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Respiratory Disorders NCLEX
Terms in this set (46)
Which factor will most contribute to a client's development of pneumonia in conjunction with a chronic illness?
b. Group living
d. Severe periodontal disease
b. Clients with chronic illnesses generally have poor immune systems. Often, residing in group living situations increases the chance of disease transmission.
Which pathophysiological mechanism will be expected to develop as a secondary response to pneumonia after development of the primary causative organism?
d. The common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent.
The nurse is reviewing the chart of a 58-year-old male client with community-acquired pneumonia. Which of the following will most likely be reported as a causative organism?
a. Haemophilus influenza
b. Klebsiella pneumoniae
c. Streptococcus pneumoniae
d. Staphylococcus aureus
c. Pneumococcal or streptococcal pneumonia, caused by streptococcus pneumonia, is the most common cause of community-acquried pneumonia.
An elderly client with pneumonia may appear with which symptoms first?
a. Altered mental status and dehydration
b. Fever and chills
c. Hemoptysis and dyspnea
d. Pleuritic chest pain and cough
a. Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
When auscultating the chest of a client with pneumonia, the nurse should expect to hear which type of sounds over areas of consolidation?
a. Chest auscultation reveals bronchial breath sounds over areas of consolidation. Bronchovesicular breath sounds are normal over midlobe lung regions, tubular sounds are commonly heard over large airways, and vesicular breath sounds are commonly heard in bases of the lung fields.
A diagnosis of pneumonia is typically achieved by which diagnostic test?
a. Arterial blood gas analysis (ABG)
b. Chest X-ray
c. Blood cultures
d. Sputum culture and sensitivity
d. Sputum culture and sensitivity is the best way to identify the organism causing the pneumonia.
A 78-year-old client is admitted with a diagnosis of dehydration and change in mental status. He's being hydrated with IV fluids. When the nurse teaks his vital signs, she notes he has a fever of 103F, a cough producing yellow sputum, and pleuritic chest pain. The nurse suspects this client may have which condition?
a. Acute respiratory distress syndrome (ARDS)
b. Myocardial infarction (MI)
d. Tuberculosis (TB)
c. Fever, productive cough, and pleuritic chest pain are common signs and symptoms of pneumonia.
A client with pneumonia develops dyspnea with a respiratory rate of 32 and difficulty expelling his secretions. The nurse auscultates his lung fields and hears bronchial sounds in the left lower lobe. The nurse determines that the client requires which treatment first?
b. Bed rest
d. Nutritional intake
c. The client is having difficulty breathing and is probably becoming hypoxic. As an emergency measure, the nurse can provide oxygen without waiting for a physician's order.
A client has been treated with antibiotic therapy for right lower-lobe pneumonia for 10 days and will be discharged today. Which physical finding would lead the nurse to believe it's appropriate to discharge this client?
a. Continued dyspnea
b. Fever of 102F
c. Respiratory rate of 32
d. Vesicular breath sounds in right base
d. If the client still has pneumonia, the breath sounds in the right base will be bronchial, not the normal vesicular breath sounds.
A 20-year-old client is being treated for pneumonia. He has a persistent cough and complains of severe pain on coughing. What type of instruction should be given to help the client reduce the discomfort he's having?
a. "Hold in your cough as much as possible"
b. "Place the head of your bed flat to help with coughing"
c. "Restrict fluids to help decrease the amount of sputum"
d. "Splint your chest wall with a pillow for comfort"
d. Showing this client how to splint his chest wall will help decrease discomfort when coughing.
A client in a long-term care facility has been receiving tube feedings around the clock. The nurse notices he has a cough producing sputum, much like the content of his tube feedings, and is now febrile to 102F. The nurse auscultates his lung fields and hears bronchial breath sounds in his right middle lobe. The nurse suspects he may have developed which condition?
d. Pulmonary embolism
c. The client probably has aspirated the contents of his tube feedings and developed aspiration pneumonia. This is the most common cause of pneumonia in clients with tube feedings.
A nurse is working in a walk-in clinic. She has been alerted that there is an outbreak of tuberculosis (TB). Which client is most at risk for developing TB?
a. A 16-year-old female high school student
b. A 33-year-old day-care worker
c. A 43-year-old homeless man with a history of alcoholism
d. A 54-year-old businessman
c. Clients who are economically disadvantaged, malnourished, and have reduced immunity, such as a client with a history of alcoholism, are at extremely high risk for developing TB
The nurse is conducting a class for family members of clients diagnosed with TB. Which of the following should the nurse teach family members regarding transmission of the disease?
a. It is transmitted by sexual contact
b. It is transmitted by contaminated needles
c. It is transmitted through contaminated eating utensils
d. It is transmitted by droplets exhaled from an infected person
d. The TB bacillus is airborne and carried in droplets exhaled by an infected person who is coughing, sneezing, laughing, or singing.
