Respiratory Lippincott NCLEX Style

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

1. Develop respiratory infections easily.

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

1. Incorporate physical exercise as tolerated into the daily routine.

59. Which of the following techniques for administering the Mantoux test is correct? 1. Hold the needle and syringe almost parallel to the client's skin. 2. Pinch the skin when inserting the needle. 3. Aspirate before injecting the medication. 4. Massage the site after injecting the medication.

1. Hold the needle and syringe almost parallel to the client's skin.

63. A client has a positive reaction to the Mantoux test. The nurse interprets this reaction to mean that the client has: 1. Active tuberculosis. 2. Had contact with Mycobacterium tuberculosis. 3. Developed a resistance to tubercle bacilli. 4. Developed passive immunity to tuberculosis.

2. Had contact with Mycobacterium tuberculosis.

69. A client who has been diagnosed with tuberculosis has been placed on drug therapy. The medication regimen includes rifampin (Rifadin). Which of the following instructions should the nurse include in the client's teaching plan related to the potential adverse effects of rifampin? Select all that apply. 1. Having eye examinations every 6 months. 2. Maintaining follow-up monitoring of liver enzymes. 3. Decreasing protein intake in the diet. 4. Avoiding alcohol intake. 5. The urine may have an orange color.

2. Maintaining follow-up monitoring of liver enzymes. 4. Avoiding alcohol intake. 5. The urine may have an orange color.

64. A client with tuberculosis is taking Isoniazid (INH). To help prevent development of peripheral neuropathies, the nurse should instruct the client to: 1. Adhere to a low-cholesterol diet. 2. Supplement the diet with pyridoxine (vitamin B6). 3. Get extra rest. 4. Avoid excessive sun exposure.

2. Supplement the diet with pyridoxine (vitamin B6).

57. The client with tuberculosis is to be discharged home with community health nursing follow-up. Of the following nursing interventions, which should have the highest priority? 1. Offering the client emotional support. 2. Teaching the client about the disease and its treatment. 3. Coordinating various agency services. 4. Assessing the client's environment for sanitation.

2. Teaching the client about the disease and its treatment.

66. Clients who have had active tuberculosis are at risk for recurrence. Which of the following conditions increases that risk? 1. Cool and damp weather. 2. Active exercise and exertion. 3. Physical and emotional stress. 4. Rest and inactivity.

3. Physical and emotional stress.

121. A nurse should interpret which of the following as an early sign of a tension pneumothorax in a client with chest trauma? 1. Diminished bilateral breath sounds. 2. Muffled heart sounds. 3. Respiratory distress. 4. Tracheal deviation.

3. Respiratory distress.

56. What is the rationale that supports multidrug treatment for clients with tuberculosis? 1. Multiple drugs potentiate the drugs' actions. 2. Multiple drugs reduce undesirable drug adverse effects. 3. Multiple drugs allow reduced drug dosages to be given. 4. Multiple drugs reduce development of resistant strains of the bacteria.

4. Multiple drugs reduce development of resistant strains of the bacteria.

131. The physician has inserted a chest tube in a client with a pneumothorax. The nurse should evaluate the effectiveness of the chest tube: 1. For administration of oxygen. 2. To promote formation of lung scar tissue. 3. To insert antibiotics into the pleural space. 4. To remove air and fluid.

4. To remove air and fluid.

130. A client has been in an automobile accident and the nurse is assessing the client for possible pneumothorax. The nurse should assess the client for: 1. Sudden, sharp chest pain. 2. Wheezing breath sounds over affected side. 3. Hemoptysis. 4. Cyanosis.

1. Sudden, sharp chest pain.

88. A client uses a metered-dose inhaler (MDI) to aid in management of asthma. Which action indicates to the nurse that the client needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.

1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.

90. A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; Pco2 48; Po23 58; HCO 26. Which of the following prescriptions should the nurse perform first? 1. Albuterol (Proventil) nebulizer. 2. Chest x-ray. 3. Ipratropium (Atrovent) inhaler. 4. Sputum culture.

1. Albuterol (Proventil) nebulizer.

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

1. Increased anteroposterior chest diameter.

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

1. Irregular heartbeat.

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

1. Maintaining functional ability.

74. The client with chronic obstructive pulmonary disease (COPD) is taking theophylline (Theo-Dur). The nurse should instruct the client to report which of the following signs of theophylline toxicity? Select all that apply. 1. Nausea. 2. Vomiting. 3. Seizures. 4. Insomnia. 5. Vision changes.

