Chapter 20-24: Respiratory

The classification of Stage I of COPD is defined as a) mild COPD b) at risk for COPD c) severe COPD d) very severe COPD

Stage I is mild COPD. Stage 0 is at risk for COPD. Stage III is severe COPD. Stage IV is very severe COPD.

Which of the following is accurate regarding status asthmaticus? a) Usually occurs with warning b) A severe asthma episode that is refractory to initial therapy c) Usually does not progress to severe obstruction d) Patients have a productive cough.

b) A severe asthma episode that is refractory to initial therapy Status epilepticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.

Which ventilation-perfusion ratio is exhibited by a pulmonary emboli? a) Normal ratio of perfusion to ventilation b) Silent unit c) Dead space d) Low ventilation-perfusion ratio

c) Dead space When ventilation exceeds perfusion a dead space exists. An example of a dead space is pulmonary emboli. A low ventilation-perfusion ratio exists in pneumonia or with a mucus plug. A silent unit occurs in pneumothorax or ARDS.

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: a) "I can refer you to the American Lung Association." b) "Have you tried to quit smoking before?" c) "Nicotine patches would be appropriate for you." d) "Many options are available for you."

b) "Have you tried to quit smoking before?" All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

The classification of Stage III of COPD is defined as a) moderate COPD. b) very severe COPD. c) at risk for COPD. d) severe COPD. e) mild COPD.

d) severe COPD. Stage III is severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage IV is very severe COPD.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as a) Emphysema b) Pleurisy c) Pneumonia d) Atelectasis

d) Atelectasis Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).

In a patient diagnosed with increased intracranial pressure (IICP), the nurse would expect to observe which of the following respiratory rate or depth? a) Tachypnea b) Bradypnea c) Hyperventilation d) Hypoventilation

b) Bradypnea Bradypnea is a slower than normal rate (<10 breaths/minute), with normal depth and regular rhythm. It is associated with IICP, brain injury, central nervous system depressants, and drug overdose. Tachypnea is associated with metabolic acidosis, septicemia, severe pain, and rib fracture. Hypoventilation is shallow, irregular breathing. Hyperventilation is an increased rate and depth of breathing.

As a cause of death in the United States, chronic obstructive pulmonary disease (COPD) ranks a) Third b) Second c) Fourth d) Fifth

c) Fourth Currently, COPD and associated conditions (chronic lower respiratory diseases are the fourth leading cause of death in the United States, accounting for almost 125,000 American deaths per year.

A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? a) Relieve shortness of breath to a level as close as possible to tolerable. b) Continue with current level of mobility at home. c) Maintain activity level of walking to the mailbox. d) Increase walking distance around a city block without shortness of breath.

d) Increase walking distance around a city block without shortness of breath. If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable.

A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: a) Sharp, stabbing chest pain b) Dyspnea c) Tachycardia d) A dry, hacking cough

a) Sharp, stabbing chest pain The initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: a) crackles have replaced wheezes. b) the attack is over. c) the swelling has decreased. d) the airways are so swollen that no air can get through.

d) the airways are so swollen that no air can get through. During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can't get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles don't replace wheezes during an acute asthma attack.

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? a) Dilated and reactive pupils b) Heart rate of 100 beats/minute c) Urine output of 40 ml/hour d) Respiratory rate of 22 breaths/minute

d) Respiratory rate of 22 breaths/minute In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

In which position should the patient be placed for a thoracentesis? a) Supine b) Lateral recumbent c) Prone d) Sitting on the edge of the bed

d) Sitting on the edge of the bed If possible place the patient upright or sitting on the edge of the bed with the feet supported and arms and head on a padded over-the-bed table. Other positions in which the patient could be placed include straddling a chair with arms and head resting on the back of the chair, or lying on the unaffected side with the head of the bed elevated 30 to 45 degrees if unable to assume a sitting position.

The nurse is caring for a client whose respiratory status has declined since shift report. The client has tachypnea, is restless, and displays cyanosis. Which diagnostic test should be assessed first? a) Pulmonary function test b) Arterial blood gases c) Chest x-ray d) Pulse oximetry

a) Pulmonary function test Pulse oximetry is a noninvasive method to determine arterial oxygen saturation. Normal values are 95% and above. Using this diagnostic test first provides rapid information of the client's respiratory system. All other options vary in amount of time and patient participation in determining further information regarding the respiratory system.

