Upper Resp. & COPD: Adaptive Quizzing

A patient presents with acute exacerbation of asthma. The nurse expects that which strategies will be included in the treatment plan? Select all that apply. 1 Administration of 100% oxygen 2 Nebulization with short-acting β2-adrenergic agonists (SABAs) 3 Intravenous administration of corticosteroids 4 Administration of sedatives 5 Administration of antibiotics

1. Administration of 100% oxygen 2. Nebulization with short acting β2-adrenergic agonists (SABAs) 3. Intravenous administration of corticosteroids Acute exacerbation of asthma may be life-threatening and needs immediate intervention. Administering 100% oxygen helps to relieve hypoxia and improve tissue oxygenation. Nebulization with SABA helps to relax the airways and promote airflow. Corticosteroids are administered to blunt the hyperactive immune response. Sedatives should be avoided as they may depress the respiratory center and worsen dyspnea. Antibiotics are not administered unless there are symptoms of pneumonia.

The patient has a prescription for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? 1 Albuterol (Proventil) 2 Salmeterol (Serevent) 3 Beclomethasone (Qvar) 4 Ipratropium bromide (Atrovent)

1. Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol is a long-acting β2 -adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone is a corticosteroid inhaler and is not recommended for an acute asthma attack. Ipratropium bromide is an anticholinergic agent that is less effective than β2 -adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2 -adrenergic agonists (SABAs).

The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. What would be a contraindication to the administration of the vaccine to a resident? 1 Hypersensitivity to eggs 2 Age greater than 80 years 3 History of upper respiratory infections 4 Chronic obstructive pulmonary disease (COPD)

1. Hypersensitivity to eggs Although current vaccines are highly purified, and reactions are extremely uncommon, a hypersensitivity to eggs precludes vaccination because the vaccine is produced in eggs. Advanced age and a history of respiratory illness are not contraindications for influenza vaccination.

A patient reports recurrent rhinitis and is prescribed diphenhydramine (Benadryl). Understanding the side effects associated with the medication, the nurse should instruct the patient to avoid which activity? 1 Driving 2 Watching television 3 Exercising 4 Sexual activity

1. Driving Benadryl causes drowsiness and sedation. It can increase the risk of injury if the patient engages in activities like driving or operating machinery. Therefore, the patient should be asked not to drive while on the drug. Watching television, exercising, and sexual activity do not pose any danger to the patient during the treatment.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? Select all that apply. 1 Exercise 2 Allergies 3 Emotional stress 4 Decreased humidity 5 Upper respiratory infections

1. Exercise 2. Allergies 3. Emotional stress 5. Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.

When caring for a patient who is three hours postoperative laryngectomy, what is the nurse's highest priority assessment? 1 Patient comfort 2 Airway patency 3 Incisional drainage 4 Blood pressure and heart rate

2. Airway patency Remember the airway, breathing, and circulation (ABCs) with prioritization. Airway patency is always the highest priority and is essential for a patient undergoing surgery surrounding the upper respiratory system. Comfort, drainage, and vital signs follow the ABCs in priority.

A patient presents with a persistent runny nose, sneezing, and watery eyes. The patient also reports a recent onset of headache and nasal congestion. On further questioning, a nurse finds that the patient recently brought a cat home. What condition is the patient likely to have? 1 Common cold 2 Allergic rhinitis 3 Nasal septal deviation 4 Influenza

2. Allergic rhinitis. Allergic rhinitis can be caused by sporadic exposure to allergens such as animal dander. Symptoms such as runny nose, sneezing, and watery eyes caused by exposure to a cat is suggestive of allergic rhinitis. The symptoms of common cold are similar to those of allergic rhinitis, but common cold is not caused by pets. Symptoms such as a runny nose, sneezing, and watery eyes are not suggestive of septal deviation. These symptoms may be suggestive of influenza, however, influenza is not associated with pets.

A patient diagnosed with acute viral sinusitis has experienced sneezing, congestion, sore throat, and fever for one week. The patient reports worsening of symptoms and severe ear pain. The nurse recognizes that the worsening of symptoms is caused by what? 1 Influenza 2 Bacterial infection 3 Fungal infection 4 Protozoal infection

2. Bacterial infection. Acute viral sinusitis may lead to secondary bacterial infection, which is manifested as high fever (more than 100.4 degrees Fahrenheit), swelling of the tonsils, severe ear pain, severe sinus pain, and worsening of present symptoms. Influenza, fungal, and protozoal infections are not caused by viral sinusitis.

