Chp32 Care of Pts w/Noninfectious Lower Resp Problems

Which intervention is important to perform with omalizumab (Xolair) therapy? A. Assess the injection site for phlebitis. B. Shake the vial vigorously for one full minute before drawing up the drug. C. Teach the client to avoid caffeinated beverages while taking this medication. D. Roll the vial between your hands before drawing up the drug until it is no longer gel-like

. ANS: D The drug is thick and slow to dissolve. Rolling the vial gently between the hands until the drug is no longer gel-like ensures that the solution is completely dissolved.

Indicate whether the manifestation or conditions listed below are A. Associated mostly with asthma B. Associated mostly with COPD C. Frequently common to both asthma and COPD D. Usually not associated with either asthma or COPD _____ Clubbed fingers _____ Increased residual volume _____ Increased bronchial secretions _____ Occurs in response to the presence of allergens _____ Deficiency of alpha1-antitrypsin _____ Increased pulmonary blood flow _____ Intermittent manifestations interspersed with periods of no manifestations _____ 70 pack-year smoking history _____ Presence of Curschmann's spirals in sputum

ANS: __B__ Clubbed fingers __C__ Increased residual volume __C__ Increased bronchial secretions __A__ Occurs in response to the presence of allergens __B__ Deficiency of alpha1-antitrypsin __D__ Increased pulmonary blood flow __A__ Intermittent manifestations interspersed with periods of no manifestations __B__ 70 pack-year smoking history __A__ Presence of Curschmann's spirals in sputum Rationale: Clubbed fingers represent change in anatomy that occur as a result of continuous and long-term hypoxemia. Asthma is not continuous. Both asthma and COPD are or have obstructive components, resulting in an increased residual volume. Usually, the increased residual volume of COPD is permanent and can be observed as a barrel chest. Increased residual volume is an acute manifestation of an asthma attack. If asthma is frequent and severe, the client may have constantly increased residual volume and a barrel chest. Both asthma and COPD have inflammatory components and increase bronchial secretions. For asthma, the secretions are usually only increased during an attack. Asthma can have allergic origins. COPD does not. A decrease in alpha1-antitrypsin is a genetic cause for COPD, specifically the emphysema component of COPD. The lack of the enzyme allows elastase to damage alveolar walls, which does not occur as part of asthma (an airway-only disorder). Neither COPD nor asthma have an increased pulmonary blood flow. Asthma is an intermittent and reversible problem. COPD is continuous and, although manifestations may be more severe at some times than others, manifestations are always present. Smoking is a major contributor to the development of COPD. Although smoking may exacerbate asthma, it is not the underlying cause. Curschmann's spirals are mucous plugs containing shed epithelial cells. These spirals are most commonly associated with asthma rather than with COPD

The client is a 48-year-old woman who has never smoked and has just been diagnosed with lung cancer. Which type is she most likely to have?

ANS: A Adenocarcinoma of the lungs is the predominant type in nonsmokers and the most frequent type of lung cancer found in women

The client tells you that he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta-agonist inhaler and wants to know why he should bother to use regularly scheduled systemic drugs. What is your best response? A. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." B. "If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema." C. "Using only short-acting beta agonists will lead to the development of drug resistance and then the drug won't work when you need it." D. "Beta-agonist inhaled drugs only treat the inflammatory aspects of asthma and do not help the inflammatory aspects of the disease."

ANS: A Because damage can occur with any asthma attack, the main focus of therapy should be on attack prevention rather than just on symptom management

The chest tube drainage system of the client 36 hours after a pneumonectomy has continuous bubbling in the water seal chamber (chamber 2). When you clamp the chest tube close to the client's dressing, the bubbling stops. What is your interpretation of this finding? A. An air leak is present at the chest tube insertion site or in the thoracic cavity. B. An air leak is present somewhere in the drainage system. C. The suction pressure applied to the system is too high. D. The suction pressure applied to the system is too low.

ANS: A Bubbling in the water seal chamber indicates air drainage from the client and is usually seen when the client's intrathoracic pressure is greater than atmospheric pressure, such as during exhalation, coughing, or sneezing. When the air in the pleural space has been sufficiently removed, bubbling stops. Increased bubbling indicates an air leak. If the air leak is in the thoracic cavity, air and air pressure increase in the thoracic cavity, forcing more air into the water seal chamber. This air movement is prevented when the chest tube is clamped close to the insertion site.

