Unit 5 - Class Activities

Question 1

Which of the following physical assessment finds would the nurse expect to find in a client with advanced chronic obstructive pulmonary disease(COPD) ?

1. Underdeveloped neck muscles
2. Collapsed neck veins
3. Increased anterior to posterior chest diameter
4. Increased chest excursions with respirations

Answer 1

3.Increased anterior to posterior chest diameter (barrel chest)

Question 2

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD). The nurse would emphasize which of the following behaviors?

1. Participate regularly in aerobic exercise
2. Maintain a high protein diet
3. Avoid exposure to people with known respiratory infections
4. Abstain from cigarette smoking

Answer 2

4.Abstain from cigarette smoking

Question 3

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema?

1. To promote oxygen intake
2. To strengthen the diaphragm
3. To strengthen the intercostal muscles
4. To promote carbon dioxide elimination

Answer 3

4. To promote carbon dioxide elimination

- (the condition traps CO2 air) difficulty getting it out

Question 4

A client with chronic obstructive pulmonary disease ( COPD) is experiencing dyspnea and has low PaO2 levels. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD?

1. High oxygen concentrations will cause coughing and dyspnea
2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe
3. Increased oxygen use will cause the client to become dependent on the oxygen
4. Administration of oxygen is contraindicated in clients who are using bronchodilators

Answer 4

2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe
   * Clients who have a long history of COPD may retain carbon dioxide (CO2) . Gradually the body adjusts to the higher CO2 concentration and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant hen becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Give: O2 at 2L/min per nasal cannula/ Question orders higher than this.

Question 5

When creating a discharge plan to manage the care of a client with COPD, the nurse will anticipate that the client will do which of the following?

1. Develop respiratory infections easily
2. Maintain current status
3. Require less supplemental oxygen
4. Show permanent improvement

Answer 5

1. Develop respiratory infections easily
   * At high risk for respiratory infections, slowly progressive so difficult to maintain current status / goal of less oxygen is unrealistic / treatment may slow progression of the disease but permanent improvement is highly unlikely

Question 6

A client with chronic obstructive pulmonary disease (COPD) reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

A.Imbalanced nutrition: Less than body requirements related to fatigue
B.Activity intolerance related to dyspnea
C.Weight loss related to COPD Ineffective breathing pattern related to alveolar hypoventilation
D.Ineffective breathing pattern related to alveolar hypoventilation

Answer 6

A.Imbalanced nutrition: Less than body requirements related to fatigue

*Ineffective breathing pattern may be a problem but this diagnosis does not specifically address the problem of weight loss described by the client.

Question 7

Which of the following outcomes would be appropriate for a client with chronic obstructive pulmonary disease (COPD) who has been discharged to home?

A.The client promises to do pursed – lip breathing at home
B.The client states actions to reduce pain
C.The client states that he will use oxygen via a nasal cannula at 5 L. minute
D.The client agrees to call the physician if dyspnea on exertion increases

Answer 7

D.The client agrees to call the physician if dyspnea on exertion increases

*Dyspnea on exertions indicates that the client may be experiencing complications of COPD Pain is not a common symptom of COPD. Clients with COPD use low flow oxygen supplementation 1 to 2 L min to avoid suppressing the respiratory drive which for these clients is stimulated by hypoxia

Question 8

Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)?

A.Maintaining functional ability
B.Minimizing chest pain
C.Increasing carbon dioxide levels in the blood
D.Treating infectious agents

Answer 8

A.Maintaining functional ability

*priority for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the clients functional ability( to perform ADL’s etc. & keep O2 levels up during) Chest pain is NOT typical symptom. The carbon dioxide concentration in the blood is increased to an abnormal level in client with COPD. It would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD

Question 9

When teaching a client with chronic obstructive pulmonary disease to conserve energy the nurse should teach the client to lift objects:

A.While inhaling through an open mouth
B.While exhaling through pursed lips
C.After exhaling but before inhaling
D.While takin a deep breath and holding it

Answer 9

B.While exhaling through pursed lips

*Exhaling requires less energy than inhaling. Therefore lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardia arrhythmias.

