29

Question 1

A patient with chronic bronchitis who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that

a. one drug decreases inflammation, and the other is a bronchodilator.
b. Advair is a combination of long-acting and slow-acting bronchodilators.
c. the combination of two drugs works more quickly in an acute asthma attack.
d. the two drugs work together to block the effects of histamine on the bronchioles.

Answer 1

a. one drug decreases inflammation, and the other is a bronchodilator

Question 2

The nurse has completed patient teaching about the administration of salmeterol (Serevent) using a metered-dose inhaler (MDI). Which action by the patient indicates good understanding of the teaching?

a. The patient attaches a spacer before using the MDI.
b. The patient coughs vigorously after using the inhaler.
c. The patient floats the MDI in water to see if it is empty.
d. The patient activates the inhaler at the onset of expiration.

Answer 2

a. The patient attaches a spacer before using the MDI.

Question 3

When preparing a patient with possible asthma for pulmonary function testing, the nurse will teach the patient to

a. avoid eating or drinking for several hours before the testing.
b. use rescue medications immediately before the tests are done.
c. take oral corticosteroids at least 2 hours before the examination.
d. withhold bronchodilators for 6 to 12 hours before the examination.

Answer 3

d. withhold bronchodilators for 6 to 12 hours before the examination.

Question 4

Which information will the nurse include when teaching the patient with asthma about the prescribed medications?

a. Utilize the inhaled corticosteroid when shortness of breath occurs.
b. Inhale slowly and deeply when using the dry-powder inhaler (DPI).
c. Hold your breath for 5 seconds after using the bronchodilator inhaler.
d. Tremors are an expected side effect of rapidly acting bronchodilators.

Answer 4

d. Tremors are an expected side effect of rapidly acting bronchodilators.

Question 5

When the nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack, which finding is the best indicator that the therapy has been effective?

a. No wheezes are audible.
b. Oxygen saturation is >90%.
c. Accessory muscle use has decreased.
d. Respiratory rate is 16 breaths/minute.

Answer 5

b. Oxygen saturation is >90%.

Question 6

A patient seen in the asthma clinic has recorded daily peak flows that are 85% of the baseline. Which action will the nurse plan to take?

a. Teach the patient about the use of oral corticosteroids.
b. Administer a bronchodilator and recheck the peak flow.
c. Instruct the patient to continue to use current medications.
d. Evaluate whether the peak flow meter is being used correctly.

Answer 6

c. Instruct the patient to continue to use current medications.

Question 7

Which action by a patient who has asthma indicates a good understanding of the nurse’s teaching about peak flow meter use?

a. The patient records an average of three peak flow readings every day.
b. The patient inhales rapidly through the peak flow meter mouthpiece.
c. The patient uses the albuterol (Proventil) metered-dose inhaler (MDI) for peak flows in the yellow zone.
d. The patient calls the health care provider when the peak flow is in the green zone.

Answer 7

c. The patient uses the albuterol (Proventil) metered-dose inhaler (MDI) for peak flows in the yellow zone.

Question 8

A 32-year-old patient who denies any history of smoking is seen in the clinic with a new diagnosis of emphysema. The nurse will anticipate teaching the patient about

a. 1-antitrypsin testing.
b. use of the nicotine patch.
c. continuous pulse oximetry.
d. effects of leukotriene modifiers.

Answer 8

a. 1-antitrypsin testing.

Question 9

Which information about a newly admitted patient with chronic obstructive pulmonary disease (COPD) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline?

a. The patient has had a recent 10-pound weight gain.
b. The patient has a cough productive of green mucus.
c. The patient denies any shortness of breath at present.
d. The patient takes cimetidine (Tagamet) 150 mg daily.

Answer 9

d. The patient takes cimetidine (Tagamet) 150 mg daily.

Question 10

A patient with chronic bronchitis has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care?

a. Titrate oxygen to keep saturation at least 90%.
b. Discuss a high-protein, high-calorie diet with the patient.
c. Suggest the use of over-the-counter sedative medications.
d. Teach the patient how to effectively use pursed lip breathing.

