Obstructive Pulmonary Diseases

23. A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask? "Are you claustrophobic?" "Are you allergic to shellfish?" "Have you taken any bronchodilators today?" "Do you have any metal implants or prostheses?"

"Have you taken any bronchodilators today?"

28. The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? "I will drink lots of fluids with my meals." "I can have ice cream as a snack every day." "I will exercise for 15 minutes before meals." "I will decrease my intake of meat and poultry."

"I can have ice cream as a snack every day."

29. Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? "Avoid upper body exercise to prevent dyspnea." "Stop exercising if you start to feel short of breath." "Use the bronchodilator before you start to exercise." "Breathe in and out through the mouth while you exercise."

"Use the bronchodilator before you start to exercise."

26. A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering getting married and wondering about having children. Which initial response by the nurse is best? "Are you aware of the normal lifespan for patients with CF?" "Would like more information to help you with that decision?" "Many women with CF do not have difficulty conceiving children." "You will need to have genetic counseling before making a decision."

"Would like more information to help you with that decision?"

42. The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? A patient with loud expiratory wheezes A patient with a respiratory rate of 38 breaths/min A patient who has a cough productive of thick, green mucus A patient with jugular venous distention and peripheral edema

A patient with a respiratory rate of 38 breaths/min

6. A patient seen in the asthma clinic has recorded daily peak flow rates that are 75% of the baseline. Which action will the nurse plan to take next? Increase the dose of the leukotriene inhibitor. Teach the patient about the use of oral corticosteroids. Administer a bronchodilator and recheck the peak flow. Instruct the patient to keep the scheduled follow-up appointment.

Administer a bronchodilator and recheck the peak flow.

21. A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which nursing diagnosis is most appropriate? Complicated grieving related to expectation of death Chronic low self-esteem related to physical dependence Ineffective coping related to unknown outcome of illness Deficient knowledge related to lack of education about COPD

Chronic low self-esteem related to physical dependence

43. Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? Cough productive of bloody, purulent mucus Scattered crackles and wheezes heard bilaterally Complaint of sharp chest pain with deep breathing Respiratory rate 28 breaths/minute while ambulating

Cough productive of bloody, purulent mucus

22. A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient's ventilation? Have the patient rest in bed with the head elevated to 15 to 20 degrees. Encourage the patient to sit up at the bedside in a chair and lean forward. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed. Place the patient in the Trendelenburg position with pillows behind the head.

Encourage the patient to sit up at the bedside in a chair and lean forward.

37. Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? Pain at injection site Flushing and dizziness Peak flow reading 75% of normal Respiratory rate 24 breaths/minute

Flushing and dizziness

19. Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? Schedule the procedure 1 hour after the patient eats. Maintain the patient in the lateral position for 20 minutes. Give the prescribed albuterol (Ventolin HFA) before the therapy. Perform percussion before assisting the patient to the drainage position.

Give the prescribed albuterol (Ventolin HFA) before the therapy.

25. A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate? Teach the patient signs of hypoglycemia. Have the patient add dietary salt to meals. Suggest decreasing intake of dietary fat and calories. Instruct the patient about pancreatic enzyme replacements.

Have the patient add dietary salt to meals.

40. The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action should the nurse take first? Tell the patient to go to the hospital emergency department. Instruct the patient to use the prescribed albuterol (Ventolin HFA). Ask about recent exposure to any new allergens or asthma triggers. Question the patient about use of the prescribed inhaled corticosteroids.

Instruct the patient to use the prescribed albuterol (Ventolin HFA).

18. A patient is receiving 35% O2 via a Venturi mask. To ensure the correct amount of O2 delivery, which action by the nurse is important? Teach the patient to keep the mask on during meals. Keep the air entrainment ports clean and unobstructed. Give a high enough flow rate to keep the bag from collapsing. Drain moisture condensation from the corrugated tubing every hour.

Keep the air entrainment ports clean and unobstructed.

36. A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first? Listen to the patient's breath sounds. Ask about inhaled corticosteroid use. Determine when the dyspnea started. Obtain the forced expiratory volume (FEV) flow rate.

Listen to the patient's breath sounds.

16. The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flow rate? Minimize O2 use to avoid O2 dependency. Maintain the pulse oximetry level at 90% or greater. Administer O2 according to the patient's level of dyspnea. Avoid administration of O2 at a rate of more than 2 L/min.

Maintain the pulse oximetry level at 90% or greater.

