Deck 31: Nursing Management: Obstructive Pulmonary Diseases

Question 1

The physician has prescribed a budesonide metered-dose inhaler (MDI)two puffs every 8 hours and ciclesonide MDI one puff twice daily (BID).In teaching the patient about the use of the inhalers,what is the best instruction?

A) "Use the budesonide inhaler first,wait a few minutes,then use the ciclesonide 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 medications,inhale quickly when using the inhalers."

Answer 1

"Using a spacer with the MDIs will improve the inhalation of the medications."

Question 2

A 25-year-old patient has had moderate asthma for 10 years.She uses an salbutamol (Apo-Salvent)inhaler when she develops chest tightness and wheezing but does not use her salmeterol (Serevent)as prescribed.To increase the patient's management and control of her asthma,what should the nurse teach the patient?

A) She should use the salmeterol when the albuterol does not relieve her symptoms.
B) Using the salmeterol helps prevent the early-phase response of bronchospasm and thus further inflammatory changes.
C) Salmeterol should be used when she uses the-agonist inhaler to decrease the late-phase inflammatory reaction of asthma.
D) Asthma attacks can be prevented if she uses both the albuterol and the salmeterol as prescribed and not just when symptoms develop.

Answer 2

Using the salmeterol helps prevent the early-phase response of bronchospasm and thus further inflammatory changes.

Question 3

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma.Which common etiological factor would the nurse document for this nursing diagnosis in patients with asthma?

A) Work of breathing
B) Fear of suffocation
C) Anxiety and restlessness
D) Side effects of medications

Answer 3

Work of breathing

Question 4

The nurse makes a diagnosis of impaired gas exchange for a patient with COPD in acute respiratory distress based on which of the following assessment findings?

A) An SpO₂ of 86%
B) Dyspnea and a respiratory rate of 32 breaths/min
C) Use of the accessory muscles of respiration
D) The presence of crackles and coarse rales in the lungs

Question 5

A patient with chronic obstructive pulmonary disease (COPD)asks the nurse how his smoking caused his lung disease.The nurse explains that long-term exposure to tobacco smoke leads to which of the following?

A) Weakening of the smooth muscle lining the airways
B) Decrease in the area available for oxygen absorption
C) A reduction in the number of red blood cells available for oxygen delivery
D) Decreased production of protective respiratory secretions

Question 6

An Advair Diskus DPI (combined fluticasone and salmeterol)dry powder inhaler is prescribed for a patient diagnosed with mild,persistent asthma.The patient asks the nurse why she must use two different drugs.What should the nurse explain about this treatment?

A) Both drugs are bronchodilators,but the exact mechanism of action of fluticasone is not known.
B) Both the salmeterol and the fluticasone are bronchodilators but act in different ways to decrease bronchospasm.
C) The salmeterol is used to decrease the bronchospasm,and the fluticasone helps control the inflammatory response.
D) The salmeterol stimulates the bronchodilator effect of₂ receptors,and the fluticasone blocks the bronchoconstrictor effect of the parasympathetic nervous system.

Question 7

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 all winter for the past 2 years.

Question 8

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

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 9

The nurse knows that the interventions carried out to promote airway clearance in the patient with COPD are successful based on which of the following findings?

A) The patient has no dyspnea.
B) The patient's mental status is improved.
C) The patient has effective and productive coughing.
D) The PaO₂ is within the normal range for the patient.

Question 10

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%.What does the nurse recognize these values as evidence of?

A) Respiratory acidosis
B) Respiratory alkalosis
C) Normal acid-base balance with hypoxemia
D) Normal acid-base balance with hypercapnia

Question 11

The nurse recognizes that intubation and mechanical ventilation are indicated for a patient experiencing a severe asthma attach when which one of the following changes occurs?

A) Ventricular dysrhythmias occur.
B) The thorax becomes hyperinflated.
C) Pulsus paradoxus is greater than 40 mm Hg.
D) Fatigue leads to increased hypercapnia and hypoxemia.