Answer 10

d. Teach the patient how to effectively use pursed lip breathing.

Question 11

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. An appropriate intervention for this problem is to

a. increase the patient’s intake of fruits and fruit juices.
b. have the patient exercise for 10 minutes before meals.
c. assist the patient in choosing foods with a lot of texture.
d. offer high calorie snacks between meals and at bedtime.

Answer 11

d. offer high calorie snacks between meals and at bedtime.

Question 12

When the nurse is interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD), which information will help most in confirming a diagnosis of chronic bronchitis?

a. The patient tells the nurse about a family history of bronchitis.
b. The patient’s history indicates a 40 pack-year cigarette history.
c. The patient denies having any respiratory problems until the last 6 months.
d. The patient complains about a productive cough every winter for 3 months.

Answer 12

d. The patient complains about a productive cough every winter for 3 months.

Question 13

After the nurse has finished teaching a patient about pursed lip breathing, which patient action indicates that more teaching is needed?

a. The patient inhales slowly through the nose.
b. The patient puffs up the cheeks while exhaling.
c. The patient practices by blowing through a straw.
d. The patient’s ratio of inhalation to exhalation is 1:3.

Answer 13

b. The patient puffs up the cheeks while exhaling.

Question 14

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?

a. Pulse oximetry reading of 91%
b. Absence of wheezes or crackles
c. Decreased use of accessory muscles
d. Respiratory rate of 22 breaths/minute

Answer 14

a. Pulse oximetry reading of 91%

Question 15

To evaluate the effectiveness of therapy for a patient with cor pulmonale, the nurse will monitor the patient for

a. elevated temperature.
b. clubbing of the fingers.
c. jugular vein distention.
d. complaints of chest pain.

Answer 15

c. jugular vein distention.

Question 16

When a hospitalized patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen, the best action by the nurse is to

a. minimize oxygen use to avoid oxygen dependency.
b. maintain the pulse oximetry level at 90% or greater.
c. administer oxygen according to the patient’s level of dyspnea.
d. avoid administration of oxygen at a rate of more than 2 L/min.

Answer 16

b. maintain the pulse oximetry level at 90% or greater.

Question 17

Which information will the nurse include in teaching a patient with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy?

a. Storage of oxygen tanks will require adequate space in the home.
b. Travel opportunities will be limited because of the use of oxygen.
c. Oxygen flow should be increased if the patient has more dyspnea.
d. Oxygen use can improve the patient’s prognosis and quality of life.

Answer 17

d. Oxygen use can improve the patient’s prognosis and quality of life.

Question 18

A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse

a. keep the air entrainment ports clean and unobstructed.
b. give a high enough flow rate to keep the bag from collapsing.
c. use an appropriate adaptor to ensure adequate oxygen delivery.
d. drain moisture condensation from the oxygen tubing every hour.

Answer 18

a. keep the air entrainment ports clean and unobstructed.

Question 19

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. The nurse will plan to

a. carry out the procedure 3 hours after the patient eats.
b. maintain the patient in the lateral position for 20 minutes.
c. perform percussion before assisting the patient to the drainage position.
d. give the ordered albuterol (Proventil) after the patient has received the therapy.

Answer 19

a. carry out the procedure 3 hours after the patient eats.

Question 20

When developing a teaching plan to help increase activity tolerance at home for a 70-year-old with severe chronic obstructive pulmonary disease (COPD), the nurse should teach the patient that an appropriate exercise goal is to

a. walk until pulse rate exceeds 130.
b. walk for a total of 20 minutes daily.
c. exercise until shortness of breath occurs.
d. limit exercise to activities of daily living (ADLs).

Answer 20

b. walk for a total of 20 minutes daily.

