Deck 29: Nursing Management: Obstructive Pulmonary Diseases

Question 1

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. A common etiologic factor for this nursing diagnosis in patients with asthma is

A) anxiety about dyspnea.
B) side effects of medications.
C) work of breathing.
D) fear of suffocation.

Answer 1

work of breathing.

Question 2

When reading the chart for a patient with COPD, the nurse notes that the patient has cor pulmonale. To assess for cor pulmonale, the nurse will monitor the patient for

A) elevated temperature.
B) complaints of chest pain.
C) jugular vein distension.
D) clubbing of the fingers.

Answer 2

jugular vein distension.

Question 3

While teaching a patient with asthma the appropriate use of a peak flow meter, the nurse instructs the patient to

A) take and record peak flow readings when having asthma symptoms or an attack.
B) increase the doses of long-term control medications for peak flows in the red zone.
C) use the flow meter each morning after taking asthma medications.
D) empty the lungs and then inhale rapidly through the mouthpiece.

Answer 3

take and record peak flow readings when having asthma symptoms or an attack.

Question 4

A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO₂ 58 mm Hg, PaCO₂ 55 mm Hg, and SaO₂ 86%. The nurse recognizes these values as evidence of

A) normal acid-base balance with hypoxemia.
B) normal acid-base balance with hypercapnia.
C) respiratory acidosis.
D) respiratory alkalosis.

Question 5

A patient with a history of asthma is admitted to the hospital in acute respiratory distress. During assessment of the patient, the nurse would notify the health care provider immediately about

A) a pulse oximetry reading of 90%.
B) a peak expiratory flow rate of 240 ml/min.
C) decreased breath sounds and wheezing.
D) a respiratory rate of 26 breaths/min.

Question 6

A patient with an acute attack of asthma comes to the emergency department, where ABGs are drawn. The nurse determines the patient is in the early phase of the attack, based on the ABG results of

A) pH 7.0, PaCO₂ 50 mm Hg, and PaO₂ 74 mm Hg.
B) pH 7.4, PaCO₂ 32 mm Hg, and PaO₂ 70 mm Hg.
C) pH 7.36, PaCO₂ 40 mm Hg, and PaO₂ 80 mm Hg.
D) pH 7.32, PaCO₂ 58 mm Hg, and PaO₂ 60 mm Hg.

Question 7

The nurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements for a patient with COPD. An appropriate intervention for this problem is to

A) have the patient exercise for 10 minutes before meals.
B) offer high calorie snacks between meals and at bedtime.
C) assist the patient in choosing foods with a lot of texture.
D) increase the patient's intake of fruits and fruit juices.

Question 8

The health care provider has prescribed triamcinolone (Azmacort) metered-dose inhaler (MDI) two puffs every 8 hours and pirbuterol (Maxair) MDI 2 puffs four times a day for a patient with asthma. In teaching the patient about the use of the inhalers, the best instruction by the nurse is

A) "Use the Maxair inhaler first, wait a few minutes, then use the Azmacort inhaler."
B) "Using a spacer with the MDIs will improve the inhalation of the medications."
C) "To avoid side effects, the inhalers should not be used within 1 hour of each other."
D) "To maximize the effectiveness of the drugs, inhale quickly when using the inhalers."

Question 9

The nurse recognizes that intubation and mechanical ventilation are indicated for a patient in status asthmaticus when

A) ventricular dysrhythmias and dyspnea occur.
B) loud wheezes are audible throughout the lungs.
C) pulsus paradoxus is greater than 40 mm Hg.
D) fatigue and an O₂ saturation of 88% develop.

Question 10

Which finding would be the best indication to the nurse that the patient having an acute asthma attack was responding to the prescribed bronchodilator therapy?

A) Wheezes are more easily heard.
B) The oxygen saturation is 89%.
C) Vesicular breath sounds resolve.
D) The respiratory effort decreases.

Question 11

The nurse makes a diagnosis of impaired gas exchange for a patient with COPD in acute respiratory distress, based on the assessment finding of

A) a pulse oximetry reading of 86%.
B) dyspnea and respiratory rate of 36.
C) use of the accessory respiratory muscles.
D) the presence of crackles in both lungs.

Question 12

During assessment of a patient with a history of asthma, the nurse notes wheezing and dyspnea. The nurse will anticipate giving medications to reduce

A) laryngospasm.
B) pulmonary edema.
C) airway narrowing.
D) alveolar distention.

Question 13

A 32-year-old patient is seen in the clinic for dyspnea associated with the diagnosis of emphysema. The patient denies any history of smoking. The nurse will anticipate teaching the patient about

A) a1-antitrypsin testing.
B) use of the nicotine patch.
C) continuous pulse oximetry.
D) effects of leukotriene modifiers.

Question 14

A patient is seen in the clinic with COPD. Which information given by the patient would help most in confirming a diagnosis of chronic bronchitis?

