Chapter 27 Care of the Paients with Non-Infectious Lower Respiratory Problems

Question 1

A chronic disease in which acute reversible airway obstruction occurs intermittently, reducing airflow.

Answer 1

asthma

Question 2

A collection of lower airway disorders that interfere with airflow and gas exchange.

Answer 2

Chronic Obstructive Pulmonary Disease (COPD)

Question 3

Right-sided heart failure caused by pulmonary disease occurring with bronchitis or emphysema.

Answer 3

Cor Pulmonale

Question 4

Asthma drugs used daily to reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and to maintain gas exchange.

Answer 4

control therapy drugs

Question 5

An inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke.

Answer 5

Chronic Bronchitis

Question 6

An autosomal recessive genetic disease that affects many organs with most impairment occurring to pancreatic and/ or lung function.

Answer 6

Cystic Fibrosis

Question 7

Perceived shortness of breath.

Answer 7

dyspnea

Question 8

A destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung.

Answer 8

Emphysema

Question 9

Higher than normal blood carbon dioxide levels. Also known as hypercarbia.

Answer 9

Hypercapnia

Question 10

Low blood oxygen levels.

Answer 10

hypoxemia

Question 11

Removal of a lobe of the lung.

Answer 11

lobectomy

Question 12

Breathlessness that is worse in a supine position

Answer 12

orthopnea

Question 13

Surgical removal of an entire lung.

Answer 13

pneumonectomy

Question 14

A. condition in which pulmonary vessels and often other lung tissues undergo growth changes that greatly increase pressure in the lung circulatory system for unknown reasons (also known as idiopathic pulmonary artery hypertension).

Answer 14

pulmonary artery hypertension

Question 15

Asthma drugs used to actually stop an asthma attack once it has started. Also known as rescue drugs.

Answer 15

reliever drugs

Question 16

trachea, 2 mainstem bronchi, 5 secondary bronchi, thousands of branching bronchi and bronchioles, alveolar ducts and aleoli

Answer 16

gas exchange

Question 17

chronic and progressive that require lifestyle changes for older adults

Answer 17

lower respiratory tract

Question 18

chronic and progressive, requiring changes in lifestyle, especially for older adults

Answer 18

many lower airway problems

Question 19

Nursing Accommodations for an Older Adult With a Respiratory Problem

Answer 19

• Provide rest periods between activities such as bathing, meals, and ambulation.
• Have the patient sit in an upright position for meals to prevent aspiration.
• Encourage nutritional fluid intake after the meal to prevent an early sensation of fullness and promote increased calorie intake.
• Schedule drugs around routine activities to increase adherence to drug therapy.
• Arrange chairs in strategic locations to allow the patient with dyspnea to stop and rest while walking.
• Urge the patient to notify the primary health care provider promptly for any symptoms of infection.
• Encourage the patient to receive the pneumococcal vaccines and to have an annual influenza vaccination.
• For patients who are prescribed home oxygen, instruct them to keep tubing coiled when walking to reduce the risk for tripping.

Question 20

occurs by both inflammation and airway tissue sensitivity (hyperresponsiveness) with bronchoconstriction

Answer 20

asthma

Question 21

asthma

What obstructs the airway lumens. (i.e.,the hollow insides)

Answer 21

Inflammation

Question 22

asthma

Airway hyperresponseiveness and what narrow the tubular structure of the airways?

Answer 22

constriction of bronchial smooth muscle

Question 23

What 2 things trigger bronchial constriction, and many adults with asthma have both problems?

Answer 23

airway inflammation; sensitivity

Question 24

How many death in the US are acute asthma related?

Answer 24

3300

Question 25

The effect on gas exchange remains what regardless of inflammation versus hyperresponsiveness.

Answer 25

the same

Question 26

Examples of Inflammation risks for asthmatics

Answer 26

• specific allergens
• general irritants- cold air, dry air, fine airborne particles, microorganisms, and aspirin or NSAIDS

Question 27

Examples of Hyperresponsiveness for Asthmatics

Answer 27

• Exercise
• upper respiratory illness
• GERD- acid
• unknown reasons

Question 28

What should asthmatics not use ASA or NSAIDS?

Answer 28

these medications affect certain substances in the body that control inflammation; inhibits an enzyme; Aspirin Exacerbates Respiratory Disease (AERD)

Question 29

Questions that should be asked in an assessment with a patient with asthma/ possible asthma-
Ask when do the symptoms occur:

Answer 29

• continuously
• seasonally
• in association with specific activities or exposures
• at work
• more frequently at night.

Question 30

Asthma: hx/ assessment

symptoms of asthma

Answer 30

dyspnea, chest tightness, coughing, wheezing, and increased mucous production

Question 31

Asthma Assessment

Patients have symptoms for how long after a cold or other upper respiratory infection?

Answer 31

4 to 8 wks

Question 32

Asthma Assessment

Questions to ask in an asthma assessment:

Answer 32

• Does any family members have asthma or respiratory problems?
• Do you currently or have smoked in the past? (if they are currently smokers use this as an opportunity to ed about smoking cessation)

Question 33

What symptom in non-smokers is important in diagnosis of asthma, as it raises suspicion because of the inflammation response?

Answer 33

wheezing

Question 34

Respiratory distress =

Answer 34

ABGs

Question 35

Physical assessment cues of asthmatics

Answer 35

• audible wheeze, increased respiratory rate, increased cough
• use of accessory muscles
• “barrel chest” from air trapping
• cyanosis
• hypoxemia

Question 36

Assess oral mucosa and nail beds for cyanosis, LOC, & tachycardia for what health problem?

