NUR 398 Noninfectious Lower Respiratory Problems: Asthma & COPD

A patient with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? 1 Albuterol 2 inhalations 2 Salmeterol 2 inhalations 3 Ipratropium 2 inhalations 4 Fluticasone 2 inhalations

1 Albuterol is a beta 2 agonist that acts rapidly as a bronchodilator. Fluticasone is a corticosteroid; it is used to prevent asthma attacks and is not used as a rescue medication. Ipratropium is an anticholinergic drug that allows the sympathetic system to dominate and cause bronchodilation; it is not as effective as a beta 2 agonist, so it is not a first-line drug. Salmeterol is a long-acting beta 2 agonist (LABA) that must be used regularly over time; this patient needs a rescue medication.

Which nursing student statement regarding severity classification for primary pulmonary arterial hypertension (PAH) indicates a need for further teaching by the precepting nurse? 1 "Class 2 severity is characterized by edema, enlarged liver, or mild fatigue with mild to moderate activity." 2 "Class 3 severity is characterized by dyspnea, fatigue, chest pain, or light-headedness as a result of mild activity." 3 "Class 4 severity is characterized by dyspnea, fatigue, dependent edema, engorged neck veins, and enlarged liver." 4 "Class 1 severity is pulmonary hypertension diagnosed by pulmonary function tests with no physical limitations."

1 Class 2 severity for PAH is characterized by dyspnea, fatigue, chest pain, or light-headedness as a result of mild to moderate physical activity. Class 1 severity is pulmonary hypertension diagnosed by pulmonary function tests with no limits on activity. Class 3 severity is characterized by dyspnea, fatigue, chest pain, or light-headedness as a result of mild activity. Class 4 severity is characterized by dyspnea, fatigue, dependent edema, engorged neck veins, and enlarged liver.

The nurse is teaching a patient about self-management of asthma. Which statement by the patient indicates a need for further teaching? 1 "The fluticasone inhaler is used as a rescue medication." 2 "I will use the albuterol inhaler when I am wheezing or short of breath." 3 "I may need oral steroid medications when my asthma action plan is not working." 4 "When I have symptoms in the yellow zone, I will need to take more medicine."

1 Fluticasone is a maintenance medication to prevent or reduce the incidence of asthma flares. Systemic steroids are added when medications used in the yellow zone are not effective. Albuterol is a rescue medication that is used to treat symptoms such as wheezing or shortness of breath. The yellow zone requires an increase in medications.Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.

In teaching a patient about asthma medication management, the nurse reinforces the need to use a long-acting beta agonist (LABA) as directed. Which statement by the patient indicates a need for further teaching? 1 "I may use the LABA as needed for wheezing and coughing." 2 "The LABA is not used as the only medication for treating asthma." 3 "I should use the LABA twice daily even when I am not having symptoms." 4 "Overuse of the LABA may result in severe worsening of symptoms."

1 LABAs are long-acting bronchodilators that take time to build up a therapeutic effect. They are used as controller medications and should not be used as needed. Overuse of the LABA may result in worsening of symptoms and death. LABAs are given twice daily every day and are not to be used as the only medication for treating asthma.Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

A patient with status asthmaticus has an initial assessment revealing a respiratory rate of 35 breaths/min, a heart rate of 110 beats/min, high-pitched wheezes in all lung fields, and marked use of accessory muscles to breathe. The patient is receiving an intravenous steroid and a continuous nebulized bronchodilator medication. Which assessment reveals a worsening of this patient's condition? 1 Absence of wheezing 2 Tremors in both hands 3 Heart rate decreased to 90 beats/min 4 Decreased respiratory rate to 20 breaths/min

1 Patients in status asthmaticus who exhibit a sudden absence of wheezing may have a complete airway obstruction. The respiratory rate and heart rate decreases indicate improved oxygenation and represent improvement. Tremors are an adverse effect of the bronchodilator and do not represent worsening of the asthma attack.Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

Why must patients with asthma avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain or fever? 1 They allow increased production of leukotrienes. 2 They increase the risk for gastroesophageal reflux. 3 Aspirin and NSAIDs can cause bronchoconstriction. 4 A patient with asthma is likely allergic to these drugs.

1 Patients with asthma are often restricted from taking aspirin (ASA) and NSAIDs because they can trigger an asthma attack by allowing increased production of leukotrienes as they suppress other inflammatory pathways. They do not directly cause bronchoconstriction or increase the risk of gastroesophageal reflux disease (GERD). Patients who are sensitive to the effects of these drugs do not have a true allergy to them.Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.

What is the underlying physiological problem in cystic fibrosis (CF)? 1 Thick, sticky mucus 2 Airway hyperreactivity 3 Interstitial lung pathology 4 Reduced pulmonary airflow

1 The basis for altered physiology in CF is blocked chloride transport in cell membranes resulting in the formation of mucus that has little water content and is thick and sticky. This mucus causes problems in all organs, including the lungs, pancreas, liver, salivary glands, and testes. Airway hyperreactivity is the underlying cause of asthma symptoms. Interstitial changes in the lungs and reduced pulmonary airflow occur late in the disease as the result of chronic, thick mucus.

A patient with chronic obstructive pulmonary disease (COPD) is using home oxygen at a flow rate of 4 L/min via nasal cannula, but experiencing only moderate improvement in shortness of breath. Which information would the nurse provide to this patient? 1 "Shortness of breath may continue even with oxygen therapy." 2 "Increase the oxygen flow rate to 6 L/min to improve dyspnea." 3 "Oxygen therapy will eventually reverse the symptoms of COPD." 4 "Use the bronchodilator medication more frequently to improve dyspnea."

1 The goal of oxygen therapy in patients with COPD is to maintain oxygen saturation of 88%-92%, so dyspnea is still likely. Increasing the oxygen flow rate is incorrect because patients with chronic lung disease rely on low partial pressure of arterial oxygen (PaO 2) as a stimulus to breathe. Patients with COPD have irreversible lung damage that does not improve with oxygen therapy. Using the bronchodilator more frequently is not recommended, because of undesirable cardiovascular side effects.Test-Taking Tip: Get a good night's sleep before an exam. Staying up all night to study before an exam rarely helps anyone. It usually interferes with the ability to concentrate.

The nurse is teaching a patient with asthma how to use a peak flow meter. What does the nurse include when teaching this patient? 1 Test symptom severity twice daily or more often if needed. 2 Blow out through the mouthpiece in a slow, controlled breath. 3 Sit up straight while performing the test to get the optimum result. 4 Perform the test twice and use the highest number as the measure.

1 The peak flow meter is used to monitor symptom severity and is useful for determining medication needs. Patients should be instructed to perform the test twice daily to monitor symptoms. They should perform the test at least three times. Patients should blow out as hard and fast as they can. They should stand up while performing the test.Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults? 1 Because of decreased sensitivity of receptors 2 Because of quick response to reliever therapy 3 Because of no response from reliever therapy 4 Because of the receptors causing bronchodilation

1 With increasing age, the agonist and beta-adrenergic receptors become less sensitive. The decreased sensitivity of receptors leads to diminished response to agonist and beta receptor drugs. Aging slows, not quickens, response to reliever drug therapy, so the expected smooth muscle relaxation and bronchodilation is less. Despite the aging process, older adults still retain some response to reliever therapy. Bronchodilation is the desired response, so it is not a sign of ineffective drug therapy.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which disorders are lung diseases that cause chronic airflow limitation? Select all that apply. 1 Chronic bronchitis 2 Intermittent asthma 3 Upper lobe lung cancer 4 Subcutaneous emphysema 5 Inflammatory bronchospasm

1,2 Asthma, although usually presenting with intermittent attacks, is a chronic condition with reversible airflow obstruction in the airways. Chronic bronchitis is one of the conditions termed as chronic obstructive pulmonary disease (COPD) and involves increased mucus production, which can cause restricted airflow. Lung cancer, depending on its location in the lung, can cause restricted airflow in the lobe(s) of the lung that are obstructed; however, it is not regarded as part of the chronic airflow limitation (CAL) group of diseases, as the mechanism of restriction is different. Subcutaneous emphysema results when air has leaked into subcutaneous tissue—this is an acute situation that may be secondary to a tear in the trachea. Inflammatory bronchospasm actually combines the terms for the two mechanisms seen causing airway obstruction in asthma.