The nurse is suctioning the patient's tracheostomy. Which occurrence is the first priority consideration by the nurse? 1 Heart rate increases from a baseline of 65 to 70 2 Heart rate decreases from a baseline of 65 to 44 3 SpO2 decreases from 100% to 92% 4 SpO2 decreases from 99% to 90%

2. Heart rate decreases from a baseline of 65 to 44. A heart rate decrease by 20 or more beats from baseline is an indication to immediately discontinue suctioning through the tracheostomy. A heart rate increase from baseline by 40 or more beats is an indication to immediately discontinue suctioning through the tracheostomy. The heart rate only increases by 5 beats and is not a reason, by itself, to discontinue suctioning. A decrease in SpO2 less than 90% is an indication to discontinue suctioning through the tracheostomy. Text Reference - p. 530

When teaching a patient about chronic obstructive pulmonary disease (COPD) rehabilitation, what strategy should the nurse teach the patient as essential to perform for energy conservation? 1 Complete inactivity 2 Exercise training 3 Reduced water intake 4 Reduced food intake

2. Exercise training Exercise training leads to energy conservation, which is an important component in COPD rehabilitation. Complete inactivity may alleviate symptoms acutely but is not helpful in the long term, because the patient needs to learn effective ways to improve muscle function. It is also important to reduce dyspnea by exercise training. Reduced water and food intake is not advisable; instead, increased water and food intake is essential to maintain energy and to loosen the secretions.

The patient seeks relief from the symptoms of an upper respiratory infection (URI) that has lasted for five days. Which patient assessment should the nurse use to help determine if the URI has developed into acute sinusitis 1 Coughing 2 Fever, chills 3 Dust allergy 4 Maxillary pain

4. Maxillary pain The nurse should assess the patient for sinus pain or pressure as a clinical indicator of acute sinusitis. Coughing and fever are nonspecific clinical indicators of a URI. A history of an allergy that is likely to affect the upper respiratory tract is supportive of the sinusitis diagnosis, but is not specific for sinusitis.

A nurse finds that the tracheostomy tube of a patient is dislodged. The nurse is unable to replace the tube and calls for assistance. Until assistance arrives, the nurse should perform what intervention? 1 Cover the stoma with sterile gauze. 2 Put the patient in a semi-Fowler position to relieve dyspnea. 3 Ventilate the patient with a bag-mask. 4 Remove the retention sutures.

2. Put the patient in a semi-Fowler position to relieve dyspnea When the dislodged tracheostomy tube cannot be replaced single-handedly, the nurse should put the patient in the semi-Fowler position. This position helps to prevent dyspnea until assistance arrives. The tracheostomy stoma should be covered only if a bag-mask ventilation needs to be performed, which is done only in case of respiratory arrest. The retention sutures help to reinsert the tube and should not be removed.

A nurse observes a patient with asthma using a metered-dose inhaler. The nurse should correct which patient actions? Select all that apply. 1 The patient inspires slowly. 2 The patient holds the breath for 5 seconds. 3 The patient shakes the device before using it. 4 The patient presses the meter dose inhaler gently. 5 The patient coordinates the use of the inhaler with inspiration

2. The patient holds the breath for 5 seconds. 4. The patient presses the meter dose inhaler gently. While using a metered dose inhaler, the breath should be held for at least 10 seconds for better absorption of the drug. The metered dose inhaler should be pressed with adequate strength to deliver the required dose. Inspiring slowly, shaking the device before using it, and coordinating use of the inhaler with inspiration are the right techniques for using a metered dose inhaler.

A nurse is caring for a patient diagnosed with chronic obstructive pulmonary disease (COPD). The lab reports of the patient reveal a hemoglobin level of 20 g/dL. What could be the reason for the increased hemoglobin? 1 The patient consumes iron-rich food. 2 The production of red blood cells increases in response to hypoxia. 3 The heart is functioning well in response to COPD treatments. 4 The patient no longer has COPD.

2. The production of RBC increases in response to hypoxia In COPD, there is chronic hypoxia. To compensate for it, the production of RBC increases, leading to polycythemia or increased hemoglobin levels. The patient cannot have a hemoglobin level of 20 g/dL by eating iron-rich food. Patients with COPD usually have compromised heart function. The patient does have COPD and polycythemia is a defense response of the body against hypoxemia.

