Deck 32: Care of Patients With Noninfectious Lower Respiratory Problems

Question 1

The home care nurse observes white patches on the oral mucosa of a client with severe,chronic airflow limitation.What is the nurse's best action?

A) Ask the client whether he or she uses a steroid inhaler.
B) Inquire about any recent viral illnesses.
C) Have the client rinse the mouth with salt water.
D) Have the client brush the patches with a soft-bristled brush.

Answer 1

Ask the client whether he or she uses a steroid inhaler.

Question 2

The nurse is caring for an older adult who reports experiencing frequent asthma attacks and severe arthritic pain.What action by the nurse is most appropriate?

A) Review pulmonary function test results.
B) Assess use of medication for arthritis.
C) Assess frequency of bronchodilator use.
D) Review arterial blood gas results.

Answer 2

Assess use of medication for arthritis.

Question 3

A client is demonstrating diaphragmatic breathing for the nurse.Which action by the client shows adequate understanding of this breathing technique?

A) Lying on his or her side with knees bent
B) Having his or her hands on the abdomen
C) Having his or her hands over the head
D) Lying in the prone position

Answer 3

Having his or her hands on the abdomen

Question 4

A client is undergoing radiation therapy as treatment for lung cancer and has developed esophagitis.Which is the best diet selection for this client?

A) Spaghetti with meat sauce, ice cream
B) Scrambled eggs, bacon, toast
C) Omelet, whole wheat bread
D) Pasta salad, custard, orange juice

Question 5

A client with lung cancer refuses pain medications because he or she is "afraid of addiction." What is the nurse's best response?

A) "I can ask the physician to change your medication to a drug that is less potent."
B) "I can use other measures such as music therapy to distract you."
C) "It is unlikely you will become addicted from taking medicine for pain."
D) "I can just give you aspirin or acetaminophen (Tylenol) if you like."

Question 6

What is the best instruction for a client who has step II (mild persistent)asthma?

A) "Avoid participating in aerobic exercise."
B) "You will need daily inhaled low-dose steroids."
C) "You need to evaluate your diet for asthma triggers."
D) "Make sure you use a rescue inhaler three times per day."

Question 7

The nurse is teaching a client with asthma about self-management.Which statement by the nurse is best?

A) "Keep a daily symptom and intervention diary."
B) "Measure your anterior/posterior diameter weekly."
C) "Note your symptoms when you don't take your medications."
D) "Exercise before and after taking inhalers and compare tolerance."

Question 8

The nurse is caring for four clients with asthma.Which client does the nurse assess first?

A) Client with a barrel chest and clubbed fingernails
B) Client with an SaO₂ level of 92% at rest
C) Client whose expiratory phase is longer than the inspiratory phase
D) Client whose heart rate is 120 beats/min

Question 9

A client diagnosed with asthma has not responded well to medication.The client is concerned and asks the nurse,"What is wrong with me,and why am I not getting better?" What is the nurse's best response?

A) "You just weren't used to the medication yet."
B) "The medication dose has to be increased."
C) "It is possible that genetic testing may help."
D) "You should try homeopathic medicine."

Question 10

A client is using omalizumab (Xolair)for the first time.What is the priority nursing action?

A) Make sure the client takes the medication with water.
B) Administer ibuprofen (Motrin) because Xolair often causes headaches.
C) Teach the client how to use a syringe.
D) Remain with the client and assess for anaphylaxis.

Question 11

What statement indicates that a client needs further teaching regarding therapy with salmeterol (Serevent)?

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 12

A client is undergoing lung reduction surgery.What is the nurse's highest priority preoperatively?

A) Administer medications.
B) Discuss the possibility of ventilator dependency.
C) Teach how to cough and deep breathe.
D) Teach about preoperative testing.

Question 13

The nurse assesses a client receiving chemotherapy for lung cancer and notes red swollen mucous membranes and open sores in the mouth.The client reports mouth pain and difficulty swallowing.Which action does the nurse perform first?

