Miscellaneous Test question for exam 2

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

A, 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

Which statement indicates that the client understands teaching about the administration of omalizumab (Xolair) for her asthma? a. "I can take this drug orally at home, since it has very few side effects." b. "I should take this drug sublingually by letting it dissolve under my tongue." c. "I should take this drug by injecting it into a muscle." d. "I will be given this drug subcutaneously in my doctor's office."

ANS: D Immunomodulators are monoclonal antibodies that prevent allergens from binding to receptor sites on mast cells and basophils. There is a high risk of anaphylaxis, so it is administered in the physician's office. The route is subcutaneous. It is not taken by mouth or injected intramuscularly.

Which of the following arterial blood gases (ABGs) would the registered nurse expect to see when a client has apnea and develops acidosis? A. pH 7.29, PaCO2 62 mm Hg, HCO3 23 mEq/L B. pH 7.30, PaCO2 42 mm Hg, HCO3 18 mEq/L C. pH 7.42, PaCO2 48 mm Hg, HCO3 25 mEq/L D. pH 7.49, PaCO2 30 mm Hg, HCO3 26 mEq/L

Answer: A. Rationale: Respiratory acidosis, apnea and hypoventilation results in rising carbon dioxide levels, which leads to acidosis.

A physician has ordered that a client with suspected lung cancer undergo magnetic resonance imaging (MRI). The nurse explains the benefits of this study to the client. Included in teaching would be which of the following regarding the MRI? a) Narrow-beam x-ray can scan successive lung layers. b) MRI can view soft tissues and can help stage cancers. c) Tumor densities can be seen with radiolucent images. d) Lung blood flow can be viewed after a radiopaque agent is injected.

B, MRI uses magnetic fields and radiofrequency signals to produce a detailed diagnostic image. MRI can visualize soft tissues, characterize nodules, and help stage carcinomas. The other options describe different studies.

A 4 year old is brought to the emergency department by his parents, who report that he swallowed a small toy. What symptom suggests complete airway obstruction by a foreign body? A. Gagging B.Coughing C.Inability to speak D. Rapid respirations

C.Inability to speak

A child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart would indicate the need for counseling regarding nutrition and gastrointestinal complications? A. Eats three snacks every day. B. Frothy, foul-smelling stools. C. Weight unchanged from yesterday.

Correct Answer B. Rationale: Frothy, foul-smelling stools reflect malabsorption and indicate that pancreatic enzymes are not being consumed or dosages may need adjustment. Maintenance of weight and consuming meals and snacks are positive nutrition goals for children with cystic fibrosis.

A result of repeated infections in children with cystic fibrosis is: A.Increased irritability B.Bone marrow depression C.Enhanced academic ability D.Being prone to developing type 1 diabetes

D

For patients with mild, intermittent asthma the pharmacologic treatment of choice is: a) Anticholinergics b) Short-acting beta-adrenergics (SABA) c) Long-acting, beta-adrenergics (LABA) d) Corticosteroids.

D, Corticosteroids are the mainstay of asthma treatment. Refer to Table 11-2 in the text.

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) Increase the flow of oxygen c) Take deep breaths d) Exhale slowly

D, When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.

A client with chronic obstructive pulmonary disease (COPD) is being evaluated for a lung transplant. The nurse performs the initial physical assessment. Which signs and symptoms should the nurse expect to find? a) Decreased respiratory rate b) Dyspnea on exertion c) Barrel chest d) Shortened expiratory phase e) Clubbed fingers and toes f) Fever

b) Dyspnea on exertion c) Barrel chest e) Clubbed fingers and toes

Prednisone (Deltasone) is prescribed to control inflammation in a client with interstitial lung disease. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: a) hyperglycemia and glycosuria. b) acute adrenocortical insufficiency. c) GI bleeding. d) restlessness and seizures.

b) acute adrenocortical insufficiency.

The 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) the attack is over. b) the airways are so swollen that no air can get through. c) the swelling has decreased. d) crackles have replaced wheezes.

b) the airways are so swollen that no air can get through.

A client recovering from a pulmonary embolism is receiving warfarin (Coumadin). To counteract a warfarin overdose, the nurse would administer: a) heparin. b) vitamin K1 (phytonadione). c) vitamin C. d) protamine sulfate.

b) vitamin K1 (phytonadione).

In planning a patient education session, the nurse sees one area of focus for Healthy People 2010 is chronic obstructive pulmonary disease (COPD). Which of the following information should the nurse include in the education session to address this focus area? a. Screening for environmental triggers b. Smoking cessation c. Develop action plans d. Identify those at risk

b. Smoking cessation

A 21-year-old client with cystic fibrosis develops pneumonia. To decrease the viscosity of respiratory secretions, the physician prescribes acetylcysteine (Mucomyst). Before administering the first dose, the nurse checks the client's history for asthma. Acetylcysteine must be used cautiously in a client with asthma because: a) it's a respiratory depressant. b) it's a respiratory stimulant. c) it may induce bronchospasm. d) it inhibits the cough reflex.

c) it may induce bronchospasm.

A nurse caring for a client with deep vein thrombosis must be especially alert for complications such as pulmonary embolism. Which findings suggest pulmonary embolism? a) Nonproductive cough and abdominal pain b) Hypertension and lack of fever c) Bradypnea and bradycardia d) Chest pain and dyspnea

d) Chest pain and dyspnea

A client hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? a) Nausea or vomiting b) Abdominal pain or diarrhea c) Hallucinations or tinnitus d) Light-headedness or paresthesia

d) Light-headedness or paresthesia

A nurse on the medical-surgical unit just received report on her client care assignment. Which client should she assess first? a) The client with anorexia, weight loss, and night sweats b) The client with crackles and fever who is complaining of pleuritic pain c) The client who had difficulty sleeping, daytime fatigue, and morning headache d) The client with petechiae over the chest who's complaining of anxiety and shortness of breath

d) The client with petechiae over the chest who's complaining of anxiety and shortness of breath

The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between puffs. 4. The mouth is rinsed with water following administration. 5. The client lies supine for 15 minutes following administration.

1, 4. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.

A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? 1. Irregular heartbeat. 2. Constipation. 3. Pedal edema. 4. Decreased pulse rate.

1. Irregular heartbeats should be reported promptly to the care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.

Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? 1. Maintaining functional ability. 2. Minimizing chest pain. 3. Increasing carbon dioxide levels in the blood. 4. Treating infectious agents.

1. A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client's functional ability. Chest pain is not a typical symptom of COPD. 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. Preventing infection would be a goal of care for the client with COPD.

Which of the following physical assessment findings are normal for a client with advanced chronic obstructive pulmonary disease (COPD)? 1. Increased anteroposterior chest diameter. 2. Underdeveloped neck muscles. 3. Collapsed neck veins. 4. Increased chest excursions with respiration.

1. 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. Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. 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 blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak flow numbers after meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4. Use sedatives to ensure uninterrupted sleep at night.

1. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the client's life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.

The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which of the following instructions should be included? 1. Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. 2. Lie flat on the back, splint the thorax, take two deep breaths, and cough. 3. Take several rapid, shallow breaths and then cough forcefully. 4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

1. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times, the client should take a deep abdominal breath, bend forward, and cough three or four times upon exhalation (" huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the the client to expect to: 1. Develop respiratory infections easily. 2. Maintain current status. 3. Require less supplemental oxygen. 4. Show permanent improvement.

1. A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.

A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? 1. Elevate the head of the bed 30 to 45 degrees. 2. Encourage the client to cough and deep breathe. 3. Auscultate the lungs to detect abnormal breath sounds. 4. Contact the physician.

1. Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physician must be kept informed of changes in a client's status, but the priority in this case is alleviating the symptoms.

107.A 68-year-old male client has been hospitalized repeatedly for chronic obstructive pulmonary disease (COPD). During this latest admission, he has refused to participate in his self-care. Every time the nurse approaches him, the client states, "I just want to die. I'm no good to anyone anymore." The nurse realizes that he's experiencing: A. self-actualization B. confabulation. C. reaction formation. D. grief.

107.ANSWER: D The client with a chronic illness goes through a grieving process that is related to the loss of his previous level of function. Grief is commonly manifested as loss of motivation and refusal to perform functions of which the client is fully capable. Self-actualization is the process of fulfilling one's potential. Confabulation is a behavioral reaction in which the client creates stories or invents answers to fill in memory gaps in an unconscious attempt to maintain self-esteem. In reaction formation, the client uses behaviors that are the opposite of what he would like to do.

109.The physician has ordered O2 at 3 liters/minute via nasal cannula. O2 amounts greater than this are contraindicated in the client with COPD because: A. Higher concentrations result in severe headache. B. Hypercapnic drive is necessary for breathing. C. Higher levels will be required later for pO2. D. Hypoxic drive is needed for breathing.

109.ANSWER: D Respiratory effort is stimulated in client's with COPD by hypoxemia. Answer A and C are incorrect because higher levels would rob the client of the drive to breathe. Answer B is an incorrect statement.

114.A client with chronic obstructive lung disease tells the 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 a prescribed nebulizer treatment. The therapist says, "I have several more percussions to do on the unit where I am now. As soon as I'm done, I'll come assess the client." The nurse's most appropriate action is to: A. notify the primary physician immediately. B. stay with the client until the therapist arrives. C. administer the treatment by metered-dose inhaler. D. give the nebulizer treatment herself.

114.ANSWER: D 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 so the nurse can't change the route without a new order from the physician.

119.Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with COPD. Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration? A. The oxygen will be lost at the client's nostrils if given at a higher level with a nasal cannula. B. The client's long history of respiratory problems indicates that he would be unable to absorb oxygen given at a higher rate. C. The cells in the alveoli are so damaged by the client's long history of respiratory problems that increased oxygen levels and reduced carbon dioxide levels likely will cause the cells to burst. D. The client's respiratory center is so accustomed to high carbon dioxide and low blood oxygen concentrations that changing these concentrations with oxygen therapy may eliminate his stimulus for breathing.

119.ANSWER: D Relatively low concentrations of oxygen are administered to clients with COPD so as not to eliminate their respiratory drive. Carbon dioxide content in the blood normally regulates respirations. Clients with COPD, though, are often accustomed to high carbon dioxide levels; the low oxygen blood level is their stimulus to breathe. If they receive excessive oxygen and experience a drop in the blood carbon dioxide, they may stop breathing. A: Oxygen flow rate is not diminished at high levels when administered through a nasal cannula. B: The client's ability to absorb oxygen administered at a higher level is not affected. C: Increased oxygen levels and decreased carbon dioxide levels cannot cause cells to burst.

12. The physician orders oxygen given in low concentration, rather than in high concentration and continuously, for a client with COPD to prevent: A. A decrease in red cell formation B. Rupture of emphysematous bullae C. Depression of the respiratory center D. An excessive drying of the respiratory mucosa

12. ANSWER: C Clients with chronic obstructive pulmonary disease (COPD) must be given only low concentrations of oxygen; a decreased oxygen blood level is the only stimulus for breathing for these clients. A: Prolonged hypoxia will stimulate erythrocyte production; the goal of therapy is to relieve hypoxia. B: The pressure, rather than the concentration, at which oxygen is administered increases this risk. D: To prevent its drying effects on secretions and the mucosa, oxygen should be humidified.

A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause coughing and dyspnea. 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. 3. Increased oxygen use will cause the client to become dependent on the oxygen. 4. Administration of oxygen is contraindicated in clients who are using bronchodilators.

2. Clients who have a long history of COPD may retain carbon dioxide (CO2). Gradually the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.

The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PC02 62; PO2 70; HCO3 34 The nurse should: 1. Apply a 100% non-rebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

2. Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift objects: 1. While inhaling through an open mouth. 2. While exhaling through pursed lips. 3. After exhaling but before inhaling. 4. While taking a deep breath and holding it.

2. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory infections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.

2. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

20. Which of the following instructions would the nurse give to the parents of an 8-year-old child with asthma who is being switched from parenteral steroid therapy to a daily dose of oral prednisone? A. Administer the dose before bedtime to minimize side effects. B. Give the medication according to the child's response. C. Have the child take the dose with meals to prevent gastric irritation. D. Make sure the pill is given intact to maintain the enteric coating.

20. ANSWER: C Prednisone causes severe gastric upset. Therefore, it should be given with food. A: It is recommended that the daily dose be given in the morning before 9:00 AM. Given at this time, the medication will suppress adrenal cortex activity less, which may reduce the risk of HPA-axis suppression. B: The drug must be given as ordered and not titrated to response. If the drug has been given over a long period, abrupt cessation can cause serious side effects. D: Because the pills are not enteric-coated, they may be crushed and mixed with food if the child has difficulty swallowing them.

