Deck 61: Management of Clients with Lower Airway and Pulmonary Vessel

Question 1

A client has a history of recurring respiratory tract infections and presents today with cough and purulent sputum. The client also complains of longstanding fatigue and weakness. The nurse would assess the client further for

A) a viral infection.
B) asthma.
C) bronchiectasis.
D) tracheobronchitis.

Answer 1

bronchiectasis.

Question 2

A client with COPD has severe shortness of breath at rest and arterial oxygen tension (PaO₂) of 35 mm Hg. When oxygen via nasal cannula is prescribed, the nurse would assess the client cautiously because

A) regulating oxygen settings can be done by unlicensed staff.
B) some clients with COPD have CO₂ narcosis.
C) skin damage under the nasal cannula is common.
D) the client may try to sneak a cigarette and get burned.

Answer 2

some clients with COPD have CO₂ narcosis.

Question 3

A client tells the nurse that he read something about "dead space" in an article about emphysema and asks the nurse to explain it to him. The nurse's most accurate answer would be the following:

A) "Any part of your lungs that contains mucous secretions is called dead space."
B) "Dead space is an area of your lung that does not participate in air exchange."
C) "Parts of the lower airway that serve as a conduit for fresh air."
D) "This is a small area of necrotic tissue that can cause infection."

Answer 3

"Dead space is an area of your lung that does not participate in air exchange."

Question 4

A client is being worked up for possible pulmonary hypertension. The nurse prepares the client for the definitive diagnostic test for this condition, which is

A) arterial blood gas measurements.
B) pulmonary function studies.
C) right heart catheterization.
D) spiral computed tomography.

Question 5

A nurse is auscultating the lungs of a client who presented to the emergency department complaining of an asthma attack. The nurse hears no wheezing. The nurse should conclude that the client

A) does not really have asthma.
B) is not having a bad attack.
C) may have severe airway constriction.
D) needs increased IV fluids.

Question 6

A client experiencing a pulmonary embolus has pleuritic pain and hemoptysis. The nurse would assesses the presence of hemoptysis as an indication of

A) alveolar damage.
B) hemorrhage in the sinuses.
C) hemothorax.
D) ruptured vessels in the trachea.

Question 7

The nurse is assessing the lab work of a client with a pulmonary embolism. The client's INR is 5.8. The most appropriate action by the nurse is to

A) call the physician and ask to increase the Coumadin.
B) document the findings as normal and continue care.
C) encourage the client to order green leafy vegetables for dinner.
D) institute safety precautions for the client.

Question 8

The nurse performing a brief physical assessment of an anxious client with asthma would carefully inspect the chest wall primarily to

A) evaluate the use of intercostal muscles.
B) gain time to calm the client.
C) observe the client for diaphoresis.
D) verify bilateral chest expansion.

Question 9

The nurse caring for a client with asthma would place the client in the

A) Fowler position.
B) lithotomy position.
C) side-lying position.
D) supine position.

Question 10

Important health promotion measures the nurse should encourage the client with COPD to consider are

A) getting influenza and pneumonia vaccinations.
B) increasing ambient humidity in the house or apartment.
C) installing a UV filter in the heating and air conditioning system.
D) moving to an area of the country with a dry climate.

Question 11

A client who experienced a pulmonary embolus is receiving heparin therapy. The client will now also start receiving sodium warfarin (Coumadin). When the client asks the nurse why both medications are being given, the best response by the nurse is

A) "It takes several days for the warfarin to become therapeutic."
B) "Most clients go home on both drugs for maximal treatment."
C) "The heparin is not working to dissolve the blood clot, so we are adding warfarin."
D) "You are right to ask. You are at increased risk of bleeding with both drugs."

Question 12

A nurse is drawing a blood sample from a client's central line and the client suddenly becomes dyspneic and complains of chest pain. The priority action by the nurse is to

A) obtain blood pressure readings in both arms.
B) notify the physician immediately.
C) put the client in a left lateral Trendelenburg position.
D) terminate the procedure and clamp the central line.

Question 13

The nurse would prepare a client with emphysema who has a ruptured emphysematous bleb for

A) chest percussion.
B) chest tube insertion.
C) incentive spirometry.
D) intubation.