A patient reporting dyspnea and fatigue is diagnosed with pulmonary arterial hypertension. Which pathological manifestations will the nurse expect in the patient? Select all that apply. 1 Hypoxemia 2 Right side heart failure 3 Blood vessel constriction 4 Decreased pulmonary blood pressure 5 Decreased vascular resistance in the lung

1,2,3 The pathological problems associated with pulmonary arterial hypertension are poor perfusion and gas exchange that lead to hypoxemia. Right side heart failure is observed due to continuous workload of pumping against the high pulmonary pressures. Due to the increased vascular resistance, blood vessels get constricted. Pulmonary blood pressure is increased due to blood vessel constriction which causes increased vascular resistance in the lung.Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or patient. All options likely relate to the situation, but only some of the options may relate directly to the situation.

Which signs/symptoms are indicators of an asthma attack? Select all that apply. 1 Eosinophils in the sputum 2 Muscle retraction between the ribs 3 Audible wheeze, especially on exhalation 4 Increased, then decreased arterial carbon dioxide (PaCO 2) level 5 Decreased forced expiratory volume in the first second (FEV 1) on flowmeter

1,2,3,5 During an acute episode of asthma, the most common manifestations are an audible wheeze and increased respiratory rate. At first, the wheeze is louder on exhalation; when inflammation occurs with asthma, coughing may increase. The patient may use accessory muscles to help breathe during an attack, which the retraction of muscles between the ribs would indicate. A decrease in either the FEV 1 or the peak expiratory flow (PEF) of 15% to 20% below the expected value for age, gender, and size is common for the patient with asthma. In allergic asthma, the sputum may contain eosinophils and mucus plugs with shed epithelial cells. Early in an attack, the PaCO 2 level may be decreased as the patient increases respiratory effort; later in the episode, PaCO 2 rises, indicating carbon dioxide retention.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is experiencing anxiety. Which of the patient's statements indicates that teaching about anxiety has been successful? Select all that apply. 1 "I will perform diaphragmatic breathing when I am anxious." 2 "I will attend counseling sessions during periods of emotional distress." 3 "I will seek medical assistance when I believe I may have an infection." 4 "I will take my prescribed antianxiety medication if I begin to feel panicky." 5 "I will ask for help if I have difficulty breathing while performing daily activities."

1,2,4 A patient with COPD can take self-care steps to reduce his or her anxiety. The patient may take antianxiety medication when experiencing severe anxiety, if prescribed. Performing diaphragmatic breathing when the patient is anxious can be calming. Counseling from a professional may help reduce stress and anxiety. The patient should seek medical help when the symptoms of infection are present, but this does not address the patient's anxiety. The patient asking for help when he or she has difficulty in breathing also does not address anxiety.

Which statements about chronic obstructive pulmonary disease (COPD) are correct? Select all that apply. 1 COPD includes emphysema and chronic bronchitis. 2 Because of increased mucus production, bronchitis leads to breathing problems in the alveoli. 3 Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. 4 The increased risk of infection in COPD is related to increased mucus production and poor oxygenation. 5 Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue.

1,3,4,5 Although they are different diseases, both emphysema and chronic bronchitis fall under the COPD umbrella. Cigarette smoking is the greatest risk factor for COPD. Chronic inhalation of other irritants also contributes to this risk. Acute lung infections make COPD worse as a result of increased inflammation and mucus production and decreased oxygenation. Emphysematous lungs contain a higher number of proteases that damage the alveoli and the small airways by breaking down elastin. Chronic bronchitis leads to increased mucus production and airway problems; emphysema affects the alveoli.

The primary health care provider prescribes endothelin-receptor agonist to a patient with primary pulmonary arterial hypertension. Which effects in the patient does the nurse observe due to endothelin-receptor agonist? Select all that apply. 1 Hypotension 2 Clot formation 3 General vessel dilation 4 Blood vessel constriction 5 Decrease in pulmonary arterial pressure

1,3,5 Endothelin-receptor agonists induce hypotension because of general vessel dilation. They decrease pulmonary arterial pressure by causing blood vessel relaxation. Endothelin-receptor agonist has no effect on clot formation.

The nurse is discussing the involvement of genetics with pulmonary arterial hypertension with a peer. Which information should the nurse include in this discussion? Select all that apply. 1 BMPR2 gene codes for a growth factor receptor 2 Excessive activation of the growth factor receptor making the arteries thinner 3 Mutations in the SMAD9 gene increasing the risk for pulmonary arterial hypertension 4 Every patient with a pulmonary arterial hypertension having a genetic mutation in the BMPR2 gene 5 Genetic mutation in the BMPR2 gene increasing the susceptibility to pulmonary arterial hypertension

1,3,5 Many patients with cystic fibrosis have mutations in the BMPR2 gene that codes for a growth factor receptor. Patients having mutations on the SMAD9 gene are at an increased risk for pulmonary arterial hypertension. Genetic mutation in the BMPR2 gene increases a patient's susceptibility to pulmonary arterial hypertension. Excessive activation of the growth factor receptor allows increased growth of arterial smooth muscle in the lungs, making the arteries thicker. Not all patients with cystic fibrosis have a genetic mutation in the BMPR2 gene.

Which diagnostic tests aid in the diagnosis of cystic fibrosis? Select all that apply. 1 Stool for fat 2 Bronchoscopy 3 Stool for trypsin 4 Sweat chloride analysis 5 Biopsy of intestinal mucosa 6 Gastric contents for hydrochloric acid levels

1,4 Sweat chloride analysis assesses for elevated chloride levels in the sweat. Levels of 60 to 200 mEq are diagnostic of cystic fibrosis (CF). Steatorrhea or excessive fat in the stool is also present in CF since the pancreatic enzymes necessary for digestion are blocked due to the thick secretions produced. A bronchoscopy is usually done following a diagnosis of CF to look for any signs of infection. An intestinal mucosa biopsy will not aid in diagnosing CF because while the pathology affects the gastrointestinal tract, it does not cause the disease. Duodenal fluid, not stool, should be tested for decreased or absence of trypsin.

Which clinical manifestations during status asthmaticus require immediate action? Select all that apply. 1 Absence of response to usual therapy 2 Irregular episodes of shortness of breath 3 Audible wheezing and increased respiratory rate 4 Sudden absence of wheezing, indicating airway obstruction 5 Development of pneumothorax and cardiac or respiratory arrest 6 Use of accessory muscles while breathing and distention of neck veins

1,4,5,6 Status asthmaticus is a severe and life-threatening condition. In this state, there is an absence of response to the usual therapy administered to acute asthma patients. The patient suddenly stops wheezing, which indicates an airway obstruction. If this condition is not reversed, the patient can develop a pneumothorax and go into cardiac or respiratory arrest. If the patient is using accessory muscles while breathing and distended neck veins are observed, the patient may require tracheotomy or intubation. Intermittent episodes of shortness of breath, audible wheezing, and increased respiratory rate are the usual symptoms observed during an asthma attack.Test-Taking Tip: Identifying the content and what is being asked about that content is critical to your choosing the correct response. Be alert for words in the stem of the item that are the same or similar in nature to those in one or two of the options.