21. After staying several hours with her 10-year-old daughter who is admitted to the hospital with an asthmatic attack, the mother leaves to attend to her other children. The child exhibits continued signs and symptoms of respiratory distress. Which of the following findings would lead the nurse to make a nursing diagnosis of Anxiety related to respiratory distress? A. Complaints of an inability to get comfortable. B. Frequently requests for someone to stay in the room. C. Inability to remember his exact address. D. Verbalization of a feeling of tightness in his chest.

21. ANSWER: B A 10-year-old should be able to tolerate being alone. Frequently asking for someone to be in the room indicates a degree of psychological distress at this age suggesting Anxiety. A: The inability to get comfortable is commonly characteristic of child with a diagnosis of Pain. C: Inability to answer questions correctly may reflect a state of anoxia or a lack of knowledge. D: Tightness in the chest occurs as a result of bronchial spasms and indicates a diagnosis of Ineffective Airway Clearance.

23. When discussing the use of cromolyn sodium (Intal) with the parent of a child diagnosed with asthma, the nurse should teach the mother that the medication will be ineffective if it is administered at which of the following? A. Intermittently for short-term use. B. During an asthmatic attack. C. Preparation for going to bed. D. Prior to riding a bicycle for a block.

23. ANSWER: B Cromolyn sodium (Intal) is used as a prophylactic agent to help prevent bronchial asthmatic attacks. The drug inhibits histamine release and acts locally to prevent the release of mediator substances from mast (connective tissue) cells after exposure to allergens. The drug is not an anti-inflammatory, bronchodilator, or antihistamine agent. Therefore, it is of no use during an asthma attack. A: To be effective, cromolyn should be administered consistently over a long period of time. Short-term dosing provides no benefits. C: Cromolyn is used prophylactically and administered routinely several times a day. Although preparation for bed would not affect the effectiveness of cromolyn, it may be one of the scheduled dosing times. D: Although cromolyn is indicated for the prevention of exercise-induced bronchospasm, riding a bicycle one block is usually not considered to be strenuous exercise. Thus, cromolyn would not be helpful in preventing airway narrowing.

24. The nurse is aware that a client understands the instructions about an appropriate breathing technique for COPD when the client: A. Inhales through the mouth B. Increases the respiratory rate C. Holds each breath for a second at the end of inspiration D. Progressively increases the length of the inspiratory phase

24. ANSWER: C This pause allows added time for gaseous exchange at the alveolar capillary beds. A: Inhalation should be through the nose to moisten, filter, and warm the air. B: This decreases the effectiveness of respirations. D: The expiratory phase should be lengthened, and exhalation should be through pursed lips.

26. In the early stage of shock, the nurse would expect the results of arterial blood gas (ABG) analysis to indicate: A. Respiratory alkalosis. B. Respiratory acidosis. C. Metabolic alkalosis. D. Metabolic acidosis.

26. ANSWER: A As a compensatory measure in the early stage of shock, the client hyperventilates in response to hypoxemia. Hyperventilation is an attempt to provide more oxygen to the tissues to compensate for decreased circulating volume. It increases minute volume and results in decreased PaCO2), while PaO2 remains normal. This is the classic picture of respiratory alkalosis. B: Respiratory acidosis occurs in the advanced stage of shock. C: Metabolic alkalosis does not develop in shock unless overcorrection of acidosis is a result of administering sodium bicarbonate. D: Metabolic acidosis occurs in the advanced stage of shock.

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? 1. Clubbing of nail beds. 2. Hypertension. 3. Peripheral edema. 4. Increased appetite.

3. 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. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation. 2. Act as an expectorant. 3. Have an anti-inflammatory effect. 4. Prevent development of respiratory infections.

3. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Relaxation of bronchial smooth muscle. 4. Thinning of tenacious, purulent sputum.

3. Theophylline (Theo-Dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

A client who has been taking flunisolide (AeroBid), two inhalations a day, for treatment of asthma.has painful, white patches in his mouth. Which response by the nurse would be most appropriate? 1. "This is an anticipated adverse effect of your medication. It should go away in a couple of weeks." 2. "You are using your inhaler too much and it has irritated your mouth." 3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." 4. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."

3. Use of oral inhalant corticosteroids such as flunisolide (AeroBid) can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.

35. Which of the following interventions is most helpful in determining the need for oxygen therapy in a client with chronic obstructive pulmonary disease? A. Ask the client to tell the nurse when oxygen is needed. B. Assess the client's fatigue level. C. Use a pulse oximeter to determine oxygen saturation. D. Evaluate the client's hemoglobin level daily.

35. ANSWER: C A pulse oximeter, which measures oxygen saturation, is the most effective noninvasive way to determine a client's need for oxygen therapy. A: Although the client may feel the need for oxygen during periods of dyspnea, this is not a reliable way of determining the client's need. B: Fatigue may be due to other factors besides oxygenation levels. D: Evaluating the client's hemoglobin level can provide an indication that the client may have less oxygen-carrying capacity but is not a reliable indicator of oxygen need.

Which of the following is an appropriate expected outcome for an adult client with well-controlled asthma? 1. Chest X-ray demonstrates minimal hyperinflation. 2. Temperature remains lower than 100 ° F (37. 8 ° C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.

4. Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest X-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises. 2. Maintain a high-protein diet. 3. Avoid exposure to people with known respiratory infections. 4. Abstain from cigarette smoking.

4. Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds. 2. Prolonged inspiration. 3. Normal chest movement. 4. Coarse crackles and rhonchi.

4. Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/ minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas analysis and send the client for a chest X-ray. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators.

4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, I.V. corticosteroids and, possibly, I.V. theophylline (Theo-Dur). Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an arterial blood gas analysis and obtaining a chest X-ray. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention.

Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands his care plan? 1. The client promises to do pursed-lip breathing at home. 2. The client states actions to reduce pain. 3. The client says that he will use oxygen via a nasal cannula at 5 L/ minute. 4. The client agrees to call the physician if dyspnea on exertion increases.

4. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/ minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia.

Which of the following diets would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? 1. Low-fat, low-cholesterol diet. 2. Bland, soft diet. 3. Low-sodium diet. 4. High-calorie, high-protein diet.

4. 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. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland, soft foods.

42. The morning weight for a client indicates that the client has gained 5 pounds in less than a week, even though his oral intake has been modest. The client's weight gain may reflect which associated complication of COPD? A. Polycythemia B. Cor pulmonale C. Left ventricular failure D. Compensated acidosis

42. ANSWER: B Answer 1 and 4 do not cause weight gain, so they're incorrect. And answer 3 would be reflected in pulmonary edema, so it's incorrect.

43. Parents of a child with cystic fibrosis demonstrate knowledge of the effects of hot weather on their child when they state that hot weather is hazardous because the child has which of the following? A. Poor ability to concentrate urine. B. Little skin pigment to prevent sunburn. C. Poorly functioning temperature control center. D. Abnormally high salt loss through perspiration.

43. ANSWER: D One characteristic of cystic fibrosis is the excessive loss of salt through perspiration. Salt supplements are almost always necessary during warm weather or any other time the child with cystic fibrosis perspires more than usual. A: In the child with cystic fibrosis, the functioning of the sweat glands is the problem, causing abnormal amounts of salt to be lost with perspiration. The ability to concentrate urine is not the problem. B: Little skin pigment is not a condition associated with cystic fibrosis. C: A poorly functioning temperature control center is not a condition related to cystic fibrosis.

44. A male adolescent with cystic fibrosis whose parents are both carriers of the disease asks the nurse, "When I have children could they have cystic fibrosis like me?" The nurse should base a response on the knowledge that: A. Men with cystic fibrosis generally have a 50% chance of having children with the disease B. Only women pass this disease to their children because it is carried on the sex chromosome C. This client has a greater chance of passing the disease to his children because his parents were only carriers D. Men with cystic fibrosis are usually unable to father a baby, although their sexual functioning is not affected

44. ANSWER: D This is not true; most men with cystic fibrosis are sterile. A: Cystic fibrosis is inherited as an autosomal recessive trait; it is not sex-linked. B: This is not true; most men with cystic fibrosis are sterile. C: Because of a failure of normal development of the vas deferens, epididymis, and seminal vesicles and a blockage of the vas deferens with abnormal secretions, there is decreased or absent sperm production.

45. The nurse formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include: A. drinking more than 1,500 ml of fluid daily. B. being overweight. C. eating a high-protein snack at bedtime. D. eating more than three large meals per day.

45. ANSWER: B Conditions that increase oxygen demands include being overweight, smoking, exposure to temperature extremes, and stress. A client with chronic bronchitis should drink at least 2,000 ml of fluid daily to thin mucus secretions; restricting fluid intake may be harmful. The nurse should encourage the client to eat a high-protein snack at bedtime because protein digestion produces an amino acid with sedating effects that may ease the insomnia associated with chronic bronchitis. Eating more than three large meals per day may cause fullness, making breathing uncomfortable and difficult; however, it doesn't increase oxygen demands. To help maintain adequate nutritional intake, the client with chronic bronchitis should eat small, frequent meals (up to six per day).

49. The nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing, and breath sounds aren't audible. The reason for this change is that: A. the attack is over. B. the airways are so swollen that no air can get through. C. the swelling has decreased. D. crackles have replaced wheezes.

49. ANSWER: B During an acute 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.

50. The nurse is interviewing a slightly overweight 43-year-old man with mild emphysema and borderline hypertension. He admits to smoking one pack of cigarettes per day. When developing a teaching plan, which of the following should receive highest priority to help decrease respiratory complications? A. Weight reduction B. Decreasing salt intake C. Smoking cessation D. Decreasing caffeine intake

50. ANSWER: C Smoking cessation should receive highest priority when trying to reduce risk factors for respiratory complications. Losing weight and decreasing salt and caffeine intake can help to decrease risk factors for hypertension.

2. When assessing the child with asthma for allergic rhinitis, which of the following would the nurse expect to find? A. Nasal crease. B. Abdominal pain. C. Fever. D. Mouth breathing.

52. ANSWER: A In the child with asthma and allergic rhinitis, the allergic reaction to inhaled particles generally causes frequent nose rubbing, subsequently leading to a nasal crease. The child also may exhibit allergic shiners, dark circles under the eyes caused by nasal congestion.

54. The client with acute bronchitis requires careful monitoring when receiving: A. oxygen therapy. B. fluid resuscitation. C. humidified air. D. postural drainage.

54. ANSWER: A The client should be monitored closely and given low-flow oxygen to decrease chances of depressing the respiratory drive. Increasing fluids to liquefy secretions, humidifying the air, and performing postural drainage are also important for a client with acute bronchitis.

56. Which of the following statements by the parents of a child with asthma being taught the reasons for using a peak expiratory flow meter indicates the need for additional teaching? A. "If there is no increase in flow after he gets his bronchodilator, we should give another treatment." B. "Finally, we have a way to monitor his condition and predict when he is getting worse." C. "This meter will help to monitor our child's condition, so changes can be made in therapy." D. "The meter readings will help us determine if he has other possible triggers besides dust and cold."

56. ANSWER: A Although the meter does assist in evaluating the effectiveness of a treatment, repeating the dose of bronchodilator therapy is not recommended unless prescribed by a physician. Bronchodilators have serious side effects, and the child would need to be monitored closely if several treatments were given in a row. B: The peak expiratory flow meter is used to follow trends for diurnal variations that predict instability of asthma and need for increased therapy. It also assists in early detection of exacerbation of the asthma because decreases in the peek expiratory flow rate may indicate a worsening condition. C: The peak expiratory flow meter is used to monitor the asthma and assist in making decisions about increasing or decreasing therapy. D: By monitoring trends in readings and the child's condition, a peak expiratory flow meter can also be used to identify triggers of asthma.

59. The nurse is assessing the breath sounds of a client with emphysema. The nurse understands that the client's respiratory status is affected by what primary pathophysiologic changes? A. Constricted airspaces in the lungs. B. Destruction of alveolar walls. C. Elevation of the diaphragm. D. Increased airflow out of the lungs.

59. ANSWER: B Emphysema is characterized by destruction of the alveolar walls, hyperinflation of the alveoli, and loss of lung elasticity. A: Airspace is not constricted as air can flow easily into the lungs. C: The diaphragm becomes flattened due to the hyperinflated lungs. D: The air becomes trapped due to the loss of elasticity and airflow going out of the lungs is decreased.

63. The nurse is teaching a client with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A. Make inhalation longer than exhalation. B. Exhale through an open mouth. C. Use diaphragmatic breathing. D. Use chest breathing.

