Module 5

Question 1

The nurse is preparing a client with a right-sided pleural effusion for a thoracentesis. Which of the following positions should the nurse position the client?

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

Answer 1

d. Sitting upright with the arms supported on an over bed table

Question 2

The nurse is caring for a client with a metabolic acidosis of unknown origin. Which of the following findings should the nurse expect based on this diagnosis? 
A.	Intercostal retractions 
B.	Kussmaul’s respirations 
C.	Low oxygen saturation (SpO2) 
D.	Decrease in venous O2 pressure

Answer 2

B. Kussmaul’s respirations

Question 3

The nurse is reviewing a client’s laboratory results and identifies which of the following values as a normal tidal volume? 
A.	100 mL 
B.	250 mL 
C.	500 mL 
D.	1000mL

Answer 3

C. 500 mL

Question 4

The nurse is caring for a client who has had an anterior packing for severe epistaxis. Which of the following nursing interventions should be included in the plan of care?
A. Educate the client to return in 3 days to have the nasal packing removed.
B. Reassure the client that the nose will look normal when the swelling subsides.
C. Instruct the client to keep the head elevated for 48 hours to minimize pain.
D. Teach the client to use nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control.

Answer 4

A. Educate the client to return in 3 days to have the nasal packing removed.

Question 5

The nurse is teaching a client with allergic rhinitis about management of the condition. Which of the following information should the nurse include in the teaching plan?
A. Over-the-counter (OTC) antihistamines cause sedation, so prescription antihistamines are usually ordered.
B. Corticosteroid nasal sprays will reduce inflammation, but systemic effects limit their use.
C. Use of oral antihistamines for a few weeks before the allergy season may prevent reactions.
D. Identification and avoidance of environmental triggers are the best ways to avoid symptoms.

Answer 5

D. Identification and avoidance of environmental triggers are the best ways to avoid symptoms.

Question 6

The nurse is providing teaching to a client who has acute viral rhinitis about management of upper respiratory infections (URI). Which of the following client statements indicate that additional teaching is needed?
A. “I can take acetaminophen to treat discomfort.”
B. “I will drink lots of juices and other fluids to stay hydrated.”
C. “I can use my nasal decongestant spray until the congestion is all gone.”
D. “I will watch for changes in nasal secretions or the sputum that I cough up.”

Answer 6

C. “I can use my nasal decongestant spray until the congestion is all gone.”

Question 7

An RN is observing a nursing student who is suctioning a hospitalized client with a tracheostomy in place. Which of the following actions by the student requires the RN to intervene?
A. The student preoxygenates the client for 1 minute before suctioning.
B. The student puts on clean gloves and uses a sterile catheter to suction.
C. The student inserts the catheter about 15 cm into the tracheostomy tube.
D. The student applies suction for 10 seconds while withdrawing the catheter.

Answer 7

B. The student puts on clean gloves and uses a sterile catheter to suction.

Question 8

The nurse is deflating the cuff of a tracheostomy tube to evaluate the client’s ability to swallow. Which of the following actions should the nurse implement?
A. Clean the inner cannula of the tracheostomy tube before deflation.
B. Deflate the cuff during the inhalation phase of the respiratory cycle.
C. Suction the client’s mouth and trachea before deflation of the cuff.
D. Insert exactly the same volume of air into the cuff during reinflation.

Answer 8

C. Suction the client’s mouth and trachea before deflation of the cuff.

Question 9

Which of the following causes is the most common cause of acute pharyngitis? 
A.	Fungal 
B.	Viral 
C.	Acute follicular 
D.	Peritonsillar

Answer 9

B. Viral

Question 10

The nurse is caring for a client with a tracheostomy who has a new prescription for a fenestrated tracheostomy tube. Which of the following actions should be included in the plan of care?
A. Leave the tracheostomy inner cannula inserted at all times.
B. Place the decannulation cap in the tube before cuff deflation.
C. Assess the ability to swallow before using the fenestrated tube.
D. Inflate the tracheostomy cuff during use of the fenestrated tube.

Answer 10

C. Assess the ability to swallow before using the fenestrated tube.

Question 11

The nurse is caring for a client with a tracheostomy tube and is inflating the cuff to the appropriate level. Which of the following actions is best for the nurse to implement?
A. Check the pilot balloon after inflation to ensure that it is firm.
B. Use a manometer to ensure cuff pressure is at an appropriate level.
C. Check the amount of cuff pressure ordered by the health care provider.
D. Fill the balloon until minimal air leakage around the cuff is auscultated.

Answer 11

B. Use a manometer to ensure cuff pressure is at an appropriate level.

Question 12

The nurse is teaching a client with laryngeal cancer about radiation therapy. Which of the following client statements indicate that the teaching has been effective?
A. “I will need to buy a water bottle to carry with me.”
B. “I should not use any lotions on my neck and throat.”
C. “Until the radiation is complete, I may have diarrhea.”
D. “Alcohol-based mouthwashes will help clean oral ulcers.”

Answer 12

A. “I will need to buy a water bottle to carry with me.”

Question 13

The nurse is obtaining a health history from a client with a 40 year, pack a day smoking history, symptoms of hoarseness and tightness in the throat, and difficulty swallowing. Which of the following questions is most important for the nurse to ask?
A. “How much alcohol do you drink in an average week?”
B. “Do you have a family history of head or neck cancer?”
C. “Have you had frequent streptococcal throat infections?”
D. “Do you use antihistamines for upper airway congestion?”

Answer 13

A. “How much alcohol do you drink in an average week?”

Question 14

The nurse is caring for a client who is scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx. The client asks the nurse, “How will I talk after the surgery?” Which of the following responses by the nurse is best?
A. “You will breathe through a permanent opening in your neck, but you will not be able to communicate orally.”
B. “You won’t be able to talk right after surgery, but you will be able to speak again after the tracheostomy tube is removed.”
C. “You won’t be able to speak as you used to, but there are artificial voice devices that will give you the ability to speak normally.”
D. “You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration.”

Answer 14

D. “You will have a permanent opening into your neck, and you will need to have rehabilitation for some type of voice restoration.”