Question 14

A client receives a beta-adrenergic bronchodilator and supplemental oxygen when entering the ED for treatment of asthma, but the client's condition remains unchanged. The nurse would anticipate that the client will

A) be coached immediately in pursed-lip breathing.
B) receive increased intravenous fluids.
C) receive intravenous (IV) steroids.
D) undergo "stat" pulmonary function tests.

Question 15

The nurse is caring for a client with a pulmonary embolism who is receiving heparin and must have an arterial blood gas (ABG) sample drawn. The nurse would arrange to remain in the room to be available to hold pressure on the puncture site for at least

A) 1 minute.
B) 2 minutes.
C) 5 minutes.
D) 10 minutes.

Question 16

A nurse evaluates that goals for self-care teaching have been met when the client with asthma states

A) "Coughing at night is an expected side effect of bronchodilators."
B) "Follow up visits with the doctor every year are important for monitoring."
C) "I won't change the dosages of my medications without talking to the doctor."
D) "If my peak flow measurements drop I will increase my medications."

Question 17

A client has chronic obstructive pulmonary disease (COPD). In reviewing this client's laboratory values, the nurse would not be surprised to see a/an

A) decreased sedimentation rate.
B) elevated RBC count.
C) normochromic anemia.
D) therapeutic INR.

Question 18

In assessing a client for emphysema, the nurse would know that a physical finding commonly associated with this condition is

A) barrel chest.
B) bulbous nose.
C) spider angiomas.
D) varicose veins.

Question 19

A client experiencing severe chest pain from a pulmonary embolism has been medicated for pain but appears anxious and restless. The additional nursing measure that most likely would assist the client in dealing with fear is

A) asking the client not to focus on the pain.
B) explaining the monitoring devices to the client.
C) reassuring the client the pain medication will work soon.
D) remaining at the bedside with the client.

Question 20

A nurse is conducting community wellness seminars and teaches that a primary prevention activity for chronic obstructive pulmonary disease (COPD) is

A) avoiding alcohol.
B) genetic testing.
C) not smoking.
D) regular exercise.

Question 21

When counseling a client with asthma who has been advised to make several major life changes, the nurse should encourage the client to consider each suggestion carefully because

A) clients may be able to simply increase their medications and not make changes.
B) no doctor has all the answers about reducing exacerbations.
C) the benefit of the change may be offset by the stress it causes.
D) there are controversies about lifestyle changes needed in asthma.

Question 22

A nonsmoking client has been diagnosed with mild asthma. The nurse instructs the client to try to identify and reduce or eliminate exposure to triggers, which may include (Select all that apply)

A) being overly excited.
B) household pets.
C) physical exercise.
D) perfumes.
E) second-hand smoke.

Question 23

The nurse working with a depressed client who has COPD realizes that many factors negatively affect the client's quality of life, including (Select all that apply)

A) familial support systems.
B) loss of control over their bodies.
C) reduced activity tolerance.
D) social isolation.

Question 24

After providing instructions to a client with newly diagnosed COPD who is learning to take a steroid medication by inhaler, the nurse would determine that proper technique has been learned when the client

A) breathes out forcefully with an open mouth.
B) gently rolls the canister in the hands before use.
C) holds the breath for 5 to 10 seconds after inhalation.
D) starts to discontinue the medication once manifestations subside.

Question 25

A nurse caring for an elderly client with COPD alters care knowing that in the older population (Select all that apply)

A) COPD is not a common problem in the elderly.
B) impaired nutrition is a common problem in the elderly.
C) multiple co-morbidities may be present that complicate care.
D) sensory disturbances may hinder their ability to provide self-care.
E) there may be more problems with drug-drug interactions.

Question 26

The ambulatory care nurse would arrange for periodic monitoring of blood levels for a client with COPD who is beginning to use

A) beclomethasone (Vanceril).
B) ipratropium (Atrovent).
C) theophylline (Theo-Dur).
D) zafirlukast (Accolate).

Question 27

A client with COPD is in the hospital. When planning care, which diagnosis takes priority?

A) Activity Intolerance
B) Anxiety
C) Imbalanced Nutrition
D) Impaired Gas Exchange