Answer 36

Hypoxemia (decreased blood oxygen levels)

Question 37

Asthma diagnostics

Answer 37

• Labs: ABGs
• RAD: PFTs

Question 38

measuring air breathed in and out, lung capacity, diffusion capacity (determine how oxygen moves into the blood)

Answer 38

PFTs (pulmonary function tests)

Question 39

Patient and Family Education for Asthma Management

Answer 39

• Avoid potential environmental asthma triggers, such as smoke, fireplaces, dust, mold, and weather changes of warm to cold.
• Avoid drugs that trigger your asthma (e.g., aspirin, NSAIDS, beta blockers).
• Avoid food that has been prepared with MSG or metabisulfite.
• If you have exercise- induced asthma, use your reliever bronchodilator inhaler 30 min before exercis to prevent or reduce bronchospasm.
• Be sure that you know the proper technique and correct sequence when you use metered dose inhalers.
• Get adequate rest and sleep.
• Reduce stress and anxiety; learn relaxation techniques; adopt coping mechanisms that have worked for you in the past.
• Wash all bedding with hot water to destroy dust mites.
• Seek immediate emergency care if you experience any of these:
  -gray or blue fingertips or lips
  -difficulty breathing, walking, or talking
  -retractions of the neck, chest, or ribs
  -nasal flaring
  failure of drugs to control worsening symptoms

Question 40

Who should have a peak flow meter for asthma attacks?

Answer 40

for those whose asthma is NOT well controlled

Question 41

The HCP and patient should discuss a plan for treatment of their asthma, what should it entail?

Answer 41

medications, lifestyle strategies

Question 43

How to take a peak flow measurement

Answer 43

1. Purchase a eak flow meter (from $10)
2. Place marker at 0 (or lowest number)
3. Stand up, Inhale deeply
4. While holding breath, place mouthpiece between teeth with lips sealed
5. Blow out as hard and fast as possible
6. Write down number shown on meter
7. REPEAT 2x

Question 44

Reliever drugs are also called what?

Answer 44

Rescue drugs

Question 45

Reliever drugs are used to what in the event of an asthma attack?

Answer 45

actually stop an attack once it has started

Question 46

When may some asthma patients only need drug therapy?

Answer 46

during an asthma episode

Question 47

While some asthmatics only need drug therapy during an episode, what are the needs of other patients with asthma?

Answer 47

daily drugs are needed to help asthma episodic rather than a more frequent problem

Question 48

What does drug therapy involve for asthmatics?

Answer 48

use of bronchodilators and various drug types to reduce inflammation

Question 49

Some drugs reduce the asthma response while others do what?

Answer 49

actually prevent it

Question 50

What is a combination drug for asthma?

Answer 50

2 or more agents from different classes combined together for a better response (i.e., bronchodilators and Corticosteroids)

Question 51

: a severe, life-threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy

Answer 51

Status Asthmaticus

Question 52

Destructive disease in which the airflow in and out of the alveoli (small sacs that promote oxygenation) is restricted therefore trapping CO2 from escaping.

Answer 52

COPD

Question 53

COPD interferes with what?

Answer 53

airflow and oxygenation

Question 54

COPD includes:

Answer 54

• emphysema
• chronic bronchitis

Question 55

:inflammation of the bronchi and bronchioles (not alveoli) caused by irritants, (smoke) the irrtant triggers inflammation, vasodilation, mucosal edema, congestions and bronchospasms

Answer 55

chronic bronchitis

Question 56

Which respiratory condition has tissue damage that’s not reversible; increases in severity, eventually leads to respiratory failure?

Answer 56

COPD

Question 57

COPD risk factors:

Answer 57

• cigarette smoking is the greatest risk factor
• alpha1- antitrypsin deficiency

Question 58

is a less common but important risk factor for COPD; is normally present in the lungs; inhibits excessive pretease activity, so the proteases only break down inhaled pollutants and organisms and do not damage lung structures.

Answer 58

Alpha1-antitrypsin (AAT) deficiency

Question 59

:is the 4th leading cause of morbidity and mortality in teh U.S.

Answer 59

COPD

Question 60

Complications of COPD:

Answer 60

• hypoxemia/ tissue anoxia
• acidosis
• respiratory infections
• cardiac failure, especially Cor Pulmonale
• cardiac dysrhythmias
• respiratory failure

Question 61

COPD assessment

Answer 61

• hx
• general appearance
• respiratory changes
• cardiac changes

Question 62

Emphysema (COPD)

Answer 62

• loss of lung elasticity
• hyperinflation of lung
• dyspnea
• air trapping

Question 63

• Inflammation of bronchi and bronchioles
• caused by chronic exposure to irritants
• inflammation, vasodilation, congestion, mucosal edema, bronchospasm
• affects only airways, not alveoli
• production of large amounts of thick mucus

Answer 63

Chronic Bronchitis (COPD)

Question 64

blue bloater

Answer 64

Chronic Bronchitis

Question 65

symptoms of chronic bronchitis

Answer 65

• chronic, productive cough
• purulent sputum
• hemoptysis
• mild dyspnea initially
• cyanosis (due to hypoxemia)
• peripheral edema (due to Cor Pulmonale)
• crackles, wheezes
• prolonged expiration
• obese

Question 66

Complications of Chronic Bronchitis

Answer 66

• secondary polycythemia vera due to hypoxemia
• pulmonary hypertension due to reactive vasoconstriction from hypoxemia
• pulmonary hypertension due to reactive vasoconstriction from hypoxemia
• Cor Pulmonale from chronic pulmonary hypertension

Question 67

pink puffer

Answer 67

emphysema

Question 68

Symptoms of Emphysema

Answer 68

“pink puffer”
* dyspnea
* minimal cough
* increased minute ventilation
* pink skin, pursed-lip breathing
* accessory muscle use
* cachexia (wasting, chronically ill; emaciated)
* hyperinflation, barrel chest
* decreased breath sounds
* tachypnea

Question 69

Complications of Emphysema

Answer 69

• pneumothorax due to ballae
• weight loss due to work of breathing

Question 70

What laboratory assessments would be drawn for patient’s with COPD?

Answer 70

• ABG values for abnormal oxygenation, ventilation, acid-base status
• sputum samples
• CBC
• hemoglobin and hematocrit
• serum electrolytes
• serum AAT
• chest x-ray
• PFTs (pulmonary function test)

Question 71

What a COPD patient looks like….