Which of the following measures may increase complications for a patient with COPD? a) Administration of antitussive agents b) Administration of antibiotics c) Increased oxygen supply d) Decreased oxygen supply

c) Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? a) "Delay self-care activities for 1 hour." b) "Sit in a chair whenever doing an activity." c) "Raise your arms over your head." d) "Drink fluids upon arising from bed."

a) "Delay self-care activities for 1 hour." Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? a) "You and your physician should discuss the options that are available for treatment." b) "You would have a difficult time recovering from the procedure." c) "At this point, do you really want to go through something like that?" d) "You are not a candidate because you have heart failure."

a) "You and your physician should discuss the options that are available for treatment." Treatment options for patients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are limited, although lung volume reduction surgery is a palliative surgical option that is approved by Medicare in selected patients. This includes patients with homogenous disease or disease that is focused in one area and not widespread throughout the lungs. Lung volume reduction surgery involves the removal of a portion of the diseased lung parenchyma. This reduces hyperinflation and allows the functional tissue to expand, resulting in improved elastic recoil of the lung and improved chest wall and diaphragmatic mechanics. This type of surgery does not cure the disease nor improve life expectancy; however, it may decrease dyspnea, improve lung function and exercise tolerance, and improve the patient's overall quality of life

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%. a) 60 mm Hg; 90% b) 56 mm Hg; 86% c) 54 mm Hg; 84% d) 58 mm Hg; 88%

a) 60 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. a) Alter smooth muscle tone b) Increase oxygen distribution c) Reduce airway obstruction d) Decrease alveolar ventilation

a) Alter smooth muscle tone b) Increase oxygen distribution c) Reduce airway obstruction Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? a) An inhaled beta2-adrenergic agonist b) An I.V. beta2-adrenergic agonist c) An oral corticosteroid d) An inhaled corticosteroid

a) An inhaled beta2-adrenergic agonist An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? a) An inspiratory-expiratory (I:E) ratio of 2:1 b) A respiratory rate of 12 breaths/minute c) A transverse chest diameter twice that of the anteroposterior diameter d) An oxygen saturation of 99%

a) An inspiratory-expiratory (I:E) ratio of 2:1 The normal I:E ratio is 1:2, meaning that expiration takes twice as long as inspiration. A ratio of 2:1 is seen in clients with COPD because inspiration is shorter than expiration. A client with COPD typically has a barrel chest in which the anteroposterior diameter is larger than the transverse chest diameter. A client with COPD usually has a respiratory rate greater than 12 breaths/minute and an oxygen saturation rate below 93%.

The nurse auscultated a patient's middle lobe of the lungs for abnormal breath sounds. To do this, the nurse placed the stethoscope on the: a) Anterior surface of the right side of the chest, between the fourth and fifth rib. b) Posterior surface of the left side of the chest, near the sixth rib. c) Anterior surface of the left side of the chest, near the sixth rib. d) Posterior surface of the right side of the chest, near T3.

a) Anterior surface of the right side of the chest, between the fourth and fifth rib. The middle lobe of the lung is only found on the right side of the thorax and can only be assessed anteriorly. It is located at the fourth rib, at the right sternal border and extends to the fifth rib, in the midaxillary line.

A client arrives in the emergency department reporting shortness of breath. She has 3+ pitting edema below the knees, a respiratory rate of 36 breaths per minute, and heaving respirations. The nurse auscultates the client's lungs to reveal coarse, moist, high-pitched, and non-continuous sounds that do not clear with coughing. The nurse will document these sounds as which type? a) Crackles b) Rhonchi c) Pleural rub d) Wheezes

a) Crackles Crackles are adventitious breath sounds that are high-pitched, discontinuous, and popping; they may or may not clear with coughing and are moist. Often crackles are associated with heart failure.

When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.) a) Decreased gag reflex b) Decreased alveolar duct diameter c) Increased presence of collagen in alveolar walls d) Decreased presence of mucus e) Increased presence of mucus

a) Decreased gag reflex c) Increased presence of collagen in alveolar walls e) Increased presence of mucus Age-related changes in the respiratory system include a decrease in mucus, decrease in gag reflex, increase in collagen in the alveolar walls of the lungs, and increase in alveolar duct diameter.

