respiratory exam practice questions

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A child attending day camp has asthma, and her parent sent with her all of medicine in a small carry bag. The child has an asthma attack that is severe enough to warrant a rescue drug. Which medication from the child's bag is best to use for the acute symptoms? a. Omalizumab b. Fluticasone c. Salmeterol d. albuterol

d. albuterol

5. A nurse is providing care after auscultating clients' breath sounds. Which assessment finding is correctly matched to the nurse's primary intervention? a. Hollow sounds are heard over the trachea. - The nurse increases the oxygen flow rate. b. Crackles are heard in bases. - The nurse encourages the client to cough forcefully. c. Wheezes are heard in central areas. - The nurse administers an inhaled bronchodilator. d. Vesicular sounds are heard over the periphery. - The nurse has the client breathe

deeply. ANS: C Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages. Hollow sounds are typically heard over the trachea, and no intervention is necessary. If crackles are heard, the client may need a diuretic. Crackles represent a deep interstitial process, and coughing forcefully will not help the client expectorate secretions. Vesicular sounds heard in the periphery are normal and require no intervention. DIF: Applying/Application REF: 506 KEY: Assessment/diagnostic examination MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

8. A nurse is caring for a client who is scheduled to undergo a thoracentesis. Which intervention should the nurse complete prior to the procedure? a. Measure oxygen saturation before and after a 12-minute walk. b. Verify that the client understands all possible complications. c. Explain the procedure in detail to the client and the family. d. Validate that informed consent has been given by the client

. ANS: D A thoracentesis is an invasive procedure with many potentially serious complications. Verifying that the client understands complications and explaining the procedure to be performed will be done by the physician or nurse practitioner, not the nurse. Measurement of oxygen saturation before and after a 12-minute walk is not a procedure unique to a thoracentesis. DIF: Applying/Application REF: 511 KEY: Assessment/diagnostic examination MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse assesses a 66-year-old client who is attempting to quit smoking. The client states, "I started smoking at age 16, and smoked one pack each day until 10 years ago. Then I decreased to a half of a pack per day." How many pack-years should the nurse document for this client? (Record your answer using a whole number.) ___ pack-years

45 pack-years 66 (current age) - 16 (year started smoking) = 50 years of smoking. (40 years ´ 1 pack per day) + (10 years ´ 0.5 pack per day) = 45 pack-years.

A client diagnosed with TB is currently taking combination drug therapy. The nurse should immediately intervene if the client makes which statement? A I will take these medications for 6-12 months as prescribed B I will still beable to go out to the bar with my friends every saturday night C Taking this combination of drugs helps prevent drug-resistant organisms D I will need to tak a B-complex vitamin while taking these drugs

7. 7. People involved in which occupations or activities are encouraged to wear masks and to have adequate ventilations? Select all that apply. A. Bakers B. Coal miners C. Electricians D. Furniture refinishers E. Plumbers F. Potters

A, B, D, F

Which of the components of a client's family history are of particular importance to the home health nurse who is assessing a new client with asthma? A. Brother is allergic to peanuts. B. Father is obese. C. Mother is diabetic. D. Sister is pregnant.

A. Brother is allergic to peanuts. Correct: Clients with asthma often have a family history of allergies. It will be important to assess whether this client has any allergies that may serve as triggers for an asthma attack.

Select all that apply The nurse is teaching a client with Influenza A about how to limit transmission.Which statements indicate teaching is successful? A I will wash my hands every time I blow my nose or sneeze B I will not go around people that smoke C I will try to sneeze into my upper sleeve instead of my hands D I will avoid large crowds, including staying home from work

A, C, D

A client with asthma reports shortness of breath. What is the nurse assessing when auscultating this client's chest? A. Adventitious breath sounds B. Fremitus C. Oxygenation status D. Respiratory excursion

A. Adventitious breath sounds Correct: Adventitious sounds are additional breath sounds superimposed on normal sounds. They indicate pathologic changes in the lung.

Four clients are sent back to the emergency department from triage at the same time. Which client requires the nurse's immediate attention? A. Client with acute allergic reaction B. Client with dyspnea on exertion C. Client with lung cancer with cough D. Client with sinus infection with fever

A. Client with acute allergic reaction Correct: An acute allergic reaction can lead to immediate respiratory distress. This is an emergent situation that requires the immediate attention of the nurse.

The RN has received report about all of these clients. Which client needs the most immediate assessment? A. Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry B. Client admitted 3 hours ago for a scheduled thoracentesis in 30 minutes C. Client with bronchogenic lung cancer who returned from bronchoscopy 3 hours ago D. Client with pleural effusion who has decreased breath sounds at the right base

A. Client with acute asthma who has an oxygen saturation of 89% by pulse oximetry Correct: An oxygen saturation level less than 91% indicates hypoxemia and requires immediate assessment and intervention to improve blood and tissue oxygenation.

The nurse auscultates popping, discontinuous sounds over the client's anterior chest. How does the nurse classify these sounds? A. Crackles B. Rhonchi C. Pleural friction rub D. Wheeze

A. Crackles Correct: Crackles are described as a popping, discontinuous sound caused by air moving into previously deflated airways. The airways have been deflated due to the presence of fluids in the lungs, and crackles should be considered to be a sign of fluid overload.

A client is admitted to the medical floor with a new diagnosis of lung cancer. How can the nurse assist the client initially with the anxiety associated with the new diagnosis? A. Encourage client to ask questions and verbalize concerns. B. Leave client alone to deal with his own feelings. C. Medicate client with diazepam (Valium) for anxiety every 8 hours. D. Provide journals about cancer treatment.

A. Encourage client to ask questions and verbalize concerns. Correct: Anxiety causes increased oxygen consumption. Oxygen availability is limited in lung cancer. The availability of the nurse to answer questions and listen to the client's concerns will decrease anxiety.

SHORT ANSWER 1. A nurse assesses a 66-year-old client who is attempting to quit smoking. The client states, "I started smoking at age 16, and smoked one pack each day until 10 years ago. Then I decreased to a half of a pack per day." How many pack-years should the nurse document for this client? (Record your answer using a whole number.) ___ pack-years

ANS: 45 pack-years 66 (current age) - 16 (year started smoking) = 50 years of smoking. (40 years × 1 pack per day) + (10 years × 0.5 pack per day) = 45 pack-years. DIF: Applying/Application REF: 495 KEY: Smoking cessation MSC: IntegratedProcess:NursingProcess:Assessment NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse plans care for a client who is experiencing dyspnea and must stop multiple times when climbing a flight of stairs. Which intervention should the nurse include in this client's plan of care? a. Assistance with activities of daily living b. Physical therapy activities every day c. Oxygen therapy at 2 liters per nasal cannula d. Complete bedrest with frequent repositioning

11. A nurse plans care for a client who is experiencing dyspnea and must stop multiple times when climbing a flight of stairs. Which intervention should the nurse include in this client's plan of care? a. Assistance with activities of daily living b. Physical therapy activities every day c. Oxygen therapy at 2 liters per nasal cannula d. Complete bedrest with frequent repositioning

ANS: A A client with dyspnea and difficulty completing activities such as climbing a flight of stairs has class III dyspnea. The nurse should provide assistance with activities of daily living. These clients should be encouraged to participate in activities as tolerated. They should not be on complete bedrest, may not be able to tolerate daily physical therapy, and only need oxygen if hypoxia is present. DIF: Applying/Application REF: 503 KEY: Respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

A nurse auscultates a harsh hollow sound over a client's trachea and larynx. Which action should the nurse take first? a. Document the findings. b. Administer oxygen therapy. c. Position the client in high-Fowler's position. d. Administer prescribed albuterol.

14. A nurse auscultates a harsh hollow sound over a client's trachea and larynx. Which action should the nurse take first? a. Document the findings. b. Administer oxygen therapy. c. Position the client in high-Fowler's position. d. Administer prescribed albuterol.

ANS: A Bronchial breath sounds, including harsh, hollow, tubular, and blowing sounds, are a normal finding over the trachea and larynx. The nurse should document this finding. There is no need to implement oxygen therapy, administer albuterol, or change the client's position because the finding is normal. DIF: Remembering/Knowledge REF: 506 KEY: Assessment/diagnostic examination MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

A nurse plans care for a client who is at high risk for a pulmonary infection. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Encourage deep breathing and coughing. b. Implement an air mattress overlay. c. Ambulate the client three times each day. d. Provide a diet high in protein and vitamins. e. Administer acetaminophen (Tylenol) twice daily.

2. A nurse plans care for a client who is at high risk for a pulmonary infection. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Encourage deep breathing and coughing. b. Implement an air mattress overlay. c. Ambulate the client three times each day. d. Provide a diet high in protein and vitamins. e. Administer acetaminophen (Tylenol) twice daily.

ANS: A, C, D Regular pulmonary hygiene and activities to maintain health and fitness help to maximize functioning of the respiratory system and prevent infection. A client at high risk for a pulmonary infection may need a specialty bed to help with postural drainage or percussion; this would not include an air mattress overlay, which is used to prevent pressure ulcers. Tylenol would not decrease the risk of a pulmonary infection. DIF: Applying/Application REF: 501 KEY: Respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

MULTIPLE RESPONSE 1. A nurse assesses a client who is prescribed varenicline (Chantix) for smoking cessation. Which manifestations should the nurse identify as adverse effects of this medication? (Select all that apply.) a. Visual hallucinations b. Tachycardia c. Decreased cravings d. Impaired judgment e. Increased thirst

ANS: A, D Varenicline (Chantix) has a black box warning stating that the drug can cause manic behavior and hallucinations. The nurse should assess for changes in behavior and thought processes, including impaired judgment and visual hallucinations. Tachycardia and increased thirst are not adverse effects of this medication. Decreased cravings is a therapeutic response to this medication. DIF: Understanding/Comprehension REF: 496 KEY: Medication| smoking cessation MSC: Integrated Process: Nursing Process: Analysis NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse assesses a client who is prescribed varenicline (Chantix) for smoking cessation. Which manifestations should the nurse identify as adverse effects of this medication? (Select all that apply.) a. Visual hallucinations b. Tachycardia c. Decreased cravings d. Impaired judgment e. Increased thirst

While obtaining a client's health history, the client states, "I am allergic to avocados." Which responses by the nurse are best? (Select all that apply.) a. "What response do you have when you eat avocados?" b. "I will remove any avocados that are on your lunch tray." c. "When was the last time you ate foods containing avocados?" d. "I will document this in your record so all of your providers will know." e. "Have you ever been treated for this allergic reaction?"