Question 12

Clinically significant airway obstruction develops in what percentage of smokers?

A) 5% to 10%
B) 15% to 20%
C) 25% to 30%
D) 40% to 50%

Question 13

While teaching a patient with asthma the appropriate use of a peak flow meter,the nurse instructs the patient to implement which of the following actions?

A) Take and record peak flow readings when having asthma symptoms or an attack.
B) Increase the doses of long-term control medications if the peak flow numbers decrease.
C) Use the flow meter each morning after taking medications to evaluate the effectiveness of the medications.
D) Empty the lungs,and then inhale as rapidly as possible through the mouthpiece to measure how fast air can be inhaled.

Question 14

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 physician immediately on finding which of the following assessment data?

A) An SpO₂ of 90%
B) A peak expiratory flow rate of 240 mL/min
C) Decreased breath sounds and decreased audible wheezing
D) Arterial blood gas (ABG)results of pH 7.4,PaCO₂ 50 mm Hg,and PaO₂ 74 mm Hg

Question 15

The nurse teaches a patient with COPD how to perform pursed-lip breathing,explaining that this technique will assist respiration by which of the following methods?

A) Loosening secretions so that they may be coughed up more easily
B) Promoting maximal inhalation for better oxygenation of the lungs
C) Preventing bronchial collapse and air trapping in the lungs during expiration
D) Slowing the respiratory rate and giving the patient control of respiratory patterns

Question 16

When reading the chart for a patient with COPD,the nurse notes that the patient has cor pulmonale.The nurse will monitor which of the following to assess for cor pulmonale?

A) Elevated temperature
B) Complaints of chest pain
C) Jugular vein distension
D) Clubbing of the fingers

Question 17

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 which of the following?

A) (?₁)-Antitrypsin testing
B) Use of the nicotine patch
C) Continuous pulse oximetry
D) Effects of leukotriene modifiers

Question 18

The nurse evaluates the effectiveness of therapy for a patient with an acute asthma exacerbation.Which of the following findings indicates to the nurse that the patient's respiratory function is beginning to improve?

A) Wheezing becomes louder.
B) The cough remains unproductive.
C) Vesicular breath sounds decrease.
D) Aerosol bronchodilators stimulate coughing.

Question 19

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

A) Order fruits and fruit juices to be offered between meals.
B) Order a high-calorie,high-protein diet with six small meals a day.
C) Teach the patient to use frozen meals that can be microwaved at home.
D) Provide a high-calorie,high-carbohydrate,nonirritating,frequent-feeding diet.

Question 20

During assessment of a patient with asthma,the nurse notes wheezing and dyspnea,recognizing that these symptoms are related to which of the following pathophysiological features?

A) Laryngospasm
B) Pulmonary edema
C) Airway narrowing
D) Overdistension of the alveoli

Question 21

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

A) Intravenous methylprednisolone (Solu-Medrol)60 mg
B) Triamcinolone (Azmacort)two puffs per MDI
C) Salmeterol 50 mcg per dry-powder inhaler (DPI)
D) Albuterol (Ventolin)2.5 mg per nebulizer

Question 22

A 19-year-old male with CF and his wife are considering having a child.In counselling the patient and his wife,the nurse determines their knowledge of the situation by asking them for which following information?

A) Whether they have considered that the patient is probably sterile
B) Whether they have thought about the patient's ability to care for a child
C) Whether they have considered adoption as a solution to their desire to have a family
D) Whether they know that any children produced by them will have CF

Question 23

In planning care for the patient with cystic fibrosis (CF),the nurse understands that which of the following interventions is the most important therapeutic approach to promote pulmonary function in the patient?

A) Regular administration of bronchodilators
B) Administration of continuous low-flow oxygen
C) Maintenance of prophylactic doses of antibiotics
D) Chest physiotherapy every 4 hours to mobilize secretions

Question 24

What grade of dyspnea would the nurse document when a patient with COPD walks slower than his peers of the same age and needs to stop for breath when walking at his own pace on a flat surface?