Which of the following would not be considered a primary symptom of COPD? a) Dyspnea on exertion b) Weight gain c) Cough d) Sputum production

a) Dyspnea on exertion c) Cough d) Sputum production COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Weight loss is common with COPD.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? a) High-protein b) Full-liquid c) 1,800-calorie ADA d) Low-fat

a) High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

Which of the following is an age-related change associated with the lung? a) Increased thickness of the alveolar membranes b) Decreased collagen of alveolar membranes c) Decreased diameter of alveoli ducts d) Increased elasticity of alveolar sacs

a) Increased thickness of the alveolar membranes Age-related changes associated with the lung include increased thickness of the alveolar membranes, decreased elasticity of alveolar air sacs, increased diameter of alveoli ducts, and increased collagen of alveolar membranes.

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. a) Infection b) Air pollution c) Tobacco smoke d) Occupational dust e) Second-hand smoke

a) Infection b) Air pollution c) Tobacco smoke d) Occupational dust e) Second-hand smoke Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection.

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. a) Montelukast (Singulair) b) Zafirlukast (Accolate) c) Zileuton (Zyflo) d) Ipratropium HFA (Atrovent) e) Tiotropium (Spiriva)

a) Montelukast (Singulair) b) Zafirlukast (Accolate) c) Zileuton (Zyflo) Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.

The nurse is reviewing the blood gas results for a patient with pneumonia. What arterial blood gas measurement best reflects the adequacy of alveolar ventilation? a) PaCO2 b) SaO2 c) pH d) PaO2

a) PaCO2 When the minute ventilation falls, alveolar ventilation in the lungs also decreases, and the PaCO2 increases.

Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. a) Prednisone is a corticosteroid. b) Ciprofloxacin is an antibiotic. c) Albuterol is a bronchodilator. d) Bactrim is a bronchodilator. e) Decadron is an antibiotic.

a) Prednisone is a corticosteroid. b) Ciprofloxacin is an antibiotic. c) Albuterol is a bronchodilator. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? a) Take ordered medications as scheduled. b) Change filters on heating and air conditioning units frequently. c) Avoid goose down pillows. d) Avoid contact with fur-bearing animals.

a) Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.

A nurse caring for a patient with a pulmonary embolism understands that a high ventilation-perfusion ratio may exist. What does this mean for the patient? a) Ventilation exceeds perfusion. b) Ventilation matches perfusion. c) There is an absence of perfusion and ventilation. d) Perfusion exceeds ventilation.

a) Ventilation exceeds perfusion. A high ventilation-perfusion rate means that ventilation exceeds perfusion, causing dead space. The alveoli do not have an adequate blood supply for gas exchange to occur. This is characteristic of a variety of disorders, including pulmonary emboli, pulmonary infarction, and cardiogenic shock.

Emphysema is described by which of the following statements? a) Chronic dilatation of a bronchus or bronchi b) A disease of the airways characterized by destruction of the walls of overdistended alveoli c) A disease that results in a common clinical outcome of reversible airflow obstruction d) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years

b) A disease of the airways characterized by destruction of the walls of overdistended alveoli Emphysema is a category of COPD. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

The nurse working in the radiology clinic is assisting with a pulmonary angiography. The nurse knows that when monitoring clients after a pulmonary angiography, what should the physician be notified about? a) Raised temperature in the affected limb b) Absent distal pulses c) Flushed feeling in the client d) Excessive capillary refill

b) Absent distal pulses When monitoring clients after a pulmonary angiography, nurses must notify the physician about diminished or absent distal pulses, cool skin temperature in the affected limb, and poor capillary refill. When the contrast medium is infused, the client will sense a warm, flushed feeling.

The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? a) A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 b) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office c) An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen d) A 62 year old with emphysema who has 300 mL of intravenous fluid remaining

b) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD.

Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation? a) Pneumonia b) Bronchitis c) Common cold d) Asthma

b) Bronchitis A wide range of viral, bacterial, and mycoplasmal infections can produce acute episodes of bronchitis, a leading cause of exacerbations. Pneumonia, the common cold, and asthma are not leading causes of exacerbations.

