LA#7 ( Respiratory) Chapters 28, 30, 31 in Med Surg

Question 1

A patient in severe respiratory distress is admitted to the medical unit at the hospital. During the admission assessment of the patient, what should the nurse do?

a. Perform a comprehensive health history with the patient to determine the extent of prior respiratory problems.
b. Complete a full physical examination to determine the effect of the respiratory distress on other body functions.
c. Delay any physical assessment of the patient, and ask family members about the patient’s history of respiratory problems.
d. Perform a physical assessment of the respiratory system, and ask specific questions related to this episode of respiratory distress.

Answer 1

ANS: D
When a patient has severe respiratory distress, only information pertinent to the current episode is obtained, and a more thorough assessment is deferred until later.

Question 2

A hypothermic patient is admitted to the emergency department, and pulse oximetry (SpO2) indicates that the O2 saturation is 95%. Which action should the nurse take next?

a. Complete a head-to-toe assessment.
b. Place the patient on high-flow oxygen.
c. Start rewarming the patient.
d. Obtain arterial blood gases.

Answer 2

ANS: B
Although the O2 saturation is adequate, the left shift in the oxyhemoglobin dissociation curve will decrease the amount of oxygen delivered to tissues, so high oxygen concentrations should be given until the patient is normothermic.

Question 3

The physician performs a thoracentesis on a patient with a right pleural effusion. In preparing the patient for the procedure, how should the nurse position the patient?

a. Supine with the head of the bed elevated 45 degrees
b. On his left side with his right arm extended above his head
c. Sitting upright with his arms supported on an overbed table
d. On his left side in the Trendelenburg’s position with both arms extended

Answer 3

ANS: C
The upright position with the arms supported increases lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space so that access to the pleural space is easier.

Question 4

A patient is admitted with a metabolic acidosis of unknown origin. Based on this diagnosis, the nurse would expect the patient to have which one of the following?

a. Kussmaul’s respirations
b. Slow, shallow respirations
c. A low oxygen saturation (SpO2)
d. A decrease in PVO2

Answer 4

ANS: A

Kussmaul’s (deep and rapid) respirations are a compensatory mechanism for metabolic acidosis.

Question 5

While caring for a patient who has a 30-pack-year history of smoking, the nurse recognizes that the patient most likely has decreased respiratory defences due to which of the following conditions?

a. Impaired cough reflex
b. Impaired mucociliary clearance
c. Impaired reflex bronchoconstriction
d. Impaired ability to filter particles from the air

Answer 5

ANS: B
Smoking decreases ciliary action and the ability of the mucociliary clearance system to trap particles and move them out of the lung.

Question 6

An 80-year-old patient breathing room air has an arterial blood gas analysis. Which of the following results does the nurse interpret as normal?

a. pH 7.32, PaO2 85 mm Hg, PaCO2 55 mm Hg, and O2 saturation 90%
b. pH 7.38, PaO2 75 mm Hg, PaCO2 40 mm Hg, and O2 saturation 92%
c. pH 7.42, PaO2 80 mm Hg, PaCO2 33 mm Hg, and O2 saturation 98%
d. pH 7.52, PaO2 90 mm Hg, PaCO2 30 mm Hg, and O2 saturation 94%

Answer 6

ANS: B

All of the values, pH 7.38, PaO2 75 mm Hg, PaCO2 40 mm Hg, and O2 saturation 92%, are normal.

Question 7

A patient with amyotrophic lateral sclerosis (ALS) is admitted to the hospital with dyspnea. During palpation of the patient’s thorax, what would the nurse expect to find?

a. Diminished expansion
b. Asymmetrical expansion
c. Normal expansion of 2.5 cm
d. Unequal, diminished expansion

Answer 7

ANS: A
Expansion is symmetrical but diminished in conditions that produce a hyperinflated or barrel-shaped chest or in neuromuscular diseases (e.g., amyotrophic lateral sclerosis, spinal cord lesions).

Question 8

On auscultation of a patient’s lungs, the nurse hears short, high-pitched sounds just before the end of inspiration in the right and left lower lobes. How should the nurse document this finding?

a. Inspiratory wheezes in both lungs
b. Crackles in the right and left lower lobes
c. Abnormal lung sounds in the bases of both lungs
d. Pleural friction rub in the right and left lower lobes

Answer 8

ANS: A
Wheezes are high-pitched sounds; in this case, they are heard during the inspiratory phase of the respiratory cycle. Abnormal breath sounds are bronchial or bronchovesicular sounds heard in the peripheral lung fields. Crackles are low-pitched, “bubbling” sounds. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.

Question 9

A patient with chronic obstructive pulmonary disease (COPD) has a barrel chest. What would the nurse expect the results of a chest X-ray to reveal?

a. Fluid in the alveoli
b. Air in the pleural space
c. Overinflation of the alveoli with air
d. Consolidation of lung tissue with mucus and exudates

Answer 9

ANS: C

A barrel chest results from lung hyperinflation and is a common finding in patients with COPD.

Question 10

When admitting a patient who has a pleural effusion, which technique will the nurse use to assess for tactile fremitus?

a. Percuss over the entire posterior chest.
b. Use the fingertips to assess for vibration.
c. Place the palms of the hands on the chest wall.
d. Auscultate while the patient says “ninety-nine.”

Answer 10

ANS: C
To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as “ninety-nine.”

Question 11

On auscultation of a patient’s lungs, the nurse hears short, low-pitched, ‘bubbling’ sounds in the right and left lower lung areas. How should the nurse document this finding?

a. Inspiratory wheezes in both lungs
b. Crackles in the right and left lower lobes
c. Abnormal lung sounds in the bases of both lungs
d. Pleural friction rub in the right and left lower lobes

Answer 11

ANS: B
Crackles are low-pitched, “bubbling” sounds. Wheezes are high-pitched sounds; in this case, they are heard during the inspiratory phase of the respiratory cycle. Abnormal breath sounds are bronchial or bronchovesicular sounds heard in the peripheral lung fields. Pleural friction rubs are grating sounds that are usually heard during both inspiration and expiration.

Question 12

A patient with a chronic cough with blood-tinged sputum undergoes a bronchoscopy. Following the bronchoscopy, what should the nurse do?

a. Keep the patient on bed rest for 8 hours.
b. Keep the patient on nothing by mouth (NPO) status until the gag reflex returns.
c. Check vital signs every 15 minutes for 2 hours.
d. Encourage fluid intake to promote elimination of the contrast media.

Answer 12

ANS: B
Because a local anaesthetic is used to suppress the gag or cough reflex during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food.

Question 13

Which of the following is an age-related change in the respiratory system?

a. Increased elastic recoil of the lungs
b. Increase in chest wall compliance
c. Increase in anteroposterior diameter
d. Increase in functional alveoli

Answer 13

ANS: C

Many older adults have a barrel-shaped thorax as a result of an increased anteroposterior diameter.

Question 14

While auscultating a patient’s chest as the patient takes a deep breath, the nurse hears loud, high-pitched, “blowing” sounds at both lung bases. How will the nurse document these sounds?

a. Adventitious sounds
b. Abnormal sounds
c. Vesicular sounds
d. Normal sounds

Answer 14

ANS: B

The description indicates that the nurse hears bronchial breath sounds that are abnormal when heard at the lung base.

Question 15

In analyzing the results of a patient’s blood gas analysis, the nurse will be most concerned about which of the following?

a. Arterial oxygen tension (PaO2) of 60 mm Hg
b. Arterial oxygen saturation (SaO2) of 91%
c. Arterial carbon dioxide (PaCO2) of 47 mm Hg
d. Arterial bicarbonate level (HCO3-) of 27 mmol/L

Answer 15

ANS: A
All the values are abnormal, but the low PaO2 indicates that the patient is at the point on the oxyhemoglobin dissociation curve where a small change in the PaO2 will cause a large drop in the O2 saturation and a decrease in tissue oxygenation. The nurse should intervene immediately to improve the patient’s oxygenation.