Which laboratory value indicates to you that the client may have allergic asthma? A. Eosinophil count of 1200 cells/mm3 (13%) B. Total white blood cell count of 9080 cells/mm3 (100%) C. Total absence of macrophages in the differential white blood cell count D. Band neutrophil count of 2880 cells/mm3 (32%) and a segmented neutrophil count of 1980 cells/mm3 (22%)

ANS: A Eosinophils are immunoreactive cells that secrete substances to limit inflammatory events. The normal percentage of these cells is 1% to 2% of the total white blood cell count. An increase in eosinophils is associated with allergic reactions

As the home care nurse, you observe oral candidiasis in the client with severe, chronic, airflow limitation. What information should you obtain from this client? A. "How often are you using your steroid inhaler?" B. "Have you had a cold or other viral infection lately?" C. "When was the last time the oxygen tank was changed?" D. "Do you share a toothbrush with any members of your family?"

ANS: A Excessive use of steroid inhalers reduces local immune function and increases the client's risk for oral-pharyngeal infections, including candidiasis

Which action should you teach a client with asthma to perform in order to assess his or her response to the prescribed asthma medications? A. "Keep a daily symptom and intervention diary." B. "Measure your chest circumference every week." C. "Add up the total cost of your asthma medications for one month." D. "Use the proper technique and correct sequence when using a metered dose inhaler."

ANS: A Keeping a daily diary or log of symptoms and drug use can help identify triggers of asthma symptoms, early cues for impending attacks, and personal responses to asthma medications.

How does prostacyclin therapy reduce the pathologic problems of primary pulmonary hypertension? A. Increasing lung blood flow by dilating pulmonary blood vessels B. Improving ventilation by increasing the contractility of the diaphragm C. Increasing gas exchange by changing the elasticity of the alveolar walls D. Protecting the heart from development of cor pulmonale by increasing cardiac muscle strength

ANS: A Primary pulmonary hypertension is the increased vascular resistance in pulmonary blood vessels, making blood flow through these vessels more difficult. The right side of the heart has to pump harder to move blood through these pulmonary vessels. The extra work of the heart causes right-sided cardiac hypertrophy and eventually failure. Continuous delivery of systemic prostacyclin keeps the smooth muscle of pulmonary blood vessels in a more relaxed state, improving blood flow through these vessels with relatively weak right-sided cardiac muscle strength

Which type of acid-base imbalance is most common among clients with COPD? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

ANS: A The major problem is poor gas exchange with extreme amounts of carbon dioxide being retained. Some of the carbon dioxide is converted to hydrogen ions in the cells and extracellular fluid. The increased level of hydrogen ions leads to acidosis and is reflected by a lower than normal arterial blood pH.

The client with severe chronic bronchitis tells you that eating is difficult because he is so short of breath. What is your best response? A. "Try using your bronchodilator inhaler about 30 minutes before you plan to have a meal." B. "Avoid eating when you are short of breath so that you can use your energy for breathing." C. "Have your wife feed you solid foods, particularly avoiding those that cause you to have gas." D. "When you find eating solid food too difficult, just drink milk and milkshakes for the protein and calories."

ANS: A When dyspnea is worsened by bronchoconstriction, using a bronchodilator before eating can decrease the shortness of breath long enough to allow the client more energy to eat.

The temperature of your client 24 hours after a pleurodesis procedure is 100o F. What is your best action? A. Obtain a specimen of chest fluid drainage for culture. B. Document the findings as the only action. C. Sponge bathe the client with tepid water. D. Notify the physician.

ANS: B A low-grade fever is an expected response to pleurodesis. If the client has no other manifestations of infection, just document the findings.

The client with asthma is prescribed to begin taking the drug zafirlukast (Accolate). Which precaution has the highest teaching priority? A. "Be sure to drink at least 4 liters of fluid each day when taking this drug." B. "If you take aspirin, the dose of the drug must be adjusted." C. "Take the drug one hour before or two hours after meals." D. "Avoid sun exposure while taking this drug."

