Question 1

The nurse is instructing a client who is prescribed ipratropium bromide (Atrovent)for asthma. Which should be included in this client's teaching? Select all that apply.
A)Take no more than the prescribed number of doses each day.
B)Rinse the mouth after taking this medication.
C)Take on an empty stomach.
D)Take with meals or a full glass of water.
E)Use hard candy or drink extra fluids to help with a dry mouth.

Accepted Answer

A)Appropriate teaching for a client prescribed ipratropium bromide (Atrovent)includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.
B)Appropriate teaching for a client prescribed ipratropium bromide (Atrovent)includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication as this medication is not a corticosteroid, but an anticholinergic agent. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.
C)Appropriate teaching for a client prescribed ipratropium bromide (Atrovent)includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication is not a corticosteroid, but an anticholinergic agent. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.
D)Appropriate teaching for a client prescribed ipratropium bromide (Atrovent)includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication as this medication is not a corticosteroid, but an anticholinergic agent. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.
E)Appropriate teaching for a client prescribed ipratropium bromide (Atrovent)includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication is not a corticosteroid, but an anticholinergic agent. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.

Question 2

The nurse is providing care to a client with ARDS who has a tracheostomy. The nurse will monitor the client for complications related to the loss of which protective mechanism?
A)The ability to cough
B)Filtration and humidification of inspired air
C)Decrease in oxygen-carrying capacity of the trachea
D)The sneeze reflex initiated by irritants in the nasal passages

Accepted Answer

A)When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen-carrying capacity of the trachea.
B)When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen-carrying capacity of the trachea.
C)When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen-carrying capacity of the trachea.
D)When the nasal passages are bypassed, as they would be in the case of a client with a tracheostomy, the filtration, humidification, and warming provided by the nasal passages are also bypassed. The client can still cough and sneeze, and there is no decrease in the oxygen-carrying capacity of the trachea.

Question 3

The nurse is providing care to a client admitted after experiencing an acute asthma attack. Which assessment findings should the nurse identify as signs that the client has progressed to respiratory failure? Select all that apply.
A)Retractions and fatigue
B)Tachycardia and tachypnea
C)Inaudible breath sounds
D)Diffuse wheezing and the use of accessory muscles when inhaling
E)Reduced wheezing and an ineffective cough

Accepted Answer

A)Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.
B)Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.
C)Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.
D)Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.
E)Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.

Question 4

A client receiving treatment for acute respiratory distress syndrome (ARDS)is demonstrating anxiety related to having to stay on the ventilator indefinitely. Which interventions by the nurse are appropriate? Select all that apply.
A)Explain about care areas specifically designed for long-term ventilatory support.
B)Dim the lights and reduce distracting noise, such as the television.
C)Instruct that intubation and ventilation are temporary measures.
D)Encourage family visits and participation in care.
E)Remain with the client as much as possible.

Accepted Answer

A)A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.
B)A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.
C)A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.
D)A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.
E)A critical illness creates anxiety for any client. For the client with ARDS, anxiety is compounded by intubation and mechanical ventilation. To reduce this client's anxiety, the nurse should encourage the family to visit and participate in care. The nurse should also remain with the client as much as possible and instruct that intubation and ventilation are temporary measures to allow the lungs to rest and heal. Explaining that there are care areas designed for long-term ventilatory support could increase the client's anxiety. The nurse should provide distractions such as television or radio and not dim the lights or turn off the television, which could also increase the client's anxiety.

Question 5

The nurse working on a pediatric unit is caring for a client newly diagnosed with asthma. Which assessment data indicate impending respiratory failure and the need for immediate intervention? Select all that apply.
A)Shallow respirations
B)Slightly diminished breath sounds
C)Decreased wheezing
D)Increased crackles
E)Increased respiratory rate

Accepted Answer

A)Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.
B)Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.
C)Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.
D)Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.
E)Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.

Question 6

The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS). Which conditions will the nurse include in the teaching session? Select all that apply.
A)Sepsis
B)Viral pneumonia
C)Drug overdose
D)Near drowning in saltwater
E)Fractured humerus

Accepted Answer

A)ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.
B)ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.
C)ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.
D)ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.
E)ARDS is a severe form of acute respiratory failure that occurs in response to pulmonary or systemic insults. Such insults include, but are not limited to, sepsis, pulmonary infections, saltwater inhalation, and drug overdose. A fractured humerus is not a risk factor for the development of ARDS.

