Mucolytics thin secretions, making them easier to expectorate. (Chp. 30; elseview resources)

A newly diagnosed client with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do? A) Nothing. This is in the green zone. B) Provide the rescue drug and reassess. C) Provide the rescue drug and seek emergency help. D) Repeat the peak flow test. (Chp. 30; elseview resources)

D) Repeat the peak flow test. (Chp. 30; elseview resources)

The client is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? A) Corticosteroids B) Long-acting beta agonists C) Nonsteroidal anti-inflammatory drugs (NSAIDs) D) Short-acting beta agonists (Chp. 30; elseview resources)

D) Short-acting beta agonists (Chp. 30; elseview resources)

An environmental assessment of a factory finds inhalation exposure with a high level of particulate matter. What does the factory nurse do to generate the quickest compliance? A) Encourages proper building ventilation B) Refers workers to a tobacco cessation program C) Suggests that workers find another job D) Teaches workers how to use a mask (Chp. 30; elseview resources)

D) Teaches workers how to use a mask (Chp. 30; elseview resources)

A client is admitted with asthma. How is this disease differentiated from other chronic lung disorders? A) It affects only young people. B) The client has dyspnea. C) The client is coughing. D) The client is symptom-free between exacerbations. (Chp. 30; elseview resources)

D) The client is symptom-free between exacerbations. (Chp. 30; elseview resources)

Which asthma drugs or drug categories have the primary purpose of asthma relief (rescue) rather than asthma control? Select all that apply. A. Anti-inflammatories B. Cholinergic antagonists C. Immunoglobulin E (IgE) antagonists D. Interleukin antagonists E. Long-acting beta agonists F. Short-acting beta agonists

F Only short-acting beta2 agonists work rapidly enough to cause bronchodilation to be effective as asthma reliever or rescue drugs. The others have a much slower onset of action. Although cholinergic antagonists are sometimes used as a reliever drug, this is not their primary purpose.

A nurse auscultates a client's lung fields. Which action should the nurse take based on the lung sounds? (Click the media button to hear the audio clip.) a. Assess for airway obstruction. b. Initiate oxygen therapy. c. Assess vital signs. d. Elevate the client's head.

A

A nurse auscultates a client's lung fields. Which pathophysiologic process should the nurse associate with this breath sound? (Click the media button to hear the audio clip.) a. Inflammation of the pleura b. Constriction of the bronchioles c. Upper airway obstruction d. Pulmonary vascular edema

A

A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process should the nurse correlate with this client's history and clinical manifestations? a. Increased pulmonary pressure creating a higher workload on the right side of the heart b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles c. Increased number and size of mucus glands producing large amounts of thick mucus d. Left ventricular hypertrophy creating a decrease in cardiac output

A

Which assessment findings are most important for the nurse to determine when assessing a client with dyspnea? Select all that apply. A. Onset of or when the client first noticed dyspnea B. Results of most recent pulmonary function test C. Conditions that relieve the dyspnea sensation D. Whether or not dyspnea interferes with ADLs E. Inspection of the external nose and its symmetry F. Whether stridor is present with dyspnea

A, C, D, F Dyspnea, especially if it is new onset, is a sensitive indicator of the possible presence of life-threatening respiratory problems. Dyspnea is subjective and determining onset, relieving factors, interference with ADLs, and presence of stridor should be elicited from the client to help assess severity and determine the level of intervention needed. Pulmonary functioning and inspection of the external nose are objective data.

17.A nurse is teaching a client about warfarin (Coumadin). What assessment finding by the nurse indicates a possible barrier to self-management? a. Poor visual acuity b. Strict vegetarian c. Refusal to stop smoking d. Wants weight loss surgery

ANS: B b. Strict vegetarian Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors. Foods high in vitamin K thus interfere with its action and need to be eaten in moderate, consistent amounts. A vegetarian may have trouble maintaining this diet. The nurse should explore this possibility with the client. The other options are not related.

6. A nurse assesses a client who is recovering from a thoracentesis. Which assessment findings would alert the nurse to a potential pneumothorax? (Select all that apply.) a. Bradycardia b. New-onset cough c. Purulent sputum d. Tachypnea e. Pain with respirations f. Rapid, shallow respirations

ANS: B, D, E Symptoms of a pneumothorax include tachycardia, tachypnea, new-onset "nagging" cough, and pain that is worse at the end of inhalation and the end of exhalation on the affected side. Additional symptoms include trachea slanted to the unaffected side, cyanosis, and the affected side of the chest that does not move in and out with respirations. Purulent sputum is a symptom of infection. DIF: Remembering TOP: Integrated Process: Nursing Process: Assessment KEY: Respiratory assessment, Diagnostic testing MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

10.A client is on a ventilator and is sedated. What care may the nurse delegate to the unlicensed assistive personnel (UAP)? a. Assess the client for sedation needs. b. Get family permission for restraints. c. Provide frequent oral care per protocol. d. Use nonverbal pain assessment tools.

ANS: C c. Provide frequent oral care per protocol. The client on mechanical ventilation needs frequent oral care, which can be delegated to the UAP. The other actions fall within the scope of practice of the nurse.

2.A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active and has no known risk factors for PE. What action by the nurse is most appropriate? a. Encourage the client to walk 5 minutes each hour. b. Refer the client to smoking cessation classes. c. Teach the client about factor V Leiden testing. d. Tell the client that sometimes no cause for disease is found.

ANS: C c. Teach the client about factor V Leiden testing. Factor V Leiden is an inherited thrombophilia that can lead to abnormal clotting events, including PE. A client with no known risk factors for this disorder should be referred for testing. Encouraging the client to walk is healthy, but is not related to the development of a PE in this case, nor is smoking. Although there are cases of disease where no cause is ever found, this assumption is premature.

2. A nurse assesses a client after assessment finding is matched with the correct intervention? a. Client reports being dizzy—nurse calls the Rapid Response Team. b. Client's heart rate is 55 beats/min—nurse withholds pain medication. c. Client has reduced breath sounds—nurse calls primary health care provider immediately. d. Client's respiratory rate is 18 breaths/min—nurse decreases oxygen flow rate.

ANS: C A potentially serious complication after biopsy is pneumothorax, which is indicated by decreased or absent breath sounds. The primary health care provider needs to be notified immediately. Dizziness without other data would not lead the nurse to call the RRT. If the client's heart rate is 55 beats/min, no reason is known to withhold pain medication. A respiratory rate of 18 breaths/min is a normal finding and would not warrant changing the oxygen flow rate. DIF: Applying TOP: Integrated Process: Nursing Process: Implementation KEY: Respiratory assessment, Critical rescue MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

1. A nurse obtains the health history of a client who is recently diagnosed with lung cancer and identifies that the client has a 60-pack-year smoking history. Which action is most important for the nurse to take when interviewing this client? a. Tell the client that he or she needs to quit smoking to stop further cancer development. b. Encourage the client to be completely honest about both tobacco and marijuana use. c. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty. d. Avoid giving the client false hope regarding cancer treatment and prognosis.