3. While obtaining a client's health history, the client states, "I am allergic to avocados." Which responses by the nurse are best? (Select all that apply.) a. "What response do you have when you eat avocados?" b. "I will remove any avocados that are on your lunch tray." c. "When was the last time you ate foods containing avocados?" d. "I will document this in your record so all of your providers will know." e. "Have you ever been treated for this allergic reaction?"

ANS: A, D, E Nurses should assess clients who have allergies for the specific cause, treatment, and response to treatment. The nurse should also document the allergies in a prominent place in the client's medical record. The nurse should collaborate with food services to ensure no avocados are placed on the client's meal trays. Asking about the last time the client ate avocados does not provide any pertinent information for the client's plan of care. DIF: Applying/Application REF: 502 KEY: Allergies/allergic response MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

A nurse teaches a client who is interested in smoking cessation. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Find an activity that you enjoy and will keep your hands busy." b. "Keep snacks like potato chips on hand to nibble on." c. "Identify a punishment for yourself in case you backslide." d. "Drink at least eight glasses of water each day." e. "Make a list of reasons you want to stop smoking."

5. A nurse teaches a client who is interested in smoking cessation. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Find an activity that you enjoy and will keep your hands busy." b. "Keep snacks like potato chips on hand to nibble on." c. "Identify a punishment for yourself in case you backslide." d. "Drink at least eight glasses of water each day." e. "Make a list of reasons you want to stop smoking."

ANS: A, D, E The nurse should teach a client who is interested in smoking cessation to find an activity that keeps the hands busy, to keep healthy snacks on hand to nibble on, to drink at least 8 glasses of water each day, and to make a list of reasons for quitting smoking. The nurse should also encourage the client not to be upset if he or she backslides and has a cigarette. DIF: Applying/Application REF: 496 KEY: Smoking cessation| patient-centered care MSC: IntegratedProcess:Teaching/Learning NOT: Client Needs Category: Health Promotion and Maintenance

A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements should the nurse include in communications with the respiratory therapist prior to the tests? (Select all that apply.) a. "I held the client's morning bronchodilator medication." b. "The client is ready to go down to radiology for this examination." c. "Physical therapy states the client can run on a treadmill." d. "I advised the client not to smoke for 6 hours prior to the test." e. "The client is alert and can follow your commands."

4. A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements should the nurse include in communications with the respiratory therapist prior to the tests? (Select all that apply.) a. "I held the client's morning bronchodilator medication." b. "The client is ready to go down to radiology for this examination." c. "Physical therapy states the client can run on a treadmill." d. "I advised the client not to smoke for 6 hours prior to the test." e. "The client is alert and can follow your commands."

ANS: A, D, E To ensure the PFTs are accurate, the therapist needs to know that no bronchodilators have been administered in the past 4 to 6 hours, the client did not smoke within 6 to 8 hours prior to the test, and the client can follow basic commands, including different breathing maneuvers. The respiratory therapist can perform PFTs at the bedside. A treadmill is not used for this test. DIF: Applying/Application REF: 509 KEY: Assessment/diagnostic examination MSC: Integrated Process: Communication and Documentation NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

A nurse is assessing a client who is recovering from a lung biopsy. Which assessment finding requires immediate action? a. Increased temperature b. Absent breath sounds c. Productive cough d. Incisional discomfort

ANS: B Absent breath sounds may indicate that the client has a pneumothorax, a serious complication after a needle biopsy or open lung biopsy. The other manifestations are not life threatening.

7. A nurse is assessing a client who is recovering from a lung biopsy. Which assessment finding requires immediate action? a. Increased temperature b. Absent breath sounds c. Productive cough d. Incisional discomfort

ANS: B Absent breath sounds may indicate that the client has a pneumothorax, a serious complication after a needle biopsy or open lung biopsy. The other manifestations are not life threatening. DIF: Applying/Application REF: 512 KEY: Assessment/diagnostic examination| respiratory distress/failure MSC: Integrated Process: Nursing Process: Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse is caring for an older adult client who has a pulmonary infection. Which action should the nurse take first? a. Encourage the client to increase fluid intake. b. Assess the client's level of consciousness. c. Raise the head of the bed to at least 45 degrees. d. Provide the client with humidified oxygen.

ANS: B Assessing the client's level of consciousness will be most important because it will show how the client is responding to the presence of the infection. Although it will be important for the nurse to encourage the client to turn, cough, and frequently breathe deeply; raise the head of the bed; increase oral fluid intake; and humidify the oxygen administered, none of these actions will be as important as assessing the level of consciousness. Also, the client who has a pulmonary infection may not be able to cough effectively if an area of abscess is present.

A nurse is caring for a client who received benzocaine spray prior to a recent bronchoscopy. The client presents with continuous cyanosis even with oxygen therapy. Which action should the nurse take next? a. Administer an albuterol treatment. b. Notify the Rapid Response Team. c. Assess the client's peripheral pulses. d. Obtain blood and sputum cultures.

13. A nurse is caring for a client who received benzocaine spray prior to a recent bronchoscopy. The client presents with continuous cyanosis even with oxygen therapy. Which action should the nurse take next? a. Administer an albuterol treatment. b. Notify the Rapid Response Team. c. Assess the client's peripheral pulses. d. Obtain blood and sputum cultures.

ANS: B Cyanosis unresponsive to oxygen therapy is a manifestation of methemoglobinemia, which is an adverse effect of benzocaine spray. Death can occur if the level of methemoglobin rises and cyanosis occurs. The nurse should notify the Rapid Response Team to provide advanced nursing care. An albuterol treatment would not address the client's oxygenation problem. Assessment of pulses and cultures will not provide data necessary to treat this client. DIF: Applying/Application REF: 510 KEY: Assessment/diagnostic examination| medication MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

A nurse observes that a client's anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question should the nurse ask the client in response to this finding? a. "Are you taking any medications or herbal supplements?" b. "Do you have any chronic breathing problems?" c. "How often do you perform aerobic exercise?" d. "What is your occupation and what are your hobbies?"

ANS: B The normal chest has a lateral diameter that is twice as large as the AP diameter. When the AP diameter approaches or exceeds the lateral diameter, the client is said to have a barrel chest. Most commonly, barrel chest occurs as a result of a long-term chronic airflow limitation problem, such as chronic obstructive pulmonary disease or severe chronic asthma. It can also be seen in people who have lived at a high altitude for many years. Therefore, an AP chest diameter that is the same as the lateral chest diameter should be rechecked but is not as indicative of underlying disease processes as an AP diameter that exceeds the lateral diameter. Medications, herbal supplements, and aerobic exercise are not associated with a barrel chest. Although occupation and hobbies may expose a client to irritants that can cause chronic lung disorders and barrel chest, asking about chronic breathing problems is more direct and should be asked first.

6. A nurse observes that a client's anteroposterior (AP) chest diameter is the same as the lateral chest diameter. Which question should the nurse ask the client in response to this finding? a. "Are you taking any medications or herbal supplements?" b. "Do you have any chronic breathing problems?" c. "How often do you perform aerobic exercise?" d. "What is your occupation and what are your hobbies?"

A patient with COPD is likely to have which findings on assessment? Select all that apply. a. Body odor and unkempt hair. b. Sitting in a chair leaning forward with elbows on knees. c. unintentional weight gain. d. decreased appetite. e. unexplained weight loss f. crooked fingers

a. Body odor and unkempt hair. b. Sitting in a chair leaning forward with elbows on knees. d. decreased appetite. e. unexplained weight loss

10. A nurse cares for a client who had a bronchoscopy 2 hours ago. The client asks for a drink of water. Which action should the nurse take next? a. Call the physician and request a prescription for food and water. b. Provide the client with ice chips instead of a drink of water. c. Assess the client's gag reflex before giving any food or water. d. Let the client have a small sip to see whether he or she can swallow.

ANS: C The topical anesthetic used during the procedure will have affected the client's gag reflex. Before allowing the client anything to eat or drink, the nurse must check for the return of this reflex. DIF: Applying/Application REF: 511 KEY: Assessment/diagnostic examination MSC: IntegratedProcess:NursingProcess:Assessment NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse assesses a client after an open lung biopsy. Which assessment finding is matched with the correct intervention? a. Client states he is dizzy. - Nurse applies oxygen and pulse oximetry. b. Client's heart rate is 55 beats/min. - Nurse withholds pain medication. c. Client has reduced breath sounds. - Nurse calls physician immediately. d. Client's respiratory rate is 18 breaths/min. - Nurse decreases oxygen flow rate.

2. A nurse assesses a client after an open lung biopsy. Which assessment finding is matched with the correct intervention? a. Client states he is dizzy. - Nurse applies oxygen and pulse oximetry. b. Client's heart rate is 55 beats/min. - Nurse withholds pain medication. c. Client has reduced breath sounds. - Nurse calls physician immediately. d. Client's respiratory rate is 18 breaths/min. - Nurse decreases oxygen flow rate.

ANS: C A potentially serious complication after biopsy is pneumothorax, which is indicated by decreased or absent breath sounds. The physician needs to be notified immediately. Dizziness after the procedure is not an expected finding. If the client's heart rate is 55 beats/min, no reason is known to withhold pain medication. A respiratory rate of 18 breaths/min is a normal finding and would not warrant changing the oxygen flow rate. DIF: Applying/Application REF: 512 KEY: Assessment/diagnostic examination| respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Physiological Adaption

A nurse teaches a client who is prescribed nicotine replacement therapy. Which statement should the nurse include in this client's teaching? a. "Make a list of reasons why smoking is a bad habit." b. "Rise slowly when getting out of bed in the morning." c. "Smoking while taking this medication will increase your risk of a stroke." d. "Stopping this medication suddenly increases your risk for a heart attack."

12. A nurse teaches a client who is prescribed nicotine replacement therapy. Which statement should the nurse include in this client's teaching? a. "Make a list of reasons why smoking is a bad habit." b. "Rise slowly when getting out of bed in the morning." c. "Smoking while taking this medication will increase your risk of a stroke." d. "Stopping this medication suddenly increases your risk for a heart attack."

ANS: C Clients who smoke while using drugs for nicotine replacement therapy increase the risk of stroke and heart attack. Nurses should teach clients not to smoke while taking this drug. The other responses are inappropriate. DIF: Applying/Application REF: 495 KEY: Smoking cessation| medication MSC: Integrated Process: Teaching/Learning NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

Why are the turbinates important? A. They decrease the weight of the skull on the neck. B. They increase the surface area of the nose for heating and filtering. C. They move inspired particles from nose to throat for removal. D. They separate two nasal passages down the middle.

B. They increase the surface area of the nose for heating and filtering. Correct: The turbinates increase the surface area of the nose, so that more heating, filtering, and humidifying of inspired air can occur before air passes into the nasopharynx.