Question 16

While assessing a patient with respiratory problems, what should the nurse specifically ask about?

a. Smoking habits
b. Alterations in sexual activity
c. The course of the patient’s illness
d. Occupational exposure to heavy lifting

Answer 16

ANS: A
An important aspect of a patient respiratory history, especially one with respiratory problems, is the history of smoking and smoking habits.

Question 17

While caring for a patient with respiratory disease, the nurse observes that the patient’s SpO2 drops from 94% to 85% when the patient ambulates in the hall. What does the nurse determine from this response?

a. Supplemental oxygen should be used when the patient exercises.
b. Arterial blood gas determinations should be done to verify the SpO2.
c. This finding is a normal response to activity, and the patient should continue to be monitored.
d. The oximetry probe should be moved from the finger to the earlobe for an accurate SpO2 during activity.

Answer 17

ANS: A

The drop in SpO2 to 85% indicates that the patient is hypoxemic and needs supplemental oxygen when exercising.

Question 18

Which of the following is a normal partial pressure of oxygen value at sea level?

a. 60 mm Hg
b. 75 mm Hg
c. 90 mm Hg
d. 105 mm Hg

Answer 18

ANS: C

The normal partial pressure of oxygen at sea level is 80 to 100 mm Hg.

Question 19

The nurse is observing a student who is auscultating a patient’s lungs. Which action by the student indicates that the nurse should intervene?

a. The student compares breath sounds from side to side.
b. The student starts at the base of the posterior lung and moves to the apices.
c. The student places the stethoscope over the scapulae and then auscultates.
d. The student listens only over the posterior part of the chest.

Answer 19

ANS: C
The stethoscope should be placed over lung tissue, not over bony structures. Breath sounds should be compared from side to side. The techniques of starting at the lung base and then moving toward the apices and listening only over the posterior chest are acceptable.

Question 20

When assessing the respiratory system of a 78-year-old patient, which of these findings indicates that the nurse should take immediate action?

a. Barrel-shaped chest
b. Weak cough effort
c. Audible crackles in the lower two thirds of the posterior chest
d. Hyperresonance across both sides of the chest

Answer 20

ANS: C
Crackles in the lower two thirds of the lungs indicate that the patient may have an acute problem such as congestive heart failure. The nurse should immediately accomplish further assessments, such as oxygen saturation, and notify the physician.

Question 21

When performing an assessment of the patient’s respiratory system, the nurse uses the following illustrated technique to evaluate which of the following respiratory functions?

a. Chest expansion
b. Tactile fremitus
c. Accessory muscle use
d. Diaphragmatic excursion

Answer 21

ANS: A
When assessing chest expansion on the posterior chest, the nurse will place the hands at the level of the tenth rib, position the thumbs until they meet over the spine, and have the patient breathe deeply.

Question 22

What is the normal volume of total lung capacity?

a. 1.0 L
b. 2.0 L
c. 3.5 L
d. 6.0 L

Answer 22

ANS: D

The normal total lung capacity volume is 6 L.

Question 23

A patient is admitted to the emergency department complaining of sudden-onset shortness of breath and is diagnosed with a possible pulmonary embolus. To confirm the diagnosis, the nurse will anticipate preparing the patient for which of the following?

a. Chest X-ray
b. Ventilation–perfusion scan
c. Bronchoscopy
d. Positron emission tomography scan

Answer 23

ANS: B
A ventilation–perfusion scan is used primarily to check for the presence of a pulmonary embolus. There is no specific preparation or aftercare.

Question 24

Which of the following is a measure of the elasticity of the lung?

a. Inspiration
b. Compliance
c. Elastic recoil
d. Oxygen–hemoglobin dissociation curve

Answer 24

ANS: B

Compliance (distensibility) is a measure of the elasticity of the lungs and the thorax.

Question 25

Which of the following is an early symptom of inadequate oxygenation?

a. Dyspnea at rest
b. Hypotension
c. Tachypnea
d. Cyanosis

Answer 25

ANS: C

Tachypnea is an early symptom of inadequate oxygenation. Dyspnea at rest, hypotension, and cyanosis are all late signs.

Question 26

Which is the most common infection causing acute pharyngitis?

a. Fungal
b. Viral
c. Acute follicular
d. Peritonsillar

Answer 26

ANS: B

Viral pharyngitis accounts for approximately 70% of all cases of acute pharyngitis.

Question 27

When the nurse removes a nasogastric tube that has been in place for 7 days postoperatively, the patient develops a nosebleed. To control the bleeding, what should the nurse do?

a. Pinch the soft lower portion of the nose for 10 to 15 minutes.
b. Place the patient in a sitting position with the head hyperextended.
c. Apply ice compresses to the patient’s forehead and back of the neck.
d. Pack the nares with ribbon gauze to apply pressure to the source of the bleeding.

Answer 27

ANS: A

The first nursing action for epistaxis is to apply direct pressure by pinching the nostrils.

Question 28

In teaching the patient with allergic rhinitis about management of the condition, what should the nurse explain?

a. Identification and avoidance of triggers of the symptoms are important to avoid reactions.
b. Allergic reactions can be prevented if oral antihistamines are taken before exposure to allergens.
c. Corticosteroid nasal sprays are the only topical drugs recommended for treatment of hay fever.
d. Prescription antihistamine drugs should be requested because over-the-counter preparations are ineffective for allergic rhinitis.

Answer 28

ANS: A

The most important intervention is to assist the patient to identify and avoid potential allergens.

Question 29

A woman calls the clinic and tells the nurse that her mother, an older adult, has had a cold for the past week. The woman is worried that pneumonia will develop. After the nurse discusses care of upper respiratory infections and prevention of secondary infections, which of the following responses by the woman alerts the nurse that additional teaching is needed?

a. “I should encourage my mother to drink a lot of juices and other fluids.”
b. “I should watch for changes in nasal secretions or the sputum she coughs up.”
c. “I can give my mother aspirin or acetaminophen to make her more comfortable.”
d. “I can encourage my mother to continue to use nasal decongestant spray until the congestion is gone.”

Answer 29

ANS: D
The nurse should clarify that nasal decongestant sprays should be used for no more than 5 days to prevent rebound vasodilation and congestion.

Question 30

When doing nutrition-related teaching with a patient who has acute pharyngitis, what should the nurse tell the patient to avoid ingesting?

a. Orange Jell-o
b. Vanilla ice cream
c. Grape popsicles
d. Orange juice

Answer 30

ANS: D
Cool, bland liquids and gelatin will not irritate the pharynx; citrus juices are to be avoided, as they can be irritating to the throat.

Question 31

To which one of the following patients should the nurse strongly recommend an influenza immunization in the autumn each year?

a. A 24-year-old woman who has an allergy to penicillin
b. A 42-year-old man who has a history of smoking for 20 years
c. A 36-year-old man who had pneumonia when he was in university
d. A 30-year-old woman who takes corticosteroids for rheumatoid arthritis

Answer 31

ANS: D
It is recommended that patients who are immunocompromised receive yearly influenza vaccinations. The corticosteroid use by the 30-year-old patient increases that person’s risk for infection.

Question 32

The nurse determines that complications of influenza are developing in a patient who experiences which of the following?

a. Myalgia and headache
b. Diffuse crackles in the lungs
c. Sore throat and productive cough
d. A fever of 38°C with chills

Answer 32

ANS: B
The crackles indicate that the patient may be developing pneumonia, a common complication of influenza, which would require aggressive treatment.

Question 33

The nurse is caring for a hospitalized 82-year-old patient who has nasal packing in place to treat a nosebleed. Which of these assessments will require the most immediate nursing action?

a. The patient’s temperature is 38.3°C.
b. The nose appears red and swollen.
c. The patient’s oxygen saturation is 89%.
d. The patient complains of pain rated as 7 on a 10-point scale.