A) Document the size of the sores.
B) Perform mouth hygiene.
C) Have the client rinse his or her mouth.
D) Call the health care provider and hold chemotherapy.

Question 14

The nurse assesses a client with asthma and finds wheezing throughout the lung fields and decreased pulse oxygen saturation.In addition,the nurse notes suprasternal retraction on inhalation.What is the nurse's best action?

A) Perform peak expiratory flow readings.
B) Assess for a midline trachea.
C) Administer oxygen and a rescue inhaler.
D) Call a code.

Question 15

A client with asthma has been having frequent asthma attacks.What is the nurse's best action?

A) Teach the client to stay away from pets.
B) Assist the client in using an incentive spirometer.
C) Administer aspirin for its anti-inflammatory properties.
D) Administer montelukast (Singulair).

Question 16

Which statement indicates that a client understands teaching about the correct use of a corticosteroid medication?

A) "This drug can reverse my symptoms during an asthma attack."
B) "This drug is effective in decreasing the frequency of my asthma attacks."
C) "This drug can be used most effectively as a rescue agent."
D) "This drug can be used safely on a long-term basis for multiple applications daily."

Question 17

Which statement indicates that the client understands teaching about the use of long-acting beta₂ agonist medications?

A) "I will not have to take this medication every day."
B) "I will take this medication when I have an asthma attack."
C) "I will take this medication daily to prevent an acute attack."
D) "I will eventually be able to stop using this medication."

Question 18

A client with asthma reports "not being able to take deep breaths." The nurse auscultates decreased breath sounds in the bases,and no wheezes.What is the nurse's best action?

A) Encourage the client to stay calm and take deep breaths.
B) Document the findings and continue to monitor.
C) Have the client cough forcefully.
D) Assess the client's oxygen saturation.

Question 19

The nurse is evaluating a client's response to medication therapy for asthma.The client has a peak flowmeter reading in the yellow zone.What does the nurse do next?

A) Nothing; this is an acceptable range.
B) Teach the client to take deeper breaths.
C) Assist the client to use a rescue inhaler.
D) Assess the client's lungs.

Question 20

Which statement indicates that a client needs additional teaching about using an inhaler?

A) "I will not exhale into the inhaler."
B) "I will store the inhaler in a drawer in my bedroom."
C) "I will soak my inhaler in water to clean it."
D) "I will inhale and hold my breath."

Question 21

A client with pulmonary fibrosis is being discharged home.What is the highest priority teaching need?

A) Dietary modifications
B) Determining activity tolerance
C) Avoiding infection
D) Medication therapy

Question 22

A client infected with Burkholderia cepacia is admitted to the unit.What is the nurse's priority action when caring for this client?

A) Instruct the client to wash his or her hands after contact with other people.
B) Place the client on strict isolation.
C) Keep the client isolated from other clients with cystic fibrosis.
D) Administer IV vancomycin daily.

Question 23

The nurse observes hematuria in a client receiving IV cyclophosphamide (Cytoxan).After notifying the health care provider,what intervention is the nurse's priority?

A) Obtain a urine specimen.
B) Assess laboratory studies.
C) Increase hydration.
D) Stop the medication.

Question 24

The nurse assesses a client's chest tube and finds continuous bubbling in the water seal chamber.When the nurse clamps the chest tube close to the client's dressing,the bubbling stops.How does the nurse interpret this finding?

A) An air leak is present at the chest tube insertion site or in the thoracic cavity.
B) An air leak is present in the drainage system.
C) More water needs to be added to the water seal.
D) The system is functioning appropriately and no intervention is needed.

Question 25

The nurse is assessing a client who has a chest tube.Which assessment finding requires intervention by the nurse?

A) Pain at the insertion site
B) Bloody drainage in the collection chamber
C) Intermittent bubbling in the water seal chamber
D) Tidaling in the water seal chamber

Question 26

A client was diagnosed with lung cancer and appears distressed.The client states,"I am so afraid." What is the best action for the nurse to take?