A nurse obtains the health history of a client who is recently diagnosed with lung cancer and identifies that the client has a 60-pack-year smoking history. Which action is most important for the nurse to take when interviewing this client? a. Tell the client that he needs to quit smoking to stop further cancer development. b. Encourage the client to be completely honest about both tobacco and marijuana use. c. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty. d. Avoid giving the client false hope regarding cancer treatment and prognosis.

ANS: C Smoking history includes the use of cigarettes, cigars, pipe tobacco, marijuana, and other controlled substances. Because the client may have guilt or denial about this habit, assume a nonjudgmental attitude during the interview. This will encourage the client to be honest about the exposure. Ask the client whether any of these substances are used now or were used in the past. Assess whether the client has passive exposure to smoke in the home or workplace. If the client smokes, ask for how long, how many packs per day, and whether he or she has quit smoking (and how long ago). Document the smoking history in pack-years (number of packs smoked daily multiplied by the number of years the client has smoked). Quitting smoking may not stop further cancer development. This statement would be giving the client false hope, which should be avoided, but is not as important as maintaining a nonjudgmental attitude.

1. A nurse obtains the health history of a client who is recently diagnosed with lung cancer and identifies that the client has a 60-pack-year smoking history. Which action is most important for the nurse to take when interviewing this client? a. Tell the client that he needs to quit smoking to stop further cancer development. b. Encourage the client to be completely honest about both tobacco and marijuana use. c. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty. d. Avoid giving the client false hope regarding cancer treatment and prognosis.

In obtaining a history for a patient with COPD, which risk factors are related to potentially causing or triggering the disease process? Select all that apply. a. Cigarette smoking b. Occupational and air pollution c. Genetic tendencies d. Smokeless tobacco e. Occupation f. Food or drug allergies

a. Cigarette smoking b. Occupational and air pollution c. Genetic tendencies e. Occupation

A nurse cares for a client who had a bronchoscopy 2 hours ago. The client asks for a drink of water. Which action should the nurse take next? a. Call the physician and request a prescription for food and water. b. Provide the client with ice chips instead of a drink of water. c. Assess the client's gag reflex before giving any food or water. d. Let the client have a small sip to see whether he or she can swallow.

A nurse is providing care after auscultating clients' breath sounds. Which assessment finding is correctly matched to the nurse's primary intervention? a. Hollow sounds are heard over the trachea. - The nurse increases the oxygen flow rate. b. Crackles are heard in bases. - The nurse encourages the client to cough forcefully. c. Wheezes are heard in central areas. - The nurse administers an inhaled bronchodilator. d. Vesicular sounds are heard over the periphery. - The nurse has the client breathe deeply.

ANS: C Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages. Hollow sounds are typically heard over the trachea, and no intervention is necessary. If crackles are heard, the client may need a diuretic. Crackles represent a deep interstitial process, and coughing forcefully will not help the client expectorate secretions. Vesicular sounds heard in the periphery are normal and require no intervention.

A patient has developed pulmonary arterial hypertension. What is the goal of drug therapy for this patient? a. Dilate pulmonary vessels and prevent clot formation. b. Decrease pain and make the patient comfortable. c. Improve or maintain gas exchange. d. Maintain and manage pulmonary exacerbation.

a. Dilate pulmonary vessels and prevent clot formation

A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action? a. The client rates pain as a 5/10 at the site of the procedure. b. A small amount of drainage from the site is noted. c. Pulse oximetry is 93% on 2 liters of oxygen. d. The trachea is deviated toward the opposite side of the neck.

ANS: D A deviated trachea is a manifestation of a tension pneumothorax, which is a medical emergency. The other findings are normal or near normal.

9. A nurse assesses a client after a thoracentesis. Which assessment finding warrants immediate action? a. The client rates pain as a 5/10 at the site of the procedure. b. A small amount of drainage from the site is noted. c. Pulse oximetry is 93% on 2 liters of oxygen. d. The trachea is deviated toward the opposite side of the neck.

ANS: D A deviated trachea is a manifestation of a tension pneumothorax, which is a medical emergency. The other findings are normal or near normal. DIF: Applying/Application REF: 511 KEY: Assessment/diagnostic examination| respiratory distress/failure MSC: Integrated Process: Nursing Process: Implementation NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

A nurse is caring for a client who is scheduled to undergo a thoracentesis. Which intervention should the nurse complete prior to the procedure? a. Measure oxygen saturation before and after a 12-minute walk. b. Verify that the client understands all possible complications. c. Explain the procedure in detail to the client and the family. d. Validate that informed consent has been given by the client

ANS: D A thoracentesis is an invasive procedure with many potentially serious complications. Verifying that the client understands complications and explaining the procedure to be performed will be done by the physician or nurse practitioner, not the nurse. Measurement of oxygen saturation before and after a 12-minute walk is not a procedure unique to a thoracentesis.

A patient who is allergic to dogs experiences a sudden "asthma attack." Which assessment finding does the nurse expect for this patient? a. Slow, deep, pursed-lip respirations b. Breathlessness and difficulty completing sentences c. Clubbing of the fingers and cyanosis of the nail beds. d. Bradycardia and irregular pulse.

b. Breathlessness and difficulty completing sentences

A nurse assesses a client's respiratory status. Which information is of highest priority for the nurse to obtain? a. Average daily fluid intake b. Neck circumference c. Height and weight d. Occupation and hobbies

3. A nurse assesses a client's respiratory status. Which information is of highest priority for the nurse to obtain? a. Average daily fluid intake b. Neck circumference c. Height and weight d. Occupation and hobbies

ANS: D Many respiratory problems occur as a result of chronic exposure to inhalation irritants used in a client's occupation and hobbies. Although it will be important for the nurse to assess the client's fluid intake, height, and weight, these will not be as important as determining his occupation and hobbies. Determining the client's neck circumference will not be an important part of a respiratory assessment. DIF: Applying/Application REF: 496 KEY: Assessment/diagnostic examination MSC: IntegratedProcess:NursingProcess:Assessment NOT: Client Needs Category: Health Promotion and Maintenance 4. A nurse is caring for an older adult client who has a pulmonary infection. Which action should the nurse take first?

The nurse is performing a client assessment for the client's potential employer. The client reports dyspnea when climbing stairs but is not dyspneic at rest. Which dyspnea classification does the nurse assign to this client in the report to the employer? A. Class I, can perform perform manual labor B. Class II, can perform desk job C. Class III, minimally employable D. Class IV, must remain at home

B. Class II, can perform desk job Correct: This client is dyspneic when climbing stairs or walking on an incline but not on level walking. Therefore, this client is employable only for a sedentary job or under special circumstances.

A client has just arrived in the postanesthesia care unit (PACU) following a successful tracheostomy procedure. Which nursing action must be taken first? Suction as needed. Clean the tracheostomy inner cannula and stoma. Auscultate lung sounds. Change the tracheostomy dressing as needed.

Auscultate lung sounds. The first step of the nursing process and nursing action for a client following an airway procedure is to assess for a patent airway by auscultating the client's lungs and assessing the client's respiratory status.Suction is not needed if the lungs are clear to auscultation. Although cleanliness is important, the PACU nurse will not typically perform this procedure immediately after the tracheotomy is created, unless copious secretions are blocking the tube.Performing a dressing change is done every 8 hours or per hospital policy. The PACU nurse will perform this if the dressing is soiled or bloody, but assessment of airway must be performed first.

A client is admitted to the surgical floor with chest pain, shortness of breath, and hypoxemia after having a knee replacement. What diagnostic test will the nurse teach the client about to help confirm the diagnosis? A. Bronchoscopy B. Chest x-ray C. Computed tomography (CT) scan D. Thoracoscopy

C. Computed tomography (CT) scan Correct: CT scans, especially spiral or helical CT scans, with injected contrast can detect pulmonary emboli.

Where does gas exchange occur? A. Acinus B. Alveolus C. Bronchus D. Carina

B. Alveolus Correct: The alveolus is the structural unit of the lung where gas exchange occurs.

Which of these assessment findings will be of greatest concern when the nurse is assessing a client with emphysema? A. Barrel-shaped chest B. Bronchial breath sounds heard at the bases C. Hyperresonance to percussion of the chest D. Ribs lying horizontal

B. Bronchial breath sounds heard at the bases Correct: Bronchial breath sounds are not normally heard in the periphery and may indicate increased lung density, as in a tumor or an infective process such as pneumonia.

In assessing the client's respiratory status, blood gas test results reveal pH of 7.50, PaO2 of 99, PaCO2 of 29, and HCO of 22. What action does the nurse need to take first? A. Call the physician. B. Encourage the client to slow his breathing rate. C. Nothing. These results are within the normal range. D. Provide oxygen support.

B. Encourage the client to slow his breathing rate. Correct: The arterial blood gases (ABGs) indicate respiratory alkalosis, which is commonly caused by hyperventilation. Encouraging the client to slow down his breathing rate may help him return to normal breathing and may correct this abnormality.

The client returns to the medical unit after a therapeutic bronchoscopy. Which intervention does the nurse apply first? A. Assess the puncture site for drainage. B. Implement NPO (nothing by mouth) status. C. Monitor for signs of anaphylaxis. D. Perform aggressive chest physiotherapy.

B. Implement NPO (nothing by mouth) status. Correct: Until the client has a gag reflex and is fully alert, he should be maintained on NPO status to prevent aspiration.

You are a charge nurse on a surgical floor. The LPN/LVN informs you that a new client who had an earlier bronchoscopy has the following vital signs: heart rate 132, respiratory rate 26, and blood pressure 98/50. The client is anxious and his skin is cyanotic. What will be your first action? A. Call the Rapid Response Team. B. Give methylene blue 1% 1 to 2 mg/kg by IV injection C. Administer oxygen. D. Notify the physician immediately.

C. Administer oxygen. Correct: Administering oxygen and reassessing vital signs to observe for improvement is the first action. Administration of oxygen by itself may help relieve the client's anxiety.

Four clients arrive in the emergency department simultaneously with chest pain. The client with which type of chest pain requires immediate attention by the nurse? A. Client with pain on deep inspiration B. Client with pain on palpation C. Client with pain radiating to the shoulder D. Client with pain that is rubbing in nature

C. Client with pain radiating to the shoulder Correct: Chest pain radiating to the shoulder should be assumed to be cardiac in origin until proven otherwise; this requires the immediate attention of the nurse.

Which nursing intervention is the priority in preparing the client for pulmonary function testing (PFT)? A. Administer bronchodilator medication on call. B. Encourage clear fluid intake 12 hours before the procedure. C. Ensure no smoking 6 hours before the test. D. Provide supplemental oxygen as testing begins.

C. Ensure no smoking 6 hours before the test. Correct: If the client has been smoking, this may alter parts of the PFT (diffusing capacity [DlCO]), yielding inaccurate results.