A) Grade 1
B) Grade 2
C) Grade 3
D) Grade 4

Question 25

To promote healthy coping in the patient with COPD,what should the nurse do?

A) Assist the patient to identify strengths and ignore limitations.
B) Teach the patient relaxation techniques and other alternative therapies.
C) Encourage family members to include the patient in family and social activities.
D) Refer the patient to a support group at the local chapter of the Lung Association.

Question 26

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 (Ventolin)and salmeterol.
C) The patient uses hydrocortisone (Solu-Cortef)before any aerobic exercise.
D) The patient's heart rate increases after using the albuterol (Ventolin)inhaler.

Question 27

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

A) "I will shake the MDI to check for fullness each time before using."
B) "I will take a slow,deep breath in after pushing down on the MDI."
C) "I will check the MDI counter."
D) "I will attach a spacer to the MDI to make it easier for me to use."

Question 28

When taking an admission history of a patient with COPD 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 29

When evaluating a patient's oral intake,the nurse knows that which fluid intake would be considered adequate for the patient with COPD?

A) 1200 mL
B) 2000 mL
C) 2500 mL
D) 3000 mL

Question 30

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 31

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

A) Keep the air entrainment ports clean and unobstructed.
B) Apply an adaptor to increase humidification of the oxygen.
C) Drain moisture condensation from the oxygen tubing every hour.
D) Keep the flow rate high enough to keep the bag from collapsing during inspiration.

Question 32

When teaching a patient about the various methods of oxygen administration,the nurse tells the patient that,with high flow rates,pain may develop in the frontal sinuses as a result of which of the following methods?

A) Simple face mask
B) Nasal cannula
C) Partial rebreathing mask
D) Transtracheal catheter

Question 33

When caring for a patient with CF,the nurse recognizes that the manifestations of the disease are caused by which of the following pathophysiological processes?

A) Inflammation and fibrosis of lung tissue
B) Failure of the bronchial goblet cells to produce mucus
C) Altered function of exocrine glands,with abnormally thick,viscous secretions
D) Thickening and fibrosis of the pleural linings of the lungs,causing thoracic wall changes

Question 34

A patient with severe COPD tells the nurse he wishes he would die because he is so disabled with his disease that he just cannot do anything for himself.Based on this information,the nurse identifies which of the following nursing diagnoses?

A) Hopelessness related to long-term stress
B) Anticipatory grieving related to expectation of death
C) Ineffective coping related to unknown outcome of illness
D) Depression related to physical and psychological dependence

Question 35

When teaching a patient about continuous home oxygen use,the nurse tells the patient that evaporation of the oxygen accelerates during which season,and they should take extra care to ensure that they do not run out of oxygen?

A) Spring
B) Summer
C) Fall
D) Winter

Question 36

What is the best nursing action when a patient with COPD is receiving oxygen?

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 37

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 38

A patient has been receiving oxygen per nasal cannula during her hospitalization for emphysema.She asks the nurse whether she will have to use oxygen at home.What should the nurse tell the patient about long-term home oxygen therapy?

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

Question 39

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

A) "I will drink a lot 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 too much meat or dairy products."

Question 40

A 70-year-old patient is recovering from an acute episode of COPD.In planning with the patient to increase his activity tolerance at home,which of the following activities does the nurse understand is an appropriate exercise goal for the patient?

A) Increase his activity any amount over his current level.
B) Walk for 20 minutes a day with his pulse rate less than 150 beats/min.
C) Limit his exercise to activities of daily living to conserve his energy.
D) Swim for 10 minutes a day,gradually increasing to 30 minutes a day.

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 which of the following?

A) "I will use my corticosteroid inhaler as soon as I start to get short of breath."
B) "I will turn the home oxygen level up only 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."

Question 42

A patient who is experiencing an acute asthma attack is admitted to the emergency department.What is the priority nursing action?

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.