Comprehensive Respiratory System Disorders NCLEX Practice Questions Quiz 1

Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination?

A 50-year-old woman caring for a spouse with cancer. Individuals who are household members or home care providers for high-risk individuals are high-priority targeted groups for immunization against influenza to prevent transmission to those who have a decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described.

A female client is scheduled to have a chest radiograph. Which of the following questions is of most importance to the nurse assessing this client?

"Is there any possibility that you could be pregnant?" The most important item to ask about is the client's pregnancy status because pregnant women should not be exposed to radiation. The risk of side effects of an X-ray while the client is pregnant is extremely minimal, but it is always important to protect the developing fetus from harm.

A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client?

"Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks." It is important for clients with allergic rhinitis to determine the precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Patients often underestimate the severity of this condition and fail to seek medical therapy. It is important to adequately control AR, especially due to the link between AR and asthma, with poor control of rhinitis predicting poor control of asthma.

Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose?

7.5 ml When the medicine is a solution of specific strength, calculations can become more complicated. Liquids (solutions and suspensions) are frequently used in children's nursing - for example for children who find swallowing tablets difficult or patients who have medicines administered via a percutaneous endoscopic gastrostomy (PEG) tube.

A low-fat, low-cholesterol diet

A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. Choose mono- and poly-unsaturated fats, which do not contain cholesterol. These are fats that are often liquid at room temperature and come from plant sources, such as canola, safflower and corn oils.

Acute bronchitis

Acute bronchitis is the result of acute inflammation of the bronchi secondary to various triggers, most commonly viral infection, allergens, pollutants, etc. Inflammation of the bronchial wall leads to mucosal thickening, epithelial-cell desquamation, and denudation of the basement membrane. At times, a viral upper respiratory infection can progress to infection of the lower respiratory tract resulting in acute bronchitis.

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client:

Agrees to call the physician if dyspnea on exertion increases. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified. There are things that everyone with COPD should do to manage their disease; quitting smoking (if they smoke) is the most important. In addition, there are other non-medication treatments that can help relieve symptoms and improve quality of life.

A client with COPD reports steady weight loss and being "too tired from just breathing to eat." Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

Altered nutrition: Less than body requirements related to fatigue. The client's problem is altered nutrition—specifically, less than required. The cause, as stated by the client, is the fatigue associated with the disease process. Instruct the patient to frequently eat high caloric foods in smaller portions. COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass.

Antibiotics

Antibiotics are powerful medicines that fight bacterial infections. They either kill bacteria or stop them from reproducing, allowing the body's natural defenses to eliminate the pathogens. Used properly, antibiotics can save lives. But growing antibiotic resistance is curbing the effectiveness of these drugs. Taking an antibiotic as directed, even after symptoms disappear, is key to curing infection and preventing the development of resistant bacteria.

Antitussives

Antitussives are drugs that suppress the cough reflex. Persistent coughing can be exhausting and can cause muscle strain and further irritation of the respiratory tract. They act on the cough-control center in the medulla to suppress the cough reflex.

Asthma

Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.

Benzonatate

Because its chemical structure resembles that of the anesthetic agents in the para-amino-benzoic acid class (such as [procaine] and [tetracaine]), benzonatate exhibits anesthetic or numbing action. Although it is not prone to drug misuse or abuse, benzonatate is associated with a risk for severe toxicity and overdose, especially in children.

Benzonatate

Benzonatate is a synthetic butylamino-benzoate derivative related to tetracaine and a peripherally acting antitussive, non narcotic Benzonatate reduces the cough reflex by anesthetizing and depressing mechanoreceptors in the respiratory passages, lungs, and pleura. It is recommended for cough relief in the common cold, bronchitis, pneumonia, and for chronic cough such as in asthma.

Benzonatate

Benzonatate suppresses cough associated with both acute and chronic respiratory conditions. It works by desensitizing the pulmonary stretch receptors involved in the cough reflex. There are limited clinical trials of benzonatate; however, earlier studies demonstrated inhibition of experimentally-induced cough and subjectively-measured pathological cough by benzonatate.