A client is having surgery. He asks his nurse, "When they put that tube in my throat, where does it really go?" What is the name of the opening of the vocal cords? A. Arytenoid cartilage B. Epiglottis C. Glottis D. Palatine tonsils

C. Glottis Correct: The glottis is the opening of the vocal cords into which the endotracheal tube is passed during intubation for surgery.

A client comes to the emergency department with a productive cough. Which symptom does the nurse look for that will require immediate attention? A. Blood in the sputum B. Mucoid sputum C. Pink frothy sputum D. Yellow sputum

C. Pink frothy sputum Correct: Pink frothy sputum is common with pulmonary edema and requires immediate attention and intervention to prevent the client's condition from getting worse.

A client had a thoracentesis 1 day ago. He calls the home health agency and tells the nurse that he is very short of breath and anxious. What is the major concern of the nurse? A. Abscess B. Pneumonia C. Pneumothorax D. Pulmonary embolism

C. Pneumothorax Correct: A pneumothorax would be the complication of thoracentesis that causes the greatest concern, along with these symptoms.

The client has a fever of 40° C. In which direction, if any, will this shift the oxyhemoglobin dissociation curve? A. Down B. To the left C. To the right D. Will not shift

C. To the right A client with fever has a higher demand for oxygen, so the curve will shift to the right for easier dissociation.

The home health nurse is assigned to visit all of these clients when a change in agency staffing requires that one of the clients should be rescheduled for a visit on the following day. Which of these clients would be best to reschedule? A. Client with emphysema who has been on home oxygen for a month and has SPO2 levels of 91% to 93% B. Client with history of a cough, weight loss, and night sweats who has just had a positive Mantoux test C. Client with newly diagnosed pleural effusion who needs an admission visit and an initial intake assessment D. Client with percutaneous lung biopsy yesterday who called in to report increased dyspnea

Client with emphysema who has been on home oxygen for a month and has SPO2 levels of 91% to 93% Correct: This client has an appropriate Spo2 for home oxygen use.

A patient is receiving ipratropium and reports nausea, blurred vision, headache, and inability to sleep. What action does the nurse take? a. Administer a PRN medication for nausea and a mild PRN sedative b. Report these symptoms to the physician as signs of overdose. c. Obtain a physician's request for an ipratropium level. d. Tell the patient that these side effects are normal and not to worry.

b. Report these symptoms to the physician as signs of overdose.

The nurse is working in an urgent clinic. Which of these four clients needs to be evaluated first by the nurse? A. Client who is short of breath after walking up two flights of stairs B. Client with soreness of the arm after receiving purified protein derivative (PPD) (Mantoux) skin test C. Client with sore throat and fever of 39° C oral D. Client who is speaking in three-word sentences and has SaO2 of 90% by pulse oximetry

D. Client who is speaking in three-word sentences and has SaO2 of 90% by pulse oximetry Correct: A client should be able to speak in sentences of more than three words, and Sao2 of 90% indicates hypoxemia that requires intervention on the part of the nurse.

Which of these clients will the charge nurse on the medical unit assign to an RN who has floated from the postanesthesia care unit (PACU)? A. Client with allergic rhinitis scheduled for skin testing B. Client with emphysema who needs teaching about pulmonary function testing C. Client with pancreatitis who needs a preoperative chest x-ray D. Client with pleural effusion who has had 1200 mL removed by thoracentesis

D. Client with pleural effusion who has had 1200 mL removed by thoracentesis Correct: A nurse working in the PACU would be familiar with assessing vital signs and respiratory status after procedures such as thoracentesis.

3. 3. A client has returned to the postanesthesia care unit (PACU) after a bronchoscopy. Which of these nursing tasks is best for the charge nurse to delegate to the experienced nursing assistant working in PACU? A. Assess breath sounds. B. Check gag reflex. C. Determine level of consciousness. D. Monitor blood pressure and pulse.

D. Monitor blood pressure and pulse. Correct: A nursing assistant working in the PACU would have experience in taking client vital signs after the client has had conscious sedation or anesthesia.

An RN and an LPN/LVN are working together to provide care for a client hospitalized with dyspnea who requires all of these nursing actions. Which of these actions is best accomplished by the RN? A. Administer the purified protein derivative (PPD) for tuberculosis testing. B. Assess vital signs and the puncture site after thoracentesis. C. Monitor oxygen saturation using pulse oximetry every 4 hours. D. Plan client and family teaching regarding upcoming pulmonary function testing.

D. Plan client and family teaching regarding upcoming pulmonary function testing. Correct: Developing the teaching plan is the most complex of the skills listed and requires RN education and licensure.

The patient with COPD is undergoing pulmonary rehabilitation by walking. What does the nurse teach this patient about when to increase his walking time? a. "You should increase your walking time when your rest periods decrease." b. "you should increase your walking time when your heart rate remains less than 80/min." c. "You should increase your walking time when you do not need to use an inhaler."

a. "You should increase your walking time when your rest periods decrease."

In the older adult client, which respiratory change does not require further assessment by the nurse? A. Increased anteroposterior (AP) diameter B. Increased respiratory rate C. Shortness of breath D. Sputum production

Increased anteroposterior (AP) diameter Correct: Increased AP diameter is normal with aging.

B, C, D, F

Select all that apply The nurse recieves a patient with a new onset of confusion, dyspnea, and an O2 sat of 80% on room air. The client is suspected of having pneumonia. What tests will the nurse anticipate to confirm this diagnosis? A MRI B Chest Xray C Sputum Culture D Arterial Blood Gas E Mantoux test F CBC with differential

The nurse is caring for a client newly diagnosed with inhalation anthrax. The patient's family is concerned that they may have also contracted the infection since they live together. What is the nurse's best response? A We will need to treat everyone in the household for inhalation anthrax B The infection is only spread if you have come in contact with the client's sputum C Inhalation anthrax is not contagious so you do not need to be treated D Inhalation anthrax is only contagious for 2 hours upon onset of symptoms so you are more than likely not infected

The nurse is teaching the client about completely antibiotic therapy for bacterial pharyngitis. The nurse hears the client tell her husband that she hates taking pills and will stop taking the medicine when she feels 100% better. What is the nurse's best action? A Educate the client about the importance of completely finishing the antibiotics to prevent resistant bacterial infections B Do nothing because the client has already been told to complete the antibiotic therapy C Let the client know that is ok because the infection is gone when the symptoms are gone D Inform the client that if she does not finish the antibiotics she can use them for future infections without the need for another doctor's appointment

A, B, C, D, E, F

The nurse knows that which people are at risk for developing pneumonia? A Infants B Elderly clients C Client that smokes D Client with HIV E A client who has had a tracheostomy for 1 year F A client who has not received the influenza vaccine

A client with respiratory failure has been intubated and placed on a ventilator with 100% oxygen delivery to maintain adequate saturation. Twenty-four hours later, the nurse notes new-onset crackles and decreased breath sounds. The most recent arterial blood gases (ABGs) show a PaO2 level of 95 mm Hg. What action will the nurse take next? a) Collaborate with the provider to lower the FiO2 level. b) Discuss the need for extubation due to the need for 100% oxygen. c) Suggest noninvasive positive airway pressure techniques with oxygen. d) Prepare to suction the client.

a (Prompt identification and correction of the underlying disease process and potential oxygen toxicity may require delivery of a lower FiO2. The HCP needs to be notified when PaO2 levels are greater than 90 mmHg. Preventing oxygen toxicity and absorptive atelectasis (new onset of crackles and decreased breath sounds) are essential. Oxygen toxicity is related to the concentration of oxygen delivered, duration of oxygen therapy, and degree of lung tissue present.The need for 100% oxygen delivery indicates that the client continues to require intubation and mechanical ventilation. Noninvasive positive airway pressure techniques are not used for clients requiring 100% oxygen. Suction is performed for rhonchi or noisy breath sounds on the anterior chest below the sternal notch (upper airway). Crackles and diminished breath sounds will be heard posteriorly reflecting fluid or poor exchange in the lower airway.)

A registered nurse (RN) from the orthopedic unit has been assigned to the medical unit for the day. Which client assignment for the reassigned RN is the best? a) The client with a resolving pulmonary embolus who is receiving oxygen at 6 L/min through a nasal cannula b) The client with chronic lung disease who is being evaluated for possible home oxygen use c) The client with a newly placed tracheostomy who is receiving oxygen through a tracheostomy collar d) The client with chronic bronchitis who is receiving oxygen at 60% through a Venturi mask

a (The best client to assign this RN is the client with a pulmonary embolism. Orthopedic nurses are familiar with pulmonary emboli, a common complication of fractures and orthopedic surgery, as well as administration of oxygen through nasal cannulas.Orthopedic nurses do not specialize in chronic lung conditions. These clients are best assigned to an RN with experience in caring for clients with chronic lung diseases who require the use of home oxygen delivery devices and equipment. Orthopedic nurses generally do not have specific experience with airway surgery clients and clients being treated for chronic bronchitis. Care of these clients is best assigned to an RN with skills in postoperative tracheostomy care and chronic respiratory disease clients.)

Which are key elements for a personal asthma action plan? Select all that apply. a. A schedule for prescribed daily controller drug and directions for prescribed reliever drug b. A list of possible triggers for each asthma attack c. Patient-specific daily asthma control assessment questions. d. Directions for adjusting the daily controller drug schedule e. Emergency actions to take when asthma is not responding to controller and reliever drugs. f. When to contact the HCP (in addition to regularly scheduled visits)

a. A schedule for prescribed daily controller drug and directions for prescribed reliever drug c. Patient-specific daily asthma control assessment questions. d. Directions for adjusting the daily controller drug schedule e. Emergency actions to take when asthma is not responding to controller and reliever drugs. f. When to contact the HCP (in addition to regularly scheduled visits)

The nurse on a pulmonary unit is caring for a client who has had a tracheostomy placed earlier today. Which of these techniques representing best practice will use the nurse use when suctioning the client's tracheostomy tube? a) Hyperoxygenate before and after suctioning. b) Repeat suctioning until the tube is clear. c) Apply suction during insertion of the tube. d) Suction through the tracheostomy tube for 30 seconds.

a (The client needs to be preoxygenated/hyperoxygenated with 100% oxygen for 30 seconds to 3 minutes to prevent hypoxemia. After suctioning, the client needs to be hyperoxygenated for 1 to 5 minutes, or until the client's baseline heart rate and oxygen saturation are within normal limits.Repeat suctioning can be performed as needed for up to three total suction passes. Any additional suctioning will cause or worsen hypoxemia. Applying suction during insertion is inappropriate because suction makes advancement of the suction tube difficult and is traumatic to the airway. Suction is applied only when the suction tube is removed. Suctioning for 30 seconds is too long and can cause or worsen hypoxemia; a suction pass should last 10 to 15 seconds.)