Answer 33

ANS: C
Older patients with nasal packing are at risk for aspiration or airway obstruction. An O2 saturation of 89% should alert the nurse to assess further for these complications.

Question 34

Which of the following is the most commonly used voice prosthesis?

a. Electrolarynx
b. Blom-Singer
c. Cooper-Rand
d. Artificial larynx

Answer 34

ANS: B

The most commonly used voice prosthesis is the Blom-Singer.

Question 35

A registered nurse is observing a nursing student who is suctioning a hospitalized patient with a tracheostomy in place. Which action by the student requires the registered nurse to intervene?

a. The student preoxygenates the patient for 2 minutes before suctioning.
b. The student applies suction for 10 seconds while withdrawing the catheter.
c. The student puts on clean gloves and uses a sterile catheter to suction.
d. The student inserts the catheter about 12.7 cm into the tracheostomy tube.

Answer 35

ANS: C

Sterile gloves and a sterile catheter are used when suctioning a tracheostomy.

Question 36

When the nurse is deflating the cuff of a tracheostomy tube to evaluate the patient’s ability to swallow, what is it most important to do?

a. Deflate the cuff during the patient’s inhalation.
b. Clean the inner cannula of the tracheostomy tube.
c. Suction the mouth and trachea before deflation of the tube.
d. Measure the amount of air removed from the cuff during deflation.

Answer 36

ANS: C
The patient’s mouth and trachea should be suctioned before the cuff is deflated to prevent aspiration of oral secretions.

Question 37

A home care nurse is completing a follow-up visit with a patient who has recently undergone a radical neck dissection. The nurse will assess the patient for signs and symptoms of which of the following emotional concerns?

a. Anxiety
b. Anorexia
c. Depression
d. Speech impediment

Answer 37

ANS: C
Depression is common in the patient who has had a radical neck dissection; therefore, the nurse should assess for its presence when providing follow-up home care.

Question 38

A patient with an uncuffed tracheostomy tube coughs violently during suctioning and dislodges the tracheostomy tube. Initially, what should the nurse do?

a. Call the physician.
b. Attempt to reinsert the tracheostomy tube.
c. Position the patient in a lateral position with the neck extended.
d. Cover the stoma with a sterile dressing, and ventilate the patient with a manual bag-mask until the physician arrives.

Answer 38

ANS: B

The first action should be to attempt to reinsert the tracheostomy tube to maintain the patient’s airway.

Question 39

A patient with a tracheostomy is to use a fenestrated tracheostomy tube to provide for speech. What is it important that the nurse do?

a. Place the decannulation cap in the tube before cuff deflation.
b. Assess the patient’s ability to swallow without risk of aspiration.
c. Remove the inner cannula of the tracheostomy tube after deflating the cuff.
d. Connect oxygen at 4 to 6 L/min to the second pigtail tubing of the tracheostomy tube.

Answer 39

ANS: B
Because the cuff is deflated when using a fenestrated tube, the patient’s risk for aspiration should be assessed before changing to a fenestrated tracheostomy tube.

Question 40

When inflating the cuff on a tracheostomy tube to the appropriate level, the best nursing action will be which of the following?

a. Use a manometer to ensure cuff pressure is at an appropriate level.
b. Verify the health care provider’s order for the amount of cuff pressure required.
c. Fill the balloon until no leakage around the cuff is auscultated.
d. Check the pilot balloon after inflation to ensure that it is firm.

Answer 40

ANS: A
Cuff inflation pressure should not exceed 20 mm Hg or 25 cm H2O because higher pressures may compress tracheal capillaries, limit blood flow, and predispose to tracheal necrosis.

Question 41

A patient is discharged from the hospital with a tracheostomy tube for long-term airway management. Which of the following responses by the patient helps the nurse determine that teaching related to care of the tracheostomy has been effective?

a. “I must use sterile gloves and catheters to suction my tracheostomy.”
b. “I should maintain a liquid diet as long as I have the tracheostomy tube in place.”
c. “I will be changing my tracheostomy tube at home about once a month.”
d. “If I have thick mucus, I can instill about a teaspoon of tap water into my tracheostomy tube.”

Answer 41

ANS: C
It takes several months for the formation of a fully healed tract, so the patient is taught that after the initial tube change the tracheostomy is to be changed once a month. Clean technique is used to suction a tracheostomy in the home environment, not sterile technique. A liquid diet is not required when a patient has a tracheostomy; many people live with a permanent tracheostomy and consume a normal diet. Tap water should not be inserted into a tracheostomy tube; if secretions are thick provide humidification and hydration.

Question 42

A patient with laryngeal cancer has received teaching about radiation therapy. Which statement by the patient indicates that the teaching has been effective?

a. “I will need to buy a water bottle to carry with me.”
b. “Until the radiation is complete, I may have diarrhea.”
c. “Alcohol-based mouthwashes will help clean oral ulcers.”
d. “I can use lotions to moisturize the skin on my throat.”

Answer 42

ANS: A

Xerostomia can be partially alleviated by drinking fluids at frequent intervals.

Question 43

When obtaining a health history from a patient with hoarseness and tightness in his throat, the nurse should specifically ask the patient about which of the following information?

a. Alcohol and tobacco use
b. The presence of dentures
c. A history of allergic rhinitis
d. A history of streptococcal pharyngitis

Answer 43

ANS: A
Prolonged alcohol use is associated with the development of laryngeal cancer, which the patient’s symptoms and history suggest.

Question 44

A patient scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx asks the nurse how the surgery will affect his throat. What is the best response?

a. “You will breathe through a permanent opening in your neck, and you will not be able to speak.”
b. “You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration.”
c. “You won’t be able to speak as you used to, but a lot of artificial voice devices are available that will give you the ability to speak normally.”
d. “You will have a tube into your trachea through which you will breathe, but you will be able to speak when the stoma heals and the tube is removed.”

Answer 44

ANS: B
Voice rehabilitation is planned after a total laryngectomy, and a variety of assistive devices are available to restore communication.

Question 45

A patient returns from surgery with a cuffed, single-cannula tracheostomy tube after a total laryngectomy and radical neck dissection. In planning tracheostomy care for the patient during the first 24 hours after surgery, what is the priority nursing intervention?

a. The tracheostomy ties should not be changed.
b. The tracheostomy dressings should not be changed.
c. The patient should be encouraged to assist in the procedure.
d. Assess the airway and breath sounds.

Answer 45

ANS: D
The most important goals post-tracheotomy are to maintain the airway and ensure adequate oxygenation. Assessment of the airway and breath sounds is the priority action.

Question 46

On entering the room of the patient who has just returned from surgery for a total laryngectomy and radical neck dissection, the nurse recognizes a need for intervention upon making which one of the following observations?

a. The gastrostomy tube is clamped.
b. The patient is coughing blood-tinged secretions from the tracheostomy.
c. The patient is positioned in a lateral position with the head of the bed flat.
d. There are 200 mL of serosanguineous drainage in the patient’s portable drainage device.

Answer 46

ANS: C

The nurse should elevate the head of the bed to maximize lung expansion and enable an effective cough.

Question 47

In which position should the nurse position the patient before commencing tracheostomy care?

a. Prone position
b. Supine position
c. Semi-Fowler’s position
d. High-Fowler’s position

Answer 47

ANS: C

Patients should be positioned in a semi-Fowler’s position before commencing tracheostomy care.

Question 48

After completing discharge instructions for a patient with a total laryngectomy, the nurse determines that additional instruction is needed when the patient makes which of the following responses?

a. “I must keep the stoma covered with a dressing at all times.”
b. “I can participate in most of my prior fitness activities except swimming.”
c. “I need to eat nutritious meals even though I can’t smell or taste very well.”
d. “I should wear a MedicAlert bracelet that identifies me as a neck breather.”