A patient has been prescribed topical decongestants for sinusitis. What information should the nurse include when teaching the patient about this medication? 1 Use these medications for at least 10 days. 2 Use these medications for a maximum of 3 days. 3 Use these medications for at least 1 month. 4 Use these medications for at least a week.

2. Use these medications for a maximum of 3 days. Topical decongestants should be used for no more than 3 days to avoid rebound congestion by vasodilatation. If used longer than 3 days, the patient's symptoms may be made worse.

A nurse is teaching a patient how to manage fatigue induced by radiation therapy. What statement by the patient indicates a correct understanding of the lesson? 1 "I will walk three to four hours every day to increase my level of energy." 2 "It's most important for me to avoid asking for help so I can become more independent." 3 "Because I have the most energy in the morning, I will plan my errands during this time." 4 "I will keep myself busy continuously throughout the daylight hours."

3. "Because I have the most energy in the morning, I will plan my errands during this time" indicates that the patient understands the importance of doing activities that are most important to them and to rest during periods of low energy. Fatigue is a common side effect of radiation therapy and usually begins a few weeks into therapy. "I will walk three to four hours every day to increase my level of energy" indicates that the patient does not understand that scheduling activities for a period of three to four hours is excessive and does not allow time for adequate rest periods. It is important that patients suffering from radiation-induced fatigue identify support systems as a means of assistance. Avoiding requests for help would be counter to this teaching. Continuous engagement in activity would not provide periods of much needed rest for a patient who is fatigued from radiation therapy.

A patient is admitted to an emergency department with injuries of the face and nose. A nurse notices a clear, pink-tinged discharge from the nostrils of the patient, even after controlling the nasal bleed. What could be the cause of the discharge? 1 Skull fracture 2 Septal deviation 3 Cerebrospinal fluid (CSF) leak 4 Epistaxis

3. Cerebrospinal fluid (CSF) leak A clear and pink-tinged discharge from the nose even after control of nasal bleeding suggests a cerebrospinal fluid (CSF) leak. It is an emergency situation and can lead to life-threatening complications. Skull fracture is manifested as ecchymosis of the eyes. There is no clear discharge in the event of a septal deviation or epistaxis.

The nurse is educating the patient on oxygen use for the home. The patient asks the nurse "Does this mean that I will not be able to go anywhere?" The most appropriate response by the nurse is: 1 Explain the need to minimize activity in the home to conserve oxygen use 2 Point out that distance traveling may not be possible because oxygen tanks are so small 3 Encourage the patient to continue normal activity and travel plans 4 Point out that most travel companies do not accommodate travelers with oxygen

3. Encourage the patient to continue normal activity and travel plans. Encourage the patient who uses home O2 to continue normal activity and travel normally; this helps the patient maintain quality of life. Explaining the need to minimize activity in the home to conserve oxygen use, pointing out that distance traveling may not be possible because oxygen tanks are so small, and pointing out that most travel companies do not accommodate travelers with oxygen are incorrect because minimizing activity in the home most likely would decrease the patient's mobility and lead to other health conditions. If travel is by automobile, arrangements can be made for O2 to be available at the destination point. O2 supply companies often can assist in these arrangements. If a patient wishes to travel by bus, train, or airplane, the patient should inform the appropriate people when reservations are made that O2 will be needed for travel.

Which precautions should the nurse take when suctioning a tracheostomy? 1 Limit suction time to 30 seconds. 2 Rinse the catheter with clean water between suction passes. 3 Monitor oxygen saturation and lung sounds after suctioning. 4 Apply suction when inserting the catheter into the tracheostomy.

3. Monitor oxygen saturation and lung sounds after suctioning. Tracheostomy is performed to establish an airway, to bypass an airway obstruction, to help removal of secretions, and for long-term mechanical ventilation. It is very important that the tracheostomy is suctioned as indicated by the lung sounds and oxygen saturation levels. The lung sounds and oxygen saturation levels should therefore be checked after suctioning to evaluate the effectiveness. The suction time should be limited to 10 seconds to prevent hypoxemia. The catheter should be rinsed in sterile water to prevent infection. Suction should not be applied when the catheter is inserted into the tracheostomy, as this can deplete oxygen.