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder? a) Bronchiectasis b) Emphysema c) Asthma d) Cystic fibrosis

b) Emphysema COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or any combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of COPD are now classified as chronic pulmonary disorders. Asthma is now considered a distinct, separate disorder and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client a) Records in a diary the number achieved after one breath b) Exhales hard and fast with a single blow c) Sits in a straight-back chair and leans forward d) Inhales deeply and holds the breath

b) Exhales hard and fast with a single blow To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.

In which stage of COPD is the forced expiratory volume (FEV) less than 30%? a) 0 b) III c) II d) I

b) III Stage III patients demonstrate an FEV less than 30% with respiratory failure or clinical signs of right heart failure. Stage II patients demonstrate an FEV of 30% to 80%. Stage I is mild COPD with an FEV less than 70%. Stage 0 is characterized by normal spirometry.

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following? a) Instructing the patient on the signs of respiratory infection b) Implementing measures to clear pulmonary secretions c) Teaching the family how to perform postural drainage d) Providing the patient with a low-calorie, high-fiber diet

b) Implementing measures to clear pulmonary secretions Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

Upon palpation of the sinus area, what would the nurse identify as a normal finding? a) Tenderness during palpation b) No sensation during palpation c) Pain sensation behind the eyes d) Light not going through the sinus cavity

b) No sensation during palpation Sinus assessment involves using the thumbs to apply gentle pressure in an upward fashion at the sinuses. Tenderness suggests inflammation. The sinuses can be inspected by transillumination, where a light is passed through the sinuses. If the light fails to penetrate, the cavity contains fluid.

A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant? a) Serevent b) Proventil c) Theo-Dur d) Cromolyn sodium

b) Proventil Short-acting beta2-adrenergic agonists (albuterol [AccuNeb, Proventil, Ventolin], levalbuterol [Xopenex HFA], and pirbuterol [Maxair]) are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. These medications are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists are not indicated for immediate relief of symptoms. These include theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus).

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? a) Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise b) Providing sufficient oxygen to improve oxygenation c) Increasing pH d) Avoiding the use of oxygen to decrease the hypoxic drive

b) Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply). a) Ascites b) Wheezes c) Jugular vein distention d) Decreased airflow e) Compromised gas exchange

b) Wheezes d) Decreased airflow e) Compromised gas exchange Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD.

A client is chronically short of breath and yet has normal lung ventilation, clear lungs, and an arterial oxygen saturation SaO2 of 96% or better. The client most likely has: a) poor peripheral perfusion. b) a possible hematologic problem. c) left-sided heart failure. d) a psychosomatic disorder.

b) a possible hematologic problem. SaO2 is the degree to which hemoglobin (Hb) is saturated with oxygen. It doesn't indicate the client's overall Hb adequacy. Thus, an individual with a subnormal Hb level could have normal SaO2 and still be short of breath, indicating a possible hematologic problem. Poor peripheral perfusion would cause subnormal SaO2. There isn't enough data to assume that the client's problem is psychosomatic. If the problem were left-sided heart failure, the client would exhibit pulmonary crackles.

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: a) maintain the client on bed rest. b) instruct the client to drink at least 2 L of fluid daily. c) administer pain medication as ordered. d) administer anxiolytics, as ordered, to control anxiety.

b) instruct the client to drink at least 2 L of fluid daily. Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? a) "I should use this inhaler whenever I get short of breath." b) "I need to call the physician right away if I feel my heart beating fast after using the drug." c) "I need to hold my breath as long as possible after I take a deep inhalation." d) "I can stop using this drug when I begin to feel better."

c) "I need to hold my breath as long as possible after I take a deep inhalation." The client demonstrates effective teaching if he states that he'll hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol needs to be used over an extended period for maximum effect. The client shouldn't use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardia is an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute.

Emphysema is described by which of the following statements? a) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years b) Chronic dilatation of a bronchus or bronchi c) A disease of the airways characterized by destruction of the walls of overdistended alveoli d) A disease that results in a common clinical outcome of reversible airflow obstruction

c) A disease of the airways characterized by destruction of the walls of overdistended alveoli Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? a) Imbalanced nutrition: More than body requirements b) Unilateral neglect c) Anxiety d) Impaired swallowing

c) Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse: a) Informs the client to limit fluid intake due to fluid retention b) Encourages the client to decrease caloric intake due to increased appetite c) Assesses fasting blood glucose levels d) Aspirates for blood return before injecting the medication

c) Assesses fasting blood glucose levels Adverse effects of methylprednisolone include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by a) Neutrophils b) Eosiniphils c) Mast cells d) Lymphocytes

c) Mast cells Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.