Answer 48

ANS: A

The stoma may be covered with clothing or a loose dressing, but this is not essential.

Question 49

Following assessment of a patient with pneumonia, the nurse documents a nursing diagnosis of ineffective airway clearance. On which of the following data would the nurse base this nursing diagnosis?

a. SpO2 of 85%
b. Respiratory rate of 28 breaths/min
c. Presence of greenish sputum
d. Weak, nonproductive cough

Answer 49

ANS: D

The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively.

Question 50

A 56-year-old normally healthy patient at the clinic is diagnosed with community-acquired pneumonia. The nurse anticipates that empirical treatment of the patient could include the administration of which of the following medications?

a. Ciprofloxacin (Cipro)
b. Azithromycin (Zithromax)
c. Trimethoprim–sulfamethoxazole (Bactrim)
d. A second- or third-generation cephalosporin

Answer 50

ANS: B
Early initiation of appropriate antibiotic therapy has been demonstrated to reduce mortality. The treatment of choice is a macrolide (erythromycin, azithromycin, or clarithromycin).

Question 51

During assessment of the chest in a patient with pneumococcal pneumonia, what would the nurse expect to find?

a. Hyperresonance on percussion
b. Increased tactile fremitus on palpation
c. Fine crackles in all lobes on auscultation
d. Asymmetrical chest expansion on inspection

Answer 51

ANS: B
Pneumonias caused by Streptococcus pneumoniae are typically lobar or segmental. The nurse would expect to find increased tactile fremitus over the affected area of the lungs. The area would be dull to percussion.

Question 52

To promote airway clearance in a patient with pleurisy, what should the nurse instruct the patient to do?

a. Splint the chest when coughing.
b. Maintain a semi-Fowler’s position.
c. Wear the nasal oxygen cannula at all times.
d. Use relaxation techniques to reduce anxiety.

Answer 52

ANS: A

Coughing is less painful and more likely to be effective when the patient splints the chest during coughing.

Question 53

Four days after admission, a patient with chronic obstructive lung disease is diagnosed with hospital-acquired pneumonia (HAP). Which of the following organisms does the nurse recognize is a common cause of this type of pneumonia?

a. Pneumocystis carinii
b. Haemophilus influenzae
c. Pseudomonas aeruginosa
d. Mycoplasma pneumoniae

Answer 53

ANS: C
Bacteria are responsible for the majority of HAP infections, including Pseudomonas, Enterobacter, Staphylococcus aureus, methicillin-resistant S. aureus, and S. pneumoniae.

Question 54

The nurse is preparing a patient with a diagnosis of bronchiectasis for chest physiotherapy with postural drainage. Which one of the following will the nurse implement?

a. Position the patient supine.
b. Elevate the head of the bed by 20 cm.
c. Elevate the foot of the bed by 10 to 15 cm.
d. Ensure the patient is in the left lateral position for the first part of the chest physiotherapy.

Answer 54

ANS: C
Chest physiotherapy with postural drainage should be done on affected parts of the lung; elevate the foot of the bed 10 to 15 cm, to facilitate drainage.

Question 55

During assessment of the patient with pneumonia, what does the nurse understand about the disease?

a. All patients with pneumonia will have a productive cough.
b. Manifestations of pneumonia vary, depending on the causative organism.
c. The typical pneumonia symptoms are usually caused by M. pneumoniae.
d. The pathophysiology of the disease is the same, regardless of the causative microorganism.

Answer 55

ANS: B

Manifestations of pneumonia vary according to their causative agent.

Question 56

Following discharge teaching, the nurse evaluates that the patient with pneumonia understands measures to prevent a relapse of the pneumonia when the patient gives which of the following responses?

a. “I will increase my food intake to 2400 calories a day.”
b. “I must use home oxygen therapy for 3 months.”
c. “I will seek medical treatment for any upper respiratory infections.”
d. “I should continue to do deep breathing and coughing exercises for at least 6 weeks.”

Answer 56

ANS: D
Patients at risk for recurrent pneumonia should use the incentive spirometer or do deep breathing and coughing exercises or both for 6 to 8 weeks after discharge.

Question 57

To protect susceptible patients in the hospital from aspiration pneumonia, what must the nurse do?

a. Turn and reposition immobile patients every 2 hours.
b. Position patients with altered consciousness in a lateral position.
c. Monitor for respiratory symptoms in those patients who are immunosuppressed.
d. Plan room assignments to prevent infected patients from placement with surgical patients.

Answer 57

ANS: B
The risk for aspiration is decreased when patients with a decreased level of consciousness are placed in a side-lying or upright position.

Question 58

Which of the following is a general term used for lung diseases caused by the inhalation and retention of dust particles?

a. Berylliosis
b. Byssinosis
c. Paraneoplastic syndrome
d. Pneumoconiosis

Answer 58

ANS: D

Pneumoconiosis is a general term for lung diseases caused by the inhalation and retention of dust particles.

Question 59

What should the nurse teach patients at risk for pneumonia to obtain?

a. Staphylococcal vaccine
b. Measles, mumps, rubella (MMR) vaccine
c. Pneumococcal vaccine
d. Bacille Calmette-Guérin (BCG) vaccine

Answer 59

ANS: C
Individuals at risk for pneumonia (e.g., the chronically ill, older adults) should be encouraged to obtain both influenza and pneumococcal vaccines. This is particularly important because the rate of drug-resistant S. pneumoniae infections is increasing. Pneumococcal vaccine can be given simultaneously with other vaccines, such as the flu vaccine, but each should be administered in a separate site.

Question 60

A hospitalized patient who may have tuberculosis (TB) has an order for a sputum specimen. When will be the best time for the nurse to collect the specimen?

a. After the patient rinses the mouth with mouthwash
b. As soon as the order is received from the physician
c. Right after the patient gets up in the morning
d. After the skin test is administered

Answer 60

ANS: C
If the patient has a productive cough, an early-morning sputum specimen will be required for an acid-fast bacilli (AFB) smear, to detect the presence of mycobacteria.

Question 61

A patient has just been started on chemotherapy for TB. What should the nurse tell the patient regarding how long the disease can be transmitted to others?

a. Until the night sweats have subsided
b. Until three AFB smears are negative
c. Until the medications have been taken for 6 months
d. Until sputum cultures on 3 consecutive days are negative

Answer 61

ANS: B

The patient is considered infectious until three sputum smears are negative for AFB.

Question 62

The nurse recognizes that the goals of teaching regarding the transmission of TB have been met when the patient with TB carries out which of the following actions?

a. Wears a mask when in contact with others
b. Reports daily to the public health department
c. Boils dishes and personal items between uses
d. Covers the mouth and nose when coughing or sneezing

Answer 62

ANS: D
Covering the mouth and nose will help decrease airborne transmission of TB. The other actions will not be effective in decreasing the spread of TB.

Question 63

A patient is receiving isoniazid (INH) after having a positive tuberculin skin test. Which information will the nurse include in the patient teaching plan?

a. “Take vitamin B6 daily to prevent peripheral nerve damage.”
b. “Read a newspaper daily to check for changes in vision.”
c. “Schedule an audiometric examination to monitor for hearing loss.”
d. “Avoid wearing soft contact lenses to avoid orange staining.”

Answer 63

ANS: A

Peripheral neurotoxicity associated with this drug can be prevented by taking vitamin B6 when being treated with INH.

Question 64

A patient diagnosed with TB is started on initial drug therapy. Which of the following medications should the nurse plan to teach the patient about the uses and effects of?

a. INH, rifampin, and ethambutol
b. INH, pyrazinamide, and streptomycin
c. INH, rifampin, pyrazinamide, streptomycin, and ethambutol
d. Para-aminosalicylic acid, ethambutol, rifampin, and pyrazinamide

Answer 64

ANS: C

The five primary drugs used are INH, rifampin, pyrazinamide, streptomycin, and ethambutol.

