WorksheetsCh 27 Lower Resp. Problems
Total questions: 49
Worksheet time: 28mins
How will the nurse categorize the level of asthma control for a client who reports usually waking at night with wheezing once weekly and needing to use the prescribed reliever inhaler to stop the episode?
Minimally controlled
Partly controlled
Controlled
Uncontrolled
Which outcome indicates to the nurse that oxygen therapy for the client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia is effective?
PCO2 is within normal range.
Finger clubbing has resolved.
Client reports decreased distress.
SpO2 is between 88% and 90%.
Which action is most important for a nurse to take to prevent complications for a client with a history of chronic obstructive pulmonary disease (COPD) is admitted for a surgical procedure that is unrelated to the respiratory system?
Assessing the client’s respiratory system every 8 hours
Instructing the client to use a tissue when coughing or sneezing
Monitoring for signs and symptoms of pneumonia
Ensuring the client remains in bed for a full 24 hours after surgery
Which point is most important to prevent harm for the nurse to teach a client with chronic obstructive pulmonary disease (COPD) who is being discharged on home oxygen therapy
Correct performance when setting up the oxygen delivery system
Understanding the signs and symptoms of hypoxemia
Demonstrating how to use a pulse oximetry device
Removing combustion hazards present in the home
Which action is most important to teach a client living with progressing idiopathic pulmonary fibrosis?
Maintaining an oral fluid intake of at least 2 L daily
Taking oral temperature daily
Using energy conservation measures
Using oxygen by nasal cannula whenever dyspnea is present
Which action will the nurse teach an older client with a respiratory problem to make as an accommodation to promote adequate gas exchange?
Notify your primary health care provider at the first sign of respiratory infection.
If you must walk any distance in cool weather move quickly to keep warm.
Replace at least one meal each day with a high-calorie liquid food supplement.
Avoid any nonessential physical activity or exercise.
What is the priority action for the nurse to take when a client comes to the emergency department with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers?
Establishing IV access to give emergency medications.
Asking the client how long he or she has had asthma and what triggered this attack
Preparing the client for intubation
Placing the client in a high-Fowler position, and starting oxygen
Which statement made by a client prescribed a reliever drug inhaler for asthma indicates to the nurse correct understanding of this therapy?
“If I forget a dose, I will use the inhaler as soon as I remember it.”
“At night, I will be sure to store the inhaler in a cool, dry place.”
“I will keep this inhaler with me at all times.”
“Reliever drugs are needed to prevent asthma attacks.”
Which assessment findings in a client with asthma indicate to the nurse that the client’s asthma condition is deteriorating and progressing toward respiratory failure?
Audible wheezing with use of accessory muscles on inhalation
Crackles, rhonchi, and productive cough with yellow sputum
Tachypnea, thick and tenacious sputum, and hemoptysis
Respiratory alkalosis; slow, shallow respiratory rate
Which action will the nurse teach a client with chronic bronchitis to use to mobilize secretions?
Drinking at least 2 L of fluid daily
Avoiding triggers that cause coughing
Elevating the head of the bed 45 degrees
Assuming the tripod position as often as possible
Which changes in arterial blood gas (ABG) values will the nurse expect in a client with long-term chronic obstructive pulmonary disease (COPD)?
Decreased pH; Decreased PaO2; Increased PaCO2; Increased bicarbonate level
Increased pH; increased PaO2; increased PaCO2; Increased bicarbonate level
Increased pH; increased PaO2; increased PaCO2; decreased bicarbonate level
Decreased pH; decreased PaO2; decreased PaCO2; decreased bicarbonate level
Which complication will the nurse assess for first in any client with cystic fibrosis (CF)?
Respiratory infection
Pneumothorax
Weight loss
Osteoporosis
Why will the nurse administer vitamin supplements to a client who has cystic fibrosis (CF)?
Clients are too fatigued to ingest sufficient vitamins and nutrients.
Steatorrhea causes a deficiency of fat-soluble vitamins.
Increased blood levels of vitamins enhance chloride transport activity.
High doses of vitamins can slow the progression of the disease.
Which action is most important for the nurse to take when preparing a client with cystic fibrosis (CF) for a lung transplantation procedure?
Teaching the client how to perform pulmonary muscle strengthening exercises
Collaborating with the registered dietitian nutritionist to provide high-calorie, high-protein meals
Reminding the client to continue taking prescribed vitamin supplementation
Using aseptic technique when assisting the client to perform pulmonary hygiene
For which side effect will the nurse monitor a client with pulmonary arterial hypertension (PAH) who is receiving endothelin receptor antagonist therapy?
Hypotension
Increased clot formation
Sepsis
Decreased urine output
The nurse has just received report on a group of clients. Which client is the nurse’s first priority?
A 62 year old with chronic obstructive pulmonary disease (COPD) being discharged with an oxygen saturation of 90%
A 42 year old with lung cancer who needs an IV antibiotic administered before going to surgery
A 22 year old with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min
A 52 year old with end-stage pulmonary fibrosis and an oxygen saturation of 89%
Which assessment finding in a client who has had a lobectomy and placement of a chest tube 8 hours ago requires immediate follow-up by the nurse?
Report of pain at the chest tube insertion site
3-cm area of red drainage on the incisional dressing
200 mL red drainage from chest tube over 2 hours
Client sleepy but able to be aroused
Which client statements about using an aerosol inhaler for asthma management indicate to the nurse that he has correct understanding of this drug delivery system? (Select all that apply.)
“I will hold my breath for 1 full minute after inhaling the drug.”
“If I use a spacer, I don’t have to wait a minute between the two puffs.”
“If the spacer makes a whistling sound, I am breathing in too rapidly.”
“Rinsing my mouth after using the inhaler and then swallowing the rinse ensures I will get all of the drug.”
“I will hold my breath for at least 10 seconds after inhaling the drug.”
Which features will the nurse expect to be present in a client who has long-term chronic obstructive pulmonary disease? (Select all that apply.)
Increased anteroposterior chest diameter from air-trapping
Respiratory acidosis with a low pH
Poor gas exchange from decreased alveolar surface area
Hypercapnia from retained PaCO2
Arterial blood gas value with increased PaO2 level
The client, who is 24 hours postoperative after a right lower lobectomy for stage II lung cancer and has two chest tubes in place, reports intense burning pain in his lower chest. On assessment, the nurse notes there is no bubbling on exhalation in the water seal chamber. What action will the nurse perform first?
Immediately notify either the Rapid Response Team or the thoracic surgical resident.
Assist the client to a side-lying position and re-assess the water seal chamber for bubbling.
Administer the prescribed opioid analgesic immediately, and then assess the chest tube system.
No action is needed because these responses are normal for the first post-op day after lobectomy.
A client with COPD has all of the following ABG changes from earlier today. Which change alerts the nurse to take immediate action to prevent harm?
pH from 7.21 to 7.20
HCO3- remains the same at 31 mEq/L
PaCO2 from 45 mmHg to 68 mmHg
PaO2 from 88 mmHg to 86 mmHg
A nurse assesses several clients who have a history of respiratory disorders. Which client would the nurse assess first?
A 66-year-old client with a barrel chest and clubbed fingernails
A 48-year-old client with an oxygen saturation level of 92% at rest
A 35-year-old client who reports orthopnea in bed
A 27-year-old client with a heart rate of 120 beats/min
A nurse cares for a client with arthritis who reports frequent asthma attacks. What action would the nurse take first?
Review the client’s pulmonary function test results.
Ask about medications the client is currently taking.
Assess how frequently the client uses a bronchodilator.
Consult the primary health care provider and request arterial blood gases.
After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the client’s understanding. Which statement indicates that the client comprehends the teaching?
“I will carry this medication with me at all times in case I need it.”
“I will take this medication when I start to experience an asthma attack.”
"I will take this medication every morning to help prevent an acute attack.”
“I will be weaned off this medication when I no longer need it.”
After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client’s understanding. Which action demonstrates that the client correctly understands the teaching?
The client lies on his or her side with knees bent.
The client places his or her hands on the abdomen.
The client lies in a prone position with straight.
The client places his or her hands above the head.
After teaching a client who is prescribed salmeterol, the nurse assesses the client’s understanding. Which statement by the client indicates a need for additional teaching?
“I will be certain to shake the inhaler well before I use it.”
“It may take a while before I notice a change in my asthma.”
“I will use the drug when I have an asthma attack.”
“I will be careful not to let the drug escape out of my nose and mouth.”
A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that going out with friends is no longer enjoyable. How would the nurse respond?
“There are a variety of support groups for people who have COPD.”
“I will ask your primary health care provider to prescribe an antianxiety agent.”
“I’d like to hear about thoughts and feelings causing you to limit social activities.”
“Friends can be a good support system for clients with chronic disorders.”
A nurse is teaching a client who has cystic fibrosis (CF). Which statement would the nurse include in this client’s teaching?
“Take an antibiotic each day.”
“You should get genetic screening.”
“Eat a well-balanced, nutritious diet.”
“Plan to exercise for 30 minutes every day.”
While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the chest tube is dislodged. Which action by the nurse is best?
Assess for drainage from the site.
Cover the insertion site with sterile gauze.
Contact the primary health care provider.
Reinsert the tube using sterile technique.
A nurse assesses a client who is prescribed fluticasone and notes oral lesions. What action would the nurse take?
Encourage oral rinsing after fluticasone administration.
Obtain an oral specimen for culture and sensitivity.
Start the client on a broad-spectrum antibiotic.
Document the finding as a known side effect.
A nurse cares for a client who had a chest tube placed 6 hours ago and refuses to take deep breaths because of the pain. What action would the nurse take?
Ambulate the client in the hallway to promote deep breathing.
Auscultate the client’s anterior and posterior lung fields.
Encourage the client to take shallow breaths to help with the pain.
Administer pain medication and encourage the client to take deep breaths.
The nurse is caring for a client who has cystic fibrosis (CF). The client asks for information about gene therapy. What response by the nurse is best?
“Unfortunately, gene therapy is only provided to children upon diagnosis.”
“Do you know that you will have to have genetic testing?”
“There is a good treatment for the most common genetic defect in CF.”
“Gene therapy will only help improve your pulmonary symptoms.”
A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process would the nurse correlate with this client’s history and clinical signs and symptoms?
Increased pulmonary pressure creating a higher workload on the right side of the
heart
Exposure to irritants resulting in increased inflammation of the bronchi and
bronchioles
Increased number and size of mucous glands producing large amounts of thick
mucus
Left ventricular hypertrophy creating a decrease in cardiac output
A clinic nurse is reviewing care measures with a client who has asthma, Step 3. What statement by the client indicates the need to review the information?
“I still will use my rapid-acting inhaler for an asthma attack.”
“I will always use the spacer with my dry powder inhaler.”
“If I am stable for 3 months, I might be able to reduce my drugs.”
“My inhaled corticosteroid must be taken regularly to work well.”
A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client would the nurse assess first?
A 46 year old with a 30–pack-year history of smoking
A 52 year old in a tripod position using accessory muscles to breathe
A 68 year old who has dependent edema and clubbed fingers
A 74 year old with a chronic cough and thick, tenacious secretions
A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, “What does this mean?” How would the nurse respond?
“Your children will be at high risk for chronic obstructive pulmonary disease.”
“I will contact a genetic counselor to discuss your condition.”
“Your risk for chronic obstructive pulmonary disease is higher, especially if you
smoke.”
“This is a recessive gene and would have no impact on your health.”
A nurse cares for a client who has a family history of cystic fibrosis. The client asks, “Will my children have cystic fibrosis?” How would the nurse respond?
“Since many of your family members are carriers, your children will also be
carriers of the gene.”
“Cystic fibrosis is an autosomal recessive disorder. If you are a carrier, your
children will have the disorder.”
“Since you have a family history of cystic fibrosis, I would encourage you and
your partner to be tested.”
“Cystic fibrosis is caused by a protein that controls the movement of chloride.
Adjusting your diet will decrease the spread of this disorder.”
A nurse administers medications to a client who has asthma. Which medication classification is paired correctly with its physiologic action?
Bronchodilator—stabilizes the membranes of mast cells and prevents the release
of inflammatory mediators.
Cholinergic antagonist—causes bronchodilation by inhibiting the parasympathetic
nervous system.
Corticosteroid—relaxes bronchiolar smooth muscles by binding to and activating
pulmonary beta2 receptors.
Cromone—disrupts the production of pathways of inflammatory mediators.
A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. What actions by the nurse are best? (Select all that apply.)
Administer oxygen and place client on an oximeter.
Administer prescribed albuterol inhaler.
Assess the client’s lung sounds after administering the inhaler.
Assess the client for a tracheal deviation.
Administer prescribed salmeterol inhaler.
A nurse assesses a client who has a mediastinal chest tube. Which symptoms require the nurse’s immediate intervention? (Select all that apply.)
Tracheal deviation
Sudden onset of shortness of breath
Drainage greater than 70 mL/hr
Disconnection at Y site
Production of pink sputum & Pain at insertion site
A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutrition would the nurse include in this client’s teaching? (Select all that apply.)
“Avoid drinking fluids just before and during meals.”
“Rest before meals if you have dyspnea.”
“Have about six small meals a day.”
“Use pursed-lip breathing during meals.”
“Choose soft, high-calorie, high-protein foods.”
A nurse assesses a client with chronic obstructive pulmonary disease. Which questions would the nurse ask to determine the client’s activity tolerance? (Select all that apply.)
“Do you have any difficulty sleeping?”
“How long does it take to perform your morning routine?”
“Have you lost any weight lately?”
“How does your activity compare to this time last year?”
“What color is your sputum?”
The nurse is preparing to teach a community group about warning signs of lung cancer. What information does the nurse include? (Select all that apply.)
Persistent coughing
Rusty or blood-tinged sputum
Dyspnea
Hoarseness
Over 10–pack-year history of smoking
A nurse is assessing a client with lung cancer. What nonpulmonary signs and symptoms would the nurse be aware of? (Select all that apply.)
Gynecomastia in male patients
Frequent shaking and sweating relieved by eating
“Moon” face and “buffalo” hump
General edema
Expectorating purulent sputum
A nurse is teaching a client how to perform pursed-lip breathing. Which instructions would the nurse include in this teaching? (Select all that apply.)
“Use your abdominal muscles to squeeze air out of your lungs.”
“Breath out slowly without puffing your cheeks.”
“Exhale at least twice the amount of time it took to breathe in.”
“Lie on your back with your knees bent.”
“Focus on inhaling and holding your breath as long as you can.”
A home health nurse evaluates a client who has chronic obstructive pulmonary disease. Which assessments would the nurse include in this client’s evaluation? (Select all that apply.)
Examination of mucous membranes and nail beds
Measurement of rate, depth, and rhythm of respirations
Determine the client’s need and use of oxygen
Ability to perform activities of daily living
Check peripheral veins for distention while at rest
A nurse cares for a client who is prescribed an intravenous prostacyclin agent for pulmonary artery hypertension. What actions would the nurse take to ensure the client’s safety while on this medication? (Select all that apply.)
Keep an intravenous line dedicated strictly to the infusion.
Ensure that there is always a backup drug cassette available.
Use strict aseptic technique when using the drug delivery system.
Start a large-bore peripheral intravenous line.
Teach the client that this medication increases pulmonary pressures.
A client, who has become increasingly dyspneic over a year, has been diagnosed with pulmonary fibrosis. What information would the nurse plan to include in teaching this client? (Select all that apply.)
The need to avoid large crowds and people who are ill
Safety measures to take if home oxygen is needed
Information about appropriate use of the drug nintedanib
Measures to avoid fatigue during the day
The possibility of receiving a lung transplant if infection-free for a year
A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secretions. Which interventions would the nurse include in this client’s plan of care? (Select all that apply.)
Ask the client to drink 2 L of fluids daily.
Add humidity to the prescribed oxygen.
Use a vibrating chest physiotherapy device.
Administer the ordered mucolytic agent.
Suction the client every 2 to 3 hours.