63. ANSWER: C In chronic bronchitis, the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and prevent air trapping. Diaphragmatic breathing — not chest breathing — increases lung expansion.

68. A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instructions? A. "Weigh yourself daily and report a loss of 1 lb in 1 day." B. "Eat a high-sodium diet." C. "Weigh yourself daily and report a gain of 2 lb in 1 day." D. "Maintain bedrest."

68. ANSWER: C COPD causes pulmonary hypertension, leading to right ventricular failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. He should eat a low-sodium diet to avoid fluid retention and should engage in moderate exercise to avoid muscle atrophy.

70. A client with oat cell lung cancer is scheduled for a mediastinoscopy with biopsy. The nurse should: A. Tell the client that chest tubes will be present after the procedure B. Explain that the procedure will visualize the lungs and the chest cavity C. Advise the client of the NPO status after midnight the night before the test D. Inform the client that some pleural fluid will be removed during the procedure

70. ANSWER: C To prevent aspiration during the procedure, clients are required to be NPO for at least 8 to 12 hours prior to the procedure. A: Chest tubes are not required unless the lungs are accidentally punctured; the client will have a small incision near the clavicle. B: A mediastinoscopy permits visualization of the anterior mediastinum or hilum extrapleurally; a bronchoscopy permits visualization of the main stem bronchus. D: Fluid is removed from the pleural space during a thoracentesis.

72. The breathing exercises that the nurse teaches to a client with emphysema (COPD) should include: A. An inhalation that is longer than an exhalation B. Abdominal exercises to limit the use of accessory muscles C. Sit-ups to strengthen the abdominal and intercostal muscles D. Diaphragmatic exercises to improve contraction of the diaphragm

72. ANSWER: D With COPD the diaphragm is flattened and weakened; strengthening the diaphragm is desirable. A: The opposite is more desirable; clients with COPD retain too much carbon dioxide, which eventually causes a barrel chest. B: The abdominal muscles are accessory muscles of respiration, and their contraction and relaxation are involved in diaphragmatic breathing. C: Sit-ups are too strenuous for clients with emphysema.

75. A male client with cystic fibrosis (CF) becomes romantically involved with a female with the same disease. He asks the nurse about the chances of having an affected child like himself. The most appropriate response by the nurse would be: A. "Use condoms for protection from pregnancy." B. "Young women with cystic fibrosis are not fertile." C. "All of your children would be carriers of cystic fibrosis." D. "You are probably not able to father children because of your cystic fibrosis."

75. ANSWER: D With few exceptions males are sterile; failure of normal development of the wolffian duct structures (vas deferens, epididymis, and seminal vesicles) and blockage of the vas deferens by abnormal secretions result in decreased or absent sperm production. A: This does not answer the client's question. B: Females with CF generally have normal ovaries and fallopian tubes and are fertile; however, fertility can be inhibited by highly viscous cervical secretions. C: Theoretically, all offspring of couples who are homozygous for a recessive gene will have the disease; however with cystic fibrosis, affected men are usually sterile.

77. For the child diagnosed with an asthmatic attack, which of the following manifestations would best correlate with the child's arterial blood gas results, which include pH of 7.46, bicarbonate of 21, and a PCO2 of 33 mm Hg? A. Greatly diminished breath sounds. B. A tingling sensation in the fingertips. C. Heart rate of 68 beats/minute. D. Absence of urination for several hours.

77. ANSWER: B The arterial blood gas results indicate respiratory alkalosis. As the alkalinity of body fluids increases, ionization of calcium decreases. A low level of circulating ionized calcium increases the excitability of nerve and muscle tissue, manifested by paresthesia (numbness and tingling) of the digits, upper lip, and earlobes. A: In mild asthma with respiratory alkalosis, breath sounds are typically loud with expiratory wheezing. C: In mild asthma with respiratory alkalosis, the heart rate is usually elevated because of hyperventilation. D: In mild asthma with respiratory alkalosis, urine production is increased because of the increased renal circulation. As a result, bicarbonate, sodium, and potassium excretion increases in an attempt to conserve hydrogen to correct the alkalosis.

81. Theophylline ethylenediamide is administered to a client with COPD to: A. Reduce bronchial secretions. B. Relax bronchial smooth muscle. C. Strengthen myocardial contractions. D. Decrease alveolar elasticity.

81. ANSWER: B Theophylline ethylenediamide is a xanthine derivative that acts directly on bronchial smooth muscle to relax and dilate the bronchi and relieve bronchial constriction and spasms. When the drug exerts its primary desired effect, dyspnea and shortness of breath decrease. Strengthen myocardial contractions. Theophylline ethylenediamide does increase strength of myocardial contractility, but this is not the action for which it is used. 1

84. A 10-year-old with history of bronchial asthma triggered by exposure to cold, smoke, and nuts is brought to the hospital's emergency room by his mother. Appearing restless and anxious, the child has a respiratory rate of 36 breaths/minute and pulse rate of 160 bpm. Which of the following findings would be of greatest concern to the nurse? A. Increased respiratory effort. B. Moist, loose cough. C. Absence of wheezing. D. Prolonged expiratory phase.

84. ANSWER: C Knowing that this child is most likely experiencing an asthmatic attack, the nurse would expect to hear wheezing and note some shortness of breath with a prolonged expiratory phase. However, of greatest concern would be the absence of wheezing indicating that the child is not moving air well through the lungs and is at risk for hypoxia and possible respiratory failure. A: Increased respiratory effort would be suspected secondary to bronchospasm associated with asthma. B: During an asthma attack, the cough usually is dry and sounds tight due to mucus accumulation and bronchoconstriction. D: Typically during an asthmatic attack, the client would demonstrate a prolonged expiratory phase because of air trapping and the increased effort to move air through constricted bronchioles.

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

86. ANSWER: C Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 qt [2 L] or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk for infection from pooled secretions.

93. A 3-year-old child with cystic fibrosis is admitted to the hospital with bronchopneumonia. Which of the following signs and symptoms would be most helpful in providing supportive diagnostic data for this child's condition? A. Weight loss and stringy stools. B. Cough and fever. C. Constipation and vomiting. D. Dysuria and rash.

93. ANSWER: B As a result of the infectious process and mucus accumulation, classic signs of pneumonia include fever and cough. A: Weight loss may occur in a child with cystic fibrosis because of the energy expenditure needed to fight the infection. Typically stools are large, bulky, and greasy. C: Constipation is not a common manifestation of pneumonia. However, vomiting may occur, especially if the child is coughing frequently and has a lot of mucus. D: Dysuria and rash are not associated with pneumonia.

An 8-month old is admitted is admitted to the pediatric unit with a history of multiple respiratory infections and suspected cystic fibrosis. Which symptom suggests cystic fibrosis? A.Fatty Stools B.Decreased Appetite C.Decreased Respiratory Rate D.Early passage of meconium in the neonatal period

A Cystic fibrosis causes thick secretions that block pancreatic ducts and prevent essential pancreatic enzymes from reaching the duodenum. This impairs digestion and absorption of nutrients. The lack of available enzymes also causes stools that are greasy, foul smelling, and frothy from undigested fat. Because of respiratory involvement children may have increased respiratory rate. An early sign of cystic fibrosis in infancy is failure to pass meconium.

You are assessing the respiratory system of a client just admitted to your unit. What do you know to assess in addition to the physical and functional issues related to breathing? a) How these issues affect the client's quality of life b) How these issues affect the relationships in the client's life c) How these issues affect the client's effort to breathe d) How these issues affect the client's ability to function

A, Assessment of the respiratory system includes obtaining information about physical and functional issues related to breathing. It also means clarifying how these issues may affect the client's quality of life. Therefore, options B, C, and D are incorrect.

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? a) Preparing a written action plan b) Using a long-acting steroid inhaler when an attack is coming c) Staying in the house if it is too cold or too hot d) Avoiding exercise and any strenuous activity

A, Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations (Expert Panel Report 3, 2007).

The nurse provides health teaching to a patient who has been prescribed an inhaler for corticosteroid administration. Which of the teaching points would the nurse include? Select all that apply: a) Shake the inhaler for up to 6 seconds to mix the medication. b) Take a deep breath with the mouth wide open as the inhaler is depressed. c) Inhale for a minimum of 20 seconds so the drug can reach the back of the oropharynx. d) Repeat this inhalation technique three times as quickly as possible. e) Exhale through pursed lips.

A, B, E Inhalation should occur over 5 to 6 seconds. The more slowly the inhalation, the deeper the medicine penetrates. The inhalation should not be done quickly.

It is recommended that the nutritional status of patients with COPD be evaluated by using: a) Body mass index. b) A standard formula based on exercise and activity levels. c) A nutritional analysis of caloric needs. d) Calorie requirements based on height and weight.

A, Body mass index should be maintained in the range of over 20 to under 25. Caloric requirements will vary according to the severity of the patient's condition.

Which of the following occupy space in the thorax, but do not contribute to ventilation? a) Bullae b) Mast cells c) Lung parenchyma d) Alveoli

A, Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. a) Thick mucus b) Destruction of the alveolar wall c) Airway remodeling d) Swelling of bronchial membranes

A, C, D As asthma becomes more persistent, inflammation progresses and airway edema, mucus hypersecretion, and formation of mucus plugs can occur. Airway remodeling may occur in response to chronic inflammation, causing further airway narrowing. Destruction of the alveolar wall does not occur with asthma.

It is important to teach patients how to manage an acute episode of dyspnea. Which of the following teaching points should be included in the lesson? Select all that apply. a) Make each breath longer and longer. b) Breathe in slowly through the nose. c) Keep arms supported and relaxed with pillows. d) Lean backward with a straight back to expand the thoracic cavity. e) Breathe out through pursed lips.

A, C. E It is important to lean forward with a straight back and breathe in through the mouth. Refer to Box 11-5 in the text.

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? a) Cromolyn sodium b) Albuterol c) Theophylline d) Budesonide

A, Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Albuterol is a long-acting beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator.

A nurse is working a 0700 to 1500 shift of a pediatric floor, and her duties include giving the morning dose of pancreatic enzyme to a 12 year old with cystic fibrosis. This medication should be administered: A.With breakfast B.After breakfast C.With antibiotics D.2 hours before breakfast

A, Explanation pancreatic enzymes help digest fat in the diet. They should be given with meals and snacks to help break down fat and increase its absorption by the body.

Which diagnostic is the most accurate in assessing acute airway obstruction? a) Pulmonary function studies b) Pulse oximetry c) Chest x-ray d) Arterial blood gases (ABGs)

A, Pulmonary function studies are the most accurate means of assessing acute airway obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics for an airway obstruction. (

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) "Raise your arms over your head." c) "Sit in a chair whenever doing an activity." d) "Drink fluids upon arising from bed."

A, 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.

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) Providing sufficient oxygen to improve oxygenation b) Increasing pH c) Avoiding the use of oxygen to decrease the hypoxic drive d) Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise

A, The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

Which of the following is the key underlying feature of asthma? a) Inflammation b) Chest tightness c) Productive cough d) Shortness of breath

A, inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.

A nurse is caring for a 17-year-old female with cystic fibrosis who has been admitted to the hospital to receive I.V. antibiotic and respiratory treatment for exacerbation of a lung infection. The adolescent has a number of questions about her future and the consequences of the disease. Which statements about the course of cystic fibrosis are true?( Select all that apply) A.Breast development is commonly delayed B.The adolescent is at risk for developing diabetes C.Pregnancy and child-bearing aren't affected D.Normal sexual relationships can be expected E.Only males carry the gene for the disease. F.By age 20, the frequency of respiratory treatment should be possible to decrease

A,B,D Cystic fibrosis delays growth and the onset of puberty. Children with cystic fibrosis tend to be smaller that average size and develop secondary sex characteristics later in life. In addition, children with CF are at risk for developing diabetes mellitus because the pancreatic duct becomes obstructed as pancreatic tissues are destroyed. People with CF can expect to have normal sexual relationships, but fertility becomes difficult because thick secretions obstruct the cervix and block sperm entry. Males and females carry the gene for cystic fibrosis. Pulmonary disease commonly progresses as the child ages, requiring additional respiratory treatment - not less.

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) a) To loosen secretions b) To facilitate expectoration c) To assist with the effectiveness of the corticosteroids d) To combat dehydration e) To relieve bronchospasm

A,B,D The nurse also assesses the patient's skin turgor for signs of dehydration. Fluid intake is essential to combat dehydration, to loosen secretions, and to facilitate expectoration.