The registered nurse is evaluating the communication of a student nurse with a patient newly diagnosed with cystic fibrosis. Which statement made by the student nurse indicates a need for correction? 1 "You may have problems hearing later in your life." 2 "Your disease will be cured completely after drug therapy." 3 "You may feel a burning sensation in the chest for some time." 4 "You should protect yourself from direct contact with bodily fluids."

2

Which is a common exclusion criterion for a patient with cystic fibrosis preparing for lung transplantation? 1 Age restriction 2 Systemic infection 3 Severe lung damage 4 Irreversible lung damage

2 A patient with cystic fibrosis having a systemic infection cannot undergo lung transplantation because of an increased risk for transplant rejection. The age of the patient undergoing transplantation is considered on an individual basis. Recipient criteria for a patient with cystic fibrosis include having severe lung damage and irreversible lung damage.

A patient with pulmonary arterial hypertension is receiving an endothelin-receptor antagonist to treat the disease. To monitor for drug side effects, which nursing assessment is important? 1 Lung sounds 2 Blood pressure 3 Intake and output 4 Oxygen saturation

2 Agents used to treat pulmonary arterial hypertension cause generalized vasodilation and can cause hypotension. The nurse should monitor blood pressure. Intake and output are necessary to monitor when diuretics are given. Assessment of lung sounds and oxygenation are part of the ongoing assessment for this condition but do not indicate drug side effects.Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.

A patient who has emphysema tells the nurse that the prescribed inhaled corticosteroid medication does not help at all. Which action by the nurse is correct? 1 Notify the patient's provider that the emphysema is worsening. 2 Ask the patient to describe how frequently the medication is used. 3 Suggest that the patient use the inhaled corticosteroid more often. 4 Request an order for an increased dose of the inhaled corticosteroid.

2 Because inhaled corticosteroids are long-term medications that work by reducing mucosal inflammation, the patient should be taught that an immediate reduction in dyspnea is not expected with these medications. The nurse should first assess how the patient is using this medication to see if further teaching is necessary. Notifying the provider of the patient's worsening condition or requesting an increased dose are not indicated until medication use is assessed. Inhaled corticosteroids are generally used twice daily and increasing the dose frequency is not indicated.Test-Taking Tip: Calm yourself by closing your eyes, putting down your pencil (or computer mouse), and relaxing. Deep-breathe for a few minutes (or as needed, if you feel especially tense) to relax your body and to relieve tension.

A patient reports a cough and limited exercise tolerance. Which disease does the nurse suspect in this patient when the diagnostic reports indicate the presence of Burkholderia cepacia? 1 Sarcoidosis 2 Cystic fibrosis 3 Idiopathic pulmonary fibrosis 4 Pulmonary arterial hypertension

2 Cystic fibrosis is a genetic disease that causes cough and limited exercise tolerance. It spreads by Burkholderia cepacia. Therefore, the presence of Burkholderia cepacia indicates cystic fibrosis. Sarcoidosis is not caused by Burkholderia cepacia; it is an autoimmune response, which is characterized by an increased number of normally protective T-lymphocytes, and damaged alveolar cells. Idiopathic pulmonary fibrosis and pulmonary arterial hypertension are not diagnosed by the presence of Burkholderia cepacia.

Inhaled corticosteroids are typically used to treat which symptom of asthma? 1 Bronchial spasms 2 Airway inflammation 3 Bronchial secretions 4 Airway hyperresponsiveness

2 Inhaled corticosteroids are given to minimize inflammation and do so partly by preventing the synthesis of chemical mediators of inflammation. By preventing inflammation, they indirectly make hyperresponsive episodes less frequent and will decrease bronchial spasms and possibly bronchial secretions.

A patient has asthma that gets worse during the summer. She tells the nurse she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the patient? 1 Guaifenesin 2 Montelukast 3 Omalizumab 4 Albuterol inhaler

2 Montelukast is a leukotriene antagonist that works well for asthma that occurs during certain seasons. It is taken on a daily basis as a preventive medication. Albuterol inhalers are beta 2 agonists that are rescue medications used on an as-needed basis only. Guaifenesin is a mucolytic that does not provide any bronchodilation; it may or may not be taken daily. Omalizumab is an immunomodulator that is injected subcutaneously every 2 to 3 weeks; it is not commonly used because a high rate of anaphylaxis is associated with it.

A patient with asthma tells the nurse that the prescribed montelukast does not help with symptoms during an asthma attack. Which action would the nurse take? 1 Contact the provider to discuss a possible increase in dose of this drug. 2 Ask the patient to describe how and when the medication is taken. 3 Instruct the patient to take the drug when known asthma triggers are present. 4 Teach the patient to take the drug at the first indication of symptoms for best effect.

2 Montelukast is taken regularly by a patient with asthma to block inflammatory mediators and help prevent asthma symptoms. It is not given to relieve acute or exacerbated symptoms. It works best when taken consistently, even when symptoms are not present. The nurse should ask the patient to describe how the medication is taken to assess why it is not working. A dose increase is not necessarily needed, especially if the patient is not taking the medication as prescribed.STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

Which home-care therapy is most important for a patient with cystic fibrosis (CF) to help prevent exacerbations of the disease? 1 Diabetes prevention 2 Chest physiotherapy 3 Prophylactic antibiotics 4 Nutritional management

2 Patients with CF have thick, tenacious secretions, which are difficult to clear, and serve as a reservoir for infections. Daily chest physiotherapy is central to ongoing management of CF. Nutritional management and diabetes prevention are necessary but not the most important. Prophylactic antibiotics are used later in the disease course after repeated infections and colonization with bacteria.

A patient admitted with chronic obstructive pulmonary disease (COPD) has a barrel chest with expiratory wheezes in the lower lobes, decreased fremitus, and hyperresonance with chest percussion. What does the nurse expect to see on this patient's chest X-ray? 1 Atelectasis 2 Flattening of the diaphragm 3 Hypoexpansion of the lungs 4 Infiltrates in the lower lobes

2 Patients with COPD often have air trapping, characterized by decreased fremitus and hyperresonance with percussion. A radiographic finding would be flattening of the diaphragm that occurs with hyperexpansion of the lungs. Atelectasis may occur as the disease progresses. Hyperexpansion, not hypoexpansion, is common. A patient with lower lobe infiltrates, common with an infectious process, will have infiltrates on chest X-ray.Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.

A patient with moderate chronic obstructive pulmonary disease (COPD) has begun a pulmonary rehabilitation program. The patient usually has an oxygen saturation of 88% to 90% with 2 L/min of oxygen via nasal cannula and walks to the end of the driveway and back each day. The patient's ideal body weight is 150 pounds, but the patient currently weighs 130 pounds. What is an expected outcome for this patient? 1 The patient will be able to ambulate around the block and back. 2 The patient will be able to increase weight to at least 135 pounds. 3 The patient will be able to be weaned off of supplemental oxygen. 4 The patient will be able to maintain oxygen saturation of 92% to 94%.

2 Patients with COPD should attempt to maintain their weight within 10% of their ideal body weight. For this patient, that would be 135 lb or greater. Patients are encouraged to increase their activity to a level they can accept and do not need to push their limits. This patient has oxygen saturation levels consistent with those of others with COPD, so an increase is not a reasonable expectation. It is not likely that this patient can wean off of supplemental oxygen.Test-Taking Tip: If the question asks for an immediate action or response, all the answers may be correct, so base your selection on identified priorities for action.

What are the classical manifestations in patients with class one primary pulmonary arterial hypertension (PAH)? 1 Shortness of breath is observed even during rest. 2 Shortness of breath is not observed during any physical activity. 3 Shortness of breath is observed during moderate physical activity. 4 Fatigue and light headedness are present, even during mild physical activity.

2 Primary pulmonary arterial hypertension (PAH) is classified on the basis of the clinical manifestations. Patients with class one primary PAH may not have shortness of breath during any kind of physical activity. Patients with class four type of primary PAH may have shortness of breath even during rest. Patients with class two primary PAH may experience shortness of breath with moderate physical activity. In patients with class three type of primary PAH, fatigue, and light headedness are observed during mild physical activity.