Question 7

The nurse is caring for a client admitted with septic shock. Which early clinical manifestation might indicate the development of ARDS?
A)Intercostal retractions
B)Cyanosis
C)Tachypnea
D)Tachycardia

Accepted Answer

A)Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation.
B)Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation.
C)Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation.
D)Dyspnea and tachypnea are early clinical manifestations of ARDS. As the distress progresses, the client would demonstrate an increasing respiratory rate, intercostal retractions, and use of accessory muscles, as well as tachycardia. Cyanosis is a late manifestation.

Question 8

A client diagnosed with asthma has a respiratory rate of 28 at rest with audible wheezes upon inspiration. Based on this data, which nursing diagnosis is the most appropriate?
A)Ineffective Airway Clearance
B)Impaired Tissue Perfusion
C)Ineffective Breathing Pattern
D)Activity Intolerance

Accepted Answer

A)The client is experiencing an increased respiratory rate and is wheezing, which is an ineffective breathing pattern. Not enough information is provided to determine whether the client has ineffective airway clearance, activity intolerance, or impaired tissue perfusion.
B)The client is experiencing an increased respiratory rate and is wheezing, which is an ineffective breathing pattern. Not enough information is provided to determine whether the client has ineffective airway clearance, activity intolerance, or impaired tissue perfusion.
C)The client is experiencing an increased respiratory rate and is wheezing, which is an ineffective breathing pattern. Not enough information is provided to determine whether the client has ineffective airway clearance, activity intolerance, or impaired tissue perfusion.
D)The client is experiencing an increased respiratory rate and is wheezing, which is an ineffective breathing pattern. Not enough information is provided to determine whether the client has ineffective airway clearance, activity intolerance, or impaired tissue perfusion.

Question 9

A nurse is teaching environmental control to the parents of a child with asthma. Which statement by the parents indicates effective teaching?
A)"We'll be sure to use the fireplace often to keep the house warm in the winter."
B)"We will replace the carpet in our child's bedroom with tile."
C)"We'll keep the plants in our child's room dusted."
D)"We're glad the dog can continue to sleep in our child's room."

Accepted Answer

A)Control of dust in the child's bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.
B)Control of dust in the child's bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.
C)Control of dust in the child's bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.
D)Control of dust in the child's bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

Question 10

The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS). The client is intubated and placed on mechanical ventilation with positive pressure ventilation. Which assessment finding indicates a decrease of cardiac output secondary to positive pressure ventilation?
A)Blood pressure increases from 88/58 mmHg to 90/60 mmHg
B)Urine output decreases from 30 mL/hr to 25 mL/hr
C)Heart rate drops from 108 bpm to 104 bpm
D)Oxygen saturation increases from 82% to 90%

Accepted Answer

A)Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment.
B)Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment.
C)Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment.
D)Reduced cardiac output results in reduced perfusion of the kidneys, with a resulting decrease in urine output. Expected urine output is at least 30 mL/hr. This client's urine output is decreased; therefore, this finding supports the diagnosis of decreased cardiac output. Although hypotension and tachycardia are indicative of a decreased cardiac output, both indicate improvement from the previous assessment, suggesting that they are not contributing to decreased cardiac output. The oxygen saturation level is within normal limits for this client and improving from the previous assessment.

Question 11

The nurse is caring for a woman who is 32 weeks pregnant and requires mechanical ventilation for ARDS. In addition to standard nursing interventions for adult clients with ARDS, what special interventions need to be implemented for this client?
A)Inducing labor
B)Administering nitric oxide and corticosteroids
C)Providing nutritional support
D)Fetal monitoring

Accepted Answer

A)Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women.
B)Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women.
C)Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women.
D)Care for pregnant clients with ARDS who are at least at 20-24 weeks' gestation should include close fetal monitoring for potential emergency delivery. If the ARDS leads to compromised placental oxygen transfer, the neonate should be delivered immediately for the best outcome. However, not all pregnant women with ARDS will need immediate emergency delivery of the neonate. Providing nutritional support and administering nitric oxide and corticosteroids are interventions for all adult clients with ARDS, not only pregnant women.

