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respiratory ignatavicius test questions, Exams of Nursing

State Fair Community CollegeNursing

respiratory ignatavicius test questions

Typology: Exams

2019/2020

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Ignatavicius
Chapter 29: Assessment of the Respiratory System
1. A client has undergone a thoracentesis. Which assessment finding requires immediate
action by the nurse?
b. Tachycardia
An increased heart rate may indicate that the client is developing a pneumothorax or
hypoxia. Although it is important to note immediately whether the client is experiencing a
decreased level of consciousness, increased temperature, or a slowed respiratory rate, none
of these is as indicative of a life-threatening complication as tachycardia.
2. The nurse assesses a client after an open lung biopsy. Which assessment finding is
matched with the correct intervention?
c. Client has reduced breath sounds; nurse calls physician immediately.
A potentially serious complication after biopsy is pneumothorax, which is indicated by
decreased or absent breath sounds. The physician needs to be notified immediately.
Dizziness after the procedure is not an expected finding. If the client’s heart rate is 55 beats/
min, no reason is known to withhold pain medication. A respiratory rate of 18 breaths/min is
a normal finding and would not warrant changing the oxygen flow rate.
3. The nurse is caring for four clients who had arterial blood gases (ABGs). Which laboratory
value warrants immediate intervention by the nurse?
d. PaCO2 of 48 mm Hg
Although the nurse should note the results of all laboratory work, only a PaCO2 of 48 mm Hg
is likely to culminate in serious symptoms for the client. HCO3–, SpO2, and pH levels as
assessed would not be life threatening, nor would they be indicative of serious complications
that would override the importance of the PaCO2 level.
4. The nurse is calculating a client’s smoking history in pack-years. The client has recently
been diagnosed with lung cancer. Which is the nurse’s priority intervention during the
interview?
c. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty.
Smoking history includes the use of cigarettes, cigars, pipe tobacco, marijuana, and other
controlled substances. Ask the client whether any of these substances are used now or were
used in the past. Assess whether the client has passive exposure to smoke in the home or
workplace. If the client smokes, ask for how long, how many packs a day, and whether he or
she has quit smoking (and how long ago). Document the smoking history in pack-years
(number of packs smoked daily multiplied by the number of years the client has smoked).
Because the client may have guilt or denial about this habit, assume a nonjudgmental
attitude during the interview. This will encourage the client to be honest about the exposure.
5. When assessing a client’s respiratory status, which information is of highest priority for
the nurse to obtain?
d. Occupation and hobbies
Many respiratory problems occur as a result of chronic exposure to inhalation irritants used
in a client’s occupation and hobbies. Although it will be important for the nurse to assess the
client’s fluid intake, height, and weight, these will not be as important as determining his
occupation and hobbies. Determining the client’s neck circumference will not be an
important part of a respiratory assessment.
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Ignatavicius Chapter 29: Assessment of the Respiratory System