41. The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first? Methylprednisolone (Solu-Medrol) 60 mg IV Albuterol (Ventolin HFA) 2.5 mg per nebulizer Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) Ipratropium (Atrovent) 2 puffs per metered-dose inhaler (MDI)

Methylprednisolone (Solu-Medrol) 60 mg IV

35. A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? Notify the health care provider. Document changes in respiratory status. Encourage the patient to cough and deep breathe. Administer IV methylprednisolone (Solu-Medrol).

Notify the health care provider.

5. The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? No wheezes are audible. O2 saturation is >90%. Accessory muscle use has decreased. Respiratory rate is 16 breaths/minute.

O2 saturation is >90%.

17. A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching? Travel is not possible with the use of O2 devices. O2 flow should be increased if the patient has more dyspnea. O2 use can improve the patient's prognosis and quality of life. Storage of O2 requires large metals tanks that each last 4 to 6 hours.

O2 use can improve the patient's prognosis and quality of life.

39. Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? Obtain O2 saturation using pulse oximetry. Monitor for increased O2 need with exercise. Teach the patient about safe use of O2 at home. Adjust O2 to keep saturation in prescribed parameters.

Obtain O2 saturation using pulse oximetry.

11. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? Encourage increased intake of whole grains. Increase the patient's intake of fruits and fruit juices. Offer high-calorie protein snacks between meals and at bedtime. Assist the patient in choosing foods with high vegetable content.

Offer high-calorie protein snacks between meals and at bedtime.

24. A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care? Schedule a sweat chloride test. Arrange for a hospice nurse visit. Place the patient on a low-sodium diet. Perform chest physiotherapy every 4 hours.

Perform chest physiotherapy every 4 hours.

15. The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? Chest pain Finger clubbing Peripheral edema Elevated temperature

Peripheral edema

14. Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? Even, unlabored respirations Pulse oximetry reading of 92% c. Absence of wheezes or crackles d. Respiratory rate of 18 breaths/min

Pulse oximetry reading of 92%

33. A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/dL. Which nursing action will the nurse plan to implement? Discuss the role of diet in blood glucose control. Evaluate the patient's use of pancreatic enzymes. Teach the patient about administration of insulin. Give oral hypoglycemic medications before meals.

Teach the patient about administration of insulin.

10. The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety? Titrate O2 to keep saturation at least 90%. Teach the patient how to use pursed-lip breathing. Discuss a high-protein, high-calorie diet with the patient. Suggest the use of over-the-counter sedative medications.

Teach the patient how to use pursed-lip breathing.

27. A patient with chronic obstructive pulmonary disease (COPD) has coarse crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? Change the O2 flow rate to the highest prescribed rate. Teach the patient to use the Flutter airway clearance device. Reinforce the ongoing use of pursed-lip breathing techniques. Teach the patient about consistent use of inhaled corticosteroids.

Teach the patient to use the Flutter airway clearance device.

13. The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? The patient inhales slowly through the nose. The patient puffs up the cheeks while exhaling. The patient practices by blowing through a straw. The patient's ratio of inhalation to exhalation is 1:3.

The patient puffs up the cheeks while exhaling.

1. The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? The patient shakes the device before use. The patient rapidly inhales the medication. The patient attaches a spacer to the Diskus. The patient performs huff coughing after inhalation.

The patient rapidly inhales the medication.

2. The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching? The patient attaches a spacer before using the inhaler. The patient coughs vigorously after using the inhaler. The patient removes the facial mask when misting stops. The patient activates the inhaler at the onset of expiration.

The patient removes the facial mask when misting stops.

12. The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis? The patient tells the nurse about a family history of bronchitis. The patient indicates a 30 pack-year cigarette smoking history. The patient reports a productive cough for 3 months every winter. The patient denies having respiratory problems until the past 12 months.

The patient reports a productive cough for 3 months every winter.

9. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline? The patient reports a recent 15-lb weight gain. The patient denies shortness of breath at present. The patient takes cimetidine (Tagamet HB) daily. d. The patient complains of coughing up green mucus.

The patient takes cimetidine (Tagamet HB) daily.

31. The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? The patient has chronic inflammatory bowel disease. The patient has a history of pneumonia 6 months ago. The patient takes propranolol (Inderal) for hypertension. The patient uses acetaminophen (Tylenol) for headaches.

The patient takes propranolol (Inderal) for hypertension.

7. The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? The patient inhales rapidly through the peak flow meter mouthpiece. The patient takes montelukast (Singulair) for peak flows in the red zone. The patient calls the health care provider when the peak flow is in the green zone. The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.

