Deck 31: Nursing Care of Patients With Lower Respiratory Tract Disorders

Question 1

The nurse is providing care for a patient taking theophylline (Theo-24). Which of the following statements should be included in the patient education?

A)"This medication can cause blurred vision and anorexia."
B)"It is important to alert the doctor to any abdominal pain or bloating."
C)"You may experience a headache and sensitivity to light while taking this medication."
D)"Notify your doctor if you have feelings of restlessness or a rapid heart rate."

Answer 1

"Notify your doctor if you have feelings of restlessness or a rapid heart rate."

Question 2

A patient with chronic obstructive pulmonary disease works with the nurse to set a goal of ambulating to the bathroom with oxygen. Which of the following statements best documents progress toward this goal?

A)"Arterial blood gases are within normal limits."
B)"Dyspnea is controlled with oxygen and rest."
C)"Ambulated to bathroom with oxygen, dyspnea level 3 on a 0 to 10 scale."
D)"Patient assisted to bathroom three times today."

Answer 2

"Ambulated to bathroom with oxygen, dyspnea level 3 on a 0 to 10 scale."

Question 3

A patient with lung cancer who is scheduled to begin a course of radiation therapy asks the nurse, "How will they know if I'm cured?" The nurse's best response is based on which of the following understandings?

A)Eighty percent of lung cancers are curable with radiation therapy.
B)Radiation in lung cancer is most often used to increase comfort, not cure disease.
C)Radiation therapy reduces inflammation; chemotherapy is used to shrink the tumor.
D)Lung cancer is never a curable disease; prolonged life is the goal.

Answer 3

Radiation in lung cancer is most often used to increase comfort, not cure disease.

Question 4

A patient's arterial blood gas analysis shows a PaCO₂ of 62 mm Hg. Which of the following actions is best?

A)Notify the RN; this is abnormally high.
B)Increase the flow rate of the patient's nasal oxygen.
C)No action is necessary; this is a normal PaCO₂ level.
D)Have the patient breathe into a paper bag.

Question 5

The nurse enters the room of a patient who is acutely short of breath. Which of the following actions should the nurse take first?

A)Assist the patient into Sims' position.
B)Encourage use of pursed-lip breathing.
C)Ask the patient what caused the dyspnea.
D)Teach the patient use of accessory muscles.

Question 6

The nurse is providing discharge teaching for a patient with newly diagnosed asthma. Which of the following should be included in the discharge teaching?

A)"Symptoms are caused by inflammation in the lining of your airways."
B)"Fluid fills the tiny sacs in the lungs and makes breathing difficult."
C)"You may notice large amounts of pus-like sputum that has a foul odor."
D)"The chest wall becomes stiff and air movement is restricted in individuals with asthma."

Question 7

Corticosteroids such as methylprednisolone (Solu-Medrol) are used in the patient with chronic obstructive pulmonary disease for which of the following purposes?

A)To dry secretions
B)To treat infection
C)To improve the oxygen-carrying capacity of hemoglobin
D)To reduce airway inflammation

Question 8

A summer camp worker reports to the camp nurse with complaints of shortness of breath and audible wheezing. Which of the following inhaled medications would the nurse provide?

A)Cromolyn sodium (Intal)
B)Triamcinolone (Azmacort)
C)Nedocromil sodium (Tilade)
D)Albuterol (Proventil)

Question 9

A patient with lung cancer develops pleural effusion. Which of the following explanations by the nurse would help the patient understand this problem?

A)"You have large amounts of fluid collecting in your airways because of the lung cancer."
B)"Pus has developed in your alveoli that must be removed to improve your breathing."
C)"Fluid has collected in the space between your lungs and the sac surrounding your lungs."
D)"Fluid in your pericardial sac places pressure on your lungs, making it difficult to breathe."

Question 10

A nurse is providing home care for a patient with chronic obstructive pulmonary disease (COPD). Which of the following orders should the nurse question?

