Chapter 29: Nursing Management: Obstructive Pulmonary Diseases 9th Edition

Question 1

1. The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful?
   a. The patient shakes the device before use.
   b. The patient attaches a spacer to the Diskus.
   c. The patient rapidly inhales the medication.
   d. The patient performs huff coughing after inhalation

Answer 1

c. The patient rapidly inhales the medication.

Question 2

2. The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching?
   a. The patient attaches a spacer before using the inhaler.
   b. The patient coughs vigorously after using the inhaler.
   c. The patient activates the inhaler at the onset of expiration.
   d. The patient removes the facial mask when misting has ceased.

Answer 2

d. The patient removes the facial mask when misting has ceased.

Question 3

3. A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure?
   a. Give the rescue medication immediately before testing.
   b. Administer oral corticosteroids 2 hours before the procedure.
   c. Withhold bronchodilators for 6 to 12 hours before the examination.
   d. Ensure that the patient has been NPO for several hours before the test.

Answer 3

c.

Withhold bronchodilators for 6 to 12 hours before the examination.

Question 4

4. Which information will the nurse include in the asthma teaching plan for a patient being discharged?
   a. Use the inhaled corticosteroid when shortness of breath occurs.
   b. Inhale slowly and deeply when using the dry powder inhaler (DPI).
   c. Hold your breath for 5 seconds after using the bronchodilator inhaler.
   d. Tremors are an expected side effect of rapidly acting bronchodilators

Answer 4

d. Tremors are an expected side effect of rapidly acting bronchodilators

Question 5

5. The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective?
   a. No wheezes are audible.
   b. Oxygen saturation is >90%.
   c. Accessory muscle use has decreased.
   d. Respiratory rate is 16 breaths/minute.

Answer 5

b. Oxygen saturation is >90%.

Question 6

6. A patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next?
   a. Increase the dose of the leukotriene inhibitor.
   b. Teach the patient about the use of oral corticosteroids.
   c. Administer a bronchodilator and recheck the peak flow.
   d. Instruct the patient to keep the next scheduled follow-up appointment.

Answer 6

c. Administer a bronchodilator and recheck the peak flow.

Question 7

7. The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?
   a. The patient inhales rapidly through the peak flow meter mouthpiece.
   b. The patient takes montelukast (Singulair) for peak flows in the red zone.
   c. The patient calls the health care provider when the peak flow is in the green zone.
   d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

Answer 7

d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

Question 8

8. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). It is most appropriate for the nurse to teach the patient about
   a. a1-antitrypsin testing.
   b. use of the nicotine patch.
   c. continuous pulse oximetry.
   d. effects of leukotriene modifiers.

Answer 8

a. a1-antitrypsin testing.

Question 9

9. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?
   a. The patient reports a recent 15-pound weight gain.
   b. The patient denies any shortness of breath at present.
   c. The patient takes cimetidine (Tagamet) 150 mg daily.
   d. The patient complains about coughing up green mucus.

Answer 9

c. The patient takes cimetidine (Tagamet) 150 mg daily.

Question 10

10. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care?
    a. Titrate oxygen to keep saturation at least 90%.
    b. Discuss a high-protein, high-calorie diet with the patient.
    c. Suggest the use of over-the-counter sedative medications.
    d. Teach the patient how to effectively use pursed lip breathing.

Answer 10

d. Teach the patient how to effectively use pursed lip breathing.

Question 11

11. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care?
    a. Encourage increased intake of whole grains.
    b. Increase the patients intake of fruits and fruit juices.
    c. Offer high-calorie snacks between meals and at bedtime.
    d. Assist the patient in choosing foods with high vegetable and mineral content.

Answer 11

c. Offer high-calorie snacks between meals and at bedtime.

Question 12

12. The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most helpful in confirming a diagnosis of chronic bronchitis?

a.

The patient tells the nurse about a family history of bronchitis.

b.

The patients history indicates a 30 pack-year cigarette history.

c.

The patient complains about a productive cough every winter for 3 months.

d.

The patient denies having any respiratory problems until the last 12 months.

Answer 12

c.

The patient complains about a productive cough every winter for 3 months.

Question 13

13. The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?

a.

The patient inhales slowly through the nose.

b.

The patient puffs up the cheeks while exhaling.

c.

The patient practices by blowing through a straw.

d.

The patients ratio of inhalation to exhalation is 1:3.

Answer 13

b.

The patient puffs up the cheeks while exhaling.

Question 14

14. Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?

a.

Even, unlabored respirations

b.

Pulse oximetry reading of 92%

c.

Respiratory rate of 18 breaths/minute

d.

Absence of wheezes, rhonchi, or crackles

Answer 14

b.

Pulse oximetry reading of 92%

Question 15

15. The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?

a.

Peripheral edema

b.

Elevated temperature

c.

Clubbing of the fingers

d.

Complaints of chest pain

Answer 15

a.