Answer 71

• Decreased gas exchange
• weight loss
• anxiety
• Decreased endurance
• potential for pneumonia

Question 72

COPD patient goals

Answer 72

• improve gas exchange & reduce carbon dioxide retention
• prevent weight loss
• minimize anxiety
• improving endurance
• prevent respiratory infection

Question 73

Non-surgical management of COPD:

Answer 73

• breathing techniques
• positioning
• effective coughing
• oxygen therapy
• drug therapy
• exercise conditioning
• suctioning
• hydration

Question 74

Surgical management of COPD:

Answer 74

• lung reduction surgery
• preoperative care and testing
• operative procedure by median sternotomy or VATS
• postoperative care and close monitoring for complications

Question 75

:hyperinflated tissue is removed from both lungs; this helps with oxygenation by removing the bad

Answer 75

VATS (video-assisted thorascopic surgery)

Question 76

Care coordination for COPD post-op

Answer 76

• home management care (long-term use of oxygen)
• self-management education (drug therapy, manifestations of infection, breathing techniques)
• health care resources

Question 77

Cystic Fibrosis

Question 78

which answer by the nurse is appropriate when a patient with asthma asks why it is nec to use an inhaled corticosteriod every day?
a) daily meds help reduce the risk for irreversible changes in your lungs.
b) using a daily steriod medication will prevent the need for rescue meds.
c) the inhaled corticosteroid stabilizes the mast cells to reduce inflammation.
d) inhaled corticosteroids meds potentiate the effects of bronchodilators.

Answer 78

a) daily meds help reduce the risk for irreversible changes in your lungs.

Question 79

Which clinical manifestation during status asthmaticus requires immediate action? SATA
a) absence of response to usual therapy
b) irregular episodes of shortness of breath
c) audible wheezing and increased respiratory rate
d) sudden absence of wheezing, indicating airway obstruction
e) development of pneumothorax and cardiac or respiratory arrest
f) use of accessory muscles while breathing and distention of neck veins.

Answer 79

a, d, e, f,

Question 80

Which disorder is a lung disease that causes chronic airflow limitation? SATA
a) chronic bronchitis
b) intermittent asthma
c) upper lobe lung cancer
e) subcutaneous emphysema
f) inflammatory bronchospasm

Answer 80

a, b

Question 81

Which statement made by a patient with asthma indicates ineffective learning about medication to prevent further asthma attacks?
a) I should shake the inhaler well before I use it
b) I should be careful to not spray the inhaler near my eyes.
c) I should use the inhaler daily even if I have no symptoms
d) I should use the inhaler only when I have an asthma attack.

Answer 81

d

Question 82

Which pain medication will the nurse anticipate the health care provider will recommend for a patient with asthma who reports having chronic pain?
a) aspirin
b) ibuprofen
c) hydrocodone
d) acetaminophen

Answer 82

d

Question 83

Which information about engaging in exercise will the nurse give a patient with asthma?
a) Adjust your exercise routines as needed to avoid asthma triggers.
b) Aerobic exercise is considered too strenuous for people with asthma.
c) Strenuous exercise is not recommended for people who have asthma.
d) Keep a short-acting beta agonist on hand to use as needed while exercising.

Answer 83

a

Question 84

Which statement by the patient with asthma indicates a need for further teaching?
a) The fluticasone inhaler is used a recue medication.
b) I will use the albuterol inhaler when I am wheezing or short of breath.
c) I may need oral steroid medication when my asthma action plan is not working.
d) When I have symptoms in the yellow zone, I will need to take more medicine.

Answer 84

a

Question 85

People involved in which occupation or activity are encouraged to wear masks and to have adequate ventilation? SATA
a) bakers
b) potters
c) plumbers
e) electricians
f) coal miners
g) furniture refinishers

Answer 85

a, b, f, g

Question 86

Which patient would the nurse assess first?
1. A patient diagnosed with idiopathic pulmonary fibrosis on parentheral morphine.
2. A patient diagnosed with sarcoidosis who just received a second dose of IV corticosteroids.
3. A patient being evaluated for latency (allergic) asthma who received an inhaled corticosteroid 1 hr ago.
4. A patient diagnosed with brochiolitis obliterans organizing pneumonia (BOOP) who returned from a biopsy 2 hrs ago.

Answer 86

1

Question 87

The nurse suspects which diagnosis when a patient presents with symptoms of hoarseness, change in respiratory pattern, persistent cough, blood-streaked sputum, dyspnea, clubbing of the fingers, and fever?
1. asthma
2. lung cancer
3. cystic fibrosis
4. pulmonary arterial hypertension

Answer 87

2 lung cancer

Question 88

Which benefit will chest physiotherapy have on a patient with cystic fibrosis?
1. It increases vascular resistance in the lungs.
2. It stops excess production of mucus in the lungs.
3. It creates mini-coughs to dislodge the mucus from the lungs.
4. It decreases the constriction of the bronchoiolar smooth muscle.

Answer 88

3. It creates mini-coughs to dislodge the mucus from the lungs.

Question 89

The student nurse starts the infusion of packed red blood cells in a patient who is already on IV antibiotic therapy; the infusion goes through the same IV line. Which complication would be expected?
1. allergy
2. clotting
3. hemolysis
4. fluid overload

Answer 89

2. clotting

Question 90

Which information will the nurse give a patient who reports using selmeterol PRN for asthma exacerbations?
1. Salmeterol should be used at the onset of symptoms for best effect.
2. Using salmeterol as a reliever medication can lead to sudden death.
3. Salmeterol should be used with a steroid to relieve acute asthma symptoms.
4. Daily use of salmeterol leads to tolerance of desired medication effects.

Answer 90

2.) Using salmeterol as a reliever medications can lead to sudden death.

Question 91

Which reason is the most important for prescribing inhaled, rather than oral, corticosteroids for patients with asthma?
1. Inhaled corticosteroids are easier to use.
2. Inhaled corticosteroids are more effective.
3. Oral corticosteroids have more adverse effects.
4. Oral corticosteroids have less predictable effects.

Answer 91

3.) Oral corticosteroids have more adverse effects.