A)Tiotropium (Spiriva) inhalation once daily
B)Increase activity as tolerated
C)Oxygen 4 L/min per nasal cannula
D)Low-sodium diet

Question 11

A patient is unable to maintain a clear airway effectively with coughing and has a respiratory rate of 22/min with coarse crackles bilaterally. Which intervention should the nurse provide first?

A)Perform tracheal suctioning.
B)Encourage fluids.
C)Encourage bedrest.
D)Assess the patient's coughing technique.

Question 12

While reinforcing discharge teaching for a patient with emphysema, which of the following patient statements would indicate that teaching was effective?

A)"My disease is caused by spasm of the smooth muscles in my breathing pipes."
B)"Air gets trapped when damage to the air sacs makes it hard for air to move in and out."
C)"Emphysema causes swelling in the airways and an increase in mucus production."
D)"There are bacteria in my lungs so my body is trying to wall off the infection."

Question 13

Which of the following medications can help reduce acute dyspnea in a patient with end-stage chronic obstructive pulmonary disease?

A)PO cortisone
B)IM meperidine (Demerol)
C)IV morphine
D)IV propranolol (Inderal)

Question 14

A patient is admitted to a respiratory unit with a diagnosis of left lower lobe pneumonia. The nursing assessment reveals the patient to be febrile and experiencing a weak, congested-sounding cough. The patient has moist crackles throughout the lung fields. Based on the data provided, which of the following nursing diagnoses is most appropriate?

A)Ineffective Airway Clearance
B)Anxiety
C)Impaired Gas Exchange
D)Ineffective Breathing Pattern

Question 15

The nurse receives a report of a theophylline level of 3 mcg/dL in a patient who is prescribed theophylline for asthma. What should the nurse do?

A)Notify the physician.
B)No action is necessary; this is a therapeutic level.
C)Hold the next dose of theophylline until further orders are given.
D)Double the next dose of theophylline.

Question 16

A patient with cystic fibrosis has ineffective airway clearance. What intervention would worsen this problem?

A)Percussion and postural drainage
B)Fluids
C)Mucolytics
D)Bedrest

Question 17

A patient diagnosed with a pleural effusion is very dyspneic. Which of the following procedures should the nurse anticipate assisting with?

A)Tracheostomy
B)Thoracentesis
C)Bronchoscopy
D)Pericardiocentesis

Question 18

The nurse is providing routine follow-up care for a young adult with asthma who has been on a 3-month course of maintenance therapy. Which of the following activities would best help the nurse to determine if the patient's treatment plan was effective?

A)Examine daily tracking records of the peak expiratory flow rate.
B)Evaluate the patient's use of an incentive spirometer.
C)Determine the patient's pulse oximeter reading.
D)Obtain an arterial blood gas (ABG) analysis.

Question 19

Which of the following laboratory tests would best help the nurse to monitor the condition of a patient with pneumonia?

A)White blood cell (WBC) count, arterial blood gases (ABGs)
B)Complete blood count (CBC), urinalysis
C)Electrolytes, serum creatinine
D)Partial thromboplastin time (PTT), serum potassium

Question 20

Which of the following factors place a patient at risk for lung cancer?

A)Living in a cold climate and having pets
B)Smoking and exposure to radon gas
C)Living in crowded conditions and lack of sunlight
D)Eating foods high in beta carotene and fiber

Question 21

A patient with tuberculosis who is in respiratory isolation must go to the x-ray department. Which of the following actions should the nurse take?

A)Call the x-ray department to make sure the waiting room is empty.
B)Place a gown and gloves on the patient.
C)Place a mask over the patient's nose and mouth.
D)Notify the x-ray department that the test must be cancelled.

Question 22

What term should the nurse use to document blood-tinged sputum?

A)Hematemesis
B)Hypoxemia
C)Hemoptysis
D)Hypercarbia

Question 23

A patient with a pneumothorax has a chest drainage system. The family asks when the chest tube will be removed. Which of the following responses, by the nurse, is best?