A) The patient tells the nurse about a family history of bronchitis.
B) The patient denies having any respiratory problems until the last 6 months.
C) The patient's history indicates a 40 pack-year cigarette history.
D) The patient complains about having a productive cough every winter for 2 months.

Question 15

When preparing a patient with possible asthma for pulmonary function testing, the nurse will teach the patient to

A) avoid eating or drinking for 4 hours before the forced expiratory volume in 1 second (FEV1)/forced expiratory volume (FEV) test.
B) take oral corticosteroids at least 2 hours before the examination.
C) withhold bronchodilators for 6 to 12 hours before the examination.
D) use rescue medications immediately before the FEV1/FEV testing.

Question 16

The nurse teaches a patient with COPD how to perform pursed-lip breathing, explaining that this technique will assist respiration by

A) loosening secretions so that they may be coughed up more easily.
B) promoting maximal inhalation for better oxygenation of the lungs.
C) preventing airway collapse and air trapping in the lungs during expiration.
D) decreasing anxiety by giving the patient control of respiratory patterns.

Question 17

An asthmatic patient who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that

A) Advair is a combination of long-acting and slow-acting bronchodilators.
B) the two drugs work together to block the effects of histamine on the bronchioles.
C) one drug decreases inflammation, and the other is a bronchodilator.
D) the combination of two drugs works more quickly in an acute asthma attack.

Question 18

A patient who has mild persistent asthma uses an albuterol (Proventil) inhaler for chest tightness and wheezing has a new prescription for cromolyn (Intal). To increase the patient's management and control of the asthma, the nurse should teach the patient to

A) use the cromolyn when the albuterol does not relieve symptoms.
B) use the cromolyn to prevent inflammatory airway changes.
C) administer the cromolyn first for chest tightness or wheezing.
D) administer the albuterol regularly to prevent airway inflammation.

Question 19

Which of these is the best goal for the patient admitted with chronic bronchitis who has a nursing diagnosis of ineffective airway clearance?

A) Patient denies having dyspnea.
B) Patient's mental status is improved.
C) Patient has a productive cough.
D) Patient's O₂ saturation is 90%.

Question 20

When teaching a patient with chronic obstructive pulmonary disease (COPD) about reasons to quit smoking, the nurse will explain that long-term exposure to tobacco smoke leads to a

A) weakening of the smooth muscle lining the airways.
B) decrease in the area available for oxygen absorption.
C) lesser number of red blood cells for oxygen delivery.
D) decreased production of protective respiratory secretions.

Question 21

Which information given by an asthmatic patient during the admission assessment will be of most concern to the nurse?

A) The patient says that the asthma symptoms are worse every spring.
B) The patient's only asthma medications are albuterol (Proventil) and salmeterol (Serevent).
C) The patient uses cromolyn (Intal) before any aerobic exercise.
D) The patient's heart rate increases after using the albuterol (Proventil) inhaler.

Question 22

A patient with COPD asks the home health nurse about home oxygen use. The nurse should teach the patient that long-term home O₂ therapy

A) can improve the patient's prognosis and quality of life.
B) may cause oxygen dependency in patients with COPD.
C) is used only for patients who have severe end-stage respiratory disease.
D) should never be used at night because the patient cannot monitor its effect.

Question 23

The nurse has completed teaching a patient about MDI use. Which patient statement indicates that further patient teaching is needed?

A) "I will shake the MDI each time before giving the medication."
B) "I will take a slow, deep breath in after pushing down on the MDI."
C) "I will float the canister in water to decide whether I need to get a new MDI."
D) "I will attach a spacer to the MDI to make it easier for me to use."

Question 24

All of these orders are received for a patient having an acute asthma attack. Which one will the nurse administer first?

A) IV methylprednisolone (Solu-Medrol) 60 mg
B) triamcinolone (Azmacort) 2 puffs per MDI
C) salmeterol (Serevent) 50 mcg per DPI
D) albuterol (Ventolin) 2.5 mg per nebulizer

Question 25

Postural drainage with percussion and vibration is ordered bid for a patient with chronic bronchitis. The nurse will plan to

A) carry out the procedure 3 hours after the patient eats.
B) maintain the patient in the lateral positions for 20 minutes.
C) perform percussion and vibration before placing the patient in the drainage position.
D) give the ordered albuterol (Proventil) after the patient has received the therapy.

Question 26

The nurse has received a change-of-shift report about these patients with COPD. Which patient should the nurse assess first?

A) A patient with loud expiratory wheezes
B) A patient who has a cough productive of thick, green mucus
C) A patient with jugular vein distension and peripheral edema
D) A patient with a respiratory rate of 38

Question 27

A patient who is experiencing an acute asthma attack is admitted to the emergency department. The nurse's first action should be to

A) determine when the dyspnea started.
B) obtain the forced expiratory flow rate.
C) listen to the patient's breath sounds.
D) ask about inhaled corticosteroid use.