  1. A client has undergone a thoracentesis. Which assessment finding requires immediate action by the nurse? b. Tachycardia An increased heart rate may indicate that the client is developing a pneumothorax or hypoxia. Although it is important to note immediately whether the client is experiencing a decreased level of consciousness, increased temperature, or a slowed respiratory rate, none of these is as indicative of a life-threatening complication as tachycardia.
  2. The nurse assesses a client after an open lung biopsy. Which assessment finding is matched with the correct intervention? c. Client has reduced breath sounds; nurse calls physician immediately. A potentially serious complication after biopsy is pneumothorax, which is indicated by decreased or absent breath sounds. The physician needs to be notified immediately. Dizziness after the procedure is not an expected finding. If the client’s heart rate is 55 beats/ min, no reason is known to withhold pain medication. A respiratory rate of 18 breaths/min is a normal finding and would not warrant changing the oxygen flow rate.
  3. The nurse is caring for four clients who had arterial blood gases (ABGs). Which laboratory value warrants immediate intervention by the nurse? d. PaCO2 of 48 mm Hg Although the nurse should note the results of all laboratory work, only a PaCO2 of 48 mm Hg is likely to culminate in serious symptoms for the client. HCO3–, SpO2, and pH levels as assessed would not be life threatening, nor would they be indicative of serious complications that would override the importance of the PaCO2 level.
  4. The nurse is calculating a client’s smoking history in pack-years. The client has recently been diagnosed with lung cancer. Which is the nurse’s priority intervention during the interview? c. Maintain a nonjudgmental attitude to avoid causing the client to feel guilty. Smoking history includes the use of cigarettes, cigars, pipe tobacco, marijuana, and other controlled substances. Ask the client whether any of these substances are used now or were used in the past. Assess whether the client has passive exposure to smoke in the home or workplace. If the client smokes, ask for how long, how many packs a day, and whether he or she has quit smoking (and how long ago). Document the smoking history in pack-years (number of packs smoked daily multiplied by the number of years the client has smoked). Because the client may have guilt or denial about this habit, assume a nonjudgmental attitude during the interview. This will encourage the client to be honest about the exposure.
  5. When assessing a client’s respiratory status, which information is of highest priority for the nurse to obtain? d. Occupation and hobbies Many respiratory problems occur as a result of chronic exposure to inhalation irritants used in a client’s occupation and hobbies. Although it will be important for the nurse to assess the client’s fluid intake, height, and weight, these will not be as important as determining his occupation and hobbies. Determining the client’s neck circumference will not be an important part of a respiratory assessment.
  1. The nursing assistant reports to the nurse that an African-American client’s pulse oximetry reading is 93%. The client has no complaints. Which action by the nurse is most appropriate? c. Assess other signs of respiratory adequacy. Normal pulse oximetry readings are 95% to 100%. However, people with dark skin can have readings that are 3% to 5% lower owing to the darker coloration of the nail bed. The nurse should assess other signs of respiratory adequacy because this may be a normal finding for this client.
  2. The nurse is caring for an older adult client with a pulmonary infection. Which nursing action is a priority with this client? b. Assessing the client’s level of consciousness Assessing the client’s level of consciousness will be most important because it will show how the client is responding to the presence of the infection. Although it will be important for the nurse to encourage the client to turn, cough, and breathe deeply frequently; to raise the head of the bed; and to humidify the oxygen administered, none of these actions will be as important as assessing the level of consciousness. Also, the client who has a pulmonary infection may not be able to cough effectively if an area of abscess is present.
  3. The nurse is assessing a client’s breath sounds. Which assessment finding has been correctly linked to the nurse’s primary intervention? c. Wheezes heard in central areas; administer inhaled bronchodilator. Wheezes are indicative of narrowed airways, and bronchodilators help to open the air passages. Hollow sounds are typically heard over the trachea, and no intervention is necessary. If crackles are heard, the client may need a diuretic. Crackles represent a deep interstitial process, and coughing forcefully will not help the client expectorate secretions. Vesicular sounds heard in the periphery are normal and require no interventions.
  4. A client has a long-standing history of chronic obstructive pulmonary disease (COPD). Which laboratory finding does the nurse correlate with this condition? b. Hemoglobin, 22 g/dL Normal hemoglobin for a female is 12 to 16 g/dL. Clients with COPD have chronic hypoxia, which stimulates the production of erythropoietin and thus raises the red blood cell count and hemoglobin and hematocrit levels. All other values are normal.
  5. The nurse is caring for several clients on a respiratory unit. Which client does the nurse see first? c. Young adult with an arterial oxygen level of 85% The young adult with an impaired arterial oxygen level should be seen first. A level of 90% to 100% is a normal level for this age-group. The older adult with a pulse oxygen of 96% is within normal limits, as is an adult with a pulse oxygen of 94%. An arterial oxygen level of 94% would also be seen as normal.
  6. A client with a history of chronic obstructive pulmonary disease (COPD) presents to the clinic with increased cough and low-grade temperature. Which question by the nurse elicits the most useful information? b. “Has your sputum changed color?” Clients with COPD usually have a productive cough. If the color has changed, that is a noteworthy finding. If the client’s sputum is yellow or green, this may indicate a pulmonary

Benzocaine spray can be used as a topical anesthetic before bronchoscopy to numb the throat. However, its use is associated with methemoglobinemia. Methemoglobin does not carry oxygen, and a clue to this problem is increasing cyanosis refractory to oxygen. Chocolate brown blood is another characteristic of this problem. The other options are all appropriate but are not the priority.