Breathing exercises

Breathing exercises slowly fill the lungs with air to expand the chest and work the intercostal muscles. To do this exercise, it is typically recommended to sit or stand with the back straight, then take a full breath from the bottom of the lungs. It can help to think of breathing from the diaphragm, by slowly expanding the abdominal muscles while inhaling, then pushing air from the lungs using these same muscles.

Findings on Physical Examination for COPD Patients

Chest movement is decreased as lungs become overdistended. Additional findings on physical examination include hyperinflation of the lungs with an increased anteroposterior chest diameter ("barrel chest"); use of accessory muscles of respiration; and distant heart sounds, sometimes best heard in the epigastrium.

Signs of COPD

Chest pain is not a typical sign of COPD. Assess and record respiratory rate, depth. Note the use of accessory muscles, pursed-lip breathing, inability to speak or converse. Useful in evaluating the degree of respiratory distress or chronicity of the disease process.

Chronic bronchitis

Chronic bronchitis is a type of chronic obstructive pulmonary disease (COPD) that is defined as a productive cough of more than 3 months occurring within a span of 2 years. Patients typically present with chronic productive cough, malaise, and symptoms of excessive coughing such as chest or abdominal pain.

Clubbing of nail beds

Clubbing of nail beds is associated with conditions of chronic hypoxia. Clubbing is a medical condition first described by Hippocrates in which the fingers (and/or toes) have the appearance of upside-down spoons. It is caused by a build-up of tissue in the distant part of the fingers (terminal phalanges), that causes the end of the fingers to become enlarged and the nails to curve downward.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected?

Coarse crackles and rhonchi Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. Crackles are usually due to airway secretions within a large airway and disappear on coughing. These crackles are scanty, gravity-independent, usually audible at the mouth, and strongly associated with severe airway obstruction.

A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences:

Decreased frequency and intensity of cough. Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. Benzonatate is an oral antitussive drug used in the relief and suppression of cough in patients older than ten years of age. Currently, benzonatate is the only non-narcotic antitussive available as a prescription drug. It works to reduce the activity of cough reflex by desensitizing the tissues of the lungs and pleura involved in the cough reflex.

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following?

Develop infections easily. A client with COPD is at high risk for development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited and release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease-mediated destruction of elastin leads to a loss of elastic recoil and results in airway collapse during exhalation.

Diaphragmatic breathing

Diaphragmatic breathing is a type of a breathing exercise that helps strengthen the diaphragm, an important muscle that helps us breathe. This breathing exercise is also sometimes called belly breathing or abdominal breathing.

COPD Expected Finding: Diminished chest excursion

Diminished, not increased, chest excursion is associated with COPD. The sensitivity of a physical examination in detecting mild to moderate COPD is relatively poor; however, physical signs are quite specific and sensitive for severe disease. Patients with severe disease experience tachypnea and respiratory distress with simple activities.

Contraindications/Precautions Taking Pseudoephedrine

Diplopia is not a side effect of pseudoephedrine. Tell your doctor if you have or have ever had high blood pressure, glaucoma (a condition in which increased pressure in the eye can lead to gradual loss of vision), diabetes, difficulty urinating (due to an enlarged prostate gland), or thyroid or heart disease. If you plan to take the 24-hour extended-release tablets, tell your doctor if you have had a narrowing or blockage of your digestive system.

COPD Expected Finding: Distended neck veins

Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. In advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed.

A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation?

Emphysema The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, which is referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.

A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client?

Ensuring the return of the gag reflex before offering foods or fluids After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based on the clinician's preference (e.g., benzodiazepines, opioids, dexmedetomidine).

Which of the following would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will:

Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination antihistamine/decongestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. H1-receptor antagonists may offer a modest reduction of rhinorrhea and sneezing during the first 2 days of a cold in adults.

A client's arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms would the nurse expect?

Flushed skin The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On the contrary, chronic respiratory acidosis may be caused by COPD where there is a decreased responsiveness of the reflexes to states of hypoxia and hypercapnia.

Cellular therapy

For those suffering from chronic obstructive pulmonary disease, the ability to take in oxygen is a constant struggle. It's possible to increase oxygen levels in other ways, such as cellular therapy. Cellular therapy may promote the healing of lung tissue, potentially improving lung function. When lung function improves, the client is able to take in more oxygen as well as expel carbon dioxide because the lungs are working more effectively.