Question 28

When developing a teaching plan to help increase activity tolerance at home for a 70-year-old with severe COPD, the nurse should teach the patient that an appropriate exercise goal is to

A) exercise until shortness of breath occurs.
B) walk for a total of 20 minutes daily.
C) limit exercise to activities of daily living (ADLs).
D) walk until pulse rate exceeds 150.

Question 29

A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse

A) give a high enough flow rate to keep the bag from collapsing.
B) use an appropriate adaptor to ensure adequate oxygen delivery.
C) drain moisture condensation from the oxygen tubing every hour.
D) keep the air entrainment ports clean and unobstructed.

Question 30

A patient with severe COPD tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, the nurse identifies the nursing diagnosis of

A) hopelessness related to presence of long-term stress.
B) anticipatory grieving related to expectation of death.
C) ineffective coping related to unknown outcome of illness.
D) disturbed self-esteem related to physical dependence.

Question 31

A patient with COPD tells the nurse, "At home, I only have to use an albuterol (Proventil) inhaler. Why did the doctor add an ipratropium (Atrovent) inhaler while I'm in the hospital? The appropriate response by the nurse is

A) "Atrovent will dilate the airways and allow the Proventil to penetrate more deeply."
B) "Atrovent is being used to decrease airway inflammation and sputum production."
C) "Atrovent works differently to dilate the bronchi, and the two drugs together are more effective."
D) "Atrovent is a potent bronchodilator and patients need to be hospitalized when receiving it."

Question 32

Which statement by the COPD patient indicates that the nurse's teaching about nutrition has been effective?

A) "I will drink lots of fluids with my meals."
B) "I will have ice cream as a snack every day."
C) "I should exercise for 15 minutes before meals."
D) "I should avoid much meat or dairy products."

Question 33

When teaching the patient with COPD about exercise, which information should the nurse include?

A) "Stop exercising if you start to feel short of breath."
B) "Use the bronchodilator before you start to exercise."
C) "Breathe in and out through the mouth while you exercise."
D) "Upper body exercise should be avoided to prevent dyspnea."

Question 34

A patient with COPD is admitted to the hospital. How can the nurse best position the patient to improve gas exchange?

A) Sitting up at the bedside in a chair and leaning slightly forward
B) Resting in bed with the head elevated to 45 to 60 degrees
C) In the Trendelenburg's position with several pillows behind the head
D) Resting in bed in a high-Fowler's position with the knees flexed

Question 35

A 26-year-old patient has had CF since birth and has severe lung changes and cor pulmonale as a result of the disease. An appropriate expected outcome is that the patient will

A) engage in aerobic exercise without dyspnea.
B) be weaned from home oxygen use.
C) achieve a realistic attitude toward treatment.
D) develop no CF-related complications.

Question 36

A 23-year-old with cystic fibrosis (CF) is admitted to the hospital. Which intervention will be included in the plan of care?

A) Schedule sweat chloride test to evaluate the effectiveness of therapy.
B) Arrange for a hospice nurse to visit with the patient regarding home care.
C) Place the patient on a low-sodium diet to prevent cor pulmonale.
D) Perform chest physiotherapy every 4 hours to mobilize secretions.

Question 37

When a patient with COPD is receiving oxygen, the best action by the nurse is to

A) avoid administration of oxygen at a rate of more than 2 L/min.
B) minimize oxygen use to avoid oxygen dependency.
C) administer oxygen according to the patient's level of dyspnea.
D) maintain the pulse oximetry level at 90% or greater.

Question 38

A 19-year-old male patient with CF and his wife are considering having a child. Which statement by the patient indicates that the nurse's teaching has been effective?

A) "We will plan on having genetic counseling before we make a decision."
B) "My erectile dysfunction will make it more difficult to have a child."
C) "It is likely that I will die before any children we have are grown."
D) "There should not be any problems as long as I take my medications."

Question 39

When taking an admission history of a patient with possible asthma who has new-onset wheezing and shortness of breath, the nurse will be most concerned about which information?

A) The patient has a history of pneumonia 2 years ago.
B) The patient takes propranolol (Inderal) for hypertension.
C) The patient uses acetaminophen (Tylenol) for headaches.
D) The patient has chronic inflammatory bowel disease.

Question 40

The nurse caring for a patient with CF recognizes that the manifestations of the disease are caused by the pathophysiologic processes of

A) inflammation and fibrosis of lung tissue.
B) altered function of exocrine glands.
C) failure of the mucus-producing goblet cells.
D) thickening and fibrosis of the pleural linings.

Question 41

After teaching the patient with asthma about home care, the nurse will evaluate that the teaching has been successful if the patient states,

A) "I will use my corticosteroid inhaler as soon as I start to get short of breath."
B) "I will only turn the home oxygen level up after checking with the doctor first."
C) "My medications are working if I wake up short of breath only once during the night."
D) "No changes in my medications are needed if my peak flow is at 80% of normal."