WK11/lippinncot/ RESPIRATORY TEST 4/EX3

4. Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: 1. Maintain a fluid intake of 800 mL every 24 hours. 2. Experience chills only once a day. 3. Cough productively without chest discomfort. 4. Experience less nasal obstruction and discharge.

4. A client recovering rom an upper respira-tory tract inection should report decreasing or no nasal discharge and obstruction. Daily uid intake should be increased to more than 1 L every 24 hours to liquey secretions. The temperature should be below 100°F (37.8°C) with no chills or diaphoresis. A productive cough with chest pain indicates a pulmonary inection, not an upper respiratory tract inection.

77. When instructing clients on how to decrease the risk o chronic obstructive pulmonary disease (COPD), the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises. 2. Maintain a high-protein diet. 3. Avoid exposure to people with known respiratory infections. 4. Abstain rom cigarette smoking.

4. Cigarette smoking is the primary cause o COPD. Other risk actors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although benefcial, will not decrease the risk o COPD. Insufcient protein intake and exposure to people with respiratory inections do not increase the risk o COPD.

88. A client uses a metered-dose inhaler (MDI) to aid in management o asthma. Which action indicates to the nurse that the client needs urther instruction regarding its use? Select all that apply. 1. Activation o the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath or 3 seconds ater inhaling with the MDI. 4. The client shakes the MDI ater use. 5. The client performs puffs in rapid succession.

1, 2, 3, 4, 5. Utilization o an MDI requires coordination between activation and inspiration; deep breaths to ensure that medication is distributed into the lungs, holding the breath or 10 seconds or as long as possible to disperse the medication into the lungs, shaking up the medication in the MDI beore use, and a sufcient amount o time between pus to provide an adequate amount o inhalation medication.

74. The client with chronic obstructive pulmo-nary disease (COPD) is taking theophylline. The nurse should instruct the client to report which of the following signs of theophylline toxicity? Select all that apply. 1. Nausea. 2. Vomiting. 3. Seizures. 4. Insomnia. 5. Vision changes.

1, 2, 3, 4. The therapeutic range or serum the-ophylline is 10 to 20 mcg/mL (55.5 to 111 µmol/L). At higher levels, the client will experience signs o toxicity such as nausea, vomiting, seizure, and insomnia. The nurse should instruct the client to report these signs and to keep appointments to have theophylline blood levels monitored. I the theoph-ylline level is below the therapeutic range, the client may be at risk or more requent exacerbations o the disease.

91. A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome or the use o steroids in clients with asthma? 1. Promote bronchodilation. 2. Act as an expectorant. 3. Have an antiinfammatory effect. 4. Prevent development of respiratory infections.

3. Corticosteroids have an anti-inammatory eect and act to decrease edema in the bronchial air-ways and decrease mucus secretion. Corticosteroids do not have a bronchodilator eect, act as expecto-rants, or prevent respiratory inections.

9. Pseudoephedrine (Sudafed) has been prescribed as a nasal decongestant. Which of the following is a possible adverse effect of this drug? 1. Constipation. 2. Bradycardia. 3. Diplopia. 4. Restlessness.

4. Adverse eects o pseudoephedrine (Sudaed) are experienced primarily in the car-diovascular system and through sympathetic eects on the central nervous system (CNS). The most common CNS adverse eects include rest-lessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular adverse eects include tachycardia, hypertension, palpita-tions, and arrhythmias. Constipation and diplopia are not adverse eects o pseudoephedrine. Tachycardia, not bradycardia, is an adverse eect o pseudoephedrine.

89. A 34-year-old emale with a history o asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate o 35 breaths/min, nasal aring, and use o accessory muscles. Auscultation o the lung felds reveals greatly diminished breath sounds. Based on these fndings, which action should the nurse take to initiate care o the client? 1. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes. 2. Draw blood or an arterial blood gas. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators as prescribed.

4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack o air movement in the lungs and impending respiratory ailure. The client requires immediate intervention with inhaled bronchodila-tors, IV corticosteroids, and, possibly, IV theoph-ylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood or an arterial blood gas analysis. It would be utile to encourage the client to relax and breathe slowly without pro-viding the necessary pharmacologic intervention.

