Nursing Management: Obstructive Pulmonary Diseases

The nurse is assessing a client with asthma who is short of breath and appears frightened. Which of the following clinical manifestations is often present as an early symptom during an exacerbation of asthma? A. Anxiety B. Cyanosis C. Bradycardia D. Hypercapnia

A. - Anxiety is an early symptom during an asthma attack because the client is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating.

Which of the following findings by the nurse for a client with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? A. Pulse oximetry reading of 91% B. Absence of wheezes or crackles C. Decreased use of accessory muscles D. RR of 22 breaths/minute

A. - For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.

Which of the following findings in a client who has received omalizumab (antiasthmatic) is considered an adverse effect? A. Inflammation, redness, and pain at the injection site. B. Flushing and dizziness. C. RR of 22 breaths/minute. D. Peak flow reading 75% of normal.

A. - Reaction at injection site is the only adverse effect of omalizumab. The other information is not related to omalizumab therapy.

The nurse is caring for a client who has a prescription for each of the following inhalers. Which of the following medications should the nurse administer to the client at the onset of an asthma attack? A. Salbutamol B. Salmeterol C. Beclomethasone D. Ipratropium bromide

A. - Salbutamol (Ventolin) is a short-acting bronchodilator that should be given initially when the client experiences an asthma attack.

The nurse is caring for a client who is prescribed salbutamol. Which of the following client vital signs indicates that the client is not experiencing any adverse effects from this medication? A. HR of 76 bpm B. RR of 18 breaths/min C. Temperature of 36.9° C (98.4°C) D. O2 sat. of 96%

A. - Salbutamol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 76 indicates that the client did not experience tachycardia as an adverse effect.

The nurse is caring for a client with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the client asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse's response? A. One drug decreases inflammation, and the other is a bronchodilator. B. It is a combination of long-acting and slow-acting bronchodilators. C. The combination of two drugs works more quickly in an acute asthma attack. D. The two drugs work together to block the effects of histamine on the bronchioles.

A. - Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. Neither medication is an antihistamine. The two-drug combination of salmeterol and fluticasone is not used during an acute attack because the medications do not work rapidly.

The nurse has completed client teaching about the administration of salmeterol using a MDI. Which of the following actions by the client indicates good understanding of the teaching? A. The client attaches a spacer before using the MDI. B. The client coughs vigorously after using the inhaler. C. The client floats the MDI in water to see if it is empty. D. The client activates the inhaler at the onset of expiration.

A. - Spacers can improve the delivery of medication to the lower airways. The other client actions indicate a need for further teaching.

The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions? A. Keep the air entrainment ports clean and unobstructed. B. Give a high enough flow rate to keep the bag from collapsing. C. Use an appropriate adaptor to ensure adequate oxygen delivery. D. Drain moisture condensation from the oxygen tubing every hour.

A. - The air entrainment ports regulate the oxygen percentage delivered to the client, so they must be unobstructed. A high oxygen flow rate is needed when administering oxygen by partial rebreather or non-rebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a client receiving mechanical ventilation.

Which of the following actions should the nurse anticipate taking first when a client who is experiencing an asthma attack develops bradycardia and a decrease in wheezing? A. Assist with endotracheal intubation. B. Document changes in respiratory status. C. Encourage the client to cough and deep breathe. D. Administer IV methylprednisolone.

A. - The client's assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation. Documentation is not a priority at this time. The client will not be able to cough or deep breathe effectively. IV corticosteroids require several hours before having any effect on respiratory status.

The nurse is caring for a client with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the client's respiratory status is improving? A. Wheezing becomes louder. B. Vesicular breath sounds decrease. C. The cough remains nonproductive. D. Aerosol bronchodilators stimulate coughing.

A. - The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange.

The nurse is assessing a young adult client in the outpatient clinic who has a new diagnosis of emphysema and does not have a history of smoking. Which of the following information should the nurse anticipate teaching the client about? A. a1-antitrypsin testing B. Use of the nicotine patch C. Continuous pulse oximetry D. Effects of leukotriene modifiers

A. - When emphysema occurs in young clients, especially without a smoking history, a congenital deficiency in a1-antitrypsin should be suspected. Because the client does not smoke, a nicotine patch would not be ordered. There is no indication that the client requires continuous pulse oximetry. Leukotriene modifiers would be used in clients with asthma, not with emphysema.