ANS: C Smoking assessments and cessation information can be an uncomfortable and sensitive topic among both clients and health care providers. The nurse would maintain a nonjudgmental attitude in order to foster trust with the client. Telling the client he or she needs to quit smoking is paternalistic and threatening. Assessing exposure to smoke includes more than tobacco and marijuana. The nurse would avoid giving the client false hope but when taking a history, it is most important to get accurate information. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Respiratory assessment MSC: Client Needs Category: Psychosocial Integrity

What is the priority or most relevant medical-surgical concept for the nurse when performing an assessment of a client's respiratory system? A. Perfusion B. Gas exchange C. Acid-base balance D. Cellular regulation

B Although all four concepts are associated with the respiratory system, the main function of the respiratory system is gas exchange. The other three concepts are dependent on gas exchange for proper activity.

A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and disheveled. Which question should the nurse ask first? a. "Do you have a strong support system?" b. "What do you understand about your disease?" c. "Do you experience shortness of breath with basic activities?" d. "What medications are you prescribed to take each day?"

C

A nurse cares for a female client who has a family history of cystic fibrosis. The client asks, "Will my children have cystic fibrosis?" How should the nurse respond? a. "Since many of your family members are carriers, your children will also be carriers of the gene." b. "Cystic fibrosis is an autosomal recessive disorder. If you are a carrier, your children will have the disorder." c. "Since you have a family history of cystic fibrosis, I would encourage you and your partner to be tested." d. "Cystic fibrosis is caused by a protein that controls the movement of chloride. Adjusting your diet will decrease the spread of this disorder."

C

A nurse is teaching a client who has cystic fibrosis (CF). Which statement should the nurse include in this client's teaching? a. "Take an antibiotic each day." b. "Contact your provider to obtain genetic screening." c. "Eat a well-balanced, nutritious diet." d. "Plan to exercise for 30 minutes every day."

C

The nurse is caring for a client with lung cancer who states, "I don't want any pain medication because I am afraid I'll become addicted." How should the nurse respond? a. "I will ask the provider to change your medication to a drug that is less potent." b. "Would you like me to use music therapy to distract you from your pain?" c. "It is unlikely you will become addicted when taking medicine for pain." d. "Would you like me to give you acetaminophen (Tylenol) instead?"

C

Which end-tidal carbon dioxide level in a client being monitored with capnography after anesthesia indicates to the nurse a possible early problem affecting gas exchange? A. 28 mm Hg B. 40 mm Hg C. 58 mm Hg D. 80 mm Hg

C The normal value of the partial pressure of end-tidal carbon dioxide ranges between 20 and 40 mm Hg. Thus options A and B are within the normal range. 58 mm Hg indicates a relatively early problem with effective gas exchange. Option D represents a severe or late problem with gas exchange.

A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take? (Select all that apply.) a. Administer prescribed salmeterol (Serevent) inhaler. b. Assess the client for a tracheal deviation. c. Administer oxygen to keep saturations greater than 94%. d. Perform peak expiratory flow readings. e. Administer prescribed albuterol (Proventil) inhaler.

C,E

A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take? a. Encourage oral rinsing after fluticasone administration. b. Obtain an oral specimen for culture and sensitivity. c. Start the client on a broad-spectrum antibiotic. d. Document the finding as a known side effect.

A

The nurse instructs a client on the steps needed to obtain a peak expiratory flow rate. In which order should these steps occur? 1. "Take as deep a breath as possible." 2. "Stand up (unless you have a physical disability)." 3. "Place the meter in your mouth, and close your lips around the mouthpiece." 4. "Make sure the device reads zero or is at base level." 5. "Blow out as hard and as fast as possible for 1 to 2 seconds." 6. "Write down the value obtained." 7. "Repeat the process two additional times, and record the highest number in your chart." a. 4, 2, 1, 3, 5, 6, 7 b. 3, 4, 1, 2, 5, 7, 6 c. 2, 1, 3, 4, 5, 6, 7 d. 1, 3, 2, 5, 6, 7, 4

A

Which arterial blood gas (ABG) values from an 86-year-old client does the nurse consider to be normal? A. pH 7.32, PaO2 94 mm Hg, PaCO2 42 mm Hg B. pH 7.35, PaO2 90 mm Hg, PaCO2 52 mm Hg C. pH 7.45, PaO2 88 mm Hg, PaCO2 48 mm Hg D. pH 7.47, PaO2 98 mm Hg, PaCO2 30 mm Hg

A Adults over 60 years of age usually have a slightly lower than normal pH and slightly lower PaO2 levels (slightly acidotic). PaCO2 levels are not affected by increasing age alone. Normal arterial pH is 7.35-7.45.

Which respiratory changes does the nurse expect to find in an 82-year-old client who has no indicators for respiratory disease? Select all that apply. A. Exhalation is twice as long as inhalation B. Wheezing on arising every morning C. Decreased force of cough D. Increased anteroposterior diameter E. Shortness of breath at rest F. Softer voice

A, C, D, F A respiratory cycle consists of one inhalation followed by one exhalation. The normal respiratory cycle has an exhalation period that is twice as long as inhalation. Vocal cords slacken with age and the voice becomes softer. All muscles of inhalation weaken and lose strength with age, making coughs less forceful. With normal aging, the anteroposterior diameter enlarges. (It is much more exaggerated in obstructive respiratory disorders). Wheezing on arising is not normal at any age. Although older adults may develop some shortness of breath on exertion or exercise, shortness of breath at rest is not a normal age-related finding.

When the SpO2 of a client with very dark skin reads 91%, which additional assessments will the nurse perform to determine the client's gas exchange adequacy? Select all that apply. A. Examine the color of oral mucosa. B. Ask the client to rate his or her dyspnea. C. Reapply the pulse oximeter to the earlobe. D. Use capnography to assess end-tidal CO2 levels. E. Examine the color of the sclera closest to the iris. F. Compare the temperature of the right foot to that of the left.

A, D The color of the oral mucous membranes is related to blood oxygenation rather than skin pigmentation and can be used to determine whether the client has any degree of cyanosis. Measurement of capnography for end-today CO2 levels is a very sensitive indicator of gas exchange adequacy. If this measure is normal, gas exchange is adequate even when pulse oximetry is low. Dyspnea is a subjective sensation and does not accurately indicate adequacy of gas exchange. The earlobe is also pigmented and moving the sensor to the earlobe is not likely to result in an accurate result. The color of the sclera is not related to blood flow and oxygenation. This area is the one used to assess for jaundice, not gas exchange. Foot temperature is not used to assess gas exchange adequacy.

Which statements indicate to the nurse that client has a strong addiction to cigarette smoking. Select all that apply. A. "I smoke a cigarette when I wake up before I make coffee." B. "To reduce my children's exposure, I only smoke outdoors." C. "I used to just 'burn' cigarettes but now I buy a pack daily for myself." D. "I only watch movies on television rather than at a theater because I can smoke at home." E. "Last night I woke up at 2:00 a.m. and 5:00 a.m. to smoke two cigarettes each time." F. "Last year when I had pneumonia, I didn't smoke for 2 weeks but started again when I was well."