Question 10

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right sided heart failure. Which of the following signs and symptoms should be included in the teaching plan?

A.Clubbing of nail beds
B.Hypertension
C.Peripheral edema
D.Increased appetite

Answer 10

C.Peripheral edema

*Right sided heart failure(Cor Pulmonale) is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right sided heart failure include peripheral edema, jugular venous distention hepatomegaly and weight gain due to increased fluid volume ( more in perfusion unit)Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left sided heart failure. Client with heart failure have decreased appetites.

Question 11

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected?

A.Normal breath sounds
B.Prolonged inspiration
C.Normal chest movement
D.Coarse crackles and rhonchi

Answer 11

D.Coarse crackles and rhonchi

*Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi (low pitched, large airways on inspiration/Blocked )would be auscultated as air moves through airways obstructed with secretions.In COPD breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expirations not inspiration becomes prolonged. Chest movement is decreased as lungs become over distended

Question 12

Which of the following blood gas abnormalities should the nurse anticipate in a client with advanced chronic obstructive pulmonary disease ( COPD)?

A.Increased Paco2
B.Increased PaO2
C.Increased PH
D.Increased oxygen saturation

Answer 12

A.Increased Paco2

*As COPD progresses, the client typically develops increased Paco2 levels and decreased Pao2 levels. This results in decreased PH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation

Question 13

Which of the following diets would be most appropriate for a client with COPD?
A.low fat low cholesterol diet
B.Bland soft diet
C.Low sodium diet
D.High calorie high protein diet

Answer 13

D.High calorie high protein diet

8high calorie, high protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small frequent meals. A low fat low cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium restricted diet unless otherwise medically indicated.

Question 14

The nurse administers theophylline ( Theo-Dur) to a client , To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate?

A.Suppression of the clients respiratory infection
B.Decrease in bronchial secretions
C.Relaxation of bronchial smooth muscle
D.Thinning of tenacious purulent sputum

Answer 14

C.Relaxation of bronchial smooth muscle

*theophylline (theo-dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions

Question 15

The nurse is planning to teach a client with chronic obstructive pulmonary diseases how to cough effectively .Which of the following instructions should be included?

A.Take a deep abdominal breath, bend forward and cough three or four times on exhalation
B.Lie flat on the back, splint the thorax, take two deep breaths and cough
C.Take several rapid shallow breaths and then cough forcefully
D. Assume a side-lying positon, extend the arm over the head and alternate deep breathing with coughing

Answer 15

A.Take a deep abdominal breath, bend forward and cough three or four times on exhalation

*goal of effective coughing is to conserve energy and facilitate removal of secretions and minimize airway collapse. They should assume a sitting position with feet on the floor if possible ( Tri-pod). Bend forward slightly and using pursed lip breathing exhale. After resuming an upright positon the client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times the client should take a deep abdominal breath bend forward and cough three or four times upon exhalation ( “huff” cough)

Question 16

low pitched sound continuous throughout inspiration =

Answer 16

Ronchi: blocked large airway passages

Question 17

Wheezing is…

Answer 17

high pitched (narrow smaller airways)

Question 18

Teach client that they should be on a . _____ _____ schedule to reduce inflammation-exacerbation at home

Answer 18

maintenance medication

Question 19

Which of the following would be an appropriate expected outcome for an adult client with well controlled asthma?

A.Chest X-ray demonstrates minimal hyperinflation
B.Temperature remains lower than 100 F
C.Arterial blood gas analysis demonstrates a decrease in PaO2
D.Breath sounds are clear

Answer 19

D.Breath sounds are clear

Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest x-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal. What would the Ph be if there is problems? Remember last week?

