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?

Accepted Answer

Clients with severe COPD may not be able to perform daily activities,including bathing and eating,because of excessive shortness of breath.The nurse should ask the client if shortness of breath is interfering with basic activities.Although the nurse should know about the client's support systems,current knowledge,and medications,these questions do not address the client's appearance.

Question 2

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

Accepted Answer

The drug reduces local immunity and increases the risk for local infection,especially Candida albicans.Rinsing the mouth after using the inhaler will decrease the risk for developing this infection.Use of mouthwash and broad-spectrum antibiotics is not warranted in this situation.The nurse should document the finding,but the best action to take is to have the client start rinsing his or her mouth after using fluticasone.An oral specimen for culture and sensitivity will not provide information necessary to care for this client.

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?

Accepted Answer

A chest tube is placed in the pleural space and may be uncomfortable for a client.The nurse should provide pain medication to minimize discomfort and encourage the client to take deep breaths.The other responses do not address the client's discomfort and need to take deep breaths to prevent complications.

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?

Accepted Answer

Intrathoracic pressures are less than atmospheric pressures; therefore,if the chest tube becomes disconnected from the drainage system,air can be sucked into the pleural space and cause a pneumothorax.A red,warm,and painful insertion site does not increase the client's risk for a pneumothorax.Tube drainage should decrease and become serous as the client heals.Sanguineous drainage is a sign of bleeding but does not increase the client's risk for a pneumothorax.

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?

Accepted Answer

Smoking increases pulmonary hypertension,resulting in cor pulmonale,or right-sided heart failure.Increased pressures in the lungs make it more difficult for blood to flow through the lungs.Blood backs up into the right side of the heart and then into the peripheral venous system,creating distended neck veins and dependent edema.Inflammation in bronchi and bronchioles creates an airway obstruction which manifests as wheezes.Thick mucus in the lungs has no impact on distended neck veins and edema.Left ventricular hypertrophy is associated with left heart failure and is not caused by a 40-year smoking history.

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?

Accepted Answer

Cotton balls can decrease pressure ulcers from the oxygen tubing.Continuous oxygen orders mean the client should wear the oxygen at all times.Oxygen fuels a fire.Wearing oxygen while grilling and smoking increases the risk for fire.

Question 7

The nurse is caring for a client who is prescribed a long-acting beta₂ 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?

Accepted Answer

Long-acting beta₂ agonists should be used every day to prevent asthma attacks.This medication should not be taken when an attack starts.Asthma medications can be expensive.Telling the client that he or she is using the inhaler incorrectly does not address the client's financial situation,which is the main issue here.Clients with limited incomes should be provided with community resources.Asking the client about fears related to breathlessness does not address the client's immediate concerns.

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?

Accepted Answer

Burkholderia cepacia infection is spread through casual contact between cystic fibrosis clients,thus the need for these clients to be separated from one another.Strict isolation measures will not be necessary.Although the client should wash his or her hands frequently,the most important measure that can be implemented on the unit is isolation of the client from other clients with cystic fibrosis.There is no need to implement Droplet Precautions or don a surgical mask when caring for this client.Obtaining blood,sputum,and urine culture specimens will not provide information necessary to care for a client with Burkholderia cepacia infection.

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?

Accepted Answer

Clients should be encouraged to take their pain medications; addiction usually is not an issue with a client in pain.The nurse would not request that the pain medication be changed unless it was not effective.Other methods to decrease pain can be used,in addition to pain medication.

Question 10

After teaching a client who is prescribed a long-acting beta₂ agonist medication,a nurse assesses the client's understanding.Which statement indicates the client comprehends the teaching?

Accepted Answer

Long-acting beta₂ agonist medications will help prevent an acute asthma attack because they are long acting.The client will take this medication every day for best effect.The client does not have to always keep this medication with him or her because it is not used as a rescue medication.This is not the medication the client will use during an acute asthma attack because it does not have an immediate onset of action.The client will not be weaned off this medication because this is likely to be one of his or her daily medications.

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?