A, D, E Indicators of strong nicotine dependence include the need to wake up in the middle of the night to smoke, to find it difficult not to smoke in places where smoking is prohibited (such as movie theaters), having a cigarette within the first 5 to 10 minutes after waking up, and smoking during illness.

Which assessment findings on a client who had a bronchoscopy using the local anesthetic benzocaine spray along with light sedation are most important to report to the health care provider who performed the procedure? Select all that apply. A. Oxygen saturation is 60% and does not increase with supplemental oxygen. B. Twenty minutes after the procedure, the client remains drowsy. C. Client coughed on first being awake but is no longer coughing. D. The client reports having a sore throat. E. Oral mucous membranes are cyanotic. F. Sputum is grossly bloody.

A, E, F The cyanosis and low oxygen saturation that does not improve with supplemental oxygen are very serious and could indicate methemoglobinemia associated with the use of benzocaine spray, which requires immediate intervention to prevent death. Grossly bloody sputum is not a normal expectation after the procedure and could herald hemorrhage. Most clients have a sore throat after bronchoscopy and remain somewhat drowsy for an hour or more after sedation. Neither of these responses are caused for alarm, nor is a reduction in coughing.

Which client conditions does the nurse recognize as most likely to cause a "left shift" of the oxyhemoglobin dissociation curve? Select all that apply. A. Alkalosis B. Increased body temperature C. Reduced blood and tissue pH D. Increased metabolic demands E. Reduced blood and tissue levels of oxygen F. Reduced blood and tissue levels of diphosphoglycerate (DPG)

A, F The oxyhemoglobin dissociation curve is shifted to the left when conditions are present that reduce overall oxygen needs. This left shift makes it harder for oxygen to dissociate from the hemoglobin molecule. Such conditions are those associated with slower or lower metabolism and oxygen need. These include less DPG, and alkalosis (fewer hydrogen ions). Reduced pH, increased metabolic demand, increased body temperature, and hypoxia are all associated with increased oxygen need and a right shift in the oxyhemoglobin dissociation curve.

A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition should the nurse include in this client's teaching? (Select all that apply.) a. "Avoid drinking fluids just before and during meals." b. "Rest before meals if you have dyspnea." c. "Have about six small meals a day." d. "Eat high-fiber foods to promote gastric emptying." e. "Increase carbohydrate intake for energy."

A,B,C

A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secretions. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Ask the client to drink 2 liters of fluids daily. b. Add humidity to the prescribed oxygen. c. Suction the client every 2 to 3 hours. d. Use a vibrating positive expiratory pressure device. e. Encourage diaphragmatic breathing.

A,B,D

A nurse cares for a client who is prescribed an intravenous prostacyclin agent. Which actions should the nurse take to ensure the client's safety while on this medication? (Select all that apply.) a. Keep an intravenous line dedicated strictly to the infusion. b. Teach the client that this medication increases pulmonary pressures. c. Ensure that there is always a backup drug cassette available. d. Start a large-bore peripheral intravenous line. e. Use strict aseptic technique when using the drug delivery system

A,C,E

19.A client in the emergency department has several broken ribs. What care measure will best promote comfort? a. Allowing the client to choose the position in bed b. Humidifying the supplemental oxygen c. Offering frequent, small drinks of water d. Providing warmed blankets

ANS: A a. Allowing the client to choose the position in bed Allow the client with respiratory problems to assume a position of comfort if it does not interfere with care. Often the client will choose a more upright position, which also improves oxygenation. The other options are less effective comfort measures.

7.A client appears dyspneic, but the oxygen saturation is 97%. What action by the nurse is best? a. Assess for other manifestations of hypoxia. b. Change the sensor on the pulse oximeter. c. Obtain a new oximeter from central supply. d. Tell the client to take slow, deep breaths.

ANS: A a. Assess for other manifestations of hypoxia. Pulse oximetry is not always the most accurate assessment tool for hypoxia as many factors can interfere, producing normal or near-normal readings in the setting of hypoxia. The nurse should conduct a more thorough assessment. The other actions are not appropriate for a hypoxic client.

12.A nurse is caring for a client on mechanical ventilation and finds the client agitated and thrashing about. What action by the nurse is most appropriate? a. Assess the cause of the agitation. b. Reassure the client that he or she is safe. c. Restrain the client's hands. d. Sedate the client immediately.

ANS: A a. Assess the cause of the agitation. The nurse needs to determine the cause of the agitation. The inability to communicate often makes clients anxious, even to the point of panic. Pain and confusion can also cause agitation. Once the nurse determines the cause of the agitation, he or she can implement measures to relieve the underlying cause. Reassurance is also important but may not address the etiology of the agitation. Restraints and more sedation may be necessary, but not as a first step.

9. A nurse plans care for a client who is experiencing dyspnea and must stop multiple times when climbing a flight of stairs. Which intervention would the nurse include in this client's plan of care? a. Assistance with activities of daily living b. Physical therapy activities every day c. Oxygen therapy at 2 L per nasal cannula d. Complete bedrest with frequent repositioning

ANS: A A client with dyspnea and the inability to complete activities such as climbing a flight of stairs without pausing has class IV dyspnea. The nurse would provide assistance with activities of daily living. These clients would be encouraged to participate in activities as tolerated. They would not be on complete bedrest, may not be able to tolerate daily physical therapy, and only need oxygen if hypoxia is present. DIF: Applying TOP: Integrated Process: Nursing Process: Implementation KEY: Respiratory assessment, Functional ability MSC: Client Needs Category: Physiological Integrity: Basic Care and Comfort

12. A nurse auscultates a harsh hollow sound over a client's trachea and larynx. What action would the nurse take first? a. Document the findings. b. Administer oxygen therapy. c. Position the client in high-Fowler position. d. Administer prescribed albuterol.

ANS: A Bronchial breath sounds, including harsh, hollow, tubular, and blowing sounds, are a normal finding over the trachea and larynx. The nurse would document this finding. There is no need to implement oxygen therapy, administer albuterol, or change the client's position because the finding is normal. DIF: Understanding TOP: Integrated Process: Communication and Documentation KEY: Respiratory assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

5. A nurse is assessing a client's history of particular matter exposure. What questions are consistent with the I PREPARE tool? (Select all that apply.) a. Investigate all history of known exposures. b. Determine if breathing problems are worse at work. c. Ask the client what type of heating is in the home. d. Gather details about the geographic location of the client's home. e. Have client list all previous jobs and work experiences. f. Assess what hobbies the client and family enjoy.

ANS: A, B, C, D, E, F All questions are appropriate for the I PREPARE model of particulate matter exposure. The R and final E stands for resources/referrals and educate. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Respiratory assessment, Smoking cessation MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

2. While obtaining a client's health history, the client states, "I am allergic to avocados, molds, and grass." Which responses by the nurse are best? (Select all that apply.) a. "What happens when you are exposed to those things? b. "How do you treat these allergies?" c. "When was the last time you ate foods containing avocados?" d. "I will document this in your record so all so everyone knows." e. "Have you ever been in the hospital after an allergic response?" f. "How do manage to avoid grass and mold?"

