Study sets, textbooks, questions
Upgrade to remove ads
NURS 105 resp diseases
Terms in this set (18)
A nurse assesses several clients who have a history of asthma. Which client should the nurse assess first?
a. A 66-year-old client with a barrel chest and clubbed fingernails
b. A 48-year-old client with an oxygen saturation level of 92% at rest
c. A 35-year-old client who has a longer expiratory phase than inspiratory phase
d. A 27-year-old client with a heart rate of 120 beats/min
Tachycardia can indicate hypoxemia as the body tries to circulate the oxygen that is available. A barrel chest is not an emergency finding. Likewise, a pulse oximetry level of 92% is not considered an acute finding. The expiratory phase is expected to be longer than the inspiratory phase in someone with airflow limitation.
A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first?
a. Review the clients pulmonary function test results.
b. Ask about medications the client is currently taking.
c. Assess how frequently the client uses a bronchodilator.
d. Consult the provider and request arterial blood gases.
Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can trigger asthma in some people. This results from increased production of leukotriene when aspirin or NSAIDs suppress other inflammatory pathways and is a high priority given the clients history. Reviewing pulmonary function test results will not address the immediate problem of frequent asthma attacks. This is a good intervention for reviewing response to bronchodilators. Questioning the client about the use of bronchodilators will address interventions for the attacks but not their cause. Reviewing arterial blood gas results would not be of use in a client between attacks because many clients are asymptomatic when not having attacks.
After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the clients understanding. Which statement indicates the client comprehends the teaching?
a. I will carry this medication with me at all times in case I need it.
b. I will take this medication when I start to experience an asthma attack.
c. I will take this medication every morning to help prevent an acute attack.
d. I will be weaned off this medication when I no longer need it.
Long-acting beta2 agonist medications will help prevent an acute asthma attack because they are long acting. The client will take this medication every day for best effect. The client does not have to always keep this medication with him or her because it is not used as a rescue medication. This is not the medication the client will use during an acute asthma attack because it does not have an immediate onset of action. The client will not be weaned off this medication because this is likely to be one of his or her daily medications.
After teaching a client how to perform diaphragmatic breathing, the nurse assesses the clients understanding. Which action demonstrates that the client correctly understands the teaching?
a. The client lays on his or her side with his or her knees bent.
b. The client places his or her hands on his or her abdomen.
c. The client lays in a prone position with his or her legs straight.
d. The client places his or her hands above his or her head.
To perform diaphragmatic breathing correctly, the client should place his or her hands on his or her abdomen to create resistance. This type of breathing cannot be performed effectively while lying on the side or with hands over the head. This type of breathing would not be as effective lying prone.
After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching?a. I will be certain to shake the inhaler well before I use it.
b. It may take a while before I notice a change in my asthma.
c. I will use the drug when I have an asthma attack.
d. I will be careful not to let the drug escape out of my nose and mouth.
Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the clients part allows the drug to escape through the nose and mouth.
A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond?
a. There are a variety of support groups for people who have COPD.
b. I will ask your provider to prescribe you with an antianxiety agent.
c. Share any thoughts and feelings that cause you to limit social activities.
d. Friends can be a good support system for clients with chronic disorders.
Many clients with moderate to severe COPD become socially isolated because they are embarrassed by frequent coughing and mucus production. They also can experience fatigue, which limits their activities. The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interventions can be selected. Joining a support group would not decrease feelings of social isolation if the client does not verbalize feelings. Antianxiety agents will not help the client with social isolation. Encouraging a client to participate in activities without verbalizing concerns also would not be an effective strategy for decreasing social isolation.
A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process should the nurse correlate with this clients history and clinical manifestations?
a. Increased pulmonary pressure creating a higher workload on the right side of the heart
b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles
c. Increased number and size of mucus glands producing large amounts of thick mucus
d. Left ventricular hypertrophy creating a decrease in cardiac output
Smoking increases pulmonary hypertension, resulting in cor pulmonale, or right-sided heart failure. Increased pressures in the lungs make it more difficult for blood to flow through the lungs. Blood backs up into the right side of the heart and then into the peripheral venous system, creating distended neck veins and dependent edema. Inflammation in bronchi and bronchioles creates an airway obstruction which manifests as wheezes. Thick mucus in the lungs has no impact on distended neck veins and edema. Left ventricular hypertrophy is associated with left heart failure and is not caused by a 40-year smoking history.