Accepted Answer

Many clients with moderate to severe COPD become socially isolated because they are embarrassed by frequent coughing and mucus production.They also can experience fatigue,which limits their activities.The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interventions can be selected.Joining a support group would not decrease feelings of social isolation if the client does not verbalize feelings.Antianxiety agents will not help the client with social isolation.Encouraging a client to participate in activities without verbalizing concerns also would not be an effective strategy for decreasing social isolation.

Question 12

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

Accepted Answer

Clients with CF often are malnourished due to vitamin deficiency and pancreatic malfunction.Maintaining nutrition is essential.Daily antibiotics and daily exercise are not essential actions.Genetic screening would not help the client manage CF better.

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?

Accepted Answer

Immediately covering the insertion site helps prevent air from entering the pleural space and causing a pneumothorax.The area will not reseal quickly enough to prevent air from entering the chest.The nurse should not leave the client to obtain a suture kit.An occlusive dressing may cause a tension pneumothorax.The site should only be assessed after the insertion site is covered.The provider should be called to reinsert the chest tube or prescribe other treatment options.

Question 14

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

Accepted Answer

The client who is in a tripod position and using accessory muscles is working to breathe.This client must be assessed first to establish how well the client is breathing and provide interventions to minimize respiratory failure.The other clients are not in acute distress.

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?

Accepted Answer

To perform diaphragmatic breathing correctly,the client should place his or her hands on his or her abdomen to create resistance.This type of breathing cannot be performed effectively while lying on the side or with hands over the head.This type of breathing would not be as effective lying prone.

Question 16

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

Accepted Answer

Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available.A barrel chest is not an emergency finding.Likewise,a pulse oximetry level of 92% is not considered an acute finding.The expiratory phase is expected to be longer than the inspiratory phase in someone with airflow limitation.

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?

Accepted Answer

Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms.Salmeterol has a slow onset of action; therefore,it should not be used as a rescue drug.The drug must be shaken well because it has a tendency to separate easily.Poor technique on the client's part allows the drug to escape through the 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?

Accepted Answer

Padded clamps should be kept at the bedside for use if the drainage system becomes dislodged or is interrupted.The nurse should never strip the tubing.Tubing junctions should be taped,not clamped.Wall suction should be set at the level indicated by the device's manufacturer,not the provider.

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?

Accepted Answer

Side effects of radiation therapy may include inflammation of the esophagus.Clients should be taught that bland,soft,high-calorie foods are best,along with liquid nutritional supplements.Tomato sauce may prove too spicy for a client with esophagitis.A grilled cheese sandwich is too difficult to swallow with this condition,and orange juice and other foods with citric acid are too caustic.

Question 20

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

Accepted Answer

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)can trigger asthma in some people.This results from increased production of leukotriene when aspirin or NSAIDs suppress other inflammatory pathways and is a high priority given the client's history.Reviewing pulmonary function test results will not address the immediate problem of frequent asthma attacks.This is a good intervention for reviewing response to bronchodilators.Questioning the client about the use of bronchodilators will address interventions for the attacks but not their cause.Reviewing arterial blood gas results would not be of use in a client between attacks because many clients are asymptomatic when not having attacks.

Quiz 30: Care of Patients with Noninfectious Lower Respiratory Problems

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

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

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?

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?

The nurse is caring for a client who is prescribed a long-acting beta₂ 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 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?

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?

After teaching a client who is prescribed a long-acting beta₂ agonist medication,a nurse assesses the client's understanding.Which statement indicates the client comprehends the teaching?

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

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

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

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

Quiz 30: Care of Patients with Noninfectious Lower Respiratory Problems

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

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

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?

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?

The nurse is caring for a client who is prescribed a long-acting beta2 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 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?

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?

After teaching a client who is prescribed a long-acting beta2 agonist medication,a nurse assesses the client's understanding.Which statement indicates the client comprehends the teaching?

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

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

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

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

The nurse is caring for a client who is prescribed a long-acting beta₂ 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?

After teaching a client who is prescribed a long-acting beta₂ agonist medication,a nurse assesses the client's understanding.Which statement indicates the client comprehends the teaching?