Deck 30: Care of Patients with Noninfectious Lower Respiratory Problems

Question 1

A nurse cares for a client with chronic obstructive pulmonary disease (COPD)who appears thin and disheveled.Which question should the nurse ask first?

A) "Do you have a strong support system?"
B) "What do you understand about your disease?"
C) "Do you experience shortness of breath with basic activities?"
D) "What medications are you prescribed to take each day?"

Answer 1

"Do you experience shortness of breath with basic activities?"

Question 2

A nurse assesses a client who is prescribed fluticasone (Flovent)and notes oral lesions.Which action should the nurse take?

A) Encourage oral rinsing after fluticasone administration.
B) Obtain an oral specimen for culture and sensitivity.
C) Start the client on a broad-spectrum antibiotic.
D) Document the finding as a known side effect.

Answer 2

Encourage oral rinsing after fluticasone administration.

Question 3

A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain.Which action should the nurse take?

A) Ambulate the client in the hallway to promote deep breathing.
B) Auscultate the client's anterior and posterior lung fields.
C) Encourage the client to take shallow breaths to help with the pain.
D) Administer pain medication and encourage the client to take deep breaths.

Answer 3

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

Question 4

A nurse cares for a client who has a chest tube.When would this client be at highest risk for developing a pneumothorax?

A) When the insertion site becomes red and warm to the touch
B) When the tube drainage decreases and becomes sanguineous
C) When the client experiences pain at the insertion site
D) When the tube becomes disconnected from the drainage system

Question 5

A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema.Which physiologic process should the nurse correlate with this client's history and clinical manifestations?

A) Increased pulmonary pressure creating a higher workload on the right side of the heart
B) Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles
C) Increased number and size of mucus glands producing large amounts of thick mucus
D) Left ventricular hypertrophy creating a decrease in cardiac output

Question 6

The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home.Which statement indicates the client correctly understands the teaching?

A) "I plan to wear my oxygen when I exercise and feel short of breath."
B) "I will use my portable oxygen when grilling burgers in the backyard."
C) "I plan to use cotton balls to cushion the oxygen tubing on my ears."
D) "I will only smoke while I am wearing my oxygen via nasal cannula."

Question 7

The nurse is caring for a client who is prescribed a long-acting beta? agonist.The client states,"The medication is too expensive to use every day.I only use my inhaler when I have an attack." How should the nurse respond?

A) "You are using the inhaler incorrectly.This medication should be taken daily."
B) "If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks."
C) "Tell me more about your fears related to feelings of breathlessness."
D) "It is important to use this type of inhaler every day.Let's identify potential community services to help you."

Question 8

A nurse cares for a client who is infected with Burkholderia cepacia.Which action should the nurse take first when admitting this client to a pulmonary care unit?

A) Instruct the client to wash his or her hands after contact with other people.
B) Implement Droplet Precautions and don a surgical mask.
C) Keep the client isolated from other clients with cystic fibrosis.
D) Obtain blood, sputum, and urine culture specimens.

Question 9

The nurse is caring for a client with lung cancer who states,"I don't want any pain medication because I am afraid I'll become addicted." How should the nurse respond?

A) "I will ask the provider to change your medication to a drug that is less potent."
B) "Would you like me to use music therapy to distract you from your pain?"
C) "It is unlikely you will become addicted when taking medicine for pain."
D) "Would you like me to give you acetaminophen (Tylenol) instead?"

Question 10

After teaching a client who is prescribed a long-acting beta? agonist medication,a nurse assesses the client's understanding.Which statement indicates the client comprehends the teaching?

A) "I will carry this medication with me at all times in case I need it."
B) "I will take this medication when I start to experience an asthma attack."
C) "I will take this medication every morning to help prevent an acute attack."
D) "I will be weaned off this medication when I no longer need it."

Question 11

A nurse cares for a client with chronic obstructive pulmonary disease (COPD).The client states that he no longer enjoys going out with his friends.How should the nurse respond?

A) "There are a variety of support groups for people who have COPD."
B) "I will ask your provider to prescribe you with an antianxiety agent."
C) "Share any thoughts and feelings that cause you to limit social activities."
D) "Friends can be a good support system for clients with chronic disorders."

