Oxygenation Prep u set 2

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer: A. alprazolam (Xanax). B. morphine. C. propranolol (Inderal). D. albuterol (Proventil).

D. albuterol (Proventil).

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? A. Teaching the client how to perform controlled coughing B. Restricting fluid intake to 1,000 ml/day C. Enforcing absolute bed rest D. Administering ordered sedatives regularly and in large amounts

A. Teaching the client how to perform controlled coughing

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. atelectasis. B. pleural effusion. C. oxygen toxicity. D. pulmonary edema.

A. atelectasis

Which type of pneumonia has the highest incidence in clients with AIDS and clients receiving immunosuppressive therapy for cancer? A. Streptococcal B. Pneumocystis C. Fungal D. Tuberculosis

B Pneumocystis

When developing a preventative plan of care for a patient at risk for developing chronic obstructive pulmonary disease (COPD), which of the following should be incorporated? A. Cholesterol management B. Smoking cessation C. Cancer prevention D. Weight reduction

B Smoking cessation

A client newly diagnosed with COPD tells the nurse, "I can't believe I have COPD; I only had a cough. Are there other symptoms I should know about"? Which is the best response by the nurse? A. "There are no other symptoms; however, your cough may get worse as the disease progresses." B. "You can also expect to experience a progressive weight gain." C. "Other symptoms you may develop are shortness of breath upon exertion and sputum production." D. "As your COPD worsens, you will frequently develop respiratory infections."

C. "Other symptoms you may develop are shortness of breath upon exertion and sputum production."

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. Continue with current level of mobility at home. B. Maintain activity level of walking to the mailbox. C. Increase walking distance around a city block without shortness of breath. D. Relieve shortness of breath to a level as close as possible to tolerable.

C. Increase walking distance around a city block without shortness of breath

An older adult patient has been diagnosed with COPD. What characteristic of the patient's current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)? A. The patient has not yet quit smoking. B. The patient requires both corticosteroids and beta2-agonists. C. The patient has severe arthritis in her hands. D. The patient has cataracts.

C. The patient has severe arthritis in her hands.

Which of the following occupy space in the thorax, but do not contribute to ventilation? A. Alveoli B. Lung parenchyma C. Mast cells D. Bullae

D. Bullae

Which would be least likely to contribute to a case of hospital-acquired pneumonia? A nurse washes her hands before beginning client care. A highly virulent organism is present. Host defenses are impaired. Inoculum of organisms reaches the lower respiratory tract and overwhelms the host's defenses.

A nurse washes her hands before beginning client care.

Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)? A. Air pollution B. Cigarette smoking C. Occupational exposure D. Genetic abnormalities

B. Cigarette smoking

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. A. Second-hand smoke B. Air pollution C. Tobacco smoke D. Infection E. Occupational dust

A. Second-hand smoke B. Air pollution C. Tobacco smoke D. Infection E. Occupational dust

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

A. "Have you tried to quit smoking before?"

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? A. "I can't use a spacer or holding chamber with the MDI." B. "I will shake the MDI container before I use it." C. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." D. "I will take a slow, deep breath in after pushing down on the MDI."

A. "I can't use a spacer or holding chamber with the MDI."

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."

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. Decrease alveolar ventilation D. Reduce airway obstruction

A. Alter smooth muscle tone D. Reduce airway obstruction B. Increase oxygen distribution

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: A. An abnormal distention of the air spaces with destruction of the alveolar walls B. Decreased sputum production with dilation of bronchioles C. Increased oxygen diffusion with inflammation of the bronchioles D. Inflammation of the bronchioles with a normal distention of the air spaces

A. An abnormal distention of the air spaces with destruction of the alveolar walls

Which of the following is a symptom diagnostic of emphysema? A. Dyspnea B. Normal elastic recoil C. The occurrence of cor pulmonale D. Copious sputum production

A. Dyspnea

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which nursing diagnosis has the highest priority? A. Impaired gas exchange B. Impaired oral mucous membranes C. Imbalanced nutrition: Less than body requirements D. Activity intolerance

A. Impaired gas exchange

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? A. Impaired gas exchange related to airflow obstruction B. Anxiety related to actual threat to health status C. Activity intolerance related to fatigue D. Risk for infection related to retained secretions

A. Impaired gas exchange related to airflow obstruction

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? A. Lung sounds B. Respiratory rate C. Skin color D. Heart rate

A. Lung sounds

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. A. Mucus secretions that block airways B. Inflamed airways that obstruct airflow C. Decreased numbers of goblet cells D. Dry airways that obstruct airflow E. Overinflated alveoli that impair gas exchange

A. Mucus secretions that block airways B. Inflamed airways that obstruct airflow E. Overinflated alveoli that impair gas exchange

Which terms means an increase in the red blood cell concentration in the blood? A. Polycythemia B. Asthma C. Emphysema D. Bronchitis

A. Polycythemia

A client is being sent home with oxygen therapy. The nurse instructs that: A. Smoking or a flame is dangerous near oxygen. B. Oxygen is addictive and its use must be decreased. C. The client should raise the flow of oxygen if shortness of breath increases. D. The client will not be able to travel with oxygen.