ANS: B Aspirin increases the plasma concentration of the drug. If the client must also take aspirin or aspirin-containing agents, the dose of zafirlukast must be reduced

What is the major difference in pathophysiology between asthma and COPD? A. Asthma is a restrictive disorder and COPD is an obstructive disorder. B. COPD results in permanent airflow obstruction and asthma is a condition of reversible airflow obstruction. C. COPD is caused by chronic exposure to inhalation irritants and the major cause of asthma is cigarette smoking. D. Asthma is the result of an inflammatory process and COPD is a result of inflammatory, infectious, and hyperresponsiveness processes.

ANS: B Asthma is an intermittent problem that demonstrates tissue return to normal between attacks; thus, any tissue changes during an attack are reversible. COPD is a continuous process (with periods of exacerbation), with permanent tissue damage. Hyperresponsiveness is a characteristic of asthma but not of COPD.

The client diagnosed with moderate stage COPD says there is no sense in stopping smoking now because the damage is done. Which response is the best rationale for encouraging this client to stop smoking? A. "The damage will be reversed." B. "The COPD will progress more slowly." C. "Your risk for asthma development, which would further reduce your lung function, will be decreased." D. "You will be less likely to lose excessive amounts of weight and will have a more normal appearance."

ANS: B Cigarette smoking contributes to the continuing deterioration of lung tissue in COPD. Stopping smoking cannot reverse this existing damage but can slow down disease progression. Cigarette smoking is only a rare cause of asthma

What should you teach the client who has step II asthma that is triggered by exercise? A. "Do not engage in any form of exercise activity." B. "Use a short-acting beta agonist before engaging in exercise." C. "Avoid participating in water-related activity such as swimming, diving, or water aerobics." D. "Use systemic corticosteroids rather than inhaled corticosteroids on the days when you exercise."

ANS: B Clients categorized as step II have mild, persistent asthma. This condition is not a contraindication for exercise; however, certain precautions should be followed. If an asthma attack occurs during exercise, the client should slow down or stop the activity, depending on the degree of breathlessness experienced. The best intervention is to prevent an episode from occurring by using asthma medication (short-acting beta-adrenergic

The client is 12 hours postoperative after a thoracotomy for lung cancer. During a portable chest x-ray at the bedside, the lower chest tube tubing is accidentally pulled out. What is your best first action? A. Clamp the tubing with padded clamps. B. Cover the insertion site with sterile gauze. C. Clamp and close the skin at the insertion site. D. Reinsert the chest tube, using sterile technique.

ANS: B Covering the insertion site immediately helps prevent air from entering the pleural space and causing a pneumothorax.

The client with lung cancer is scheduled for surgery and is receiving oxygen for hypoxia. The client tells you that the sensation of air hunger is worse. What is your best first action? A. Notify the physician. B. Increase the oxygen flow rate. C. Document the observation as the only action. D. Attempt to calm the client using guided imagery.

ANS: B Depending on the location of the tumor, dyspnea can increase quickly. The client should be provided with sufficient oxygen to reduce the hypoxia and its associated symptoms

What is the primary cause for the increased incidence in lung cancer among women during the past 20 years? A. Women now have a longer life expectancy than men. B. Cigarette smoking among women increased dramatically 50 years ago. C. More women now work in the industrial setting than in previous decades. D. Increased use of oral contraceptives combined with air pollution has driven the incidence of lung cancer up in women.

ANS: B Lung cancer is caused mainly by cigarette smoking and has a latency period of approximately 30 years or more. The acceptance of smoking among women and its dramatic increase after World War II are the causes of the increased incidence of lung cancer seen among women for the past 2 decades

Which statement made by the client taking methotrexate (Folex) weekly for pulmonary fibrosis indicates understanding of the side effects of this therapy? A. "I will reduce my oxygen flow rate while taking the methotrexate." B. "I will not drink wine within two days of taking the methotrexate." C. "I will be sure to drink at least 4 liters of fluids on the days I actually take the methotrexate." D. "I will avoid drinking coffee or any other caffeinated beverages within two days of taking the methotrexate."

ANS: B Methotrexate induces some degree of liver damage when taken long term. Avoiding other liver-damaging agents, such as alcohol near the time that the methotrexate is taken, reduces the potential for enhancing the liver-damaging actions of methotrexate.