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2. A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply. 1. Operating machinery and driving may be dangerous while taking antihistamines. 2. Continue taking antihistamines even i nasal inection develops. 3. The effect o antihistamines is not felt until a day later. 4. Do not use alcohol with antihistamines. 5. Increase fluid intake to 2,000 mL/day.

1, 4, 5. Antihistamines have an anticholinergic action and a drying effect and reduce nasal, salivary, and lacrimal gland hypersecretion (runny nose, tearing, and itching eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during antihistamine use. The client should ensure adequate fluid intake of at least eight glasses per day due to the drying effect of the drug. Antihistamines have no antibacterial action. The effect of antihistamines is prompt, not delayed.

92. The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following indicates that the client is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between pus. 4. The client rinses the mouth with water following administration. 5. The client lies supine for 15 minutes following administration.

1, 4. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between pus. The mouth should be rinsed ollowing the use o a corti-costeroid MDI to decrease the likelihood o develop-ing an oral inection. The client does not need to lie supine; instead, the client will likely to be able to breathe more reely i sitting upright.

73. When developing a discharge plan to manage the care o a client with chronic obstructive pulmo-nary disease (COPD), the nurse should advise the client to expect to: 1. Develop respiratory infections easily. 2. Maintain current status. 3. Require less supplemental oxygen. 4. Show permanent improvement.

1. A client with COPD is at high risk or devel-opment o respiratory inections. COPD is slowly progressive; thereore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression o the disease, but permanent improvement is highly unlikely.

79. Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? 1. Maintaining functional ability. 2. Minimizing chest pain. 3. Increasing carbon dioxide levels in the blood. 4. Treating infectious agents.

1. A priority goal or the client with COPD is to manage the signs and symptoms o the disease process so as to maintain the client's unctional abil-ity. Chest pain is not a typical symptom o COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level urther. Preventing inection would be a goal o care or the client with COPD.

1. A nurse is completing the health history For a client who has been taking echinacea For a head cold. The client asks, "Why isn't this helping me Feel better?" Which of the following responses by the nurse would be the most accurate? 1. "There is limited information as to the effectiveness o herbal products." 2. "Antibiotics are the agents needed to treat a head cold." 3. "The head cold should be gone within the month." 4. "Combining herbal products with prescrip-tion antiviral medications is sure to help you."

1. At this time, there is no strong research evidence to warrant recommendations o herbal products or management o colds; urther study is needed to show evidence o therapeutic eects and indications. Antibiotics are eective against bacteria; the head cold may have a viral cause. An uncomplicated upper respiratory tract inec-tion subsides within 2 to 3 weeks. There may be a drug-drug interaction with herbal products and prescriptions.

76. Which o the ollowing physical assessment fndings are normal or a client with advanced chronic obstructive pulmonary disease (COPD)? 1. Increased anteroposterior chest diameter. 2. Underdeveloped neck muscles. 3. Collapsed neck veins. 4. Increased chest excursions with respiration.

1. Increased anteroposterior chest diameter is characteristic o advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fxed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD because o their increased use in the work o breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom o the heart ailure that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

93. A client is prescribed metaproterenol via a metered-dose inhaler, two pus every 4 hours. The nurse instructs the client to report adverse eects. Which o the ollowing are potential adverse eects o metaproterenol? 1. Irregular heartbeat. 2. Constipation. 3. Pedal edema. 4. Decreased pulse rate.

1. Irregular heartbeats should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because o its adrenergic eect on beta-adren-ergic receptors in the heart. It is not recommended or use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

97. Which o the ollowing health promotion activities should the nurse include in the discharge teaching plan or a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak ow numbers ater meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4. Use sedatives to ensure uninterrupted sleep at night.

1. Physical exercise is benefcial and should be incorporated as tolerated into the client's schedule. Peak ow numbers should be monitored daily, usually in the morning (beore taking medi-cation). Peak ow does not need to be monitored ater each meal. Stressors in the client's lie should be modifed but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.