The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.

30. The nurse completes an admission assessment on a patient with asthma. Which information given by patient is indicates a need for a change in therapy? The patient uses albuterol (Ventolin HFA) before aerobic exercise. The patient says that the asthma symptoms are worse every spring. The patient's heart rate increases after using the albuterol (Ventolin HFA) inhaler. The patient's only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).

The patient's only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).

4. Which information will the nurse include in the asthma teaching plan for a patient being discharged? Use the inhaled corticosteroid when shortness of breath occurs. Inhale slowly and deeply when using the dry powder inhaler (DPI). Hold your breath for 5 seconds after using the bronchodilator inhaler. Tremors are an expected side effect of rapidly acting bronchodilators.

Tremors are an expected side effect of rapidly acting bronchodilators.

34. The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? Pulse oximetry reading of 91% Respiratory rate of 26 breaths/min Use of accessory muscles in breathing Peak expiratory flow rate of 240 L/min

Use of accessory muscles in breathing

20. The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care? Stop exercising when you feel short of breath. Walk until pulse rate exceeds 130 beats/minute. Limit exercise to activities of daily living (ADLs). Walk 15 to 20 minutes a day at least 3 times/week.

Walk 15 to 20 minutes a day at least 3 times/week.

3. A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure? Give the rescue medication immediately before testing. Administer oral corticosteroids 2 hours before the procedure. Withhold bronchodilators for 6 to 12 hours before the examination. Ensure that the patient has been NPO for several hours before the test.

Withhold bronchodilators for 6 to 12 hours before the examination.

26. The nurse instructs a client on the steps needed to obtain a peak expiratory flow rate. In which order should these steps occur? 1. Take as deep a breath as possible. 2. Stand up (unless you have a physical disability). 3. Place the meter in your mouth, and close your lips around the mouthpiece. 4. Make sure the device reads zero or is at base level. 5. Blow out as hard and as fast as possible for 1 to 2 seconds. 6. Write down the value obtained. 7. Repeat the process two additional times, and record the highest number in your chart. a. 4, 2, 1, 3, 5, 6, 7 b. 3, 4, 1, 2, 5, 7, 6 c. 2, 1, 3, 4, 5, 6, 7 d. 1, 3, 2, 5, 6, 7, 4

a. 4, 2, 1, 3, 5, 6, 7

6. A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secretions. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Ask the client to drink 2 liters of fluids daily. b. Add humidity to the prescribed oxygen. c. Suction the client every 2 to 3 hours. d. Use a vibrating positive expiratory pressure device. e. Encourage diaphragmatic breathing.

a. Ask the client to drink 2 liters of fluids daily. b. Add humidity to the prescribed oxygen. d. Use a vibrating positive expiratory pressure device.

3. A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition should the nurse include in this clients teaching? (Select all that apply.) a. Avoid drinking fluids just before and during meals. b. Rest before meals if you have dyspnea. c. Have about six small meals a day. d. Eat high-fiber foods to promote gastric emptying. e. Increase carbohydrate intake for energy.

a. Avoid drinking fluids just before and during meals. b. Rest before meals if you have dyspnea. c. Have about six small meals a day.

11. A nurse assesses a client who is prescribed fluticasone (Flovent) and notes oral lesions. Which action should the nurse take? a. Encourage oral rinsing after fluticasone administration. b. Obtain an oral specimen for culture and sensitivity. c. Start the client on a broad-spectrum antibiotic. d. Document the finding as a known side effect.

a. Encourage oral rinsing after fluticasone administration.

15. A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process should the nurse correlate with this clients history and clinical manifestations? a. Increased pulmonary pressure creating a higher workload on the right side of the heart b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles c. Increased number and size of mucus glands producing large amounts of thick mucus d. Left ventricular hypertrophy creating a decrease in cardiac output

a. Increased pulmonary pressure creating a higher workload on the right side of the heart

8. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). The nurse should plan to teach the patient about a1-antitrypsin testing leukotriene modifiers. use of the nicotine patch. continuous pulse oximetry.

a1-antitrypsin testing

18. A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? a. A 46-year-old with a 30pack-year history of smoking b. A 52-year-old in a tripod position using accessory muscles to breathe c. A 68-year-old who has dependent edema and clubbed fingers d. A 74-year-old with a chronic cough and thick, tenacious secretions

b. A 52-year-old in a tripod position using accessory muscles to breathe

2. A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first? a. Review the clients pulmonary function test results. b. Ask about medications the client is currently taking. c. Assess how frequently the client uses a bronchodilator. d. Consult the provider and request arterial blood gases.

b. Ask about medications the client is currently taking.