  1. A client is scheduled to undergo a thoracentesis. What is the nurse’s priority intervention? d. Verify that informed consent has been given by the client. A thoracentesis is an invasive procedure with many potentially serious complications. Verifying that the client understands complications and explaining the procedure to be performed will be done by the physician, not the nurse. Measurement of oxygen saturation before and after a 12-minute walk is not a procedure unique to a thoracentesis.
  2. The nurse is caring for a client after a thoracentesis. Which assessment finding by the nurse warrants immediate action? d. Trachea is deviated toward opposite side of the neck. A deviated trachea is a manifestation of a tension pneumothorax, which is a medical emergency. The other findings are normal or near-normal.
  3. A client had a bronchoscopy 2 hours ago and is requesting water to drink. Which action by the nurse is most appropriate? c. Assess the client’s gag reflex before giving anything. The topical anesthetic used during the procedure will have affected the client’s gag reflex. Before allowing the client anything to eat or drink, the nurse must check for the return of this reflex.
  4. A client is scheduled for pulmonary function tests (PFTs) in the morning. The nurse calls the client to teach about the procedure. Which statement by the client indicates a need for further teaching? c. “I should use my inhaler anytime during the test if I need it.” Bronchodilators may need to be held before PFTs. The client should not plan to use them at any time during the test if he or she experiences dyspnea. The other options show adequate understanding.

Ignatavicius Chapter 30: Care of Patients Requiring Oxygen Therapy or Tracheostomy

  1. The nurse is caring for a client with a new tracheostomy. Which assessment finding requires the nurse’s immediate action? c. Crackling sensation around the neck when skin is palpated. Subcutaneous emphysema occurs when an opening or tear occurs in the trachea and air escapes into fresh tissue planes of the neck. Air can also progress through the chest and other tissues into the face. Inspect and palpate for air under the skin around the new tracheostomy. If the skin is puffy and you can feel a crackling sensation, notify the physician immediately. Cuff pressures should be maintained between 14 and 20 mm Hg or between 20 and 28 cm H2O. Tracheostomy ties need to be changed at least once a day or whenever soiled. It is not uncommon for a client with a new tracheostomy to have heavy secretions that would necessitate changing them. It is not unusual to have a small amount of bleeding around the incision for the first few days after surgical placement.
  2. A client has a new tracheostomy and is receiving 60% oxygen via tracheostomy collar. Which assessment finding requires immediate action by the nurse? a. Constant, nonproductive coughing Causes and manifestations of lung injury from oxygen toxicity include nonproductive cough, substernal chest pain, GI upset, and dyspnea. Blood-tinged sputum is expected in clients with new tracheostomies. Rhonchi in upper lobes indicates sputum that can be expectorated and is not an emergent problem. Dry mucous membranes should be lubricated, and the client’s hydration status can be checked.
  3. A client has been placed on 6 L of humidified oxygen via nasal cannula. Which action by the nurse is most appropriate? d. Remove condensation in the tubing by disconnecting and emptying it appropriately. Condensation often forms in the tubing when a client receives humidified high-flow oxygen. Remove this condensation as it collects by disconnecting the tubing and emptying the water. Some humidifiers and nebulizers have a water trap that hangs from the tubing so the condensation can be drained without disconnecting. To prevent bacterial contamination, never drain the fluid back into the humidifier or the nebulizer. Do not turn down the humidity because the physician has ordered it and the client needs it. Minimize how long the tubing is disconnected because the client does not receive oxygen during this period.
  4. A client is being discharged with a tracheostomy and voices concern about his appearance. What discharge teaching will assist the client with maintaining a positive body image? b. “Your clothing can help hide the tracheostomy so it is not as noticeable.” The client may have an alteration in body image because of the tracheostomy stoma. Encourage the client to wear loose-fitting shirts and collars to help hide the appearance of the stoma. Clients should not be encouraged to tell people about their illness, because they should not be made to “justify” their appearance. You should not bandage the tracheostomy, because airflow would be impaired. Ignoring comments will not help the client’s self-image.
  5. A client is becoming frustrated because of an inability to communicate with a tracheostomy. Which intervention by the nurse most effectively enhances communication? d. Provide the client with a communication board and call light within easy reach. A communication board and the call light will reassure the client that needs will be communicated and met. It is doubtful that the client with a tracheostomy will ever speak

condition, the best action is first to assess pulse oximetry and then to increase the oxygen. You would not just document the assessment finding without intervening. Raising the head of the bed would not help the client oxygenate better.