Which diagnostic test is used to determine the diffusion capacity in a patient with pulmonary arterial hypertension? 1 Computed tomography 2 Pulmonary function tests 3 Ventilation-perfusion scans 4 Right-sided heart catheterization

2 Pulmonary function tests are used to determine the diffusion capacity in a patient with pulmonary arterial hypertension. Computed tomography is used to create detailed pictures or scans of the areas inside the body. Ventilation-perfusion scans are used to measure breathing and circulation. Right-sided heart catheterization is used to measure pulmonary pressure.

Which medication is an example of a long-acting beta 2 agonist (LABA) used in asthma management? 1 Albuterol 2 Salmeterol 3 Terbutaline 4 Levalbuterol

2 Salmeterol is a LABA. Albuterol, levalbuterol, and terbutaline are all short-acting beta 2 agonists (SABAs).

The nurse is performing a medication history for a patient who reports using salmeterol as needed for asthma exacerbations. What does the nurse tell the patient about this practice? 1 "Salmeterol should be used at the onset of symptoms for best effect." 2 "Using salmeterol as a reliever medication can lead to sudden death." 3 "Salmeterol should be used with a steroid to relieve acute asthma symptoms." 4 "Daily use of salmeterol leads to a tolerance of desired medication effects."

2 Salmeterol is a long-acting beta-adrenergic (LABA) medication. It is used for maintenance and not to relieve acute symptoms; doing so can worsen symptoms and lead to death. It should be used daily; frequent use does not lead to tolerance. Salmeterol is often used with a steroid but not to relieve acute symptoms. It should be used daily, whether symptoms are present or not.STUDY TIP: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly? 1 "I don't have to wait between the two puffs if I use a spacer." 2 "If the spacer makes a whistling sound, I am breathing in too rapidly." 3 "I should shake the inhaler only if I want to see whether it is empty." 4 "I should rinse my mouth and then swallow the water to get all of the medicine."

2 Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the patient of which technique needs to be used. The patient must wait 1 minute between puffs. The patient should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important to prevent the development of an oral fungal infection if the inhaled medication is a corticosteroid. An empty inhaler will float on its side in water; a full inhaler will sink. Shaking an inhaler helps ensure that the same dose is delivered in each puff.

A patient with asthma describes wheezing, dyspnea, and coughing episodes once or twice a month lasting 1 to 2 days. The patient uses an inhaled bronchodilator for symptom relief but does not use medication between episodes. The patient requires an oral corticosteroid medication approximately once every 2 years when symptoms are more severe. The patient does not have limitations in activities or nighttime awakening with symptoms. Which plan of action does the nurse anticipate this patient will require? 1 Adding an inhaled corticosteroid as a maintenance medication 2 Continuation of the current therapy plan with no daily medication required 3 Treatment with a long-acting bronchodilator plus an inhaled corticosteroid 4 Supplementation with a leukotriene modifier and a daily bronchodilator

2 This patient has intermittent symptoms that are easily managed with a bronchodilator medication. The reliever medication is used less than twice weekly, and the patient does not have night time symptoms or changes in activity participation. The current treatment plan is effective and does not need to be changed. Adding an inhaled corticosteroid or a leukotriene modifier is done as part of step 2 management (of the step system for medication use in asthma control). A long-acting bronchodilator plus an inhaled corticosteroid is part of step 3 management.STUDY TIP: Do not change your pattern of study. It obviously has contributed to your being here, so it worked. If you have studied alone, continue to study alone. If you have studied in a group, form a study group.

Which sign/symptom is significant in diagnosing asthma in a nonsmoker? 1 Dyspnea 2 Wheezing 3 Chest tightness 4 Increased mucus production

2 Wheezing in a patient who is a nonsmoker is an indicator of airway obstruction. Although dyspnea, chest tightness, and increased mucus production can also be seen with asthma, these signs and symptoms are also more often present with other respiratory conditions.

Which interventions to improve oxygenation and decrease carbon dioxide retention does the nurse teach the patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Limiting dietary intake to avoid weight gain, which will add to activity intolerance 2 Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea 3 Partnering with the family in COPD management by adhering to prescribed therapies 4 Maintaining hydration to loosen secretions and suctioning frequently to eliminate build up 5 Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity

2,3,5 Optimum COPD management requires an active partnership between the patient/family and the health care team. COPD is a chronic disease, and it is important for patients/families to learn symptom management and when to seek medical care. A change in respiratory rate and rhythm may indicate the presence of an infection or buildup of respiratory secretions. In addition, a change in activity tolerance should trigger more in-depth assessment of respiratory status changes. Breathing techniques may be helpful for managing dyspneic episodes; the amount of stale air in the lungs is reduced, and the patient gains confidence and control in managing dyspnea. Although hydration is important, routine suctioning of the patient with COPD is not indicated. Excessive weight gain from overeating is not desirable; however, COPD patients are more likely to experience inadequate nutrition and weight loss secondary to the work of breathing and decreased appetite.Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank question poses a problem, read the situation and essential information carefully and then formulate your response.

The nurse finds that a patient is experiencing air hunger and has uncoordinated breathing. Laboratory tests reveal normal arterial blood gasses as well as a normal eosinophil count. What should the nurse infer from the diagnostic tests? 1 The patient has asthma. 2 The patient has allergic asthma. 3 The patient has acute emphysema. 4 The patient has severe emphysema.

3 A patient with acute emphysema experiences weakening of the diaphragm muscle, which leads to an increased need for oxygen, or air hunger. Due to increased work of breathing and loss of alveolar tissue, gas exchange is affected. Arterial blood gas (ABG) values will be normal as the patient adjusts to it by increasing respiratory rate. Uncoordinated breathing is observed due to incomplete cycles of inhalation and exhalation. A patient with asthma shows irregular episodes of dyspnea, chest tightness, coughing, wheezing, and increased mucus production. Allergic asthma occurs due to inflammatory responses. A patient with severe emphysema shows an increased arterial carbon dioxide level (PaCO 2) level, indicating carbon dioxide retention.Test-Taking Tip: Look for options that are similar in nature. If all are correct, either the question is poor or all options are incorrect, the latter of which is more likely. Example: If the answer you are seeking is directed to a specific treatment and all but one option deal with signs and symptoms, you would be correct in choosing the treatment-specific option.

After reviewing the genetic analysis reports of a patient with cystic fibrosis, the primary health care provider prescribes ivacaftor. Which finding will the nurse expect in the patient during follow-up visits? 1 Bone fracture 2 Sensory hearing loss 3 Elevated liver enzymes 4 Gastroesophageal reflux disease

3 A patient with cystic fibrosis who is having mutations in one of the CFTR genes, such as G551D, will be prescribed ivacaftor. The most common adverse effect of ivacaftor is the elevation of liver enzymes. Bone fracture, sensory hearing loss, and gastroesophageal reflux disease are problems that occur with cystic fibrosis over time.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the patient indicates a correct understanding of the nurse's instructions? 1 "Preventive drugs can stop an attack." 2 "Asthma drugs help everybody breathe better." 3 "I must have my emergency inhaler with me at all times." 4 "I must carry my emergency inhaler only when activity is anticipated."

3 Because asthma attacks cannot always be predicted, patients with asthma must always carry a rescue inhaler such as a short-acting beta agonist (SABA) like albuterol. Asthma medications are specific to the disease and should never be shared or used by anyone other than the person for whom they are prescribed. An emergency inhaler should be carried when activity is anticipated, as well as at other times. Preventive drugs are those that are taken every day to help prevent an attack from occurring. They are not able to stop an attack once it begins.