Question 92

Which medication will the nurse teach the patient with asthma to use first?
1. albuterol 2 puffs
2. montelukast 1 tablet
3. triamcinolone 2 puffs
4. ipratropium bromide 2 puffs

Answer 92

1.) albuterol 2 puffs

Question 93

Which intervention to improve oxygenation and decrease carbin dioxide retention will the nurse teach the patient with chronic obstructive pulmonary disease (COPD)? SATA
1. Limiting dairy intake to avoid weight gain, which will add to activity intolerance.
2. Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea,
3. Partnering with the family in COPD managment by adhering to prescribed therapies.
4. Maintaining hydration to loosen secretions and suctioning frequently to eliminate build up.
5. Monitoring for changes in respiratory status including rate and rhythm and tolerence of activity.

Answer 93

2, 3, 5

Question 94

Which statement about chronic obstructive pulmonary disease (COPD) is correct? SATA
1. COPD includes emphysema and chronic bronchitis
2. Because of increased mucus production, bronchitis leads to breathing problems in the alveoli.
3. Most emphysema is associated with smoking or chronic exposure to other inhaled irritants.
4. The increased risk for infection in COPD is related to increased mucus production and poor oxygenation.
5. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue.

Answer 94

1, 3, 4, 5

Question 95

Which teaching will the nurse provide to a patient with chronic obstructive pulmonary disease (COPD) who expresses having disruptive feelings of anxiety?
1. You should take deep, slow breaths through your mouth.
2. You should consult a dietician to plan well-balanced nutrition.
3. You should avoid working with your arms raised when doing housework.
4. You should recall the plan that you and your primary health provider have devised and try to work through that.

Answer 95

4.) You should recall the plan that you and your primary health care provider devised and try to work through that.

Question 96

Which action will the nurse do next when a patient’s family is expressing concern about the new diagnosis of chronic obstructive pulmonary disease (COPD) in their loved one?
1. Discuss the importance of smoking cessation as it is a leading cause of emphsema.
2. Listen to the basis of the family’s concerns, and then develop a focused teaching plan.
3. Assure the family that with appropriate management, their loved one can lead a quality life.
4. Refer them to a community-base support group to meet other families with similar concerns.

Answer 96

2.) Listen to the basis of the family’s concerns, and then develop a focused teaching plan.

Question 97

Which question would the nurse ask a patient with chronic obstructive pulmonary disease (COPD) to help with the psychosocial assessment? SATA
1. How many people live in your home?
2. How has your illness affected your lifestyle?
3. What do you eat and drink on a typical day?
4. When and how often do you use your inhaler?
5. Can you mark this line to show the amount of breathing difficulty you are having now?
6. Do you find it necessary to take a breath between every one or two words while speaking?

Answer 97

1, 2, 4,

Question 98

Which respiratory condition is a potential complication associated with surgery? SATA
1. asthma
2. atelectasis
3. pneumonia
4. laryngeal edema
5. chronic obstructive pulmonary disorder (COPD)

Answer 98

2, 3, 4

Question 99

Which disease of the lungs may occur as a result of exposure to occupational irritants? SATA
1. asthma
2. lung cancer
3. cystic fibrosis
4. pulmonary fibrosis
5. chronic obstructive pulmonary disease (COPD)

Answer 99

1, 2, 4, 5

Question 100

Which patient statement indicates that teaching about anxiety with chronic obstructive pulmonary disease (COPD) has been successful? SATA
1. I will perform diaphragmatic breathing when I am anxious.
2. I will attend counseling sessions during periods of emotional distress.
3. I will seek medical assistance when I believe I may have an infection.
4. I will take my prescribed antianxiety medication if I begin to feel panicky.
5. I will ask for help if I have difficulty breathing while performing daily activities.

Answer 100

1, 2, 4

Question 101

Which nursing assessment finding supports a patient’s new diagnosis of right-sided heart failure in a patient with chronic obstructive pulmonary disease (COPD)? SATA
1. fatigue
2. acidosis
3. thready pulses
4. hypoxemia
5. enlarged and tender liver

Answer 101

1, 4, 5

Question 102

Symptoms of Cor Pulmonale

Answer 102

• fatigue
• hypoxemia
• enlarged and tender liver

Question 103

Cor Pulmonale is cardiac failure that especially occurs with what?

Answer 103

bronchitis or emphysema

Question 104

Cor Pulmonale

Answer 104

:right-sided heart failure caused by pulmonary disease

Question 105

Cor Pulmonale presents with what s/s?

Answer 105

• warm, cyanotic hands and feet
• bounding pulses (instead of thready pulses)

Question 106

Which arterial blood gas reading would be expected in a patient who has had chronic obstructive pulmonary disease (COPD) for the last 15 yrs?
a) pH 7.33, PaO2 65mm Hg, PaCO2 41mm Hg, and HCO3 19mEq/L
b) pH 7.36, PaO2 63mm Hg, PaCO2 52mm Hg, and HCO3 32mEq/L
c) pH 7.48, PaO2 82mm Hg, PaCO2 32mm Hg, and HCO3 25mEq/L
d) pH 7.36, PaO2 72mm Hg, PaCO2 30mm Hg, and HCO3 18mEq/L

Answer 106

b) pH 7.36, PaO2 63mm Hg, PaCO2 52mm Hg, and HCO3 32mEq/L

The kidneys will compensate to correct for changes in blood pH that occur when the respiratory system is unhealthy (ie COPD) or overwhelmed by increasing the absorption of bicarbonate and excreting hydrogen ions. The reading of pH 7.36, partial pressure of arterial oxygen (PaO2) 63mm Hg, partial pressure of arterial carbon dioxide (PaCO2) 52mm Hg, and HCO3 32mEq/L reflects this state of compensated respiratory acidosis.

Question 107

A patient with chronic obstructive pulmonary disease (COPD) suddenly becomes dyspneic with a respiratory rate of 32 breaths/ min and an oxygen saturation of 94%. The patient appears pale and anxious and is using accessory muscles to breathe. Which action would the nurse take?
1. notify the Rapid Response Team
2. Request an order for a chest x-ray
3. Obtain an order for arterial blood gases
4. Apply high-flow oxygen with a Venturi mask

Answer 107

3.) Obtain an order for arterial blood gases.