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

A. COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Weight loss is common with COPD

The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response? a) "It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." b) "It is a term that covers so many lung diseases I can't list them all." c) "It means your lungs can't expand and contract like they are supposed to which makes it hard for you to breathe." d) "It is an umbrella term for diseases like acute bronchitis."

A. Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.

A client with respiratory acidosis is admitted to the intensive care unit for close observation. The nurse should stay alert for which complication associated with respiratory acidosis? a) Shock b) Stroke c) Seizures d) Hyperglycemia

A. Shock - Complications of respiratory acidosis include shock and cardiac arrest. Stroke and hyperglycemia aren't associated with respiratory acidosis. Seizures may complicate respiratory alkalosis, not respiratory acidosis.

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

ALL OF THEM Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection.

The nurse teaches the client about therapy to prevent asthma attacks. What statement by the nurse would best explain the purpose for daily asthma therapy? a. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." b. "If asthma attacks are uncontrolled, they could potentially lead to the development of emphysema, as well as chronic bronchitis." c. "Using only short-acting beta agonists will lead to the development of drug resistance and the drug won't work as effectively when you need it." d. "Beta-agonist inhaled drugs don't treat the inflammatory aspects of the disease and don't halt the attack."

ANS: A Because damage can occur with any asthma attack, the main focus of therapy should be on prevention rather than just on symptom management. Frequent asthma attacks will damage bronchial tissues but will not necessarily cause lung cancer, emphysema, or chronic bronchitis. There is no evidence that use of short-acting beta agonists will lead to drug resistance or that beta-agonist drugs will not affect the inflammatory aspects of the overall disease process.

The client with chronic obstructive pulmonary disease (COPD) states that he feels "full after eating a little food." What will the nurse teach the client? a. "Avoid drinking fluids just before and during meals." b. "Use a bronchodilator inhaler 30 minutes before meals." c. "Increase the amount of protein and reduce fat in your diet." d. "Practice diaphragmatic breathing against resistance 4 times daily."

ANS: A Early satiety makes it harder for clients with COPD to eat enough food to meet their energy requirements. Drinking fluids just before a meal or during a meal contributes to the sensation of fullness and clients stop eating sooner. Although it is recommended that clients with COPD use an inhaler before meals to increase ventilation and gas exchange (and to reduce coughing during meals), this practice does not affect early satiety and neither does diaphragmatic breathing. There is no evidence that changing the amount of protein and fat in the diet will change the client's feelings of satiety.

The client has been diagnosed with chronic obstructive pulmonary disease (COPD). The nurse is attempting to determine if the client's self-image has suffered as a result of his diagnosis. What is the nurse's priority line of questioning? a. Whether the earning power of the client's household has decreased b. Whether the client has experienced difficulty quitting smoking c. Whether the client has a fulfilling relationship with his wife d. Whether the client has changed his hobbies to accommodate his disease

ANS: A Economic status may be affected by COPD through changes in income and health insurance coverage. If the client is the head of the household, severe COPD may require role changes that have a negative impact on self-image. If the client is experiencing difficulty in quitting smoking, his self-image will probably not be altered as much as it would be related to income. The client may be experiencing difficulty with his marital relationship, but it probably will not be causing changes in his self-image. Although the client may have had to change his hobbies to accommodate the disease, it probably will not have affected his self-image adversely.

The home care nurse observes oral candidiasis in the client with severe, chronic, airflow limitation. What information will the nurse obtain from this client? a. "How often are you using your steroid inhaler?" b. "Have you had a cold or other viral infection lately?" c. "When was the last time the oxygen tank was changed?" d. "Have you changed your toothbrush recently?"

ANS: A Excessive use of steroid inhalers reduces local immune function and increases the client's risk for oral-pharyngeal infections, including candidiasis. There is no evidence that the common cold, long-term use of the same oxygen tank, or using a toothbrush for a longer period will increase the client's chances of developing candidiasis.

The nurse teaches the client about dietary changes necessary with chronic obstructive pulmonary disease (COPD). Which statement best indicates understanding? a. "I will decrease calories from carbohydrates." b. "I will decrease my calories to 1000 per day." c. "I will increase vegetables in my diet." d. "I will decrease milk products in my diet."

ANS: A The client should decrease his ingestion of carbohydrates, since excess carbohydrate metabolism causes carbon dioxide production. There is no reason to decrease dairy products, decrease calories to 1000/day, or increase vegetables in the diet.

Which statement is correct concerning the development of cystic fibrosis (CF)? a. It is an autosomal recessive disorder. b. Male children do not pass on the disease or the gene. c. Children of carriers do not carry the gene. d. Female children do not pass on the disease or the gene.

ANS: A The development of CF depends on inheriting a pair of mutated CF gene alleles because the disorder is autosomal recessive. Both parents are carriers (heterozygous) with one normal CF gene allele and one mutated CF gene allele. If he is a carrier and has children with another carrier, there is a chance he could have a child with CF. He can be tested so that he knows his risk.

The client has recently been started on fluticasone (Flovent). Which assessment finding would require the nurse's immediate intervention? a. Oral lesions b. Dry eyes c. Heart rate of 100 d. Headache

ANS: A The drug reduces local immunity and increases the risk for local infections, especially Candida albicans. The other symptoms are not known to be characteristic of fluticasone (Flovent) use.

How will the nurse teach the client to assess response to asthma therapy at home? a. "Keep a daily symptom and intervention diary." b. "Measure your chest circumference every week." c. "Note your symptoms when you don't take your medications." d. "Use proper technique and correct sequence with your metered dose inhaler."

ANS: A The nurse should tell the client to keep a daily symptom diary. This will help identify triggers and responses to therapy in asthma. Chest circumference is not expected to change in clients with asthma. The client should not be instructed to discontinue medications. Teaching proper technique with inhalers is appropriate; however, this will not assist in assessing response to therapy.

The client with severe chronic bronchitis tells the nurse that eating is difficult because of his shortness of breath. What is the nurse's best response? a. "Try using your bronchodilator inhaler about 30 minutes before you plan to eat." b. "Do not avoid eating when you are short of breath; you need to keep your strength up." c. "Try eating only pureed foods, avoiding anything that causes you to have gas." d. "If eating solid food is too tiring, drink milkshakes for the protein and calories."

ANS: A When dyspnea is worsened by bronchoconstriction, using a bronchodilator before eating can decrease the shortness of breath long enough to allow the client more energy to eat. The client who is short of breath will need to conserve his energy to breathe and thus should avoid eating when he is experiencing dyspnea. There is no evidence that eating only pureed foods or a lack of solid foods will keep the client from tiring and therefore encourage his intake

Which symptoms are commonly associated with asthma? (Select all that apply.) a. Clubbed fingers b. Increased residual volume c. Increased bronchial secretions d. Occurs in response to the presence of allergens e. Deficiency of alpha1-antitrypsin f. Increased pulmonary blood flow g. Intermittent manifestations interspersed with periods of no manifestations h. 70-pack-year smoking history i. Presence of Curschmann spirals in sputum

ANS: A, B, C, D, G, I Clubbed fingers represent changes in anatomy that occur as a result of continuous and long-term hypoxemia. Both asthma and chronic obstructive pulmonary disease (COPD) have obstructive components, resulting in an increased residual volume. Both asthma and COPD have inflammatory components and increased bronchial secretions. Asthma can have allergic origins. Asthma is an intermittent and reversible problem. Curschmann spirals are mucous plugs containing shed epithelial cells. These spirals are more commonly associated with asthma than with COPD.

The client with asthma is scheduled to begin taking zafirlukast (Accolate). What will the nurse teach the client? a. "Drink at least 4 liters of fluid daily when taking this drug." b. "Avoid aspirin for headaches and take acetaminophen instead." c. "Take the drug 1 hour before you eat or 2 hours after meals." d. "Avoid sun exposure while taking this drug."

ANS: B Aspirin increases the plasma concentration of zafirlukast (Accolate). If the client must also take aspirin or aspirin-containing agents, the dose of zafirlukast must be reduced. There is no evidence that the fluid intake must be increased, that the drug should be taken before or after meals, or that sun exposure should be avoided while the client takes the drug.

What will the nurse teach the client about the relationship between smoking and the development of chronic lung disease? a. "If you stop smoking, you will get better." b. "Your condition will not progress as rapidly if you stop smoking." c. "You will not be at risk for asthma if you do not smoke." d. "You will be able to have surgery if you stop smoking."

ANS: B Cigarette smoking contributes to the continuing deterioration of lung tissue in chronic obstructive pulmonary disease (COPD). Stopping smoking cannot reverse the existing damage, but it can slow down disease progression. Cigarette smoking is a rare cause of asthma. Asthma does not disfigure the client's appearance.

Which statement indicates that the client understands teaching about the correct use of a corticosteroid medication? a. "This drug can reverse my symptoms during an asthma attack." b. "This drug is effective in decreasing the frequency of my asthma attacks." c. "This drug can be used most effectively as a rescue agent." d. "This drug can safely be used on a long-term basis for multiple applications daily."

ANS: B Corticosteroids decrease inflammatory and immune responses in many ways, including preventing the synthesis of mediators. Both inhaled corticosteroids and those taken orally are preventive; they are not effective in reversing symptoms during an asthma attack and should not be used as rescue drugs. Systemic corticosteroids, because of severe side effects, are avoided for mild to moderate intermittent asthma and are used on a short-term basis for moderate asthma.

The client with lung cancer is scheduled for surgery and is receiving oxygen for hypoxia. The client tells the nurse that he is becoming more short of breath. How will the nurse intervene? a. Notify the physician. b. Increase the oxygen flow rate. c. Prepare chest tube insertion tray. d. Calm the client using guided imagery.

ANS: B Depending on the location of the tumor, dyspnea can increase quickly. The client should be provided with sufficient oxygen to reduce the hypoxia and its associated symptoms. Notifying the physician, preparing a chest tube insertion tray, or calming the client will not solve the immediate problem of the shortness of breath.

Which statement indicates that the client understands side effects of methotrexate (Folex) therapy? a. "I can reduce my oxygen flow rate while I'm taking methotrexate." b. "I shouldn't drink wine for 48 hours after taking methotrexate." c. "I will limit fluids on the days I take methotrexate." d. "I won't drink caffeinated beverages for 72 hours after taking methotrexate."

ANS: B Methotrexate induces some degree of liver damage when taken long term. Avoiding other liver-damaging agents, such as alcohol, near the time that the methotrexate is taken reduces the potential for enhancing the liver-damaging actions of methotrexate. There is no need to reduce the client's oxygen flow rate or eliminate caffeinated beverages while the client is on the medication. Fluids should be increased, not decreased, while taking this medication.

The client with a diagnosis of lung cancer is scheduled to have a liver scan and asks the nurse why the procedure is being done. How will the nurse respond? a. "What has your doctor told you about this test? Make a list of the questions that you'd like to ask about it." b. "The treatment for lung cancer is different if it has spread to the liver than if it is confined only to the lungs." c. "Some treatments are toxic to the liver. It is best to test liver function before these treatments are started." d. "An enlarged liver can interfere with cancer therapy, so the doctor wants to make certain of the liver's size and position before therapy is started."

ANS: B Surgery and radiation are considered local treatments for lung cancer confined to the chest. If cancer has spread beyond the chest, systemic therapy (chemotherapy) is required to control the disease. The nurse can teach the client about this procedure. Telling the client to ask the doctor is not appropriate. Although some treatments may cause liver damage, this is not the reason for a liver scan at the time of diagnosis. An enlarged liver may indicate other problems, but it is not appropriate to say that the size can interfere with therapy

A client with chronic obstructive pulmonary disease (COPD) tells the nurse that she cannot have sexual relations with her partner because of her fatigue. What will the nurse suggest to the client to help her relieve the fatigue associated with sexual intercourse? a. "Consider couples therapy to help your partner understand your problem." b. "Consider intercourse in the morning or after a nap." c. "Take an antianxiety medication before attempting intercourse." d. "Ask your doctor for an antidepressant to use as your disease progresses."

ANS: B The client should consider timing intercourse for a time when she is well rested, such as the morning or after a rest period. Couples therapy will not help the client relieve fatigue. A decrease in the client's anxiety level will not make her better rested. An antidepressant medication will not decrease fatigue associated with sexual intercourse.

What is the best instruction for the client who has step II asthma that is triggered by exercise? a. "Avoid participating in aerobic exercise more than three times per week." b. "Use a short-acting beta agonist before you participate in exercise." c. "Maintain an exercise diary to determine specific exercises that trigger asthma attacks." d. "Use systemic corticosteroids before you participate in exercise."