Question 12

A client asks why asthma medication is needed even though the client's last attack was several months ago. Which response by the nurse is appropriate?
A)"The medication needs to be taken or your lungs will be severely damaged and we will not be able to prevent an acute attack."
B)"The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him."
C)"The medication is still needed to decrease inflammation in your airways and help prevent an attack."
D)"The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it."

Accepted Answer

A)Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just 1 year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.
B)Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just 1 year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.
C)Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just 1 year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.
D)Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just 1 year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.

Question 13

The nurse instructs a client with asthma on bronchodilator therapy. Which statement indicates client understanding of how the drug works?
A)"The medication widens the airways by causing airway muscle contraction."
B)"The medication widens the airways by causing airway muscle relaxation."
C)"The medication widens the airways by decreasing histamine production."
D)"The medication widens the airways by decreasing mucus production."

Accepted Answer

A)Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine.
B)Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine.
C)Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine.
D)Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine.

Question 14

Friends of a client hospitalized with asthma would like to bring the client a gift. Which gift should the nurse recommend for this client?
A)A basket of flowers
B)A stuffed animal
C)Fruit and candy
D)A book

Accepted Answer

A)A client with asthma must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.
B)A client with asthma must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.
C)A client with asthma must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.
D)A client with asthma must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.

Question 15

A client admitted with smoke inhalation injuries develops signs and symptoms of acute respiratory distress syndrome (ARDS). The nurse anticipates the healthcare provider will prescribe which course of action with regard to oxygenation?
A)Oxygen via a nasal cannula
B)Mechanical ventilation
C)Oxygen via a face mask
D)Oxygen via a Venturi mask

Accepted Answer

A)With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS.
B)With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS.
C)With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS.
D)With ARDS, it is rarely possible to maintain adequate tissue oxygenation with oxygen therapy alone. Therefore, mechanical ventilation is often necessary. Oxygen administered via nasal cannula, face mask, or venture mask all require active and adequate breathing by the client, which may not be possible for the client with ARDS.

Question 16

The nurse is planning care for a young adolescent client diagnosed with asthma. Which evidence-based age-appropriate interventions will the nurse include in the plan of care? Select all that apply.
A)Referring to a peer-led support group
B)Teaching the parents how to administer maintenance medication prior to teaching the client
C)Assessing peer support when planning care
D)Collaborating with teachers for support in the school setting
E)Telling the client to avoid medication while at school

Accepted Answer

A)Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.
B)Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.
C)Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.
D)Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.
E)Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.

Question 17

The client with ARDS who is likely to have the poorest outcome is
A)a Hispanic male with pneumonia.
B)an African American male with sepsis.
C)a Caucasian female with sepsis.
D)an African American female with chest trauma.

Accepted Answer

A)The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome.
B)The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome.
C)The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome.
D)The risk for mortality from ARDS is greater for men than for women, and it is greater for African Americans than people from other races. In addition, clients who develop ARDS from sepsis have poorer outcomes than clients who develop ARDS from pulmonary infections or trauma. Therefore, the African American male with ARDS from sepsis will likely have the poorest outcome.

Question 18

A client with acute respiratory distress syndrome (ARDS)is being weaned from ventilatory support. Which nursing actions are appropriate for this client? Select all that apply.
A)Increase percentage of oxygen being provided through the ventilator.
B)Place in the Fowler position.
C)Provide morning care during the weaning procedures.
D)Begin weaning procedures in the morning.
E)Medicate with morphine for pain as needed.

Accepted Answer

A)Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.
B)Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.
C)Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.
D)Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.
E)Weaning a client from ventilatory support should begin in the morning when the client is well-rested. The client should be in the Fowler or high-Fowler position, as this facilitates lung expansion and reduces the work of breathing. Activities and care should be limited during the weaning process to reduce the demand for oxygen. The client should not be given any medication known to suppress respirations, as this would interfere with the weaning process. The percentage of oxygen is typically reduced during the weaning process.