The nurse identifies the nursing diagnosis of activity intolerance for a client with asthma. Which of the following etiological factors should the nurse assess in the client? A. Work of breathing. B. Fear of suffocation. C. Effects of medications. D. Anxiety and restlessness.

A. - When the client does not have sufficient gas exchange to engage in activity, the etiological factor is often the work of breathing. When clients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity.

The nurse is admitting a client with a diagnosis of asthma exacerbation. Which of the following potential triggers should the nurse assess in the client? Select all that apply. A. Exercise B. Allergies C. Emotional stress D. Decreased humidity E. Upper respiratory infections

A., B., C., & E. - Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include exercise, allergens, air pollutants, psychological factors, upper respiratory infections, drug and food additives, and gastro-esophageal reflux disease (GERD).

The client has an order for salbutamol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. How many millilitres should the nurse use to prepare the client's dose? A. 0.2 mL B. 2.5 mL C. 3.75 mL D. 5.0 mL

B. - 5 mg ÷ 2 mg/mL = 2.5 mL

The nurse is teaching a client about the use of a spacer device when taking inhaled medications. Which of the following client statements indicates that the teaching has been effective? A. "I will pay less for medication because it will last longer." B. "More of the medication will get down into my lungs to help my breathing." C. "Now I will not need to breathe in as deeply when taking the inhaler medications." D. "This device will make it so much easier and faster to take my inhaled medications."

B. - A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat.

The nurse is caring for a client with COPD who is receiving oxygen. Which of the following actions is best for the nurse to implement to determine the appropriate oxygen flow rate? A. Minimize oxygen use to avoid oxygen dependency. B. Maintain oxygen saturation at 90% or greater. C. Administer oxygen according to the client's level of dyspnea. D. Avoid administration of oxygen at a rate of more than 2 L/minute.

B. - An oxygen saturation of 90% or greater indicates an adequate blood oxygen level without the danger of suppressing respiratory function and prolongs life in patients with hypoxemia. Because oxygen use improves survival rate in clients with COPD, there is not a concern about oxygen dependency. The client's perceived dyspnea level may be affected by other factors (i.e., anxiety) besides ABGs. For clients with an exacerbation of COPD, an oxygen flow rate of 2 L/minute may not be adequate.

The nurse is caring for a client with COPD and identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 14 kg. Which of the following actions should the nurse include in the plan of care for this client? A. Order fruits and fruit juices to be offered between meals. B. Order a high-calorie, high-protein diet with 5-6 small meals a day. C. Teach the client to use frozen meals at home that can be microwaved. D. Provide a high-calorie, high-carbohydrate, non-irritating, frequent feeding diet.

B. - Because the client with COPD needs to use greater energy to breathe, there is often decreased oral intake due to dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, interfering with the work of breathing. Finally, the metabolism of a high-carbohydrate diet yields large amounts of CO2, which may lead to acidosis in clients with pulmonary disease. For these reasons, the client with COPD should take in a high-calorie, high-protein diet, eating 5-6 small meals per day.

The nurse is admitting a client with COPD to the hospital. Which of the following positions should the nurse place the client in to improve gas exchange? A. Resting in bed with the head elevated to 45-60 degrees. B. Sitting up in the bed/chair and leaning slightly forward. C. Resting in bed in a high Fowler's position with the knees flexed. D. Trendelenburg position with several pillows behind the head.

B. - Clients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated would be an alternative position if the client was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the client's ability to ventilate well.

The nurse is teaching a client about continuous home oxygen use and cautions the client to take extra care to not run out of oxygen. Which of the following seasons should the nurse instruct the client has the highest rate of oxygen evaporation? A. Spring B. Summer C. Fall D. Winter

B. - During the summer, with liquid oxygen, evaporation is accelerated and may decrease reservoir duration to less than 1 week.

After the nurse has completed diet teaching for a client with COPD who has a body mass index (BMI) of 20, which of the following client statements indicate that the teaching has been effective? A. "I will drink lots of fluids with my meals." B. "I will have ice cream as a snack every day." C. "I will exercise for 15 minutes before meals." D. "I will decrease my intake of meat or poultry."