How does chest physiotherapy benefit a patient with cystic fibrosis (CF) through relieving symptoms? 1 It increases vascular resistance in the lungs. 2 It stops excess production of mucus in the lungs. 3 It creates mini-coughs to dislodge the mucus from the lungs. 4 It decreases the constriction of the bronchiolar smooth muscle.

3 Chest physiotherapy uses chest percussion, chest vibration, and dependent drainage to loosen secretions and promote drainage. This therapy encourages mini-coughs that dislodge the mucus from the bronchial walls and increase mobilization. This mucus moves toward the central airways where it can be removed by coughing or suctioning. Vascular resistance in the lungs is seen in patients with pulmonary arterial hypertension (PAH). Drug therapy helps in the management of excess mucus production in patients with cystic fibrosis (CF). Bronchodilator drugs help in the relaxation of the smooth muscles in patients with asthma.Test-Taking Tip: Read the question, and relate the patient's condition to the management performed. Then select the option which shows the effective outcome.

The nurse is reviewing the medical record of a patient with asthma and notes elevated serum eosinophils and elevated immunoglobulin E levels. Which medication does the nurse expect the provider to order for this patient based on this finding? 1 Albuterol 2 Fluticasone 3 Cromolyn sodium 4 Ipratropium bromide

3 Cromolyn sodium is a mast cell stabilizer that prevents mast cells from opening when an allergen binds to immunoglobulin E (IgE) and helps to block this trigger of asthma. When patients have elevated eosinophils and elevated IgE, they have allergic asthma that is triggered by allergens binding to IgE. The other medications may all be prescribed for any patient with asthma but not based on this finding.Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.

Which non-pulmonary manifestation of cystic fibrosis is commonly seen in this patient population? 1 Vitamin toxicity 2 Increased weight 3 Excessive fat in stools 4 Increased insulin production

3 Cystic fibrosis causes steatorrhea, a non-pulmonary manifestation which is characterized by excessive fat in the stools resulting from malabsorption and malnourishment. Vitamin deficiencies, not vitamin toxicities, also contribute to this. A patient with cystic fibrosis is thin, not overweight, as a result of malabsorption. Pancreatic function is decreased in cystic fibrosis patients resulting in diabetes mellitus; therefore insulin production is decreased.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

Which medication exposure in a patient increases the risk for primary pulmonary arterial hypertension? 1 Warfarin 2 Bosentan 3 Dasatinib 4 Verapamil

3 Dasatinib is a multi-tyrosine kinase inhibitor used in the treatment of leukemia. Exposure to dasatinib increases the risk for primary pulmonary arterial hypertension. Warfarin, bosentan, and verapamil are used in the management of primary pulmonary arterial hypertension.

The nurse is caring for patient with severe emphysema who asks for assistance with meal and snack choices for the next day. Which snack selection is best for the nurse to advise this patient to make? 1 Bean soup with crackers 2 Apple slices and caramel dip 3 Chocolate ice cream shake 4 Salted cheese crackers

3 High-calorie, high-protein meals are recommended to prevent weight loss in patients with severe lung disease. A chocolate ice cream shake is the best snack of those listed because it is high in calories and protein and it is thick and cool on the throat which promotes safer swallowing. Apple slices are low-calorie and low in protein. Beans are gas-producing foods that can cause abdominal bloating. Salted cheese crackers are dry and can induce coughing.Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best.

What is the most important reason for ordering inhaled, rather than oral, corticosteroids for patients with asthma? 1 Inhaled corticosteroids are easier to use. 2 Inhaled corticosteroids are more effective. 3 Oral corticosteroids have more adverse effects. 4 Oral corticosteroids have less predictable effects.

3 Inhaled corticosteroids are given because they have direct actions on the target tissues in the lungs, causing fewer systemic adverse effects than oral corticosteroids. They are not necessarily more effective, nor are they easier to use. Oral corticosteroids do not have less predictable effects.

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? 1 Cough 2 Dyspnea 3 Barrel chest 4 Reduced gas exchange

3 Interstitial lung diseases are restrictive, not obstructive, so they do not cause barrel chest, which is the result of air trapping. Both types of pulmonary disease cause cough, dyspnea, and reduced gas exchange.STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it.

What does the nurse do first when setting up a safe environment for the new patient on oxygen? 1 Uses a pulse oximetry unit 2 Ensures that staff members wear protective clothing 3 Ensures that no combustion hazards are present in the room 4 Sets the oxygen delivery to maintain no fewer than 16 breaths per minute

3 Oxygen is highly flammable. The nurse must ensure that no open flames or combustion hazards are present in a room where oxygen is in use. Protective clothing is not necessary for a patient who requires oxygen therapy other than the use of Standard Precautions. The oxygen delivery setting is usually determined in conjunction with the respiratory therapy care partner. Although the setting is important for safe administration, it is not necessary for a safe environment. Pulse oximetry would be useful for monitoring the patient's oxygenation status but is not necessary for a safe environment.

The nurse is caring for a patient with COPD who reports increased fatigue and nausea. The nurse notes distended neck veins, bounding peripheral pulses, dependent edema, and cyanosis of the lips and hands. The nurse notifies the health care provider of which condition? 1 Orthopnea 2 Hypercapnia 3 Cor pulmonale 4 Respiratory distress

3 Patients develop cor pulmonale when air trapping, airway collapse, and stiff alveolar walls increase lung tissue pressure and make blood flow through lung vessels more difficult. The right side of the heart eventually enlarges and thickens, leading to right-sided heart failure with backup of blood into the general venous system. Hypercapnia is an increase in partial pressure of arterial carbon dioxide (PaCO 2). Orthopnea (difficulty breathing while lying down) is often a symptom of cor pulmonale. Signs of respiratory distress include tachypnea, nasal flaring, anxiety, sternal retraction, shortness of breath, restlessness, decreased oxygen saturation, decreased level of consciousness, and stridor.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking; look for key words; (2) read each answer thoroughly and see if it completely covers the material asked by the question; (3) narrow the choices by immediately eliminating answers you know are incorrect.

A patient admitted with pulmonary arterial hypertension experiences dyspnea and light-headedness when transferred from the wheelchair to the bed. Which level of severity does the nurse document the patient as having? 1 Class I 2 Class II 3 Class III 4 Class IV

3 Patients who experience dyspnea, chest pain, fatigue, and light-headedness while engaged in less-than-ordinary physical activity are categorized as class III in severity. Class I is characterized by no symptoms with moderate physical activity. Class II is characterized by symptoms associated with mild to moderate physical activity. Class IV is characterized by symptoms with any physical activity along with manifestations of right-sided heart failure.Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.

The patient is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? 1 Corticosteroids 2 Long-acting beta agonists 3 Short-acting beta agonists 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

3 Short-acting beta agonist medications have a rapid onset and cause bronchodilation; they would be excellent for marathon running because some types of asthma may be exercise induced. Corticosteroids disrupt production pathways of inflammatory mediators. Maximum effectiveness requires 48 to 72 hours of continued use, therefore, they are not appropriate as a rescue medication. Long-acting beta agonists do cause bronchodilation but have a slow onset; they are not used as rescue inhalers. NSAIDs stabilize the membranes of mast cells and prevent release of inflammatory mediators. They have a slow onset of action and are used for prevention of symptoms, not as rescue medication.

What is the rationale behind prescribing digoxin and diuretics to a patient with pulmonary arterial hypertension? 1 To reduce dyspnea 2 To prevent clot formation 3 To improve cardiac function 4 To cure pulmonary arterial hypertension

3 The heart of a patient with pulmonary arterial hypertension undergoes hypertrophy and decreased cardiac function. Therefore, digoxin and diuretics are prescribed to improve cardiac function. Calcium channel blockers are prescribed to dilate blood vessels. Oxygen therapy is used to reduce dyspnea and to ensure proper oxygen supply. Digoxin and diuretics do not cure pulmonary arterial hypertension completely.