ANS: B The most important information for the client with step II asthma is that the short-acting beta agonist should be used before participating in exercise. The client should not avoid exercise but should simply use the agonist before participation. Water-related activity is not restricted for this client. Systemic medications may decrease the frequency of attacks but do not have a rapid onset of action and will not prevent an attack if taken before exercise.

Which observed action indicates that the client understands teaching on the correct way to perform diaphragmatic breathing? a. Lying on side with knees bent b. Having hands on abdomen c. Having hands over head d. Lying prone

ANS: B To perform diaphragmatic breathing correctly, the client should put his hands on his abdomen to create resistance. This type of breathing cannot be effectively performed while lying on the side or with hands over the head. This type of breathing would not be as effective lying prone.

What are the later signs and symptoms associated with the progression of lung cancer? (Select all that apply.) a. White sputum b. Chest pain or tightness c. Shortness of breath d. Wheezing e. Weight gain f. Recurrent attacks of asthma g. Purulent sputum

ANS: B, C, D, G Chest pain or tightness, shortness of breath, wheezing, and purulent sputum are all symptoms associated with lung cancer. White sputum, weight gain, and recurrent attacks of asthma are not known to be associated with lung cancer

Which signs and symptoms are most indicative of hypercarbia? a. pH = 7.33 while experiencing mechanical ventilation b. Bicarbonate = 20 mEq/L, unable to tolerate low levels of oxygen c. PaCO2 = 60 mm Hg, unable to tolerate more than 2 L of oxygen d. PaO2 = 80 mm Hg while receiving 40% oxygen via Venturi mask

ANS: C Assess for oxygen-induced hypoventilation in the client whose main respiratory drive is hypoxia (hypoxic drive), such as in the client with chronic lung disease who also has carbon dioxide retention (hypercarbia). The arterial carbon dioxide (PaCO2) level for these clients gradually rises over time. The central chemoreceptors in the brain (medulla) are normally sensitive to increased PaCO2 levels. When these receptors are active, they stimulate breathing and cause an increased respiratory rate. When the PaCO2 increases gradually to above 60 to 65 mm Hg, this normal mechanism no longer functions. The central chemoreceptors lose sensitivity to increased levels of PaCO2 and do not respond by increasing the rate and depth of respiration.

Which statement by the client indicates an accurate understanding of the most appropriate dietary selections to make while he is trying to stop smoking? a. "If I can lose about 20 pounds, it will make it easier for me to stop smoking." b. "I should be on a low-fat diet while I'm trying to stop smoking." c. "I should chew sugarless gum rather than start smoking again." d. "I should eat only fruits and vegetables while I'm trying to quit smoking."

ANS: C Fruits and vegetables make healthy substitution snacks, but the client does not need to eat them exclusively while he is trying to quit smoking. Also, he should neither limit himself to a low-fat diet nor necessarily try to lose weight while trying to stop smoking. It is much healthier for the client to chew sugarless gum when he has the urge to smoke.

Which assessment finding indicates the need for the nurse's immediate intervention? a. Peak expiratory flow rate 10% below expected value b. Presence of bilateral tactile fremitus c. Suprasternal retraction on inhalation d. Trachea at the midline

ANS: C Inhalation that causes suprasternal retraction usually means that the client is using accessory muscles and is having difficulty moving air into the respiratory passages because of airway narrowing. The asthma is not responding to the medication, and the regimen should be changed. A 10% decrease of peak expiratory flow rate is not significant. Bilateral tactile fremitus is a normal finding, as is a midline trachea.

How will the nurse most effectively intervene for the client who is experiencing social isolation related to his chronic obstructive pulmonary disease (COPD)? a. Encourage the client to join a support group for people with COPD. b. Encourage the client to ask his physician for an antianxiety agent. c. Encourage the client to verbalize his thoughts and feelings. d. Encourage the client to participate in community activities.

ANS: C Many clients with moderate to severe COPD become socially isolated because they are embarrassed by frequent coughing and mucus production. They believe that these processes draw unnecessary attention in public and disgust their friends. The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interventions can be selected. Joining a support group would not decrease feelings of social isolation if the client does not verbalize his feelings. Antianxiety agents will not help the client with social isolation. Encouraging a client to participate in activities without verbalizing concerns would also not be an effective strategy to decrease social isolation.

The nurse assesses a client receiving aminophylline. What assessment finding indicates a dangerous side effect of this medication? a. Heart rate of 50 beats/min b. Urinary output of 30 mL in 1 hour c. Development of seizures d. Blood pressure of 100/60 mm Hg

ANS: C Methylxanthines, including aminophylline, stimulate the sympathetic nervous system, the cardiovascular system, and the kidneys. The development of a seizure would indicate central nervous system irritability. A bradycardiac heart rate would not be a side effect of the medication. Urinary output of 30 mL per hour is a normal assessment finding. A blood pressure of 100/60 is also considered within normal range.

The nurse assesses the client receiving radiation therapy for lung cancer. Which finding is most likely to be a direct result of his therapy? a. Thinning scalp hair b. Pain in the left shoulder c. Difficulty swallowing solid food d. Heart palpitations and night sweats

ANS: C Radiation has the potential to damage the tissues directly in the radiation path. The esophagus is in the radiation path and can become irritated as the therapy continues (esophagitis). When esophagitis occurs, clients may have difficulty swallowing solid foods and may experience "heartburn." The scalp is not in the radiation path, and scalp hair loss is not related to this therapy for this client. Pain in the left shoulder is probably related to disease progression. Although the heart is somewhat in the radiation path, this does not result in palpitations or night sweats.

What statement indicates that the client did not understand teaching regarding therapy with salmeterol (Serevent)? a. "I will be certain to shake the inhaler well before I try to take a puff." b. "I will keep using the drug even if I don't notice a difference in my asthma immediately." c. "I will keep the inhaler with me always so that I can get the medicine in my lungs quickly." d. "I will be careful not to let the drug escape out of my nose and mouth."

ANS: C Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. The client does not have to keep this inhaler with him or her always because it is not used as a rescue medication. Salmeterol (Serevent) has a slow onset of action; therefore it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the client's part allows the drug to escape through the nose and mouth.

What is the highest priority concept for the nurse to teach about early symptoms of lung cancer? a. "There are no clearly identifiable early symptoms of lung cancer." b. "Early symptoms include bloody sputum and nagging chest pain." c. "Symptoms are vague, such as cough and shortness of breath on moderate exertion." d. "Wheezing on exhalation is usually considered a positive sign of lung cancer."

ANS: C The early symptoms of lung cancer are nonspecific (chronic cough, less endurance with heavy exercise, more easily becoming short of breath) and could be associated with almost any acute or chronic pulmonary problem. Pain, abnormal breath sounds, and bloody sputum are late manifestations of some types of lung cancer. Wheezing on exhalation is not considered an early symptom of lung cancer.

The unit manager is teaching new nursing staff the importance of implementing measures to avoid infecting cystic fibrosis clients with the Burkholderia cepacia organism. What is the most important measure that the nurse manager will teach the staff? a. Instruct the client to wash his hands after contact with other people. b. Place the client on strict isolation, with the staff wearing gowns, gloves, and masks. c. Keep other cystic fibrosis clients isolated from each other on the unit. d. Inspect the client's respiratory equipment daily.

ANS: C The infection is spread through casual contact between cystic fibrosis clients, thus the need for isolation of these clients from each other. Strict isolation measures will not be necessary. Although the client should wash his hands frequently and his respiratory equipment should be analyzed frequently for evidence of the organism, the most important measure that can be implemented on the unit is isolation of the client from other cystic fibrosis clients.

What information is essential for the nurse to teach the client about diaphragmatic breathing? a. "Keep your muscles tense during the activity." b. "Make sure you are lying prone when you perform this activity." c. "Have your abdomen rise on inhalation and fall on exhalation." d. "Contract your abdominal muscles on inhalation for this activity."

ANS: C The technique of diaphragmatic breathing uses the diaphragm and the abdominal muscles actively during inhalation and exhalation. The abdomen rises on inhalation and falls on exhalation, indicating that the abdominal muscles are relaxed during inhalation and contracted during exhalation. The client does not need to keep muscles tense during the activity and should not lie prone.

Which statement indicates that the client understands teaching about the use of his long-acting beta2 agonist medication? a. "I will not have to take this medication every day." b. "I will take an extra dose of this medication when I have an asthma attack." c. "I will take this medication daily to prevent an acute attack." d. "I will eventually be able to stop using this medication."

ANS: C This medication will help prevent an acute asthma attack because it is long acting. The client will take this medication every day for best effect. This is not the medication the client will use during an acute asthma attack because it does not have an immediate onset of action. The client will not be weaned off this medication because this is likely to be one of his daily medications.

Which statement indicates that the client needs additional teaching about a dry powder inhaler? a. "I will not exhale into the inhaler." b. "I will store the inhaler in the drawer of my bedroom dresser." c. "I will wash the inhaler mouthpiece daily with soap and water." d. "I will inhale twice as hard through this inhaler as I do with my aerosol inhaler."

ANS: C Washing the dry powder inhaler (DPI) may cause the medication in the inhaler to clump together. This action reduces the precision of the delivery of the drug to the client. The other statements are all correct—the client should not exhale into the inhaler, can store the inhaler in his or her bedroom, and will need to inhale more forcefully than with an aerosol inhaler.

The client with emphysema must learn how to use exercise conditioning for his pulmonary rehabilitation. What teaching strategy will have highest priority? a. Exercise only while in the standing position. b. Hold breath between sets of exercises. c. Keep arms above the head while exercising. d. Breathe against a set resistance for 5 minutes 3 times/day.

ANS: D Exercise conditioning for pulmonary rehabilitation focuses on strengthening the diaphragm and other respiratory muscles. Breathing against a set resistance increases the strength and endurance of respiratory muscles. Exercising only while in the standing position, holding breath between sets, and keeping arms above the head while exercising will not increase the strength and endurance of respiratory muscles.

What assessment information could most directly relate to the adult client's diagnosis of new-onset asthma? a. Previous history of pneumonia or tuberculosis b. Known allergies and hypersensitivity reactions c. Nutritional intake and diet history d. Occupation and usual hobbies

ANS: D New-onset asthma could be directly related to a hobby that involves inhalation irritants. There is no evidence that previous history of pneumonia or tuberculosis, allergies, nutritional intake, or diet history is directly related to new-onset asthma.

The nurse is teaching an Asian-American client who is not fluent in English about long-acting beta2-agonist medications for asthma, and the client agrees to follow the guidelines. What is the best action for the nurse to take to ensure that the client follows the guidelines? a. If the client agrees, the nurse only needs to document on the chart that the teaching was done. b. Write the information on note cards for the client to have with him. c. Enlist an interpreter to write the information in the client's native language. d. Reinforce the reasons that compliance is important.

ANS: D The Asian-American client may show respect in communication with health care providers by agreeing to statements or teaching without intent to carry through. Knowing this, the nurse needs to reinforce that compliance with these medications is important in decreasing the frequency of asthma attacks. The nurse needs to follow through with this teaching, so documentation alone is not the only intervention. Although note cards may be beneficial, repeating the information in this way or writing it in the client's native language will not increase compliance.

The client has recently been placed on prednisone (Deltasone). What is the highest priority instruction the nurse will provide? a. "Expect to experience weight loss and hypoglycemia." b. "Use the drug with the onset of asthma symptoms." c. "Take the drug on an empty stomach." d. "Do not stop taking the drug abruptly."

ANS: D The client should not stop taking this drug abruptly because it suppresses the adrenal gland's production of corticosteroids. This could create a life-threatening situation. The client can expect weight gain and hyperglycemia. Use of the drug with the onset of asthma symptoms is not characteristic of Deltasone. The client should take the drug with food.

The client arrives in the emergency department experiencing difficulty breathing. Which assessment finding requires immediate action by the nurse? a. Auscultation of crackles b. Flushed appearance of skin c. Production of white sputum d. Use of accessory muscles to breathe

ANS: D The use of accessory muscles to breathe is characteristic of status asthmaticus—a severe, life-threatening, acute episode of airway obstruction. Use of accessory muscles for breathing and distention of neck veins are observed. Whereas wheezing is characteristic of status asthmaticus, crackles typically do not develop. Although crackles indicate atelectasis or fluid buildup, they do not indicate a more critical situation than the use of accessory muscles to breathe. Cyanosis may develop as the condition progresses, rather than a flushed appearance, and the client may have difficulty speaking. White sputum is not a cause for concern.

