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1. Promote expectoration
2. Suppress the cough
3. Relax smooth muscles of the bronchial airway
4. Prevent infection
1. Constipation
2. Diarrhea
3. Bradycardia
4. Tachycardia
3. A nurse teaches a client about the use of a respiratory inhaler. Which action by
the client indicated a need for further teaching?
1. Removes the cap and shakes the inhaler well before use.
2. Presses the canister down with finger as he breathes in.
3. Inhales the mist and quickly exhales.
4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
5. A client has just returned to a nursing unit following bronchoscopy. A nurse would
implement which of the following nursing interventions for this client?
6. A client has an order to have radial ABG drawn. Before drawing the sample, a
nurse occludes the:
1. Brachial and radial arteries, and then releases them and observes the circulation
of the hand.
2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and
repeats the process with the other artery.
3. Radial artery and observes for color changes in the affected hand.
4. Ulnar artery and observes for color changes in the affected hand.
7. A nurse is assessing a client with chronic airflow limitation and notes that the
client has a barrel chest. The nurse interprets that this client has which of the
following forms of chronic airflow limitation?
9. Which of the following would be an expected outcome for a client recovering from
an upper respiratory tract infection? The client will:
10. Which of the following individuals would the nurse consider to have the highest
priority for receiving an influenza vaccination?
1. Use your nasal decongestant spray regularly to help clear your nasal passages.
2. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.
3. It is important to increase your activity. A daily brisk walk will help promote
drainage.
4. Keep a diary if when your symptoms occur. This can help you identify what
precipitates your attacks.
12. An elderly client has been ill with the flu, experiencing headache, fever, and
chills. After 3 days, she develops a cough productive of yellow sputum. The nurse
auscultates her lungs and hears diffuse crackles. How would the nurse best
interpret these assessment findings?
13. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The
dosage strength of the liquid is 200mg/5ml. How many mL should the nurse
administer each dose?
1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml
1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness
15. A client with 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?
16. When developing a discharge plan to manage the care of a client with COPD,
the nurse should anticipate that the client will do which of the following?
17. Which of the following outcomes would be appropriate for a client with COPD
who has been discharged to home? The client:
18. Which of the following physical assessment findings would the nurse expect to
find in a client with advanced COPD?
19. Which of the following is the primary reason to teach pursed-lip breathing to
clients with emphysema?
20. Which of the following is a priority goal for the client with COPD?
21. A clients arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg,
PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms
would the nurse expect?
1. Cyanosis
2. Flushed skin
3. Irritability
4. Anxiety
22. When teaching a client with COPD to conserve energy, the nurse should teach
the client to lift objects:
23. The nurse teaches a client with COPD to assess for s/s of right-sided heart
failure. Which of the following s/s would be included in the teaching plan?
25. Which of the following ABG abnormalities should the nurse anticipate in a client
with advanced COPD?
1. Increased PaCO2
2. Increased PaO2
3. Increased pH.
4. Increased oxygen saturation
26. Which of the following diets would be most appropriate for a client with COPD?
27. The nurse is planning to teach a client with COPD how to cough effectively.
Which of the following instructions should be included?
29. The nurse would anticipate which of the following ABG results in a client
experiencing a prolonged, severe asthma attack?
30. A client with acute asthma is prescribed short-term corticosteroid therapy. What
is the rationale for the use of steroids in clients with asthma?
31. The nurse is teaching the client how to use a metered dose inhaler (MDI) to
administer a Corticosteroid drug. Which of the following client actions indicates that
he is using the MDI correctly? Select all that apply.
1. Irregular heartbeat
2. Constipation
3. Pedal edema
4. Decreased heart rate.
33. A client has been taking flunisolide (Aerobid), two inhalations a day, for
treatment of asthma. He tells the nurse that he has painful, white patches in his
mouth. Which response by the nurse would be the most appropriate?
34. Which of the following health promotion activities should the nurse include in
the discharge teaching plan for a client with asthma?
35. 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?