Question 65

A homeless patient with alcoholism is diagnosed with active TB. Which nursing intervention will be most effective in ensuring adherence to the treatment regimen?

a. Giving the patient written instructions about how to take the medications
b. Teaching the patient about the high risk for infecting others unless treatment is followed
c. Arranging for a daily noontime meal at a community centre and giving the medication then
d. Educating the patient about the long-term impact of TB on health

Answer 65

ANS: C
Directly observed therapy (DOT) is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication.

Question 66

A patient being treated for TB comes to the clinic after 2 months for a follow-up visit. Sputum smears for AFB are still positive. A sputum specimen is taken for culture and to determine whether the microorganism is sensitive to the medications. What knowledge does the nurse use to question the patient regarding the treatment regimen?

a. DOT will be necessary if the patient has been noncompliant.
b. A combination product of INH, rifampin, and pyrazinamide is indicated if the patient skips doses.
c. Treatment protocols involving twice-weekly administration of the drugs are not as effective as daily administration.
d. If the drugs are causing side effects, a regimen including the administration of only INH can be substituted.

Answer 66

ANS: A
After 2 months of therapy, negative sputum smears would be expected if the TB bacillus is susceptible to the medications and if the medications have been taken correctly. The nurse will need to initiate DOT if the patient has not been consistently taking the medications.

Question 67

A staff nurse has a TB skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. The occupational health nurse will plan on teaching the staff nurse about which of the following?

a. Use and side effects of INH
b. Standard four-medication therapy for TB
c. Need for annual repeat TB skin testing
d. Recommendation guidelines for BCG vaccine

Answer 67

ANS: A

The nurse is considered to have a latent TB infection and should be treated with INH daily for 6 to 9 months.

Question 68

During intravenous (IV) administration of amphotericin B ordered for treatment of coccidioidomycosis, how can the nurse increase the patient’s tolerance of the drug?

a. Cooling the solution to 26.7°C before administration
b. Keeping the patient flat in bed for 1 hour after the infusion is completed
c. Diluting the amphotericin B in 500 mL of distilled water before administering
d. Administering diphenhydramine (Benadryl) 1 hour before the infusion

Answer 68

ANS: D
Many of the side effects of an infusion can be avoided by premedicating with an anti-inflammatory or diphenhydramine 1 hour before the infusion.

Question 69

The nurse is performing TB screening in a clinic that has many patients who have immigrated to Canada. Before doing a TB skin test on a patient, which question is most important for the nurse to ask?

a. “How long have you lived in Canada?”
b. “Do you have a family history of TB?”
c. “Have you received the BCG vaccine for TB?”
d. “Do you take any over-the-counter medications?”

Answer 69

ANS: C
Patients who have received the BCG vaccine will have a positive purified protein derivative test. Another method for screening (such as a chest X-ray) will be used in determining whether the patient has a TB infection.

Question 70

When caring for a patient who is hospitalized with active TB, the nurse observes a family member who is visiting the patient. The nurse will need to intervene if the family member does which of the following?

a. Washes the hands before entering the patient’s room
b. Puts on a surgical face mask before visiting the patient
c. Brings food from a “fast-food” restaurant to the patient
d. Hands the patient a tissue from the box at the bedside

Answer 70

ANS: B
A high-efficiency particulate-absorbing (HEPA) mask, rather than a standard surgical mask, should be used when entering the patient’s room because the HEPA mask can filter out 100% of small airborne particles.

Question 71

The occupational nurse at a manufacturing plant where there is high worker exposure to beryllium dust will monitor workers for which of the following?

a. Shortness of breath
b. Stabbing chest pain
c. Elevated temperature
d. Barrel chest

Answer 71

ANS: A
Occupational asthma refers to the development of symptoms of shortness of breath, wheezing, cough, and chest tightness as a result of exposure to fumes or dust that trigger an allergic response.

Question 72

When developing a teaching plan for a patient with a 42-pack-year history of cigarette smoking, it will be most important for the nurse to include information about which of the following?

a. Reasons for annual sputum cytology testing
b. Computed tomography screening for lung cancer
c. Erlotinib (Tarceva) therapy to prevent tumour risk
d. Options for smoking cessation

Answer 72

ANS: D
Because smoking is the major cause of lung cancer, the most important role for the nurse to educate patients about the benefits of and means of smoking cessation.

Question 73

A lobectomy is scheduled for a patient with squamous cell carcinoma of the lung. The patient tells the nurse, “I would rather have radiation than surgery.” What is the most appropriate response?

a. “Are you afraid that the surgery will be very painful?”
b. “Tell me what you know about the various treatments available.”
c. “Surgery is the treatment of choice for stage I lung cancer.”
d. “Did you have bad experiences with previous surgeries?”

Answer 73

ANS: B
More assessment of the patient’s concerns about surgery is indicated. An open-ended response will elicit the most information from the patient.

Question 74

A 52-year-old patient has a 40-pack-year history of smoking and has been diagnosed with cancer of the lung. He tells the nurse that he did not know that anything was wrong until he had a routine chest X-ray. The nurse explains that symptoms of lung cancer occur late in the disease. What is the first thing people usually notice?

a. Fatigue
b. Chest pain
c. A persistent cough
d. Shortness of breath

Answer 74

ANS: C

The first thing usually noticed with lung cancer is a persistent cough.

Question 75

In relation to lung cancer and gender, which of the following statements is true?

a. More women than men are diagnosed with lung cancer.
b. Men are more likely to develop small-cell carcinoma than women.
c. Women develop lung cancer after fewer years of smoking than men do.
d. Lung cancer incidence and deaths are increasing in men.

Answer 75

ANS: C
The accurate fact related to gender and lung cancer is that women develop lung cancer after fewer years of smoking than men do.

Question 76

A young man is admitted to the emergency department with a stab wound to the right chest. He has moderate bleeding from the site, and his vital signs show symptoms of shock. Air can be heard entering his chest with each inspiration. To decrease the possibility of a tension pneumothorax in the patient, what should the nurse do?

a. Position the patient on his injured side.
b. Administer high-flow oxygen using a nonrebreathing mask.
c. Cover the sucking chest wound with a petrolatum gauze dressing.
d. Apply a nonporous dressing taped on three sides to the chest wound.

Answer 76

ANS: D
The dressing taped on three sides will allow air to escape when intrapleural pressure increases during expiration, but it will prevent air from moving into the pleural space during inspiration.

Question 77

The physician inserts two chest tubes connected with a Y-connecter in a patient with a hemopneumothorax. When monitoring the patient after the chest tube placement, the nurse will be concerned about which of the following?

a. A large air leak in the water-seal chamber
b. 400 mL of blood in the collection chamber
c. Severe pain with each deep patient inspiration
d. Subcutaneous emphysema at the insertion site

Answer 77

ANS: B

The large amount of blood may indicate that the patient is in danger of developing hypovolemic shock.

Question 78

A patient experiences a flail chest as a result of an automobile accident. During the respiratory assessment, what would the nurse expect to find?

a. Bloody sputum
b. Laryngeal stridor
c. Deep, irregular respirations
d. Paradoxical chest movement

Answer 78

ANS: D
Paradoxical chest movement indicates that the patient may have flail chest, which will severely compromise gas exchange and can rapidly lead to hypoxemia.

Question 79

The nurse establishes the presence of a tension pneumothorax when assessment findings reveal which of the following results?

a. Decreased breath sounds on the affected side
b. Inability to auscultate tracheal breath sounds
c. A sucking sound with each patient breath
d. A shift of the point of maximal impulse to the left, with bounding pulses

Answer 79

ANS: A
Breath sounds are decreased on the affected side with tension pneumothorax because air trapped in the pleural space compresses the lung on that side.