A nurse is suctioning the airway of a patient with a tracheostomy tube in place. While suctioning, the nurse notices that the heart rate of the patient drops from 80 to 60 beats per minute. What nursing intervention is most appropriate in this case? 1 Apply continuous suction. 2 Apply rapid intermittent suction. 3 Stop suction. 4 Start rotating the suction catheter.

3. Stop suction. (If you don't know why you don't deserve to be in nursing school.) A drop in the heart rate during suctioning indicates hypoxia. If the heart rate drops or increases by 20 beats per minute while suctioning the airway through a tracheostomy tube, suctioning should be stopped immediately. No intermittent or continuous suction should be applied as it may lead to hypoxia. The suction catheter should be rotated while applying suction.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? 1 Intravenous (IV) fluids 2 Biofeedback therapy 3 Systemic corticosteroids 4 Pulmonary function testing

3. Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.

What is the priority nursing assessment in the care of a patient who has a tracheostomy? 1 Electrolyte levels and daily weights 2 Assessment of speech and swallowing 3 Respiratory rate and oxygen saturation 4 Pain assessment and assessment of mobility

3. The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurse's assessments that also may be necessary, such as nutritional status, speech, pain, and swallowing ability.

The patient is prescribed a high-flow oxygen delivery system. Which of the following are high-flow devices? Select all that apply. 1 Nasal cannula 2 Simple face mask 3 Venturi mask 4 Non-rebreather mask 5 Mechanical ventilator

3. Venturi mask 5. Mechanical ventilator Venturi mask and mechanical ventilator are correct because oxygen (O2) delivery systems are classified as low- or high-flow systems. Venturi mask is a high-flow device that delivers fixed concentrations of O2 (e.g., 24%, 28%) independent of the patient's respiratory pattern. Mechanical ventilators are another example of high-flow O2 delivery system. Mechanical ventilation is a means of support until the patient can breathe on his or her own. A nasal cannula, simple face mask, and non-rebreather mask are low-flow devices that deliver O2 in concentrations that vary with the person's respiratory pattern. Because room air is mixed with O2, in low-flow systems, the percentage of O2 delivered to the patient is not as precise as with high-flow systems.

Which disease is associated with scratchy throat, severe pain, and enlargement of the anterior cervical lymph node? 1 Sinusitis 2 Influenza 3 Allergic rhinitis 4 Acute pharyngitis

4. Acute pharyngitis is an inflammation of the pharynx and enlargement of the anterior cervical lymph node. Sore throat, scratchiness in the throat, and difficulty swallowing are clinical manifestations of acute pharyngitis. Sinusitis is inflammation of the sinuses. It develops when inflammation or hypertrophy of the mucosa blocks the openings in the sinuses through which mucus drains into the nose. This causes pain over the affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, and malaise. Influenza is an infectious disease caused by influenza virus. The systemic symptoms of influenza include chills, fever, anorexia, malaise, and generalized myalgia. Allergic rhinitis is an allergic inflammation of the nasal airways. It includes sneezing; watery, itchy eyes; altered sense of smell; and thin, watery nasal discharge resulting in sustained mucus production and nasal congestion.

The nurse concludes that interventions carried out to promote airway clearance in a patient admitted with asthma are successful on the basis of which finding? 1 Oxygen saturation 96% 2 Use of accessory muscles 3 Absence of wheezing 4 Clearance of mucous from the bronchi

4. Clearance of mucous from the bronchi The issue is airway clearance, which is evaluated most directly as successful if the patient can engage in effective and productive coughing. Oxygen saturation would indicate gas exchange, not airway clearance. Use of accessory muscles indicates respiratory distress. The absence of wheezing does not always coincide with improved airway clearance, and may represent worsening bronchospasm.

What is an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands? 1 Sickle-cell disease 2 Tay-Sachs disease 3 Spinal muscular atrophy 4 Cystic fibrosis (CF)

4. Cystic fibrosis (CF) CF is an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands. This defect primarily affects the lungs, pancreas and biliary tract, and sweat glands. Sweat glands excrete increased amounts of sodium and chloride. While sickle-cell disease, Tay-Sachs disease, and spinal muscular atrophy are all autosomal recessive, multisystem diseases, they are not characterized by altered function of the exocrine glands.