Peripheral edema

Question 16

16. The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD).What is the best way for the nurse to determine the appropriate oxygen flow rate?

a.

Minimize oxygen use to avoid oxygen dependency.

b.

Maintain the pulse oximetry level at 90% or greater.

c.

Administer oxygen according to the patients level of dyspnea.

d.

Avoid administration of oxygen at a rate of more than 2 L/minute.

Answer 16

b.

Maintain the pulse oximetry level at 90% or greater.

Question 17

17. A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching?

a.

Storage of oxygen tanks will require adequate space in the home.

b.

Travel opportunities will be limited because of the use of oxygen.

c.

Oxygen flow should be increased if the patient has more dyspnea.

d.

Oxygen use can improve the patients prognosis and quality of life.

Answer 17

d.

Oxygen use can improve the patients prognosis and quality of life.

Question 18

18. A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, which action by the nurse is most important?

a.

Teach the patient to keep mask on at all times.

b.

Keep the air entrainment ports clean and unobstructed.

c.

Give a high enough flow rate to keep the bag from collapsing.

d.

Drain moisture condensation from the oxygen tubing every hour.

Answer 18

b.

Keep the air entrainment ports clean and unobstructed

Question 19

19. Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care?

a.

Schedule the procedure 1 hour after the patient eats.

b.

Maintain the patient in the lateral position for 20 minutes.

c.

Perform percussion before assisting the patient to the drainage position.

d.

Give the ordered albuterol (Proventil) before the patient receives the therapy.

Answer 19

d.

Give the ordered albuterol (Proventil) before the patient receives the therapy.

Question 20

20. The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be most appropriate for the nurse to include in the plan of care?

a.

Stop exercising when short of breath.

b.

Walk until pulse rate exceeds 130 beats/minute.

c.

Limit exercise to activities of daily living (ADLs).

d.

Walk 15 to 20 minutes daily at least 3 times/week.

Answer 20

d.

Walk 15 to 20 minutes daily at least 3 times/week.

Question 21

21. A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, I wish I were dead! Im just a burden on everybody. Based on this information, which nursing diagnosis is most appropriate?

a.

Complicated grieving related to expectation of death

b.

Ineffective coping related to unknown outcome of illness

c.

Deficient knowledge related to lack of education about COPD

d.

Chronic low self-esteem related to increased physical dependence

Answer 21

d.

Chronic low self-esteem related to increased physical dependence

Question 22

22. A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate?

a.

Have the patient rest in bed with the head elevated to 15 to 20 degrees.

b.

Ask the patient to rest in bed in a high-Fowlers position with the knees flexed.

c.

Encourage the patient to sit up at the bedside in a chair and lean slightly forward.

d.

Place the patient in the Trendelenburg position with several pillows behind the head.

Answer 22

c.

Encourage the patient to sit up at the bedside in a chair and lean slightly forward.

Question 23

23. A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask?

a.

Are you claustrophobic?

b.

Are you allergic to shellfish?

c.

Do you have any metal implants or prostheses?

d.

Have you taken any bronchodilators in the past 6 hours?

Answer 23

d.

Have you taken any bronchodilators in the past 6 hours?

Question 24

24. A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care?

a.

Schedule a sweat chloride test.

b.

Arrange for a hospice nurse visit.

c.

Place the patient on a low-sodium diet.

d.

Perform chest physiotherapy every 4 hours.

Answer 24

d.

Perform chest physiotherapy every 4 hours.

Question 25

25. A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate?

a.

Have the patient add dietary salt to meals.

b.

Teach the patient about the signs of hypoglycemia.

c.

Suggest decreasing intake of dietary fat and calories.

d.

Instruct the patient about pancreatic enzyme replacements.

Answer 25

a.

Have the patient add dietary salt to meals.

Question 26

26. A young adult female patient with cystic fibrosis (CF) tells the nurse that she is not sure about getting married and having children some day. Which initial response by the nurse is best?

a.

Are you aware of the normal lifespan for patients with CF?

b.

Do you need any information to help you with that decision?

c.

Many women with CF do not have difficulty conceiving children.

d.

You will need to have genetic counseling before making a decision.

Answer 26

b.

Teach the patient about the signs of hypoglycemia.

Question 27

27. A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective?

a.

Change the oxygen flow rate to the highest prescribed rate.

b.

Teach the patient to use the Flutter airway clearance device.

c.

Reinforce the ongoing use of pursed lip breathing techniques.

d.

Teach the patient about consistent use of inhaled corticosteroids.

Answer 27

b.

Teach the patient to use the Flutter airway clearance device.

Question 28

28. The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective?

a.

I will drink lots of fluids with my meals.

b.

I can have ice cream as a snack every day.

c.

I will exercise for 15 minutes before meals.

d.

I will decrease my intake of meat and poultry.

Answer 28

b.

I can have ice cream as a snack every day.

Question 29

29. Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)?

a.

Stop exercising if you start to feel short of breath.

b.