Question 20

A client with acute asthma is prescribed short term corticosteroid therapy. Which is the rationale for the use of steroids in clients with asthma?

A.Corticosteroids promote bronchodilation
B.Corticosteroids act as an expectorant
C.Corticosteroids have an anti-inflammatory effect.
D.Corticosteroids prevent development of respiratory infections

Answer 20

C.Corticosteroids have an anti-inflammatory effect.

*corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do NOT have a bronchodilator effect

Question 21

A mother brings her 4 month old infant to the walk in clinic and reports that the infant has a bad cold and is having trouble breathing. And “she is not acting her self”. Which of the following nursing actions should the nurse do first?

1. Check the infant’s heart rate
2. Weigh the infant
3. Assess the infant’s oxygen saturation
4. Obtain more information from the father

Answer 21

3.Assess the infant’s oxygen saturation

Question 22

A 34 year old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic with a respiratory rate of 35 breaths minute, nasal flaring and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds based on these findings which action should the nurse take to initiate care of the client?

A.Initiate oxygen therapy reassess the client in 10 minutes
B.Draw blood for an arterial blood gas analysis and send the client for a chest X-ray
C.Encourage the client to relax and breathe slowly through the mouth
D.Administer bronchodilators

Answer 22

D.Administer bronchodilators

*in an acute asthma attack diminished or absent breath sounds/ reduced wheeze (no air movement heard) can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids and possibly IV theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical attention as would drawing blood and obtaining a chest xray. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention

Question 23

A nurse is teaching a client to use a metered dose inhaler (MDI) to administer his bronchodilator medication. Indicate the correct order of the steps the client should take to use the MDI appropriately

A.Shake the inhaler immediately before use
B.Hold breath for 5 to 10 seconds and then exhale
C.Activate the MDI on inhalation
D.Breathe out through the mouth

Answer 23

A.Shake the inhaler immediately before use
D.Breathe out through the mouth
C.Activate the MDI on inhalation
B.Hold breath for 5 to 10 seconds and then exhale

Question 24

A client is prescribed a metaproterenol (Alupent) via a metered dose inhaler two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?

A.Irregular heartbeat
B.Constipation
C.Pedal edema
D.Decreased pulse rate

Answer 24

A.Irregular heartbeat

*Irregular heartbeats should be reported promptly to care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or angina pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders.

Question 25

Which of the following health promotion activates should the nurse include in the discharge teaching plan for a client with asthma?

A.Incorporate physical exercise as tolerated into the daily routine
B.Monitor peak flow numbers after meals and at bedtime
C.Eliminate stressors in the work and home environment
D.Use sedatives to ensure uninterrupted sleep at night

Answer 25

A.Incorporate physical exercise as tolerated into the daily routine

*physical exercise is beneficial and should be incorporated as tolerated into the clients schedule. Peak flow numbers should be monitored daily usually in the morning before taking medication. Peak flow does not need to be monitored after each meal. Stressors in the client’s life should be modified but cannot be totally eliminated. Although adequate sleep is important. It is not recommended that sedatives be routinely take to induce sleep

Question 26

The Client with asthma should be taught that which of the following is one of the most common precipitating factors of an acute asthma attack?

A.Occupational exposure to toxins
B.Viral respiratory infections
C.Exposure to cigarette smoke
D.Exercising in cold temperatures

Answer 26

B.Viral respiratory infections

*The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or cold and should get yearly flu vaccinations. Environmental exposure to allergic triggers for the client i.e.( animals, dust, grass, dust mites etc.) or heavy particulates matter can trigger asthma attacks . Cigarette smoke can also trigger asthma attacks, but to lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

Question 27

A 12 year old with asthma wants to exercise. Which of the following activities should the nurse suggest to improve her breathing?