ANS: A, B, D, E Nurses would assess clients who have allergies for the specific cause, treatment, and response to treatment. The nurse would also document the allergies in a prominent place in the client's medical record. Asking about the last time the client ate avocados does not provide any pertinent information for the client's plan of care. Asking how a client manages to avoid environmental allergies in this fashion also does not provide any pertinent information. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Respiratory assessment, Allergies MSC: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

1. A nurse assesses a client who is prescribed varenicline for smoking cessation. Which signs or symptoms would the nurse identify as adverse effects of this medication? (Select all that apply.) a. Visual hallucinations b. Tachycardia c. Decreased cravings d. Manic behavior e. Increased thirst f. Orangish urine

ANS: A, D Varenicline has a black box warning stating that the drug can cause manic behavior and hallucinations. The nurse would assess for changes in behavior and thought processes, including manic behaviors and visual hallucinations. Tachycardia, increased thirst, and orange-colored urine are not adverse effects of this medication. Decreased cravings are a therapeutic response to this medication. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Medication administration, Medication side effects MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements would the nurse include in communications with the respiratory therapist prior to the tests? (Select all that apply.) a. "I held the client's morning bronchodilator medication." b. "The client is ready to go down to radiology for this examination." c. "Physical therapy states the client can run on a treadmill." d. "I advised the client not to smoke for 6 hours prior to the test." e. "The client is alert and can follow your commands"

ANS: A, D, E To ensure that the PFTs are accurate, the therapist needs to know that no bronchodilators have been administered in the past 4 to 6 hours (depending on the suspected cause), the client did not smoke within 6 to 8 hours prior to the test, and the client can follow basic commands, including different breathing maneuvers. The respiratory therapist can perform PFTs at the bedside or the respiratory lab. A treadmill is not used for this test. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Respiratory assessment, Diagnostic testing MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care

4. A nurse teaches a client who is interested in smoking cessation. Which statements would the nurse include in this client's teaching? (Select all that apply.) a. "Find an activity that you enjoy and will keep your hands busy." b. "Keep snacks like potato chips on hand to nibble on." c. "Identify a consequence for yourself in case you backslide." d. "Drink at least eight glasses of water each day." e. "Make a list of reasons you want to stop smoking." f. "Set a quit date and stick to it."

ANS: A, D, E, F The nurse would teach a client who is interested in smoking cessation to find an activity that keeps the hands busy, to keep healthy snacks on hand to nibble on, to drink at least eight glasses of water each day, to make a list of reasons for quitting smoking, and to set a firm quit date and stick to it. The nurse would also encourage the client not to be upset if he or she backslides and has a cigarette but to try to determine what conditions caused him or her to smoke. DIF: Understanding TOP: Integrated Process: Teaching/Learning KEY: Smoking cessation, Health teaching MSC: Client Needs Category: Health Promotion and Maintenance

18.A student nurse is preparing to administer enoxaparin (Lovenox) to a client. What action by the student requires immediate intervention by the supervising nurse? a. Assessing the client's platelet count b. Choosing an 18-gauge, 2-inch needle c. Not aspirating prior to injection d. Swabbing the injection site with alcohol

ANS: B b. Choosing an 18-gauge, 2-inch needle Enoxaparin is given subcutaneously, so the 18-gauge, 2-inch needle is too big. The other actions are appropriate.

13.A nurse is preparing to admit a client on mechanical ventilation from the emergency department. What action by the nurse takes priority? a. Assessing that the ventilator settings are correct b. Ensuring there is a bag-valve-mask in the room c. Obtaining personal protective equipment d. Planning to suction the client upon arrival to the room

ANS: B b. Ensuring there is a bag-valve-mask in the room Having a bag-valve-mask device is critical in case the client needs manual breathing. The respiratory therapist is usually primarily responsible for setting up the ventilator, although the nurse should know and check the settings. Personal protective equipment is important, but ensuring client safety takes priority. The client may or may not need suctioning on arrival.

4.A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What order should the nurse anticipate? a. Decrease the heparin rate. b. Increase the heparin rate. c. No change to the heparin rate. d. Stop heparin; start warfarin (Coumadin).

ANS: B b. Increase the heparin rate. For clients on heparin, a PTT of 1.5 to 2.5 times the normal value is needed to demonstrate the heparin is working. A normal PTT is 25 to 35 seconds, so this client's PTT value is too low. The heparin rate needs to be increased. Warfarin is not indicated in this situation.

16.A client is being discharged soon on warfarin (Coumadin). What menu selection for dinner indicates the client needs more education regarding this medication? a. Hamburger and French fries b. Large chef's salad and muffin c. No selection; spouse brings pizza d. Tuna salad sandwich and chips

ANS: B b. Large chef's salad and muffin Warfarin works by inhibiting the synthesis of vitamin K-dependent clotting factors. Foods high in vitamin K thus interfere with its action and need to be eaten in moderate, consistent amounts. The chef's salad most likely has too many leafy green vegetables, which contain high amounts of vitamin K. The other selections, while not particularly healthy, will not interfere with the medication's mechanism of action.

1.A nurse answers a call light and finds a client anxious, short of breath, reporting chest pain, and having a blood pressure of 88/52 mm Hg on the cardiac monitor. What action by the nurse takes priority? a. Assess the client's lung sounds. b. Notify the Rapid Response Team. c. Provide reassurance to the client. d. Take a full set of vital signs.

ANS: B b. Notify the Rapid Response Team. This client has manifestations of a pulmonary embolism, and the most critical action is to notify the Rapid Response Team for speedy diagnosis and treatment. The other actions are appropriate also but are not the priority.

6.A nurse is caring for four clients on intravenous heparin therapy. Which laboratory value possibly indicates that a serious side effect has occurred? a. Hemoglobin: 14.2 g/dL b. Platelet count: 82,000/L c. Red blood cell count: 4.8/mm3 d. White blood cell count: 8.7/mm3

ANS: B b. Platelet count: 82,000/L This platelet count is low and could indicate heparin-induced thrombocytopenia. The other values are normal for either gender.

5.A client is hospitalized with a second episode of pulmonary embolism (PE). Recent genetic testing reveals the client has an alteration in the gene CYP2C19. What action by the nurse is best? a. Instruct the client to eliminate all vitamin K from the diet. b. Prepare preoperative teaching for an inferior vena cava (IVC) filter. c. Refer the client to a chronic illness support group. d. Teach the client to use a soft-bristled toothbrush.