The nurse is caring for a group of clients on a medical surgical unit. Which client will the nurse assess first? a) A client admitted 2 hours ago who has a 90 pack-year smoking history and is receiving 50% oxygen by Venturi mask b) A client who has had a tracheostomy for 1 week, who has SpO2 of 95%-97% and foul-smelling drainage on the tracheostomy ties c) A client who is being discharged with a new prescription for home oxygen therapy by nasal cannula d) A client who was admitted yesterday with pneumonia and is receiving antibiotics and oxygen through a nasal cannula

a (The first client to assess is the newly admitted client with a long smoking history receiving 50% oxygen by Venturi mask. There is insufficient data to determine if this client is stable. The client is at an elevated risk for respiratory depression due to the hypoxic drive of respirations countered by high levels of oxygen and must be assessed frequently.The client with the tracheostomy is showing no signs or symptoms of respiratory compromise, and the client who meets discharge criteria do not require frequent assessment. Although the client with pneumonia will require more frequent assessment than a client who does not require oxygen therapy, the client wearing the Venturi mask must be assessed first.)

A client who has a "do not resuscitate" (DNR) prescription has a non-rebreather oxygen mask, and breathing appears to be labored. What does the nurse do first? a) Ensure that the tubing is patent and that oxygen flow is high. b) Notify the chaplain and the family member of record. c) Call the Rapid Response Team (RRT) and prepare to intubate. d) Comfort the client.

a (The nurse needs to first ensure that the tubing is patent and that the O2 flow is high. Labored breathing and ultimately suffocation can occur if the reservoir bag on a non-rebreather mask kinks, or if the oxygen source disconnects or is not set to high flow levels.The chaplain and the family member of record would not be notified until assessment confirms that death is imminent at this time. The RRT team can be called but the client may not want to be intubated, as indicated in the DNR orders. The RRT needs to know the client's wishes when they arrive. Comforting the client must be done but is not the first action by the action.)

A client has just been admitted to the emergency department and requires high-flow oxygen therapy after suffering facial burns and smoke inhalation. Which oxygen delivery device will the nurse select? a) Face tent b) Venturi mask c) Nasal cannula d) Non-rebreather mask

a (The nurse will initially select a fact tent for this client. A client with smoke inhalation and facial burns who requires high-flow oxygen must initially be placed on a face tent because this is the only noninvasive high-flow device that will minimize painful and contaminating contact with burned facial tissue.Although a Venturi mask and a non-rebreather mask are high-flow oxygen delivery devices, they are snugly fitted on the face, which can be painful and can introduce infection to compromised facial skin. A nasal cannula is not a high-flow device.)

A client with chronic obstructive pulmonary disease (COPD) has a prescription to adjust oxygen to maintain SpO2 between 90% and 92%. Which action can be delegated to an unlicensed assistive personnel (UAP) under the supervision of an RN? a) Adjust the position of the oxygen tubing. b) Assess for signs and symptoms of hypoventilation. c) Change the O2 flow rate to keep SpO2 as prescribed. d) Select the O2 delivery device used for the client.

a (The scope of a UAPs role includes positioning of oxygen tubing for client comfort.Assessing for signs and symptoms of hypoventilation, choosing which O2 delivery device to use, and changing the O2 flow rate are actions that are skills that should be performed by skilled personnel and are beyond the scope of practice for a UAP.)

A client is being discharged home with a tracheostomy. Which statement by the client indicates the need for further teaching about correct tracheostomy care? Select all that apply. a) "I can only take baths, but no showers." b) "I can put normal saline in my tracheostomy to keep the secretions from getting thick." c) "I should put cotton or foam over the tracheostomy hole." d) "I will have to learn to suction myself." e) "I will be unable to wear a necklace."

a, b, c, e (Need for teaching is indicated when the client says that only baths and no showers can be taken. The client is permitted to shower with the use of a shower shield over the tracheostomy, which prevents water from entering the airway. Also, the client does not instill anything into the artificial airway unless prescribed. The client would not put cotton or foam over the tracheostomy hole; this action may cause airway obstruction. The stoma may be covered loosely with a small cotton cloth to protect it during the day. This filters the air entering the stoma, keeps humidity in the airway, and enhances appearance. Attractive coverings are available as cotton scarves, decorative collars, and jewelry including necklaces.The client is correct when commenting about learning to suction self, and will be taught clean suction technique to use at home.)

The nurse has completed a community presentation about lung cancer. Which statement from a participant demonstrates and understanding of the information presented? a. "The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid secondhand smoke." b. "The overall 5 year survival rate fro all patients with lung cancer is 85%." c. "The death rate for lung cancer is less than prostrate, breast, and colon cancer combined." d. "Cures are most likely for patients who undergo treatment for stage III disease."

a. "The primary prevention for reducing the risk of lung cancer is to stop smoking and avoid secondhand smoke."

What are the goals for drug therapy in the treatment of asthma? Select all that apply. a. Drugs are used to stop an attack once it has started. b. Weekly drugs are used to reduce the asthma response. c. Combination drugs are avoided in the treatment of asthma. d. Some patients only require drug therapy during an asthma episode. e. Drugs are used to change airway responsiveness. f. Some drugs are used to decrease inflammation.

a. Drugs are used to stop an attack once it has started. d. Some patients only require drug therapy during an asthma episode. e. Drugs are used to change airway responsiveness. f. Some drugs are used to decrease inflammation.

Which of the following may be warning signs of lung cancer? Select all that apply. a. Dyspnea b. Dark yellow-colored sputum c. Persistent cough or change in cough d. Abdominal pain and frequent stools e. Use of accessory muscles for breathing f. Labored or painful breathing

a. Dyspnea c. Persistent cough or change in cough e. Use of accessory muscles for breathing f. Labored or painful breathing

A patient with a history of asthma enters the emergency department with severe dyspnea, accessory muscle involvement, neck vein distention, and severe inspiratory/expiratory wheezing. The nurse is prepared to assist the physician with which procedure if the patient does not respond to initial interventions. a. Emergency intubation b. Emergency needle thoracentesis c. Emergency chest tube insertion d. Emergency pleurodesis

a. Emergency intubation

A patient with asthma is repeatedly non-compliant with the medication regimen, which has resulted in the patient being hospitalized for a severe asthma attack. Which interventions does the nurse suggest to help the patient manage asthma on a daily basis? Select all that apply. a. Encourage active participation in the plan of care. b. Help the patient develop a flexible plan of care. c. Have the pharmacist establish a plan of care. d. Teach the patient about asthma and the treatment plan. e. Assess symptom severity using a peak flow meter 1-2 times a week. f. Educate the patient about implementation of his or her personal asthma action plan.

a. Encourage active participation in the plan of care. d. Teach the patient about asthma and the treatment plan. f. Educate the patient about implementation of his or her personal asthma action plan.

The nurse is taking a history from a patient with chronic cystic fibrosis. Which symptoms would the nurse expect? Select all that apply. a. Frequent respiratory infections b. Occasional respiratory congestion c. Decreased exercise tolerance d. ABGs that show respiratory alkalosis e. Increased sputum production f. Decreased carbon dioxide levels on ABGs

a. Frequent respiratory infections c. Decreased exercise tolerance e. Increased sputum production

Which drugs are essential for slowing the progression of the disease in a patient with pulmonary fibrosis? a. Immunosuppressants b. Opioids c. Antibiotics d. Bronchodilators

a. Immunosuppressants

The patient is receiving high-frequency chest wall oscillation (HFCWO). What are the actions of this therapy? Select all that apply. a. It dislodges mucous from the bronchial walls. b. It increases mobilization of mucous. c. It causes bronchodilation of the airways. d. It moves mucous upward toward the central airways. e. It decreases inflammation within the lung tissues. f. It thins secretions, making them easier to clear from the lungs.

a. It dislodges mucous from the bronchial walls. b. It increases mobilization of mucous. d. It moves mucous upward toward the central airways. f. It thins secretions, making them easier to clear from the lungs.

Which statement is true about the relationship of smoking cessation to the pathophysiology of COPD? a. Smoking cessation completely reverses the damage to the lungs b. Smoking cessation slows the rate of the disease progression c. Smoking cessation is an important therapy for asthma, but not for COPD, d. Smoking cessation reverses the effects on the airways but not the lungs.

b. Smoking cessation slows the rate of the disease progression

The nurse is caring for a patient who has cystic fibrosis. Which assessment findings indicate the need for exacerbation therapy? Select all that apply. a. New onset crackles b. Increased activity tolerance c. Increased frequency of coughing d. Increased chest congestion e. Increased SaO2. f. At least a 10% decrease in FEV1.

a. New onset crackles c. Increased frequency of coughing d. Increased chest congestion f. At least a 10% decrease in FEV1.

A patient has returned several times to the clinic for treatment of respiratory problems. Which action does the nurse perform first? a. Obtain a history of the patient's previous respiratory problems and response to therapy. b. Ask the patient to describe his compliance to the prescribed therapies. c. Obtain a request for diagnostic testing, including TB and HIV. d. Listen to the patient's lungs, obtain a pulse oximetry reading, and count the respiratory rate.

a. Obtain a history of the patient's previous respiratory problems and response to therapy.

In assisting a patient with COPD to relieve dyspnea, which sitting positions are beneficial to the patient for breathing? Select all that apply. a. On edge of chair, leaning forward with arms folded and resting on a small table. b. In a low semi-reclining position with the shoulders back and knees apart. c. Forward in a chair with feet spread apart and elbows placed on the knees. d. Head slightly flexed, with feet spread apart, and shoulders relaxed. e. Low semi-Fowler's with knees elevated. f. Side lying to facilitate diaphragm movement.

a. On edge of chair, leaning forward with arms folded and resting on a small table. c. Forward in a chair with feet spread apart and elbows placed on the knees. d. Head slightly flexed, with feet spread apart, and shoulders relaxed.

Which are the main purposes of asthma treatment? Select all that apply. a. Prevent asthma episodes b. Avoid secondhand smoke c. Improve airflow d. Relieve symptoms e. Improve exercise tolerance f. Control asthma episodes

a. Prevent asthma episodes c. Improve airflow d. Relieve symptoms f. Control asthma episodes

The nurse is caring for an older adult patient with a chronic respiratory disorder. Which interventions are best to use in caring for this patient? Select all that apply. a. Provide rest periods between activities such as bathing, meals, and ambulation. b. Place the patient in a supine position after meals to allow for rest. c. Schedule drug administration around routine activities to increase adherence to drug therapy. d. Arrange chairs in strategic locations to allow the patient to walk and rest. e. Teach the patient to avoid getting the pneumococcal vaccine. f. Encourage the patient to have an annual flu vaccination.

a. Provide rest periods between activities such as bathing, meals, and ambulation. c. Schedule drug administration around routine activities to increase adherence to drug therapy. d. Arrange chairs in strategic locations to allow the patient to walk and rest. f. Encourage the patient to have an annual flu vaccination.