Use the bronchodilator before you start to exercise.

c.

Breathe in and out through the mouth while you exercise.

d.

Upper body exercise should be avoided to prevent dyspnea.

Answer 29

b.

Use the bronchodilator before you start to exercise.

Question 30

30. The nurse completes an admission assessment on a patient with asthma. Which information given by patient is most indicative of a need for a change in therapy?

a.

The patient uses albuterol (Proventil) before any aerobic exercise.

b.

The patient says that the asthma symptoms are worse every spring.

c.

The patients heart rate increases after using the albuterol (Proventil) inhaler.

d.

The patients only medications are albuterol (Proventil) and salmeterol (Serevent)

Answer 30

d.

The patients only medications are albuterol (Proventil) and salmeterol (Serevent)

Question 31

31. The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy?

a.

The patient has chronic inflammatory bowel disease.

b.

The patient has a history of pneumonia 6 months ago.

c.

The patient takes propranolol (Inderal) for hypertension.

d.

The patient uses acetaminophen (Tylenol) for headaches.

Answer 31

c.

The patient takes propranolol (Inderal) for hypertension.

Question 32

32. A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching?

a.

Use of long-acting b-adrenergic medications

b.

Side effects of sustained-release theophylline

c.

Self-administration of inhaled corticosteroids

d.

Complications associated with oxygen therapy

Answer 32

c.

Self-administration of inhaled corticosteroids

Question 33

33. A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/dL. Which nursing action will the nurse plan to implement?

a.

Discuss the role of diet in blood glucose control.

b.

Teach the patient about administration of insulin.

c.

Give oral hypoglycemic medications before meals.

d.

Evaluate the patients home use of pancreatic enzymes.

Answer 33

b.

Teach the patient about administration of insulin.

Question 34

34. The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action?

a.

Pulse oximetry reading of 91%

b.

Respiratory rate of 26 breaths/minute

c.

Use of accessory muscles in breathing

d.

Peak expiratory flow rate of 240 L/minute

Answer 34

c.

Use of accessory muscles in breathing

Question 35

35. A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first?

a.

Notify the health care provider.

b.

Document changes in respiratory status.

c.

Encourage the patient to cough and deep breathe.

d.

Administer IV methylprednisolone (Solu-Medrol).

Answer 35

a.

Notify the health care provider.

Question 36

36. A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?

a.

Listen to the patients breath sounds.

b.

Ask about inhaled corticosteroid use.

c.

Determine when the dyspnea started.

d.

Obtain the forced expiratory volume (FEV) flow rate.

Answer 36

a.

Listen to the patients breath sounds.

Question 37

37. Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider?

a.

Pain at injection site

b.

Flushing and dizziness

c.

Peak flow reading 75% of normal

d.

Respiratory rate 22 breaths/minute

Answer 37

b.

Flushing and dizziness

Question 38

38. The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse?

a.

22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

b.

34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg

c.

45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg

d.

65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

Answer 38

a.

22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

Question 39

39. Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)?

a.

Obtain oxygen saturation using pulse oximetry.

b.

Monitor for increased oxygen need with exercise.

c.

Teach the patient about safe use of oxygen at home.

d.

Adjust oxygen to keep saturation in prescribed parameters.

Answer 39

a.

Obtain oxygen saturation using pulse oximetry.

Question 40

40. The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse takefirst?

a.

Tell the patient to go to the hospital emergency department.

b.

Instruct the patient to use the prescribed albuterol (Proventil).

c.

Ask about recent exposure to any new allergens or asthma triggers.

d.

Question the patient about use of the prescribed inhaled corticosteroids.

Answer 40

b.

Instruct the patient to use the prescribed albuterol (Proventil).

Question 41

41. The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first?

a.

Albuterol (Ventolin) 2.5 mg per nebulizer

b.

Methylprednisolone (Solu-Medrol) 60 mg IV

c.

Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI)

d.

Triamcinolone (Azmacort) 2 puffs per metered-dose inhaler (MDI)

Answer 41

a.

Albuterol (Ventolin) 2.5 mg per nebulizer

Question 42

42. The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?

a.

A patient with loud expiratory wheezes

b.

A patient with a respiratory rate of 38/minute.

c.
A patient who has a cough productive of thick, green mucus

d.

A patient with jugular venous distention and peripheral edema

Answer 42

b.

A patient with a respiratory rate of 38/minute.

Question 43

43. Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider?

a.

Cough productive of bloody, purulent mucus

b.

Scattered rhonchi and wheezes heard bilaterally

c.

Respiratory rate 28 breaths/minute while ambulating in hallway

d.

Complaint of sharp chest pain with deep breathing

Answer 43

a.

Cough productive of bloody, purulent mucus

Question 44

1. A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/minute. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute

Answer 44

320

A PEFR less than 80% of the personal best indicates that the patient is in the yellow zone where changes in therapy are needed to prevent progression of the airway narrowing.