Your client with asthma is receiving aminophylline intravenously. Which manifestation alerts you to the possibility of aminophylline toxicity? A. Pulse oximetry of 93% B. Increased restlessness C. Hourly urine output of 45 mL D. Heart rate increase from 72 to 84 beats per minute

ANS: B Methylxanthine, including aminophylline, stimulates the sympathetic nervous system. Manifestations of toxicity include CNS irritability, restlessness, tachycardia, nausea and vomiting, palpitations, and dizziness.

The client with a diagnosis of lung cancer is scheduled to have a liver scan and asks you why this procedure is being done. What is your best response? A. "Cigarette smoking can also cause liver cancer. The treatment for lung cancer is different if it has spread to the liver than if it is only confined to the lungs." B. "The treatment for lung cancer is different if it has spread to the liver than if it is only confined to the lungs." C. "Some treatments are toxic to the liver and it is best to test liver function before these treatments are started." D. "An enlarged liver can interfere with cancer therapy, so the doctor wants to make certain of the liver's size and position before therapy is started."

ANS: B Surgery and radiation are considered local treatments for lung cancer confined to the chest. If cancer has spread beyond the chest, systemic therapy (chemotherapy) is required to control the disease

The client is a 24-year-old woman with asthma who takes terbutaline orally. She has all the following clinical manifestations. Which one alerts you to possible terbutaline toxicity? A. Increased menstrual cramping B. Palpitations and tachycardia C. Oral and vaginal candidiasis D. Diarrhea and abdominal bloating

ANS: B Terbutaline is a sympathomimetic agent (beta-adrenergic stimulant). Excessive amounts of this drug would result in the same effects as those seen by exciting the sympathetic nervous system, including tachycardia and palpitations.

The client with long-standing COPD has the following lab values. What is your interpretation? WBC 11,500; Hct 57%; Hgb 22 g/dL; serum sodium 139 mEq/L A. Dehydration is present as a result of rapid, shallow breathing. B. Polycythemia is present as a result of compensation for hypoxemia. C. Septicemia is present as a result of bronchitis and possible pneumonia. D. Cor pulmonale is present as a result of increased pulmonary vascular resistance.

ANS: B The WBC count is not high enough to indicate a significant infection. The hematocrit and hemoglobin are greatly elevated, but the serum sodium is not. Therefore, the most likely current problem is that the chronic hypoxemia stimulated the renal tissue to increase the secretion of erythropoietin, increasing the blood levels of red blood cells and hemoglobin above the normal level.

You are the only licensed health care professional assigned to a small medical-surgical unit with 12 beds. Two unlicensed assistive personnel are also working on this unit. Which of these four clients with respiratory problems should be assigned to you rather than to the unlicensed assistive personnel? A. 82-year-old woman receiving steroid therapy for pulmonary fibrosis whose pulse oximetry is 92% B. 35-year-old woman receiving intravenous aminophylline for asthma whose pulse oximetry is 92% and whose FEV1 is 50% of expected C. 55-year-old man with chronic obstructive lung disease whose pulse oximetry is 88% and who has the following arterial blood gas values: pH, 7.35; HCO3-, 36 mEq/L; PCO2, 65 mm Hg; PO2, 78 mm Hg D. 50-year-old man 2 days postoperative from a pneumonectomy for lung cancer whose pulse oximetry is 92% and whose chest tube is draining 200 mL/8-hour shift

ANS: B This client's condition is the least stable and she is receiving a medication intravenously that has a narrow therapeutic range, with great risk for toxicity.

What are the possible consequences of chronic, poorly controlled asthma resulting from inflammatory processes? A. Failure of bronchiolar smooth muscle to respond appropriately to bronchodilating agents B. Permanent hyperplasia of bronchial epithelial cells with resultant airway narrowing C. Progression to emphysema D. Progression to lung cancer

ANS: B When asthma is not well controlled, the presence of chronic inflammation can lead to damage and hyperplasia of the bronchial epithelial cells and of the bronchial smooth muscle. In addition, when asthma attacks are more frequent, exposure even to reduced levels of the triggering agent or event will stimulate an attack.

What is the priority nursing diagnosis for an adult client with cystic fibrosis (CF)? A. Disturbed Body Image related to low body weight B. Risk for Infection related to presence of thick mucus C. Ineffective Breathing Pattern related to presence of mucus or infection D. Imbalanced Nutrition: Less than Body Requirements related to reduced intestinal absorption

ANS: C Although all the client problems and nursing diagnoses are important, the one with the highest priority is Ineffective Breathing Pattern. The most common cause of death for the client with CF is respiratory failure.