Question 12

A nurse is teaching a client who has cystic fibrosis (CF).Which statement should the nurse include in this client's teaching?

A) "Take an antibiotic each day."
B) "Contact your provider to obtain genetic screening."
C) "Eat a well-balanced, nutritious diet."
D) "Plan to exercise for 30 minutes every day."

Question 13

While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer,a nurse notices that the lower chest tube is dislodged.Which action should the nurse take first?

A) Assess for drainage from the site.
B) Cover the insertion site with sterile gauze.
C) Contact the provider and obtain a suture kit.
D) Reinsert the tube using sterile technique.

Question 14

A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD).Which client should the nurse assess first?

A) A 46-year-old with a 30-pack-year history of smoking
B) A 52-year-old in a tripod position using accessory muscles to breathe
C) A 68-year-old who has dependent edema and clubbed fingers
D) A 74-year-old with a chronic cough and thick, tenacious secretions

Question 15

After teaching a client how to perform diaphragmatic breathing,the nurse assesses the client's understanding.Which action demonstrates that the client correctly understands the teaching?

A) The client lays on his or her side with his or her knees bent.
B) The client places his or her hands on his or her abdomen.
C) The client lays in a prone position with his or her legs straight.
D) The client places his or her hands above his or her head.

Question 16

A nurse assesses several clients who have a history of asthma.Which client should the nurse assess first?

A) A 66-year-old client with a barrel chest and clubbed fingernails
B) A 48-year-old client with an oxygen saturation level of 92% at rest
C) A 35-year-old client who has a longer expiratory phase than inspiratory phase
D) A 27-year-old client with a heart rate of 120 beats/min

Question 17

After teaching a client who is prescribed salmeterol (Serevent),the nurse assesses the client's understanding.Which statement by the client indicates a need for additional teaching?

A) "I will be certain to shake the inhaler well before I use it."
B) "It may take a while before I notice a change in my asthma."
C) "I will use the drug when I have an asthma attack."
D) "I will be careful not to let the drug escape out of my nose and mouth."

Question 18

A nurse cares for a client who has a pleural chest tube.Which action should the nurse take to ensure safe use of this equipment?

A) Strip the tubing to minimize clot formation and ensure patency.
B) Secure tubing junctions with clamps to prevent accidental disconnections.
C) Connect the chest tube to wall suction at the level prescribed by the provider.
D) Keep padded clamps at the bedside for use if the drainage system is interrupted.

Question 19

A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer.Which diet selection should the nurse provide for this client?

A) Spaghetti with meat sauce, ice cream
B) Chicken soup, grilled cheese sandwich
C) Omelet, soft whole wheat bread
D) Pasta salad, custard, orange juice

Question 20

A nurse cares for a client with arthritis who reports frequent asthma attacks.Which action should the nurse take first?

A) Review the client's pulmonary function test results.
B) Ask about medications the client is currently taking.
C) Assess how frequently the client uses a bronchodilator.
D) Consult the provider and request arterial blood gases.

Question 21

A nurse assesses a client with asthma and notes bilateral wheezing,decreased pulse oxygen saturation,and suprasternal retraction on inhalation.Which actions should the nurse take? (Select all that apply.)

A) Administer prescribed salmeterol (Serevent) inhaler.
B) Assess the client for a tracheal deviation.
C) Administer oxygen to keep saturations greater than 94%.
D) Perform peak expiratory flow readings.
E) Administer prescribed albuterol (Proventil) inhaler.

Question 22

A nurse assesses a client who has a mediastinal chest tube.Which symptoms require the nurse's immediate intervention? (Select all that apply.)

A) Production of pink sputum
B) Tracheal deviation
C) Pain at insertion site
D) Sudden onset of shortness of breath
E) Drainage greater than 70 mL/hr
F) Disconnection at Y site

Question 23

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

A) 2, 3, 4, 5, 6, 1
B) 3, 4, 5, 1, 6, 2
C) 4, 3, 5, 1, 2, 6
D) 5, 3, 6, 1, 2, 4

Question 24

A nurse cares for a client who tests positive for alpha?-antitrypsin (AAT)deficiency.The client asks,"What does this mean?" How should the nurse respond?