B. - High-calorie foods like ice cream are an appropriate snack for clients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The client should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the client with COPD.

The nurse is providing client teaching about COPD and the client asks the nurse what is the cause of COPD symptoms. Which of the following information is the basis for the nurse's response? A. An overproduction of the antiprotease α1-antitrypsin. B. Hyperinflation of alveoli and destruction of alveolar walls. C. Hypertrophy and hyperplasia of goblet cells in the bronchi. D. Collapse and hypoventilation of the terminal respiratory unit.

B. - In COPD, there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.

The nurse is teaching a client how to self-administer ipratropium via MDI. Which of the following instructions should the nurse provide to the client about proper inhalation technique? A. "Avoid shaking the inhaler before use." B. "Breathe out slowly before positioning the inhaler." C. "After taking a puff, hold the breath for 30 seconds before exhaling." D. "Using a spacer should be avoided for this type of medication."

B. - It is important to breathe out slowly before positioning the inhaler. This allows the client to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose.

The nurse is teaching a client with asthma about the appropriate use of a peak flowmeter. Which of the following instructions should the nurse include in the teaching plan? A. Use the flowmeter each morning after taking medications to evaluate their effectiveness. B. Keep a record of the peak flowmeter numbers if symptoms of asthma are getting worse. C. Increase the doses of the long-term control medication if the peak flow numbers decrease. D. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

B. - It is important to keep track of peak flow readings daily, especially when the client's symptoms are getting worse. The client should have specific directions as to when to call the physician, based on personal peak flow numbers. Peak flow is measured by exhaling into the flowmeter and should be assessed before and after medications to evaluate their effectiveness.

The nurse is evaluating whether a client understands how to safely determine whether a MDI without a counter is empty. Which of the following methods to check the inhaler to prevent underdosing should the nurse teach the client? A. Place it in water to see if it floats. B. Keep track of the number of inhalations used. C. Shake the canister while holding it next to the ear. D. Check the indicator line on the side of the canister.

B. - It is no longer appropriate to determine whether a canister is empty by seeing if it floats in water since this is not accurate. The best method to determine when to replace an inhaler is by knowing the maximum number of puffs available per MDI and then replacing it when those inhalations have been used.

The following medications are prescribed by the health care provider for a client having an acute asthma attack. Which medication should the nurse administer first? A. Salmeterol 50 mcg per DPI. B. Salbutamol 2.5 mg per nebulizer. C. Triamcinolone 2 puffs per MDI. D. Methylprednisolone 60 mg IV.

B. - Salbutamol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. It is known as an asthma rescue medication. The other medications work more slowly.

The nurse is caring for a client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use? A. Oxygen tent. B. Venturi mask. C. Nasal cannula. D. Partial non-rebreather mask.

B. - The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicates that more teaching is needed? A. The client inhales slowly through the nose. B. The client tenses the neck muscles while exhaling. C. The client practices by blowing through a straw. D. The client's ratio of inhalation to exhalation is 1:3.

B. - The client should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the client indicate a good understanding of pursed lip breathing

The nurse is caring for a client with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first? A. Tell the client to go to the hospital emergency department. B. Instruct the client to use the prescribed albuterol. C. Ask about recent exposure to any new allergens or asthma triggers. D. Question the client about use of the prescribed inhaled corticosteroids.

B. - The client's peak flow is 70% of normal, in the yellow zone, indicating a need for immediate use of short-acting B2-adrenergic (SABA) medications. Because the client is currently in the yellow zone, urgent care is not needed. Assessing for exposure to allergens or correct use of medications is appropriate, but would not address the current decrease in peak flow.

Which of the following diagnostic tests should the nurse plan to discuss with a client who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of COPD? A. Eosinophil count B. Spirometry C. Immunoglobulin E (IgE) levels D. Radioallergosorbent test (RAST)

B. - The diagnosis of COPD is confirmed by spirometry, regardless of whether the client has chronic symptoms. The other tests would be used to test for an allergic component for asthma but will not be used in the diagnosis of COPD.

The nurse is caring for a client with CF who has blood glucose levels that are consistently 11-14 mmol/L. Which of the following nursing actions should the nurse plan to implement? A. Discuss the role of diet in blood glucose control. B. Educate the client about administration of insulin. C. Give oral hypoglycemic medications before meals. D. Evaluate the client's home use of pancreatic enzymes.