A client with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client's history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these findings, the nurse closely monitors the oxygen flow and the client's respiratory status. Which complication may arise if the client receives a high oxygen concentration? A. Apnea B. Anginal pain C. Respiratory alkalosis D. Metabolic acidosis

ANSWER: A Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. Anginal pain results from a reduced myocardial oxygen supply. A client with COPD may have anginal pain from generalized vasoconstriction secondary to hypoxia; however, administering oxygen at any concentration dilates blood vessels, easing anginal pain. Respiratory alkalosis results from alveolar hyperventilation, not excessive oxygen administration. In a client with COPD, high oxygen concentrations decrease the ventilatory drive, leading to respiratory acidosis, not alkalosis. High oxygen concentrations don't cause metabolic acidosis.

For a client with COPD who has trouble raising respiratory secretions, which of the following nursing measures would help reduce the tenacity of secretions? A. Ensuring that the client's diet is low in salt. B. Ensuring that the client's oxygen therapy is continuous. C. Helping the client maintain a high fluid intake. D. Keeping the client in a semi-sitting position as much as possible.

ANSWER: C A fluid intake of 2 to 3 L/day, providing that the client does not have cardiovascular or renal disease, helps liquefy bronchial secretions. 1 A: A low-salt diet does not help reduce the viscosity of mucus. B: Continuous oxygen therapy does not help reduce the viscosity of mucus. D: Maintaining a semi-sitting position does not help reduce the viscosity of mucus.

A female client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism? a. Dyspnea b. Bradypnea c. Bradycardia d. Decreased respiratory

Answer A. The common clinical manifestations of pulmonary embolism are tachypnea, tachycardia, dyspnea, and chest pain

An unconscious male client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, a normal oxygen level, and an elevated potassium level. These results indicate the presence of: a. Metabolic acidosis b. Respiratory acidosis c. Overcompensated respiratory acidosis d. Combined respiratory and metabolic acidosis

Answer A. In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the low pH would indicate a metabolic state. Therefore, options B, C, and D are incorrect.

A nurse teaches a male client about the use of a respiratory inhaler. Which action by the client indicates a need for further teaching? a. Inhales the mist and quickly exhales b. Removes the cap and shakes the inhaler well before use c. Presses the canister down with the finger as he breathes in d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed

Answer A. The client should be instructed to hold his or her breath for at least 10 to 15 seconds before exhaling the mist. Options B, C, and D are accurate instructions regarding the use of the inhaler.

A nurse is assessing a male client with chronic airflow limitations and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitations? a. Emphysema b. Bronchial asthma c. Chronic obstructive bronchitis d. Bronchial asthma and bronchitis

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

A nurse is caring for a male client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Increase oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray

Answer B. Clinical manifestations of chronic obstructive pulmonary disease (COPD) include hypoxemia, - hypercapnia, - dyspnea on exertion and at rest - oxygen desaturation with exercise - and the use of accessory muscles of respiration. Chest x-rays reveal a hyperinflated chest and a flattened diaphragm if the disease is advanced.

A nurse is caring for a male client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: a. 1 L/min b. 2 L/min c. 6 L/min d. 10 L/min

Answer B. Oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.

Before an ABG is drawn from the patient's radial artery which test should be performed? A. Doppler flow test B. Allen test C. Babinski's test D. A/B Index

Answer B. The Allen test is used to assess for adequate perfusion of the hand via the ulnar artery prior to puncturing the radial artery for an arterial blood gas. This test assesses patency of the ulnar artery and/or collateral circulation. However, while you do not need an actual doppler flow test, as simple little ultra sound or doppler check of the patency of the ulnar artery is correct as well.

A client has been admitted to the hospital to rule out pulmonary embolism. The nurse on the medical-surgical unit assesses the client for which of the most commonly reported initial symptoms of this condition? A. Hot, flushed feeling B. Sudden chills and fever C. Dyspnea, tachypnea and tachycardia D. Cough and plueritic chest pain

Answer C. Dyspnea, Tachycardia and tachypnea are the most common symptoms of PE.

A patient is receiving thrombolytic therapy for the treatment of a PE. The nurse must monitor which of the following side effects during therapy? A.Chest pain B.Rash C. Hyperthermia D. Bleeding

Answer D. Rationale: Thrombolytic therapy dissolves the thrombi or emboli more quickly and restores more normal hemodynamic functioning of the pulmonary circulation, thereby reducing pulmonary hypertension and improving perfusion, oxygenation, and cardiac output. However, bleeding is a significant side effect. Chest pain, a rash, and elevated temperature are not therapy-specific side effects associated with the use of thrombolytics.

A NOVA student nurse is teaching an asthmatic client how to use a metered-dose inhaler. Which statements by the client indicate that the teachings have been effective? Select all that apply A. "Shake the inhaler" B. "Flex my neck forward a bit" C. "Seal lips and teeth around the mouthpiece" D. " hold the mouthpiece 1-2 inches in front my mouth" E. "hold breath for 5 minutes after each puff" F. "breath out forcefully after pressing the inhaler"

Answer: A, B, C, D

Which of these factors contribute to infant's and children's increased risk for upper airway obstruction as compared to adults. A. Underdeveloped cricoid cartilage and narrow nasal passages. B. Small tonsils and narrow nasal passages. C.Cylinder-shaped larynx and underdeveloped sinuses. D. Underdeveloped cricoid cartilage and smaller tongue.

Answer: A. Rationale: Infants and children have smaller nasal passages than adults, thus making obstruction with mucus more common. The funnel shape of the larynx due to underdevelopment of the cricoid cartilage places children less than 10 years of age at increased risk of airway obstruction in the event of edema or mucus production..

A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing with a respiratory rate of 40. What is the priority nursing intervention? A. Airway maintenance & 100% oxygen by mask. B. 100% oxygen and pulse oximetry monitoring. C.Airway maintenance and continued reassessment. D. 100% oxygen and provision of comfort.

Answer: A. Rationale: Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation.

A registered nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

Answer: B. Metabolic alkalosis, continuous suctioning can cause a loss of H+ or acid, resulting in an accumulation of base. Look for signs and symptoms of metabolic alkalosis in the client who is attached to low continuous or intermittent suctioning.

A 5-month-old infant with RSV Bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis and a respiratory rate of 78. What is the appropriate initial nursing intervention? A.Attempt to calm the infant by placing him in his mother's lap and offering him a bottle. B. Alert the physician to the situation and ask for an order for a stat chest radiograph. C. Suction secretions, provide 100% O2 via face mask and anticipate respiratory failure. D. Bring emergency equipment to the room and begin bag-valve-mask ventilations.

Answer: C. Rationale: Priorities of care for the child with respiratory distress are to clear the airway and provide oxygen supplementation. Children who experience respiratory distress often deteriorate very quickly, and the nurse must be prepared in the event of respiratory failure or arrest.

The organ that regulates the electrolyte balance in the body is the: A. Liver. B. Kidney. C.Heart. D. Parathyroid.

Answer: b. Kidney

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. a) Destruction of the alveolar wall b) Swelling of bronchial membranes c) Airway remodeling d) Thick mucus

B C D As asthma becomes more persistent, inflammation progresses and airway edema, mucus hypersecretion, and formation of mucus plugs can occur. Airway remodeling may occur in response to chronic inflammation, causing further airway narrowing. Destruction of the alveolar wall does not occur with asthma.

An 18-month-old child is brought to the Emergency Department by parents who explain that their child swallowed a watch battery. Radiologic studies show that the battery is in the lungs. Which area of lung is the battery most likely to be in? a) Left upper lung b) Right upper lung c) Right lower lung d) Left lower lung

B, Aspiration of foreign objects is more likely in the right mainstem bronchus and right upper lung.

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

B, C, E Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.

Which of the following is a characteristics of emphysema? a) Normal elastic recoil b) Increased total lung capacity c) Copious sputum d) Peripheral edema

B, Characteristics of emphysema include dyspnea, scant sputum, increased total lung capacity, barrel chest, and markedly decreased elastic recoil. Peripheral edema occurs with chronic bronchitis

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) Respiratory acidosis. c) Hypoxemia secondary to impaired oxygen diffusion. d) Hypercapnia resulting from decreased carbon dioxide elimination.

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

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) Gastrointestinal viruses b) Air pollution c) Fractured hip d) Hypertension e) Tracheobronchial infection

B, E Common causes of an acute exacerbation include tracheobronchial infection and air pollution. However, the cause of approximately one third of severe exacerbations cannot be identified. Fractured hips, hypertension, and GI viruses are not causes of exacerbation of COPD.

You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what? a) Side effects of medication therapy b) Atelectasis c) Pain d) Impaired physical mobility

B, For a client with obstructive pulmonary disease, atelectasis is one of the conditions for which nursing actions are identified to detect, manage, and minimize the unexpected outcomes

A 10 year old with a history of asthma is diagnosed with status asthmaticus. This child: A.Has severe wheezing B.Hasn't responded to treatment C.Requires emergency intubation D.Has underlying pneumonia

B, Status asthmaticus is asthma with moderate to sever airway obstruction that doesn't respond to initial treatment. The asthma "stays in place" rather than improving with treatment. A child's wheezing stops when status asthmaticus develops because the airways are obstructed.

A 5 year old child is brought into the emergency department with drooling, strident cough, and lethargy. Epiglottitis is suspected. The priority intervention for this child is to: A. Take vital signs B.Secure the child's airway C.Visualize the child's throat with a tongue depressor D.Obtain throat cultures

B, The priority in treating epiglottitis is achieving a patent airway as quickly as possible.

A client has the following arterial blood gas (ABG) values: pH, 7.12; partial pressure of arterial carbon dioxide (PaCO2), 40 mm Hg; and bicarbonate (HCO3-), 15 mEq/L. These ABG values suggest which disorder? a) Metabolic acidosis b) Metabolic alkalosis c) Respiratory alkalosis d) Respiratory acidosis

B, This client's pH value is below normal, indicating acidosis. The HCO3- value also is below normal, reflecting an overwhelming accumulation of acids or excessive loss of base, which suggests metabolic acidosis. The PaCO2 value is normal, indicating absence of respiratory compensation. These ABG values eliminate respiratory alkalosis, respiratory acidosis, and metabolic alkalosis.

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: a) sits in tripod position. b) uses the sternocleidomastoid muscles. c) wants the head of the bed raised to a 90-degree level. d) has a pulse oximetry reading of 93%.

B, Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.

A 15-month old with croup is admitted to the pediatric unit. The nurse is most concerned that: A.An inspiratory stridor is heard B.The mother cannot calm the child C.The toddler has a barking cough D.The toddler is restless while sleeping

B, When a mother can't calm a child with a respiratory problem, assess for increasing hypoxia. Normal symptoms of croup include inspiratory stridor and barking cough. Children are commonly restless in their sleep when ill.

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

B, 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.

During a preadmission assessment, for what diagnosis would the nurse expect to find decreased tactile fremitus and hyperresonant percussion sounds? a) Pulmonary edema b) Emphysema c) Atelectasis d) Bronchitis

B,Emphysema is associated with decreased tactile fremitus and hyperresonant percussion sounds. Bronchitis is associated with normal tactile fremitus and resonant percussion sounds. Atelectasis is associated with absent tactile fremitus and dull percussion sounds. Pulmonary edema is associated with normal tactile fremitus and resonant percussion sounds.

Presence of overdistended and non-functional alveoli is a condition called: a. Bronchitis b. Emphysema c. Empyema d. Atelectasis Answer:

B. An overdistended and non-functional alveoli is a condition called emphysema. Atelectasis is the collapse of a part or the whole lung. Empyema is the presence of pus in the lung.

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) Anxiety related to actual threat to health status b) Impaired gas exchange related to airflow obstruction c) Activity intolerance related to fatigue d) Risk for infection related to retained secretions

B. A patent airway and an adequate breathing pattern are the top priority for any client, making Impaired gas exchange related to airflow obstruction the most important nursing diagnosis. Although Activity intolerance, Anxiety, and Risk for infection may also apply to this client, they aren't as important as Impaired gas exchange

Cystic fibrosis is inherited as an Autosomal recessive trait. So in order for a child to present with a diagnosis of Cystic Fibrosis who had the Gene??? A. Only the mom B. Only the dad C. Both the mom and dad D. Neither, it's caused by nurses not washing their hands.

C

When a patient is diagnosed with pulmonary fibrosis, the nurse will teach the patient about the risk for poor oxygenation because of a. too-rapid movement of blood flow through the pulmonary blood vessels. b. incomplete filling of the alveoli with air because of reduced respiratory ability. c. decreased transfer of oxygen into the blood because of thickening of the alveoli. d. mismatch between lung ventilation and blood flow through the blood vessels of the lung.