Question 15

The nurse is caring for a client who had a total laryngectomy and has a nursing diagnosis of hopelessness related to loss of control of personal care. Which of the following information obtained by the nurse is the best indicator that the problem identified in this nursing diagnosis is resolving?
A. The client lets the spouse provide tracheostomy care.
B. The client allows the nurse to suction the tracheostomy.
C. The client asks how to clean the tracheostomy stoma and tube.
D. The client uses a communication board to request “No Visitors.”

Answer 15

C. The client asks how to clean the tracheostomy stoma and tube.

Question 16

The nurse is providing discharge instructions for a client with a total laryngectomy. Which of the following client statements indicate that additional instruction is required?
A. “I must keep the stoma covered with a loose sterile dressing at all times.”
B. “I can participate in most of my prior fitness activities except swimming.”
C. “I should wear a Medic Alert bracelet that identifies me as a neck breather.”
D. “I need to be sure that I have smoke and carbon monoxide detectors installed.”

Answer 16

A. “I must keep the stoma covered with a loose sterile dressing at all times.”

Question 17

The nurse is caring for a client who has had a total laryngectomy and radical neck dissection. During the first 24 hours after surgery, which of the following actions is priority?
A. Monitor for bleeding.
B. Assess breath sounds.
C. Clean the inner cannula every 8 hours.
D. Avoid changing the tracheostomy ties.

Answer 17

B. Assess breath sounds.

Question 18

The nurse is caring for a client with an uncuffed tracheostomy tube who coughs violently during suctioning and dislodges the tracheostomy tube. Which of the following actions should the nurse take first?
A. Insert the obturator and attempt to reinsert the tracheostomy tube.
B. Position the client in an upright position with the neck extended.
C. Assess the client’s oxygen saturation and notify the health care provider.
D. Ventilate the client with a manual bag until the health care provider arrives.

Answer 18

A. Insert the obturator and attempt to reinsert the tracheostomy tube.

Question 19

Which of the following clients in the respiratory disease clinic should the nurse assess first?
A. A 23-year-old, complaining of a sore throat, who has stridor
B. A 34-year-old who has a “scratchy throat” and a positive rapid strep antigen test
C. A 55-year-old who is receiving radiation for throat cancer and has severe fatigue
D. A 72-year-old with a history of a total laryngectomy whose stoma is red and inflamed

Answer 19

A. A 23-year-old, complaining of a sore throat, who has stridor

Question 20

Which of the following nursing actions should the nurse perform when suctioning a tracheostomy?
A. Insert tube 13–15 cm while suctioning.
B. Withdraw catheter in a straight time while applying intermittent suction.
C. Limit suction time to 10 seconds.
D. Oxygenate the client once all suctioning is completed.

Answer 20

C. Limit suction time to 10 seconds.

Question 21

The nurse is reviewing the charts for five clients who are scheduled for their yearly physical examinations in October. Which of the following clients are considered a target population for the influenza vaccination? (Select all that apply.)
A. A 72-year-old client who has diabetes
B. A 36-year-old female client who is pregnant
C. A 42-year-old client who has a 15 pack-year smoking history
D. A 30-year-old client who takes corticosteroids for rheumatoid arthritis
E. A 9-month-old client who is teething

Answer 21

A. A 72-year-old client who has diabetes
B. A 36-year-old female client who is pregnant
E. A 9-month-old client who is teething

Question 22

Following assessment of a client with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which of the following information best supports this diagnosis?
A. Weak, nonproductive cough effort
B. Large amounts of greenish sputum
C. Respiratory rate of 28 breaths/minute
D. Resting pulse oximetry (SpO2) of 85%

Answer 22

A. Weak, nonproductive cough effort

Question 23

The nurse is conducting a chest assessment on a client with pneumococcal pneumonia. Which of the following findings should the nurse expect to assess? 
A.	Vesicular breath sounds 
B.	Increased tactile fremitus 
C.	Dry, nonproductive cough 
D.	Hyper-resonance to percussion

Answer 23

B. Increased tactile fremitus

Question 24

The nurse is caring for a client with bacterial pneumonia who has pleurisy. Which of the following actions should the nurse implement to promote airway clearance?
A. Assist the client to splint the chest when coughing.
B. Educate the client about the need for fluid restrictions.
C. Encourage the client to wear the nasal oxygen cannula.
D. Instruct the client on the pursed lip breathing technique.

Answer 24

A. Assist the client to splint the chest when coughing.

Question 25

The nurse is providing teaching to a client with pneumonia. Which of the following client statements indicate a good understanding of the discharge instructions given by the nurse?
A. “I will call the doctor if I still feel tired after a week.”
B. “I will need to use home oxygen therapy for 3 months.”
C. “I will continue to do the deep-breathing and coughing exercises at home.”
D. “I will schedule two appointments for the pneumonia and influenza vaccines.”

Answer 25

C. “I will continue to do the deep-breathing and coughing exercises at home.”

Question 26

Which of the following nursing actions is most effective in preventing aspiration pneumonia in clients who are at risk?
A. Turn and reposition immobile clients at least every 2 hours.
B. Place clients with altered consciousness in side-lying positions.
C. Monitor for respiratory symptoms in clients who are immuno-suppressed.
D. Provide for continuous subglottic aspiration in clients receiving enteral feedings.

Answer 26

B. Place clients with altered consciousness in side-lying positions.

Question 27

The health care provider writes a prescription for bacteriological testing for a client who has a positive tuberculosis skin test. Which of the following actions should the nurse take?
A. Repeat the tuberculin skin testing.
B. Teach about the reason for the blood tests.
C. Obtain consecutive sputum specimens from the client for 3 days.
D. Instruct the client to expectorate three specimens as soon as possible.

Answer 27

C. Obtain consecutive sputum specimens from the client for 3 days.

Question 28

Which of the following information about a client who has a recent history of tuberculosis (TB) indicates that the nurse can discontinue airborne isolation precautions?
A. Chest x-ray shows no upper lobe infiltrates.
B. TB medications have been taken for 6 months.
C. Mantoux testing shows an induration of 10 mm.
D. Three sputum smears for acid-fast bacilli are negative.