Question 80

The nurse identifies a nursing diagnosis of ineffective airway clearance for a patient who has incisional pain, a poor cough effort, and expiratory wheezing after having a pneumonectomy. To promote airway clearance, what is the nurse’s initial action?

a. Have the patient use the incentive spirometer.
b. Medicate the patient with the ordered morphine.
c. Splint the patient’s chest during coughing.
d. Assist the patient to sit up at the bedside.

Answer 80

ANS: B
A major reason for atelectasis and poor airway clearance in patients after chest surgery is incisional pain (which increases with deep breathing and coughing), so it is important that patients be appropriately medicated so that they are able to breathe deeply and cough.

Question 81

A patient has a chest tube following a thoracotomy. Continuous bubbling in the suction-control chamber of the collection device would alert the nurse to which of the following facts?

a. An air leak may be present.
b. The lung has fully expanded.
c. The unit is functioning normally.
d. A tension pneumothorax is developing.

Answer 81

ANS: C
Continuous bubbling is expected in the suction-control chamber and indicates that the suction-control chamber is connected to suction.

Question 82

When providing preoperative instruction for a patient scheduled for a left pneumonectomy for cancer of the lung, the nurse informs the patient that postoperatively he can expect which of the following interventions?

a. To be positioned on the unaffected side
b. Chest tubes to water-seal chest drainage
c. Endotracheal intubation with mechanical ventilation
d. Frequent use of an incentive spirometer

Answer 82

ANS: D

Frequent deep breathing and coughing are needed after chest surgery to prevent atelectasis.

Question 83

A 68-year-old man has a long history of chronic obstructive pulmonary disease and is admitted to the hospital with cor pulmonale. Which clinical manifestation noted by the nurse is would indicate that the patient with a diagnosis of cor pulmonale also has heart failure?

a. Audible crackles at both lung bases
b. Peripheral edema
c. Loud murmur at the mitral area
d. High systemic blood pressure

Answer 83

ANS: B
Clinical manifestations of cor pulmonale include dyspnea, chronic productive cough, wheezing respirations, retrosternal or substernal pain, and fatigue. If heart failure accompanies cor pulmonale, additional manifestations will also be found, including peripheral edema; weight gain; distended neck veins; full, bounding pulse; and enlarged liver.

Question 84

Which of the following is an extrapulmonary cause of restrictive lung disease?

a. Kyphoscoliosis
b. Atelectasis
c. Interstitial lung disease
d. Tuberculosis

Answer 84

ANS: A
Kyphoscoliosis is an extrapulmonary cause of restrictive lung disease. The other answer choices are all intrapulmonary causes of restrictive lung disease.

Question 85

A patient with primary pulmonary hypertension (PPH) is on diuretic therapy. The nurse will evaluate that the treatment is effective in which of the following situations?

a. The patient reports decreased exertional dyspnea.
b. The blood pressure is less than 140/90 mm Hg.
c. The heart rate is between 60 and 100 beats/min.
d. The patient’s chest X-ray indicates clear lung fields.

Answer 85

ANS: A
Given that a major symptom of PPH is exertional dyspnea, an improvement in this symptom would indicate that the medication was effective.

Question 86

A patient is scheduled for a thoracentesis to obtain pleural fluid for diagnosis of a large pleural effusion. Before the procedure, the nurse will anticipate which of the following?

a. Position the patient sitting upright on the edge of the bed and leaning forward.
b. Instruct the patient about the importance of incentive spirometer use after the procedure.
c. Start a peripheral IV line to administer the necessary sedative drugs.
d. Remove the water pitcher and remind the patient not to eat or drink anything for 8 hours.

Answer 86

ANS: A
When the patient is sitting up, fluid accumulates in the pleural space at the lung bases and can be located and removed more easily. The lung will expand after the effusion is removed.

Question 87

After discharge teaching has been completed for a patient who has had a lung transplant, the nurse will evaluate that the teaching has been effective if the patient states which of the following?

a. “I will make an appointment to see the doctor every year.”
b. “I will not turn the home oxygen up higher than 2 L/min.”
c. “I will be careful to use sterile technique with my central line.”
d. “I will write down my medications and spirometry in a journal.”

Answer 87

ANS: D

After lung transplant, patients are taught to keep logs of medications, spirometry, and laboratory results.

Question 88

A patient who was admitted the previous day with pneumonia complains of a sharp pain whenever he takes a deep breath. Which action will the nurse take next?

a. Listen to the patient’s lungs.
b. Check the patient’s O2 saturation.
c. Have the patient cough forcefully.
d. Notify the patient’s health care provider.

Answer 88

ANS: A
The patient’s statement indicates that pleurisy or a pleural effusion may have developed, so the nurse will need to listen for a pleural friction rub, decreased breath sounds, or both.

Question 89

A patient with a chronic productive cough and weight loss is receiving a TB skin test and asks the nurse the reason for the test. Which response should the nurse give?

a. “The skin test will determine if you have a TB infection.”
b. “The skin test will indicate whether you have active TB.”
c. “The skin test is used to decide which antibiotic therapy will work best.”
d. “The skin test is done before notification of the public health department.”

Answer 89

ANS: A

A positive skin test will indicate whether the patient has been infected with TB.

Question 90

The nurse obtains the following information when caring for a patient receiving subcutaneous heparin injections to treat a pulmonary embolus. Which assessment information is most important to communicate to the physician?

a. The patient has many abdominal bruises.
b. The patient’s blood pressure is 90/46 mm Hg.
c. The activated partial thromboplastin time is two times the patient baseline.
d. The patient’s stool is dark green and liquid.

Answer 90

ANS: B
The low blood pressure may indicate that the patient is experiencing bleeding, a possible adverse effect of heparin therapy.

Question 91

The nurse is preparing a patient for discharge after treatment for a pulmonary embolism. The patient asks the nurse how long he will have to be on anticoagulant therapy. The nurse’s response is based on knowledge that the patient will be on this therapy for which period of time?

a. 10 days post discharge
b. 2 to 4 weeks
c. 3 to 6 months
d. 6 to 8 months

Answer 91

ANS: C

Anticoagulant therapy continues for at least 3 to 6 months for patients after having a pulmonary embolism.

Question 92

Which assessment information obtained by the nurse when caring for a patient who has just had a thoracentesis is most important to communicate to the physician?

a. Blood pressure is 150/90 mm Hg.
b. Pain level is 5 on a 10-point scale with a deep breath.
c. Oxygen saturation is 89%.
d. Respiratory rate is 24 breaths/min when lying flat.

Answer 92

ANS: C
Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 89% indicates that a complication such as pneumothorax may be occurring.

Question 93

All of the following orders are received for a patient who has just been admitted with probable bacterial pneumonia and sepsis. Which one will the nurse accomplish first?

a. Obtain blood cultures from two sites.
b. Give ciprofloxacin (Cipro) 400 mg IV.
c. Send patient to have a chest radiograph.
d. Administer an aspirin suppository.

Answer 93

ANS: A
Initiating antibiotic therapy rapidly is essential, but it is important that the cultures be obtained before antibiotic administration.

Question 94

The nurse has received a change-of-shift report about these four patients. Which one will the nurse plan to assess first?

a. A 23-year-old patient with cystic fibrosis who has pulmonary function testing scheduled in 30 minutes
b. A 35-year-old patient who was admitted the previous day with bacterial pneumonia and has a temperature of 38.5°C
c. A 46-year-old patient who is complaining of dyspnea after having a thoracentesis an hour previously
d. A 77-year-old patient with TB who has four antitubercular medications due in 15 minutes

Answer 94

ANS: C

Dyspnea after a thoracentesis may indicate a pneumothorax or hemothorax and requires immediate evaluation by the nurse.

