Chapter 24 Quiz

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Question #1

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 25% for a patient with COPD. What stage should the nurse document the patient is in?

A I

B III

C IV

D III

Question #2

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

A Ipratropium bromide

B Albuterol

C Fluticasone propionate

D Ipratropium bromide and albuterol sulfate

Question #3

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?

A “I will take a slow, deep breath in after pushing down on the MDI.”

B “Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use.”

C “I can’t use a spacer or holding chamber with the MDI.”

D “I will shake the MDI container before I use it.”

Question #4

Which of the following is the key underlying feature of asthma?

A Inflammation

B Chest tightness

C Productive cough

D Shortness of breath

Question #5

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.,,

A Dry airways that obstruct airflow

B Decreased numbers of goblet cells

C Mucus secretions that block airways

D Inflamed airways that obstruct airflow

E Overinflated alveoli that impair gas exchange

Question #6

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?

A Budesonide

B Albuterol

C Cromolyn sodium

D Theophylline

Question #7

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client

A Records in a diary the number achieved after one breath

B Inhales deeply and holds the breath

C Sits in a straight–back chair and leans forward

D Exhales hard and fast with a single blow

Question #8

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client’s condition is worsening when he:

A uses the sternocleidomastoid muscles.

B has a pulse oximetry reading of 93%.

C sits in tripod position.

D wants the head of the bed raised to a 90-degree level.

Question #9

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can’t produce an effective cough, the nurse should monitor closely for:

A pleural effusion.

B atelectasis.

C pulmonary edema.

D oxygen toxicity.

Question #10

A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is:

A Tachycardia

B Dyspnea

C Sharp, stabbing chest pain

D A dry, hacking cough

Question #11

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

A Respiratory alkalosis

B Respiratory acidosis

C Metabolic acidosis

D Metabolic alkalosis

Question #12

Which statement is true about both lung transplant and bullectomy?

A Both procedures treat end-stage emphysema.

B Both procedures cure COPD.

C Both procedures improve the overall quality of life of a client with COPD.

D Both procedures treat patients with bullous emphysema.

Question #13

A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects?

A Disturbed sleep pattern related to cough

B Activity intolerance related to fatigue

C Ineffective coping related to anxiety

D High risk for ineffective therapeutic regimen management related to lack of knowledge

Question #14

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

A “I do not need to rinse my mouth with this type of inhaler.”

B “If I use the spacer, I know I am only supposed to push on the inhaler once.”

C “After I breathe in, I will hold my breath for 10 seconds.”

D “I will make sure to take a slow, deep breath as I push on my inhaler.”

Question #15

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?

A Respiratory rate

B Lung sounds

C Skin color

D Heart rate

Question #16

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

A Metabolic alkalosis

B Respiratory acidosis

C Metabolic acidosis

D Respiratory alkalosis

Question #17

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86%, and he’s still wheezing. The nurse should plan to administer:

A alprazolam (Xanax).

B propranolol (Inderal).

C albuterol (Proventil).

D morphine.

Question #18

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?

A An inhaled corticosteroid

B An inhaled beta2-adrenergic agonist

C An I.V. beta2-adrenergic agonist

D An oral corticosteroid

Question #19

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

A Keeping the client in semi-Fowler’s position

B Using a Venturi mask to deliver oxygen as ordered

C Encouraging the client to drink three glasses of fluid daily

D Administering a sedative as ordered

Question #20

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted?

A III

B I

C IV

D II

Question #21

The classification of Stage III of COPD is defined as

A mild COPD.

B very severe COPD.

C at risk for COPD.

D moderate COPD.

E severe COPD.

Question #22

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

A Increasing pH

B Avoiding the use of oxygen to decrease the hypoxic drive

C Providing sufficient oxygen to improve oxygenation

D Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels

Question #23

A Decreased numbers of goblet cells

B Dry airways that obstruct airflow

C Mucus secretions that block airways

D Inflamed airways that obstruct airflow

E Overinflated alveoli that impair gas exchange

Question #24

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse?

A Provides nebulized tobramycin (TOBI)

B Gives oral pancreatic enzymes with meals

C Collects sputum for culture and sensitivity

D Administers vancomycin intravenously

Question #25

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?

A Informs the client to limit fluid intake due to fluid retention

B Assesses fasting blood glucose levels

C Aspirates for blood return before injecting the medication

D Encourages the client to decrease caloric intake due to increased appetite

Question #26

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

A “Many options are available for you.”

B “Nicotine patches would be appropriate for you.”

C “Have you tried to quit smoking before?”

D “I can refer you to the American Lung Association.”

Question #27

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client

A Has a respiratory rate of 28 breaths/minute

B Has wheezes in the right lung lobes

C Reports shortness of breath

D Cannot perform activities of daily living

Question #28

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?

A Administer the triamcinolone and then administer the salmeterol.

B Administer the salmeterol and then administer the triamcinolone.

C Allow the client to choose the order in which the drugs are administered.

D Monitor the client’s theophylline level before administering the medications.

Question #29

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

A Increased sputum production

B Normothermia

C Decreased activity tolerance

D Decreased oxygen requirements

Question #30

The classification of Stage IV of COPD is defined as

A severe COPD.

B at risk for COPD.

C moderate COPD.

D very severe COPD.