ANS: B b. Prepare preoperative teaching for an inferior vena cava (IVC) filter. Often clients are discharged from the hospital on warfarin (Coumadin) after a PE. However, clients with a variation in the CYP2C19 gene do not metabolize warfarin well and have higher blood levels and more side effects. This client is a poor candidate for warfarin therapy, and the prescriber will most likely order an IVC filter device to be implanted. The nurse should prepare to do preoperative teaching on this procedure. It would be impossible to eliminate all vitamin K from the diet. A chronic illness support group may be needed, but this is not the best intervention as it is not as specific to the client as the IVC filter. A soft-bristled toothbrush is a safety measure for clients on anticoagulation therapy.

11. A nurse is caring for a client who received benzocaine spray prior to a recent bronchoscopy. The client presents with continuous cyanosis even with oxygen therapy. What action would the nurse take next? a. Administer an albuterol treatment. b. Notify the Rapid Response Team. c. Assess the client's peripheral pulses. d. Obtain blood and sputum cultures.

ANS: B Cyanosis unresponsive to oxygen therapy is a sign of methemoglobinemia, which is an adverse effect of benzocaine spray. This condition can lead to death. The nurse would notify the Rapid Response Team to provide advanced care. An albuterol treatment would not address the client's oxygenation problem. Assessment of pulses and cultures will not provide data necessary to treat the client. DIF: Applying TOP: Integrated Process: Nursing Process: Implementation KEY: Respiratory assessment, Critical rescue MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

5. A nurse is assessing a client who is recovering from a lung biopsy. The client's breath sounds are absent. While another nurse calls the Rapid Response Team, what action by the nurse takes is most important? a. Take a full set of vital signs. b. Obtain pulse oximetry reading. c. Ask the patient about hemoptysis. d. Inspect the biopsy site.

ANS: B Absent breath sounds may indicate that the client has a pneumothorax, a serious complication after a needle biopsy or open lung biopsy. The nurse would first obtain a pulse oximetry reading and perform other respiratory assessments. Temperature is not a priority. The nurse can ask about other symptoms while conducting the assessment. The nurse would assess the biopsy site and/or dressings, but this is not the first action. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Respiratory assessment, Critical rescue MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

4. A nurse observes that a client's anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question would the nurse ask the client in response to this finding? a. "Are you taking any medications or herbal supplements?" b. "Do you have any chronic breathing problems?" c. "How often do you perform aerobic exercise?" d. "What is your occupation and what are your hobbies?"

ANS: B The normal chest has an anteroposterior (AP or front-to-back) diameter ratio with the lateral (side-to-side) diameter. This ratio normally is about 1:1.5. When the AP diameter approaches the lateral diameter, and the ratio is 1:1, the client is said to have a barrel chest. Most commonly, barrel chest occurs as a result of a long-term chronic airflow limitation problem, such as chronic emphysema. It can also be seen in people who have lived at a high altitude for many years. Medications, herbal supplements, and aerobic exercise are not associated with a barrel chest. Although occupation and hobbies may expose a client to irritants that can cause chronic lung disorders and barrel chest, asking about chronic breathing problems is more direct and would be asked first. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Respiratory assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

7. A nurse prepares a client who is scheduled for a bronchoscopy with transbronchial biopsy procedure at 9:00 AM (0900). What actions would the nurse take? (Select all that apply.) a. Provide a clear liquid breakfast. b. Verify that the informed consent was obtained. c. Document the client's allergies. d. Review laboratory results. e. Hold the client's bronchodilator. f. Monitor the client for at least 24 hours afterwards.

ANS: B, C, D, F Prior to a bronchoscopy, the nurse would verify that the informed consent was obtained, keep the client NPO for 4 to 8 hours prior to the procedure or per agency policy to prevent aspiration, document allergies, and review laboratory results including complete blood count and bleeding times. There is no reason to hold the client's bronchodilator prior to this procedure. The nurse will monitor the client at least every 4 hours for 24 hours. DIF: Applying TOP: Integrated Process: Nursing Process: Implementation KEY: Respiratory assessment, Diagnostic testing MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care

8.A nurse is assisting the health care provider who is intubating a client. The provider has been attempting to intubate for 40 seconds. What action by the nurse takes priority? a. Ensure the client has adequate sedation. b. Find another provider to intubate. c. Interrupt the procedure to give oxygen. d. Monitor the client's oxygen saturation.

ANS: C c. Interrupt the procedure to give oxygen. Each intubation attempt should not exceed 30 seconds (15 is preferable) as it causes hypoxia. The nurse should interrupt the intubation attempt and give the client oxygen. The nurse should also have adequate sedation during the procedure and monitor the client's oxygen saturation, but these do not take priority. Finding another provider is not appropriate at this time.

9.An intubated client's oxygen saturation has dropped to 88%. What action by the nurse takes priority? a. Determine if the tube is kinked. b. Ensure all connections are patent. c. Listen to the client's lung sounds. d. Suction the endotracheal tube.

ANS: C c. Listen to the client's lung sounds. When an intubated client shows signs of hypoxia, check for DOPE: displaced tube (most common cause), obstruction (often by secretions), pneumothorax, and equipment problems. The nurse listens for equal, bilateral breath sounds first to determine if the endotracheal tube is still correctly placed. If this assessment is normal, the nurse would follow the mnemonic and assess the patency of the tube and connections and perform suction.

10. A nurse teaches a client who is prescribed nicotine replacement therapy. Which statement would the nurse include in this client's teaching? a. "Make a list of reasons why smoking is a bad habit." b. "Rise slowly when getting out of bed in the morning." c. "Smoking while taking this medication will increase your risk of a stroke." d. "Stopping this medication suddenly increases your risk for a heart attack."

ANS: C Clients who smoke while using drugs for nicotine replacement therapy increase the risk of stroke and heart attack. Nurses would teach clients not to smoke while taking these drugs. The nurse would encourage the client to make a list of reasons for stopping the habit but would not phrase it so judgmentally. Orthostatic hypotension is not a risk with nicotine replacement therapy. Stopping suddenly does not increase the risk of heart attack. DIF: Applying TOP: Integrated Process: Teaching/Learning KEY: Respiratory assessment, Smoking cessation MSC: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

14.A client is on mechanical ventilation and the client's spouse wonders why ranitidine (Zantac) is needed since the client "only has lung problems." What response by the nurse is best? a. "It will increase the motility of the gastrointestinal tract." b. "It will keep the gastrointestinal tract functioning normally." c. "It will prepare the gastrointestinal tract for enteral feedings." d. "It will prevent ulcers from the stress of mechanical ventilation."

ANS: D d. "It will prevent ulcers from the stress of mechanical ventilation." Stress ulcers occur in many clients who are receiving mechanical ventilation, and often prophylactic medications are used to prevent them. Frequently used medications include antacids, histamine blockers, and proton pump inhibitors. Zantac is a histamine blocking agent.

11.A nurse is caring for a client on mechanical ventilation. When double-checking the ventilator settings with the respiratory therapist, what should the nurse ensure as a priority? a. The client is able to initiate spontaneous breaths. b. The inspired oxygen has adequate humidification. c. The upper peak airway pressure limit alarm is off. d. The upper peak airway pressure limit alarm is on.