1. Nausea. 2. Vomiting. 3. Seizures. 4. Insomnia.

127. For a client with rib fractures and a pneumothorax, the physician prescribes morphine sulfate, 1 to 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which of the following outcomes would indicate successful achievement of this goal? 1. Pain rating of 0 on a scale of 0 to 10 by the client. 2. Decreased client anxiety. 3. Respiratory rate of 26 breaths/min. 4. PaO2 of 70 mm Hg.

1. Pain rating of 0 on a scale of 0 to 10 by the client.

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

1. The inhaler is held upright. 4. The client rinses the mouth with water following administration.

53. A client is receiving streptomycin for the treatment of tuberculosis. The nurse should assess the client for eighth cranial nerve damage by observing the client for: 1. Vertigo. 2. Facial paralysis. 3. Impaired vision. 4. Difficulty swallowing.

1. Vertigo.

50. Which of the following symptoms is common in clients with active tuberculosis? 1. Weight loss. 2. Increased appetite. 3. Dyspnea on exertion. 4. Mental status changes.

1. Weight loss.

128. A client undergoes surgery to repair lung injuries. Postoperative prescriptions include the transfusion of one unit of packed red blood cells at a rate of 60 mL/h. How long will this transfusion take to infuse? 1. 2 hours. 2. 4 hours. 3. 6 hours. 4. 8 hours.

2. 4 hours.

72. The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are: pH 7.35; PCO2 62; PO2 70; HCO3 34 The nurse should first: 1. Apply a 100% nonrebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.

2. Assess the vital signs.

125. A client who is recovering from chest trauma is to be discharged home with a chest tube drainage system intact. The nurse should instruct the client to call the physician for which of the following? 1. Respiratory rate greater than 16 breaths/min. 2. Continuous bubbling in the water-seal chamber. 3. Fluid in the chest tube. 4. Fluctuation of fluid in the water-seal chamber.

2. Continuous bubbling in the water-seal chamber.

129. The primary reason for infusing blood at a rate of 60 mL/h is to help prevent which of the following complications? 1. Emboli formation. 2. Fluid volume overload. 3. Red blood cell hemolysis. 4. Allergic reaction.

2. Fluid volume overload.

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

2. Viral respiratory infections.

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

3. Have an anti-inflammatory effect.

52. A client is receiving streptomycin in the treatment regimen of tuberculosis. The nurse should assess for: 1. Decreased serum creatinine. 2. Difficulty swallowing. 3. Hearing loss. 4. IV infiltration.

3. Hearing loss.

101. The nurse is caring for a client who has asthma. The nurse should conduct a focused assessment to detect which of the following? 1. Increased forced expiratory volume. 2. Normal breath sounds. 3. Inspiratory and expiratory wheezing. 4. Morning headaches.

3. Inspiratory and expiratory wheezing.

61. Which of the following family members exposed to tuberculosis would be at highest risk for contracting the disease? 1. 45-year-old mother. 2. 17-year-old daughter. 3. 8-year-old son. 4. 76-year-old grandmother.

4. 76-year-old grandmother.

96. Which of the following is an expected outcome for an adult client with well-controlled asthma? 1. Chest x-ray demonstrates minimal hyperinflation. 2. Temperature remains lower than 100°F (37.8°C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.

4. Breath sounds are clear.

124. A client with rib fractures and a pneumothorax has a chest tube inserted that is connected to a water-seal chest tube drainage system. The nurse notes that the fluid in the water-seal column is fluctuating with each breath that the client takes. What is the significance of this fluctuation? 1. An obstruction is present in the chest tube. 2. The client is developing subcutaneous emphysema. 3. The chest tube system is functioning properly. 4. There is a leak in the chest tube system.

3. The chest tube system is functioning properly.

49. A client newly diagnosed with tuberculosis (TB) is being admitted with the prescription for "isolation precautions for tuberculosis." The nurse should assign the client to which type of room? 1. A room at the end of the hall for privacy. 2. A private room to implement contact precautions. 3. A room near the nurses' station to ensure confidentiality. 4. The implementation of contact precautions for possible TB requires a private room assignment.

1. A room at the end of the hall for privacy.

70. The nurse is providing follow-up care to a client with tuberculosis who does not regularly take the prescribed medication. Which nursing action would be most appropriate for this client? 1. Ask the client's spouse to supervise the daily administration of the medications. 2. Visit the client weekly to verify compliance with taking the medication. 3. Notify the physician of the client's noncompliance and request a different prescription. 4. Remind the client that tuberculosis can be fatal if it is not treated promptly

1. Ask the client's spouse to supervise the daily administration of the medications.

134. When assessing a client with chest trauma, the nurse notes that the client is taking small breaths at first, then bigger breaths, then a couple of small breaths, then 10 to 20 seconds of no breaths. The nurse should chart the breathing pattern as: 1. Cheyne-Stokes respiration. 2. Hyperventilation. 3. Obstructive sleep apnea. 4. Bior's respiration.