Question 95

A patient with a deep-vein thrombophlebitis complains of sudden chest pain and difficulty breathing. The nurse finds a heart rate of 142 beats/min, blood pressure of 100/60 mm Hg, and respiration of 42 breaths/min. The nurse’s first action should be to do which of the following?

a. Elevate the head of the bed.
b. Administer the ordered pain medication.
c. Notify the patient’s health care provider.
d. Offer emotional support and reassurance.

Answer 95

ANS: A
The patient has symptoms consistent with a pulmonary embolism, so elevating the head of the bed will improve ventilation and gas exchange.

Question 96

A patient with a history of asthma is admitted to the hospital in acute respiratory distress. During assessment of the patient, the nurse would notify the physician immediately on finding which of the following assessment data?

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

Answer 96

ANS: C
Decreased breath sounds and wheezing would indicate that the patient was experiencing an asthma attack, and immediate bronchodilator treatment would be indicated.

Question 97

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

a. Ventricular dysrhythmias occur.
b. The thorax becomes hyperinflated.
c. Pulsus paradoxus is greater than 40 mm Hg.
d. Fatigue leads to increased hypercapnia and hypoxemia.

Answer 97

ANS: D
Although all of the assessment data indicate the need for rapid intervention, the fatigue and hypoxia indicate that the patient is no longer able to maintain an adequate respiratory effort and needs mechanical ventilation.

Question 98

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

a. Both drugs are bronchodilators, but the exact mechanism of action of fluticasone is not known.
b. Both the salmeterol and the fluticasone are bronchodilators but act in different ways to decrease bronchospasm.
c. The salmeterol is used to decrease the bronchospasm, and the fluticasone helps control the inflammatory response.
d. The salmeterol stimulates the bronchodilator effect of 2 receptors, and the fluticasone blocks the bronchoconstrictor effect of the parasympathetic nervous system.

Answer 98

ANS: C
Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks.

Question 99

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

a. “Use the budesonide inhaler first, wait a few minutes, then use the ciclesonide inhaler.”
b. “Using a spacer with the MDIs will improve the inhalation of the medications.”
c. “To avoid side effects, the inhalers should not be used within 1 hour of each other.”
d. “To maximize the effectiveness of the medications, inhale quickly when using the inhalers.”

Answer 99

ANS: B

More medication reaches the bronchioles when a spacer is used along with an MDI.

Question 100

Clinically significant airway obstruction develops in what percentage of smokers?

a. 5% to 10%
b. 15% to 20%
c. 25% to 30%
d. 40% to 50%

Answer 100

ANS: B

Clinically significant airway obstruction develops in 15% to 20% of smokers.

Question 101

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

a. Work of breathing
b. Fear of suffocation
c. Anxiety and restlessness
d. Side effects of medications

Answer 101

ANS: A
The activity intolerance patients with asthma experience is related to the increased effort needed to breathe when airways are inflamed and narrowed, and interventions are focused on decreasing inflammation and bronchoconstriction.

Question 102

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

a. Wheezing becomes louder.
b. The cough remains unproductive.
c. Vesicular breath sounds decrease.
d. Aerosol bronchodilators stimulate coughing.

Answer 102

ANS: A

Louder wheezes indicate that more air is moving through the airways and that the bronchodilator therapy is working.

Question 103

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

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

Answer 103

ANS: B
Salmeterol is prescribed to reduce airway inflammation. It takes several weeks for maximal effect and is not used to treat acute asthma symptoms.

Question 104

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

a. Laryngospasm
b. Pulmonary edema
c. Airway narrowing
d. Overdistension of the alveoli

Answer 104

ANS: C

The symptoms of asthma are caused by inflammation and spasm of the bronchioles, leading to airway narrowing.

Question 105

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

a. pH 7.0, PaCO2 50 mm Hg, and PaO2 74 mm Hg
b. pH 7.4, PaCO2 32 mm Hg, and PaO2 70 mm Hg
c. pH 7.36, PaCO2 40 mm Hg, and PaO2 80 mm Hg
d. pH 7.32, PaCO2 58 mm Hg, and PaO2 60 mm Hg

Answer 105

ANS: B
The initial response to hypoxemia caused by airway narrowing in a patient having an acute asthma attack is an increase in respiratory rate, which causes a drop in PaCO2.

Question 106

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

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

Answer 106

ANS: A
It is recommended that patients check peak flows when asthma symptoms or attacks occur to compare the peak flow with the baseline.

Question 107

A 32-year-old patient is seen in the clinic for dyspnea associated with the diagnosis of emphysema. The patient denies any history of smoking. The nurse will anticipate teaching the patient about which of the following?

a. 1-Antitrypsin testing
b. Use of the nicotine patch
c. Continuous pulse oximetry
d. Effects of leukotriene modifiers

Answer 107

ANS: A
When emphysema occurs in young patients, especially without a smoking history, a congenital deficiency in 1-antitrypsin should be suspected.

Question 108

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

a. Weakening of the smooth muscle lining the airways
b. Decrease in the area available for oxygen absorption
c. A reduction in the number of red blood cells available for oxygen delivery
d. Decreased production of protective respiratory secretions

Answer 108

ANS: B
Carbon monoxide is a component of tobacco smoke. Carbon monoxide has a high affinity for hemoglobin and combines with it more readily than does oxygen, thereby reducing the smoker’s oxygen-carrying capacity. Smokers inhale a lower percentage of oxygen than normal; as a result, less oxygen is available at the alveolar level.

Question 109

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

a. The patient has no dyspnea.
b. The patient’s mental status is improved.
c. The patient has effective and productive coughing.
d. The PaO2 is within the normal range for the patient.

Answer 109

ANS: C
The goal for the nursing diagnosis of ineffective airway clearance is to maintain a clear airway by coughing effectively.

Question 110

A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO2 58 mm Hg, PaCO2 55 mm Hg, and SaO2 86%. What does the nurse recognize these values as evidence of?

a. Respiratory acidosis
b. Respiratory alkalosis
c. Normal acid–base balance with hypoxemia
d. Normal acid–base balance with hypercapnia

Answer 110

ANS: A
The elevated PaCO2 and low pH indicate respiratory acidosis. The patient is hypoxemic and hypercapnic, but the pH indicates acidosis, not a normal acid–base balance.

Question 111

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

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

Answer 111

ANS: B
Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals.

Question 112

A patient is seen in the clinic with COPD. Which information given by the patient would help most in confirming a diagnosis of chronic bronchitis?

a. The patient tells the nurse about a family history of bronchitis.
b. The patient denies having any respiratory problems until the last 6 months.
c. The patient’s history indicates a 40-pack-year cigarette history.
d. The patient complains about having a productive cough all winter for the past 2 years.

Answer 112

ANS: D
A diagnosis of chronic bronchitis is based on a history of having a productive cough for at least 3 months for at least 2 consecutive years.

Question 113

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

a. Loosening secretions so that they may be coughed up more easily
b. Promoting maximal inhalation for better oxygenation of the lungs
c. Preventing bronchial collapse and air trapping in the lungs during expiration
d. Slowing the respiratory rate and giving the patient control of respiratory patterns

Answer 113

ANS: C
Pursed-lip breathing increases the airway pressure during the expiratory phase and prevents collapse of the airways, allowing for more complete exhalation.

Question 114

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

a. An SpO2 of 86%
b. Dyspnea and a respiratory rate of 32 breaths/min
c. Use of the accessory muscles of respiration
d. The presence of crackles and coarse rales in the lungs

Answer 114

ANS: A

The best data to support the diagnosis of impaired gas exchange are abnormalities in the ABGs or pulse oximetry.

Question 115

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

a. Elevated temperature
b. Complaints of chest pain
c. Jugular vein distension
d. Clubbing of the fingers

Answer 115

ANS: C

Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension.

