CODP ?

A client did not seek medical treatment for a previous respiratory infection, and subsequently an empyema developed in the left lung. The nurse should assess the client for which signs and symptoms associated with this problem? 1. Pleural pain and fever 2. Decreased respiratory rate 3. Diaphoresis during the day 4. Hyperresonant breath sounds over the left thorax

1

A nurse and an unlicensed assistive personnel (UAP) are assisting the respiratory therapist to position a client for postural drainage. The UAP asks the nurse how the respiratory therapist selects the position to be used for the procedure. The nurse responds that a position is chosen that will use gravity to help drain secretions from which primary areas? 1. Lobes 2. Alveoli 3. Trachea 4. Main bronchi

1

A nurse is caring for a client experiencing dyspnea. The nurse plans care, knowing that which factor will decrease the work of breathing? 1. Bronchodilation 2. Increased airway resistance 3. Interstitial pulmonary edema 4. Increased mucus production

1

A nurse is caring for a hospitalized client who is retaining carbon dioxide (CO2) because of respiratory disease. The nurse plans care, anticipating that which physical response will initially occur? 1. The client's pH will fall. 2. The client will lose consciousness. 3. The client's sodium and chloride level will rise. 4. The client will complain of facial numbness and tingling.

1

A nurse is providing morning care to a client who has a closed chest tube drainage system to treat a pneumothorax. When the nurse turns the client to the side, the chest tube is accidentally dislodged from the chest. The nurse immediately applies sterile gauze over the chest tube insertion site. Which is the nurse's next action? 1. Call the health care provider. 2. Replace the chest tube system. 3. Obtain a pulse oximetry reading. 4. Place the client in a Trendelenburg position

1

A nurse is using an airway clearance device to mobilize secretions in a patient with chronic obstructive pulmonary disease (COPD). The nurse instructs the patient, "You must sit in an upright position during the process." Which device does the nurse use during this procedure? 1 Flutter 2 Acapella 3 SmartVest 4 TheraPEP therapy system

1

The nurse is assisting a respiratory therapist to position a client for postural drainage. The nurse understands that a position is chosen that will use gravity to help drain which areas? 1. Lobes 2. Alveoli 3. Trachea 4. Main bronchi

1

When should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? 1 One hour before a meal 2 Immediately after meals 3 After providing juice to the patient 4 After administering nasal medications

1

The nurse is teaching a class about smoking cessation. Select the respiratory-related symptoms associated with cigarette smoking. Select all that apply. 1 Chronic cough 2 Decreased sense of taste 3 Decreased sputum production 4 Paralysis of the cilia inside the lungs 5 Increased function of alveolar macrophages

1, 2, 4 The effects of cigarette smoking on the respiratory system include development of a chronic cough, paralysis of the cilia, decreased sense of taste and smell, increased sputum production (not decreased), and decreased (not increased) function of alveolar macrophages.

An ambulatory care nurse is assessing a client with chronic sinusitis. The nurse would expect to note which assessment findings in this client? Select all that apply. 1. Anosmia 2. Chronic cough 3. Purulent nasal discharge 4. Intolerance to strong aromas

1,2,3

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for lung transplantation. The nurse performs the initial physical assessment. Which findings should the nurse anticipate in this client? Select all that apply. 1. Dyspnea at rest 2. Clubbed fingers 3. Muscle retractions 4. Decreased respiratory rate 5. Increased body temperature 6. Prolonged expiratory breathing phase

1,2,3,6

A client who is experiencing respiratory difficulty asks the nurse, "Why it is so much easier to breathe out than in?" In providing a response, the nurse explains that breathing is easier on exhalation because of which respiratory responses? 1. Air flows by gravity. 2. The respiratory muscles relax. 3. The respiratory muscles contract. 4. Air is flowing against a pressure gradient.

2

A client with a tracheostomy tube who is on a ventilator is at risk for impaired gas exchange. The nurse should assess for which finding as the best indicator of adequate ongoing respiratory status? 1. Oxygen saturation of 89% 2. Respiratory rate of 16 breaths per minute 3. Moderate amounts of tracheobronchial secretions 4. Small to moderate amounts of frank blood suctioned from the tube

2

A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 to 4 L/min. The nurse responds that this would be harmful because a higher oxygen flow rate could lead to which physical responses? 1. Drying of nasal passages 2. Decrease in the client's oxygen-based respiratory drive 3. Increase for the risk of pneumonia from drier air passages 4. Decrease in the client's carbon dioxide-based respiratory drive

2

A nurse caring for a client with chronic obstructive pulmonary disease (COPD) anticipates which arterial blood gas (ABG) findings? 1. pH, 7.40; Pao2, 90 mm Hg; CO2, 39 mEq/L; HCO3, 23 mEq/L 2. pH, 7.32; Pao2, 85 mm Hg; CO2, 57 mEq/L; HCO3, 26 mEq/L 3. pH, 7.47; Pao2, 82 mm Hg; CO2, 30 mEq/L; HCO3, 31 mEq/L 4. pH, 7.31; Pao2, 95 mm Hg; CO2, 22 mEq/L; HCO3, 19 mEq/L