Guaifenesin

Guaifenesin is an expectorant. It works by thinning and loosening mucus in the airways, clearing congestion, and making breathing easier. Mucolytics are drugs belonging to the class of mucoactive agents. They exert their effect on the mucus layer lining the respiratory tract with the motive of enhancing its clearance.

Which of the following diets would be most appropriate for a client with COPD?

High-calorie, high-protein diet The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. Eat 20 to 30 grams of fiber each day, from items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of protein at least twice a day to help maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat, fish, poultry, nuts and dried beans or peas.

COPD & Breath Sounds

In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. A reduction in breath sound intensity (BSI) is often seen in patients with COPD. Pardee et al. developed a scoring system for BSI. According to this system, the clinician listens sequentially over six locations on the patient's chest: bilaterally over the upper anterior portion of the chest, in the midaxillary, and at the posterior bases.

Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD?

Increased PaCO2 As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation. Arterial blood gas (ABG) analysis provides the best clues as to acuteness and severity of disease exacerbation.

Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD?

Increased anteroposterior chest diameter. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. In addition, coarse crackles beginning with inspiration may be heard.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?

Inhales the mist and quickly exhales. Take the inhaler out of the mouth. If the client can, he should hold his breath as he slowly counts to 10. This lets the medicine reach deep into the lungs. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?

It is likely that the client is developing a secondary bacterial pneumonia. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza.

Which of the following is a priority goal for the client with COPD?

Maintaining functional ability A priority goal for the client with COPD is to manage the s/s of the disease process so as to maintain the client's functional ability. Evaluate the level of activity tolerance. Provide a calm, quiet environment. Limit a patient's activity or encourage bed or chair rest during the acute phase. Have patient resume activity gradually and increase as individually tolerated.

COPD Expected Finding: Overly developed neck muscles

Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign).

The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan?

Peripheral edema Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling.

Preventing infection for the client with COPD

Preventing infection would be a goal of care for the client with COPD. Demonstrate and assist the patient in the disposal of tissues and sputum. Stress proper handwashing (nurse and patient), and use gloves when handling or disposing of tissues, sputum containers. Prevents spread of fluid-borne pathogens.

Pseudoephedrine

Pseudoephedrine is used to relieve nasal congestion caused by colds, allergies, and hay fever. It is also used to temporarily relieve sinus congestion and pressure. Pseudoephedrine will relieve symptoms but will not treat the cause of the symptoms or speed recovery. Pseudoephedrine is in a class of medications called nasal decongestants. It works by causing narrowing of the blood vessels in the nasal passages.

A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:

Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allen's test. This involves compressing the radial and ulnar arteries and asking the client to close and open the fist. This should cause the hand to become pale. The nurse then releases pressure on one artery and observes whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The blood sample may be taken safely if collateral circulation is adequate.

Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the medication, knowing that the primary action of this medication is to:

Relax smooth muscles of the bronchial airway. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial airway. Theophylline causes non-selective inhibition of type III and type IV isoenzymes of phosphodiesterase, which leads to increased tissue cyclic adenosine monophosphate (cAMP) and cyclic 3?,5? guanosine monophosphate concentrations, resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS and cardiac stimulation.

Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

Restlessness Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias.

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication?

Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat. Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively common, especially within the first weeks of usage.

Complications Taking Pseudoephedrine

Tachycardia, not bradycardia, is a side effect of pseudoephedrine. Nonprescription cough and cold combination products, including products that contain pseudoephedrine, can cause serious side effects or death in young children. Do not give nonprescription pseudoephedrine products to children younger than 4 years of age.

Diagnostic Test For COPD Patients

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 further. Monitor arterial blood gasses values as ordered. As the patient's condition progresses, Pa02 usually decreases. For patients with chronic carbon dioxide retention may have chronically compensated respiratory acidosis with a low normal pH and a PaCo2 higher than 50 mm Hg.

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?

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

When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects:

While exhaling through pursed lips. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. When one practices regularly, breathing exercises can help exert oneself less during daily activities. They can also potentially aid in return to exercising, which can lead to feeling more energetic overall.