A patient with a history of bronchitis for greater than 20 years is hospitalized. With this patient's history, what is a potential complication? a. Right-sided heart failure b. Left-sided heart failure c. Renal disease. d. Stroke

a. Right-sided heart failure

A patient who has well-controlled asthma has what kind of airway changes? a. Chronic, leading to hyperplasia b. Temporary and reversible c. Acute loss of smooth muscle mass d. Permanent and irreversible

b. Temporary and reversible

Patients with asthma are taught self-care activities and treatment modalities according to the "step method." Which symptoms and medication routines relate to Step 3? a. Symptoms occur daily; daily use of inhaled corticosteroid and a long-acting beta agonist. b. Symptoms occur more than once per week; daily use of anti-inflammatory inhaler. c. Symptoms occur less than once per week; use of rescue inhalers once per week. d. Frequent exacerbations with limited physical activity; increased use of rescue inhalers.

a. Symptoms occur daily; daily use of inhaled corticosteroid and a long-acting beta agonist

The nurse is caring for a patient with a chest tube. What is the correct nursing intervention for this patient? a. The patient is encouraged to cough and do deep-breathing exercises frequently b. "Stripping" of the chest tubes is done routinely to prevent obstruction by blood clots c. Water level in the suction chamber need not be monitored, just the collection chamber d. Drainage containers are positioned upright or on the bed next to the patient.

a. The patient is encouraged to cough and do deep-breathing exercises frequently

The nurse is providing discharge instructions to a patient with pulmonary fibrosis and the patient's family. What instructions are appropriate for this patient? Select all that apply. a. Using home oxygen b. Maintaining activity level as before. c. Preventing respiratory infections. d. Limiting fluid intake e. Energy conservation measures. f. Encouraging patient to complete all ADLs.

a. Using home oxygen c. Preventing respiratory infections. e. Energy conservation measures

A patient with COPD has meal-related dyspnea. To address this issue, which drug does the nurse offer the patient 30 mins before the meal? a. albuterol lb. guaifenesin c. fluticasone d. pantoprazole sodium

a. albuterol

Which of the following are characteristics of chronic pulmonary emphysema? Select all that apply. a. Decreased surface area of alveoli b. chronic thickening of bronchial walls c. high arterial oxygen level d. hypercapnia e. ABGs show chronic respiratory acidosis f. increased eosinophils

a. decreased surface area of alveoli d. hypercapnia e. ABGs show chronic respiratory acidosis

The nurse is helping a patient learn about managing her asthma. What does the nurse instruct the patient to do? a. keep a symptom diary to identify what triggers the asthma attack b. make an appointment with an allergist for allergy therapy c. take a low dose of aspirin every day for the anti-inflammatory action d. drink large amounts of clear fluid to keep mucus thin and watery.

a. keep a symptom diary to identify what triggers the asthma attack

Which are characteristics of asthma? Select all that apply. a. narrowed airway lumen due to inflammation b. increased eosinophils c. increased secretions d. intermittent bronchospasm e. loss of elastic recoil f. stimulation of disease process by allergies

a. narrowed airway lumen due to inflammation b. increased eosinophils d. intermittent bronchospasm f. stimulation of disease process by allergies

An older adult client is being discharged home with a tracheostomy. Which nursing action is an acceptable assignment for an experienced LPN/LVN? a) Complete the referral form for a home health agency. b) Suction the tracheostomy using sterile technique. c) Teach the client and spouse about tracheostomy care. d) Consult with the health care provider (HCP) about using a fenestrated tube.

b (An experienced LPN/LVN can perform complex sterile procedures such as suctioning a tracheostomy tube using sterile technique.Completion of client referral forms, client and family teaching, and consulting with the (HCP) are all actions that must be performed by an RN.)

A client with pneumonia is receiving 100% oxygen via a non-rebreather mask. Which of these situations requires immediate intervention by the nurse? a) The client's skin has pink color. b) The oxygen reservoir deflates during inspiration. c) The client has crackles at the lung bases. d) The client is expectorating rust colored sputum.

b (The nurse intervene immediately if the reservoir bag is deflated. Suffocation can occur if the reservoir bag deflates, kinks, or if the oxygen source disconnects. The nurse needs to remove the device, refill the reservoir, and then reapply the mask.It is anticipated that the client's color is now pink. The client's color is expected to improve (from ashen or gray to pink) because of an increase in PaO2 level. Crackles in lung bases are an expected finding in a client with pneumonia, as is expectorating rust-colored sputum. Monitoring for adventitious breath sounds is important for the nurse to assess.)

A new graduate RN discovers that her client, who had a tracheostomy placed the previous day, has completely dislodged both the inner cannula and the tracheostomy tube. Which action should the nurse take first? a) Auscultate the client's breath sounds while applying a nasal cannula. b) Direct someone to call the Rapid Response Team (RRT) while using a resuscitation bag and facemask. c) Apply a 100% non-rebreather mask while administering high-flow oxygen. d) Replace the obturator while reinserting the tracheostomy tube.

b (The nurse must first have someone call the RRT while attempting to resuscitate the client. Because a fresh tracheostomy stoma will collapse and airway patency lost, the nurse needs to ventilate the client through the mouth and nose while awaiting assistance to recannulate the client. Directing someone else to call the Rapid Response Team allows the nurse to provide immediate care required by the client.Auscultation of the client's breath sounds at this time will not improve the client's respiratory status. Effective use of a 100% non-rebreather mask requires a patent airway. During the first 72 hours following a tracheostomy, reinsertion of the tube is difficult and should not be attempted by the nurse but rather by the surgeon or an expert in this area such as a member of the RRT. The obturator aids in insertion of the tube and must be removed immediately or it will obstruct the airway.)

A patient has a chest tube in place. What does the water in the water seal chamber do when the system is functioning correctly? a. Bubbles vigorously and continuously b. Bubbles gently and continuously c. Fluctuates with the patient's respirations d. Stops fluctuation, and bubbling is not observed.

c. Fluctuates with the patient's respirations

A client who is concerned about getting a tracheostomy says, "I will be ugly, with a hole in my neck." What is the nurse's best response? a) "But you know you need this to breathe, right?" b) "Do you have a light scarf that you could place over it?" c) "Your family and friends probably won't even care." d) "It won't take you long to learn to manage."

b (The nurse's best response is to suggest some strategies to cover the tracheostomy. This statement recognizes the client's concerns and explores options for dealing with the effects of the procedure.Reiterating the reason for the tracheostomy, suggesting that the client's loved ones won't care, and telling the client that he or she will learn to live with the tracheostomy are insensitive responses and minimize the client's concerns.)

The nurse is planning to provide tracheostomy care for a client with a soiled tracheostomy dressing. Which of these actions would be included in the plan of care? Select all that apply a) Cut a sterile 4 × 4 gauze to fit around the tracheostomy tube. b) Suction the client if needed. c) Cleanse the inner cannula with a mixture of peroxide and saline. d) Replace the dressing with a sterile, folded 4 × 4 gauze. e) Provide clean tracheostomy ties that fit snugly against the neck.

b, c, d (The nurse needs to first suction the tracheostomy tube if necessary. Use half-strength hydrogen peroxide to clean the inner cannula and sterile saline to rinse it. Alternatively, remove a disposable inner cannula and replace it with a new one.Never cut tracheostomy tube dressings because small bits of gauze could then be aspirated through the tube. If specific tracheal tube dressings are not available, then fold a sterile 4 × 4 gauze to fit around the tube. Also, make sure tracheal ties do not fit snuggle to the neck. Secure new ties in place before removing soiled ones. Tie a square knot that is visible on the side of the neck which is snug against one finger placed between the tie tape and the neck.)

The nurse is teaching a patient with COPD about his medications. Which statement by the patient indicates the need for additional teaching? a. "I will carry my albuterol with me at all times." b. "I will use my salmeterol whenever I start to feel short of breath." c. "I will check my heart rate before and after my exercise period." d. "I will use my ipratropium 4 times a day."

b. "I will use my salmeterol whenever I start to feel short of breath.

A patient is undergoing diagnostic testing for possible cystic fibrosis. Which non-pulmonary assessment findings does the nurse expect to observe in a patient with CF? Select all that apply. a. Peripheral edema b. Abdominal distention c. Steatorrhea d. Constipation e. Gastroesophageal reflux f. Malnourished appearance

b. Abdominal distention c. Steatorrhea e. Gastroesophageal reflux f. Malnourished appearance

The nurse is working for a manufacturing company and is responsible for routine employee health issues. Which primary prevention is most important for those employees at high risk for occupational pulmonary disease? a. Screen all employees by use of chest x-ray films twice a year b. Advise employees not to smoke and to use masks and ventilation equipment c. Perform pulmonary function tests once a year on all employees. d. Refer at-risk employees to a social worker for information about pensions.

b. Advise employees not to smoke and to use masks and ventilation equipment

Which sites are commonly affected by lung cancer metastasis? Select all that apply. a. Heart. b. Bone c. Liver. d. Colon e. Brain f. Adrenal glands

b. Bone c. Liver. e. Brain f. Adrenal glands

What is the most serious complication of cystic fibrosis? a. Pancreatic insufficiency b. Constant presence of thick, sticky mucous c. Intestinal obstruction d. Cirrhosis of the liver

b. Constant presence of thick, sticky mucous

The nurse is caring for a patient with chronic bronchitis and notes the following clinical findings: fatigue, dependent edema, distended neck veins, and cyanotic lips. These assessment findings are consistent with which disease process? a. COPD. b. Cor pulmonale c. Asthma d. Lung cancer

b. Cor pulmonale

A patient with respiratory difficulty has completed a pulmonary function test before starting any treatment. The peak expiratory flow (PEF) is 15%-20% below what is expected for the adult's age, gender, and size. the nurse anticipates this patient will need additional information about which topic? a. Further diagnostic tests to confirm pulmonary hypertension. b. How to manage asthma medications and identify triggers. c. Smoking cessation and its relationship to COPD. d. How to manage the acute episode of respiratory infection.

b. How to manage asthma medications and identify triggers.

A patient is diagnosed with cor pulmonale secondary to pumonary hypertension and is receiving an infusion of epoprostenol through a small portable IV pump. What is the critical priority for the patient? a. Strict aseptic technique must be used to prevent sepsis. b. Infusion must not be interrupted, even for a few minutes. c. The patient must have a daily dose of warfarin. d. the patient must be assessed for angina-like chest pain and fatigue.

b. Infusion must not be interrupted, even for a few minutes.