  1. The nurse assesses a client who is receiving oxygen via a partial rebreather mask. Which assessment finding does the nurse intervene to correct? c. The oxygen flow rate is 2 L/min. Flow rate should be 6 to 11 L/min. A flow rate of 2 L/min will not adequately inflate the bag. A bag that is two thirds inflated is desired. A pulse oximetry reading of 93% and higher is adequate, as is an arterial oxygenation of 90%.
  2. A client is to be discharged home on oxygen therapy. What information does the nurse teach the client? c. “The D or C cylinder can be carried.” The D and C cylinders are small enough to be carried. The H cylinder cannot be carried. The E tank can be transported. The tanks should not be rolled and should be carried only in a stand or a rack.
  3. The nurse assesses a client with a new tracheotomy, and the tracheostomy tube is pulsating in synchrony with the client’s heartbeat. Which is the nurse’s priority action? a. Notify the health care provider immediately. If a tracheostomy tube is pulsating with the client’s heart rate, this could indicate proximity to the innominate artery and may cause erosion of the artery if left in this position. The provider should be notified immediately. Reapplying the ties, changing the inner cannula, and increasing the inflation pressure of the cuff are all interventions that will not solve the immediate problem of proximity of the tube to the innominate artery.
  4. A client is 24 hours postoperative after a tracheostomy has been performed. The nurse finds the client cyanotic, with the tracheostomy tube lying on his chest. Which action by the nurse takes priority? b. Ventilate with a resuscitation bag and mask. Tube dislodgment in the first 72 hours after surgery is an emergency because the tracheostomy tract has not matured and replacement is difficult. First, ventilate the client using a manual resuscitation bag and facemask while another nurse calls for help. Although auscultation of breath sounds is important, the client’s airway must be opened and ventilation started. Ventilation should begin while another nurse calls the code. Reinsertion of a fresh tracheostomy tube will require the physician’s intervention.
  5. While suctioning a client who had a tracheostomy placed 4 days ago, the nurse notes particles of food in the tracheal secretions. Which action by the nurse is most appropriate? d. Perform a more thorough assessment of the client. Before calling the provider, the nurse needs more data, such as lung sounds, presence of cough, pulse oximetry reading, and possibly mental status. The nurse could temporarily make the client NPO while conducting this assessment, but calling the provider must wait until he or she has more complete data. The nurse should not decide to increase the inflation pressure in the tracheostomy cuff on his or her own. Adding dye to food, drink, or tube feeding formulas was commonly done in the past but should be avoided because the dye is toxic to lung tissues if aspirated.
  6. The nurse is teaching a client about his fenestrated tracheostomy tube. Which statement by the client indicates an accurate understanding of the tube?

a. “I’m glad I will still be able to talk with this tube in place.” The client can speak with a fenestrated tube, which has a hole in it and allows air to flow over the vocal cords. The tube still needs to be cleaned and suctioned. The tube may become dislodged, and the client is able to swallow.