Question 19

Which data supports the nurse's assessment that a newborn with acute respiratory distress syndrome (ARDS)is improving? A)Increased PaCO₂ B)Oxygen saturation of 92% C)Pulmonary vascular resistance increases D)Thick secretions from the respiratory tract

Accepted Answer

A)An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO₂, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress. B)An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO₂, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress. C)An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO₂, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress. D)An expected outcome for a client being treated for ARDS is maintaining an oxygen saturation of greater than 90%. The newborn diagnosed with ARDS with an oxygen saturation of 92% is improving. Increased PaCO₂, increased pulmonary vascular resistance, and thick secretions from the respiratory tract are indicative of continued distress.

Question 20

One primary method for preventing ARDS in hospitalized clients is
A)performing postural drainage for clients with respiratory congestion.
B)elevating the head of the bed for clients who are ingesting food.
C)providing smoking cessation literature to clients who smoke.
D)administering oxygen as ordered by the healthcare provider.

Accepted Answer

A)Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients.
B)Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients.
C)Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients.
D)Aspiration of gastric contents is a major risk factor for developing ARDS. Therefore, simple interventions such as elevating the head of the bed for clients who are ingesting food can help prevent ARDS. Performing postural drainage and administering oxygen will not prevent ARDS. Although smoking may increase the risk for ARDS, it is not a direct cause of ARDS, so smoking cessation literature will not prevent ARDS in hospitalized clients.

Quiz 15: Oxygenation

The nurse is instructing a client who is prescribed ipratropium bromide (Atrovent) for asthma. Which should be included in this client's teaching? Select all that apply.

The nurse is providing care to a client with ARDS who has a tracheostomy. The nurse will monitor the client for complications related to the loss of which protective mechanism?

The nurse is providing care to a client admitted after experiencing an acute asthma attack. Which assessment findings should the nurse identify as signs that the client has progressed to respiratory failure? Select all that apply.

A client receiving treatment for acute respiratory distress syndrome (ARDS) is demonstrating anxiety related to having to stay on the ventilator indefinitely. Which interventions by the nurse are appropriate? Select all that apply.

The nurse working on a pediatric unit is caring for a client newly diagnosed with asthma. Which assessment data indicate impending respiratory failure and the need for immediate intervention? Select all that apply.

The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS) . Which conditions will the nurse include in the teaching session? Select all that apply.

The nurse is caring for a client admitted with septic shock. Which early clinical manifestation might indicate the development of ARDS?

A client diagnosed with asthma has a respiratory rate of 28 at rest with audible wheezes upon inspiration. Based on this data, which nursing diagnosis is the most appropriate?

A nurse is teaching environmental control to the parents of a child with asthma. Which statement by the parents indicates effective teaching?

The nurse is caring for a client diagnosed with acute respiratory distress syndrome (ARDS) . The client is intubated and placed on mechanical ventilation with positive pressure ventilation. Which assessment finding indicates a decrease of cardiac output secondary to positive pressure ventilation?

The nurse is caring for a woman who is 32 weeks pregnant and requires mechanical ventilation for ARDS. In addition to standard nursing interventions for adult clients with ARDS, what special interventions need to be implemented for this client?

A client asks why asthma medication is needed even though the client's last attack was several months ago. Which response by the nurse is appropriate?

The nurse instructs a client with asthma on bronchodilator therapy. Which statement indicates client understanding of how the drug works?

Friends of a client hospitalized with asthma would like to bring the client a gift. Which gift should the nurse recommend for this client?

A client admitted with smoke inhalation injuries develops signs and symptoms of acute respiratory distress syndrome (ARDS) . The nurse anticipates the healthcare provider will prescribe which course of action with regard to oxygenation?

The nurse is planning care for a young adolescent client diagnosed with asthma. Which evidence-based age-appropriate interventions will the nurse include in the plan of care? Select all that apply.

The client with ARDS who is likely to have the poorest outcome is

A client with acute respiratory distress syndrome (ARDS) is being weaned from ventilatory support. Which nursing actions are appropriate for this client? Select all that apply.

Which data supports the nurse's assessment that a newborn with acute respiratory distress syndrome (ARDS) is improving?

One primary method for preventing ARDS in hospitalized clients is