1. Cheyne-Stokes respiration.

99. Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma? 1. Cough productive of yellow sputum. 2. Bilateral expiratory wheezing. 3. Chest tightness. 4. Respiratory rate of 30 breaths/min.

1. Cough productive of yellow sputum.

133. A client is undergoing a thoracentesis. The nurse should monitor the client during and immediately after the procedure for which of the following? Select all that apply. 1. Pneumothorax. 2. Subcutaneous emphysema. 3. Tension pneumothorax. 4. Pulmonary edema. 5. Infection.

1. Pneumothorax. 2. Subcutaneous emphysema. 3. Tension pneumothorax. 4. Pulmonary edema.

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

1. Take a deep abdominal breath, bend forward, and cough three or four times on exhalation.

62. The nurse is teaching a client who has been diagnosed with tuberculosis how to avoid spreading the disease to family members. Which statement(s) indicate(s) that the client has understood the nurse's instructions? Select all that apply. 1. "I will need to dispose of my old clothing when I return home." 2. "I should always cover my mouth and nose when sneezing." 3. "It is important that I isolate myself from family when possible." 4. "I should use paper tissues to cough in and dispose of them promptly." 5. "I can use regular plates and utensils whenever I eat."

2. "I should always cover my mouth and nose when sneezing." 4. "I should use paper tissues to cough in and dispose of them promptly." 5. "I can use regular plates and utensils whenever I eat."

55. The nurse should teach clients that the most common route of transmitting tubercle bacilli from person to person is through contaminated: 1. Dust particles. 2. Droplet nuclei. 3. Water. 4. Eating utensils.

2. Droplet nuclei.

80. A client's arterial blood gas values are as follows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO3-, 36 mEq/L. The nurse should assess the client for: 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety.

2. Flushed skin.

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

2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe.

67. In which areas of the United States is the incidence of tuberculosis highest? 1. Rural farming areas. 2. Inner-city areas. 3. Areas where clean water standards are low. 4. Suburban areas with significant industrial pollution.

2. Inner-city areas.

123. A young adult is admitted to the emergency department after an automobile accident. The client has severe pain in the right chest where there was an impact on the steering wheel. Which is the primary client goal at this time? 1. Reduce the client's anxiety. 2. Maintain adequate oxygenation. 3. Decrease chest pain. 4. Maintain adequate circulating volume.

2. Maintain adequate oxygenation.

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

2. While exhaling through pursed lips.

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

3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent."

65. The nurse should caution sexually active female clients taking isoniazid (INH) that the drug has which of the following effects? 1. Increases the risk of vaginal infection. 2. Has mutagenic effects on ova. 3. Decreases the effectiveness of hormonal contraceptives. 4. Inhibits ovulation.

3. Decreases the effectiveness of hormonal contraceptives.

60. A client had a Mantoux test result of an 8-mm induration. The test is considered positive when the client: 1. Lives in a long-term care facility. 2. Has no known risk factors. 3. Is immunocompromised. 4. Works as a health care provider in a hospital.

3. Is immunocompromised.

86. The nurse administers theophylline (Theo-Dur) to a client. When evaluating the effectiveness of this medication, the nurse should assess the client for which of the following? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Less difficulty breathing. 4. Thinning of tenacious, purulent sputum.

3. Less difficulty breathing.

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

3. Peripheral edema.

126. Which of the following findings would suggest pneumothorax in a trauma victim? 1. Pronounced crackles. 2. Inspiratory wheezing. 3. Dullness on percussion. 4. Absent breath sounds.

4. Absent breath sounds.

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

4. Abstain from cigarette smoking.

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

4. Administer bronchodilators as prescribed.

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

4. Coarse crackles and rhonchi.

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

4. High-calorie, high-protein diet.

68. The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving isoniazid and rifampin (Rifamate) for treatment of tuberculosis? 1. Take the medication with antacids. 2. Double the dosage if a drug dose is missed. 3. Increase intake of dairy products. 4. Limit alcohol intake.

4. Limit alcohol intake.

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

4. The client agrees to call the physician if dyspnea on exertion increases.

78. Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake. 2. To strengthen the diaphragm. 3. To strengthen the intercostal muscles. 4. To promote carbon dioxide elimination.

4. To promote carbon dioxide elimination.