  1. The nurse observes a nursing student suctioning a client. Which intervention by the student nurse requires the supervising nurse to intervene? d. Applying suction when the catheter is inserted Applying suction as the catheter is introduced allows the tubing to adhere to the airway and destroys cells. The other options are appropriate actions on the part of a nurse or student who is suctioning a client.
  2. The nurse assesses a client during suctioning. Which finding indicates that the procedure should be stopped? d. Heart rate decreases from 78 to 40 beats/min. A decrease in heart rate indicates that the client is not tolerating the procedure, and the vasovagal reflex may be stimulated. An increase in heart rate may be stimulated by suctioning and is expected, as is a slight increase in blood pressure. A slight increase in respiratory rate after the procedure might be caused by the feeling of oxygen being suctioned from the client’s airway, along with secretions.
  3. A client is being discharged home with a tracheostomy. Which action does the nurse teach the client to decrease the risk for aspiration while eating? b. Thicken all liquids. Thickening liquids may assist the client in swallowing and may help prevent aspiration. Swallowing quickly will not decrease the risk of aspiration and may actually put the client at greater risk. It is not recommended that the client drink water to wash down food. Chewing food completely will help prevent choking but will not decrease aspiration risk.
  4. The nursing student is performing tracheostomy care on a client. Which action by the student leads the supervising nurse to intervene? b. Cutting a slit in a gauze 4 ´ 4 pad to fit around the stoma Tracheostomy dressings should be made from gauze pads with a manufactured slit in them that fits around the tube. If none are available, use two gauze pads folded in half placed on either side of the tube. Cutting a piece of gauze could result in entry of tiny shreds of the gauze the tracheostomy. The other interventions are appropriate.
  5. A client receiving high-flow oxygen has new crackles and diminished breath sounds since the last assessment 1 hour ago. Which action by the nurse is most appropriate? b. Instruct the client to use the spirometer and to cough and deep breathe. A client who is receiving high rates of oxygen is at risk for absorption atelectasis, in which the normal nitrogen in the air becomes diluted and the alveoli collapse. Hallmarks of this condition include new onset of crackles and diminished breath sounds. Spirometer use, coughing, and deep-breathing exercises would help to re-expand the alveoli. None of the other options are appropriate choices.
  6. Which statement by a client indicates an accurate understanding of home self-care of a tracheostomy? c. “While showering, I need to keep water out of my airway.”

The client with a tracheostomy will require close supervision, even if the client is feeding himself or herself. Do not rush the client. Allow him or her to indicate when ready for another bite. Teaching interventions should include instructing the client to tuck the chin down and forward while swallowing to encourage food to move down smoothly. Dry swallowing helps remove food residue. Food may actually become easier to aspirate if it is thinner in texture. The nurse should not initiate adding air to inflate the cuff of a tracheostomy tube further without a physician’s order; if possible, the cuff should be deflated during eating. Placing the client in a semi-Fowler’s position after the meal will not prevent aspiration.

Ignatavicius Chapter 31: Care of Patients with Noninfectious Upper Respiratory Problems

  1. A high school athlete has suffered a nasal fracture. What is the priority action of the nurse caring for the client? d. Assess for airway patency. A patent airway is the priority. The nurse first should make sure that the airway is patent, then should determine whether the client is in pain, and whether bone displacement or blood loss has occurred.
  2. After facial trauma, a client has a nasal fracture and is reporting constant nasal drainage, a headache, and difficulty with vision. What is the nurse’s first action? a. Collect the nasal drainage on a piece of filter paper. The client with nasal drainage after facial trauma could have a skull fracture that has resulted in leakage of cerebral spinal fluid (CSF). CSF can be differentiated from regular drainage by the fact that it forms a halo when dripped on filter paper. The other actions would be appropriate but are not as high a priority as assessing for CSF. A CSF leak would increase the client’s risk for infection.
  3. What is the nurse’s most important action after a client’s gag reflex has returned post rhinoplasty? d. Have the client drink at least 2500 mL/day. Once the gag reflex has returned, the client should drink at least 2 1/2 liters per day. The client should not change position frequently; the best position is semi-Fowler’s. Ice rather than heat should be applied. Lying flat is not recommended.
  4. A client reports waking up feeling very tired, even after 8 hours of good sleep. What is the nurse’s best action? d. Ask the client whether he or she has ever been evaluated for sleep apnea. Clients are usually unaware that they have sleep apnea, but it should be suspected in people who have persistent daytime sleepiness and report waking up tired. Causes of the problem should be assessed before the client is offered suggestions for treatment.
  5. A client had a partial laryngectomy and has received instructions on the supraglottic method of swallowing. Which action by the nurse is most appropriate? a. Place a chart in the client’s room detailing the steps in the process. The client who is status post partial laryngectomy should be taught alternative methods of swallowing, and a chart should be placed in the client’s room to reinforce teaching. A dynamic swallow study is performed to guide rehabilitation for swallowing. Repeating the steps each shift is not as effective as showing the client a chart. Having the client demonstrate swallowing may not verify that he or she correctly understands supraglottic swallowing. A chart in the room will be most effective in helping both client and staff with this method.
  6. A client has open vocal cord paralysis. Which technique does the nurse teach the client to do to prevent aspiration? b. Tuck the chin down when swallowing. The client with open vocal cord paralysis may aspirate. The nurse should teach the client to tuck in his or her chin during swallowing to prevent aspiration. Tilting the head back would increase the chance of aspiration. Breathing slowly would not decrease the risk of aspiration,

b. “When I speak at all, I will whisper rather than use a normal tone of voice.” Treatment for vocal cord polyps includes not speaking, no lifting, and no smoking. The client has to be educated not to even whisper when resting the voice. It is also appropriate for the client to stay out of rooms where people are smoking, and to stay hydrated and use stool softeners.