A)"The tube is removed when serous drainage has stopped collecting in the system."
B)"The tube is taken out when the patient is able to cough and deep breathe effectively."
C)"When tidaling stops and lung sounds are equal on both sides, the tube can be removed."
D)"When the adventitious lung sounds are resolved, it is usually safe to remove the tube."

Question 24

A patient with tuberculosis takes the prescribed drugs until the bottle runs out and then feels better and does not refill the prescription. The home health nurse explains that continuing the drugs is important for which of the following reasons?

A)"If taken consistently, your drugs will prevent hemoptysis."
B)"You must take all the drugs to prevent development of resistant bacteria."
C)"The drugs will keep you pain free so you can cough more effectively."
D)"If you don't take all your drugs you can develop a superinfection."

Question 25

A patient with respiratory failure would have which of the following acid-base abnormalities?

A)Respiratory acidosis
B)Respiratory alkalosis
C)Metabolic acidosis
D)Metabolic alkalosis

Question 26

What is the most common cause of death from infection?

A)AIDS
B)Tuberculosis (TB)
C)Pneumonia
D)Influenza

Question 27

A nurse performs purified protein derivative and Candida skin tests on a patient suspected of tuberculosis. After 48 hours, what finding at the injection sites should the nurse document as a positive result?

A)Redness
B)Induration
C)Purulent discharge
D)Warmth

Question 28

Which of the following measures is the most effective way to prevent lung cancer?

A)Eat a balanced diet.
B)Avoid smoking.
C)Avoid exposure to air pollution.
D)Avoid excessive sun exposure.

Question 29

An LPN is collecting data on a patient who had thoracic surgery this morning. Vital signs earlier following surgery were as follows: blood pressure 156/94 mm Hg, pulse 100 beats/min, respirations 14/min, and temperature 97.4°F (approximately 36.3°C). Which new finding should be reported to the physician immediately?

A)Blood pressure 110/76 mm Hg
B)Pulse 88 beats/min
C)Respirations 18/min
D)Temperature 98.4°F (approximately 36.9°C)

Question 30

Which of the following patients is most at risk for tuberculosis (TB)?

A)The patient with lung cancer
B)The patient with chronic airflow limitation
C)The patient with acquired immunodeficiency syndrome
D)The patient with a history of alcohol abuse

Question 31

The nurse teaches a patient with tuberculosis (TB) about drug therapy. Which of the following statements by the patient indicate that the teaching has been effective?

A)"I will have to take the antibiotics for 10 days."
B)"I will get a prescription for 2 weeks of antibiotics."
C)"I will probably need to be on antibiotic therapy for 6 months to 2 years."
D)"I will have to take antibiotics for the rest of my life."

Question 32

What is a major risk factor for many respiratory problems?

A)Smoking
B)Eating spicy foods
C)Excessive sun exposure
D)Eating a high-fat diet

Question 33

Which of the following patients should the nurse monitor most closely for symptoms of a pulmonary embolism (PE)?

A)A patient with chronic obstructive pulmonary disease (COPD)
B)A patient with a deep vein thrombosis in the leg
C)A patient who smokes
D)A patient with a history of radiation therapy for lung cancer

Question 34

What is the nurse listening for during auscultation of the lungs of a patient with a pneumothorax?

A)Presence of crackles or wheezes
B)Evidence of bilateral lung sounds
C)Presence of secretions in the lungs
D)Evidence of obstruction

Question 35

Which drugs are commonly prescribed to treat tuberculosis (TB)?

A)Alupent and theophylline
B)Aspirin and guaifenesin
C)Claforan and penicillin
D)Isoniazid and rifampin

Question 36

The nurse answers a call light and finds the patient gasping for breath and looking very anxious. Based on the patient’s history, the nurse believes the patient may be experiencing a pulmonary embolism (PE). Which of the following actions should the nurse take first?

A) Place the patient in a left lateral position.
B) Page the physician.
C) Yell for help and start oxygen.
D) Check the patient’s vital signs.

Question 37

Which medication should the nurse anticipate administering to a patient with a pulmonary embolism?