36. A female client comes into the emergency room complaining of SOB and pain in
the lung area. She states that she started taking birth control pills 3 weeks ago and
that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABGs,
results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24
mEq/L; SaO2 86%. Considering these results, the first intervention is to:
37. Basilar crackles are present in a clients lungs on auscultation. The nurse knows
that these are discrete, non continuous sounds that are:
38. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to
oxygen, the first nursing action would be to:
40. If a client continues to hypoventilate, the nurse will continually assess for a
complication of:
1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis
41. A client is admitted to the hospital with acute bronchitis. While taking the
clients VS, the nurse notices he has an irregular pulse. The nurse understands that
cardiac arrhythmias in chronic respiratory distress are usually the result of:
1. Respiratory acidosis
2. A build-up of carbon dioxide
3. A build-up of oxygen without adequate expelling of carbon dioxide.
4. An acute respiratory infection.
42. Auscultation of a clients lungs reveals crackles in the left posterior base. The
nursing intervention is to:
1. Repeat auscultation after asking the client to deep breathe and cough.
2. Instruct the client to limit fluid intake to less than 2000 ml/day.
3. Inspect the clients ankles and sacrum for the presence of edema
4. Place the client on bedrest in a semi-Fowlers position.
43. The most reliable index to determine the respiratory status of a client is to:
44. A client with COPD has developed secondary polycythemia. Which nursing
diagnosis would be included in the plan of care because of the polycythemia?
45. The physician has scheduled a client for a left pneumonectomy. The position
that will most likely be ordered postoperatively for his is the:
46. Assessing a client who has developed atelectasis postoperatively, the nurse will
most likely find:
1. A flushed face
2. Dyspnea and pain
47. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The
first intervention in completing this procedure would be to:
48. A client states that the physician said the tidal volume is slightly diminished and
asks the nurse what this means. The nurse explains that the tidal volume is the
amount of air:
50. The best method of oxygen administration for client with COPD uses:
1. Cannula
2. Simple Face mask
3. Non rebreather mask
4. Venturi mask
2. Answer: 4. Tachycardia
Side effects that can occur from a beta 2 agonist include tremors, nausea,
nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the
mouth or throat.
The client should be instructed to hold his or her breath at least 10 to 15 seconds
before exhaling the mist.
5. Answer: 2. Ensuring the return of the gag reflex before offering foods or fluids
After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex
returns because the preoperative sedation and the local anesthesia impair
swallowing and the protective laryngeal reflexes for a number of hours. Additional
fluids is unnecessary because no contrast dye is used that would need to be flushed
from the system. Atropine and Versed would be administered before the procedure,
not after.
6. Answer: 2. Radial and ulnar arteries, releases one, evaluates the color of the
hand, and repeats the process with the other artery.
Before drawing an ABG, the nurse assesses the collateral circulation to the hand
with Allens test. This involves compressing the radial and ulnar arteries and asking
the client to close and open the fist. This should cause the hand to become pale.
The nurse then releases pressure on one artery and observes whether circulation is
restored quickly. The nurse repeats the process, releasing the other artery. The
blood sample may be taken safely if collateral circulation is adequate.
7. Answer: 2. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the
diaphragm. These lead to increased anteroposterior diameter, which is referred to
as barrel chest. The client also has dyspnea with prolonged expiration and has
hyperresonant lungs to percussion.
A client recovering from an URI should report decreasing or no nasal discharge and
obstruction. Daily fluid intake should be increase to more than 1 L every 24 hours to
liquefy secretions. The temperature should be below 100*F (37.8*C) with no chills or
diaphoresis. A productive cough with chest pain indicated pulmonary infection, not
an URI.
Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza to
prevent transmission to those who have a decreased capacity to deal with the
disease. The wife who is caring for a husband with cancer has the highest priority of
the clients described.
11. Answer: 4. Keep a diary if when your symptoms occur. This can help you
identify what precipitates your attacks.
It is important for clients with allergic rhinitis to determine the precipitating factors
so that they can be avoided. Keeping a diary can help identify these triggers. Nasal
decongestant sprays should not be used regularly because they can cause a
rebound effect. Antibiotics are not appropriate. Increasing activity will not control
the clients symptoms; in fact, walking outdoors may increase them if the client is
allergic to pollen.