A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and disheveled. Which question should the nurse ask first?
a. Do you have a strong support system?
b. What do you understand about your disease?
c. Do you experience shortness of breath with basic activities?
d. What medications are you prescribed to take each day?
Clients with severe COPD may not be able to perform daily activities, including bathing and eating, because of excessive shortness of breath. The nurse should ask the client if shortness of breath is interfering with basic activities. Although the nurse should know about the clients support systems, current knowledge, and medications, these questions do not address the clients appearance.
The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, The medication is too expensive to use every day. I only use my inhaler when I have an attack. How should the nurse respond?
a. You are using the inhaler incorrectly. This medication should be taken daily.
b. If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks.
c. Tell me more about your fears related to feelings of breathlessness.
d. It is important to use this type of inhaler every day. Lets identify potential community services to help you.
Long-acting beta2 agonists should be used every day to prevent asthma attacks. This medication should not be taken when an attack starts. Asthma medications can be expensive. Telling the client that he or she is using the inhaler incorrectly does not address the clients financial situation, which is the main issue here. Clients with limited incomes should be provided with community resources. Asking the client about fears related to breathlessness does not address the clients immediate concerns.
A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first?
a. A 46-year-old with a 30pack-year history of smoking
b. A 52-year-old in a tripod position using accessory muscles to breathe
c. A 68-year-old who has dependent edema and clubbed fingers
d. A 74-year-old with a chronic cough and thick, tenacious secretions
The client who is in a tripod position and using accessory muscles is working to breathe. This client must be assessed first to establish how well the client is breathing and provide interventions to minimize respiratory failure. The other clients are not in acute distress.
The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home. Which statement indicates the client correctly understands the teaching?
a. I plan to wear my oxygen when I exercise and feel short of breath.
b. I will use my portable oxygen when grilling burgers in the backyard.
c. I plan to use cotton balls to cushion the oxygen tubing on my ears.
d. I will only smoke while I am wearing my oxygen via nasal cannula.
Cotton balls can decrease pressure ulcers from the oxygen tubing. Continuous oxygen orders mean the client should wear the oxygen at all times. Oxygen fuels a fire. Wearing oxygen while grilling and smoking increases the risk for fire.
A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, What does this mean? How should the nurse respond?
a. Your children will be at high risk for the development of chronic obstructive pulmonary disease.
b. I will contact a genetic counselor to discuss your condition.
c. Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke.
d. This is a recessive gene and should have no impact on your health.
The gene for AAT is a recessive gene. Clients with only one allele produce enough AAT to prevent chronic obstructive pulmonary disease (COPD) unless the client smokes. A client with two alleles is at high risk for COPD even if not exposed to smoke or other irritants. The client is a carrier, and children may or may not be at high risk depending on the partners AAT levels. Contacting a genetic counselor may be helpful but does not address the clients current question.
A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic response to the medication?
a. Bronchodilator Stabilizes the membranes of mast cells and prevents the release of inflammatory mediators
b. Cholinergic antagonist Causes bronchodilation by inhibiting the parasympathetic nervous system
c. Corticosteroid Relaxes bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors
d. Cromone Disrupts the production of pathways of inflammatory mediators
Cholinergic antagonist drugs cause bronchodilation by inhibiting the parasympathetic nervous system. This allows the sympathetic nervous system to dominate and release norepinephrine that actives beta2 receptors. Bronchodilators relax bronchiolar smooth muscles by binding to and activating pulmonary beta2 receptors. Corticosteroids disrupt the production of pathways of inflammatory mediators. Cromones stabilize the membranes of mast cells and prevent the release of inflammatory mediators.