A) Provide comfort by holding the client's hand.
B) Offer to give the client a back rub for relaxation.
C) Offer the client a PRN antianxiety medication.
D) Ask the client what is causing the most fear right now.

Question 27

A client with chronic obstructive pulmonary disease (COPD)reports social isolation.What does the nurse encourage the client to do?

A) Join a support group for people with COPD.
B) Ask the client's physician for an antianxiety agent.
C) Verbalize his or her thoughts and feelings.
D) Participate in community activities.

Question 28

Which nursing intervention is an example of primary prevention for lung cancer?

A) Teaching clients with lung cancer how to cough and deep breathe
B) Teaching clients with lung cancer to avoid infection
C) Teaching clients about prophylactic antibiotics
D) Teaching people about smoking and secondhand smoke

Question 29

A client with lung cancer is lying flat in bed and reports shortness of breath.What action does the nurse take first?

A) Notify the health care provider.
B) Elevate the head of the bed.
C) Assess oxygen saturation.
D) Have the client take deep breaths.

Question 30

The nurse is teaching a client with bronchiolitis obliterans organizing pneumonia (BOOP)about corticosteroid therapy.What statement is accurate for the nurse to teach the client?

A) "You will be on this drug the rest of your life."
B) "You will be prone to many long-term side effects of this drug."
C) "A short course of therapy will help with acute episodes."
D) "This medication cannot be taken with antibiotic therapy."

Question 31

A client's chest tube is accidentally dislodged.What action by the nurse is best?

A) No action is necessary because the area will reseal itself.
B) Cover the insertion site with a sterile gauze and tape three sides.
C) Obtain a suture kit and prepare for the physician to suture the site.
D) Cover the area with an occlusive dressing.

Question 32

A client has recently been placed on prednisone (Deltasone).What is the highest priority instruction the nurse will provide?

A) "Expect to experience weight gain."
B) "Watch your diet while on this medication."
C) "Take the drug with food or milk."
D) "Report any abdominal pain or dark-colored vomit."

Question 33

The nurse assesses the following lung sounds in a client.What is the nurse's best action? (Click the media button to hear the audio clip.)

A) Administer a rescue inhaler.
B) Administer oxygen.
C) Assess vital signs.
D) Elevate the client's head.

Question 34

The nurse is assessing a client with lung disease.Which symptom does the nurse intervene for first?

A) The client's anterior-posterior chest diameter is 2:2.
B) Clubbing of the finger tips is noted.
C) The client has bilateral dependent leg edema.
D) The client is pale.

Question 35

The nurse is caring for a client with bronchiolitis obliterans organizing pneumonia (BOOP)and assesses decreased vital capacity during pulmonary function testing.What is the nurse's best action?

A) Administer intermittent positive-pressure breathing treatments.
B) Administer a short-acting beta-adrenergic medication.
C) Prepare to administer IV antibiotics.
D) Document the finding in the client's chart.

Question 36

The nurse is teaching a client about different medications for asthma.Which medication does the nurse teach the client to administer to control the prolonged inflammatory response?

A) Diphenhydramine (Benadryl)
B) Montelukast (Singulair)
C) Aspirin
D) Bitolterol (Tornalate)

Question 37

The nurse assesses a client who is on fluticasone (Flovent)and notes oral lesions.What is the nurse's best action?

A) Teach the client to rinse the mouth after Flovent use.
B) Have the client use a mouthwash daily.
C) Start the client on a broad-spectrum antibiotic.
D) Document the finding as a known side effect.

Question 38

The nurse is teaching a client with cystic fibrosis.What activity does the nurse teach as the priority?

A) Taking daily antibiotics
B) Having genetic screening
C) Maintaining good nutrition
D) Exercising daily

Question 39

Which is the highest priority problem for a client with late-stage lung cancer?