A patient experiencing an acute asthma exacerbation has received a bronchodilator and supplemental oxygen. Which treatment should the nurse anticipate if the patient's condition remains unchanged? 1 Chest x-ray 2 Intravenous (IV) antibiotics 3 Peak flow measurements 4 Intravenous corticosteroids

4. Intravenous corticosteriods Corticosteroids are antiinflammatories that are effective in treating respiratory distress caused by bronchoconstriction. The patient would be given this medication as an IV push medication. Chest x-ray is not a treatment of an asthma exacerbation. IV antibiotics are not indicated in the absence of infection. Peak flow measurements can measure airflow, but will not improve the patient's condition.

The nurse is caring for the patient with cystic fibrosis (CF). What is the most important factor for the nurse to consider when using clearance techniques and devices? 1 Positive expiratory pressure (PEP) devices are the method of choice as a clearing technique 2 Acapella devices have better results than other techniques 3 Pursed-lip breathing is critical for the success of any technique 4 No single technique has shown superiority over the others

4. No single technique has shown superiority over the others. Airway clearance techniques are critical, because the normal ciliary motion in CF airways is impaired. Chest Physical Therapy (CPT) (including postural drainage with percussion and vibration) and high-frequency chest wall oscillation loosen mucus. Clearance is achieved by the specialized expiratory techniques aimed at using airflow to remove the loosened secretions. Examples of clearance techniques and devices are PEP devices (e.g., Flutter device), Acapella, breathing exercises (autogenic drainage), pursed-lip breathing, and huff coughing. Individuals with CF may prefer a certain technique or device that works well for them in a daily routine. No clear evidence exists that any of the airway clearance techniques are superior to the others.

What is the best method to prevent oral infection while the patient is taking fluticasone (Flovent HFA)? 1 Rinse the mouth daily with an oral antibiotic solution. 2 Brush the teeth before and after medication administration. 3 Rinse the mouth with water before each puff of medication. 4 Rinse the mouth with water after the second puff of medication

4. Rinse the mouth with water after the second puff of medication The patient should rinse the mouth with water after the second puff of medication to reduce the risk of fungal overgrowth and oral infection. An oral antibiotic solution is not indicated and would not treat a fungal infection. Brushing the teeth is not necessary before medication administration and the mouth should be rinsed after, not before, medication administration.

Which statement about a deviated septum is correct? 1 All septal deviations are symptomatic 2 A septoplasty will not correct a deviated septum 3 Epistaxis is a rare manifestation of a deviated septum 4 The aim of medical management is nasal allergy control

4. The aim of medical management is nasal allergy control The aim of medical management is symptom control because medical management of a deviated septum is focused on symptom control of nasal inflammation and congestion. All septal deviations are symptomatic, a septoplasty will not correct a deviated septum, and an epistaxis is a rare manifestation of a deviated septum are incorrect because minor septal deviations are typically asymptomatic, septoplasty will properly align a deviated septum, and epistaxis is one of many common manifestations of septal deviation.

The nurse is completing tracheostomy care. Which of these is the best method for ensuring the fit of tracheostomy ties? 1 Have the respiratory therapist check the ties. 2 Ask the patient if the ties feel comfortable after tying them. 3 Place one finger underneath the ties to ensure they are not too tight around the neck. 4 Place two fingers underneath the ties to ensure they are not too tight around the neck.

4. When securing tracheostomy ties , place two fingers underneath the ties to ensure that they are not too tight around the patient's neck. The respiratory therapist may not be trained in changing the ties, or may not check them accurately. The patient may not be able to identify if the ties are too tight. One finger beneath the tie is too tight.

The nurse is caring for the patient with chronic obstructive pulmonary disease (COPD). Which of the following are appropriate patient goals? Select all that apply. 1 Prevention of disease progression 2 Relief of symptoms 3 Healing of damaged lung tissue 4 Ability to perform activities of daily living (ADLs) 5 Improved quality of life

The overall goals are that the patient with COPD will have (1) prevention of disease progression, (2) ability to perform ADLs and improved exercise tolerance, (3) relief from symptoms, (4) no complications related to COPD, (5) knowledge and ability to implement a long-term treatment regimen, and (6) overall improved quality of life. Lung tissue does not regenerate so "healing" is not a realistic goal. Patients need to know that symptoms can be managed, but COPD cannot be cured.