23. A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication? a. Bronchodilator Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators b. Cholinergic antagonist Causes bronchodilation by inhibiting the parasympathetic nervous system c. Corticosteroid Relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors d. Cromone Disrupts the production of pathways of inflammatory mediators

b. Cholinergic antagonist Causes bronchodilation by inhibiting the parasympathetic nervous system

10. While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the lower chest tube is dislodged. Which action should the nurse take first? a. Assess for drainage from the site. b. Cover the insertion site with sterile gauze. c. Contact the provider and obtain a suture kit. d. Reinsert the tube using sterile technique.

b. Cover the insertion site with sterile gauze.

4. A nurse assesses a client with chronic obstructive pulmonary disease. Which questions should the nurse ask to determine the clients activity tolerance? (Select all that apply.) a. What color is your sputum? b. Do you have any difficulty sleeping? c. How long does it take to perform your morning routine? d. Do you walk upstairs every day? e. Have you lost any weight lately?

b. Do you have any difficulty sleeping? c. How long does it take to perform your morning routine? e. Have you lost any weight lately?

4. After teaching a client how to perform diaphragmatic breathing, the nurse assesses the clients understanding. Which action demonstrates that the client correctly understands the teaching? a. The client lays on his or her side with his or her knees bent. b. The client places his or her hands on his or her abdomen. c. The client lays in a prone position with his or her legs straight. d. The client places his or her hands above his or her head.

b. The client places his or her hands on his or her abdomen.

5. A nurse assesses a client who has a chest tube. For which manifestations should the nurse immediately intervene? (Select all that apply.) a. Production of pink sputum b. Tracheal deviation c. Sudden onset of shortness of breath d. Pain at insertion site e. Drainage of 75 mL/hr

b. Tracheal deviation c. Sudden onset of shortness of breath

2. A nurse assesses a client who has a mediastinal chest tube. Which symptoms require the nurses immediate intervention? (Select all that apply.) a. Production of pink sputum b. Tracheal deviation c. Pain at insertion site d. Sudden onset of shortness of breath e. Drainage greater than 70 mL/hr f. Disconnection at Y site

b. Tracheal deviation d. Sudden onset of shortness of breath e. Drainage greater than 70 mL/hr f. Disconnection at Y site

27. The nurse instructs a client on how to correctly use an inhaler with a spacer. In which order should these steps occur? 1. Press down firmly on the canister to release one dose of medication. 2. Breathe in slowly and deeply. 3. Shake the whole unit vigorously three or four times. 4. Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. 5. Place the mouthpiece into your mouth, over the tongue, and seal your lips tightly around the mouthpiece. 6. Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds. a. 2, 3, 4, 5, 6, 1 b. 3, 4, 5, 1, 6, 2 c. 4, 3, 5, 1, 2, 6 d. 5, 3, 6, 1, 2, 4

c. 4, 3, 5, 1, 2, 6

1. A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take? (Select all that apply.) a. Administer prescribed salmeterol (Serevent) inhaler. b. Assess the client for a tracheal deviation. c. Administer oxygen to keep saturations greater than 94%. d. Perform peak expiratory flow readings. e. Administer prescribed albuterol (Proventil) inhaler.

c. Administer oxygen to keep saturations greater than 94%. e. Administer prescribed albuterol (Proventil) inhaler.

16. A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and disheveled. Which question should the nurse ask first? a. Do you have a strong support system? b. What do you understand about your disease? c. Do you experience shortness of breath with basic activities? d. What medications are you prescribed to take each day?

c. Do you experience shortness of breath with basic activities?

19. The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home. Which statement indicates the client correctly understands the teaching? a. I plan to wear my oxygen when I exercise and feel short of breath. b. I will use my portable oxygen when grilling burgers in the backyard. c. I plan to use cotton balls to cushion the oxygen tubing on my ears. d. I will only smoke while I am wearing my oxygen via nasal cannula.

c. I plan to use cotton balls to cushion the oxygen tubing on my ears.

3. After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the clients understanding. Which statement indicates the client comprehends the teaching? a. I will carry this medication with me at all times in case I need it. b. I will take this medication when I start to experience an asthma attack. c. I will take this medication every morning to help prevent an acute attack. d. I will be weaned off this medication when I no longer need it.

c. I will take this medication every morning to help prevent an acute attack.