C Rationale: Pulmonary fibrosis causes the alveolar-capillary interface to become thicker, which increases the amount of time it takes for gas to diffuse across the membrane. Too-rapid pulmonary blood flow is another cause of shunt but does not describe the pathology of pulmonary fibrosis. Decrease in alveolar ventilation will cause hypercapnia. Ventilation and perfusion are matched in pulmonary fibrosis; the problem is with diffusion. Cognitive Level: Application Text Reference: p. 1802 Nursing Process: Implementation NCLEX: Physiological Integrity

Which of the following is a common irritant that acts as a trigger of asthma? a) Aspirin sensitivity b) Peanuts c) Esophageal reflux d) Molds

C, Esophageal reflux, viral respiratory infections, cigarette smoke, and exercise are all irritants that can trigger asthma. Peanuts, aspirin sensitivity, and molds are antigens

A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? a) Oral prednisone (Deltasone) b) Oral sustained-release albuterol (Proventil) c) Inhaled beclomethasone (Beconase) d) Subcutaneous omalizumab (Xolair)

C, For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone. The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma

Which of the following disease processes cause increased compliance? a) Pulmonary edema b) Pulmonary fibrosis c) Emphysema d) Acute respiratory distress syndrome

C, High or increased compliance occurs if the lungs have lost their elasticity (cannot return to normal state) and the thorax is overdistended, as in emphysema. Low or decreased compliance occurs if the lungs and thorax are "stiff" (difficult to stretch). Conditions associated with decreased compliance include pneumothorax, hemothorax, pleural effusion, pulmonary edema, atelectasis, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS).

The nurse assesses a patient for a possible pulmonary embolism. What frequent sign of pulmonary embolus does the nurse anticipate finding on assessment? a) Cough b) Hemoptysis c) Tachypnea d) Syncope

C, Symptoms of PE depend on the size of the thrombus and the area of the pulmonary artery occluded by the thrombus; they may be nonspecific. Dyspnea is the most frequent symptom; the duration and intensity of the dyspnea depend on the extent of embolization. Chest pain is common and is usually sudden and pleuritic in origin. It may be substernal and may mimic angina pectoris or a myocardial infarction. Other symptoms include anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope. The most frequent sign is tachypnea (very rapid respiratory rate).

Which intervention is most appropriate for a client with an arterial blood gas (ABG) of pH 7.5, a partial pressure of arterial carbon dioxide (PaCO2) of 26 mm Hg, oxygen (O2) saturation of 96%, bicarbonate (HCO3-) of 24 mEq/L, and a PaO2 of 94 mm Hg? a) Administer ordered supplemental oxygen. b) Administer an ordered decongestant. c) Instruct the client to breathe into a paper bag. d) Offer the client fluids frequently.

C, The ABG results reveal respiratory alkalosis. The best intervention to raise the PaCO2 level would be to have the client breathe into a paper bag. Administering a decongestant, offering fluids frequently, and administering supplemental oxygen wouldn't raise the lowered PaCO2 level.

A nurse evaluates the results of a spirometry test to help confirm a diagnosis of obstructive lung disease. Which one of the following results indicates an initial early stage of COPD? (FEV1 refers to forced expired volume in 1 second.) a) FEV1 = 50% b) FEV1 = 70% c) FEV1 > 80% d) FEV1 = 30%

C, The FEV1 decreases as the severity of obstruction increases. Therefore, an FEV1 of more than 80% indicates an initial stage, and an FEV1 of 30% indicates a very severe stage.

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 an hour before meals or 2 hours after a meal. d) The patient should take the medication with meals since it may cause nausea.

C, The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

A 13-year-old client at the pulmonary clinic where you practice nursing has an extensive history of asthma and is seeing the pulmonologist for her monthly appointment. What are the primary functions of the lungs? Choose all correct options. a) Destroying CO b) Oxygen production c) Ventilation d) Gas exchange

C,D The primary functions of the lungs include ventilation and gas exchange.

A camp nurse is providing immediate care for a child who is having an asthma attack. What is the preferred treatment to alleviate this patient's airflow obstruction? A. Corticosteroids B. Anticholinergics C. Beta-adrenergics D. Peak flow monitoring device

C. Rationale: Asthma exacerbations are best managed by early treatment. This often involves quick-acting beta-adrenergic medications for prompt relief of airflow obstruction.

A nurse teaches a COPD patient not to smoke because smoking: A. Collapses the alveoli in the lungs B. Decreases the amount of mucus production C. Increases the amount of mucus production D. Shrinks the alveoli in the lungs

C. Rationale: Smoking irritates the goblet cells and mucus glands, causing an increased accumulation of mucus. This in turn produces more irritation, infection, and damage to the lung. Smoking does not directly shrink or collapse the alveoli.

A nurse is analyzing her patient's ABG values. Which of the following is inconsistent with the diagnosis of respiratory acidosis? A. pH 7.3 B. CO2 48 C. Hyperventilation D. Hypoventilation

C. Respiratory acidosis is always due to inadequate excretion of CO2 with inadequate ventilation, resulting in elevated plasma CO2. Any condition that causes hypoventilation is associated with an elevated PaCO2 and usually a decrease in PaCO2.

The highest priority nursing intervention for a child with cystic fibrosis hospitalized with respiratory infection would be: A. Maintaining strict intake and output. B. Administering intravenous antibiotics. C. Recording vital signs every four hours. D. Arranging for sweat chloride testing

Correct Answer: B. Rationale: Pulmonary infections in CF patients must be treated with antibiotics aggressively to minimize the chance for colonization of resistant pathogens. Once colonized, children have a poorer survival rate. Sweat chloride test is for diagnostic purposes only. Maintaining adequate hydration helps liquefy secretions

Which of the following might a child with asthma be advised to avoid? A. Swimming. B. Gymnastics. C. Snow skiing. D. Playgrounds

Correct Answer: C. Rationale: Sudden temperature change is a common asthma trigger, and snow skiing would expose the child to cold air. Exercise is a trigger in some children, but activities with short bursts like gymnastics are not usually a problem. Swimming is actually beneficial because of the breathing of moistened air and prolonged expiration required under water.

The father of a premature infant asks why oxygen concentrations are not higher to help his son breathe better. The nurse's best response is based on an understanding of: A. Cystic fibrosis. B. Pneumonia. C. Bronchiolitis. D. Bronchopulmonary dysplasia.

Correct Answer: D. Rationale: Bronchopulmonary dysplasia is an obstructive lung disease that occurs primarily when premature infants are subject to prolonged mechanical ventilation and high levels of oxygen therapy. Pneumonia results from bacterial or viral infections.

A 6-year-old client with cystic fibrosis (CF) is preparing to eat breakfast. What is the most important piece of information the nurse would want before the child eats? A. Whether the meal is exactly what he ordered. B. If he plans to eat all of it. C. When he ate last. D. If he has taken his enzymes.

Correct Answer: D. Rationale: Children with CF require pancreatic enzymes before each meal and snack to manage malabsorption and steatorrhea. Enzyme dosage is individualized based on nutritional status and stool consistency. It is also important that child eats his prescribed high-calorie, high-protein diet to support weight gain.

Arterial blood gas analysis would reveal which of the following related to acute respiratory failure? A. PaO 80 mm Hg B. pH 7.28 C. PaCO 32 mm Hg D. pH 7.35

Correct answer B. Rationale: Acute respiratory failure (ARF) is defined as a decrease in the arterial oxygen tension (PaO2) to less than 50 mm Hg (hypoxemia) and an increase in arterial carbon dioxide tension (PaCO2) to greater than 50 mm Hg (hypercapnia), with an arterial pH of less than 7.35.

Mr. F. presents to the emergency department anxious, hyperventilating, and experiencing tingling in his fingers and lips. He states that the symptoms have been present for the past 2 hours. His ABG results reveal the following: pH 7.50, PCO₂ 30, HCO₃ 22. These results would indicate that the client is experiencing which acid-base imbalance? A. Respiratory alkalosis B. Metabolic acidosis C.Metabolic alkalosis D. Respiratory acidosis

Correct answer: A, Rationale: Hyperventilation will result in the excess elimination of carbon dioxide and a state of alkalosis. Alkalosis causes central nervous system irritation, which is the cause of extremity tingling. Having Mr. F. breathe into a paper bag will restore the carbon dioxide levels by rebreathing exhaled carbon dioxide.

A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department complaining of acute respiratory distress. When monitoring the patient, which assessment by the nurse will be of most concern? a. The patient is sitting in the tripod position. b. The patient has bibasilar lung crackles. c. The patient's pulse oximetry indicates an O2 saturation of 91%. d. The patient's respiratory rate has decreased from 30 to 10/min.

D Rationale: A decrease in respiratory rate in a patient with respiratory distress suggests the onset of fatigue and a high risk for respiratory arrest; therefore, the nurse will need to take immediate action. Patients who are experiencing respiratory distress frequently sit in the tripod position because it decreases the work of breathing. Crackles in the lung bases may be the baseline for a patient with COPD. An oxygen saturation of 91% is common in patients with COPD and will provide adequate gas exchange and tissue oxygenation. Cognitive Level: Application Text Reference: p. 1804 Nursing Process: Assessment NCLEX: Physiological Integrity

A patient is diagnosed with a large pulmonary embolism. When explaining to the patient what has happened to cause respiratory failure, which information will the nurse include? a. "Oxygen transfer into your blood is slow because of thick membranes between the small air sacs and the lung circulation." b. "Thick secretions in your small airways are blocking air from moving into the small air sacs in your lungs." c. "Large areas of your lungs are getting good blood flow but are not receiving enough air to fill the small air sacs." d. "Blood flow though some areas of your lungs is decreased even though you are taking adequate breaths."

D Rationale: A pulmonary embolus limits blood flow but does not affect ventilation, leading to a ventilation-perfusion mismatch. The response beginning, "Oxygen transfer into your blood is slow because of thick membranes" describes a diffusion problem. The remaining two responses describe ventilation-perfusion mismatch with adequate blood flow but poor ventilation. Cognitive Level: Application Text Reference: p. 1802 Nursing Process: Implementation NCLEX: Physiological Integrity

The nurse organizes care for an infant with bronchiolitis to allow for uniterrupted periods of rest. This plan would be: A.Inappropriate because constant care is necessary in the acute stage B.Appropriate because the cool mist helps to maintain hydration status C.Inappropriate because frequent assessment by auscultation is required D.Appropriate because this action promotes decreased oxygen demands

D The infant is having difficulty with breathing: disturbing the infant frequently causes an increased expenditure of energy, thus increasing oxygen needs.Cool mist does not promote hydration; it limits inflammation and lowers fever.

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 can stop using this drug when I begin to feel better." d) "I need to hold my breath as long as possible after I take a deep inhalation."

D , 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.

You are studying for a physiology test about the respiratory system. What should you know about central chemoreceptors in the medulla? a) They respond to changes in the O2 levels in the brain. b) They respond to changes in O2 levels and bicarbonate levels in the atmosphere. c) They respond to changes in CO2 levels in the brain. d) They respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid.

D, Central chemoreceptors in the medulla respond to changes in CO2 levels and hydrogen ion concentrations (pH) in the cerebrospinal fluid. Central chemoreceptors do not respond to changes in the O2 levels in the brain; changes in CO2 levels in the brain; changes in O2 levels and bicarbonate levels in the atmosphere.

Patients with advanced COPD experience progressive inactivity, exercise intolerance, and disability. The nurse must carefully monitor the exercise tolerance of patients taking: a) Short acting beta-adrenergics b) Anticholinergics c) Antihistamines d) Corticosteroids

D, Corticosteroids are associated with myopathy, especially in leg muscles.

A child with cystic fibrosis has early signs of an upper respiratory tract infection, including a cough and runny nose. The nurse should teach the child's mother to: A.Make sure the child eats a good diet B.Take the child's temperature twice a day C.Offer the child lots of orange juice to drink D.Increase chest physiotherapy to four times per day

D, Explanation With CF, a simple URI may develop into pneumonia if the thick secretions aren't loosened and removed by percussion and postural drainage. Making sure the child has an adequate diet, taking the child's temperature, and giving he child orange juice are important but not as vital as percussion and postural drainage.

Before seeing a newly assigned client with respiratory alkalosis, a nurse quickly reviews the client's medical history. Which condition is a predisposing factor for respiratory alkalosis? a) Type 1 diabetes mellitus b) Opioid overdose c) Myasthenia gravis d) Extreme anxiety

D, Extreme anxiety may lead to respiratory alkalosis by causing hyperventilation, which results in excessive carbon dioxide (CO2) loss. Other conditions that may set the stage for respiratory alkalosis include fever, heart failure, injury to the brain's respiratory center, overventilation with a mechanical ventilator, pulmonary embolism, and early salicylate intoxication. Type 1 diabetes may lead to diabetic ketoacidosis; the deep, rapid respirations occurring in this disorder (Kussmaul's respirations) don't cause excessive CO2 loss. Myasthenia gravis and opioid overdose suppress the respiratory drive, causing CO2 retention, not CO2 loss; this may lead to respiratory acidosis, not alkalosis.