An adult client is being screened in the clinic today for TB. He reports having negative PPD test results in the past. The nurse performs a PPD test on his right forearm today. When should he return to have the test read?
a. Immediately after performing the test
b. 24 hours after performing the test
c. 48 hours after performing the test
d. 1 week after performing the test
c. PPD tests should be read in 48-72 hours. If read too early or too late, the results won't be accurate
The right forearm of a client who had a PPD test for TB is reddened and raised about 3mm where the test was given. This PPD should be read as having which result?
b. Needs to be redone
c. This test would be classes as negative. A 3mm raised area would be a positive result if the client had recent close contact with someone diagnosed with or suspected of having infectious TB. Follow-up should be done with this client, and a chest X-ray should be ordered.
A client with a primary TB infection can expect to develop:
a. Activate TB within 2 weeks
b. Activate TB within 1 month
c. A fever that requires hospitalization
d. A positive skin test
d. A primary TB infection occurs when the bacillus has successfully invaded the entire body after entering through the lungs. At this point, the bacilli are walled off and skin tests read positive.
A client was infected with TB bacillus 10 years ago but never developed the disease. He's now being treated for cancer. The client begins to develop signs of TB. This is known as which type of infection?
a. Active infection
b. Latent infection
d. Tertiary infection
a. Some people carry dormant TB infections that may develop into active disease.
A client has active TB. Which symptoms will he exhibit?
a. Chest and lower back pain
b. Chills, fever, night sweats, and hemoptysis
c. Fever of more than 104F and nausea
d. Headache and photophobia
b. Typical signs and symptoms are chills, fever, night sweats, and hemoptysis. Chest pain may be present from coughing.
A client has received a preliminary diagnosis of TB. In order to obtain a definitive diagnosis, which test will the nurse expect to see ordered?
a. Chest X-ray
b. Mantoux test
c. Sputum culture
d. Tuberculin test
c. The sputum culture for mycobacterium tuberculosis is the only method of confirming the diagnosis.
A client with a positive Mantoux test result will be sent for a chest x-ray. For which reason is this done?
a. To confirm the diagnosis
b. To determine if a repeat skin test is needed
c. To determine the extent of lesions
d. To determine if this is a primary or secondary infection
c. If the lesions are large enough, the chest x-ray will show their presence in the lungs.
A chest X-ray shows a client's lungs to be clear. His Mantoux test is positive, with 10mm of induration. His previous test was negative. These test results are possible because:
a. He had TB in the past and no longer has it
b. He was successfully treated for TB, but skin tests always stay positive
c. He's a "seroconverter," meaning the TB has gotten to his bloodstream
d. He's a "tuberculin converter," which means he has been infected with TB since his last skin test
d. A tuberculin converter's skin test will be positive, meaning he has been exposed to and infected with TB and now has a cell-mediated immune response to the skin test. The client's blood and X-ray results may stay negative.
A client with a positive skin test of TB isn't showing signs of active disease. To help prevent the development of active TB, the client should be treated with isoniazid, 300mg daily, for how long?
a. 10-14 days
b. 2-4 weeks
c. 3-6 months
d. 9-12 months
d. Because of the increasing incidence of resistant strains of TB, the disease must be treated for up to 24 months in some cases, but treatment typically lasts from 9-12 months. Isoniazid is the most common medication used for the treatment of TB, but other antibiotics are added to the regimen to obtain the best results.
A client with a productive cough, chills, and night sweats is suspected of having active TB. The physician should take which action?
a. Admit him to the hospital in respiratory isolation
b. Prescribe isoniazid and tell him to go home and rest
c. Give a tuberculin test and tell him to come back in 48 hours to have it read
d. Give a prescription for isoniazid, 300mg daily for 2 weeks, and send him home
a. This client is showing signs and symptoms of active TB and, because of the productive cough, is highly contagious. He should be admitted to the hospital, placed in respiratory isolation, and three sputum cultures should be obtained to confirm the diagnosis.
A client is diagnosed with active TB and started on triple antibiotic therapy. What sign or symptom should the client show if therapy is inadequate?
a. Decreased shortness of breath
b. Improved chest x-ray
c. Nonproductive cough
d. Positive acid-fast bacilli in a sputum sample after 2 months of treatment
d. Continuing to have acid-fast bacilli in the sputum after 2 months indicates continued infection. The other choices would all indicate improvement with therapy.
Which instruction should the nurse give a client about his active TB?
a. "It's ok to miss a dose every day or two"
b. "If side effects occur, stop taking the medication"
c. "Only take the medication until you feel better"
d. "You must comply with the medication regimen to treat TB"
d. The regimen may last up to 24 months. It's essential that the client comply with therapy during that time or resistance will develop. At no time should he stop taking the medications before his physician tells him to.
A client diagnosed with active TB would be hospitalized primarily for which reason?
a. To evaluate his condition
b. To determine his compliance
c. To prevent spread of the disease
d. To determine the need for antibiotic therapy
c. The client with active TB is highly contagious until three consecutive sputum cultures are negative, so he's put in respiratory isolation in the hospital.
A 7-year-old is brought to the emergency department. He's tachypneic and afebrile and has a respiratory rate of 36 and a nonproductive cough. He recently had a cold. From this history, the child may have which condition?
a. Acute asthma
b. Bronchial pneumonia
a. Based on the child's history and symptoms, acute asthma is the most likely diagnosis.
