NURS MISC ASTHMA AND COPD 1 - Ana G. Mendez University System

NURS MISC ASTHMA AND COPD 1 QUIZ An elderly client with pneumonia may appear with which of the following symptoms first? B fever and chills D Pleuritic chest pain and cough Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop? B Bronchiectasis Inflammation Question 2 Explanation: The most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn’t occur with pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia. Question 3 CORRECT A 7-year-old client is brought to the E.R. He’s tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? B Bronchial pneumonia D Emphysema Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? B Increased forced expiratory volume D Normal breath sounds Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection? B Extrinsic D Mediated A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? Bronchodilators D Oral steroids Question 6 Explanation: Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren’t used for emergency relief. Question 7 CORRECT A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? Give a bronchodilator by nebulizer D Provide emotional support to the client A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? B Asthma D Emphysema The term “blue bloater” refers to which of the following conditions? B Asthma D Emphysema Question 9 Explanation: Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don’t exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting). Question 10 CORRECT The term “pink puffer” refers to the client with which of the following conditions? B Asthma Emphysema Question 10 Explanation: Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They’re pink and usually breathe through pursed lips, hence the term “puffer”. Clients with ARDS are usually acutely short of breath. Clients with asthma don’t have any particular characteristics, and clients with chronic obstructive bronchitis are bloated and cyanotic in appearance. Question 11 CORRECT A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders? B Asthma Emphysema It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? B These vaccines produce bronchodilation and improve oxygenation Respiratory infections can cause severe hypoxia and possibly death in these clients. Question 12 Explanation: It’s highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. The vaccines have no effect on bronchodilation or respiratory care. Question 13 CORRECT Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? B It improves respiratory muscle strength D It worsens respiratory function and is discouraged Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why? B Reducing fluid volume improves clients’ mobility D Reducing fluid volume improves respiratory function A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions? B Asthma Emphysema Question 15 Explanation: In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchial collapse, as well. In ARDS, the client’s condition is more acute and typically requires mechanical ventilation. In asthma and bronchitis, wheezing is prevalent. Question 16 CORRECT A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? B The client breathes only when his oxygen levels climb above a certain point D The client breathes only when his carbon dioxide level dips below a certain point Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics? B How to increase his oxygen therapy How to recognize the signs of an impending respiratory infection Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery? B Bronchitis D Pneumothorax Which of the following measures can reduce or prevent the incidence of atelectasis in a post-operative client? B Mechanical ventilation Use of an incentive spirometer Question 19 Explanation: Using an incentive spirometer requires the client to take deep breaths and promotes lung expansion. Chest physiotherapy helps mobilize secretions but won’t prevent atelectasis. Reducing oxygen requirements or placing someone on mechanical ventilation doesn’t affect the development of atelectasis. Question 20 CORRECT Emergency treatment of a client in status asthmaticus includes which of the following medications? B Inhaled corticosteroids D Oral corticosteroids Which of the following treatment goals is best for the client with status asthmaticus? B Determining the cause of the attack D Reducing secretions Dani was given dilaudid for pain. She’s sleeping and her respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she might have which of the following reactions? Respiratory arrest D Constipation Question 22 Explanation: Narcotics can cause respiratory arrest if given in large quantities. Question 23 CORRECT Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute? Level of consciousness and a pulse oximetry value D Pulse oximetry value and heart sounds A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be which of the following values? B 30 mm Hg 80 mm Hg A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following conditions? B Pulmonary embolism D Rheumatoid arthritis Question 25 Explanation: The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventual respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism, consider the new drug first. Rheumatoid arthritis doesn’t manifest these signs. Question 26 CORRECT Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first? B Inserting an I.V. catheter D Taking vital signs anaphylactic shock is developing. Obtaining a CBC wouldn’t help the emergency situation. Question 27 CORRECT Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next? Administer bronchodilators D Have the client lie flat in the bed A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions? B Metabolic alkalosis D Respiratory alkalosis A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance? B Respiratory alkalosis D Metabolic alkalosis A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? Potassium level of 3.0 mEq/L D Phosphorus level of 4.0 mg/dl A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating: B Metabolic alkalosis, uncompensated D Respiratory acidosis, compensated A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before the blood is drawn, an Allen’s test is performed to determine the adequacy of the: Ulnar circulation D Carotid circulation Question 32 Explanation: Before radial puncture for obtaining an ABG, you should perform an Allen’s test to determine adequate ulnar circulation. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury o the hand if damage to the radial artery occurs with arterial puncture. Question 33 CORRECT A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? B Respiratory alkalosis Metabolic alkalosis A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? B Respiratory alkalosis D Metabolic alkalosis A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul’s respirations. Based on this documentation, which of the following did the nurse observe? B Respirations that are regular but abnormally slow D Respirations that cease for several seconds A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? B Respiratory acidosis Metabolic alkalosis A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. The nurse has determined that the client is experiencing metabolic acidosis. Which of the following laboratory values would the nurse expect to note? B Magnesium level of 2.0 mg/dL D Phosphorus level of 4.0 mg/dL A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen’s test on the client. Number in order of priority the steps for performing the Allen’s test (#1 is first step). 1. Ask the client to open and close the hand repeatedly. 2. Apply pressure over the ulnar and radial arteries. 3. Assess the color of the extremity distal to the pressure point 4. Release pressure from the ulnar artery 5. Explain the procedure to the client. B 5, 3, 2, 1, 4. D 5, 2, 4, 1, 3. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? Having the client take 3 deep breaths D Asking the client to obtain the specimen after eating A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician? B Dry cough Bronchospasm A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning to a maximum of: 10 seconds D 1 minute Question 41 Explanation: Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells within the heart. A vasovagal response may occur causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds. Question 42 CORRECT A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate decreases. Which of the following is the most appropriate nursing intervention? B Ensure that the suction is limited to 15 seconds D Notify the physician immediately An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. An elevated potassium level is also present. These results indicate the presence of: B Respiratory acidosis D Over compensated respiratory acidosis A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client? B Hypocapnia D A widened diaphragm noted on chest x-ray film Question 44 Explanation: Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm is the disease is advanced. Question 45 CORRECT An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? B Aerosol mask D Tracheostomy collar oxygen delivery systems but most often are used to administer high humidity. Question 46 CORRECT Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and the nurse instructs the client about the medication. Which statement by the client indicates a need for further teaching? B “I will take the medication with food.” D “Periodic blood levels will need to be obtained.” A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed 2 L/min D 10 L/min The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the following values would indicate that this acid-base imbalance exists? B PCO2 of 32 mm Hg D HCO3- of 20 mEq/L A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is: B Strengthen the diaphragm Promote carbon dioxide elimination A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values as indicating: Respiratory alkalosis uncompensated