Question 108

Which treatment is often chosen for small cell lung cancer?
1. chemotherapy
2. tartgeted therapy
3. radiation therapy
4. immunosuppression

Answer 108

1) chemotherapy

Question 109

Which patient teaching point could conceivably prevent most lung cancers?
1. smoking cessation
2. genetic testing for risk
3. use of respirator in at-risk jobs
4. radiologic examination of smokers

Answer 109

1) smoking cessation

Question 110

A 72-year-old patient recovering from lung cancer surgery asks the nurse to explain how she developed cancer when she has never smoked. Which factor may explain the possible cause?
1. advancing age
2. a history of cardiac disease
3. a diagnosis of diabetes treated with insulin and diet
4. an exercise regimen of jogging 3 miles fours times a week

Answer 110

1) advancing age

Question 111

Which condition is indicated when the lab report of a patient with suspected lung cancer shows purulent and copious sputum?
1. Necrosis
2. Bronchitis
3. Hemoptysis
4. Pneumonitis

Answer 111

1) Necrosis

Question 112

Which information is included in the teaching for a patient scheduled for a bone marrow biopsy? SATA
1. it is used to analyze bone marrow function
2. the patient must sign an informed consent form
3. cells and fluids are suctioned from the bone marrow with a syringe
4. the procedure lasts for half an hour
5. the procedure is performed by a physician

Answer 112

1, 2, 5

Question 113

Which site on the body can be used for bone marrow aspiration? SATA
1. ulna
2. tibia
3. patella
4. sternum
5. pelvic bone

Answer 113

4, 5

Question 114

Which statement about the role of platelets in the clotting of blood is correct? SATA
1. Platelets in the blood initate the clotting process
2. Platelets are produced in the bone marrow
3. Platelets are stored in the liver
4. Production of platelets is controlled by erythropoitin
5. Each platelet has a life span of 1 to 2 wks

Answer 114

1, 2, 5

Question 115

A patient who is scheduled to undergo bone marrow transplant will have high-dose chemotherapy followed by total body irradiation (TBI) just before the transplant. Which statement by the patient indicates a need for further teaching about the purpose of this therapy?
1. My bone marrow cells will be obliterated.
2. Any remaining leukemic cells will be destroyed.
3. Graft-versus-Host disease will control the cancer.
4. My immune system will be replaced with the transplant.

Answer 115

3) Graft-versus-Host disease will control the cancer.

Question 116

Which statement is the nurse’s best response when a patient diagnosed with lymphoma asks about the risk for infection?
1. Infection is a risk for anyone with cancer.
2. Because you have Lymphoma, the risk for infection is very low.
3. Lymphoma is a bone marrow cancer, so you are at increased risk for infection.
4. Lymphoma is not a bone marrow cancer, so you are not at increased risk for infection.

Answer 116

3) Lymphoma is a bone marrow cancer, so you are at increased risk for infection.

Question 117

Which occurrence is considered a serious side effect of hydroxyurea prescribed for a patient with sickle cell anemia? SATA
1. stroke
2. diarrhea
3. leukemia
4. cardiomyopathy
5. bone marrow suppression

Answer 117

3, 5

Question 118

Which cause would the nurse suspect for a patient with cancer who has a white blood cell (WBC) count of 1200/mm3? SATA
1. the patient had an infection
2. the cancer has metastasized
3. chemotherapy is depleting the cells
4. the patient may have leukemia
5. cancer cells have invaded the bone marrow

Answer 118

4, 5

Question 119

A patient is prescribed subcutaneous synthetic erythropoietin. Which information would the nurse teach the patient about the drug? SATA
1. take stool softeners
2. report breathing difficulty
3. report any muscle weakness
4. have hemoglobin levels monitored weekly
5. understand it is used to stimulate red blood cell growth

Answer 119

2, 4, 5

Question 120

The nurse is caring for a patient who has weakness, pallor, fatigue, reduced exercise tolerence, and fissures at the corners of the mouth. The nurse recognizes these symptoms are associated with which condition?
1. Aplastic Anemia
2. Folic Acid Deficiency
3. Iron Deficiency Anemia
4. Vitmamin B12 Deficiency (pernicious) anemia

Answer 120

3) Iron Deficiency Anemia

Question 121

Which rationale would the nurse provide to an older patient with anemia regarding the importance of seeking follow-up care from a health care provider?
1. You may get dizzy and fall because of your anemia.
2. GI Bleeding is the most frequent cause of anemia, so you should be monitored closely.
3. To help with your blood levels, you need to increase your fluid intake, and we need to monitor your intake.
4. There is a link between anemia and many skin disorders, so you need to be further assessed for these conditions.

Answer 121

2) GI bleeding is the most frequent cause of anemia, so you should be monitored closely.

Question 122

Which vitamin absorption is affected by a lack of intrinsic factor, as occurs with pernicious anemia?
1. iron
2. folic acid
3. pyridoxine
4. cyanocobalamin

Answer 122

4) cyanocobalamin (aka Vitamin B12)

Question 123

Which clinical manifestation is associated with sickle cell crisis in a patient with sickle cell disease? SATA
1. jaundice
2. pallor
3. dyspnea
4. joint pain
5. low iron levels
6. bradycardia

Answer 123

1, 2 , 3 , 4

Question 124

Which assessment finding represents a positive response to erythropoietin therapy?
1. less fatigue
2. hematocrit of 26.7%
3. potassium within normal range
4. absence of spontaneous fractures

Answer 124

1) less fatigue

Question 125

Which complication likely caused a patient with cancer to have anemia? SATA
1. impaired immune function
2. impaired respiratory function
3. impaired platelet production
4. impaired tissue oxygenation
5. impaired blood- producing function

Answer 125

4, 5

Question 126

Which assessment finding is consistent with a diagnosis of leukemia? SATA
1. pallor
2. weight gain
3. brown urine
4. hypertension
5. frequent colds
6. multiple bruises

Answer 126

1, 5, 6

Question 127

Which complication would the nurse expect to find in a patient diagnosed with multiple myeloma?
1. amnesia
2. hypercalcemia
3. superior vena cava syndrome
4. syndrome of inappropriate antidiuretic hormone

Answer 127

2) hypercalcemia

Question 128

Which information would the nurse provide to a patient with cancer presenting with a platelet count of 21,000 cells/ mm3 to decrease the risk for bleeding? SATA
1. use an electric razor
2. avoid flowers and plants
3. increased fluid intake
4. perform hand hygiene
5. drink warm beverages

Answer 128

1) use an electric razor

Question 129

Which intervention would the nurse plan to implement when caring for a patient with neutropenia? SATA
1. Assess for fever
2. observe for bleeding
3. administer pegfilgrastim
4. do not permit fresh flowers or plants in the room.
5. do not allow the patient’s 16-year-old child to visit.
6. teach the patient to omit raw fruits and vegetables from their diet.