ANS: D d. The upper peak airway pressure limit alarm is on. The upper peak airway pressure limit alarm will sound when the airway pressure reaches a preset maximum. This is critical to prevent damage to the lungs. Alarms should never be turned off. Initiating spontaneous breathing is important for some modes of ventilation but not others. Adequate humidification is important but does not take priority over preventing injury.

7. A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action? a. The client rates pain as a 5/10 at the site of the procedure. b. A small amount of drainage from the site is noted. c. Pulse oximetry is 93% on 2L of oxygen d. The trachea is shifted toward the opposite side of the neck.

ANS: D A shift of central thoracic structures toward one side is a sign of a tension pneumothorax, which is a medical emergency. The other findings are normal or near normal. The nurse would report this finding immediately or call the Rapid Response Team. DIF: Applying TOP: Integrated Process: Nursing Process: Implementation KEY: Respiratory assessment, Critical rescue MSC: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6. A nurse is caring for a client who is scheduled to undergo a thoracentesis. Which intervention would the nurse complete prior to the procedure? a. Measure oxygen saturation before and after a 12-minute walk. b. Verify that the client understands all possible complications. c. Explain the procedure in detail to the client and the family. d. Validate that informed consent has been given by the client.

ANS: D A thoracentesis is an invasive procedure with many potentially serious complications. The nurse would ensure signed informed consent has been obtained. Verifying that the client understands complications and explaining the procedure to be performed will be done by the primary health care provider, not the nurse. Measurement of oxygen saturation before and after a 12-minute walk is not a procedure unique to a thoracentesis. DIF: Applying TOP: Integrated Process: Communication and Documentation KEY: Respiratory assessment, Diagnostic testing MSC: Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A nurse assesses a client's respiratory status. Which information is most important for the nurse to obtain? a. Average daily fluid intake. b. Neck circumference. c. Height and weight. d. Occupation and hobbies.

ANS: D Many respiratory problems occur as a result of chronic exposure to inhalation irritants used in a client's occupation and hobbies. Although it will be important for the nurse to assess the client's fluid intake, height, and weight, these will not be as important as determining his occupation and hobbies. This is part of the I-PREPARE assessment model for particulate matter exposure. Determining the client's neck circumference will not be an important part of a respiratory assessment. DIF: Applying TOP: Integrated Process: Nursing Process: Assessment KEY: Respiratory assessment MSC: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication? a. Bronchodilator - Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators b. Cholinergic antagonist - Causes bronchodilation by inhibiting the parasympathetic nervous system c. Corticosteroid - Relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors d. Cromone - Disrupts the production of pathways of inflammatory mediators

B

A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first? a. Review the client's pulmonary function test results. b. Ask about medications the client is currently taking. c. Assess how frequently the client uses a bronchodilator. d. Consult the provider and request arterial blood gases.

B

A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? a. A 46-year-old with a 30-pack-year history of smoking b. A 52-year-old in a tripod position using accessory muscles to breathe c. A 68-year-old who has dependent edema and clubbed fingers d. A 74-year-old with a chronic cough and thick, tenacious secretions

B

After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client's understanding. Which action demonstrates that the client correctly understands the teaching? a. The client lays on his or her side with his or her knees bent. b. The client places his or her hands on his or her abdomen. c. The client lays in a prone position with his or her legs straight. d. The client places his or her hands above his or her head.

B

While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the lower chest tube is dislodged. Which action should the nurse take first? a. Assess for drainage from the site. b. Cover the insertion site with sterile gauze. c. Contact the provider and obtain a suture kit. d. Reinsert the tube using sterile technique.

B

How will the nurse categorize a client's level of dyspnea who reports no shortness of breath (SOB) at rest, fair to moderate SOB with activity, some SOB while dressing, and has to stop to catch his breath when going up a flight of stairs? A. Class II B. Class III C. Class IV D. Class V

B Clients with class III dyspnea report that shortness of breath commonly occurs during usual activities such as showering or dressing, but the patient can manage without assistance from others (although the client may consider asking for help because self-care is too time-consuming). Dyspnea is not present at rest and client can walk for more than a city block at own pace but cannot keep up with others of own age. Usually clients must stop to catch their breath partway up a flight of stairs.

The nurse assessing a client's respiratory status finds fremitus has increased from the assessment performed yesterday. For which possible respiratory problem will the nurse assess further? A. Pneumothorax B. Pneumonia C. Pleural effusion D. Emphysema

B Fremitus is a vibration that can be felt on the chest wall when the client speaks. It is decreased if the transmission of sound waves from the larynx to the chest wall is slowed, such as when the pleural space is filled with air (pneumothorax) or fluid (such as with a pleural effusion) or when the bronchus is obstructed. Fremitus is increased with pneumonia and lung abscesses because the increased density of the chest enhances transmission of the vibrations.

Which precaution to prevent harm is most important for the nurse to teach a client who is newly prescribed to take varenicline? A. Avoid crowds and people who are ill because your immunity is reduced while on this drug. B. Immediately report any change in thought process or suicide ideation because this drug can alter behavior. C. Be sure to remain in an upright position for an hour after taking the drug to avoid esophageal reflux and ulceration. D. Do not smoke cigarettes or use nicotine in any form while on this drug because the risk for heart attach or stroke is increased.

B This drug has psychotropic properties and can increase feelings of self-harm or suicide ideation. It does not contain nicotine and can be used at the same time as nicotine to gradually reduce the urge to smoke. Varenicline does not induce esophageal irritation or ulcers nor does it reduce immunity.

Which are the nurse's priority actions when caring for a client who has labored, shallow respirations and a respiratory rate of 32 breaths/min with a pulse oximetry reading of 85%? Select all that apply. A. Notify the respiratory therapist to give the client a breathing treatment. B. Start oxygen using a nasal cannula at a rate of 2 L/min. C. Assess other indicators of adequate gas exchange. D. Obtain an order for a stat arterial blood gas (ABG). E. Assist with coughing and deep-breathing exercises. F. Place the client in an upright position.

B, C, F The client is demonstrating difficulty breathing and ineffective gas exchange with hypoxemia. Placing the client in an upright position may improve respiratory effectiveness. Oxygen therapy is an appropriate immediate action to prevent harm. Pulse oximetry is usually a good indicator of gas exchange; however, the equipment may be faulty or the probe incorrectly placed. Therefore, assessing other indicators of adequate gas exchange is an appropriate early action. None of the other actions will have an immediate effect on gas exchange.

Which findings noted during assessment of a client who reports a respiratory problem will the nurse document as abnormal? Select all that apply. A. Moveable trachea B. Use of pursed-lip breathing C. Intercostal space two finger-breadths wide D. Flat percussive sound in the upper center chest E. No breath sounds heard below the diaphragm F. Rough scratching sounds over the right lower lobe

B, C, F The trachea should be midline and slightly moveable. Pursed-lip breathing is abnormal and generally used only in clients who have obstructive disease with air trapping. The space between the ribs (intercostal space) should be only one finger-breadth wide. A flat percussive sound is expected in the upper center chest because the sternum is located there. No breath sounds are heard below the diaphragm because the lungs are located above the diaphragm. Rough scratching sounds heard over the right lower lobe are an abnormal sound known as a pleural friction rub.