The change-of-shift report has just been completed on the medical-surgical unit. Which patient will the oncoming nurse plan to assess first? 1 Hospice patient with terminal pulmonary fibrosis and an oxygen saturation level of 89%. 2 Patient with lung cancer who needs an IV antibiotic administered before going to surgery. 3 Patient with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38. 4 Patient with COPD who is ready for discharge but is not able to pay for prescribed home medications.

3 The patient with CF with an elevated temperature and respiratory rate is exhibiting signs of an exacerbation and needs to be assessed first. The nurse will need to speak with the patient who has COPD to help find a plan that will enable the patient to obtain his or her prescribed medications; this may involve contacting case management or social services and discussing the discharge with the discharge health care provider. An oxygen saturation of 89% may be normal for a hospice patient with terminal pulmonary fibrosis; not enough information is provided to determine whether this patient is in distress. The patient who needs an IV antibiotic could have the medication administered by another RN, or it could be administered in the operating room (OR).STUDY TIP: Enhance your time-management abilities by designing a study program that best suits your needs and current daily routines by considering issues such as the following: (1) Amount of time needed; (2) Amount of time available; (3) "Best" time to study; (4) Time for emergencies and relaxation.

A patient has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this patient? 1 Mucolytics decrease secretion production. 2 Mucolytics increase gas exchange in the lower airways. 3 Mucolytics thin secretions, making them easier to expectorate. 4 Mucolytics provide bronchodilation in patients with chronic obstructive pulmonary disease (COPD).

3 The term mucolytic means "breaking down mucus." Mucolytics cause secretions to thin, making them easier to expectorate; this is important for a patient with chronic bronchitis. Mucolytics do not decrease secretion production. Mucolytics may increase gas exchange, but this is an indirect property and is not the main function. Mucolytics do not have any bronchodilation properties.

A patient with chronic obstructive pulmonary disease (COPD) reports having off-and-on symptoms of dyspnea, coughing, and sputum production. The patient's FEV 1/FVC is 65% of predicted value and the FEV 1 is 55% of predicted value. Which level of COPD severity does this patient have? 1 I - mild 2 III - severe 3 II - moderate 4 IV - very severe

3 This patient has intermittent symptoms and has an FEV 1/FVC of less than 70% of predicted value and an FEV 1 between 50% and 80% of predicted value, which means the patient has moderate COPD. Patients with mild COPD do not have dyspnea. Patients with severe COPD have an FEV 1 between 30% and 50% of predicted value with persistent symptoms. Patients with very severe COPD have an FEV 1 less than 30% or less than 50% of predicted value with respiratory failure along with more severe symptoms.Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect.

Which statements are correct regarding the drug management of asthma? Select all that apply. 1 Anti-inflammatory medications are used to cause bronchodilation. 2 Long-acting beta agonists are indicated to relieve acute attack symptoms. 3 Reliever medications are used to stop an asthma attack once it has started. 4 Control therapy medications are used to prevent asthma attacks from occurring. 5 Control therapy medications are used to reduce airway responsiveness.

3,4,5 Control (formerly called preventive) therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long-acting beta agonists do not act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation.

After reviewing the laboratory and diagnostic reports of a patient with cystic fibrosis, the nurse suspects that interventional radiology is needed in the patient. Which finding supports the nurse's suspicion? 1 Genetic mutation 2 Bacterial infection 3 Vitamin deficiency 4 Bronchiole bleeding

4 A patient with cystic fibrosis develops bronchiole bleeding in the later stages of life. Interventional radiology is needed to embolize the bleeding of the arterial branches. Ivacaftor is needed for a patient with genetic mutations. Co-trimoxazole is needed for a patient with bacterial infection. Vitamin supplements are needed for a patient with vitamin deficiency.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

A patient with asthma performs a peak flow assessment, which is 60% of normal and in the yellow range, and has an oxygen saturation of 94% on room air. Which initial action should the nurse take? 1 Notify the Rapid Response Team. 2 Give the patient oxygen by nasal cannula. 3 Request an order for an oral corticosteroid medication. 4 Administer the ordered PRN short-acting beta 2 agonist.

4 A peak flow assessment between 50% and 80% of normal indicates that the patient is in the yellow zone. A short-acting beta 2 agonist is indicated. If the patient is hypoxic, oxygen is indicated. An oxygen saturation of 94% or greater does not indicate hypoxia. It is not necessary to notify the Rapid Response Team unless the patient continues to deteriorate in spite of adequate treatment. If the patient progresses to the red zone, a systemic corticosteroid would be indicated.Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.

Because patients with cystic fibrosis (CF) are at increased risk for infection, what will the nurse advise the patient with CF who is infected with Burkholderia cepacia to do? 1 Avoid the hospital. 2 Use an antiseptic hand gel. 3 Stay at home most of the time. 4 Avoid Cystic Fibrosis Foundation-sponsored events.

4 A serious bacterial infection for patients with CF is Burkholderia cepacia, which is spread by casual contact from one CF patient to another. For this reason, the Cystic Fibrosis Foundation bans infected patients (those who have had a positive sputum culture) from participating in any foundation-sponsored events. Avoiding the hospital completely is unrealistic, although special infection control procedures may be implemented, such as scheduling the patient's office visits on different days or in different areas of the hospital. Social isolation is not needed for patients with CF and may be detrimental to the psychosocial well-being of the patient. Hand hygiene is important, although this is not the best response.

A patient who has frequent respiratory infections and chronic chest congestion has a sweat chloride level of 85 mEq/L. The nurse suspects this laboratory value indicates which disease process? 1 Asthma 2 Bronchitis 3 Emphysema 4 Cystic fibrosis

4 A sweat chloride level between 60 and 200 mEq/L is positive for cystic fibrosis (CF) because the defect in chloride movement that is characteristic of CF prevents absorption of sodium chloride in the sweat glands and increased chloride in a patient's sweat. This does not occur with asthma, bronchitis, or emphysema.Test-Taking Tip: Do not read information into questions, and avoid speculating. Reading into questions creates errors in judgment.

A patient with pulmonary arterial hypertension is prescribed a prostacyclin agent. Which nursing intervention is beneficial to prevent high drug rate error? 1 Changing the brand of the prostacyclin agent 2 Administering prostacyclins in periodic intervals 3 Flushing the dedicated prostacyclin infusion line 4 Including the patient in the administration of prostacyclins

4 Administration of a prostacyclin agent involves a high drug rate error. The best nursing intervention is including the patient in the administration of prostacyclins. The patient should be made responsible for self-administration of the medication. Changing the brand name of prostacyclin will alter the desired therapeutic action. Administering prostacyclins in periodic intervals may result in death. Flushing the dedicated prostacyclin infusion line increases drug rate errors.

A patient who has been diagnosed with asthma a few months ago is using a salmeterol inhaler as a reliever therapy, but has no relief from the symptoms. Which statement made by the nurse would benefit the patient? 1 "Use oral prednisone during an acute asthma attack." 2 "Use the salmeterol inhaler when you have an asthma attack." 3 "Use the fluticasone inhaler when you have an asthma attack." 4 "Use a short-acting inhaler such as albuterol for reliever therapy."

4 Albuterol is a short-acting beta 2 agonist bronchodilator that relaxes the bronchiolar smooth muscle by binding to and activating pulmonary beta 2 receptors. This drug can stop or reduce life-threatening bronchoconstriction. Oral agents such as prednisone do not work fast enough to stop an asthma attack. Prednisone is an anti-inflammatory drug used to prevent asthma attacks. Salmeterol is a long-acting beta 2 agonist; its onset of action is slow, and it does not relieve symptoms during an asthma attack. Fluticasone is an anti-inflammatory drug that is also used to prevent asthma attacks.Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

. An asthmatic patient who is allergic to pollen is prescribed cromolyn sodium; however, the patient reports that it does not help relieve symptoms during an asthma attack. Which instruction would be beneficial to the patient? 1 "Include an exercise program in your daily life to improve your health." 2 "Refrain from exposure to allergens that will aggravate the allergic reaction." 3 "Use proper technique while inhaling the drug for maximum effectiveness." 4 "Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler."