Answer 28

D. Three sputum smears for acid-fast bacilli are negative.

Question 29

Which of the following information should the nurse include in the teaching plan for a client who is receiving rifampin for treatment of tuberculosis?
A. “Your urine, sweat, and tears will be orange coloured.”
B. “Read a newspaper daily to check for changes in vision.”
C. “Take vitamin B6 daily to prevent peripheral nerve damage.”
D. “Call the health care provider if you notice any hearing loss.”

Answer 29

A. “Your urine, sweat, and tears will be orange coloured.”

Question 30

The nurse is teaching a client who is receiving standard multidrug therapy for tuberculosis (TB) about possible toxic effects of the antitubercular medications. Which of the following findings should the nurse instruct the client to report to the health care provider? 
A.	Yellow-tinged skin 
B.	Changes in hearing 
C.	Orange-coloured sputum 
D.	Thickening of the fingernails

Answer 30

A. Yellow-tinged skin

Question 31

The nurse is caring for clients with active tuberculosis (TB) who misuse alcohol and/or are homeless. Which of the following interventions by the nurse will be most effective in ensuring adherence with the treatment regimen?
A. Educating the client about the long-term impact of TB on health
B. Giving the client written instructions about how to take the medications
C. Teaching the client about the high risk for infecting others unless treatment is followed
D. Arranging for a daily noontime meal at a community centre and giving the medication then

Answer 31

D. Arranging for a daily noontime meal at a community centre and giving the medication then

Question 32

After 2 months of tuberculosis (TB) treatment with a standard four-drug regimen, a client continues to have positive sputum smears for acid-fast bacilli (AFB). Which of the following actions should the nurse take next?
A. Ask the client whether medications have been taken as directed.
B. Discuss the need to use some different medications to treat the TB.
C. Schedule the client for directly observed therapy three times weekly.
D. Educate about using a 2-drug regimen for the last 4 months of treatment.

Answer 32

A. Ask the client whether medications have been taken as directed.

Question 33

A staff nurse has a tuberculosis (TB) skin test of 16-mm induration. A chest radiograph is negative, and the nurse has no symptoms of TB. Which of the following information should the occupational health nurse provide to the staff nurse?
A. Use and adverse effects of isoniazid (INH)
B. Standard four-drug therapy for TB
C. Need for annual repeat TB skin testing
D. Bacille Calmette–Guérin (BCG) vaccine

Answer 33

A. Use and adverse effects of isoniazid (INH)

Question 34

a lobectomy. The client tells the nurse, “I would rather have radiation than surgery.” Which of the following responses by the nurse is best?
A. “Are you afraid that the surgery will be very painful?”
B. “Did you have bad experiences with previous surgeries?”
C. “Surgery is the treatment of choice for stage I lung cancer.”
D. “Tell me what you know about the various treatments available.”

Answer 34

D. “Tell me what you know about the various treatments available.”

Question 35

The nurse is caring for a client who had a thoracotomy 1 hour ago and reports incisional pain at a level 7 out of 10 and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak. Which of the following actions is best for the nurse to take next?
A. Administer the prescribed PRN morphine.
B. Assist the client to deep breathe and cough.
C. Milk the chest tube gently to remove any clots.
D. Tape the area around the insertion site of the chest tube.

Answer 35

A. Administer the prescribed PRN morphine.

Question 36

The health care provider inserts a chest tube in a client with a hemo-pneumothorax. When monitoring the client after the chest tube placement, which of the following findings is of greatest concern?
A. A large air leak in the water-seal chamber
B. 400 mL of blood in the collection chamber
C. Complaint of pain with each deep inspiration
D. Subcutaneous emphysema at the insertion site

Answer 36

B. 400 mL of blood in the collection chamber

Question 37

The nurse is caring for a client who has a steering wheel injury as a result of an automobile accident. Which of the following findings should be of most concern to the nurse during the initial assessment? 
A.	Paradoxical chest movement 
B.	The complaint of chest wall pain 
C.	A heart rate of 110 beats/minute 
D.	A large bruised area on the chest

Answer 37

A. Paradoxical chest movement

Question 38

The nurse is assessing a client who has just arrived after an automobile accident and the nurse notes that the breath sounds are absent on the right side. Which of the following actions should the nurse anticipate?
A. Emergency pericardiocentesis
B. Stabilization of the chest wall with tape
C. Administration of an inhaled bronchodilator
D. Insertion of a chest tube with a chest drainage system

Answer 38

D. Insertion of a chest tube with a chest drainage system

Question 39

The nurse is caring for a client who has a right-sided chest tube following a thoracotomy and has continuous bubbling in the suction-control chamber of the collection device. Which of the following actions should the nurse implement?
A. Document the presence of a large air leak
B. Obtain and attach a new collection device
C. Notify the surgeon of a possible pneumothorax
D. Take no further action with the collection device

Answer 39

D. Take no further action with the collection device

Question 40

The nurse is providing preoperative instruction for a client who is scheduled for a left pneumonectomy for cancer of the lung. Which of the following information should the nurse include related to postoperative care?
A. Positioning on the right side
B. Bed rest for the first 24 hours
C. Frequent use of an incentive spirometer
D. Chest tubes to water-seal chest drainage

Answer 40

C. Frequent use of an incentive spirometer

Question 41

right-sided heart failure, which of the following assessments should the nurse make? 
A.	Lung sounds 
B.	Heart sounds 
C.	Blood pressure 
D.	Peripheral edema

Answer 41

D. Peripheral edema

Question 42

The nurse is caring for a client with primary pulmonary hypertension (PPH) who is receiving nifedipine. Which of the following findings indicate that the treatment is effective?
A. BP is less than 140/90 mm Hg
B. Client reports decreased exertional dyspnea
C. Heart rate is between 60 and 100 beats/minute
D. Client’s chest x-ray indicates clear lung fields

Answer 42

B. Client reports decreased exertional dyspnea

Question 43

The nurse is caring for a client with a pleural effusion who is scheduled for a thoracentesis. Which of the following actions should the nurse implement prior to the procedure?
A. Start a peripheral intravenous line to administer the necessary sedative drugs.
B. Position the client sitting upright on the edge of the bed and leaning forward.
C. Remove the water pitcher and remind the client not to eat or drink anything for 6 hours.
D. Instruct the client about the importance of incentive spirometer use after the procedure.

