ATI Respiratory Practice Questions

A nurse is teaching a client who has asthma how to use metered-dose inhaler (MDI). The nurse identifies the sequence of steps the client should follow. What are the steps of using a MDI?

- Inhale deeply and then exhale completely. - Place lips firmly around the mouthpiece. - Breathe in deeply over 2-3 seconds while pushing down on the canister. - Hold breath for 10 seconds. - Exhale slowly through pursed-lips. - Wait 60 seconds between each puff.

A nurse is teaching a client who has a new diagnosis of asthma. What medications should the nurse instruct the client to use to abort an acute asthma attack?

Albuterol. Rationale: Albuterol is an inhaled short-acting beta2 agonist used as a rescue medication to relieve an acute asthma attack. Albuterol dilates the airways, decreases wheezing, and improves oxygenation.

A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that he has frequent productive cough and is short of breath. The nurse should anticipate which of the following assessment findings for this client?

Increased anteroposterior diameter of the chest. Rationale: The nurse should anticipate an increased anteroposterior diameter of the chest (barrel chest) because of chronic hyperinflation of the lungs.

A nurse is a provider's office is assessing a client. The nurse should identify that what findings are manifestations of pulmonary tuberculosis?

Night sweats, Low-grade fever, and Blood in the sputum.

A nurse is a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe what diagnostic test first?

Nucleic acid amplification test (NAAT). Rationale: The CDC recommends that the NAAT test replace other diagnostic screening tests for tuberculosis. The test is performed on a client's sputum.

A nurse is teaching a client who has tuberculosis and is to start combination drug therapy. What medications should the nurse plan to administer?

Rifampin, Isoniazid, Pyrazinamide. Rationale: Rifampin - a client who has tuberculosis should take rifampin to kill slower growing micro-organisms. Isoniazid - A client who has tuberculosis should take isoniazid to kill actively growing mycobacteria. Pyrazinamide - A client who has tuberculosis usually takes pyrazinamide for the first 12 months of therapy and can shorten the entire course of therapy to 6 months.

A nurse is a community health center is assessing the results of a tuberculin skin test she performed for a client. What result indicates exposure to and a possible infection with tuberculosis (TB)?

15 mm induration. Rationale: A positive reaction to a tuberculin skin test is an induration (a hardened area) that is 10 mm or greater in diameter. The nurse should measure the area of induration, not any accompanying erythema or swelling.

A nurse is caring for a client who requires isolation for active pulmonary tuberculosis. What precautions should the nurse include when creating a sign to post outside of the client's room?

A protective mask (N95), closed door sign, puncture-proof sharps container, and hand hygiene.

A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. What room assignment should the nurse make for the client?

A room with air exhaust directly to the outdoor environment. Rationale: A room with air exhaust directly to the outside environment eliminates contamination of other client-care areas. This type of ventilation system is referred to as an airborne infection isolation room.

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent what adverse effect?

Adrenocortical insufficiency. Rationale: Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A home health nurse visits a client who has COPD and receives oxygen at 2L/min via nasal cannula. The client reports difficulty breathing. What action is the nurses priority?

Asses the client's respiratory status. Rationale: The first action the nurse should take using the nursing process is to collect data from the client. The nurse should immediately assess the client's respiratory status before determining the appropriate interventions.

A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

Barrel. Rationale: Clients who has COPD use accessory muscles to assist with respiratory effort. The use of those accessory muscles causes the chest wall to eventually increase in anterior-posterior diameter, making it appear barrel shaped.

A nurse is caring for a client who has COPD. The client tells the nurse, "I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up." What actions should the nurse take to help this client with tenacious bronchial secretions?

Encouraging the client to drink 2 to 3 L of water daily. Rationale: COPD is a term for two diseases of the respiratory system: chronic bronchitis and emphysema. Maintaining hydration through the consumption of adequate fluids will help liquefy thick secretions and facilitate their expectoration.

A nurse is developing a plan of care for a client who has COPD. The nurse should include what interventions in the plan?

Instruct the client to use pursed-lip breathing. Rationale: Pursed-lip breaking lengthens the expiratory phase of respiration and also increases the pressure in the airway during exhalation. This action reduces airway resistance and decreases trapped air for clients who has COPD.

A nurse is assessing a client who has pulmonary tuberculosis. What finding should the nurse expect?

Lethargy. Rationale: Manifestations of pulmonary tuberculosis includes lethargy and fatigue.

A nurse is admitting a client who is having an exacerbation of his asthma. When reviewing the provider's orders, the nurse recognizes that clarification is needed for what medication?

Propanolol. Rationale: Medications that block beta-2 receptors, such as propranolol, are contraindicated in clients with asthma.

A nurse is caring for a client who has active pulmonary tuberculosis (TB) and a new prescription for IV rifampin. The nurse should instruct the client that they should expect to experience what manifestation while taking this medication?

Red-colored urine. Rationale: Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. What instructions should the nurse provide?

Rinse the mouth after administration. Rationale: Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. What action by the client indicates understanding of the teaching?

The client holds his breath for 10 seconds after inhaling the medication. Rationale: The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse is auscultating the breath sounds of a client who has asthma. When the client exhales, the nurse hears continuous high-pitched squeaking sounds. The nurse should document this as what adventitious breath sound?

Wheezes. Rationale: Wheezes are continuous, high-pitched squeaking sounds, first evident on expiration, but possibly evident on inspiration as the airway obstruction of asthma worsens. Wheezes are often audible without a stethoscope.