A.Soccer
B.Swimming
C.Track
D.Gymnastics

Answer 27

B.Swimming

*swimming is appropriate for this child because it requires controlled breathing, a assists in maintaining cardiac health enhances skeletal muscle strength and promotes ventilation and perfusion. Stop and start activities such as soccer, track and gymnastics commonly trigger symptoms in asthmatic clients.

Question 28

The client with asthma should be taught that which of the following is one of the most common precipitating factors of an acute asthma attack?

A.Occupational exposure to toxins
B.Viral respiratory infections
C.Exposure to cigarette smoke
D.Exercising in cold temperatures

Answer 28

B.Viral respiratory infections

• Clients with asthma should avoid people who have the flu or cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particles matter can trigger asthma attacks however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks but to lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

Question 29

When preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as signs to alert the mother that her child is having an asthma attack?

A.A Secretion of thin, copious mucus.
B.Tight , productive cough
C.Wheezing an expiration
D.Temperature of 99.4 F.

Answer 29

C.Wheezing an expiration

*Asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to Broncho- constriction. The child’s expiratory phase is normally longer than the inspiratory phase. Expiratory is passive as the diaphragm relaxes. During as asthma attack, secretion are thick and are not usually expelled until the bronchioles are more relaxed. At the beginning of the asthma attack the cough will be tight but not productive. Fever is not always present unless there is an infection that may have triggered the attack

Question 30

Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress Select all that apply

A.coughing 
B.respiratory rate of 35 breaths minute
C.Heart rate of 95 bpm
D.Restlessness
E.Malaise
F. Diaphoresis

Answer 30

B.respiratory rate of 35 breaths minute
D.Restlessness
F. Diaphoresis

*Early signs of respiratory distress include restlessness, tachypnea, tachycardia and diaphoresis. Coughing and malaise typically do not indicate respiratory distress. A heart rate of 95 is normal for a toddler. Other signs and symptoms include hypertension, nasal flaring, expiratory grunting, wheezing, and intercostal retractions

Question 31

An adolescent complains of chest pain and goes to the school nurse. The nurse determines that the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do next?

A.Call the adolescents parent
B.Have the adolescent lie down for 30 minutes obtain a peak flow reading
C.Obtain a peak flow reading
D.Give two puffs of a short acting bronchodilator

Answer 31

C.Obtain a peak flow reading

*complaint of chest pain in children and adolescents as are rarely cardiac. With a history of asthma the most likely cause of the chest pain is related to the asthma. So the nurse should check the adolescents peak flow reading( blow out) to evaluate the status of the air flow. Calling the parents would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment data. Having the adolescent lie down may be an option. But more data need to be collected to help establish a possible cause. Because the adolescent has not experienced any asthma problems for a long time it would be inappropriate for the nurse to administer a short acting bronchodilator at this time

Question 32

When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers which of the following suggestions should the nurse expect to include?

A.Keep the humidity in the home between 50% and 60% B.Have the child sleep in the bottom bunkbed
C.Use a scented room deodorizer to keep the room fresh
D.Vacuum the carpet once or twice a week

Answer 32

A.Keep the humidity in the home between 50% and 60%

*To help reduce allergic triggers in the home the nurse should recommend that the humidity level be kept between 50 and 60% . Doing so keeps the air moist and comfortable for breathing. When air is dry the risk for respiratory infections increase. Too high a level of humidity increases the risk for mold growth. Typically the child with asthma should sleep I the top bunkbed to minimize the risk of exposure to dust mites. Scented sprays should be avoided because they may trigger an asthmatic episode. Ideally carpeting should be avoided in the home if the child has asthma.

Question 33

A 9 month old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is:

A.the child will become dehydrated if the supplement is not taken with meals and snacks
B.The child needs these pancreatic enzymes to help the digestive system absorb fats. Carbohydrates and proteins
C.The child needs the pancreatic enzymes to aid tin liquefying mucus to keep the lungs clear
D.The child will experience severe diarrhea if the supplement is not taken as prescribed

Answer 33

B.The child needs these pancreatic enzymes to help the digestive system absorb fats. Carbohydrates and proteins

*they must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul fatty stools. Due to the undigested nutrients and may experience developmental delays due to malnutrition. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement

Question 34

A client’s diagnosis of cystic fibrosis was made 13 years ago and he has since been hospitalized several times. On the latest admission the client has labored respirations fatigue, malnutrition and failure to thrive. Which nursing actions are most important initially?