2

A nurse is caring for a client with acute respiratory distress syndrome. What should the nurse expect to note in the client? 1. Pallor 2. Low arterial Pao2 3. Elevated arterial Pao2 4. Decreased respiratory rate

2

A nurse is teaching a client with pulmonary disease about fundamental concepts of gas exchange. When asked for further details by the client, the nurse explains that gas exchange occurs through which process? 1. Osmosis 2. Diffusion 3. Ionization 4. Active transport

2

An oxygen delivery system is prescribed for a client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? 1. Face tent 2. Venturi mask 3. Aerosol mask 4. Tracheostomy collar

2

The nurse instructs a client regarding pursed-lip breathing and asks the client to demonstrate the breathing technique. Which observation by the nurse would indicate that the client is performing the technique correctly? 1. The client breathes in through the mouth. 2. The client breathes out slowly through the mouth. 3. The client avoids using the abdominal muscles to breathe out. 4. The client puffs out the cheeks when breathing out through the mouth.

2

The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the client? 1. Coma 2. Flushing 3. Dizziness 4. Tachycardia

2

The nurse is developing a plan of care for a client at risk for acute respiratory distress syndrome (ARDS). As part of the plan, the nurse will check for which item to detect an early sign of this disorder? 1. Edema 2. Dyspnea 3. Frothy sputum 4. Diminished breath sounds

2

The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucus production in the lower airway. The nurse explains that after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions? 1. Palpation and clubbing 2. Percussion and vibration 3. Hyperoxygenation and suctioning 4. Administer a bronchodilator and monitor peak flow.

2

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? 1 An overproduction of the antiprotease a1 antitrypsin 2 Hyperinflation of alveoli and destruction of alveolar walls 3 Hypertrophy and hyperplasia of goblet cells in the bronchi 4 Collapse and hypoventilation of the terminal respiratory unit

2

Which position would best help the breathing of a client with chronic obstructive pulmonary disease (COPD)? 1. Sitting position 2. Tripod position 3. Supine position 4. High Fowler's position

2

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which finding would the nurse expect to note on assessment of this client? Select all that apply. 1. Hypocapnia 2. A hyperinflated chest noted on the chest x-ray 3. Decreased oxygen saturation with mild exercise 4. A widened diaphragm noted on the chest x-ray 5. Pulmonary function tests that demonstrate increased vital capacity

2,3

Which nursing interventions are appropriate in caring for a client with emphysema? Select all that apply. 1. Reduce fluid intake to less than 1500 mL/day. 2. Teach diaphragmatic and pursed-lip breathing. 3. Encourage alternating activity with rest periods. 4. Teach the client techniques of chest physiotherapy. 5. Keep the client in a supine position as much as possible.

2,3,4

Which complications, along with edema in the ankles, does the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Leukopenia 2 Weight gain 3 Polycythemia 4 Hepatomegaly 5 Jugular vein distension

2,4,5

A client is experiencing severe dyspnea, and the nurse listens to the client's breath sounds and hears this sound. The nurse should document this finding as which sound? 1. Crackles 2. Rhonchi 3. Stridor 4. High-pitched wheezes

3

A client who experiences frequent upper respiratory infections (URIs) asks the nurse why food does not seem to have any taste during illness. In formulating a response, the nurse understands that this is owing to which symptom? 1. Anorexia, triggered by the infectious organism 2. Lack of client energy to cook wholesome meals 3. Blocked nasal passages that impair the sense of smell 4. Infection, which blocks sensation in the taste buds of the tongue

3

A client who is mouth breathing is receiving oxygen by face mask. The unlicensed assistive personnel (UAP) asks the registered nurse (RN) why a water bottle is attached to the oxygen tubing near the wall oxygen outlet. The RN responds that this feature facilitates which purpose? 1. Prevents the client from getting a nosebleed 2. Gives the client added fluid via the respiratory tree 3. Humidifies the oxygen that is bypassing the client's nose 4. Prevents fluid loss from the lungs during mouth breathing

3

A nurse is instructing a client in diaphragmatic breathing. To reinforce the need for this technique, the nurse teaches the client that in normal respiration, which is an action of the diaphragm? 1. Aids in exhalation as it contracts 2. Moves up and inward as it contracts 3. Moves downward and out as it contracts 4. Makes the thoracic cage smaller as it contracts

3

A nurse is providing instructions to a client about diaphragmatic breathing. The nurse tells the client that this technique is helpful because, in normal respiration, as the diaphragm contracts, it takes which action? 1. Aids in exhalation 2. Moves up and inward 3. Moves downward and out 4. Makes the thoracic cage smaller

3

A nurse is reinforcing instructions to a client about the use of an incentive spirometer. The nurse tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that which is the primary benefit? 1. Dilate the major bronchi. 2. Increase surfactant production. 3. Maintain inflation of the alveoli. 4. Enhance ciliary action in the tracheobronchial tree.