Answer 43

B. Position the client sitting upright on the edge of the bed and leaning forward.

Question 44

The nurse has completed discharge teaching for a client who has had a lung transplant. Which of the following client statements indicate that the teaching was effective?
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/minute.”
C. “I will not worry if I feel a little short of breath with exercise.”
D. “I will call the health care provider right away if I develop a fever.”

Answer 44

D. “I will call the health care provider right away if I develop a fever.”

Question 45

Which of the following prescriptions should the nurse implement first for a client who has just been admitted with probable bacterial pneumonia and sepsis? 
A.	Administer Aspirin suppository. 
B.	Send to radiology for chest x-ray. 
C.	Give ciprofloxacin 400 mg IV . 
D.	Obtain blood cultures from two sites

Answer 45

D. Obtain blood cultures from two sites

Question 46

The nurse is caring for a client who has just had a thoracentesis. Which of the following information is most important to communicate to the health care provider?
A. BP is 150/90 mm Hg.
B. Oxygen saturation is 89%.
C. Pain level is 5/10 with a deep breath.
D. Respiratory rate is 24 when lying flat.

Answer 46

B. Oxygen saturation is 89%.

Question 47

The nurse is caring for a client who has just been admitted with pneumococcal pneumonia has a temperature of 38.7°C (101.7°F) with a frequent cough and symptoms of severe pleuritic chest pain. Which of the following prescribed medications should the nurse give first? 
A.	Guaifenesin 
B.	Acetaminophen 
C.	Azithromycin 
D.	Codeine phosphate

Answer 47

C. Azithromycin

Question 48

Which of the following information obtained by the nurse about a client who has human immunodeficiency virus (HIV) and active tuberculosis (TB) disease is most important to communicate to the health care provider?
A. The Mantoux test had an induration of only 8 mm.
B. The chest x-ray showed infiltrates in the upper lobes.
C. The client is being treated with antiretrovirals for HIV infection.
D. The client has a cough that is productive of blood-tinged mucus.

Answer 48

C. The client is being treated with antiretrovirals for HIV infection.

Question 49

The nurse observes an unregulated care provider doing all the following activities when caring for a client with a pulmonary embolism. Which of the following actions should cause the nurse to intervene with the client’s care?
A. Lowers the head of the client’s bed to 10 degrees.
B. Splints the client’s chest during coughing.
C. Helps the client to ambulate to the bathroom.
D. Assists the client to a bedside chair for meals.

Answer 49

A. Lowers the head of the client’s bed to 10 degrees.

Question 50

The nurse is caring for a client with a possible pulmonary embolism who has symptoms of chest pain and difficulty breathing. The nurse assesses a heart rate of 142, BP 100/60 mm Hg, and respirations of 42 breaths/minute. Which of the following actions should the nurse implement first?
A. Elevate the head of the bed to 45–60 degrees.
B. Administer the ordered pain medication.
C. Notify the client’s health care provider.
D. Offer emotional support and reassurance.

Answer 50

A. Elevate the head of the bed to 45–60 degrees.

Question 51

The nurse is caring for a client with a possible pulmonary embolism who has symptoms of chest pain and difficulty breathing. The nurse assesses a heart rate of 142, BP 100/60 mm Hg, and respirations of 42 breaths/minute. Which of the following actions should the nurse implement first?
A. Elevate the head of the bed to 45–60 degrees.
B. Administer the ordered pain medication.
C. Notify the client’s health care provider.
D. Offer emotional support and reassurance.

Answer 51

A. Elevate the head of the bed to 45–60 degrees.

Question 52

After the nurse has received change-of-shift report about the following four clients, which client should be assessed first?
A. A 77-year-old client with tuberculosis (TB) who has four antitubercular medications due in 15 minutes
B. A 23-year-old client with cystic fibrosis who has pulmonary function testing scheduled
C. A 46-year-old client who has a deep vein thrombosis and is complaining of sudden onset shortness of breath.
D. A 35-year-old client who was admitted the previous day with pneumonia and has a temperature of 37.9°C (100.2°F)

Answer 52

C. A 46-year-old client who has a deep vein thrombosis and is complaining of sudden onset shortness of breath.

Question 53

The nurse is performing tuberculosis (TB) screening in a clinic that has many clients who have immigrated to Canada. Before doing a TB skin test on a client, which of the following questions is most important for the nurse to ask?
A. “Is there any family history of TB?”
B. “Have you received the bacille Calmette–Guérin (BCG) vaccine for TB?”
C. “How long have you lived in the Canada?”
D. “Do you take any over-the-counter (OTC) medications?”

Answer 53

B. “Have you received the bacille Calmette–Guérin (BCG) vaccine for TB?”

Question 54

The nurse is caring for a client in the emergency department who has an open stab wound to the right chest. Which of the following actions should the nurse implement first?
A. Position the client so that the right chest is dependent.
B. Keep the head of the client’s bed at no more than 30 degrees elevation.
C. Tape a nonporous dressing on three sides over the chest wound.
D. Cover the sucking chest wound firmly with an occlusive dressing.

Answer 54

C. Tape a nonporous dressing on three sides over the chest wound.

Question 55

The nurse is caring for a client who has incisional pain, a poor cough effort, and scattered rhonchi after a thoracotomy. Which of the following actions should the nurse take first?
A. Assist the client to sit up at the bedside.
B. Splint the client’s chest during coughing.
C. Medicate the client with the prescribed morphine.
D. Have the client use the prescribed incentive spirometer.

Answer 55

C. Medicate the client with the prescribed morphine.

Question 56

The nurse is caring for a client with primary pulmonary hypertension (PPH) who has been taking a calcium channel blocker with no effect. Which of the following medications should the nurse expect that the client will receive next?
A.	Nifedipine 
B.	Diltiazem
C.	Iloprost 
D.	Bosentan

Answer 56

C. Iloprost

Question 57

The nurse is caring for a client with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the client asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse’s response?
A. One drug decreases inflammation, and the other is a bronchodilator.
B. It is a combination of long-acting and slow-acting bronchodilators.
C. The combination of two drugs works more quickly in an acute asthma attack.
D. The two drugs work together to block the effects of histamine on the bronchioles.