A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse a) Tells the client that arterial blood gas is performed after spirometry testing b) States that various blood tests must also be done c) Explains to the client not to eat or drink before the spirometry test d) Asks the client, "What are your allergies?"

D, Spirometry testing includes use of a bronchodilator and then further testing. The nurse needs to assess for allergies first. The client does not need to be NPO prior to spirometry testing. Venous blood work may be done for clients younger than 45 years old, to check for a deficiency in alpha 1-antitrypsin. Arterial blood gases, if ordered, are obtained prior to spirometry testing.

A client who underwent surgery 12 hours ago has difficulty breathing. He has petechiae over his chest and complains of acute chest pain. What action should the nurse take first? a) Administer analgesics as ordered. b) Administer a heparin bolus and begin an infusion at 500 units/hour. c) Perform nasopharyngeal suctioning. d) Initiate oxygen therapy.

D, The client's signs and symptoms suggest pulmonary embolism. Therefore, maintaining respiratory function takes priority. The nurse should first initiate oxygen therapy and then notify the physician immediately. The physician will most likely order an anticoagulant such as heparin or an antithrombolytic to dissolve the thrombus. Analgesics can be administered to decrease pain and anxiety but administering oxygen takes priority. Suctioning typically isn't necessary with pulmonary embolism.

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) A transverse chest diameter twice that of the anteroposterior diameter b) An oxygen saturation of 99% c) A respiratory rate of 12 breaths/minute d) An inspiratory-expiratory (I:E) ratio of 2:1

D, 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%

A child who had been admitted for status asthmaticus appears to be improving. The most objective way for the nurse to evaluate the child's response to therapy is to: A.Auscultate the child's breath sounds B.Monitor the child's respiratory pattern C.Assess the child's lips for a decrease in cyanosis D.Evaluate the child's current peak expiratory flow rate.

D, The peak expiratory flow meter is an objective tool that measures the maximum flow of air that can be forcefully exhaled in 1 second. The tool individualizes data for the child because after a personal best value has been established it can be compared with current values to determine the present respiratory status

When vibrating the patient's chest, the nurse applies vibration: a) While the patient is exhaling. b) While the patient is holding his or her breath. c) During both inhalation and exhalation. d) While the patient is inhaling.

D, Vibration is performed either manually or with a mechanical device. The nurse places his or her hands over the affected area and rapidly contracts the arms and shoulders while the patient exhales. This maneuver is done for 5 to 10 breaths over each lung area when the patient is exhaling

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)? a) Occupational exposure b) Passive smoking c) Ambient air pollution d) Exposure to tobacco smoke

D. 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 do not account for the majority.

he nursing instructor is discussing pulmonary arterial hypertension with the nursing students. What would the instructor describe as the pathophysiology of secondary pulmonary arterial hypertension? a) Bronchial thickening causes increased resistance and pressure in the pulmonary vascular bed. b) Chronic lung disease causes scaring in the bronchioles raising pressure in the pulmonary vascular bed. c) Left-sided heart failure causes increased resistance and pressure in the pulmonary vascular bed. d) Alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed.

D. In secondary pulmonary arterial hypertension, alveolar destruction causes increased resistance and pressure in the pulmonary vascular bed. Therefore options A, B, and C are incorrect.

During a pulmonary assessment, the nurse observes the chest for configuration. She identifies the findings as normal. Which of the following would be consistent with normal assessment? a) Elevation of the scapula with the lateral diameter unaffected b) Anteroposterior diameter that equals the lateral diameter c) Lateral diameter less than anteroposterior diameter d) Lateral diameter greater than anteroposterior diameter

D. Inspecting the thorax is part of assessment of the respiratory system. Normally, the ratio of the anteroposterior diameter to the lateral diameter is 1:2. Chest deformities are associated with respiratory disease

The nurse is teaching a COPD patient about his newly prescribed corticosteroid. The nurse should explain that the drug is used for: A.Relieving bronchospasm in an emergency B.Curing underlying systemic infections C. Preventing recurrent pulmonary infections D. Achieving longer-term control of COPD symptoms

D. Rationale: Corticosteroids are integrated in the medication regimen of a patient with COPD in order to minimize the frequency of exacerbations and achieve long-term symptom control. Corticosteroids are not normally used as an emergency medication, and they do not address infections.

The home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? a) Decreased oxygen requirements b) Increased sputum production c) Decreased activity tolerance d) Normothermia

a) Decreased oxygen requirements

The nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? a) It helps prevent early airway collapse. b) It increases inspiratory muscle strength. c) It decreases use of accessory breathing muscles. d) It prolongs the inspiratory phase of respiration.

a) It helps prevent early airway collapse.

A client with chronic obstructive pulmonary disease presents with respiratory acidosis and hypoxemia. He tells the nurse that he doesn't want to be placed on a ventilator. What action should the nurse take? a) Notify the physician immediately so he can determine client competency. b) Have the client sign a do-not-resuscitate (DNR) form. c) Determine whether the client's family was consulted about his decision. d) Consult the palliative care group to direct care for the client.

a) Notify the physician immediately so he can determine client competency.

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

a) Respiratory rate of 22 breaths/minute

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) instruct the client to drink 2 L of fluid daily. b) maintain the client on bed rest. c) administer anxiolytics, as prescribed, to control anxiety. d) administer pain medication as prescribed.

a) instruct the client to drink 2 L of fluid daily.

For a client with an acute pulmonary embolism, the physician prescribes heparin (Liquaemin), 25,000 U in 500 ml of dextrose 5% in water (D5W) at 1,100 U/hour. The nurse should administer how many milliliters per hour? a) 8 b) 22 c) 30 d) 50

b) 22

A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? a) Instruct the client to breathe into a paper bag. b) Administer oxygen by nasal cannula as prescribed. c) Auscultate breath sounds bilaterally every 4 hours. d) Encourage the client to deep-breathe and cough every 2 hours.

b) Administer oxygen by nasal cannula as prescribed.

An adult client with cystic fibrosis is admitted to an acute care facility with an acute respiratory infection. Prescribed respiratory treatment includes chest physiotherapy. When should the nurse perform this procedure? a) Immediately before a meal b) At least 2 hours after a meal c) When bronchospasms occur d) When secretions have mobilized

b) At least 2 hours after a meal

When a client's ventilation is impaired, the body retains which substance? a) Sodium bicarbonate b) Carbon dioxide c) Nitrous oxide d) Oxygen

b) Carbon dioxide

The physician orders a palliative care consult for a client with end-stage chronic obstructive pulmonary disease who wishes no further medical intervention. Which step should the nurse anticipate based on her knowledge of palliative care? a) Decreasing administration of pain medications b) Reducing oxygen requirements c) Increasing the need for antianxiety agents d) Decreasing the use of bronchodilators

c) Increasing the need for antianxiety agents

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

c) Take prescribed medications as scheduled.

in the OR a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a) Encouraging the client to drink three glasses of fluid daily b) Keeping the client in semi-Fowler's position c) Using a high-flow Venturi mask to deliver oxygen as prescribed d) Administering a sedative as prescribed

c) Using a high-flow Venturi mask to deliver oxygen as prescribed

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) pleural effusion. b) pulmonary edema. c) atelectasis. d) oxygen toxicity.

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 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 contact with fur-bearing animals. d) Avoid goose down pillows.

A, 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 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) Dry airways that obstruct airflow b) Overinflated alveoli that impair gas exchange c) Inflamed airways that obstruct airflow d) Mucus secretions that block airways e) Decreased numbers of goblet cells

B C D Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.

An important nursing measure for a 6-month old infant with bronchiolitis is: A.Promoting stimulating activities that meet the infant's developmental needs B.Making regular assessments of the infant's skin color, anterior fontanel, and vital signs C.Discouraging visits from the parents during the acute phase to conserve the infant's energy D.Maintaining airborne precautions including wearing a gown, cap, mask, and gloves when giving care to the infant.

B, these assessments are vital to determine the infant's hydration status.

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, 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 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) "Many options are available for you." d) "Nicotine patches would be appropriate for you."

B, 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.

A 2 year old is admitted with croup and 1/4L oxygen via nasal canula is administered because it: A.Congeals the mucous secretions and relieves the dyspnea B.Decreases the effort required for breathing and also allows for rest. C.Triggers the cough reflex and facilitates expectoration of mucus D.Liquifies the mucous secretions and makes them easier to expectorate

B. Administering oxygen via nasal cannula limits the energy required for breathing, thus allowing the child to conserve energy that can be used for fluid and nutrient intake.

The mother of a 3-year old calls the nurse into the room because she says that her son is choking. What intervention should be the nurse's highest priority? A. Opening the child's mouth and sweeping for foreign materials B. Giving five back blows with the child face down over the nurse's arm C. Assessing whether the child can make vocal sounds D. Performing up to five subdiaphragmatic abdominal thrusts with the child in a supine position

C, Managing a foreign-body airway obstruction begins with assessment, including whether the child is coughing and can make vocal sounds. Finger sweeps should be avoided because they may push the foreign object back into the airway, causing obstructions. Back blows are used on an infant age 1 and younger. If the child can't speak or cough, abdominal thrusts are used.

A client is being evaluated for possible lung cancer. Which client statement most likely indicates lung cancer? a) "I've lost 10 pounds in the last month." b) "I've had a low-grade fever for 2 weeks." c) "My cough has changed from a dry cough to one with lots of sputum production." d) "My voice is hoarser than it used to be."

C, A cough that changes in character is one of the hallmark signs of lung cancer. Low-grade fever, hoarseness, and weight loss may be attributed to other disease processes and don't necessarily indicate lung cancer.

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) Decreased numbers of goblet cells b) Dry airways that obstruct airflow c) Overinflated alveoli that impair gas exchange d) Inflamed airways that obstruct airflow e) Mucus secretions that block airways

C, D,E Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. a) Thoracentesis b) Pertussis c) Atelectasis d) Status asthmaticus e) Respiratory failure

C, D,E Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Pertussis and pneumothorax are not complications.

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) Inflammation of the bronchioles with a normal distention of the air spaces b) Increased oxygen diffusion with inflammation of the bronchioles c) An abnormal distention of the air spaces with destruction of the alveolar walls d) Decreased sputum production with dilation of bronchioles

C, Emphysema is a pathologic term that describes an abnormal distention of the air spaces beyond the terminal bronchioles and destruction of the walls of the aveoli. This causes a decrease in oxygen diffusion and an increase in sputum production.

The nurse is caring for a child with cystic fibrosis. Which of the following treatments would be used to promote mucus clearance through percussion or vibration? A. suctioning B. chest tube C. bronchoscopy D. chest physiotherapy

Correct Answer: D. Rationale: Chest physiotherapy promotes mucus clearance through percussion or vibration. Suctioning removes secretions via bulb syringe or suction catheter, chest tubes remove air or fluid though a drain inserted into the pleural cavity, and bronchoscopy is the introduction of a bronchoscope into the bronchial tree for diagnostic purposes.

12. A patient in acute respiratory failure as a complication of COPD has a PaCO2 of 65 mm Hg, rhonchi audible in the right lung, and marked fatigue with a weak cough. The nurse will plan to a. allow the patient to rest to help conserve energy. b. arrange for a humidifier to be placed in the patient's room. c. position the patient on the right side with the head of the bed elevated. d. assist the patient with augmented coughing to remove respiratory secretions.

D Rationale: The patient's assessment indicates that assisted coughing is needed to help remove secretions, which will improve PaCO2 and will also help to correct fatigue. If the patient is allowed to rest, the PaCO2 will increase. Humidification may help loosen secretions, but the weak cough effort will prevent the secretions from being cleared. The patient should be positioned with the good lung down to improve gas exchange. Cognitive Level: Application Text Reference: p. 1809 Nursing Process: Planning NCLEX: Physiological Integrity

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) Respiratory rate b) Heart rate c) Skin color d) Lung sounds

D, A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax

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) Intravenous methylprednisolone (Solu-Medrol) 120 mg b) Ipratropium bromide (Alupent) by metered-dose inhaler c) Vancomycin 1 gram intravenously over 1 hour d) Oxygen through nasal cannula at 2 L/minute

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

D, 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.