Question 21

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, “I wish I were dead! I cannot do anything for myself anymore.” Based on this information, which nursing diagnosis is most appropriate?

a. Complicated grieving related to expectation of death
b. Ineffective coping related to unknown outcome of illness
c. Deficient knowledge related to lack of education about COPD
d. Chronic low self-esteem related to increased physical dependence

Answer 21

d. Chronic low self-esteem related to increased physical dependence

Question 22

A patient with chronic obstructive pulmonary disease (COPD) is admitted to the hospital. How can the nurse best position the patient to improve gas exchange?

a. Resting in bed with the head elevated to 45 to 60 degrees
b. Sitting up at the bedside in a chair and leaning slightly forward
c. Resting in bed in a high-Fowler’s position with the knees flexed
d. In the Trendelenburg position with several pillows behind the head

Answer 22

b. Sitting up at the bedside in a chair and leaning slightly forward

Question 23

Which diagnostic test will the nurse plan to discuss with a 54-year-old patient with progressively increasing dyspnea who is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)?

a. Eosinophil count
b. Pulmonary function testing
c. Immunoglobin E (IgE) levels
d. Radioallergosorbent test (RAST)

Answer 23

b. Pulmonary function testing

Question 24

Which action will be included in the plan of care for a 23-year-old with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea?

a. Schedule a sweat chloride test.
b. Arrange for a hospice nurse visit.
c. Place the patient on a low-sodium diet.
d. Perform chest physiotherapy every 4 hours.

Answer 24

d. Perform chest physiotherapy every 4 hours.

Question 25

A patient who is hospitalized with cystic fibrosis (CF) coughs up large quantities of thick green mucus. The nurse will plan to teach the patient about a. antibiotic resistance. b. inhaled bronchodilators. c. oral corticosteroid therapy. d. aerosolized tobramycin (TOBI).

Answer 25

d. aerosolized tobramycin (TOBI).

Question 26

A 20-year-old patient with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which initial response by the nurse is best? a. “Are you aware of the normal lifespan for patients with CF?” b. “Do you need any information to help you with the decision?” c. “You will need to have genetic counseling before making a decision.” d. “Many women with CF do not have difficulty in conceiving children.”

Answer 26

b. “Do you need any information to help you with the decision?”

Question 27

A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing action will be most effective? a. Change the oxygen flow rate to the highest prescribed rate. b. Reinforce the ongoing use of pursed lip breathing techniques. c. Educate the patient to use the Flutter airway clearance device. d. Teach the patient about consistent use of inhaled corticosteroids.

Answer 27

c. Educate the patient to use the Flutter airway clearance device.

Question 28

After the nurse has completed diet teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which patient statement indicates that the teaching has been effective? a. “I will drink lots of fluids with my meals.” b. “I will have ice cream as a snack every day.” c. “I will exercise for 15 minutes before meals.” d. “I will decrease my intake of meat or poultry.”

Answer 28

b. “I will have ice cream as a snack every day.”

Question 29

When teaching the patient with chronic obstructive pulmonary disease (COPD) about exercise, which information should the nurse include? a. “Stop exercising if you start to feel short of breath.” b. “Use the bronchodilator before you start to exercise.” c. “Breathe in and out through the mouth while you exercise.” d. “Upper body exercise should be avoided to prevent dyspnea.”

Answer 29

b. “Use the bronchodilator before you start to exercise.”

Question 30

Which information given by an asthmatic patient while the nurse is doing the admission assessment is most indicative of a need for a change in therapy? a. The patient uses cromolyn (Intal) before any aerobic exercise. b. The patient says that the asthma symptoms are worse every spring. c. The patient’s heart rate increases after using the albuterol (Proventil) inhaler. d. The patient’s only medications are albuterol (Proventil) and salmeterol (Serevent).

Answer 30

d. The patient’s only medications are albuterol (Proventil) and salmeterol

Question 31

When the nurse takes an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath, which information may indicate a need for a change in therapy? a. The patient has a history of pneumonia 2 years ago. b. The patient has chronic inflammatory bowel disease. c. The patient takes propranolol (Inderal) for hypertension. d. The patient uses acetaminophen (Tylenol) for headaches.