B. - The glucose levels indicate that the client has developed CF-related diabetes; insulin therapy will be required. Since the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Clients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a client with CF.

The nurse is evaluating the effectiveness of therapy for a client who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective? A. No wheezes are audible. B. O2 sat. is >92%. C. Accessory muscle use has decreased. D. RR is 16 breaths/minute.

B. - The goal for treatment of an asthma attack is to keep O2 sat. >92%. The other client data may occur when the client is too fatigued to continue with the increased work of breathing required in an asthma attack.

A young adult client with CF tells the nurse that she is considering having a child. Which of the following responses is best for the nurse to respond initially? A. "Are you aware of the normal lifespan for clients with CF?" B. "Do you need any information to help you with the decision?" C. "You will need genetic counselling before making a decision." D. "Many women with CF do not have difficulty in conceiving children."

B. - The nurse's initial response should be to assess the client's knowledge level and need for information. Although the lifespan for clients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the client's comments. The other responses are accurate, but the nurse should first assess the client's understanding about the issues surrounding pregnancy.

The nurse is preparing to administer salmeterol to a client by metered-dose inhaler (MDI). The nurse tells the client that which of the following time frames is the onset of action for this medication? A. 3-5 minutes B. 10-20 minutes C. 30-60 minutes D. 2-4 hours

B. - The onset of action for salmeterol, an adrenergic bronchodilator, is 10-20 minutes.

The nurse determines that a client is experiencing common adverse effects from the inhaled corticosteroid beclomethasone. Which of the following symptoms is the basis for this determination? A. Hypertension and pulmonary edema. B. Oropharyngeal candidiasis and hoarseness. C. Elevation of blood glucose and calcium levels. D. Adrenocortical dysfunction and hyperglycemia.

B. - These symptoms are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the client does not rinse the mouth following each dose.

The nurse is teaching a client with COPD about exercise. Which of the following information should the nurse include? A. "Stop exercising if you start to feel short of breath." B. "Use the bronchodilator before you start to exercise." C. "Breathe in and out through the mouth while you exercise." D. "Upper body exercise should be avoided to prevent dyspnea."

B. - Use of a bronchodilator before exercise improves airflow for some clients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Clients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in clients with COPD.

The nurse is caring for a client with COPD who has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which of the following nursing actions is best? A. Change the oxygen flow rate to the highest prescribed rate. B. Reinforce the ongoing use of pursed lip breathing techniques. C. Educate the client to use the Flutter airway clearance device. D. Teach the client about consistent use of inhaled corticosteroids.

C. - Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some clients with COPD, but they are not indicated for this client's problem of thick mucous secretions.

The nurse evaluates that nursing interventions to promote airway clearance in a client admitted with COPD are successful based on which of the following findings? A. Absence of dyspnea. B. Improved mental status. C. Effective and productive coughing. D. PaO2 within normal range for the client.

C. - Airway clearance is most directly evaluated as successful if the client can engage in effective and productive coughing.

The nurse is conducting an admission history for a client with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy? A. The client has a history of pneumonia 2 years ago. B. The client has chronic inflammatory bowel disease. C. The client takes propranolol for hypertension. D. The client uses acetaminophen for headaches.

C. - B-Blockers (i.e., propranolol) can cause bronchospasm in some clients. The other information will be documented in the health history but does not indicate a need for a change in therapy.

The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client? A. Elevated temperature B. Clubbing of the fingers C. Jugular vein distension D. Complaints of chest pain

C. - Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the client with other complications of COPD but are not indicators of cor pulmonale.

The nurse, who has administered a first dose of oral prednisone to a client with asthma, writes on the care plan to begin monitoring which of the following client parameters? A. Apical pulse B. Bowel sounds C. Intake and output D. Deep tendon reflexes

C. - Corticosteroids (i.e., prednisone) can lead to fluid retention. For this reason, it is important to monitor the client's intake and output.

Which of the following topics should the nurse include in medication teaching for a client with newly diagnosed persistent asthma? A. Use of long-acting B-adrenergic medications. B. Adverse effects of sustained-release theophylline. C. Self-administration of inhaled corticosteroids. D. Complications associated with oxygen therapy.

C. - Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all clients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.