The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care? a) Providing the patient with a low sodium diet b) Restricting oral intake to 1,000 mL/day c) Performing chest physiotherapy as ordered d) Discussing palliative care and end-of-life issues with the patient

c) Performing chest physiotherapy as ordered Nursing care includes helping patients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. The patient with CF also experiences increased salt content in sweat gland secretions; thus, it is important to ensure the patient consumes a diet that is adequate in sodium. As the disease progresses, the patient will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the patient terminally ill.

The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client a) Carefully holds the inhaler upright without shaking it b) Immediately repeats the second puff after the first puff c) Positions the inhaler 1 to 2 inches away from his open mouth d) Holds the breath for 5 seconds after administering the medication

c) Positions the inhaler 1 to 2 inches away from his open mouth To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 1 to 2 inches away from the client's open mouth. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: a) Diminished alveolar surface area. b) Hypercapnia resulting from decreased carbon dioxide elimination. c) Respiratory acidosis. d) Hypoxemia secondary to impaired oxygen diffusion.

c) Respiratory acidosis. Decreased carbon dioxide elimination results in increased carbon dioxide tension (hypercapnia), which leads to respiratory acidosis and chronic respiratory failure.

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? a) Fever, chills, and diaphoresis b) Tachypnea and tachycardia c) Sputum and a productive cough d) Chest pain during respiration

c) Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

The nurse receives an order to obtain a sputum sample from a client with hemoptysis. When advising the client of the physician's order, the client states not being able to produce sputum. Which suggestion, offered by the nurse, is helpful in producing the sputum sample? a) Use the secretions present in the oral cavity. b) Drink 8 oz of water to thin the secretions for expectoration. c) Take deep breaths and cough forcefully. d) Tickle the back of the throat to produce the gag reflex.

c) Take deep breaths and cough forcefully. Taking deep breaths moves air around the sputum and coughing forcefully moves the sputum up the respiratory tract. Once in the pharynx, the sputum can be expectorated into a specimen container. Producing a gag reflex elicits stomach contents and not respiratory sputum. Dilute and thinned secretions are not helpful in aiding expectoration. A sputum culture is not a component of oral secretions.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: a) oxygen toxicity. b) pleural effusion. c) atelectasis. d) pulmonary edema.

c) atelectasis. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: a) tracheal deviation to the unaffected side. b) muffled or distant heart sounds. c) diminished or absent breath sounds on the affected side. d) paradoxical chest wall movement with respirations.

c) diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.

In relation to the structure of the larynx, the cricoid cartilage is a) the valve flap of cartilage that covers the opening to the larynx during swallowing. b) the largest of the cartilage structures. c) the only complete cartilaginous ring in the larynx. d) used in vocal cord movement with the thyroid cartilage.

c) the only complete cartilaginous ring in the larynx. The cricoid cartilage is located below the thyroid cartilage. The arytenoid cartilages are used in vocal cord movement with the thyroid cartilage. The thyroid cartilage is the largest of the cartilage structures and part of it forms the Adam's apple. The epiglottis is the valve flap of cartilage that covers the opening to the larynx during swallowing.

A nurse would question the accuracy of a pulse oximetry evaluation in which of the following conditions? a) A client sitting in a chair after prolonged bed rest b) A client on a ventilator with PEEP c) A client receiving oxygen therapy via Venturi mask d) A client experiencing hypothermia

d) A client experiencing hypothermia Pulse oximetry is a noninvasive method of continuously monitoring the oxygen saturation of hemoglobin. The reading is referred to as SpO2. A probe or sensor is attached to the fingertip, forehead, earlobe, or bridge of the nose. Values less than 85% indicate that the tissues are not receiving enough oxygen. SpO2 values obtained by pulse oximetry are unreliable in states of low perfusion such as hypothermia.

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be a) Isuprel b) Atrovent c) Foradil d) Albuterol

d) Albuterol Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? a) Pneumonia b) Pleurisy c) Emphysema d) Atelectasis

d) Atelectasis In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at curing COPD. b) Both are aimed at treating end-stage emphysema. c) Both are used to treat patients with bullous emphysema. d) Both are aimed at improving the overall quality of life of a patient with COPD.

d) Both are aimed at improving the overall quality of life of a patient with COPD. The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat patients with bullous emphysema.