4 Anti-inflammatory drugs such as cromolyn sodium are useful as a controller drug. This drug decreases inflammation by releasing inflammatory chemicals or preventing mast cell membranes from opening when an allergen binds to immunoglobulin E. Therefore, taking a controller drug instead of the reliever drug is the reason the patient's symptoms are not relieved during an asthma attack. Adding a reliever drug to the patient's medication regimen along with the controller drug will help decrease the symptoms during an asthma attack. A regular exercise routine, proper inhaler use, and refraining from allergen exposure are general self-management tips for patients with asthma.Test-Taking Tip: Read the question stem carefully. Try to eliminate the options by first identifying the wrong option, which will help you to reduce the options. Continue to read the options once again, while recalling your knowledge about the content. One of the options may reveal a trigger to correct response.

When reviewing asthma management with an older adult patient, which topic is most important for the nurse to include? 1 Frequent peak flow assessments 2 Need to reduce strenuous exercise 3 Increased use of rescue medications 4 Correct use of controller medications

4 Correct use by older adult patients of controller medications is the most important factor in helping avoid asthma attacks. Older adult patients become less sensitive to bronchodilating medications, so increased use of rescue drugs is not effective. Older adult patients do not necessarily need to increase peak flowmeter use or to reduce strenuous exercise.Test-Taking Tip: Come to your test prep with a positive attitude about yourself, your nursing knowledge, and your test-taking abilities. A positive attitude is achieved through self-confidence gained by effective study. This means (a) answering questions (assessment), (b) organizing study time (planning), (c) reading and further study (implementation), and (d) answering questions (evaluation).

What is the primary factor responsible for the clinical manifestations of cystic fibrosis? 1 Hyperactivity of the sweat glands 2 Hypoactivity of the autonomic nervous system 3 Atrophic changes in the mucosal wall of the intestines 4 Mechanical obstruction by increased viscosity of secretions

4 Cystic fibrosis (CF) is caused by blocked chloride transport across the cell membrane, which results in the production of thick mucus secretions that can cause obstruction. It is not caused by hyperactivity of the sweat glands. The mucosal wall of the intestines does not atrophy with CF; however, there is a large volume of undigested food in the bowel from the lack of pancreatic enzymes present in the GI tract. CF pathology results in hyperactivity, not hypoactivity, of the autonomic nervous system.

Which statement should the nurse use to describe cystic fibrosis when teaching a patient about the disease? 1 Cystic fibrosis affects only the lungs. 2 Cystic fibrosis is present only in elderly people. 3 Cystic fibrosis is an autosomal dominant disorder. 4 Cystic fibrosis is associated with the formation of thick mucus.

4 Cystic fibrosis is associated with the formation of thick mucus because of poor chloride transport. Cystic fibrosis affects the lungs, pancreas, liver, salivary glands, and testes. Cystic fibrosis is present in a patient from birth. Cystic fibrosis is an autosomal recessive disorder.

What is the nurse's priority for care in the postoperative period for a patient with severe chronic obstructive pulmonary disease (COPD) who has undergone lung reduction surgery? 1 Control the patient's anxiety levels by staying away from crowds. 2 Control the patient's diet so that cough-stimulating foods are avoided. 3 Monitor the patient's weight and other indicators of nutrition such as serum albumin. 4 Monitor the patient's oxygen saturation levels continuously and use the incentive spirometer.

4 For a patient who has undergone lung reduction surgery and has severe chronic pulmonary disease, the main objective is to improve oxygen saturation, which should be continuously monitored with the incentive spirometer. Crowds are usually not an issue in the hospital setting, so anxiety related to crowds is not a concern here. Care should be taken to stay away from foods that stimulate coughing. Monitoring nutrition levels and serum albumin levels helps to prevent malnutrition, but this is not a priority over oxygenation.Test-Taking Tip: Once you have decided on an answer, look at the stem again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. If the question stem is singular, then be sure the option is singular, and the same for plural stems and plural responses. Many times, checking to make sure that the choice makes sense in relation to the stem will reveal the correct answer.

The nurse assesses a patient who has chronic obstructive pulmonary disease (COPD) 15 minutes after an aerosolized bronchodilator has been administered. Which finding prompts the nurse to notify the provider? 1 Barrel chest 2 PaCO 2 of 68 mm Hg 3 Clubbing of the fingers 4 Oxygen saturation of 87%

4 For patients with COPD, an oxygen saturation less than 88% indicates hypoxemia and should be reported. Findings of a barrel chest and clubbing of the fingers are typical of COPD and do not warrant notifying the provider since they do not improve with treatment. A PaCO 2 that is elevated is common in chronic lung disease.Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice.

Which symptom would be found in a patient with respiratory muscle fatigue? 1 Silent chest on auscultation 2 Slow breathing with deep respirations 3 Respiratory rate of 25 to 35 per minute 4 Sucked-in abdominal wall during inspiration

4 In patients with respiratory muscle fatigue, the abdominal wall is sucked in during inspiration. Patients with serious airflow obstruction or pneumothorax may have a silent chest on auscultation. Patients with respiratory muscle fatigue breathe with rapid, shallow respirations, and the respiratory rate could be as high as 40 to 50 breaths/min.

The nurse is administering oxygen to a patient with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. Which blood oxygen saturation percentage (SpO 2) would the nurse set as a target for therapy? 1 75% 2 100% 3 85% 4 90%

4 In the past, a patient with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels rose. However, recent evidence does not support this. In fact, this idea has been responsible for ineffective management of hypoxia in patients with COPD. All hypoxic patients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring SpO 2 levels up between 88% and 92%. Levels of 75% and 85% are not high enough to set as goals, and 100% is too high and may create unwanted symptoms in the COPD patient.

Which mechanism of action is accurate for ivacaftor, when used in a patient with cystic fibrosis (CF)? 1 Elimination of all mucus produced in the airways 2 Increased production of mucus in the airways of the lungs 3 Relaxation of bronchiolar smooth muscle causing bronchodilation 4 Targeted transfer of chloride ions indirectly across the cell membrane

4 Ivacaftor is a new drug in the gene therapy classification which acts on the CF transmembrane conductance regulator. This regulates transportation of the chloride ions from the cell membrane, which leads to decreased sodium and fluid absorption in the body and makes the mucus less sticky and thin. Totally eliminating the production of mucus will lead to improper functioning of the entire human body. Excess production of mucus in the airways worsens the condition of patients with CF by blocking the airway. Bronchodilator drugs used in patients with asthma cause relaxation of the smooth muscles.Test-Taking Tip: Read the question carefully before looking at the answers: (1) determine what the question is really asking; look for key words; (2) read each answer thoroughly and see if it completely covers the material asked by the question; (3) narrow the choices by immediately eliminating answers you know are incorrect.

What should a nurse advise women of childbearing age who are getting treated with macitentan for pulmonary arterial hypertension (PAH)? 1 Take measures to prevent any infections. 2 Avoid chewing, breaking, or crushing the tablet. 3 Ensure continuous and uninterrupted use of the drug. 4 Use at least two types of contraceptive methods during treatment.

4 Macitentan, an endothelin receptor antagonist drug, is used to treat pulmonary arterial hypertension (PAH). Its use is contraindicated in women as it causes birth defects if taken during pregnancy. Therefore, women should be advised to use two types of contraceptive methods to avoid pregnancy during the treatment period. The medication does not increase the risk of infection, so preventive measures are not needed. Trying to change the form of the tablet by chewing, breaking, or crushing it may change its mechanism of action. Using the drug without abrupt stopping is general advice for all medications.