Answer 57

A. One drug decreases inflammation, and the other is a bronchodilator.

Question 58

The nurse has completed client teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the client indicates good understanding of the teaching?
A. The client attaches a spacer before using the MDI.
B. The client coughs vigorously after using the inhaler.
C. The client floats the MDI in water to see if it is empty.
D. The client activates the inhaler at the onset of expiration.

Answer 58

A. The client attaches a spacer before using the MDI.

Question 59

The nurse is preparing a client with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?
A. Avoid eating or drinking for several hours before the testing.
B. Use rescue medications immediately before the tests are done.
C. Take oral corticosteroids at least 2 hours before the examination.
D. Withhold bronchodilators for 6–12 hours before the examination.

Answer 59

D. Withhold bronchodilators for 6–12 hours before the examination.

Question 60

Which of the following information should the nurse include when teaching the client with asthma about the prescribed medications?
A. Utilize 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 adverse effect of rapidly acting bronchodilators.

Answer 60

D. Tremors are an expected adverse effect of rapidly acting bronchodilators.

Question 61

The nurse is evaluating the effectiveness of therapy for a client who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective?
A. No wheezes are audible.
B. Oxygen saturation is >92%.
C. Accessory muscle use has decreased.
D. Respiratory rate is 16 breaths/minute.

Answer 61

B. Oxygen saturation is >92%.

Question 62

The nurse is assessing a client in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take?
A. Teach the client about the use of oral corticosteroids.
B. Administer a bronchodilator and recheck the peak flow.
C. Instruct the client to continue to use current medications.
D. Evaluate whether the peak flow meter is being used correctly.

Answer 62

C. Instruct the client to continue to use current medications.

Question 63

Which of the following actions by a client who has asthma indicates a good understanding of the nurse’s teaching about peak flow meter use?
A. The client records an average of three peak flow readings every day.
B. The client inhales rapidly through the peak flow meter mouthpiece.
C. The client uses the albuterol metered-dose inhaler (MDI) for peak flows in the yellow zone.
D. The client calls the health care provider when the peak flow is in the green zone.

Answer 63

C. The client uses the albuterol metered-dose inhaler (MDI) for peak flows in the yellow zone.

Question 64

The nurse is assessing a young adult client in the outpatient clinic who has a new diagnosis of emphysema and does not have a history of smoking. Which of the following information should the nurse anticipate teaching the client about?
A.	a1-antitrypsin testing 
B.	Use of the nicotine patch 
C.	Continuous pulse oximetry 
D.	Effects of leukotriene modifiers

Answer 64

A. a1-antitrypsin testing

Question 65

Which of the following information about a newly admitted client with chronic obstructive pulmonary disease (COPD) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline?
A. The client has had a recent 10-pound weight gain.
B. The client has a cough productive of green mucus.
C. The client denies any shortness of breath at present.
D. The client takes cimetidine 150 mg daily

Answer 65

D. The client takes cimetidine 150 mg daily

Question 66

The nurse is caring for a client with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best 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 client.
C. Suggest the use of over-the-counter sedative medications.
D. Teach the client how to effectively use pursed lip breathing.

Answer 66

D. Teach the client how to effectively use pursed lip breathing.

Question 67

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem?
A. Increase the client’s intake of fruits and fruit juices.
B. Have the client exercise for 10 minutes before meals.
C. Assist the client in choosing foods with a lot of texture.
D. Offer high calorie snacks between meals and at bedtime.

Answer 67

D. Offer high calorie snacks between meals and at bedtime.

Question 68

The nurse is interviewing a client with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
A. The client tells the nurse about a family history of bronchitis.
B. The client’s history indicates a 40 pack-year cigarette history.
C. The client denies having any respiratory problems until the last 6 months.
D. The client complains about a productive cough every winter for 3 months.

Answer 68

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

Question 69

After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicate that more teaching is needed?
A. The client inhales slowly through the nose.
B. The client tenses the neck muscles while exhaling.
C. The client practises by blowing through a straw.
D. The client’s ratio of inhalation to exhalation is 1:3.

Answer 69

B. The client tenses the neck muscles while exhaling.

Question 70

Which of the following findings by the nurse for a client with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? 
A.	Pulse oximetry reading of 91% 
B.	Absence of wheezes or crackles 
C.	Decreased use of accessory muscles 
D. Respiratory rate of 22 breaths/min

Answer 70

A. Pulse oximetry reading of 91%

Question 71

The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client? 
A.	Elevated temperature 
B.	Clubbing of the fingers 
C.	Jugular vein distension 
D.	Complaints of chest pain

Answer 71

C. Jugular vein distension

Question 72

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement 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 client’s level of dyspnea.
D. Avoid administration of oxygen at a rate of more than 2 L/minute

Answer 72

B. Maintain the pulse oximetry level at 90% or greater.

Question 73

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement 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 client’s level of dyspnea.
D. Avoid administration of oxygen at a rate of more than 2 L/minute.

Answer 73

B. Maintain the pulse oximetry level at 90% or greater.

Question 74

The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions?
A. Keep the air entrainment ports clean and unobstructed.
B. Give a high enough flow rate to keep the bag from collapsing.
C. Use an appropriate adaptor to ensure adequate oxygen delivery.
D. Drain moisture condensation from the oxygen tubing every hour.

Answer 74

A. Keep the air entrainment ports clean and unobstructed.

Question 75

Which of the following information should the nurse teach a client with COPD?
A. To exercise immediately before a meal.
B. To eat a high-calorie, low-protein diet.
C. To have 5 or 6 small meals a day.
D. Avoid foods that are cooked in a microwave.

Answer 75

C. To have 5 or 6 small meals a day.

Question 76

The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old client with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the client?
A. Walk until pulse rate exceeds 130.
B. Walk for a total of 20 minutes daily.
C. Exercise until shortness of breath occurs.
D. Limit exercise to activities of daily living (ADLs).