A patient has a history of COPD but is admitted for a surgical procedure that is unrelated to the respiratory system. To prevent any complications related to the patient's COPD, what action does the nurse take? a. Assess the patient's respiratory system every 8 hrs b. Monitor for signs and symptoms of pneumonia c. Give high-flow oxygen to maintain pulse oximetry readings. d. Instruct the patient to use a tissue if coughing or sneezing.

b. Monitor for signs and symptoms of pneumonia

A patient is receiving a chemotherapy agent for lung cancer. The nurse anticipates that the patient is likely to have which common side effect? a. Diarrhea b. Nausea c. Flatulence d. Constipation

b. Nausea

The nurse is taking a history for a patient with chronic pulmonary disease. The patient reports often sleeping in a chair that allows his head to be elevated rather than going to bed. The patient's behavior is a strategy to deal with which condition? a. Paroxysmal nocturnal dyspnea b. Orthopnea c. Tachypnea d. Cheyne-Stokes

b. Orthopnea

A patient is experiencing an asthma attack and shows an increased respiratory effort. Which ABG value is more associated with the early phase of the attack? a. PaCO2 of 60 mmHg b. PaCO2 of 30 mmHg c. pH of 7.40 d. PaO2 of 98 mmHg

b. PaCO2 of 30 mmHg

A patient admitted for a respiratory workup has baseline pulmonary function tests. After treatment with a bronchodilator the FEV1 increases by 14%. How does the nurse best interpret this value? a. The patient has emphysema b. The patient has asthma c. The patient has chronic bronchitis d. The patient has acute bronchitis

b. The patient has asthma

The patient is diagnosed with early pulmonary fibrosis. Which finding indicates that the patient's disease is progressing? a. The patient is short of breath with exertion b. The patient is becoming increasingly more short of breath c. The patient is experiencing respiratory infections d. The patient is experiencing side effects from his or her drugs.

b. The patient is becoming increasingly more short of breath

The nurse teaches a patient with asthma to perform which intervention before exercising? a. Rest for at least an hour. b. Use the short-acting beta-adrenergic (SABA) medication. c. Dress in extra clothing during cold weather. d. Practice pursed lip breathing.

b. Use the short-acting beta-adrenergic (SABA) medication.

What is the priority medical-surgical concept for patients with noninfectious lower respiratory problems such as emphysema? a. perfusion b. gas exchange c. cellular regulation d. tissue integrity

b. gas exchange

An elderly patient is discussing pneumonia prevention with the nurse. The nurse would include which statement in the teaching? A You need to have to the pneumonia vaccination once a year to fully protect yourself B If you have had the pneumonia vaccine in the last 10 years you will not need to repeat the vaccination C It is recommended that you repeat the pneumonia vaccination if it has been longer than 5 years since youve recieved it D There is no vaccination that can protect you from pneumonia

The adult client with degenerative arthritis is admitted for surgery to create a tracheostomy. What is the best communication method for this client during the postoperative period? a) Computer keyboard b) Magic Slate c) Picture board d) Pen and paper

c (A picture board is the best communication strategy for this client. It does not require very much dexterity for someone who has degenerative arthritis.A computer keyboard, Magic Slate, and pen and paper require dexterity that may be difficult and/or painful for a client with degenerative arthritis.)

A patient with asthma has been prescribed a fluticasone inhaler. What is the purpose of this drug for the patient? a. Relaxes the smooth muscles of the airway. b. Acts as a bronchodilator in severe episodes. c. Reduces obstruction of airways by decreasing inflammation. d. Reduces the histamine effect of the triggering agent.

c. Reduces obstruction of airways by decreasing inflammation.

The interprofessional team is collaborating about using noninvasive positive-pressure ventilation (NPPV) for a confused client with pneumonia. What information is essential for the nurse to share with the team while making this decision? a) The client requires frequent respiratory assessment. b) NPPV uses positive pressure to keep the alveoli open. c) The client is unable to cough and protect the airway. d) A full face mask may not fit this client's small face well.

c (It is most essential to determine the client's respiratory status including ability to cough and presence of a gag reflex before beginning NPPV. NPPV may cause gastric insufflation that can lead to vomiting or aspiration. NPPV must only be used on clients who have the ability to protect their own airway.NPPV uses positive pressure to keep the alveoli open; function of the devices is not the most important consideration in this scenario. If NPPV is used, full face masks, nasal pillows, and nasal-oral masks are available in a variety of sizes. One may provide a better seal and comfort than the other.)

The nurse is teaching a patient how to interpret peak expiratory flow (PEF) readings and to use this information to manage drug therapy at home. Which statement by the patient indicates a need for additional teaching? a. "If the reading is in the green zone, there is no need to increase the drug therapy." b. "Red is 50% below my 'personal best.' I should try a rescue drug and seek help." c. "If the reading is in the yellow zone. I should increase my use of my inhalers." d. "If frequent yellow readings occur, I should see my doctor for a change in medications."

c. "If the reading is in the yellow zone. I should increase my use of my inhalers."

A family member of a patient with COPD asks the nurse, "What is the purpose of making him cough on a routine basis?" What is the nurse's best response? a. "We have to check the color and consistency of his sputum." b. "We don't want him to feel embarrassed when coughing in public, so we actively encourage it." c. "It improves air exchange by increasing airflow in the larger airways." d. "If he cannot cough, the physician may elect to do a tracheostomy."

c. "It improves air exchange by increasing airflow in the larger airways."

A patient has been prescribed cromolyn sodium for the treatment of asthma. Which statement by the patient indicates a correct understanding of this drug? a. "It opens my airways and provides short-term relief." b. "It is the medication that should be used 30 mins before exercise." c. "It is not intended for use during acute episodes of asthma attacks." d. "It is a steroid medication, so there are severe side effects."

c. "It is not intended for use during acute episodes of asthma attacks."

The nurse is instructing a patient regarding complications of COPD. Which statement by the patient indicates the need for additional teaching? a. "I have to be careful because I am susceptible to respiratory infections." b. "I could develop heart failure, which could be fatal if untreated." c. "My COPD is serious, but it can be reversed if I follow my doctor's order." d. "The lack of oxygen could cause my heart to beat in an irregular pattern."

c. "My COPD is serious, but it can be reversed if I follow my doctor's order."

A patient is having pain resulting from bone metastases caused by lung cancer. What is the most effective intervention for relieving the patient's pain? a. Support the patient through chemotherapy b. Handle and move the patient very gently c. Administer analgesics around the clock d. Reposition the patient, and use distraction

c. Administer analgesics around the clock

A patient is admitted with asthma. Which assessment findings are most likely to indicate that the patient's asthma condition is deteriorating and progressing toward respiratory failure? a. Crackles, rhonchi, and productive cough with yellow sputum b. Tachypnea, thick and tenacious sputum, and hemoptysis c. Audible breath sounds, wheezing, and use of accessory muscles. d. Respiratory alkalosis; slow, shalllow respiratory rate.

c. Audible breath sounds, wheezing, and use of accessory muscles.

For a patient who is a non-smoker, which classic assessment finding is particularly important in diagnosing asthma? a. Cough b. Dyspnea c. Audible wheezing d. Tachypnea

c. Audible wheezing

A patient is fearful that she might develop lung cancer because her father and grandfather died of cancer. She seeks advice about how to modify lifestyle factors that contribute to cancer. How does the nurse advise this patient? a. Not to worry about air pollution unless there is hydrocarbon exposure. b. Quit her job if she has continuous exposure to lead or other heavy metals c. Avoid situations where she would be exposed to secondhand smoke d. Not to be concerned because there are no genetic factors associated with lung cancer

c. Avoid situations where she would be exposed to secondhand smoke

The nurse assesses a patient and finds a dusky appearance with bluish mucous membranes and production of lots of mucous secretions. What illness does the nurse suspect? a. Asthma b. Emphysema c. Chronic bronchitis d. Acute bronchitis

c. Chronic bronchitis

After the nurse has instructed a patient with COPD in the proper coughing technique, which action the next day by the patient indicates the need for additional teaching or intervention? a. Coughing upon rising in the morning. b. Coughing before meals. c. Coughing after meals. d. Coughing at bedtime.

c. Coughing after meals.

Which are the most common early symptoms of pulmonary arterial hypertension a. Shortness of breath and dizziness b. Hypotension and headache c. Dyspnea and fatigue d. Chest pain and orthopnea

c. Dyspnea and fatigue

The nurse is developing a teaching plan for a patient with chronic airflow limitation using the priority patient problem of insufficient knowledge related to energy conservation. What does the nurse advise the patient to avoid? a. Performing activities at a relaxed pace. b. Working on activities that require using arms at chest level or lower. c. Eating three large meals a day. d. Talking and performing activities separately.

c. Eating three large meals a day.

A patient has COPD with chronic difficulty breathing. In planning this patient's care, what condition must the nurse acknowledge is present in this patient? a. Decreased need for calories and protein requirements since dyspnea causes activity intolerance. b. COPD has no effect on calorie and protein needs, meal tolerance, satiety, appetite, and weight. c. Increased metabolism and the need for additional calories and protein supplements. d. Anabolic state, which creates conditions for building body strength and muscle mass.

c. Increased metabolism and the need for additional calories and protein supplements.

Which statement is true about radiation therapy for lung cancer patients? a. It is given daily in "cycles" over the course of several months. b. It causes hair loss, nausea, and vomiting for the duration of treatment c. It causes dry skin at the radiation site, fatigue, and changes in appetite with nausea d. It is the best method of treatment for systemic metastatic disease.

c. It causes dry skin at the radiation site, fatigue, and changes in appetite with nausea

A patient with chronic bronchitis often shows signs of hypoxia. Which clinical manifestation is the priority to monitor in this patient? a. Chronic, non-productive dry cough b. Clubbing of fingers c. Large amounts of thick mucous d. Barrel chest

c. Large amounts of thick mucous

A patient had prolonged occupational exposure to petroleum distillates and subsequently developed a chronic lung disease. The patient is advised to seek frequent health examinations because there is a high risk for developing which respiratory disease condition? a. Tuberculosis b. Cystic fibrosis c. Lung cancer d. Pulmonary hypertension

c. Lung cancer

A patient presents to the walk-in clinic with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers or medications. What is the first priority nursing action? a. Establish IV access to give emergency medications. b. Obtain the equipment and prepare the patient for intubation. c. Place the patient in high Fowler's position and start oxygen. d. Call 911 and report the patient has probable status asthmaticus.

c. Place the patient in high Fowler's position and start oxygen.