E mild COPD.

Question #31

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

A Ipratropium bromide

B Fluticasone propionate

C Ipratropium bromide and albuterol sulfate

D Albuterol

Question #32

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

A Tachypnea and tachycardia

B Fever, chills, and diaphoresis

C Sputum and a productive cough

D Chest pain during respiration

Question #33

Which exposure accounts for most cases of COPD?

A Passive smoking

B Exposure to tobacco smoke

C Occupational exposure

D Ambient air pollution

Question #34

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process?

A Asthma

B Bronchitis

C Polycythemia

D Emphysema

Question #35

Which of the following occupy space in the thorax, but do not contribute to ventilation?

A Lung parenchyma

B Alveoli

C Bullae

D Mast cells

Question #36

Asthma is cause by which type of response?

A IgA-mediated

B IgE-mediated

C IgD-mediated

D IgM-mediated

Question #37

A nurse consulting with a nutrition specialist knows it’s important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?

A High-protein

B Low-fat

C Full-liquid

D 1,800-calorie ADA

Question #38

A client is diagnosed with a chronic respiratory disorder. After assessing the client’s knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?

A Unilateral neglect

B Imbalanced nutrition: More than body requirements

C Anxiety

D Impaired swallowing

Question #39

A nurse is assisting with a subclavian vein central line insertion when the client’s oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

A muffled or distant heart sounds.

B tracheal deviation to the unaffected side.

C diminished or absent breath sounds on the affected side.

D paradoxical chest wall movement with respirations.

Question #40

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse’s concern? Select all that apply.,,

A Compromised gas exchange

B Decreased airflow

C Wheezes

D Jugular vein distention

E Ascites

Question #41

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client’s care plan?

A Providing the client a low-sodium diet

B Restricting oral intake to 1,000 mL/day

C Discussing palliative care and end-of-life issues with the client

D Performing chest physiotherapy as ordered

Question #42

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes

A providing the client a low-calorie, high-fiber diet.

B teaching the family how to perform postural drainage.

C instructing the client on the signs of respiratory infection.

D implementing measures to clear pulmonary secretions.

Question #43

Which statement describes emphysema?

A A disease that results in reversible airflow obstruction, a common clinical outcome

B Chronic dilatation of a bronchus or bronchi

C A disease of the airways characterized by destruction of the walls of overdistended alveoli

D Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years

Question #44

Which of the following is the most common chronic disease of childhood?

A Cerebral palsy

B Autism

C Obesity

D Asthma

Question #45

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid–base imbalances?

A Metabolic acidosis

B Respiratory alkalosis

C Respiratory acidosis

D Metabolic alkalosis

Question #46

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client?

A Ipratropium bromide

B Albuterol

C Formoterol

D Isoproterenol

Question #47

A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of:

A Metabolic alkalosis

B Metabolic acidosis

C Respiratory acidosis

D Respiratory alkalosis

Question #48

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?

A Intravenous methylprednisolone (Solu–Medrol) 120 mg

B Oxygen through nasal cannula at 2 L/minute

C Ipratropium bromide (Alupent) by metered-dose inhaler

D Vancomycin 1 gram intravenously over 1 hour

Question #49

Which is the strongest predisposing factor for asthma?

A Congenital malformations

B Air pollution

C Male gender

D Allergy

Question #50

The classification of Stage II of COPD is defined as

A mild COPD.

B severe COPD.

C at risk for COPD.

D moderate COPD.

E very severe COPD.

Question #51

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.

A 60 mm Hg; 90%

B 58 mm Hg; 88%

C 56 mm Hg; 86%

D 54 mm Hg; 84%

Question #52

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for?

A Emphysema

B Pneumonia

C Pleurisy

D Atelectasis

Question #53

When developing a preventative plan of care for a patient at risk for developing chronic obstructive pulmonary disease (COPD), which of the following should be incorporated?

A Smoking cessation

B Weight reduction

C Cholesterol management

D Cancer prevention

Question #54

To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations?

A Haemophilus influenzae and varicella

B Streptococcus pneumonia and Haemophilus influenzae

C Streptococcus pneumonia and varicella

D Haemophilus influenzae and Gardasil

Question #55

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client

A Sits in a straight–back chair and leans forward

B Records in a diary the number achieved after one breath

C Inhales deeply and holds the breath

D Exhales hard and fast with a single blow

Question #56

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)?

A Exposure to tobacco smoke

B Ambient air pollution

C Passive smoking

D Occupational exposure

Question #57

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

A Respiratory acidosis

B Metabolic alkalosis

C Metabolic acidosis

D Respiratory alkalosis

Question #58

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

A Respiratory rate of 22 breaths/minute

B Dilated and reactive pupils

C Urine output of 40 ml/hour

D Heart rate of 100 beats/minute

Question #59

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in?

A II

B IV

C I

D III

Question #60

Which of the following is accurate regarding status asthmaticus?

A Usually occurs with warning

B Patients have a productive cough.

C A severe asthma episode that is refractory to initial therapy

D Usually does not progress to severe obstruction

Question #61

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?

A Emphysema

B Bronchiectasis

C Asthma

D Cystic fibrosis

Question #62

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?

A Lymphocytes

B Eosiniphils

C Neutrophils

D Mast cells

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