  1. A client states that he is going to relax on the beach between radiation treatments for laryngeal cancer to help his “mental status.” What is the nurse’s best response? c. “Your skin can become severely burned, and you should not be out in the sun.” The client should stay out of the sun during treatment because the skin can become severely burned. Sunscreen may or may not help, but an SPF of 15 is low and does not provide adequate prevention.
  2. The nurse is observing a client performing stoma care for a laryngectomy for the first time. Which action does the nurse reinforce? a. Washing the stoma with soap and water The client is taught to wash the stoma gently and to prevent anything from getting into the opening. The client should never scrape around the opening because this could cause broken skin, irritation, and infection. Peroxide is not used for irrigation; irrigation of the stoma is not done.
  3. A client has undergone a nasoseptoplasty 2 hours ago. It is a priority for the nurse to assess for which factor? d. Airway patency Assessing and maintaining a patent airway is always the top priority. The other assessments are important but do not take priority over airway.
  4. A client develops posterior nasal bleeding and has packing inserted. What is the nurse’s priority action? d. Make sure the string is taped to the client’s cheek. The thread is attached to the client’s cheek that holds the packing in place. The nurse needs to make sure that this does not move because it can occlude the client’s airway. The other options are good interventions, but ensuring that the airway is patent is the priority objective.
  5. A client who has sleep apnea is reporting constant daytime sleepiness. The client has multiple other chronic diseases. What is the nurse’s best action? b. Perform a health history. The nurse should first assess the client and determine whether he or she has other chronic diseases. If the client’s other disorders are not contradictory, the client may be eligible for therapy with modafinil (Attenace) to increase wakefulness during the day. Certain cardiac disorders may prohibit the use of this drug owing to its simulative effects. A sleeping pill would not be an appropriate intervention for a client with sleep apnea. A private room will not help to increase the client’s sleep in sleep apnea. MULTIPLE RESPONSE
  6. The nurse is assessing a client who is 6 hours post surgery for a nasal fracture. The client has facial pain (5 out of 10) and nasal packing in place. What actions by the nurse are most appropriate at this time? (Select all that apply.)

a. Observe for clear drainage. b. Observe for bleeding. c. Observe the client for frequent swallowing. d. Ask the client to open his or her mouth. g. Administer pain medication. ANS: A, B, C, D, G The nurse should observe for clear drainage because of the risk for cerebrospinal fluid (CSF) leakage. The nurse should note whether the client is swallowing frequently because this could indicate postnasal bleeding. The nurse should also ask the client to open his or her mouth and should observe the back of the throat for bleeding. Pain medication should also be administered. It is too soon to change the packing, which should be changed by the surgeon the first time. A nasal steroid would increase the risk for infection.

  1. The client with which conditions requires immediate nursing intervention? (Select all that apply.) a. Shortness of breath b. Sternal retractions e. Respiratory rate of 8 breaths/min g. Stridor ANS: A, B, E, G The client with sternal retraction is experiencing serious respiratory difficulty, as is the client with stridor. The client who reports shortness of breath needs immediate assessment, as does the client with a respiratory rate of 8. A pulse oximetry of 95% is within normal limits, as is a pH of 7.35. The client with expiratory wheezes needs to be assessed, but not immediately.
  2. A client develops epistaxis. Which conditions in the client’s history could have contributed to this problem? (Select all that apply.) b. Hypertension c. Leukemia d. Cocaine use ANS: B, C, D Frequent causes of nosebleeds include trauma, hypertension, leukemia and other blood dyscrasias, inflammation, tumor, dry air, blowing or picking the nose, cocaine use, and intranasal procedures. Diabetes, migraine, and elevated platelets and cholesterol levels do not cause epistaxis.
  3. The nurse is assessing a client with facial trauma. Which assessment findings require immediate intervention? (Select all that apply.) a. Stridor d. Ecchymosis behind the ear ANS: A, D