A.Placing the client on bed rest and ordering a blood gas analysis
B.Ordering a high calorie, high protein low fat vitamin enriched diet and pancreatic granules
C.Applying an oximeter and initiating respiratory therapy
D.Inserting an IV line and initiating antibiotic therapy

Answer 34

C.Applying an oximeter and initiating respiratory therapy

*clients commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel. Leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by oximeter reading. The child will be on bed rest due to respiratory distress. However although blood gases will probably be ordered the oximeter readings will be used to determine oxygen deficit and are therefore more of a priority. Diet high in calories, proteins and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorptions and help the malnutrition. Inserting an IV to administer antibiotic is important and can be done after ensuring adequate respiratory function.

Question 35

When developing the plan of care for a child with cystic fibrosis who is scheduled to receive postural drainage. The nurse would anticipate performing postural drainage at which of the following times?

A.After meals
B.Before meals
C.After rest periods
D.Before inhalation treatments

Answer 35

B.Before meals

*perform before meals to avoid the possibility of vomiting or regurgitating food. Although the child with CF needs frequent rest periods this is not an important factor in scheduling postural drainage. However the nurse would not want to interrupt the child’s rest period to perform the treatment. Inhalation treatments are usually given before postural drainage to help loosen secretions.

Question 36

When teaching the parents of an older infant with cystic fibrosis about the type of diet the child should consume, which of the following would be most appropriate?

A.low protein diet
B.High fat diet
C.Low carbohydrate diet
D.High calorie diet

Answer 36

D.High calorie diet

*CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction. Because the difficulty with digestion and absorption a high calorie high protein high carbohydrate moderate fat diet is indicated.

Question 37

At a follow up appointment after being hospitalized an adolescent with history of cystic fibrosis describes his stools to the nurse. Which of the following descriptions should the nurse interpret as indicative of continued problems with malabsorption?

A.soft with little odor
B.Large and foul smelling
C.Loose with bits of food
D.Hard with streaks of blood

Answer 37

B.Large and foul smelling

*poor digestion and absorption of foods, especially fats results in frequents bowel movements that are bulky large and foul smelling. The stools also contain abnormally large quantities of fat which is called steatorrhea. An adolescent experiencing good control of the disease would describe soft stools with little odor. Stool describes as loose with bits of food indicates diarrhea. Stool describes as hard with streaks of blood may indicate constipation.

Question 38

Which of the following, if described by the parents of a child with cystic fibrosis. Indicates that the parents understand the underlying problem of the disease?

A.An abnormality in the body’s mucus secreting glands
B.Formation of fibrous cysts in various body organs
C.Failure of the pancreatic ducts to develop properly
D.Reaction to the formation of antibodies against streptococcus

Answer 38

A.An abnormality in the body’s mucus secreting glands

8CF is characterized by a dysfunction in the body’s mucus producing exocrine glands the mucus secretions are think and sticky rather than thin and slippery. The mucus obstructs the bronchi bronchioles and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine resulting in poor digestion and poor absorption of various food nutrients.

Question 39

When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract?

A.Friction between the cilia
B.Force of gravity
C.Sweeping motion of cilia
D.Involuntary muscle contractions

Answer 39

B.Force of gravity

*the principle behind using postural drainage is that gravity will help move secretions from smaller to larger airways. Postural drainage is best used after percussion has loosened secretions. Coughing or suctioning is then used to remove secretions. Movement of cilia is not sufficient to move secretions. Muscle contractions do not move secretions within the lungs