3

A nurse providing instructions to a client using an incentive spirometer tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that the primary benefit is to have which effect? 1. Dilate the major bronchi. 2. Increase surfactant production. 3. Maintain inflation of the alveoli. 4. Enhance ciliary action in the tracheobronchial tree.

3

A nurse who is participating in a client care conference with other members of the health care team is discussing the condition of a client with acute respiratory distress syndrome (ARDS). The health care provider states that as a result of fluid in the alveoli, surfactant production is falling. The nurse understands that which is the natural consequence of insufficient surfactant? 1. Atelectasis and viral infection 2. Bronchoconstriction and stridor 3. Collapse of alveoli and decreased compliance 4. Decreased ciliary action and retained secretions

3

The nurse cares for a patient with emphysema. What change in the alveolar sacs is the pathophysiological change in the lungs most characteristic of this disease? 1 The alveolar sacs collapse. 2 The alveolar sacs retain CO2. 3 The alveolar sacs are overdistended. 4 The alveolar sacs become filled with fluid

3

The nurse caring for a client who is mechanically ventilated is monitoring for complications of mechanical ventilation. Which assessment finding, if noted by the nurse, indicates the need for follow-up? 1. Muscle weakness in the arms and legs 2. A temperature of 98.6° F decreased from 99.0° F 3. A blood pressure of 90/60 mm Hg decreased from 112/78 mm Hg 4. A heart rate of 80 beats per minute decreased from 85 beats per minute

3

The nurse is caring for a client with a respiratory disorder who is attempting to stop smoking. The health care provider has recommended nicotine (Nicorette) gum. When reviewing this treatment with the client, the nurse should provide which instruction to the client? 1. Drink water while chewing the gum. 2. Only chew the gum for a maximum of 10 minutes. 3. Hold the gum between the cheek and teeth periodically. 4. Eat a light snack immediately before chewing the gum.

3

The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation? 1. Cyanosis 2. Hyperinflated chest 3. Rapid, shallow respirations 4. Coarse crackles auscultated bilaterally

3

Which position of the patient with hemoptysis may result in further complications while a nurse performs postural drainage? 1 Supine position 2 Side-lying position 3 Trendelenburg position 4 Dorsal recumbent position

3

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? 1 Acute respiratory failure 2 Secondary respiratory infection 3 Fluid volume excess resulting from cor pulmonale 4 Pulmonary edema caused by left-sided heart failure

3 Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema. Text Reference - p. 586

A client is admitted to the hospital with difficulty breathing. Which is the best approach for the nurse to use in obtaining the client's health history? 1. Focus only on the physical examination. 2. Obtain all information from family members. 3. Use the health care provider's medical history. 4. Plan short sessions with the client to obtain data

4

A client with chronic obstructive pulmonary disease (COPD) has a respiratory rate of 24 breaths per minute, bilateral crackles, and cyanosis and is coughing but is unable to expectorate sputum. Which problem is the priority? 1. Low cardiac output secondary to cor pulmonale 2. Gas exchange alteration related to ventilation-perfusion mismatch 3. Altered breathing pattern secondary to increased work of breathing 4. Inability to clear the airway related to inability to expectorate sputum

4

A client with long-standing empyema undergoes decortication of the affected lung area. Postoperatively the nurse should place the client in which position? 1. Sims 2. Supine 3. Side-lying 4. Semi-Fowler's

4

A nurse is caring for a client who is anxious and is experiencing dyspnea and restlessness from hypoxemia associated with pulmonary edema. Auscultation of the lungs reveals these breath sounds. The nurse determines that these breath sounds are usually caused by which condition? 1. Obstruction of the bronchus 2. Inflammation of the pleural surfaces 3. Passage of air through a narrowed airway 4. Opening of small airways that contain fluid

4

A nurse is teaching a client with chronic airflow limitation (CAL) about positions that help breathing during dyspneic episodes. Which position, assumed by the client, would indicate that the client needs additional teaching regarding positioning? 1. Sitting up and leaning on a table 2. Standing and leaning against a wall 3. Sitting up with elbows resting on knees 4. Lying on his or her back in a low Fowler's position

4

A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? 1 "Long-term home oxygen therapy should be used to prevent respiratory failure." 2 "Oxygen will not be needed until or unless you are in the terminal stages of this disease." 3 "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." 4 "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

4

A patient with emphysema is receiving oxygen at 1 L/min by way of nasal cannula. The nurse understands that this prescription is appropriate because: 1 The patient does not require more than 1 L of oxygen 2 High concentrations of oxygen may rupture the alveoli 3 Oxygen is the natural stimulus for breathing and not required 4 High concentrations of oxygen eliminate the respiratory drive

4

The nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to promote which outcome? 1. Promote oxygen intake 2. Strengthen the diaphragm 3. Strengthen the intercostal muscles 4. Promote carbon dioxide elimination

4

The nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? 1. Sitting up in bed 2. Side-lying in bed 3. Sitting in a recliner chair 4. Sitting on the side of the bed and leaning on an overbed table

4