A. Smoking or a flame is dangerous near oxygen

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. Sputum and a productive cough B. Chest pain during respiration C. Fever, chills, and diaphoresis D. Tachypnea and tachycardia

A. Sputum and a productive cough

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. A. Prevent airway collapse B. Strengthen the diaphragm C. Release air trapped in the lungs D. Control the rate and depth of respirations E. Condition the inspiratory muscles

A.Prevent airway collapse D. Control the rate and depth of respirations C. Release air trapped in the lungs

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? A. "Eat a high-sodium diet." B. "Weigh yourself daily and report a gain of 2 lb in 1 day." C. "Limit yourself to smoking only 2 cigarettes per day." D."Maintain bed rest."

B. "Weigh yourself daily and report a gain of 2 lb in 1 day."

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. An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen 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. A 62 year old with emphysema who has 300 mL of intravenous fluid remaining D. 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

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to A. Perform upper chest breaths B. Exhale slowly C. Take deep breaths D. Increase the flow of oxygen

B. Exhale slowly

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? A. Human papilloma virus (HPV) B. Influenza C. Varicella D. Hepatitis B

B. Influenza

To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? A. Streptococcus pneumonia and varicella B. Streptococcus pneumonia and Haemophilus influenzae C. Haemophilus influenzae and varicella D. Haemophilus influenzae and Gardasil

B. Streptococcus pneumonia and Haemophilus influenzae

A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? A. nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 B. salmeterol/fluticasone (Seretide) MDI daily at 0800 C. azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 D. prednisone 5 mg oral daily at 0800

B. salmeterol/fluticasone (Seretide) MDI daily at 0800

Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply. A. Hypertension B. Air pollution C. Fractured hip D. Tracheobronchial infection E. Gastrointestinal viruses

B.Air pollution D. Tracheobronchial infection

An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care? A. Bedrest B. Administration of probiotic supplements C. Cautious hydration D. Nasogastric intubation

C Cautious hydration

A client being seen in the emergency department has labored respirations. Auscultation reveals inspiratory and expiratory wheezes. Oxygen saturation is 86%. The client was nonresponsive to an albuterol (Ventolin) inhaler and intravenous methylprednisolone (Solu-Medrol). The nurse administers the following prescribed treatment first: A. Intravenous magnesium sulfate B. Normal saline 0.9% at 100 mL/hr intravenously C. Oxygen therapy through a non-rebreather mask D. Oral fluid of at least 2500 mL/day

C. Oxygen therapy through a non-rebreather mask

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

C. Respiratory acidosis

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. Urine output of 40 ml/hour C. Respiratory rate of 22 breaths/minute D. Heart rate of 100 beats/minute

C. Respiratory rate of 22 breaths/minute

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. 58 mm Hg; 88% B. 56 mm Hg; 86% C. 54 mm Hg; 84% D. 60 mm Hg; 90%

D. 60 mm Hg; 90%

Which statement describes emphysema? A. 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 that results in reversible airflow obstruction, a common clinical outcome C. Chronic dilatation of a bronchus or bronchi D. A disease of the airways characterized by destruction of the walls of overdistended alveoli

D. A disease of the airways characterized by destruction of the walls of overdistended alveoli

In which statements regarding medications taken by a client diagnosed with COPD do the the drug name and the drug category correctly match? Select all that apply. A. Prednisone is a corticosteroid. B. Cotrimoxazole is a bronchodilator. C. Ciprofloxacin is an antibiotic. D. Albuterol is a bronchodilator. E. Dexamethasone is an antibiotic.

D. Albuterol is a bronchodilator. C. Ciprofloxacin is an antibiotic. A. Prednisone is a corticosteroid.

Which statement is true about both lung transplant and bullectomy? A. Both procedures cure COPD. B. Both procedures treat patients with bullous emphysema. C. Both procedures treat end-stage emphysema. D. Both procedures improve the overall quality of life of a client with COPD.

D. Both procedures improve the overall quality of life of a client with COPD

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client A. Has a respiratory rate of 28 breaths/minute B. Reports shortness of breath C. Cannot perform activities of daily living D. Has wheezes in the right lung lobes

D. Has wheezes in the right lung lobes

Which measure may increase complications for a client with COPD? A. Decreased oxygen supply B. Administration of antitussive agents C. Administration of antibiotics D. Increased oxygen supply

D. Increased oxygen supply

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? A. Emphysema B. Bronchitis C. Asthma D. Polycythemia

D. Polycythemia

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. Increasing pH C. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise D. Providing sufficient oxygen to improve oxygenation

D. Providing sufficient oxygen to improve oxygenation

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. Dyspnea B. Tachycardia C. A dry, hacking cough D. Sharp, stabbing chest pain

D. Sharp, stabbing chest pain

A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching? A. Lie supine to facilitate air entry B. Use chest breathing C. Avoid pursed lip breathing D. Use diaphragmatic breathing

D. Use diaphragmatic breathing

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. Wheezes B. Decreased airflow C. Jugular vein distention D. Ascites E. Compromised gas exchange

E. Compromised gas exchange B. Decreased airflow A. Wheezes

The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.) A. It is not necessary to hold your breath after using. B. The device may increase delivery of the MDI medication. C. Activate the MDI once. D. Use normal inhalations with the device. E. Take a slow, deep inhalation from the device.

E. Take a slow, deep inhalation from the device. C. Activate the MDI once. B. The device may increase delivery of the MDI medication.