Question 116

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

a. Avoid administration of oxygen at a rate of more than 2 L/min.
b. Minimize oxygen use to avoid oxygen dependency.
c. Administer oxygen according to the patient’s level of dyspnea.
d. Maintain the pulse oximetry level at 90% or greater.

Answer 116

ANS: D
The best way to determine the appropriate oxygen flow rate is by monitoring the patient’s oxygenation either by ABGs or pulse oximetry. An oxygen saturation of 90% indicates an adequate blood oxygen level without the danger of suppressing the respiratory drive.

Question 117

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

a. It can improve the patient’s prognosis and quality of life.
b. It is contraindicated in patients with COPD to prevent oxygen dependency.
c. It is used only for patients who have severe end-stage respiratory disease.
d. It should never be used at night because the patient cannot monitor its effect.

Answer 117

ANS: A

Research supports the use of home oxygen to improve quality of life and prognosis.

Question 118

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

a. Keep the air entrainment ports clean and unobstructed.
b. Apply an adaptor to increase humidification of the oxygen.
c. Drain moisture condensation from the oxygen tubing every hour.
d. Keep the flow rate high enough to keep the bag from collapsing during inspiration.

Answer 118

ANS: A

The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed.

Question 119

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

a. Grade 1
b. Grade 2
c. Grade 3
d. Grade 4

Answer 119

ANS: C
A patient with grade 3 dyspnea walks slower than people of the same age on the level or stops for breath while walking at his or her own pace on the level.

Question 120

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

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

Answer 120

ANS: B
The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily, with the pulse rate not to exceed 150 beats/min.

Question 121

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

a. Hopelessness related to long-term stress
b. Anticipatory grieving related to expectation of death
c. Ineffective coping related to unknown outcome of illness
d. Depression related to physical and psychological dependence

Answer 121

ANS: D
The patient’s statement about not being able to do anything for himself supports this diagnosis. Although hopelessness, anticipatory grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the patient does not mention long-term stress, death, or an unknown outcome as being concerns.

Question 122

A patient with COPD is admitted to the hospital. How can the nurse best position the patient to improve gas exchange?

a. Sitting up at the bedside in a chair and leaning slightly forward
b. Resting in bed with the head elevated to 45 to 60 degrees
c. In the Trendelenburg’s position, with several pillows behind the head
d. Resting in bed in a high-Fowler’s position with the knees flexed

Answer 122

ANS: A
Patients with COPD improve the mechanics of breathing by sitting up in the “tripod” position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation.

Question 123

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

a. 1200 mL
b. 2000 mL
c. 2500 mL
d. 3000 mL

Answer 123

ANS: D

Collaborative care for the patient with COPD includes hydration of 3 L/day.

Question 124

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

a. “I will shake the MDI to check for fullness each time before using.”
b. “I will take a slow, deep breath in after pushing down on the MDI.”
c. “I will check the MDI counter.”
d. “I will attach a spacer to the MDI to make it easier for me to use.”

Answer 124

ANS: A
Shaking the container is no longer recommended as a means of determining whether the medication needs replacement because the patient may be hearing only the propellant move in the canister when the MDI is nearly empty.

Question 125

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

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

Answer 125

ANS: B
Relaxation techniques may provide benefit in terms of relief of dyspnea for some patients, but the evidence for this is unclear. Relaxation techniques include progressive muscular relaxation; positive thinking and visualization; and use of music, yoga, massage, and humour.

Question 126

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

a. Regular administration of bronchodilators
b. Administration of continuous low-flow oxygen
c. Maintenance of prophylactic doses of antibiotics
d. Chest physiotherapy every 4 hours to mobilize secretions

Answer 126

ANS: D

Routine scheduling of airway clearance techniques is an essential intervention for patients with CF.

Question 127

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

a. Simple face mask
b. Nasal cannula
c. Partial rebreathing mask
d. Transtracheal catheter

Answer 127

ANS: B

When using nasal prongs, high-flow rates often cause dry nasal membranes and pain in the frontal sinuses.

Question 128

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

a. Whether they have considered that the patient is probably sterile
b. Whether they have thought about the patient’s ability to care for a child
c. Whether they have considered adoption as a solution to their desire to have a family
d. Whether they know that any children produced by them will have CF

Answer 128

ANS: A

Most men with CF are sterile.

Question 129

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

a. Inflammation and fibrosis of lung tissue
b. Failure of the bronchial goblet cells to produce mucus
c. Altered function of exocrine glands, with abnormally thick, viscous secretions
d. Thickening and fibrosis of the pleural linings of the lungs, causing thoracic wall changes

Answer 129

ANS: C

CF is characterized by abnormal secretions of exocrine glands, mainly of the lungs, pancreas, and sweat glands

Question 130

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

a. Intravenous methylprednisolone (Solu-Medrol) 60 mg
b. Triamcinolone (Azmacort) two puffs per MDI
c. Salmeterol 50 mcg per dry-powder inhaler (DPI)
d. Albuterol (Ventolin) 2.5 mg per nebulizer

Answer 130

ANS: D
Albuterol (Ventolin) is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

Question 131

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

a. “I will drink a lot of fluids with my meals.”
b. “I will have ice cream as a snack every day.”
c. “I should exercise for 15 minutes before meals.”
d. “I should avoid too much meat or dairy products.”

Answer 131

ANS: B
High-calorie foods such as ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods.

Question 132

When teaching the patient with COPD about exercise, which information should the nurse include?

a. “Stop exercising if you start to feel short of breath.”
b. “Use the bronchodilator before you start to exercise.”
c. “Breathe in and out through the mouth while you exercise.”
d. “Upper body exercise should be avoided to prevent dyspnea.”

Answer 132

ANS: B

Use of a bronchodilator before exercise improves airflow for some patients and is recommended.

Question 133

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

a. Spring
b. Summer
c. Fall
d. Winter

Answer 133

ANS: B
During the summer, with liquid oxygen, evaporation is accelerated and may decrease reservoir duration to less than 1 week.

Question 134

Which information given by an asthmatic patient during the admission assessment will be of most concern to the nurse?

a. The patient says that the asthma symptoms are worse every spring.
b. The patient’s only asthma medications are albuterol (Ventolin) and salmeterol.
c. The patient uses hydrocortisone (Solu-Cortef) before any aerobic exercise.
d. The patient’s heart rate increases after using the albuterol (Ventolin) inhaler.

Answer 134

ANS: B
Long-acting 2-adrenergic agonists should be used only in patients who are also using another medication for long-term control (typically an inhaled corticosteroid). Salmeterol
should not be used as the first-line therapy for long-term control.

Question 135

When taking an admission history of a patient with COPD who has new-onset wheezing and shortness of breath, the nurse will be most concerned about which information?

a. The patient has a history of pneumonia 2 years ago.
b. The patient takes propranolol (Inderal) for hypertension.
c. The patient uses acetaminophen (Tylenol) for headaches.
d. The patient has chronic inflammatory bowel disease.

Answer 135

ANS: B

-Adrenergic blockers such as propranolol can cause bronchospasm in some patients.

Question 136

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

a. Determine when the dyspnea started.
b. Obtain the forced expiratory flow rate.
c. Listen to the patient’s breath sounds.
d. Ask about inhaled corticosteroid use.

Answer 136

ANS: C
Assessment of the patient’s breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary.

Question 137

After teaching the patient with asthma about home care, the nurse will evaluate that the teaching has been successful if the patient states which of the following?

a. “I will use my corticosteroid inhaler as soon as I start to get short of breath.”
b. “I will turn the home oxygen level up only after checking with the doctor first.”
c. “My medications are working if I wake up short of breath only once during the night.”
d. “No changes in my medications are needed if my peak flow is at 80% of normal.”

Answer 137

ANS: D

Peak flows of 80% or greater indicate that the asthma is well controlled.