Ignatavicius Chapter 32: Care of Patients with Noninfectious Lower Respiratory Problems

  1. A client with asthma reports “not being able to take deep breaths.” The nurse auscultates decreased breath sounds in the bases, and no wheezes. What is the nurse’s best action? d. Assess the client’s oxygen saturation. Decreased wheezing accompanied by decreased breath sounds can mean airway occlusion from mucus and from inflammation. The nurse should assess the client’s oxygenation and determine whether additional interventions are needed. Coughing forcefully may cause the smaller airways to collapse and may not help the client. Encouraging the client to remain calm and to try to take deep breaths is not helpful. Although providing documentation is important, the nurse needs to do more than that.
  2. A client with asthma has been having frequent asthma attacks. What is the nurse’s best action? d. Administer montelukast (Singulair). A client who has been having increased attacks can have some chronic inflammation occurring. This inflammation is probably stimulated by mediators such as histamine and leukotriene and can be blocked by drugs like diphenhydramine (Benadryl) and montelukast (Singulair).
  3. A client diagnosed with asthma has not responded well to medication. The client is concerned and asks the nurse, “What is wrong with me, and why am I not getting better?” What is the nurse’s best response? c. “It is possible that genetic testing may help.” Some genetic variations may cause the activity of beta-adrenergic receptors to change, meaning that the client would not respond as expected to beta agonists. Genetic testing may help to determine why the drug therapy is not working and may help the clinician to identify new therapy that will work.
  4. The nurse is caring for four clients with asthma. Which client does the nurse assess first? d. Client whose heart rate is 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.
  5. The nurse is caring for an older adult who reports experiencing frequent asthma attacks and severe arthritic pain. What action by the nurse is most appropriate? b. Assess use of medication for arthritis. Aspirin and other 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 client’s 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.
  6. The nurse is evaluating a client’s response to medication therapy for asthma. The client has a peak flowmeter reading in the yellow zone. What does the nurse do next?

c. Assist the client to use a rescue inhaler. The client with a peak flow reading in the yellow zone needs to use a rescue inhaler, then have a reading taken again within a few minutes. The nurse has no reason to assess the client’s lungs at this point in time, nor would the nurse take the time to teach at this moment.

  1. Which statement indicates that the client understands teaching about the use of long- acting beta2 agonist medications? c. “I will take this medication daily to prevent an acute attack.” This medication will help prevent an acute asthma attack because it is long acting. The client will take this medication every day for best effect. 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.
  2. Which statement indicates that a client understands teaching about the correct use of a corticosteroid medication? b. “This drug is effective in decreasing the frequency of my asthma attacks.” Corticosteroids decrease inflammatory and immune responses in many ways, including preventing the synthesis of mediators. Both inhaled corticosteroids and those taken orally are preventive; they are not effective in reversing symptoms during an asthma attack and should not be used as rescue drugs. Systemic corticosteroids, because of severe side effects, are avoided for mild to moderate intermittent asthma and are used on a short-term basis for moderate asthma.
  3. A client is using omalizumab (Xolair) for the first time. What is the priority nursing action? d. Remain with the client and assess for anaphylaxis. Immune modulators are monoclonal antibodies that prevent allergens from binding to receptor sites on mast cells and basophils. The risk of anaphylaxis is high; the nurse should assess and stay with the client.
  4. A client is demonstrating diaphragmatic breathing for the nurse. Which action by the client shows adequate understanding of this breathing technique? b. Having his or her hands on the abdomen To perform diaphragmatic breathing correctly, the client should put the 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.
  5. A client is undergoing lung reduction surgery. What is the nurse’s highest priority preoperatively? d. Teach about preoperative testing. In addition to standard preoperative testing, the client who will undergo lung reduction surgery is tested to determine the location of greatest lung hyperinflation and poorest lung blood flow. These tests include pulmonary plethysmography, gas dilution, and perfusion scans. The other interventions are lower priorities.
  6. The nurse assesses a client receiving chemotherapy for lung cancer and notes red swollen mucous membranes and open sores in the mouth. The client reports mouth pain and difficulty swallowing. Which action does the nurse perform first?

Comparing exercise tolerance before and after activity will not give the client the most complete information about his or her asthma.