Which clinical manifestation in a client with chronic bronchitis indicates to you a worsening of the client's respiratory condition? A. Fatigue B. Cachexia C. Confusion D. Slow capillary refill

ANS: C As the client's respiratory efforts become less effective, hypoxia increases. The central nervous system, particularly cerebral functioning, is sensitive to increasing hypoxia. Confusion can be a subtle indicator of increased hypoxia

Which assessment finding in a client with severe dyspnea indicates to you that the respiratory problem is chronic? A. Wheezing on exhalation B. Productive cough C. Clubbed fingers D. Cyanosis

ANS: C Clubbed fingers take years to develop and reflect chronic hypoxia, such as that seen with chronic bronchitis and late-stage emphysema

Which statement made by the client starting on the drug cromolyn sodium indicates a need for clarification regarding the purpose, administration schedule, or side effects of this drug? A. "If I get a skin rash, I will call my doctor right away." B. "I will keep using the drug even if I don't notice a difference in my asthma after the first week." C. "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs." D. "I will hold my breath for 10 seconds after I trigger the inhaler so that more of the medicine stays in my lungs."

ANS: C Cromolyn sodium is a prophylactic medication that stabilizes mast cell membranes, inhibiting inflammatory responses in the tissues it contacts. It is not useful during acute attacks.

Which arterial blood gas values are typical for the client with cystic fibrosis? A. pH 7.28, HCO3- 12 mEq/L, PCO2 45 mm Hg, PO2 96 mm Hg B. pH 7.32, HCO3- 17 mEq/L, PCO225 mm Hg, PO2 98 mm Hg C. pH 7.28, HCO3- 36 mEq/L, PCO2 65 mm Hg, PO2 78 mm Hg D. pH 7.48, HCO3- 12 mEq/L, PCO2 35 mm Hg, PO2 85 mm Hg

ANS: C Cystic fibrosis in adults is usually a long-standing disorder in which gas exchange is impaired. Most adult clients with CF have arterial blood gas values indicating poor gas exchange and partially compensated respiratory acidosis with greatly reduced PaO2, increased PaCO2, increased bicarbonate level, and low pH.

In which client with chronic airflow limitation would you expect to find dependent edema? A. 25-year-old with cold-induced asthma B. 65-year-old with exercise-induced asthma C. 55- year-old with chronic bronchitis D. 45-year-old with moderate emphysema

ANS: C Dependent edema is associated with right-side heart failure. As the pressures within the lung tissue increase, the right ventricle must work harder to move blood into the pulmonary vasculature. When the heart weakens from this exertion (cor pulmonale), blood backs up in the venous system, increasing vessel hydrostatic pressure and causing dependent edema to form. Chronic bronchitis is most frequently associated with cor pulmonale

It is time for the client's third round of chemotherapy for lung cancer. After checking the client's white blood count, the decision is made to delay the treatment for an additional week because of the low white blood count and the increased risk for infection. The client is upset at the delay. What is your best response? A. "This extra time will give your hair a chance to grow back in." B. "I will call the physician and request a prescription for something to calm your nerves." C. "Try not to worry. Your counts will probably be high enough next week and the chemotherapy will work just as well then." D. "This delay is for the best because receiving the chemotherapy now would greatly increase your risks for skin-related complications."

ANS: C Many clients are concerned that a delay in treatment will mean that they are missing a treatment and that the cancer cells will overgrow. Delayed treatments are not missed treatments and 1 week's additional growth time for lung cancer is not significant.

The client with lung cancer who is receiving radiation therapy tells you that she has all the following health problems. Which one is most likely a result of the radiation therapy? A. Thinning scalp hair B. Pain in the left shoulder C. Difficulty swallowing solid food D. Heart palpitations and night sweats

ANS: C Radiation has the potential to damage the tissues directly in the radiation path only. The scalp is not in the radiation path and scalp hair loss is not related to this therapy for this client. Pain in the left shoulder is most likely related to disease progression. Although the heart is somewhat in the radiation path, this does not result in palpitations or night sweats. The esophagus is in the radiation path and can become irritated as the therapy continues (esophagitis). When esophagitis occurs, clients may have difficulty swallowing solid foods and may experience "heartburn."