The nurse is evaluating a client who taking ipratropium. Which of the following assessment findings indicates that the medication is beneficial? A. Decreased respiratory rate. B. Increased respiratory rate. C. Increased peak flow readings. D. Decreased sputum production.

C. - Ipratropium is a bronchodilator that should lead to increased peak expiratory flow rates (PEFRs).

Which of the following actions by a client who has asthma indicates a good understanding of the nurse's teaching about peak flowmeter use? A. The client records an average of three peak flow readings every day. B. The client inhales rapidly through the peak flowmeter mouthpiece. C. The client uses the albuterol MDI for peak flows in the yellow zone. D. The client calls the health care provider when the peak flow is in the green zone.

C. - Readings in the yellow zone indicate a decrease in peak flow; the client should use short-acting B2-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The client should exhale quickly and forcefully through the peak flowmeter mouthpiece to obtain the readings.

The nurse is caring for a client in the ED admitted with an exacerbation of asthma. The client has received a β-adrenergic bronchodilator and supplemental oxygen with no improvement in symptoms. Which of the following actions should the nurse anticipate next? A. Intravenous fluids. B. Biofeedback therapy. C. Systemic corticosteroids. D. Pulmonary function testing.

C. - Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient.

The nurse is assessing a client in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take? A. Teach the client about the use of oral corticosteroids. B. Administer a bronchodilator and recheck the peak flow. C. Instruct the client to continue to use current medications. D. Evaluate whether the peak flowmeter is being used correctly.

C. - The client's peak flow readings indicate good asthma control (values <80%), no changes are needed. The other actions would be indicated for clients in the yellow or red zones for peak flow.

The nurse is preparing to administer a dose of ipratropium bromide by MDI to a client. The nurse tells the client that which of the following time frames is the expected duration of action for this medication? A. 30 minutes to 1 hour B. 2-3 hours C. 4-6 hours D. 8-12 hours

C. - The duration of action for ipratropium bromide, an anticholinergic medication, is 4-6 hours.

The nurse reviews pursed-lip breathing with a client newly diagnosed with COPD. The nurse reinforces that this technique will assist respiration by which of the following mechanisms? A. Loosening secretions so that they may be coughed up more easily. B. Promoting maximal inhalation for better oxygenation of the lungs. C. Preventing bronchial collapse and air trapping in the lungs during exhalation. D. Increasing the respiratory rate and giving the client control of respiratory patterns.

C. - The focus of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.

The nurse is caring for a client who has anxiety and an exacerbation of asthma. For which of the following reasons should the nurse carefully inspect the chest wall of the client? A. Allow time to calm the client. B. Observe for signs of diaphoresis. C. Evaluate the use of intercostal muscles. D. Monitor the client for bilateral chest expansion.

C. - The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the client.

Which of the following positions is best for the nurse to place a client who is experiencing an asthma exacerbation? A. Supine B. Lithotomy C. High Fowler's D. Reverse Trendelenburg

C. - This position allows for optimal chest expansion and enlists the aid of gravity during inspiration.

The nurse is caring for a client with a history of asthma. Which of the following assessments finding should the nurse communicate immediately to the health care provider? A. Pulse oximetry reading of 91% B. RR of 26 breaths/minute C. Use of accessory muscles in breathing D. Peak expiratory flow rate of 240 mL/minute

C. - Use of accessory muscle indicates that the client is experiencing respiratory distress and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.

The nurse is assessing a client with asthma and notes wheezing and dyspnea. Which of the following pathophysiological changes is attributable to these symptoms? A. Laryngospasm. B. Pulmonary edema. C. Narrowing of the airway. D. Overdistension of the alveoli.

C. Narrowing of the airway leads to reduced airflow, making it difficult for the client to breathe and producing the characteristic wheezing.

The nurse is interviewing a client with a new diagnosis of COPD. Which of the following information will help most in confirming a diagnosis of chronic bronchitis? A. The client tells the nurse about a family history of bronchitis. B. The client's history indicates a 40 pack-year cigarette history. C. The client denies having any respiratory problems until the last 6 months. D. The client complains about a productive cough every winter for 3 months.