Which assessment finding helps confirm a diagnosis of asthma in a client suspected of having the disorder?
a. Circumoral cyanosis
b. Increased forced expiratory volume
c. Inspiratory and expiratory wheezing
d. Normal breath sounds
c. Inspiratory and expiratory wheezes are typical findings in asthma.
The client has recently had a common cold and subsequently experiences an asthma attack. Which type of asthma is the client most likely experiencing?
c. Non-allergic asthma doesn't have an easily identifiable allergen and can be triggered by the common cold.
A client with acute asthma showing inspiratory and expiratory wheezes and a decreased forced expiratory volume should be treated with which class of medication right away?
a. Beta-adrenergic blockers
c. Inhaled steroids
d. Oral steroids
b. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow.
A 19-year-old client comes to the ER with acute asthma. His respiratory rate is 44, and he appears in acute respiratory distress. Which action should be taken first?
a. Take a full medical history
b. Give a bronchodilator by nebulizer
c. Apply a cardiac monitor to the client
d. Provide emotional support to the client
b. The client having an acute asthma attack needs to increase oxygen delivery
A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes per day has a chronic cough producing thick sputum and peripheral edema. He also has cyanotic nail beds. Based on this information, he most likely has which condition?
a. Acute respiratory distress syndrome
c. Chronic obstructive bronchitis
c. Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis.
The term "blue bloater" refers to which condition?
a. Acute respiratory distress syndrome
c. Chronic obstructive bronchitis
c. Clients with chronic obstructive bronchitis appear bloated, they have large barrel chests and peripheral edema, cyanotic nail beds, and, at times, circumoral cyanosis
The term "pink puffer" refers to a client with which condition?
c. Chronic obstructive bronchitis
d. Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They're pink and usually breath through pursed lips, hence the term "puffer"
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 and leans forward with his arms braced on his knees to support his chest and shoulders for breathing. The client has symptoms of which respiratory disorder?
c. Chronic obstructive bronchitis
d. These are classic signs and symptoms of emphysema
It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which reason?
a. These vaccines are recommended for all clients
b. These vaccines produce bronchodilation and improve oxygenation
c. These vaccines help reduce the tachypnea these clients experience
d. Respiratory infections can cause severe hypoxia and possibly death in these clients
d. 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.
Exercise has which effect on clients with asthma, chronic bronchitis, and emphysema?
a. It enhances cardiovascular fitness
b. It improves respiratory muscle strength
c. It reduces the number of acute attacks
d. It worsens respiratory function and is discouraged
a. Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack.
Clients with chronic obstructive bronchitis are given diuretic therapy. Which reason best explains why?
a. Reducing fluid volume reduces oxygen demand
b. Reducing fluid volume improves clients' mobility
c. Reducing fluid volume reduces sputum production
d. Reducing fluid volume improves respiratory function
a. Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate.
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 with condition?
c. Chronic obstructive bronchitis
d. In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange.
A client with emphysema should receive only 1-3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which statement is correct about hypoxic drive?
a. The client doesn't notice he needs to breathe
b. The client breathes only when his oxygen levels climb above a certain point
c. The client breathes only when his oxygen levels dip below a certain point
d. The client breathes only when his carbon dioxide level dips below a certain point
c. Clients with emphysema breath when their oxygen levels drop to a certain level
Teaching for a client with chronic obstructive pulmonary disease should include which topic?
a. How to listen to his own lungs
b. How to change his oxygen therapy
c. How to treat respiratory infections without going to the physician
d. How to recognize the signs of an impending respiratory infection
d. Respiratory infection in clients with a respiratory disorder can be fatal. It's important that the client understands how to recognize the signs and symptoms of an impending respiratory infection.
Which respiratory disorder is most common in the first 24-48 hours after surgery?
a. Atelectasis develops when there's interference with the normal negative pressure that promotes lung expansion. Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia.
Which measure can reduce or prevent the incidence of atelectasis in a postoperative client?
a. Chest physiotherapy
b. Mechanical ventilation
c. Reducing oxygen requirements
d. Use of an incentive spirometer
d. Using an incentive spirometer requires the client to take deep breaths and promotes lung expansion.
Initial emergency treatment of a client in status asthmaticus includes which medications?
a. Inhaled beta-adrenergic agents
b. Inhaled corticosteroids
c. IV beta-adrenergic agents
d. Oral corticosteroids
a. Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation.
Which treatment goal is best for a client with status asthmaticus?
a. Avoiding intubation
b. Determining the cause of the attack
c. Improving exercise tolerance
d. Reducing secretions
a. Inhaled beta-adrenergic agents, IV corticosteroids, and supplemental oxygen are used to reduce bronchospasm, improve oxygenation, and avoid intubation.
A client was given morphine for pain. He's sleeping and his respiratory rate is 4. If action isn't taken quickly, he might have which reaction?
a. Asthma attack
b. Respiratory arrest
d. Wake up on his own
b. Opioids such as morphine can cause respiratory arrest if given in large quantities.
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