  1. Which statement indicates that a client needs additional teaching about using an inhaler? c. “I will soak my inhaler in water to clean it.” Submerging an inhaler in water to wash it is not necessary and may cause the medication in the inhaler to clump together if it is a dry powder inhaler. The other statements are all correct—the client should not exhale into the inhaler, can store the inhaler in his or her bedroom, and will need to inhale and hold breath slightly when using the inhaler.
  2. The home care nurse observes white patches on the oral mucosa of a client with severe, chronic airflow limitation. What is the nurse’s best action? a. Ask the client whether he or she uses a steroid inhaler. Excessive use of steroid inhalers reduces local immune function and increases the client’s risk for oral-pharyngeal infection, including candidiasis, which manifests as white patches on the oral mucosa. The client should not brush the lesions, and salt water will not help the sores. Recent illnesses would have no effect on these lesions.
  3. What statement indicates that a client needs further teaching regarding therapy with salmeterol (Serevent)? c. “I will use the drug when I have an asthma attack.” Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. The client does not have to keep this inhaler with him or her always because it is not used as a rescue medication. Salmeterol (Serevent) 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 client’s part allows the drug to escape through the nose and mouth.
  4. The nurse is teaching a client about different medications for asthma. Which medication does the nurse teach the client to administer to control the prolonged inflammatory response? b. Montelukast (Singulair) Leukotriene and eotaxin cause later, prolonged inflammatory responses in asthma, which can be blocked by drugs like montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo). No evidence suggests that aspirin helps this inflammatory response. Histamine starts an immediate inflammatory response, which can be blocked by drugs like diphenhydramine (Benadryl). Bitolterol (Tornalate) is a short-acting beta agonist that will enhance bronchodilation during an asthma attack, but it will not assist in controlling late inflammation.
  5. A client with chronic obstructive pulmonary disease (COPD) reports social isolation. What does the nurse encourage the client to do? c. Verbalize his or her thoughts and feelings. 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.

  1. The nurse is teaching a client with cystic fibrosis. What activity does the nurse teach as the priority? c. Maintaining good nutrition Clients with cystic fibrosis (CF) often are malnourished owing to vitamin deficiency and pancreatic malfunction. Maintaining nutrition is essential. Daily antibiotics and daily exercise are not essential actions. Genetic screening would not help the client manage CF better.
  2. The nurse is assessing a client with lung disease. Which symptom does the nurse intervene for first? c. The client has bilateral dependent leg edema. The client with bilateral dependent edema may be developing right-sided heart failure in response to respiratory disease. This symptom should be investigated right away and reported to the health care provider. Further assessment is needed. The client with chronic lung disease may develop increased anterior-posterior diameter and clubbing as responses to chronic hypoxia. These symptoms do not require immediate intervention. The client is often pale or has a dusky appearance; this also would not warrant immediate intervention.
  3. A client with lung cancer is lying flat in bed and reports shortness of breath. What action does the nurse take first? b. Elevate the head of the bed. The nurse’s first action should be to elevate the head of the bed. Next, assessing oxygen saturation will help the nurse determine the client’s status. If the oxygen is low, the nurse would increase oxygen flow and have the client take deep breaths. The provider could be notified after the nurse performs the interventions.
  4. The nurse observes hematuria in a client receiving IV cyclophosphamide (Cytoxan). After notifying the health care provider, what intervention is the nurse’s priority? d. Stop the medication. Hemorrhagic cystitis is a frequent side effect of cyclophosphamide therapy. The physician should be notified to prescribe co-administration of a bladder-protecting agent. The nurse then should stop the medication. Other actions would be to further assess the client and provide hydration to flush the medication.
  5. A client with pulmonary fibrosis is being discharged home. What is the highest priority teaching need? c. Avoiding infection It is extremely important to teach the client with pulmonary fibrosis to avoid infection because the disease will quickly become worse as a result of decreased lung function. The client may take longer to recover from an infection, and the ability to recover may be severely limited owing to the progression of the disease. Teaching the client about modifications in diet, how to determine response to activity, and treatment medications would be secondary.
  6. The nurse is caring for a client with bronchiolitis obliterans organizing pneumonia (BOOP) and assesses decreased vital capacity during pulmonary function testing. What is the nurse’s best action? d. Document the finding in the client’s chart.