Which client descriptions of sputum production alert the nurse to the possibility of a current respiratory problem? Select all that apply. A. Totals about 2 ounces daily B. Is streaked with mucous C. Is clear and thin D. Is frothy and pink E. Has a foul odor F. Is colorless

B, D, E Sputum is continually produced in all clients. The sputum of a client with no respiratory problem is thin, clear, colorless, has no odor, and is less than 90 mL daily. Excessive pink, frothy sputum is common with pulmonary edema. Bacterial pneumonia often produces rust-colored sputum, and a lung abscess may cause foul-smelling sputum. Clients with chronic bronchitis, especially smokers, have thicker sputum with mucous.

Which statements made by a client indicate to the nurse the need for additional eduction regarding smoking-related health risks? Select all that apply. A. "I have heard that cigarette smoking can cause both lung problems and heart problems." B. "I don't worry about lung problems because, unlike my wife, I don't smoke daily." C. "I worry about lung disease because I borrow cigarettes when I'm out with friends." D. "I use a hookah when I smoke, but I'm trying to quit because I know it's not good for me." E. "I don't worry about lung problems because no one in my family has ever had lung cancer." F. "I am trying to get my college-age daughter to 'vape' rather than smoke because it is safer than cigarettes."

B, E, F Anyone who lives with a smoker has passive exposure to smoke and has a greater risk for lung problems than those who never experience exposure to cigarette smoke. Passive smoking contributes to health problems, especially when chronic exposure occurs in small, confined spaces. Lung cancer is an environmentally acquired malignancy. Current evidence does not associate any genetic mutation with an increased risk for lung cancer. New evidence from the Center for Disease Control and Prevention indicate that vaping as a form of nicotine delivery is at least as problematic for lung disease as cigarette smoking is. Statements B, E, and F are recognized by the nurse as gaps in the client's knowledge of the health risk. The other three statements indicate the client is aware of health risks.

A nurse assesses a client who has a chest tube. For which manifestations should the nurse immediately intervene? (Select all that apply.) a. Production of pink sputum b. Tracheal deviation c. Sudden onset of shortness of breath d. Pain at insertion site e. Drainage of 75 mL/hr

B,C

A nurse assesses a client with chronic obstructive pulmonary disease. Which questions should the nurse ask to determine the client's activity tolerance? (Select all that apply.) a. "What color is your sputum?" b. "Do you have any difficulty sleeping?" c. "How long does it take to perform your morning routine?" d. "Do you walk upstairs every day?" e. "Have you lost any weight lately?"

B,C,E

A nurse assesses a client who has a mediastinal chest tube. Which symptoms require the nurse's immediate intervention? (Select all that apply.) a. Production of pink sputum b. Tracheal deviation c. Pain at insertion site d. Sudden onset of shortness of breath e. Drainage greater than 70 mL/hr f. Disconnection at Y site

B,D,E,F

A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection should the nurse provide for this client? a. Spaghetti with meat sauce, ice cream b. Chicken soup, grilled cheese sandwich c. Omelet, soft whole wheat bread d. Pasta salad, custard, orange juice

C

A nurse cares for a client who is infected with Burkholderia cepacia. Which action should the nurse take first when admitting this client to a pulmonary care unit? a. Instruct the client to wash his or her hands after contact with other people. b. Implement Droplet Precautions and don a surgical mask. c. Keep the client isolated from other clients with cystic fibrosis. d. Obtain blood, sputum, and urine culture specimens.

C

A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, "What does this mean?" How should the nurse respond? a. "Your children will be at high risk for the development of chronic obstructive pulmonary disease." b. "I will contact a genetic counselor to discuss your condition." c. "Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke." d. "This is a recessive gene and should have no impact on your health."

C

A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond? a. "There are a variety of support groups for people who have COPD." b. "I will ask your provider to prescribe you with an antianxiety agent." c. "Share any thoughts and feelings that cause you to limit social activities." d. "Friends can be a good support system for clients with chronic disorders."

C

After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the client's understanding. Which statement indicates the client comprehends the teaching? a. "I will carry this medication with me at all times in case I need it." b. "I will take this medication when I start to experience an asthma attack." c. "I will take this medication every morning to help prevent an acute attack." d. "I will be weaned off this medication when I no longer need it."

C

After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I will be certain to shake the inhaler well before I use it." b. "It may take a while before I notice a change in my asthma." c. "I will use the drug when I have an asthma attack." d. "I will be careful not to let the drug escape out of my nose and mouth."

C

The nurse instructs a client on how to correctly use an inhaler with a spacer. In which order should these steps occur? 1. "Press down firmly on the canister to release one dose of medication." 2. "Breathe in slowly and deeply." 3. "Shake the whole unit vigorously three or four times." 4. "Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer." 5. "Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece." 6. "Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds." a. 2, 3, 4, 5, 6, 1 b. 3, 4, 5, 1, 6, 2 c. 4, 3, 5, 1, 2, 6 d. 5, 3, 6, 1, 2, 4

C

The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home. Which statement indicates the client correctly understands the teaching? a. "I plan to wear my oxygen when I exercise and feel short of breath." b. "I will use my portable oxygen when grilling burgers in the backyard." c. "I plan to use cotton balls to cushion the oxygen tubing on my ears." d. "I will only smoke while I am wearing my oxygen via nasal cannula."

C

With which client will the nurse expect to find a "barrel chest" on respiratory assessment? A. 22-year-old with mild, intermittent asthma B. 28-year-old with cystic fibrosis C. 55-year-old with chronic emphysema D. 60-year-old with bilateral pneumonia

C A barrel chest occurs when air trapping and increased residual volume is severe and long-standing, such as in chronic emphysema. Neither pneumonia nor cystic fibrosis cause air trapping. Although asthma can result in air trapping, this does not happen with mild disease occurring intermittently. Although the anteroposterior chest diameter does increase somewhat as a result or normal aging, it does not increase to the point that it is equal to or greater than the lateral chest diameter.

Which question will the nurse ask first when a client reports a persistent, nagging cough? A. "Have you been running a fever?" B. "Do you have pain when coughing?" C. "How long has your cough been present?" D. "Do you have a family history of lung cancer?"

C A cough is a common symptom with a variety of respiratory problems and some cardiac problems, and must be thoroughly assessed. The first cough assessment questions should be to determine the extent and duration of when it occurs.

What type of assessment information does the nurse expect to gather when asking a client who has a respiratory problem whether the symptoms are worse at work or at home? A. Exposure to respiratory infections B. Presence of inherited predisposition C. Possible particulate matter exposure D. Possible continuation of a childhood respiratory problem

C In using the I-PREPARE model to determine whether a respiratory problem is possibly caused by particulate matter exposure (PME), the nurse investigates all aspects of a client's work history for exposure to industrial dusts, fumes, or chemicals. Occupations with higher risk for exposures include bakers, coal miners, stone masons, cotton handlers, woodworkers, welders, potters, plastic and rubber manufacturers, printers, farm workers, those working in grain elevators of flour mills, and steel foundry workers. A key indicator of PME is when breathing difficulties are less severe when away from the work environment. Answers to this question do not determine whether the problem is inherited, a continuation of a childhood disorder, or infectious in nature.