Answer 129

1, 3, 4, 6

Question 130

Which statement made by the nurse would benefit the patient who has been diagnosed with asthma a few months ago and is using a salmeterol inhaler as a reliever therapy, but has no relief from the symptoms?
1. use oral prednisone during an acute asthma attack
2. use the salmeterol inhaler when you have an asthma attack
3. use the fluticasone inhaler when you have an asthma attack
4. use a short-acting inhaler such as albuterol for reliever therapy

Answer 130

4) use a short-acting inhaler such as albuterol for reliever therapy

Question 131

Which 2 major categories are included in asthma medications?
1. control and reliever
2. preventive and quick acting
3. steroids and bronchodilators
4. bronchodilators and anti-inflammatories

Answer 131

1) control and reliever

Question 132

Which statement will the nurse recognize as accurate regarding self management of asthma? SATA
1. NSAIDS should be taken
2. Peak expiratory flow rates should be monitored 2x daily
3. bronchodilator inhalers should be used 30 min after excercising
4. bronchodilators should be used only when the patient is in a sitting position
5. avoid any foods that have been prepared with MSG

Answer 132

2, 5

Question 133

Which statement indicates an understanding of the correct use of emergency drug therapy for asthma?
1. preventive drugs can stop an attack
2. asthma drugs help everybody breathe better
3. i must have an emergency inhaler with me at all times
4. I must carry my emergency inhaler only when activity is anticipated

Answer 133

3) I must have an emergency inhaler with me at all times.

Question 134

Which best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease?
1. genetic variation in the gene that controls the normal synthesis and activity of beta-adrenergic receptors
2. chronic yet usually intermittent body response that can lead to night-time awakening with respiratory symptoms
3. collapse of the walls of bronchioles and alveolar air sacs secondary to lung proteases leading to airway structures
4. airway obstruction secondary to inflammation and/ or bronchocontriction secondary to airway hyperresponsiveness

Answer 134

4) airway obstruction secondary to inflammation and/ or bronchoconstriction secondary to airway hyperresponsiveness

Question 135

Which component of a patient’s family history is of particular importance to the home health nurse who is assessing a new patient with asthma?
1. father is obese
2. mother is diabetic
3. sister is pregnant
4. brother is allergic to peanuts

Answer 135

4) brother is allergic to peanuts

Question 136

Which recommendation will the nurse give to a patient with asthma who reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms?
1. participating in a stretching and light calisthenics program instead
2. avoidng aerobic exercise because it will make symptoms worse
3. using oral corticosteroids to prevent severe asthma symptoms
4. premedicating with a short-acting beta-adrenergic (SABA) medications before exercise

Answer 136

4) premedicating with a short-acting beta-adrenergic (SABA) medication before exercise

Question 137

Which action would the nurse take for a patient with asthma who tells the nurse that the prescribed montelukast does not help with symptoms during an asthma attack?
1. contact the health care provider to discuss a possible increase in dose of this drug
2. ask the patient to describe how and when the medication is taken
3. instruct the patient to take the drug when known asthma triggers are present
4. teach the patient to take the drug at the first indication of symptoms for best effect

Answer 137

2) ask the patient to describe how and when the medication is taken

Question 138

Which statement by the patient indicates a need for further teaching about asthma medication management and the need to use a long-acting beta agonist (LABA) as directed?
1. I may use the LABA as needed for wheezing and coughing
2. The LABA is not used as the only medication for treating asthma
3. I shoud use the LABA twice daily even when I am not having symptoms
4. Overuse of the LABA may result in severe worsening of symptoms

Answer 138

1) I may use the LABA as needed for wheezing and coughing.

Question 139

Of the patients scheduled for CT with contrast, which patient would prompt the nurse to communicate safety concerns to the health care provider? SATA
1. patient with an allergy to shrimp
2. patient with a history of asthma
3. patient who took metformin 4 hrs ago
4. patient who requests morphine sulfate every 3 hrs
5. patient with a blood urea nitrogen (BUN) of 62 mg/L and a creatinine level of 2.0 mg/L

Answer 139

1, 2, 3, 5

Question 140

Which disease process will a nurse suspect in a patient who has frequent respiratory infections, chronic chest congestion, and a sweat chloride level of 85mEq/L?
1. asthma
2. bronchitis
3. emphsema
4. cystic fibrosis

Answer 140

4) cystic fibrosis

Question 141

Which sign or symptom is significant in diagnosing asthma in a nonsmoker?
1. dyspnea
2. wheezing
3. chest tightness
4. increased mucus production

Answer 141

2) wheezing

Question 142

Which category of medication is used as a rescue inhaler for a patient who is a marathon runner and who has asthma?
1. corticosteroids
2. long-acting beta agonists
3. short-acting beta agonists
4. NSAIDS

Answer 142

3) short-acting beta-agonists

Question 143

Which medication will the nurse recommend to the patient with asthma that gets worse during the summer, she she takes a medication every day, so she does not get short of breath when she walks to work?
1. guaifenesin
2. montelukast
3. omalizumab
4. albuterol inhaler

Answer 143

2) montelukast

Question 144

Which topic is most important for the nurse to include when reviewing asthma management with an older-adult patient?
1. frequent peak flow assessments
2. need to reduce strenuous exercise
3. increased use of rescue medications
4. correct use of controller medications

Answer 144

4) correct use of controller medications

Question 145

Which underlying physiologic problem is associated with cystic fibrosis?
1. thick, sticky mucus
2. airway hyperreactivity
3. interstitial lung pathology
4. reduced pulmonary airflow