90. A client experiencing a severe asthma attack has the ollowing arterial blood gas results:pH 7.33; Pco2 48 (6.4 kPa); Po2 58 (7.7 kPa); HCO3 26 (26 mmol/L).Which o the ollowing prescriptions should the nurse perorm frst? 1. Albuterol nebulizer. 2. Chest x-ray. 3. Ipratropium inhaler. 4. Sputum culture.

1. The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodila-tor, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a mainte-nance treatment or bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.

87. The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which of the ollowing instruc-tions should be included? 1. Take a deep abdominal breath, bend orward, and cough three or our times on exhalation. 2. Lie at on the back, splint the thorax, take two deep breaths, and cough. 3. Take several rapid, shallow breaths and then cough orceully. 4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

1. The goal o eective coughing is to con-serve energy, acilitate removal o secretions, and minimize airway collapse. The client should assume a sitting position with eet on the oor i possible. The client should bend orward slightly and, using pursed-lip breathing, exhale. Ater resuming an upright position, the client should use abdomi-nal breathing to slowly and deeply inhale. Ater repeating this process three or our times, the client should take a deep abdominal breath, bend orward, and cough three or our times upon exhalation ("hu" cough). Lying at does not enhance lung expansion; sitting upright promotes ull expansion o the thorax. Shallow breathing does not acilitate removal o secretions, and orceul coughing pro-motes collapse o airways. A side-lying position does not allow or adequate chest expansion to promote deep breathing.

71. The nurse is instructing a client with chronic obstructive pulmonary disease (COPD) how to do pursed-lip breathing. In which order should the nurse explain the steps to the client? 1. "Breathe in normally through your nose for two counts (while counting to yourself, one, two)." 2. "Relax your neck and shoulder muscles." 3. "Pucker your lips as if you were going to whistle." 4. "Breathe out slowly through pursed lips for four counts (while counting to yourself, one, two, three, four)."

2,1,3,4

84. A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as prescribed. Which o the ollowing statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause cough-ing and dyspnea. 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. 3. Increased oxygen use will cause the client to become dependent on the oxygen. 4. Administration o oxygen is contraindicated in clients who are using bronchodilators.

2. Clients who have a long history o COPD may retain carbon dioxide (CO2). Gradually the body adjusts to the higher CO2 concentration, and the high levels o CO2 no longer stimulate the respiratory center. The major respiratory stimu-lant then becomes hypoxemia. Administration o high concentrations o oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying i it is not humidifed, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen depen-dency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use o bronchodilators.

72. The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are: pH 7.35; PCO2 62 (8.25 kPa); PO2 70 (9.31 kPa) (34 mmol/L); HCO3 34. The nurse should first: 1. Apply a 100% nonrebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

2. Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respira-tory rate, and blood pressure should be evaluated to determine i the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, i indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

5. The nurse teaches the client how to instill nose drops. Which of the following techniques is correct? 1. The client uses sterile technique when handling the dropper. 2. The client blows the nose gently beore instilling drops. 3. The client uses a new dropper for each instillation. 4. The client sits in a semi-Fowler's position with the head tilted orward ater administration o the drops.

2. The client should blow the nose beore instilling nose drops. Instilling nose drops is a clean technique. The dropper should be cleaned ater each administration, but it does not need to be changed. The client should assume a position that will allow the medication to reach the desired area; this is usu-ally a supine position.

80. A client's arterial blood gas values are as follows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO3-, 36 mEq/L. The nurse should assess the client for: 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety.

2. The high PaCO2 level causes ushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depres-sant eect on the central nervous system. Cyanosis is a sign o hypoxia. Irritability and anxiety are not common with a PaCO2 level o 65 mm Hg but are associated with hypoxia.

98. The nurse should teach the client with asthma that which o the ollowing is one o the most common precipitating actors o an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory inections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.

2. The most common precipitator o asthma attacks is viral respiratory inection. Clients with asthma should avoid people who have the u or a cold and should get yearly u vaccinations. Environmental exposure to toxins or heavy partic-ulate matter can trigger asthma attacks; however, ar ewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory inections. Some asth-matic attacks are triggered by exercising in cold weather.