What is the nurse's best response to a client who says he is afraid to have pulmonary function testing (PFTs) because it may reveal that he has lung cancer? A. "This test can establish whether lung cancer is present at a very early state when the disease is more curable." B. "Because this test is noninvasive, it is less likely to cause you pain or increase your risk for infection." C. "These tests only determine whether your breathing is normal and cannot diagnose lung cancer." D. "There is nothing to fear because of local anesthetic is used."

C PFTs are noninvasive, which makes them painless and without risk for infection; however, they cannot diagnose lung cancer. The fear of a lung cancer diagnosis is this client's concern, not fear of pain or discomfort.

How will the nurse document the respiratory assessment findings on auscultation that are heard as squeaky, musical continuous sounds when the client inhales and exhales? A. Fine crackles B. Coarse crackles C. Wheezes D. Rhonchi

C Squeaky, musical continuous sounds heard when the client inhales and exhales are abnormal (adventitious) and described as wheezes. Fine crackles are heard as popping, discontinuous high-pitched sounds at the end of inhalation. Coarse crackles are a rattling sound. Rhonchi are heard as low-pitched continuous snoring sounds.

Which description of respiratory physiology features is correct? A. The elastic tissues of the tracheobronchial tree are the major structures responsible for gas exchange. B. The epiglottis closes during speech to divert air movement into and through the vocal cords to produce sound. C. Any problem with the right lung interferes with gas exchange and perfusion to a greater degree than a problem in the left lung. D. The left lung is responsible for approximately 60% of gas exchange and the right lung is responsible for 60% of pulmonary perfusion.

C The right lung is larger and has more diffusing surface and more blood vessels than does the left lung. All lung functions (gas exchange and perfusion) are greater in the right lung, which means that problems in the right lung more severely affect (reduce) gas exchange than do similar problems in the left lungs. Surfactant reduces surface tension rather than increases it. Gas exchange does not occur within the tracheobronchial tree because the tissues are too thick for adequate diffusion of gas in either direction.

A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first? a. A 66-year-old client with a barrel chest and clubbed fingernails b. A 48-year-old client with an oxygen saturation level of 92% at rest c. A 35-year-old client who has a longer expiratory phase than inspiratory phase d. A 27-year-old client with a heart rate of 120 beats/min

D

A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take? a. Ambulate the client in the hallway to promote deep breathing. b. Auscultate the client's anterior and posterior lung fields. c. Encourage the client to take shallow breaths to help with the pain. d. Administer pain medication and encourage the client to take deep breaths.

D

A nurse cares for a client who has a pleural chest tube. Which action should the nurse take to ensure safe use of this equipment? a. Strip the tubing to minimize clot formation and ensure patency. b. Secure tubing junctions with clamps to prevent accidental disconnections. c. Connect the chest tube to wall suction at the level prescribed by the provider. d. Keep padded clamps at the bedside for use if the drainage system is interrupted

D

A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic obstructive pulmonary disease (COPD): Arterial Blood Gas Results Vital Signs pH = 7.32 PaCO2 = 62 mm Hg PaO2 = 46 mm Hg HCO3- = 28 mEq/L Heart rate = 110 beats/min Respiratory rate = 12 breaths/min Blood pressure = 145/65 mm Hg Oxygen saturation = 76% Which action should the nurse take first? a. Administer a short-acting beta2 agonist inhaler. b. Document the findings as normal for a client with COPD. c. Teach the client diaphragmatic breathing techniques. d. Initiate oxygenation therapy to increase saturation to 92%.

D

The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, "The medication is too expensive to use every day. I only use my inhaler when I have an attack." How should the nurse respond? a. "You are using the inhaler incorrectly. This medication should be taken daily." b. "If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks." c. "Tell me more about your fears related to feelings of breathlessness." d. "It is important to use this type of inhaler every day. Let's identify potential community services to help you."

D

What is the priority action to prevent harm for a nurse to take before allowing a client who had a flexible bronchoscopy 2 hours ago to drink or eat? A. Assessing pulse oximetry to be sure oxygen saturation has returned to normal B. Measuring the client's end-tidal carbon dioxide level C. Asking whether the client has any nausea D. Checking for return of the gag reflex

D A flexible bronchoscopy is often performed using light sedation or local anesthesia, both of which can reduce the gag reflex. When the gag reflex is reduced or not intact, the risk for aspiration increases. Oxygen saturation and end-tidal carbon dioxide levels do not determine whether the client's gag reflux has returned. Although nausea should be ruled out, the priority action to prevent harm is ascertaining the presence of an intact gag reflex.

Which client will the nurse assess most often for the possibility of a post procedure pneumothorax? A. Pulmonary function testing B. Flexible bronchoscopy C. Laryngoscopy D. Thoracentesis

D A pneumothorax (collapsed lung) is most common after invasive procedures that allow air into the intrapleural space, such as with a thoracentesis that involves having a needle penetrate through the chest wall into the pleural space. Pulmonary function testing is noninvasive; a flexible bronchoscopy does not penetrate the chest wall, and a laryngoscopy does not enter the lungs.

Which factor does the nurse teach clients as the most common cause of chronic respiratory problems and physical limitations? A. Annual chest x-ray exposure to ionizing radiation B. Age-related decreased strength of respiratory muscles C. Failure to receive influenza and pneumonia vaccinations D. Smoking cigarettes or chronic exposure to cigarette smoke

D Although age-related decreased muscle strength can increase the work of breathing and not having up-to-date immunizations increases the risk for respiratory infection, exposure to cigarette smoke (directly or indirectly as secondhand smoke) is the single most common factor causing chronic respiratory problems and physical limitations. Ionizing radiation exposure is an uncommon source of respiratory injury and chronic respiratory problems.

Which client assessment finding does the nurse recognize as an immediate gas exchange and perfusion problem? A. Pursed-lip breathing B. Clubbed fingers C. Barrel chest D. Cyanosis

D Finger clubbing and a barrel chest take many months to years of inadequate gas exchange to develop. Pursed-lip breathing is a learned behavior to compensate for loss of elastic recoil. Only cyanosis reflects an immediate decrease in gas exchange and/or perfusion.

How will the nurse document the pack-year smoking history for a client who reports smoking a pack of cigarettes a day for 10 years, quitting for 4 years, and then smoking 2 packs a day for the last 25 years? A. 30 years B. 35 years C. 45 years D. 60 years

D Pack-years are calculated by multiplying the number of packs smoked per day by the number of years of smoking at that rate. One pack per day x 10 years = 10 pack-years, plus 2 packs per day x 25 years = 50 years. Total is 50 plus 10 for 60 pack-years.