Answer 76

B. Walk for a total of 20 minutes daily.

Question 77

The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who tells the nurse, “I wish I were dead! I cannot do anything for myself anymore.” Based on this information, which of the following nursing diagnoses is best?
A. Hopelessness related to chronic stress (expectation of death)
B. Ineffective coping related to insufficient sense of control
C. Deficient knowledge related insufficient information (education about COPD)
D. Social isolation related to insufficient personal resources (increased physical dependence)

Answer 77

D. Social isolation related to insufficient personal resources (increased physical dependence)

Question 78

The nurse is caring for a client who is hospitalized with cystic fibrosis (CF) and is coughing up large quantities of thick green mucus. Which of the following treatments should the nurse include in the teaching plan? 
A.	Antibiotic resistance 
B.	Inhaled bronchodilators 
C.	Oral corticosteroid therapy 
D.	Aerosolized amoxicillin

Answer 78

D. Aerosolized amoxicillin

Question 79

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which of the following nursing actions is best?
A. Change the oxygen flow rate to the highest prescribed rate.
B. Reinforce the ongoing use of pursed lip breathing techniques.
C. Educate the client to use the Flutter airway clearance device.
D. Teach the client about consistent use of inhaled corticosteroids.

Answer 79

C. Educate the client to use the Flutter airway clearance device.

Question 80

Which of the following information given by a client with asthma while the nurse is doing the admission assessment is most indicative of a need for a change in therapy?
A. The client uses terbutaline before any aerobic exercise.
B. The client says that the asthma symptoms are worse every spring.
C. The client’s heart rate increases after using the salbutamol inhaler.
D. The client’s only medications are formoterol and salmeterol.

Answer 80

D. The client’s only medications are formoterol and salmeterol.

Question 81

The nurse is conducting an admission history for a client with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
A. The client has a history of pneumonia 2 years ago.
B. The client has chronic inflammatory bowel disease.
C. The client takes propranolol for hypertension.
D. The client uses acetaminophen for headaches.

Answer 81

C. The client takes propranolol for hypertension.

Question 82

The nurse is caring for a client with cystic fibrosis (CF) who has blood glucose levels that are consistently 11–14 mmol/L. Which of the following nursing actions should the nurse plan to implement?
A. Discuss the role of diet in blood glucose control.
B. Educate the client about administration of insulin.
C. Give oral hypoglycemic medications before meals.
D. Evaluate the client’s home use of pancreatic enzymes.

Answer 82

B. Educate the client about administration of insulin.

Question 83

assessments finding should the nurse communicate immediately to the health care provider?
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 mL/minute

Answer 83

C. Use of accessory muscles in breathing

Question 84

Which of the following actions should the nurse anticipate taking first when a client who is experiencing an asthma attack develops bradycardia and a decrease in wheezing?
A. Assist with endotracheal intubation.
B. Document changes in respiratory status.
C. Encourage the client to cough and deep breathe.
D. Administer IV methylprednisolone.

Answer 84

A. Assist with endotracheal intubation

Question 85

The nurse is caring for a client in the emergency department who is experiencing an acute asthma attack. After listening to the client’s breath sounds, which of the following actions should the nurse take next?
A. Start an intravenous with Ringer’s Lactate.
B. Ask about inhaled corticosteroid use.
C. Determine when the dyspnea started.
D. Obtain the forced expiratory volume (FEV) flow rate.

Answer 85

D. Obtain the forced expiratory volume (FEV) flow rate.

Question 86

The nurse in the emergency department receives arterial blood gas results for four recently admitted clients with asthma. Which of the following clients require the most rapid action by the nurse?
A. 20-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg
B. 32-year-old with ABG results: pH 7.50, PaCO2 30 mm Hg, and PaO2 65 mm Hg
C. 40-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg
D. 64-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

Answer 86

A. 20-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

Question 87

The nurse is teaching a client about continuous home oxygen use and cautions the client to take extra care to not run out of oxygen. Which of the following seasons should the nurse instruct the client has the highest rate of oxygen evaporation?
A.	Spring 
B.	Summer 
C.	Fall
D.	Winter

Answer 87

B. Summer

Question 88

The nurse is caring for a client with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
A. Tell the client to go to the hospital emergency department.
B. Instruct the client to use the prescribed albuterol.
C. Ask about recent exposure to any new allergens or asthma triggers.
D. Question the client about use of the prescribed inhaled corticosteroids.

Answer 88

B. Instruct the client to use the prescribed albuterol.

Question 89

The nurse has received a change-of-shift report about the following clients with chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first?
A. A client with a respiratory rate of 38
B. A client with loud expiratory wheezes
C. A client with jugular vein distension and peripheral edema
D. A client who has a cough productive of thick, green mucus

Answer 89

A. A client with a respiratory rate of 38

Question 90

When assessing a patient’s lungs, the nurse recognizes that the left lung:
A. Consists of two lobes.
B. Is divided by the horizontal fissure.
C. Primarily consists of an upper lobe on the posterior chest.
D. Is shorter than the right lung because of the underlying stomach.

Answer 90

A. Consists of two lobes.

Question 91

The nurse landmarks the apices of the lungs to:
A. Be at the level of the second rib anteriorly.
B. Extend 3 to 4 cm above the inner third of the clavicles.
C. Be located at the sixth rib anteriorly and the eighth rib laterally.
D. Rest on the diaphragm at the fifth intercostal space in the midclavicular line (MCL).

Answer 91

B. Extend 3 to 4 cm above the inner third of the clavicles.

Question 92

During an assessment, the nurse knows that expected assessment findings in the normal adult lung include the presence of:
A. Adventitious sounds and limited chest expansion.
B. Increased tactile fremitus and dull percussion tones.
C. Muffled voice sounds and symmetrical tactile fremitus.
D. Absent voice sounds and hyper-resonant percussion tones.

Answer 92

C. Muffled voice sounds and symmetrical tactile fremitus.

Question 93

The primary respiratory muscles engaged in normal inspiration include the:
A. Diaphragm and intercostals.
B. Sternomastoid and scalene.
C. Trapezius and rectus abdominis.
D. d. External obliques and pectoralis maj

Answer 93

A. Diaphragm and intercostals.

Question 94

During assessment of the patient’s posterior chest for lung sounds, the nurse will auscultate the right lung for the:
A. Apex of the lung.
B. Upper and lower lobes.
C. Lower lobe, because the upper lobe is too small.
D. Upper, middle, and lower lobes.