7. After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. I will be certain to shake the inhaler well before I use it. b. It may take a while before I notice a change in my asthma. c. I will use the drug when I have an asthma attack. d. I will be careful not to let the drug escape out of my nose and mouth.

c. I will use the drug when I have an asthma attack.

6. The nurse is caring for a client with lung cancer who states, I dont want any pain medication because I am afraid Ill become addicted. How should the nurse respond? a. I will ask the provider to change your medication to a drug that is less potent. b. Would you like me to use music therapy to distract you from your pain? c. It is unlikely you will become addicted when taking medicine for pain. d. Would you like me to give you acetaminophen (Tylenol) instead?

c. It is unlikely you will become addicted when taking medicine for pain.

5. A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection should the nurse provide for this client? a. Spaghetti with meat sauce, ice cream b. Chicken soup, grilled cheese sandwich c. Omelet, soft whole wheat bread d. Pasta salad, custard, orange juice

c. Omelet, soft whole wheat bread

8. A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond? a. There are a variety of support groups for people who have COPD. b. I will ask your provider to prescribe you with an antianxiety agent. c. Share any thoughts and feelings that cause you to limit social activities. d. Friends can be a good support system for clients with chronic disorders.

c. Share any thoughts and feelings that cause you to limit social activities.

21. A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, What does this mean? How should the nurse respond? a. Your children will be at high risk for the development of chronic obstructive pulmonary disease. b. I will contact a genetic counselor to discuss your condition. c. Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke. d. This is a recessive gene and should have no impact on your health.

c. Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke.

32. A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? a. use of long-acting B-adrenergic medications b. side effectics of sustained-release theophylline c. self-administration of inhaled corticosteroids d. complications associated with O2 therapy

c. self-administration of inhaled corticosteroids

1. A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first? a. A 66-year-old client with a barrel chest and clubbed fingernails b. A 48-year-old client with an oxygen saturation level of 92% at rest c. A 35-year-old client who has a longer expiratory phase than inspiratory phase d. A 27-year-old client with a heart rate of 120 beats/min

d. A 27-year-old client with a heart rate of 120 beats/min

13. A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. Which action should the nurse take? a. Ambulate the client in the hallway to promote deep breathing. b. Auscultate the clients anterior and posterior lung fields. c. Encourage the client to take shallow breaths to help with the pain. d. Administer pain medication and encourage the client to take deep breaths.

d. Administer pain medication and encourage the client to take deep breaths.

28. A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic obstructive pulmonary disease (COPD): Arterial Blood Gas Results Vital SignspH = 7.32 PaCO2 = 62 mm Hg PaO2 = 46 mm HgHCO3 = 28 mEq/L Heart rate = 110 beats/min Respiratory rate = 12 breaths/min Blood pressure = 145/65 mm Hg Oxygen saturation = 76% Which action should the nurse take first? a. Administer a short-acting beta2 agonist inhaler. b. Document the findings as normal for a client with COPD. c. Teach the client diaphragmatic breathing techniques. d. Initiate oxygenation therapy to increase saturation to 92%.

d. Initiate oxygenation therapy to increase saturation to 92%.

17. The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, The medication is too expensive to use every day. I only use my inhaler when I have an attack. How should the nurse respond? a. You are using the inhaler incorrectly. This medication should be taken daily. b. If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks. c. Tell me more about your fears related to feelings of breathlessness. d. It is important to use this type of inhaler every day. Lets identify potential community services to help you.

d. It is important to use this type of inhaler every day. Lets identify potential community services to help you.

20. A nurse cares for a client who has a pleural chest tube. Which action should the nurse take to ensure safe use of this equipment? a. Strip the tubing to minimize clot formation and ensure patency. b. Secure tubing junctions with clamps to prevent accidental disconnections. c. Connect the chest tube to wall suction at the level prescribed by the provider. d. Keep padded clamps at the bedside for use if the drainage system is interrupted.

d. Keep padded clamps at the bedside for use if the drainage system is interrupted.

14. A nurse cares for a client who has a chest tube. When would this client be at highest risk for developing a pneumothorax? a. When the insertion site becomes red and warm to the touch b. When the tube drainage decreases and becomes sanguineous c. When the client experiences pain at the insertion site d. When the tube becomes disconnected from the drainage system

d. When the tube becomes disconnected from the drainage system

38. The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse? pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg