lewis 28

Question 1

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful?

a. The patient shakes the device before use.
b. The patient rapidly inhales the medication.
c. The patient attaches a spacer to the Diskus.
d. The patient performs huff coughing after inhalation.

Answer 1

B

Question 2

The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching?

a. The patient attaches a spacer before using the inhaler.
b. The patient coughs vigorously after using the inhaler.
c. The patient removes the facial mask when misting stops.
d. The patient activates the inhaler at the onset of expiration.

Answer 2

C

Question 3

A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?

a. Give the rescue medication immediately before testing.
b. Administer oral corticosteroids 2 hours before the procedure.
c. Withhold bronchodilators for 6 to 12 hours before the examination.
d. Ensure that the patient has been NPO for several hours before the test.

Answer 3

C

Question 4

Which information will the nurse include in the asthma teaching plan for a patient being discharged?

a. Use 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

Question 5

The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective?

a. No wheezes are audible.
b. O2 saturation is >90%.
c. Accessory muscle use has decreased.
d. Respiratory rate is 16 breaths/minute.

Answer 5

B

Question 6

A patient seen in the asthma clinic has recorded daily peak flow rates that are 75% of the baseline. Which action will the nurse plan to take next?

a. Increase the dose of the leukotriene inhibitor.
b. Teach the patient about the use of oral corticosteroids.
c. Administer a bronchodilator and recheck the peak flow.
d. Instruct the patient to keep the scheduled follow-up appointment.

Answer 6

C

Question 7

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?

a. The patient inhales rapidly through the peak flow meter mouthpiece.
b. The patient takes montelukast (Singulair) for peak flows in the red zone.
c. The patient calls the health care provider when the peak flow is in the green zone.
d. The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.

Answer 7

D

Question 8

A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). The nurse should plan to teach the patient about

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

Answer 8

A

Question 9

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?

a. The patient reports a recent 15-lb weight gain.
b. The patient denies shortness of breath at present.
c. The patient takes cimetidine (Tagamet HB) daily.
d. The patient complains of coughing up green mucus.

Answer 9

C

Question 10

The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety?

a. Titrate O2 to keep saturation at least 90%.
b. Teach the patient how to use pursed-lip breathing.
c. Discuss a high-protein, high-calorie diet with the patient.
d. Suggest the use of over-the-counter sedative medications.

Answer 10

B

Question 11

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care?

a. Encourage increased intake of whole grains.
b. Increase the patient’s intake of fruits and fruit juices.
c. Offer high-calorie protein snacks between meals and at bedtime.
d. Assist the patient in choosing foods with high vegetable content.

Answer 11

C

Question 12

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis?

a. The patient tells the nurse about a family history of bronchitis.
b. The patient indicates a 30 pack-year cigarette smoking history.
c. The patient reports a productive cough for 3 months every winter.
d. The patient denies having respiratory problems until the past 12 months.

Answer 12

C

Question 13

The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further 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

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. Even, unlabored respirations c. Absence of wheezes or crackles
b. Pulse oximetry reading of 92% d. Respiratory rate of 18 breaths/min

Answer 14

B

Question 15

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?

a. Chest pain c. Peripheral edema
b. Finger clubbing d. Elevated temperature

Answer 15

C

Question 16

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flow rate?

a. Minimize O2 use to avoid O2 dependency.
b. Maintain the pulse oximetry level at 90% or greater.
c. Administer O2 according to the patient’s level of dyspnea.
d. Avoid administration of O2 at a rate of more than 2 L/min.

Answer 16

B

Question 17

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching?

a. Travel is not possible with the use of O2 devices.
b. O2 flow should be increased if the patient has more dyspnea.
c. O2 use can improve the patient’s prognosis and quality of life.
d. Storage of O2 requires large metals tanks that each last 4 to 6 hours.

Answer 17

C

Question 18

A patient is receiving 35% O2 via a Venturi mask. To ensure the correct amount of O2 delivery, which action by the nurse is important?

a. Teach the patient to keep the mask on during meals.
b. Keep the air entrainment ports clean and unobstructed.
c. Give a high enough flow rate to keep the bag from collapsing.
d. Drain moisture condensation from the corrugated tubing every hour.

Answer 18

B

Question 19

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care?

a. Schedule the procedure 1 hour after the patient eats.
b. Maintain the patient in the lateral position for 20 minutes.
c. Give the prescribed albuterol (Ventolin HFA) before the therapy.
d. Perform percussion before assisting the patient to the drainage position.

Answer 19

C

Question 20

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care?

a. Stop exercising when you feel short of breath.
b. Walk until pulse rate exceeds 130 beats/minute.
c. Limit exercise to activities of daily living (ADLs).
d. Walk 15 to 20 minutes a day at least 3 times/week.

Answer 20

D

Question 21

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, “I wish I were dead! I’m just a burden on everybody.” Based on this information, which nursing diagnosis is most appropriate?

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

Answer 21

B

Question 22

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient’s ventilation?

a. Have the patient rest in bed with the head elevated to 15 to 20 degrees.
b. Encourage the patient to sit up at the bedside in a chair and lean forward.
c. Ask the patient to rest in bed in a high-Fowler’s position with the knees flexed.
d. Place the patient in the Trendelenburg position with pillows behind the head.

Answer 22

B

Question 23

A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask?

a. “Are you claustrophobic?”
b. “Are you allergic to shellfish?”
c. “Have you taken any bronchodilators today?”
d. “Do you have any metal implants or prostheses?”

Answer 23

C

Question 24

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care?

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

Question 25

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate? a. Teach the patient signs of hypoglycemia. b. Have the patient add dietary salt to meals. c. Suggest decreasing intake of dietary fat and calories. d. Instruct the patient about pancreatic enzyme replacements.

Answer 25

B

Question 26

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering getting married and wondering about having children. Which initial response by the nurse is best? a. “Are you aware of the normal lifespan for patients with CF?” b. “Would like more information to help you with that decision?” c. “Many women with CF do not have difficulty conceiving children.” d. “You will need to have genetic counseling before making a decision.”

Answer 26

B

Question 27

A patient with chronic obstructive pulmonary disease (COPD) has coarse crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the O2 flow rate to the highest prescribed rate. b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed-lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.

Answer 27

B

Question 28

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? a. “I will drink lots of fluids with my meals.” b. “I can 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 and poultry.”

Answer 28

B

Question 29

Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? a. “Avoid upper body exercise to prevent dyspnea.” b. “Stop exercising if you start to feel short of breath.” c. “Use the bronchodilator before you start to exercise.” d. “Breathe in and out through the mouth while you exercise.”

Answer 29

C

Question 30

The nurse completes an admission assessment on a patient with asthma. Which information given by patient is indicates a need for a change in therapy? a. The patient uses albuterol (Ventolin HFA) before 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 (Ventolin HFA) inhaler. d. The patient’s only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).

Answer 30

D

Question 31

The nurse takes an admission history on 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 chronic inflammatory bowel disease. b. The patient has a history of pneumonia 6 months ago. c. The patient takes propranolol (Inderal) for hypertension. d. The patient uses acetaminophen (Tylenol) for headaches.

Answer 31

C

Question 32

A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? a. Use of long-acting -adrenergic medications b. Side effects of sustained-release theophylline c. Self-administration of inhaled corticosteroids d. Complications associated with O2 therapy

Answer 32

C

Question 33

A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/dL. Which nursing action will the nurse plan to implement? a. Discuss the role of diet in blood glucose control. b. Evaluate the patient’s use of pancreatic enzymes. c. Teach the patient about administration of insulin. d. Give oral hypoglycemic medications before meals.

Answer 33

C

Question 34

The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? a. Pulse oximetry reading of 91% b. Respiratory rate of 26 breaths/min c. Use of accessory muscles in breathing d. Peak expiratory flow rate of 240 L/min

Answer 34

C

Question 35

A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? a. Notify the health care provider. b. Document changes in respiratory status. c. Encourage the patient to cough and deep breathe. d. Administer IV methylprednisolone (Solu-Medrol).

Answer 35

A

Question 36

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first? 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

Question 37

Which assessment 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 c. Peak flow reading 75% of normal b. Flushing and dizziness d. Respiratory rate 24 breaths/minute

Answer 37

B

Question 38

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse? a. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg b. pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

Answer 38

A

Question 39

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Obtain O2 saturation using pulse oximetry. b. Monitor for increased O2 need with exercise. c. Teach the patient about safe use of O2 at home. d. Adjust O2 to keep saturation in prescribed parameters.

Answer 39

A

Question 40

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. 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 (Ventolin HFA). 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

Question 41

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first? a. Methylprednisolone (Solu-Medrol) 60 mg IV b. Albuterol (Ventolin HFA) 2.5 mg per nebulizer c. Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) d. Ipratropium (Atrovent) 2 puffs per metered-dose inhaler (MDI)

Answer 41

A right answer is B Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

Question 42

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

Answer 42

B

Question 43

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? a. Cough productive of bloody, purulent mucus b. Scattered crackles and wheezes heard bilaterally c. Complaint of sharp chest pain with deep breathing d. Respiratory rate 28 breaths/minute while ambulating

Answer 43

A

Question 44

A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute

Answer 44

ANS: 320 A PEFR less than 80% of the personal best indicates that the patient is in the yellow zone where changes in therapy are needed to prevent progression of the airway narrowing.