Answer 94

B. Upper and lower lobes.

Question 95

A 65-year-old patient with a history of heart failure comes to the clinic with complaints of “being awakened from sleep with shortness of breath.” Which action by the nurse is most appropriate?
A. Obtain a detailed health history of the patient’s allergies and a history of asthma
B. Recommend that the patient sleep on his or her right side to facilitate ease of respirations
C. Assess for other signs and symptoms of paroxysmal nocturnal dyspnea
D. Assure the patient that paroxysmal nocturnal dyspnea is normal and will probably resolve within the next week

Answer 95

C. Assess for other signs and symptoms of paroxysmal nocturnal dyspnea

Question 96

When assessing tactile fremitus, the nurse normally feel tactile fremitus most intensely:
A. Between the scapulae.
B. Third intercostal space, MCL.
C. Fifth intercostal space, midaxillary line (MAL).
D. Over the lower lobes, posterior side.

Answer 96

A. Between the scapulae.

Question 97

The nurse is reviewing the technique of palpating for tactile fremitus with a new graduate. Which statement by the graduate nurse reflects a correct understanding of tactile fremitus? “Tactile fremitus”:
A. “Is caused by moisture in the alveoli.”
B. “Indicates that air is present in the subcutaneous tissues.”
C. “Is caused by sounds generated from the larynx.”
D. “Reflects the blood flow through the pulmonary arteries.”

Answer 97

C. “Is caused by sounds generated from the larynx.”

Question 98

During percussion, the nurse knows that a dull percussion note elicited over a lung lobe most likely results from: 
A.	Shallow breathing. 
B.	Normal lung tissue. 
C.	Decreased adipose tissue. 
D.	Increased density of lung tissue.

Answer 98

D. Increased density of lung tissue.

Question 99

The nurse is observing the auscultation technique of another nurse. The correct method to use when progressing from one auscultatory site on the thorax to another is ______ comparison.

a. Side-to-side
b. Top-to-bottom
c. Posterior-to-anterior
d. Interspace-by-interspace

Answer 99

a. Side-to-side

Question 100

When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. The nurse interprets these sounds as:
A. Normally auscultated over the trachea.
B. Bronchial breath sounds, which are normal in that location.
C. Vesicular breath sounds, which are normal in that location.
D. Bronchovesicular breath sounds, which are normal in that location.

Answer 100

C. Vesicular breath sounds, which are normal in that location.

Question 101

The nurse is percussing over the lungs of a patient with pneumonia. The nurse knows that percussion over an area of atelectasis in the lungs will reveal:

a. Dullness.
b. Tympany.
c. Resonance.
d. Hyper-resonance.

Answer 101

a. Dullness.

Question 102

During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which situation?
A. When the bronchial tree is obstructed
B. When adventitious sounds are present
C. In conjunction with whispered pectoriloquy
D. In conditions of consolidation, such as pneumonia

Answer 102

A. When the bronchial tree is obstructed

Question 103

The nurse knows that a normal finding when assessing the respiratory system of an older adult is:
A. Increased thoracic expansion.
B. Decreased mobility of the thorax.
C. Decreased anteroposterior diameter.
D. Bronchovesicular breath sounds throughout the lungs

Answer 103

B. Decreased mobility of the thorax.

Question 104

A mother brings her 3-month-old infant to the clinic for evaluation of a cold. She tells the nurse that he has had “a runny nose for a week.” When performing the physical assessment, the nurse notes that the child has nasal flaring and sternal and intercostal retractions. The nurse’s next action should be to:
A. Assure the mother that these signs are normal symptoms of a cold.
B. Recognize that these are serious signs, and contact the physician.
C. Ask the mother if the infant has had trouble with feedings.
D. Perform a complete cardiac assessment because these signs are probably indicative of early heart failure

Answer 104

B. Recognize that these are serious signs, and contact the physician.

Question 105

When assessing the respiratory system of a 4-year-old child, which of these findings would the nurse expect?
A. Crepitus palpated at the costochondral junctions
B. No diaphragmatic excursion as a result of a child’s decreased inspiratory volume
C. Presence of bronchovesicular breath sounds in the peripheral lung fields
D. Irregular respiratory pattern and a respiratory rate of 40 breaths per minute at rest

Answer 105

C. Presence of bronchovesicular breath sounds in the peripheral lung fields

Question 106

During auscultation of the lungs of an adult patient, the nurse notices the presence of bronchophony. The nurse should assess for signs of which condition? 
A.	Airway obstruction 
B.	Emphysema 
C.	Pulmonary consolidation 
D.	Asthma

Answer 106

C. Pulmonary consolidation

Question 107

The nurse is listening to the breath sounds of a patient with severe asthma. Air passing through narrowed bronchioles would produce which of these adventitious sounds? 
A.	Wheezes 
B.	Bronchial sounds 
C.	Bronchophony
D.	Whispered pectoriloquy

Answer 107

A. Wheezes

Question 108

A patient has a long history of chronic obstructive pulmonary disease (COPD). During the assessment, the nurse will most likely observe which of these?
A. Unequal chest expansion
B. Increased tactile fremitus
C. Atrophied neck and trapezius muscles
D. Anteroposterior-to-transverse diameter ratio of 1:1

Answer 108

D. Anteroposterior-to-transverse diameter ratio of 1:1

Question 109

A 35-year-old recent immigrant is being seen in the clinic for complaints of a cough that is associated with rust-coloured sputum, low-grade afternoon fevers, and night sweats for the past 2 months. The nurse’s preliminary analysis, based on this history, is that this patient may be suffering from: 
A.	Bronchitis. 
B.	Pneumonia. 
C.	Tuberculosis. 
D.	Pulmonary edema.

Answer 109

C. Tuberculosis.

Question 110

A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe in this patient?
A. Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema
B. Rasping cough, thick mucoid sputum, wheezing, and bronchitis
C. Productive cough, dyspnea, weight loss, anorexia, and tuberculosis
D. Fever, dry nonproductive cough, and diminished breath sounds

Answer 110

A. Shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, and ankle edema

Question 111

A patient comes to the clinic complaining of a cough that is worse at night but not as bad during the day. The nurse recognizes that this cough may indicate:
A. Pneumonia.
B. Postnasal drip or sinusitis.
C. Exposure to irritants at work.
D. d. Chronic bronchial irritation from smoking.