D. - A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

Which of the following findings may be a direct result of cystic fibrosis (CF)? A. Visual impairment B. Renal insufficiency C. Osteoporosis D. Malnutrition

D. - Because of malabsorption caused by thick mucous secretions throughout the GI tract, clients often present with malnutrition. While CF affects many body systems, visual impairment, renal insufficiency, and osteoporosis are not necessarily linked directly to CF.

The nurse is preparing a client with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan? A. Avoid eating or drinking for several hours before the testing. B. Use rescue medications immediately before the tests are done. C. Take oral corticosteroids at least 2 hours before the examination. D. Withhold bronchodilators for 6-12 hours before the examination.

D. - Bronchodilators are held before pulmonary function testing so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the client to be NPO. Rescue medications (bronchodilators) would not be given until after the baseline pulmonary function was assessed. Oral corticosteroids also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level.

Which of the following information about a newly admitted client with COPD indicates that the nurse should consult with the MD before administering the prescribed theophylline? A. The client has had a recent 10-pound weight gain. B. The client has a cough productive of green mucus. C. The client denies any shortness of breath at present. D. The client takes cimetidine 150 mg daily.

D. - Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other client information would not impact on whether the theophylline should be administered or not.

The nurse is caring for a client with COPD and they express concerns related to sexual intercourse. Which of the following information should the nurse provide to the client? A. Abstain from intercourse but not intimacy. B. Assume the dominant position during intercourse. C. Increase the time spent in foreplay. D. Use slow pursed-lip breathing during intercourse.

D. - Clients with COPD may need modifications related to sexual activity but abstaining from intercourse is not required. Clients with COPD also need less energy if these guidelines are followed: (a) have sexual activity during the part of the day when breathing is best, (b) use slow pursed-lip breathing, (c) refrain from sexual activity after eating or other strenuous activity, (d) do not assume a dominant position, and (e) do not prolong foreplay.

The nurse is caring for a client with emphysema and notes jugular vein distension and pedal edema. Which of the following possible complications of emphysema are these symptoms reflective of? A. Acute respiratory failure. B. Secondary respiratory infection. C. Pulmonary edema caused by left-sided heart failure. D. Fluid volume excess resulting from cor pulmonale.

D. - Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distension and pedal edema.

The nurse is caring for a client with COPD who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem? A. Increase the client's intake of fruits and fruit juices. B. Have the client exercise for 10 minutes before meals. C. Assist the client in choosing foods with a lot of texture. D. Offer high-calorie snacks between meals and at bedtime.

D. - Eating small amounts more frequently will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals which can affect respirations. Although fruits and juices are not contraindicated, foods high in protein are a better choice. Clients with COPD should rest before meals. Foods that have a lot of texture may take more energy to eat and lead to decreased intake.

Which of the following information given by a client with asthma while the nurse is doing the admission assessment is most indicative of a need for a change in therapy? A. The client uses terbutaline before any aerobic exercise. B. The client says that the asthma symptoms are worse every spring. C. The client's heart rate increases after using the salbutamol inhaler. D. The client's only medications are formoterol and salmeterol.

D. - Long-acting B2-agonists should be used only in clients who also are using an inhaled corticosteroid for long-term control. The other information given by the client requires further assessment by the nurse but is not unusual for a client with asthma.

The nurse is caring for a client who is receiving oxygen per nasal cannula while hospitalized for COPD. The client asks the nurse whether oxygen use will be needed at home. Which of the following responses is best? A. "Long-term home oxygen therapy should be used to prevent respiratory failure." B. "Oxygen will not be needed until or unless you are in the terminal stages of this disease." C. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." D. "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."

D. - Long-term oxygen therapy in the home should be considered when the oxygen saturation is 88% or less and the client has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status.

The nurse is caring for a client with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care? A. Titrate oxygen to keep saturation at least 90%. B. Discuss a high-protein, high-calorie diet with the client. C. Suggest the use of over-the-counter sedative medications. D. Teach the client how to effectively use pursed lip breathing.

D. - Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the client requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory function.

Which of the following information should the nurse include in teaching a client with COPD who has a new prescription for home oxygen therapy? A. Storage of oxygen tanks will require adequate space in the home. B. Travel opportunities will be limited because of the use of oxygen. C. Oxygen flow should be increased if the client has more dyspnea. D. Oxygen use can improve the client's prognosis and quality of life.