A)Theophylline
B)Corticosteroid
C)Heparin
D)Expectorant

Question 38

The nurse develops a plan for impaired gas exchange for a patient with end-stage chronic obstructive pulmonary disease (COPD). Which finding best helps the nurse to know when the goal has been reached?

A)The patient is alert and oriented.
B)The patient is able to clear the airway with coughing.
C)The patient correctly demonstrates pursed lip breathing.
D)The patient's oxygen saturation is 92%.

Question 39

A patient has difficulty raising pulmonary secretions, and the nurse writes a nursing diagnosis of "Ineffective Airway Clearance related to weak cough and fatigue." What would best help the patient maintain a clear airway?

A)Allow rest periods between activities.
B)Teach relaxation exercises.
C)Instruct in abdominal and pursed-lip breathing.
D)Encourage fluids; suction prn as ordered.

Question 40

What is the purpose of a Candida skin test when testing for tuberculosis (TB)?

A)To determine if the patient has a Candida albicans infection
B)To provide a control test
C)To potentiate the purified protein derivative (PPD) test
D)To test for skin superinfection

Question 41

What is the biggest killer worldwide of children and adults?

A)AIDS
B)Cancer
C)Pneumonia
D)Tuberculosis (TB)

Question 42

Which type of pneumonia occurs most often as a nosocomial infection in hospitalized patients, very young patients, and elderly patients?

A)Lobar pneumonia
B)Fungal pneumonia
C)Viral pneumonia
D)Bronchopneumonia

Question 43

Which of the following tests/procedures are used to diagnose a pulmonary embolism (PE)? (Select all that apply.?

A)Spirometry
B)D-dimer
C)Angiogram
D)Ventilation-perfusion lung scan
E)Spiral computed tomography (CT) scan
F)Bronchoscopy

Question 44

To be effective, thrombolytic agents such as urokinase or tissue plasminogen activator should be used within 4 to ________________hours of a pulmonary embolism occurrence.

Question 45

According to Centers for Disease Control and Prevention (CDC) guidelines, which of the following individuals would be considered positive for the tuberculin skin test? (Select all that apply.?

A)A 5-mm induration in an HIV-infected individual
B)A 10-mm induration in an individual with no risk factors for tuberculosis
C)A 10-mm induration in a child younger than 4 years old
D)A 10-mm induration in an HIV-negative individual who uses illicit injected drugs
E)A 5-mm induration in a foreign-born individual
F)A 5-mm induration in an individual from a low-income group

Question 46

More than ________________mL of fluid in the pleural space around each lung is considered abnormal.

Question 47

An older adult patient who reports difficulty breathing and a productive cough and has a low-grade fever is admitted to the hospital for diagnosis and treatment. Intervention for which of the following new-onset symptoms should take priority?

A)Confusion
B)Crackles on lung auscultation
C)Blood-tinged sputum
D)Fatigue
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 48

A patient has a positive response to a Candida test, in addition to a positive purified protein derivative (PPD) skin test. Which interpretation of this result is correct?

A)The patient is anergic.
B)The patient has a Candida infection.
C)The patient's PPD test is reliable.
D)The patient has active tuberculosis infection.

Question 49

A patient with a chronic oxygen saturation level of less than or equal to ____________________% should be placed on home oxygen.

Question 50

Which of the following signs or symptoms in a patient with severe long-standing bronchiectasis should the nurse report immediately?

A)Fever of 100.6°F (approximately 38°C) and dyspnea
B)Copious sputum
C)Distended neck veins and dependent edema
D)Periodic episodes of harsh coughing

Question 51

A nurse is providing care for a patient with Ineffective Airway Clearance. Which of the following are appropriate interventions to address this problem? (Select all that apply.?

A)Encourage patient to cough and deep breathe every 2 hours.
B)Place patient in supine position and turn every 2 hours.
C)Teach patient proper use of an incentive spirometer.
D)Administer guaifenesin (Mucinex) every 4 to 6 hours prn as ordered.
E)Assess respiratory rate and pattern every 4 hours and prn.
F)Weigh patient every day.Completion
Complete each statement.