A) Malnutrition
B) Constipation
C) Weakness and fatigue
D) Pain

Question 40

A client recently diagnosed with lung cancer is being taught by the nurse.What information does the nurse teach the client?

A) "You will receive 6 weeks of daily radiation therapy."
B) "Lung cancer has a very good prognosis."
C) "Further testing is not needed because lung cancer rarely metastasizes."
D) "It is very likely that surgery will be curative."

Question 41

A client has a mediastinal chest tube.Which symptoms require the nurse's immediate intervention?

A) Production of pink sputum
B) Tracheal deviation
C) Oxygen saturation greater than 95%
D) Sudden onset of shortness of breath
E) Drainage greater than 70 mL/hr
F) Pain at insertion site
G) Disconnection at Y site

Question 42

The nurse is teaching a client with asthma how to avoid attacks.What information does the nurse give the client?

A) "You should not dust your furniture."
B) "Stay inside as much as possible."
C) "Stay away from people who are sick."
D) "Do not go out in the fall."
E) "Stay out of the snow."
F) "Do not take aspirin."

Question 43

A client has a chest tube.What assessment findings require immediate intervention from the nurse?

A) Intermittent bubbling in the water seal chamber in the client with a pneumothorax
B) "Silent chest" in the client with a pneumothorax
C) Tidaling in the water seal chamber in a client with a pneumothorax
D) Bloody drainage in the tubing of a client with a hemothorax
E) Tracheal deviation in a client after chest trauma
F) No drainage in the chest tube of a client with a pneumothorax
G) Constant bubbling in the water seal chamber in a client post chest surgery

Question 44

What information about nutrition does the nurse teach a client with chronic obstructive pulmonary disease (COPD)?

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) "Practice diaphragmatic breathing against resistance four times daily."
E) "Eat high-fiber foods to promote gastric emptying."
F) "Eat dry foods rather than wet foods, which are heavier."
G) "Increase carbohydrate intake for energy."

Question 45

Place the steps for obtaining a peak expiratory flow rate in the order in which they should occur.

A) Take as deep a breath as possible.
B) Stand up (unless you have a physical disability).
C) Place the meter in your mouth, and close your lips around the mouthpiece.
D) Make sure the device reads zero or is at base level.
E) Blow out as hard and as fast as possible for 1 to 2 seconds.
F) Write down the value obtained.
G) Repeat the process two additional times, and record the highest number in your chart.

Question 46

The nurse is assessing a client with chronic obstructive pulmonary disease (COPD)to determine activity tolerance.Which questions elicit the most important information?

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?"

Question 47

The nurse is assessing a client with asthma.Scattered wheezes are noted,and the client's oxygen saturation is 88%.What other assessments are essential for the nurse to perform?

A) Assess for accessory muscle use.
B) Assess anterior-posterior diameter.
C) Assess inspiration/expiration ratios.
D) Assess the suprasternal notch.
E) Perform a stress test.
F) Assess a chest x-ray.
G) Assess mucous membranes.

Question 48

Which symptoms in chronic lung disease require nursing intervention?

A) Clubbed fingers
B) Increased residual volume
C) Decreased peak flow
D) Increased anterior-posterior diameter
E) Elevated platelets
F) Expiratory wheezing
G) Stridor
H) Change in sputum color and amount

Question 49

The nurse is teaching a client to cough productively.Put the actions in proper sequence.

A) Have the client flex the head and hold a pillow to the stomach.
B) Assist the client to a sitting position with feet on the floor.
C) Instruct the client to bend forward and to cough two or three times.
D) Have the client return to an upright position and take a deep breath.
E) Encourage the client to take several deep breaths.

Question 50

The nurse assesses an older adult after an upper respiratory infection and notes the following lung sound on auscultation.What is the nurse's best action? (Click the media button to hear the audio clip.)

A) Assess the client for the development of asthma.
B) Ask the client if he or she finished all the medication.
C) Administer oxygen immediately.
D) Assess arterial blood gas.