Answer 31

c. The patient takes propranolol (Inderal) for hypertension.

Question 32

Which topic will the nurse include in medication teaching for a patient with newly-diagnosed persistent asthma? a. Use of long-acting -adrenergic medications b. Side effects of sustained-release theophylline c. Self-administration of inhaled corticosteroids d. Complications associated with oxygen therapy

Answer 32

c. Self-administration of inhaled corticosteroids

Question 33

A patient with cystic fibrosis (CF) has blood glucose levels that are consistently 200 to 250 mg/dL. Which nursing action will the nurse plan to implement? a. Discuss the role of diet in blood glucose control. b. Educate the patient about administration of insulin. c. Give oral hypoglycemic medications before meals. d. Evaluate the patient’s home use of pancreatic enzymes.

Answer 33

b. Educate the patient about administration of insulin.

Question 34

When caring for a patient with a history of asthma, which assessment finding should the nurse communicate immediately to the health care provider? a. Pulse oximetry reading of 91% b. Respiratory rate of 26 breaths/minute c. Use of accessory muscles in breathing d. Peak expiratory flow rate of 240 mL/min

Answer 34

c. Use of accessory muscles in breathing

Question 35

Which action should the nurse anticipate taking first when a patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing? a. Assist with endotracheal intubation. b. Document changes in respiratory status. c. Encourage the patient to cough and deep breathe. d. Administer IV methylprednisolone (SoluMedrol).

Answer 35

a. Assist with endotracheal intubation.

Question 36

A patient who is experiencing an acute asthma attack is admitted to the emergency department. The nurse’s first action should be to a. listen to the patient’s breath sounds. b. ask about inhaled corticosteroid use. c. determine when the dyspnea started. d. obtain the forced expiratory volume (FEV) flow rate.

Answer 36

a. listen to the patient’s breath sounds.

Question 37

Which finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? a. Pain at injection site b. Flushing and dizziness c. Respiratory rate 22 breaths/minute d. Peak flow reading 75% of normal

Answer 37

b. Flushing and dizziness

Question 38

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 20-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 32-year-old with ABG results: pH 7.50, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 40-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 64-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

Answer 38

a. 20-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg

Question 39

Which of these nursing actions included in the care plan for a patient with chronic obstructive pulmonary disease (COPD) should the nurse delegate to experienced nursing assistive personnel (NAP)? a. Obtain oxygen saturation using pulse oximetry. b. Monitor for increased oxygen need with exercise. c. Teach the patient about safe use of oxygen at home. d. Adjust oxygen to keep saturation in prescribed parameters.

Answer 39

a. Obtain oxygen saturation using pulse oximetry.

Question 40

A patient with asthma who has a baseline peak flow reading of 600 mL calls the nurse, stating that the current peak flow is 420 mL. Which action should the nurse take first? a. Tell the patient to go to the hospital emergency department. b. Instruct the patient to use the prescribed albuterol (Proventil). c. Ask about recent exposure to any new allergens or asthma triggers. d. Question the patient about use of the prescribed inhaled corticosteroids.

Answer 40

b. Instruct the patient to use the prescribed albuterol (Proventil).

Question 41

The following medications are prescribed by the health care provider for a patient having an acute asthma attack. Which one will the nurse administer first? a. salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) b. albuterol (Ventolin) 2.5 mg per nebulizer c. triamcinolone (Azmacort) 2 puffs per metered-dose inhaler (MDI) d. methylprednisolone (Solu-Medrol) 60 mg IV

Answer 41

b. albuterol (Ventolin) 2.5 mg per nebulizer

Question 42

The nurse has received a change-of-shift report about the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first? a. A patient with a respiratory rate of 38 b. A patient with loud expiratory wheezes c. A patient with jugular vein distention and peripheral edema d. A patient who has a cough productive of thick, green mucus

Answer 42

a. A patient with a respiratory rate of 38