Answer 111

B. Postnasal drip or sinusitis.

Question 112

During a morning assessment, the nurse notices that the patient’s sputum is frothy and pink. Which condition could this finding indicate? 
A.	Croup 
B.	Tuberculosis 
C.	Viral infection 
D.	Pulmonary edema

Answer 112

D. Pulmonary edema

Question 113

To correctly auscultate the patient’s breath sounds, the nurse will:
A. Listen to at least one full respiration in each location.
B. Listen as the patient inhales and then go to the next site during exhalation.
C. Instruct the patient to breathe in and out rapidly while listening to the breath sounds.
D. If the patient is modest, listen to sounds over his or her clothing or hospital gown.

Answer 113

A. Listen to at least one full respiration in each location.

Question 114

A patient has been admitted to the emergency department with a possible medical diagnosis of pulmonary embolism. The nurse expects to see which assessment findings related to this condition?
A. Absent or decreased breath sounds
B. Productive cough with thin, frothy sputum
C. Chest pain that is worse on deep inspiration and dyspnea
D. Diffuse infiltrates with areas of dullness upon percussion

Answer 114

C. Chest pain that is worse on deep inspiration and dyspnea

Question 115

During palpation of the anterior chest wall, the nurse notices a coarse, crackling sensation over the skin surface. On the basis of these findings, the nurse suspects: 
A.	Tactile fremitus. 
B.	Crepitus. 
C.	Friction rub. 
D.	Adventitious sounds.

Answer 115

B. Crepitus.

Question 116

A patient has been admitted to the emergency department for a suspected drug overdose. His respirations are shallow, with an irregular pattern, with a rate of 12 respirations per minute. The nurse interprets this respiration pattern as which of the following? 
A.	Bradypnea 
B.	Cheyne-Stokes respirations 
C.	Hypoventilation 
D.	Chronic obstructive breathing

Answer 116

C. Hypoventilation

Question 117

A patient with pleuritis has been admitted to the hospital and complains of pain with breathing. Upon auscultation, the nurse notes coarse, low-pitched sounds with a grating quality and documents them as: 
A.	Stridor. 
B.	Friction rub. 
C.	Crackles. 
D.	Wheezing

Answer 117

B. Friction rub.

Question 118

The nurse is assessing a 52-year-old patient admitted with aspiration pneumonia and a history of excessive alcohol consumption. The patient has been deteriorating and has developed sepsis. The nurse identifies the following findings indicating he likely has acute respiratory distress syndrome (ARDS): (Select all that apply.)
A. Respirations regular and easy
B. Crackles upon auscultation of lungs
C. Muscles between ribs pull in during inspiration
D. Very short of breath
E. Blood pressure 70/50 mm Hg
F. Apical heart rate 60 beats per minute

Answer 118

B. Crackles upon auscultation of lungs
C. Muscles between ribs pull in during inspiration
D. Very short of breath
E. Blood pressure 70/50 mm Hg

Question 119

Which of the following instructions is correct for a patient taking an antihistamine?

a. Eat chocolate bars to ease the discomfort of dry mouth.
b. Antihistamines are generally safe to take with over-the-counter (OTC) medications.
c. Take the medication on an empty stomach to maximize absorption of the drug.
d. Take the medication with food, even though doing so may slightly reduce the absorption of the drug.

Answer 119

d. Take the medication with food, even though doing so may slightly reduce the absorption of the drug.

Question 120

A gardener needs a decongestant because of seasonal allergy problems. Which of the following is one of the benefits of orally administered decongestants?

a. Onset is immediate.
b. The effect is more potent.
c. Rebound congestion is almost nonexistent.
d. The adverse effects of restlessness and nervousness are reduced.

Answer 120

c. Rebound congestion is almost nonexistent.

Question 121

The nurse knows that an antitussive drug is most appropriate for which of the following patients?

a. A patient with pneumonia who has a productive cough
b. A patient who has a tracheostomy and thick mucus secretions
c. A patient who has had a productive cough for 2 weeks
d. A patient who has developed bronchitis 2 days after hernia repair surgery

Answer 121

d. A patient who has developed bronchitis 2 days after hernia repair surgery

Question 122

A patient has been advised to add a nasal spray (an adrenergic decongestant) to treat a cold. What important information should the nurse tell the patient about the nasal spray?

a. Expect the effects to be delayed at least 1 week.
b. Limit use of this spray to 3 to 5 days.
c. Continue the spray until nasal stuffiness has resolved.
d. Avoid use of this spray if a fever develops.

Answer 122

b. Limit use of this spray to 3 to 5 days.

Question 123

Which of the following is the rationale for using inhaled budesonide (Pulmicort)?

a. It causes bronchodilation.
b. It thins bronchial secretions.
c. It inhibits the activity of β-agonists.
d. It provides an anti-inflammatory response.

Answer 123

d. It provides an anti-inflammatory response.

Question 124

A patient has been prescribed an inhaled respiratory medication. What should the nurse tell this patient about the proper method for taking this medication?

a. Rinsing of the mouth after using the inhaler or nebulizer is recommended.
b. Nebulizer tubings and mouthpieces should be cleaned only with hot water.
c. Inhale the medication deeply, with the head tipped forward to maximize opening of the airway.
d. After administering an inhaler medication, patients should remove the inhaler and hold their breath for at least 20 seconds.

Answer 124

a. Rinsing of the mouth after using the inhaler or nebulizer is recommended

Question 125

Which of the following drugs is used in the treatment of acute attacks of bronchial asthma?

a. nedocromil
b. salbutamol (Ventolin)
c. zafirlukast (Accolate)
d. triamcinolone (Nasacort AQ)

Answer 125

b. salbutamol (Ventolin)

Question 126

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction should the nurse give the patient regarding these inhalers?

a. The corticosteroid should be taken first.
b. The bronchodilator should be taken first.
c. The two drugs should be taken at least 2 hours apart.
d. The order of administration does not matter with these two drugs.

Answer 126

b. The bronchodilator should be taken first.