Answer 145

1) thick, sticky mucus

Question 146

Which two assessement findings are changes secondary to chronic obstruction pulmonary disease (COPD)?
1. emphysema and bronchitis
2. wheezing and excess mucus
3. barrel chest and finger clubbing
4. lung crackles and finger clubbing

Answer 146

3) barrel chest and finger clubbing

Question 147

Which clinical manifestation in a patient recovering from an open lung biopsy will lead the nurse to suspect the presence of a pneumothorax?
1. low respiratory rate
2. rapid capillary refill
3. diminished breath sounds
4. presence of barrel chest

Answer 147

3) diminished breath sounds

Question 148

Which statement by the patient with asthma indicates a need for further teaching about using a controller medication?
1. if I have an increased frequnecy of attacks, I should notfiy my health care provider
2. I will use this medication every day whether I am having symptoms or not.
3. I should take this medication PRN when my symptoms become more severe
4. Controller medications are given to help prevent acute exacerbations of asthma

Answer 148

3) I should take this medication PRN when my symptoms become more severe.

Question 149

Which medication would the nurse expect to administer to a patient with a history of asthma that develops shortness of breath and stridor and becomes hypotensive during allergy skin testing?
1. Zileuton
2. Epinephrine
3. Fexofenadine
4. Cromolyn sodium

Answer 149

2) Epinephrine

Question 150

Which medication is an example of a long-acting beta agonist (LABA) used in asthma management?
1. Albuterol
2. Salmeterol
3. Terbutaline
4. Levalbuterol

Answer 150

2) Salmeterol

Question 151

Inhaled corticosteroids are typically used to treat which symptom of asthma?
1. bronchial spasms
2. airway inflammation
3. bronchial secretions
4. airway hyerresponsiveness

Answer 151

2) airway inflammation

Question 152

Which is the nurse assessing when auscultating the chest of a patient with asthma who is complaining of shortness of breath?
1. fremitus
2. oxygenation status
3. respiratory excursion
4. adventitious breath sounds

Answer 152

4) adventitious breath sounds

Question 153

Which patient will the nurse assess first after receiving report?
1. patient admitted 3 hrs ago for a thoracentesis in 30 mins
2. patient with acute asthma who has an oxygen saturation of 89% by pulse ox
3. patient with bronchogenic lung cancer who had a bronchoscopy 3 hrs ago
4. patient with pleural effusion who has decreased breath sounds at the right base

Answer 153

2) patient with acute asthma who has an oxygen sat of 89% by pulse ox

Question 154

Which pathologic process is present in most patients with chronic obstructive pulmonary disease (COPD)? SATA
1. bronchitis
2. pneumonia
3. sarcoidosis
4. emphysema
5. cystic fibrosis
6. pulmonary tuberculosis

Answer 154

1, 4

Question 155

Which statement by a patient with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instructions?
1. I need to eat more protein.
2. I don’t need to get a flu shot.
3. I don’t need to use my oxygen all the time.
4. It is normal to feel more tired than I used to.

Answer 155

2) I don’t need to get a flu shot.

Question 156

Which information would the nurse provide to a patient with chronic obstructive pulmonary disease (COPD) who is using home oxygen at a flow rate of 4L/ min via nasal cannula but experiencing only moderate improvement in shortness of breath?
1. shortness of breath may continue even with oxygen therapy
2. increase the oxygen flow rate to 6L/ min to improve dyspnea
3. oxygen therapy will eventually reverese the symptoms of COPD
4. use the bronchodilator medication more frequently to improve dyspnea

Answer 156

1) shortness of breath may continue even with oxygen therapy.

Question 157

Which finding prompts the nurse to notify the health care provider when assessing a patient who has chronic obstruction pulmonary disease (COPD) 15 min after an aerosolized bronchodilator has been administered?
1. barrel chest
2. partial pressure of carbon dioxide (PaCO2) of 68mm Hg
3. clubbing of the fingers
4. oxygen saturation of 87%

Answer 157

4) oxygen saturation of 87%

Question 158

A patient with chronic obstruction pulmonary disease (COPD) is exhibiting increased air hungar while recieving oxygen via nasal cannula at a flow rate of 2L/min. Which treatment option would the nurse discuss with the provider?
1. aerosol facemask
2. venturi mask with oxygen at 4L/ min
3. intubation and mechanical ventilation
4. noninvasive positive- pressure ventilation

Answer 158

4) noninvasive positive-pressure ventilation

Question 159

Which patient will the oncoming registered nurse (RN) plan to assess first on the medical-surgical unit?
1. hospice patient with terminal pulmonary fibrosis and an oxygen saturation level of 89%
2. patient with lung cancer who needs an IV antibiotic administered before going to surgery
3. patient with cystic fibrosis (CF) who has an elevated temp and a respiratory rate of 38 breath/min.
4. patient with chronic obstructive pulmonary disease (COPD) who is ready for discharge but is not able to pay for prescribed home medications

Answer 159

3) patient with cystic fibrosis (CF) who has an elevated temp and a respiratory rate of 38 breaths/ min.

Question 160

Which topic will the nurse include when teaching a patient who has chronic obstructive pulmonary disease (COPD) about the need to prevent respiratory infections?
1. consuming a well-balanced diet
2. reporting runny nose and cough
3. avoiding exposure to cold weather
4. getting an annual influenza vaccine

Answer 160

4) getting an annual influenza vaccine

Question 161

Which nursing intervention will help prevent chronic fatigue in patients with chronic obstructive pulmonary disease (COPD)?
1. encourage the patient to work with the arms raised
2. teaching the patient to not rush through morning activities
3. suggesting that the patient avoid high-energy tasks such as walking
4. allowing the patient to eat, bathe, and groom himself or herself during acute exacerbations.