D. - Research supports the use of home oxygen to improve quality of life and prognosis. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual client circumstances. Travel is possible by using portable oxygen concentrators. Since increased dyspnea may be a symptom of an acute process such as pneumonia, the client should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse.

Which of the following actions should be included in the plan of care for a client with CF who is admitted to the hospital with increased dyspnea? A. Schedule a sweat chloride test. B. Arrange for a hospice nurse visit. C. Place the client on a low-sodium diet. D. Perform chest physiotherapy every 4 hours.

D. - Routine scheduling of airway clearance techniques is an essential intervention for clients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the client is terminally ill. Clients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.

Which of the following statements made by a client with COPD indicates a need for further teaching regarding the use of an ipratropium inhaler? A. "I should rinse my mouth following the two puffs to get rid of the bad taste." B. "I should wait at least one to two minutes between each puff of the inhaler." C. "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse." D. "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

D. - The client should not take extra puffs of the inhaler at will to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the client's respiratory status.

The nurse is assisting a client to learn self-administration of beclomethasone. Which of the following actions should the nurse include in the teaching plan as the best way to prevent an oral infection while taking this medication? A. Chew a hard candy before the first puff of medication. B. Rinse the mouth with water before each puff of medication. C. Ask for a breath mint following the second puff of medication. D. Rinse the mouth with water following the second puff of medication.

D. - The client should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection.

The nurse is providing discharge information related to activity levels to a 61-year-old client with COPD and pneumonia. Which of the following exercise goals is most appropriate once the client is fully recovered from this episode of illness? A. Slightly increase activity over the current level. B. Swim for 10 minutes/day, gradually increasing to 30 minutes/day. C. Limit exercise to activities of daily living to conserve energy. D. Walk for 20 minutes/day, keeping the pulse rate >130 bpm.

D. - The client will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The client should be encouraged to walk for 15-20 minutes/day, keeping the HR <75% to 80% of maximum HR (220 - client's age). For this client, the maximum HR is 162* (*220 - 58) × 80% = 129.6 beats/min.

The nurse is caring for a client with severe COPD who tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, which of the following nursing diagnoses is best?A. Hopelessness related to chronic stress. B. Ineffective coping related to inadequate sense of control. C. Deficient knowledge related to inadequate information. D. Social isolation related to difficulty performing ADLs.

D. - The client's statement about not being able to do anything for themselves supports this diagnosis. Emotions frequently encountered include guilt, depression, anxiety, social isolation, denial, and dependence. Although hopelessness, ineffective coping, and deficient knowledge may be appropriate diagnoses for clients with COPD, the data for this client do not support these diagnoses.

The nurse is caring for a client who is hospitalized with CF and is coughing up large quantities of thick, green mucus. Which of the following treatments should the nurse include in the teaching plan? A. Antibiotic resistance B. Inhaled bronchodilators C. Oral corticosteroid therapy D. Aerosolized amoxicillin

D. - The colour of the mucus and the client's history of CF suggest Pseudomonas infection; an antibiotic is required. Pseudomonas infections are usually responsive (not resistant) to antibiotics. Oral corticosteroids and inhaled bronchodilators will not be effective in treating the respiratory infection; the effectiveness of bronchodilators has not been established for CF.

The nurse is caring for a client in the emergency department who is experiencing an acute asthma attack. After listening to the client's breath sounds, which of the following actions should the nurse take next? A. Start an intravenous with Ringer's Lactate. B. Ask about inhaled corticosteroid use. C. Determine when the dyspnea started. D. Obtain the forced expiratory volume (FEV1) flow rate.

D. - The examiner can assess the degree of severity by measuring FEV1 or PEFR, identifying the degree of change in objective measurements, and evaluating the baseline pulse oximetry value. Initiating IV therapy is not a priority at this time. It is important to know about the medications the client is using but not as important as assessing pulmonary functioning. The length of time the attack has persisted is not as important as determining the client's status at present.

Which of the following information should the nurse include when teaching the client with asthma about the prescribed medications? A. Utilize the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry-powder inhaler (DPI). C. Hold your breath for 5 seconds after using the bronchodilator inhaler. D. Tremors are an expected adverse effect of rapidly acting bronchodilators.

D. - Tremors are a common adverse effect of short-acting B2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The client should hold the breath for 10 seconds after using inhalers.