A) "Your children will be at high risk for the development of chronic obstructive pulmonary disease."
B) "I will contact a genetic counselor to discuss your condition."
C) "Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke."
D) "This is a recessive gene and should have no impact on your health."

Question 25

A nurse administers medications to a client who has asthma.Which medication classification is paired correctly with its physiologic response to the medication?

A) Bronchodilator - Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators
B) Cholinergic antagonist - Causes bronchodilation by inhibiting the parasympathetic nervous system
C) Corticosteroid - Relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors
D) Cromone - Disrupts the production of pathways of inflammatory mediators

Question 26

A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic obstructive pulmonary disease (COPD):

Which action should the nurse take first?

A) Administer a short-acting beta2 agonist inhaler.
B) Document the findings as normal for a client with COPD.
C) Teach the client diaphragmatic breathing techniques.
D) Initiate oxygenation therapy to increase saturation to 92%.

Question 27

A nurse auscultates a client's lung fields.Which action should the nurse take based on the lung sounds?
(Click the media button to hear the audio clip.)

A) Assess for airway obstruction.
B) Initiate oxygen therapy.
C) Assess vital signs.
D) Elevate the client's head.

Question 28

A nurse auscultates a client's lung fields.Which pathophysiologic process should the nurse associate with this breath sound?
(Click the media button to hear the audio clip.)

A) Inflammation of the pleura
B) Constriction of the bronchioles
C) Upper airway obstruction
D) Pulmonary vascular edema

Question 29

A nurse teaches a client who has chronic obstructive pulmonary disease.Which statements related to nutrition should the nurse include in this client's teaching? (Select all that apply.)

A) "Avoid drinking fluids just before and during meals."
B) "Rest before meals if you have dyspnea."
C) "Have about six small meals a day."
D) "Eat high-fiber foods to promote gastric emptying."
E) "Increase carbohydrate intake for energy."

Question 30

A nurse assesses a client who has a chest tube.For which manifestations should the nurse immediately intervene? (Select all that apply.)

A) Production of pink sputum
B) Tracheal deviation
C) Sudden onset of shortness of breath
D) Pain at insertion site
E) Drainage of 75 mL/hr

Question 31

A nurse plans care for a client who has chronic obstructive pulmonary disease and thick,tenacious secretions.Which interventions should the nurse include in this client's plan of care? (Select all that apply.)

A) Ask the client to drink 2 liters of fluids daily.
B) Add humidity to the prescribed oxygen.
C) Suction the client every 2 to 3 hours.
D) Use a vibrating positive expiratory pressure device.
E) Encourage diaphragmatic breathing.

Question 32

A nurse cares for a female client who has a family history of cystic fibrosis.The client asks,"Will my children have cystic fibrosis?" How should the nurse respond?

A) "Since many of your family members are carriers, your children will also be carriers of the gene."
B) "Cystic fibrosis is an autosomal recessive disorder.If you are a carrier, your children will have the disorder."
C) "Since you have a family history of cystic fibrosis, I would encourage you and your partner to be tested."
D) "Cystic fibrosis is caused by a protein that controls the movement of chloride.Adjusting your diet will decrease the spread of this disorder."

Question 33

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

A) 4, 2, 1, 3, 5, 6, 7
B) 3, 4, 1, 2, 5, 7, 6
C) 2, 1, 3, 4, 5, 6, 7
D) 1, 3, 2, 5, 6, 7, 4

Question 34

A nurse cares for a client who is prescribed an intravenous prostacyclin agent.Which actions should the nurse take to ensure the client's safety while on this medication? (Select all that apply.)

A) Keep an intravenous line dedicated strictly to the infusion.
B) Teach the client that this medication increases pulmonary pressures.
C) Ensure that there is always a backup drug cassette available.
D) Start a large-bore peripheral intravenous line.
E) Use strict aseptic technique when using the drug delivery system.

Question 35

A nurse assesses a client with chronic obstructive pulmonary disease.Which questions should the nurse ask to determine the client's activity tolerance? (Select all that apply.)

A) "What color is your sputum?"
B) "Do you have any difficulty sleeping?"
C) "How long does it take to perform your morning routine?"
D) "Do you walk upstairs every day?"
E) "Have you lost any weight lately?"