Your neighbors' baby girl has just been diagnosed with cystic fibrosis and they have been told that this is an autosomal recessive disorder. They have one child who does not have cystic fibrosis. They ask you if their older child, a boy, could have children with cystic fibrosis. What is your best response? A. "Because CF is an autosomal recessive disorder and your older child does not have the disease himself, his children would only be affected if he had children with a woman who has CF." B. "Because he is a boy and it is your daughter who has CF, he has no risk of passing the problem on to his children." C. "Because you and your husband are carriers, your son may or may not be a carrier also. If he is a carrier and his wife is also a carrier, it is possible for them to have a child with CF." D. "Because your son may have one CF gene, it is possible for him to father a child with CF. When he is older, he can find out his CF gene status and risk for passing on the disorder."

ANS: C The development of CF is dependent on inheriting a pair of mutated CF gene alleles, because the disorder is autosomal recessive. Both parents are carriers (heterozygous) with one normal CF gene allele and one mutated CF gene allele. If their son does not have CF, he has two chances out of three of being a carrier for the CF allele and one chance out of three of not being a carrier. If he is a carrier and has children with another carrier, there is a chance he could have a child with CF. He can be tested so that he knows his risk. If he has children with a woman who does not have a mutated CF gene allele, his children may be completely normal (for CF) or may also be carriers

The client, a 63-year-old man who has smoked 2 packs of cigarettes per day for 45 years, has just had his brother die of small cell lung cancer. Knowing that cancer is easier to cure in the early stages, the client asks you about early symptoms of lung cancer. What is your best response? A. "There are no early symptoms of lung cancer." B. "Early symptoms of lung cancer include bloody sputum and nagging chest pain." C. "Early symptoms are nonspecific, consisting of cough and shortness of breath on moderate exertion." D. "Wheezing on exhalation should always be considered a positive sign of lung cancer until proven otherwise."

ANS: C The early symptoms of lung cancer are nonspecific (chronic cough, less endurance with heavy exercise, more easily becoming short of breath) and could be associated with almost any acute or chronic pulmonary problem. Pain, abnormal breath sounds, and bloody sputum are late manifestations of some types of lung cancer

Which assessment finding in a client who has been medicated during an asthma attack indicates to you that the therapy should be modified? A. Peak expiratory rate flow 10% below expected value B. Presence of bilateral tactile fremitus C. Suprasternal retraction on inhalation D. Trachea at the midline

ANS: C The location of the trachea and the presence of tactile fremitus are normal assessment findings. A 10% decrease of peak expiratory rate flow is not significant. Inhalation that causes suprasternal retraction usually means that the client with asthma is having difficulty moving air into the respiratory passages because of airway narrowing and must use accessory muscles. The asthma is not responding to the medication, and the regimen should be changed

Which statement made by a client prescribed to use a DPI indicates the need for more instruction? A. "I will not exhale into the inhaler." B. "I will keep the inhaler in the drawer of my bedroom dresser." C. "I will wash the inhaler mouthpiece daily with soap and water." D. "I will inhale twice as hard through this inhaler as I do with my aerosol inhaler."

ANS: C Washing the DPI may cause the medication in the inhaler to clump together. This action reduces the precision of the delivery of the drug to the client.

The client is a 64-year-old man with late-stage small cell lung cancer being cared for in the home by his 63-year-old wife. Which nursing diagnosis has the highest priority for you as the home care nurse in teaching the wife how to manage symptoms? A. Imbalanced Nutrition: Less than Body Requirements related to fatigue and increased metabolism B. Constipation related to decreased activity and medication regimen C. Activity Intolerance related to dyspnea and fatigue D. Acute Pain related to metastasis

ANS: D Although all the listed nursing diagnoses are important issues, effective pain management is the most important issue for this client and family. The home care nurse must serve as a client advocate and ensure that all appropriate measures for management of intractable, severe pain are implemented.

The client is a 42-year-old man recently diagnosed with new-onset asthma. What specific personal/demographic information should you obtain related to this diagnosis? A. Previous diagnosis of pneumonia or tuberculosis B. Known allergies and hypersensitivities C. Nutritional intake and diet history D. Occupation and hobbies

ANS: D An environmental cause, such as occupational or leisure time exposures to inhalation irritants, should be investigated for all adult clients with new-onset asthma.