15. Answer: 1. Altered nutrition: Less than body requirements related to fatigue.
The clients problem is altered nutritionspecifically, less than required. The cause,
as stated by the client, is the fatigue associated with the disease process. Activity
intolerance is a likely diagnosis but is not related to the clients nutritional problems.
Weight loss is not a nursing diagnosis. Ineffective breathing pattern may be a
problem, but this diagnosis does not specifically address the problem of weight loss
described by the client.
A client with COPD is at high risk for development of respiratory infections. COPD is
a slowly progressive; therefore, maintaining current status and establishing a goal
that the client will require less supplemental oxygen are unrealistic expectations.
Treatment may slow progression of the disease, but permanent improvement is
highly unlikely.
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and helping
the client relax, pursed-lip breathing helps the client learn to control the rate and
depth of respiration. Pursed-lip breathing does not promote the intake of oxygen,
strengthen the diaphragm, or strengthen intercostal muscles.
A priority goal for the client with COPD is to manage the s/s of the disease process
so as to maintain the clients functional ability. Chest pain is not a typical sign of
COPD. The carbon dioxide concentration in the blood is increased to an abnormal
The high PaCO2 level causes flushing due to vasodilation. The client also becomes
drowsy and lethargic because carbon dioxide has a depressant effect on the CNS.
Cyanosis is a late sign of hypoxia. Irritability and anxiety are not common with a
PaCO2 level of 65 mm Hg but are associated with hypoxia.
Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves
energy and reduced perceived dyspnea. Pursing the lips prolongs exhalation and
provides the client with more control over breathing. Lifting after exhalation 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
cardiac dysrhythmias.
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.
The client should eat high-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.
27. Answer: 1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times
on exhalation.
As the severe asthma attack worsens, the client becomes fatigued and alveolar
hypotension develops. This leads to carbon dioxide retention and hypoxemia. The
client develops respiratory acidosis. Therefore, the PaCO2 level increase, the PaO2
level decreases, and the pH decreases, indicating acidosis.
Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development
of oral thrush, a fungal infection. Once developed, thrush must be treated by
antibiotic therapy; it will not resolve on its own. Fungal infections can develop even
without overuse of the Corticosteroid inhaler. Although good oral hygiene can help
prevent development of a fungal infection, it cannot be used alone to treat the
problem.
34. Answer: 1. Incorporate physical exercise as tolerated into the treatment plan.
The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are involved.
The client should immediately be placed on oxygen via mask so that the SaO2 is
brought up to 95%. Encourage slow, regular breathing to decrease the amount of
Basilar crackles are usually heard during inspiration and are caused by sudden
opening of the alveoli.
Administer oxygen at 2 L/minute and no more, for if the client if emphysemic and
receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory
system will cease to function.
Increased pulse and pallor are symptoms associated with shock. A compromised
venous return may occur if there is a mediastinal shift as a result of excessive fluid
removal. Usually no more than 1 L of fluid is removed at one time to prevent this
from occurring.
42. Answer: 1. Repeat auscultation after asking the client to deep breathe and
cough.
Although crackles often indicate fluid in the alveoli, they may also be related to
hypoventilation and will clear after a deep breath or a cough. It is, therefore,
premature to impose fluid (2) or activity (4) restrictions (which Margaret would
totally do if Dani werent there to smack her). Inspection for edema (3) would be
appropriate after re-auscultation.
To check for breathing, the nurse places her ear and cheek next to the clients
mouth and nose to listen and feel for air movement. The chest rising and falling (1)
is not conclusive of a patent airway. Observing skin color (2) is not an accurate
assessment of respiratory status, nor is checking the femoral pulse.
Chronic hypoxia associated with COPD may stimulate excessive RBC production
(polycythemia). This results in increased blood viscosity and the risk of thrombosis.
The other nursing diagnoses are not applicable in this situation.
Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction to
the airway to prevent secretions from falling into the lung. Dressing change (1) and
humidity (2) do not relate to suctioning.
Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.
The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated
from the oxy-hemoglobin molecule.