A nurse evaluates the following arterial blood gas and vital sign results for a client with chronic obstructive pulmonary disease (COPD):Arterial Blood Gas Results Vital Signs
pH = 7.32
PaCO2 = 62 mmHg
PaO2 = 46 mm Hg
HCO3 = 28 mEq/L
Heart rate = 110 beats/min
Respiratory rate = 12 breaths/min
Blood pressure = 145/65 mm Hg
Oxygen saturation = 76%
Which action should the nurse take first?
a. Administer a short-acting beta2 agonist inhaler.
b. Document the findings as normal for a client with COPD.
c. Teach the client diaphragmatic breathing techniques.
d. Initiate oxygenation therapy to increase saturation to 92%.
Oxygen should be administered to a client who is hypoxic even if the client has COPD and is a carbon dioxide retainer. The other interventions do not address the clients hypoxia, which is the priority.
A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take? (Select all that apply.)
a. Administer prescribed salmeterol (Serevent) inhaler.
b. Assess the client for a tracheal deviation.
c. Administer oxygen to keep saturations greater than 94%.
d. Perform peak expiratory flow readings.
e. Administer prescribed albuterol (Proventil) inhaler.
ANS: C, E
Suprasternal retraction caused by inhalation usually indicates that the client is using accessory muscles and is having difficulty moving air into the respiratory passages because of airway narrowing. Wheezing indicates a narrowed airway; a decreased pulse oxygen saturation also supports this finding. The asthma is not responding to the medication, and intervention is needed. Administration of a rescue inhaler is indicated, probably along with administration of oxygen. The nurse would not do a peak flow reading at this time, nor would a code be called. Midline trachea is a normal and expected finding.
A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition should the nurse include in this clients teaching? (Select all that apply.)
a. Avoid drinking fluids just before and during meals.
b. Rest before meals if you have dyspnea.
c. Have about six small meals a day.
d. Eat high-fiber foods to promote gastric emptying.
e. Increase carbohydrate intake for energy.
ANS: A, B, C
Fluids can make a client feel bloated and should be avoided with meals. Resting before the meal will help a client with dyspnea. Six small meals a day also will help to decrease bloating. Fibrous foods can produce gas, which can cause abdominal bloating and can increase shortness of breath. The client should increase calorie and protein intake to prevent malnourishment. The client should not increase carbohydrate intake as this will increase carbon dioxide production and increase the clients risk of for acidosis.
A nurse assesses a client with chronic obstructive pulmonary disease. Which questions should the nurse ask to determine the clients activity tolerance? (Select all that apply.)
a. What color is your sputum?
b. Do you have any difficulty sleeping?
c. How long does it take to perform your morning routine?
d. Do you walk upstairs every day?
e. Have you lost any weight lately?
ANS: B, C, E
Difficulty sleeping could indicate worsening breathlessness, as could taking longer to perform activities of daily living. Weight loss could mean increased dyspnea as the client becomes too fatigued to eat. The color of the clients sputum would not assist in determining activity tolerance. Asking whether the client walks upstairs every day is not as pertinent as determining if the client becomes short of breath on walking upstairs, or if the client goes upstairs less often than previously.
A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secretions. Which interventions should the nurse include in this clients plan of care? (Select all that apply.)
a. Ask the client to drink 2 liters of fluids daily.
b. Add humidity to the prescribed oxygen.
c. Suction the client every 2 to 3 hours.
d. Use a vibrating positive expiratory pressure device.
e. Encourage diaphragmatic breathing.
ANS: A, B, D
Interventions to decrease thick tenacious secretions include maintaining adequate hydration and providing humidified oxygen. These actions will help to thin secretions, making them easier to remove by coughing. The use of a vibrating positive expiratory pressure device can also help clients remove thick secretions. Although suctioning may assist with the removal of secretions, frequent suctioning can cause airway trauma and does not support the clients ability to successfully remove secretions through normal coughing. Diaphragmatic breathing is not used to improve the removal of thick secretions.
Sets found in the same folder
NCLEX questions: Perioperative Nursing
NCLEX Questions-Acid-Base Balance
POST-OP CARE NCLEX QUESTIONS
Acid Base Nclex Questions
Other sets by this creator
peds exam 2
Fast Stream OB Scenarios
Nclex style questions somatoform/disassociative fo…
Exam 1 - Psychiatric/Mental Health Nursing
Other Quizlet sets
Mineral's, Igneous, Sedimentary, Metamor…
Osmosis and diffusion quest browne
ap psych unit 1