Which disorder is an example of a "restrictive" pulmonary disease?

ANS: D Asthma, bronchitis, and lung cancer (certain types) are considered to be obstructive diseases because their major pathology is in the airways, leading to obstruction of airflow. Fibrosis is a disease of the interstitium of the lung, which thickens the lung, preventing good lung expansion

The client scheduled to undergo radiation therapy for lung cancer asks you why 6 weeks of daily treatment are necessary. What is your best response? A. "Your cancer is widespread and requires more than the usual amount of radiation treatment." B. "The cost of giving larger doses of radiation for a shorter period of time is unjustified by the results." C. "It is less likely that you will become anemic if the radiation is given in small doses over a longer time period." D. "Research has shown that more cancer cells are killed if the radiation is given in smaller doses over a longer time period."

ANS: D Because of the varying responses of all cancer cells within a given tumor, small doses of radiation are given on a daily basis for a set period of time. This method allows multiple opportunities to destroy cancer cells while minimizing damage to normal tissues

Which health problem or characteristic would exclude a client from receiving a lung transplant? A. Being 45 years of age B. Having a latex allergy C. Having cystic fibrosis D. Developing a systemic infection

ANS: D Clients who receive a transplant must take immunosuppressive drugs for the rest of their lives to prevent transplant rejection. Such medications, when given to a person with a systemic infection, could lead to sepsis and death.

Which client taking theophylline for respiratory problems is at greatest risk for development of theophylline toxicity? A. 67-year-old male cigarette smoker B. 32-year-old female with hyperthyroidism C. 28-year-old male taking phenytoin for seizure control D. 45-year-old female taking erythromycin for a sinus infection

ANS: D Erythromycin decreases the plasma clearance of theophylline, resulting in increased drug levels and greater risk for toxicity at lower dosages.

Which technique should you teach the client with emphysema to use as exercise conditioning for pulmonary rehabilitation? A. Exercising only in the standing position B. Holding his or her breath between sets of exercises C. Keeping his or her arms above the head while exercising D. Breathing against a set resistance for 5 minutes 3 times/day

ANS: D Exercise conditioning for pulmonary rehabilitation focuses on strengthening the diaphragm and other respiratory muscles. Breathing against a set resistance increases the strength and endurance of respiratory muscles

The client is receiving cyclophosphamide, doxorubicin, and vincristine as chemotherapy for lung cancer. At the second round of therapy, the client tells you that a lot of blood was in the urine for 3 days after the therapy. What is your best action? A. Obtain a urine specimen for culture and sensitivity. B. Document the information as the only action. C. Check the client's platelet count. D. Notify the physician.

ANS: D Hemorrhagic cystitis is a frequent side effect of cyclophosphamide therapy. The physician should be notified to prescribe increased hydration during therapy and the co-administration of a bladder-protecting agent.

What assessment finding would you expect to find as a result of increased residual volume in a client who has extensive, long-term chronic airflow limitation? A. Copious amounts of thick sputum B. Clubbed fingers C. Hypercarbia D. Barrel chest

ANS: D The increased residual volume increases the anteroposterior diameter of the chest so that the cross-sectional shape is round (like a barrel) instead of the normal oval shape, with the lateral diameter greater than the anteroposterior diameter

What part of the pulmonary system is most affected by asthma? A. Alveoli B. Larynx C. Pharynx D. Airways

ANS: D The portion of the airways affected by asthma is the smaller airways, with constriction of the bronchiolar smooth muscle and inflammation of the mucous membranes.

Which observation indicates to you that the client is correctly using the technique of diaphragmatic breathing? A. Abdomen rises on inhalation and remains elevated during exhalation B. Abdomen falls on inhalation and remains low during exhalation C. Abdomen falls on inhalation and rises on exhalation D. Abdomen rises on inhalation and falls on exhalation

ANS: D The technique of diaphragmatic breathing uses the diaphragm and the abdominal muscles actively during inhalation and exhalation. The abdomen rises on inhalation and falls on exhalation, indicating that the abdominal muscles are relaxed during inhalation and contracted during exhalation.