Which of the following exposures accounts for most of the risk factors for COPD? a) Ambient air pollution b) Passive smoking c) Occupational exposure d) Exposure to tobacco smoke

d) Exposure to tobacco smoke

Which of the following exposures accounts for most of the risk factors for COPD? a) Ambient air pollution b) Passive smoking c) Occupational exposure d) Exposure to tobacco smoke

d) Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors, but they do not account for most cases.

A thoracentesis is performed to obtain a sample of pleural fluid or a biopsy specimen from the pleural wall for diagnostic purposes. What does bloody fluid indicate? a) Trauma b) Infection c) Emphysema d) Malignancy

d) Malignancy A thoracentesis may be performed to obtain a sample of pleural fluid or to biopsy a specimen from the pleural wall for diagnostic purposes. The fluid, which may be clear, serous, bloody, or purulent, provides clues to the pathology. Bloody fluid may indicate malignancy, whereas purulent fluid usually indicates an infection. Pneumothorax, tension pneumothorax, subcutaneous emphysema, and pyogenic infection are complications of a thoracentesis. Pulmonary edema or cardiac distress can occur after a sudden shift in mediastinal contents when large amounts of fluid are aspirated.

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? a) Vancomycin 1 gram intravenously over 1 hour b) Ipratropium bromide (Alupent) by metered-dose inhaler c) Intravenous methylprednisolone (Solu-Medrol) 120 mg d) Oxygen through nasal cannula at 2 L/minute

d) Oxygen through nasal cannula at 2 L/minute All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? a) Combivent b) Flovent c) Atrovent d) Proventil

d) Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? a) Avoiding the use of oxygen to decrease the hypoxic drive b) Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise c) Increasing pH d) Providing sufficient oxygen to improve oxygenation

d) Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory acidosis d) Respiratory alkalosis

d) Respiratory alkalosis As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.

The client is returning from the operating room following a broncho scopy. Which action, performed by the nursing assistant, would the nurse stop if began prior to nursing assessment? a) The nursing assistant is assisting the client to the side of the bed to use a urinal. b) The nursing assistant is asking a question requiring a verbal response. c) The nursing assistant is assisting the client to a semi-Fowler's position. d) The nursing assistant is pouring a glass of water to wet the client's mouth.

d) The nursing assistant is pouring a glass of water to wet the client's mouth. When completing a procedure which sends a scope down the throat, the gag reflex is anesthetized to reduce discomfort. Upon returning to the nursing unit, the gag reflex must be assessed before providing any food or fluids to the client. The client may need assistance following the procedure for activity and ambulation but this is not restricted in the post procedure period.

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education? a) The patient should take the medication with a small amount of liquid. b) The patient should take the medication separately without other medications. c) The patient should take the medication with meals since it may cause nausea. d) The patient should take the medication an hour before meals or 2 hours after a meal.

d) The patient should take the medication an hour before meals or 2 hours after a meal. The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: a) stay with the client until the therapist arrives. b) notify the primary physician immediately. c) administer the treatment by metered-dose inhaler. d) give the nebulizer treatment herself.

d) give the nebulizer treatment herself. The client's needs are preeminent, so the nurse should administer the nebulizer treatment immediately. The nurse can deal with the respiratory therapist's lack of response after the client's condition is stabilized. There is no need to involve the physician in personnel issues. Staying with the client is important, but it isn't a substitute for administering the needed bronchodilator. The order is for a nebulizer treatment not a metered-dose inhaler, so the nurse can't change the route without a new order from the physician.

It is important for a nurse to provide required information and appropriate explanations of diagnostic procedures to patients with respiratory disorders to a) ensure adequate rest periods. b) manage respiratory distress. c) aid the caregivers of the patient. d) manage decreased energy levels.

d) manage decreased energy levels. In addition to the nursing management of individual tests, patients with respiratory disorders require informative and appropriate explanations of any diagnostic procedures they will experience. Nurses must remember that for many of these patients, breathing may in some way be compromised and energy levels may be decreased. For that reason, explanations should be brief, yet complete, and may need to be repeated later after a rest period. The nurse must also ensure adequate rest periods before and after the procedures. After invasive procedures, the nurse must carefully assess for signs of respiratory distress.