Answer 161

2) teaching the patient to not rush through morning activities

Question 162

Which patient would be appropriate to assign to the new nurse working on the med-surg unit?
1. patient with chronic obstructive pulmonary disease (COPD) with a partial pressure of arterial carbon dioxide (PaCO2) level of 50mm Hg.
2. Patient with reactive airway disease, wheezing, and a partial pressure of arterial oxygen (PaCO2) level of 62mm Hg
3. Patient with diabetic ketoacidosis and change in mental status who has a pH level of 7.18.
4. Patient with an irregular heart rate and prolonged vomiting with a bicarbonate level of 40mEq/L

Answer 162

1) Patient with chronic obstructive pulmonary disease (COPD) with a partial pressure of arterial carbon dioxide (PaCO2) level of 50mm Hg.
2)

Question 163

A patient with chronic obstructive pulmonary disease (COPD) reports acute difficulty breathing and right-sided pleuritic pain. Auscultation reveals decreased breath sounds in the right lung field compared with the left lung field. Which condition would the nurse expect?
1. flail chest
2. pneumothorax
3. pulmonary embolism
4. tension pneumothorax

Answer 163

2) pneumothorax

Question 164

Which statement about the risks of lung cancer indicates a need for further teaching?
1. people who do not smoke have minimal risk
2. people who are passive smokers are at high risk
3. people who are addicted to smoking have a high risk
4. people who are exposed to air pollutants are not at risk

Answer 164

4) people who are exposed to air pollutants are not at risk

Question 165

Which is the leading cause of cancer-related deaths in North America?
1. lung cancer
2. colon cancer
3. breast cancer
4. prostate cancer

Answer 165

1) lung cancer

Question 166

Which is the greatest risk factor for lung cancer?
1. cigarette smoking
2. asbestos exposure
3. smoking marijuana
4. alcohol consumption

Answer 166

1) cigarette smoking

Question 167

Which is a late manifestation of lung cancer?
1. dysphagia
2. polyphagia
3. tachypnea
4. weight gain

Answer 167

1) dysphagia

Question 168

Which statement regarding the growth and spread of lung cancer requires correction?
1. lung cancer can spread to other tissues, including bone
2. tumors can grow so large they can compress the airway
3. metastasis can occur through the blood but not through respiration
4. lung cancere can spread only to lung lymph nodes but not distant lymph nodes

Answer 168

4) lung cancer can spread only to lung lymph nodes but not distant lymph nodes

Question 169

When couseling a 60-year-old African American male patient with all of the risk factors for lung cancer, teaching would focus most on which risk factor?
1. gender
2. ethnicity
3. tobacco use
4. increased age

Answer 169

3) tobacco use

Question 170

A patient diagnosed with leukemia has developed an infection. Which response would the nurse give the patient about the reason for the infection? SATA
1. impaired immune function occurs most often in patients with leukemia
2. impaired blood-producing functions occur most often in patients with leukemia
3. impaired immune functions are usually associated with other cancers.
4. impaired blood-producing functions rarely occur in patients with leukemia
5. impaired immune functions are not associated with bone marrow cancer

Answer 170

1, 2

Question 171

Which occurrence is because of side effects of chemotherapy on bone marrow? SATA
1. anemia
2. alopecia
3. mucositis
4. neutropenia
5. thrombocytopenia

Answer 171

1, 4, 5

Question 172

A patient has aplastic anemia. The nurse regularly assesses which diagnostic test result? SATA
1. platelets
2. d-dimer assay
3. white blood cells
4. prothrombin time
5. hemoglobin/ hematocrit
6. b-type natriuretic peptide

Answer 172

1, 3, 5

Question 173

A patient presents to the ER with a new onset of bruising and a petechial rash around the upper chest and arms. The patient’s lab results demonstrate a platelet count of 51,000 platelets/mL. Which action by the nurse is most appropriate?
1. administer corticosteroids
2. plan for bone marrow aspiration
3. implement bleeding precautions
4. examine the patient’s history for recent virus

Answer 173

3) implement bleeding precautions

Question 174

Which is the purpose of a prothrombin time (PT) test? SATA
1. determines time taken for blood to clot
2. identifies bone suppression
3. reflects the level of clotting factors II, V, VII, and X
4. indicates excess of vitamin K
5. indicates hypersplenism

Answer 174

1, 3, 4

Question 175

A patient who underwent bone marrow transplantation 21 days ago is receiving growth factors. The patient’s blood test reveals mixed chimerism with a greater percentage of donor cells than 1 wk ago. How does the nurse interpret this result?
1. graft failure seems likely
2. engraftment appears to be successful
3. the patient should 100% donor cells
4. the patient will probably need an increased dose of growth factor

Answer 175

2) engraftment appears to be successful

Question 176

Which symptom is a typical clinical manifestation of anemia? SATA
1. pallor
2. fatigue
3. tachycardia
4. dyspnea on exertion
5. elevated temperature
6. decreased breath sounds

Answer 176

1, 2, 3, 4

Question 177

A patient with pallor; jaundice; a smooth, beefy tongue; has been experiencing difficulty with balance; and reports tingling of the hands and feet. the patient’s lab workup indicates macrocytic anemia. The nurse notifies the health care provider of these findings and anticipates a prescription for which medication?
1. steroids
2. folic acid
3. iron dextran
4. vitamin b12

Answer 177

4) vitamin b12

Question 178

While performing an admission assessment on a 55-year-old woman, the nurse notes serum hemoglobin level that indicates anemia. Which question does the nurse ask the patient first?
1. does she consume red meat regularly?
2. does she still have menstrual periods?
3. does she take a vitamin supplement?
4. has she noticed blood in her stools?

Answer 178

4) has she noticed blood in her stools?

Question 179

a patient with a history of chronic alcohol abuse is pale and jaundiced. A review of the medical record reveals a low hemoglobin level with macrocytic red blood cells. This information may point to which nutrient deficiency?
1. iron
2. folic acid
3. Vitamin A
4. Vitamin B12

Answer 179

2) folic acid

Question 180

A patient with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this patient’s problem?
1. ask your doctor to prescribe more medication
2. ill turn on some soothing classical music for you
3. would like to try some relaxation techniques?
4. it is too soon for additional medications to be given

Answer 180

3) would you like to try some relaxation techniques?

Question 181

A patient with a large, painless lymph node has a biopsy that reveals Reed- Sternberg cells. Which form of cancer does this finding indicate?
1. multiple myeloma
2. Hodgkin lymphoma
3. Non-Hodgkin lymphoma
4. Acute myelogenous leukemia

Answer 181

2) Hodgkin Lymphoma