The physician's prescriptions indicate an increase in the suction to -20 cm for a patient with a chest tube. To implement this, the nurse performs which intervention? a. Increases the wall suction to the medium setting and observes gentle bubbling in the suction chamber. b. Adds water to the suction and drainage chambers to the level of -20 cm. c. Stops the suction, adds sterile water to the level of -20 cm in the water seal chamber, and resumes the wall suction d. Has the patient cough and deep breathe and monitors the level of fluctuation to achieve -20 cm.

c. Stops the suction, adds sterile water to the level of -20 cm in the water seal chamber, and resumes the wall suction

The patient has one gene allele for alpha-1 anti-trypsin (AAT) that is faulty and one that is normal. Which statement is true about this patient? a. The patient will have an alpha-1 anti-trypsin deficiency and is at risk for COPD. b. The patient will not be at risk for development of COPD. c. The patient will be a carrier for alpha-1 anti-trypsin deficiency. d. The patient will make enough alpha-1 anti-trypsin to avoid COPD even if exposed to smoking.

c. The patient will be a carrier for alpha-1 anti-trypsin deficiency.

The nurse is caring for an older adult patient with a history of chronic asthma. Which problem related to aging can influence the care and treatment of this patient? a. Asthma usually resolves with age, so the condition is less severe in older adult patients. b. It is more difficult to teach older adult patients about asthma than to teach younger patients. c. With aging, the beta-adrenergic drugs do not work as effectively. d. Older adult patients have difficulty manipulating handheld inhalers.

c. With aging, the beta-adrenergic drugs do not work as effectively.

The nurse is caring for a client who has had a tracheostomy placed yesterday. Which of these assessments is essential for the nurse to make? a) Measure the cuff pressure. b) Assess the color and consistency of secretions. c) Ensure a second tracheostomy tube is available. d) Assess for tachypnea.

d (It is essential for the nurse to assess the client for tachypnea. Tachypnea can indicate hypoxia. Assessing secretions, ensuring a second tube is available in case of accidental extubation, and measuring cuff pressure are all appropriate interventions, after assessing airway and breathing.)

A client who smokes is being discharged home on oxygen. The client states, "My lungs are already damaged, so I'm not going to quit smoking." What is the discharge nurse's best response? a) "You can quit when you are ready." b) "It's never too late to quit." c) "For safety, turn off your oxygen when you smoke." d) "Let's discuss why smoking around oxygen is dangerous."

d (The nurse best response is to ask the client to discuss why smoking around oxygen is dangerous. The nurse would use this opportunity to educate the client about the dangers of smoking in the presence of oxygen, as well as the benefits of quitting.Telling the client it is okay to quit when ready, or that it's never too late to quit, does not address the safety issue of smoking in the presence of oxygen. Recommending that the client turn off the oxygen when smoking also puts the client at risk for harm.)

The nurse is caring for a client with COPD who has a prescription for supplemental oxygen. Which situation will cause the nurse to further assess the need to increase the fraction of inspired oxygen (FiO2)? a) Client's last ECG showed atrial fibrillation at a rate of 82 b) Client's blood pressure is 106/80 c) Client has been cooperative with all treatments d) Client has developed restlessness over the last hour

d (The nurse needs to assess the client who has recently become restless for the need to increase this client's FiO2. This client may be exhibiting symptoms of hypoxemia including restlessness. Additional symptoms of hypoxemia include increased heart rate and blood pressure, oxygen desaturation, cyanosis, restlessness, and dysrhythmias.A client with controlled or treated atrial fibrillation with a pulse of 82 beats per minute is stable and not cause for alarm or a change in FiO2. A client with a blood pressure of 106/80 and a client cooperating with the treatment plan indicate positive outcomes to oxygen therapy. The nurse will continue to observe these clients.)

The respirations of a sedated client with a new tracheostomy have become noisy, and the ventilator alarms indicate high peak pressures. The ventilator tubing is clear. What is the best immediate action by the nurse? a) Humidify the oxygen source b) Increase provided oxygenation c) Remove the inner cannula of the tracheostomy d) Suction the tracheostomy tube

d (The best immediate action by the nurse is to suction the tracheostomy tube. This will likely result in clear lung sounds and lower peak pressure, and the appearance of the sputum will indicate whether bleeding is a concern. Humidifying the oxygen source may help mobilize secretions, but an active cough response is also required to clear the airway; a sedated client has a weak cough. Increasing oxygenation does nothing to clear the airway of whatever is making it noisy and is elevating peak pressures. Removing the inner cannula of a ventilated client is contraindicated.Humidifying the oxygen source will help mobilize secretions, but an active cough response is required to clear the airway. This client is sedated and has a weak cough. Increasing oxygenation does nothing to clear the airway of whatever is making it noisy and is elevating peak pressures. Removing the inner cannula of a ventilated client is contraindicated.)

The nurse is developing the plan of care to reduce risk for aspiration for a client with a tracheostomy. Which nursing interventions would be included in the plan of care? Select all that apply. a)Encourage frequent sipping from a cup. b) Encourage water with meals. c) Inflate the tracheostomy cuff during meals. d) Maintain the client upright for 30 minutes after eating. e) Provide small, frequent meals. f) Teach the client to "tuck" the chin down in the forward position to swallow.

d, e, f (Interventions that must be noted in the client's plan of care include having the client remain upright for at least 30 minutes after eating to reduce the chance of aspiration. Also, making sure that small frequent meals are available for the client. Shorter and more frequent intervals of eating tire the client less and also reduce the chance of aspiration. Teaching the client how to tuck the chin down in the forward position helps to open the upper esophageal sphincter and again reduces the risk of aspiration.Sipping from a cup is contraindicated. Liquids are consumed using a spoon to ensure that the client is attempting to swallow only small volumes of liquid. Controlled small amounts of thickened liquids are given. Thin liquids such as water should be avoided because they are easily aspirated. The tracheostomy cuff needs to be deflated because an inflated tube narrows the upper esophageal sphincter opening, which increases the risk for aspiration.)

The nurse is taking a medical history on a new patient who has come to the office for a checkup. the patient states that he was supposed to take a medication called montelukast, but that he never got the prescription filled. What is the best response by the nurse? a. "When were first diagnosed with a respiratory disorder?" b. "Why didn't you get the prescription filled?" c. "Tell me how you feel about your decision to not fill the prescription." d. "Are you having any problems with your asthma?"

d. "Are you having any problems with your asthma?"

The nurse is taking a report on a patient who had a pneumonectomy 4 days ago. Which question is the best to ask during the shift report? a. "Does the physician want us to continue encouraging use of the spirometer?" b. "How much drainage did you see in the Pleur-evac during your shift?" c. "Do we have a request to 'milk' the patient's chest tube?" d. "Does the surgeon want the patient placed on the operative or nonoperative side?"

d. "Does the surgeon want the patient placed on the operative or nonoperative side?"

A neighbor with asthma is experiencing a severe and prolonged asthma attack that is unresponsive to treatment with a SABA drug. What is the nurse's best action? a. Continue to administer the patient's SABA drug at 5 minute intervals. b. Call the patient's HCP. c. Apply the supplemental oxygen that is in the patient's home. d. Call 911 and get the patient to emergency care ASAP

d. Call 911 and get the patient to emergency care ASAP

What is the purpose of pulmonary function testing, especially airflow rates and lung volume measurements, when classifying COPD? a. Determines the oxygen liter flow rates required by the patient. b. Measures blood gas levels before bronchodilators are administered. c. Evaluates the movement of oxygenated blood from the lung to the heart. d. Distinguishes airway disease (obstructive) from interstitial lung disease (restrictive).

d. Distinguishes airway disease (obstructive) from interstitial lung disease (restrictive).

A patient with pulmonary arterial hypertension is prescribed bosentan. For which side effect must the nurse monitor? a. Bradycardia b. Increased risk for blood clotting c. Decreased urine output d. Hypotension

d. Hypotension

What principle guides the nurse when providing oxygen therapy for a patient with COPD? a. The patient depends on a high serum carbon dioxide level to stimulate the drive to breathe. b. The patient requires a low serum oxygen level for the stimulus to breathe to work. c. The patient who receives oxygen therapy ata high flow rate is at risk for a respiratory arrest. d. The patient should receive oxygen therapy at rates to reduce hypoxia and bring SpO2 levels up between 88%-92%.

d. The patient should receive oxygen therapy at rates to reduce hypoxia and bring SpO2 levels up between 88%-92%.

A patient has chronic bronchitis. The nurse plans interventions for inadequate oxygenation based on which set of clinical manifestations? a. Chronic cough, thin secretions, and chronic infection b. Respiratory alkalosis, decreased PaCO2, and increased PaO2. c. Areas of chest tenderness and sputum production (often with hemoptysis) d. Large amounts of thick secretions and repeated infections.

d. Large amounts of thick secretions and repeated infections.

A patient with cystic fibrosis is admitted to the med-surg unit for an elective surgery. Which infection control is best for this patient? a. It is best to put two patients with CF in the same room b. Standard Precautions including hand-washing are sufficient c. The patient is to be placed on contact isolation d. Measures that limit close contact between people with CF are needed.

d. Measures that limit close contact between people with CF are needed.

Drugs for the treatment of COPD are the same as those used for the management of asthma. Which additional class of drugs would the nurse expect to administer for a patient with COPD? a. Beta-blocker drugs b. Corticosteroids c. Xanthines d. Mucolytics

d. Mucolytics

The nurse is caring for a patient with a chest tube in place. Over the past hour the drainage from the tube was 110 mL. What is the nurse's best action? a. Gently "milk" the tubing to remove clots b. Check the chest tube system for leaks. c. Instruct the patient to cough and deep breathe d. Notify the surgeon immediately.

d. Notify the surgeon immediately.

Which intervention promotes comfort in dyspnea management for a patient with lung cancer? a. Administer morphine only when the patient requests it. b. Place the patient in a supine position with a pillow under the knees and legs c. Encourage coughing and deep-breathing and independent ambulation d. Provide supplemental oxygen via cannula or mask

d. Provide supplemental oxygen via cannula or mask

What is the advantage of using aerosol route for administering short-acting beta2 agonists? a. Achieves a rapid and effective anti-inflammatory action. b. Reduces the risk for fungal infections. c. Increases patient compliance because it is easy to use. d. Provides rapid therapy with fewer systemic side effects.

d. Provides rapid therapy with fewer systemic side effects.

Upon observation of a chest tube setup, the nurse reports to the physician that there is a leak in the chest tube and system. How has the nurse identified this problem? a. Drainage in the collection chamber has decreased b. The bubbling in the suction chamber has suddenly increased c. Fluctuation in the water seal chamber has stopped d. There was onset of continuous vigorous bubbling in the water seal chamber

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