82. The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess or signs and symptoms o right-sided heart ailure. Which o the ollowing signs and symptoms should be included in the teaching plan? 1. Clubbing o nail beds. 2. Hypertension. 3. Peripheral edema. 4. Increased appetite.

3. Right-sided heart ailure is a complication o COPD that occurs because o pulmonary hyper-tension. Signs and symptoms o right-sided heart ailure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased uid volume. Clubbing o nail beds is associated with conditions o chronic hypoxemia. Hypertension is associated with let-sided heart ailure. Clients with heart ailure have decreased appetites.

6. The nurse should include which o the ol-lowing instructions in the teaching plan or a client with chronic sinusitis? 1. Avoid the use of caffeinated beverages. 2. Perform postural drainage every day. 3. Take hot showers twice daily. 4. Report a temperature o 102°F (38.9°C) or higher.

3. The client with chronic sinusitis should be instructed to take hot showers in the morning and evening to promote drainage o secretions. There is no need to limit caeine intake. Perorming pos-tural drainage will inhibit removal o secretions, not promote it. Clients should elevate the head o the bed to promote drainage. Clients should report all temperatures higher than 100.4°F (38°C), because a temperature that high can indicate inection.

3. A client with allergic rhinitis is instructed on the correct technique or using an intranasal inhaler. Which o the ollowing statements would demon-strate to the nurse that the client understands the instructions? 1. "I should limit the use o the inhaler to early morning and bedtime use." 2. "It is important to not shake the canister because that can damage the spray device." 3. "I should hold one nostril closed while I insert the spray into the other nostril." 4. "The inhaler tip is inserted into the nostril and pointed toward the inside nostril wall."

3. When using an intranasal inhaler, it is important to close o one nostril while inhaling the spray into the other nostril to ensure the best inhala-tion o the spray. Use o the inhaler is not limited to mornings and bedtime. The canister should be shaken immediately beore use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhala-tion o the medication.

75. Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home under-stands the care plan? 1. The client promises to do pursed-lip breathing at home. 2. The client states actions to reduce pain. 3. The client will use oxygen via a nasal cannula at 5 L/min. 4. The client agrees to call the physician if dyspnea on exertion increases.

4. Increasing dyspnea on exertion indicates that the client may be experiencing complications o COPD. Thereore, the nurse should notiy the physician. Extracting promises rom clients is not an outcome criterion. Pain is not a common symptom o COPD. Clients with COPD use low-ow oxygen supplementation (1 to 2 L/min) to avoid suppress-ing the respiratory drive, which, or these clients, is stimulated by hypoxia.

7. A client with allergic rhinitis asks the nurse what to do to decrease the rhinorrhea. Which of the following instructions would be appropriate for the nurse to give the client? 1. "Use your nasal decongestant spray regularly to help clear your nasal passages." 2. "Ask the doctor for antibiotics. Antibiotics will help decrease the secretion." 3. "It is important to increase your activity. A daily brisk walk will help promote drainage." 4. "Keep a diary of when your symptoms occur. This can help you identify what precipitates your attacks."

4. It is important or clients with allergic rhinitis to determine the precipitating actors so that they can be avoided. Keeping a diary can help identiy these triggers. Nasal decongestant sprays should not be used regularly because they can cause a rebound eect. Antibiotics are not appropriate or allergic rhinitis because an inection is not present. Increasing activity will not control the client's symptoms; in act, walking outdoors may increase them i the client is allergic to pollen.

85. Which o the ollowing diets would be most appropriate or a client with chronic obstructive pulmonary disease (COPD)? 1. Low-at, low-cholesterol diet. 2. Bland, sot diet. 3. Low-sodium diet. 4. High-calorie, high-protein diet.

4. The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results rom the increased work o breathing. The client should be encouraged to eat small, requent meals. A low-at, low-cho-lesterol diet is indicated or clients with coronary artery disease. The client with COPD does not

78. Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake. 2. To strengthen the diaphragm. 3. To strengthen the intercostal muscles. 4. To promote carbon dioxide elimination.

4. To promote carbon dioxide elimination. Pursed-lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby pro-moting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth o respiration. Pursed-lip breathing does not promote the intake o oxygen, strengthen the diaphragm, or strengthen intercostal muscles.