A patient asks the nurse how montelukast helps asthma. What is the best response by the nurse? 1 "It is a monoclonal antibody which decreases the body's allergic response." 2 "It is a corticosteroid which decreases inflammatory and immune responses in the airways." 3 "It is a cholinergic antagonist which opens your airway and decreases lung secretions." 4 "It prevents the synthesis of leukotrienes that can cause bronchoconstriction and inflammation."

4 Montelukast, zafirlukast, and zileutin are all leukotriene modifiers, which prevent, but do not reverse, symptoms during an asthma attack. Montelukast is not a cholinergic agonist, steroid, or monoclonal antibody.Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.

A patient with asthma reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms. What does the nurse recommend for this patient? 1 Participating in a stretching and light calisthenics program 2 Avoiding aerobic exercise since it will make symptoms worse 3 Using oral corticosteroids to prevent severe asthma symptoms 4 Premedicating with a short-acting bronchodilator before exercise

4 Patients who have asthma should be encouraged to participate in aerobic exercise to maintain cardiac health, enhance skeletal muscle strength, and promote ventilation and perfusion. If exercise triggers asthma symptoms, a short-acting beta-adrenergic (SABA) medication used before exercise can help prevent symptoms. Patients should not be told to avoid aerobic exercise. Oral steroids are not recommended to prevent symptoms.Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.

The nurse is teaching a patient who has chronic obstructive pulmonary disease (COPD) about the need to prevent respiratory infections. Which topic does the nurse include in the patient's teaching? 1 Consuming a well-balanced diet 2 Reporting runny nose and cough 3 Avoiding exposure to cold weather 4 Getting an annual influenza vaccine

4 Patients with COPD should remain free from serious respiratory infection and all patients with this disorder are strongly encouraged to receive the pneumococcal vaccine and an annual influenza vaccine. Exposure to cold weather is not a risk factor. Although a well-balanced diet is recommended, it does not directly prevent respiratory infections. Early reporting of symptoms is not a preventive measure.Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or responses that appear to be degrading.

Which individual does the nurse identify as being more likely to have primary pulmonary arterial hypertension? 1 A male child of 10 years 2 An adult male of 40 years 3 A female child of 14 years 4 An adult woman of 30 years

4 Primary pulmonary arterial hypertension is common in women between the ages of 20 and 40 years. Therefore, an adult woman of 30 years is most likely to have primary pulmonary arterial hypertension. A male child of 10 years, an adult male of 40 years, and a female child of 14 years are less likely to have primary pulmonary arterial hypertension.

A patient who has a history of asthma is prescribed a medicine to prevent further asthma attacks. Which statement made by the patient indicates ineffective learning about how to use the medication? 1 "I should shake the inhaler well before I use it." 2 "I should be careful to not spray the inhaler near my eyes." 3 "I should use the inhaler daily even if I have no symptoms." 4 "I should use the inhaler only when I have an asthma attack."

4 The drug used to prevent asthma attacks is a long-acting beta 2 agonist, which causes bronchodilation by relaxing the bronchodilator muscles upon binding to the pulmonary beta 2 receptors. The onset of the action of the drug is slow, so it should not be taken during an acute asthma attack since it will not relieve the symptoms. The inhaler should be shaken well before use of the drug because it separates easily. The inhaler should not be sprayed near or into the eyes because this could cause serious irritation or damage. The long-term action of the drug can only be observed after consistent daily use, as prescribed by the primary health care provider.Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.

A patient reports breathing difficulty and fatigue at rest. After assessing the patient and reviewing the diagnostic reports, the nurse finds dependent edema, engorged neck veins, and enlarged liver. Which class of primary pulmonary arterial hypertension does the nurse categorize this patient in? 1 Class I 2 Class II 3 Class III 4 Class IV

4 The manifestations of class IV primary pulmonary arterial hypertension are presence of dyspnea or breathing difficulties and fatigue at rest. Right-sided heart failure is apparent, which includes dependent edema, engorged neck veins, and enlarged liver. The manifestation of class I primary pulmonary arterial hypertension is pulmonary hypertension diagnosed by pulmonary function tests and right-sided cardiac catheterization. The manifestations of class II primary pulmonary arterial hypertension are dyspnea and fatigue during mild activity. The manifestations of class III primary pulmonary arterial hypertension are dyspnea and fatigue during less-than-ordinary activities.

What best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease? 1 Genetic variation in the gene that controls the normal synthesis and activity of beta-adrenergic receptors 2 Chronic yet usually intermittent body response that can lead to night time awakening with respiratory symptoms 3 Collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures 4 Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

4 Two processes are potentially involved in the pathophysiology of asthma: inflammation and airway hyperresponsiveness that leads to bronchoconstriction. Inflammation obstructs the internal aspect of the airways; constriction of the smooth muscle during hyperresponsiveness narrows the airways. Knowledge is being gained regarding the role of genetics in asthma; genetic variation is known to alter the response of beta-adrenergic receptors to treatment, but not pathophysiology of the disease process. People with asthma can experience nighttime awakenings with respiratory symptoms; however, this is not yet fully understood as part of the pathophysiology of the disease itself. The collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures describes emphysema.

A female patient with pulmonary arterial hypertension is prescribed iloprost. What instructions given by the nurse would be appropriate for the patient? Select all that apply. 1 "Take the medicine with a glass of water." 2 "Be alert for the side effects of the steroid therapy." 3 "Avoid drinking alcoholic beverages while taking the drug." 4 "Notify the pulmonologist at the first manifestation of any infection." 5 "Use strict aseptic technique in all aspects of using the drug delivery system."

4,5 Iloprost is a prostacyclin agent that is infused by intravenous administration. The patient should notify the pulmonologist at the first manifestation of any infection, which will help provide early treatment that will decrease the morbidity of the patient. The patient should use strict aseptic technique in all aspects of drug delivery system to prevent infection. Iloprost is not an orally administered drug; therefore, instructing the patient to take the medicine with water is not applicable. Instructing the patient about side effects of steroid therapy would not be helpful because iloprost is a vasodilating agent. A patient who is prescribed macitentan will be instructed to avoid drinking alcoholic beverages and use at least two reliable methods of contraception because it may cause birth defects.

The nurse is educating the parents of a child about asthma management. The asthma is often triggered by exercise. What statements of the parents indicate a need for further teaching? Select all that apply. 1 "Our child will not eat food containing metabisulfite." 2 "If our child's lips or fingertips turn gray, we will go to the hospital." 3 "Our child should not take aspirin, ibuprofen, acebutolol, or betaxolol unless recommended by our health care provider." 4 "After 30 minutes of exercise, our child will use the bronchodilator." 5 "We will wash all our child's bedding in cold water."

4,5 The patient should use a bronchodilator inhaler 30 minutes before, not after, exercise to prevent or reduce bronchospasm. The family should wash the child's bedding in hot, not cold, water to get rid of any dust mites. The other statements indicate understanding. The patient should not eat food prepared with metabisulfite, because it is found to trigger asthma attacks. If the parents notice any graying of lips or fingertips, they should immediately seek emergency care for the patient. Nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin and ibuprofen should be avoided, and the parents should not give the patient beta-blockers such as acebutolol and betaxolol to avoid complications.

The patient says, "I hate this stupid COPD." What is the best response by the nurse? 1 "You will get used to it." 2 "What is bothering you?" 3 "Why do you feel this way?" 4 "Then you need to stop smoking."

Encourage the patient and the family to express their feelings about limitations on their lifestyle and about disease progression. This is not the time to lecture the patient regarding his smoking habits; the patient is expressing a need for support. "Why" questions can seem accusatory and may make a patient less likely to talk about what he or she is feeling. The patient's feelings should never be minimized.