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.

Accepted Answer

Bronchiectasis is an extreme form of obstructive bronchitis causing permanent abnormal dilation and distortion of bronchi and bronchioles. It occurs most often after recurrent inflammatory conditions. This client is presenting with the major manifestations and because of the history of recurrent infections, the nurse should be suspicious for this problem.

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.

Accepted Answer

Some clients with COPD and hypercapnia may be oxygen-sensitive; that is, their PaCO₃ levels may rise when given supplemental oxygen, leading to suppression of the central nervous system and lethargy. This phenomenon is known as CO₂ narcosis. Clients with hypercapnia need to be monitored closely for their response to oxygen administration.

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."

Accepted Answer

As the alveoli and septa collapse, pockets of air form between the alveolar spaces (blebs) and within the lung parenchyma (bullae). This process leads to increased ventilatory dead space, resulting from areas that do not participate in gas or blood 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.

Accepted Answer

Right heart catheterization is required both to diagnose pulmonary hypertension and to stage its severity.

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.

Accepted Answer

The inability to auscultate wheezing in an asthmatic client with acute respiratory distress may be an ominous sign. It may indicate that the small airways are too constricted to allow any air flow. The client may require immediate, aggressive medical intervention.

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.

Accepted Answer

Hemoptysis is an indication that the atelectasis has caused alveolar damage.

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.

Accepted Answer

The optimal INR ratio for heparin therapy is 2.5 to 3. A reading of 5.8 is much too high and puts the client at risk for bleeding episodes. The nurse should place the client on safety precautions. The next dose of Coumadin may need to be held or reduced. The client should not alter the amount of green leafy vegetables in the diet because they contain vitamin K, which works to antagonize the effects of Coumadin.

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.

Accepted Answer

The ongoing assessment of an asthmatic client includes evaluation of the accessory muscles of respiration. The nurse should assess the client frequently, observing the respiratory rate and depth. The breathing pattern is assessed for shortness of breath, pursed-lip breathing, nasal flaring, sternal and intercostal retractions, and a prolonged expiratory phase.

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.

Accepted Answer

The nurse should place the client in the Fowler position and give oxygen as ordered.

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.

Accepted Answer

Vaccinations are recommended to help prevent infectious illness. Influenza vaccination should be given annually. The pneumonia vaccine is recommended for clients 65 years and older and for those younger than 65 if their VEV? is <40% of predicted value.

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."

Accepted Answer

Administration of sodium warfarin is begun about 3 to 5 days before heparin is stopped to provide a transition to oral anticoagulants. Warfarin has a long half-life and if the heparin was stopped too early, the client would not be protected. It is important to note that heparin does not dissolve the blood clot.

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.

Accepted Answer

This client is probably experiencing a venous air embolism from the open central line. The priority action is to stop the procedure and clamp the line. Then the nurse should position the client in Trendelenburg and rotate the client to the left side to trap the air in the apex of the heart. The nurse can attempt to aspirate the air from the distal port of the catheter. Someone else should notify the physician while the nurse remains with the client.

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.

Accepted Answer

Spontaneous pneumothorax may develop from rupture of an emphysematous bleb. This results in a closed pneumothorax and requires chest tube insertion for reexpansion of the lung.

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.

Accepted Answer

Emergency management of the asthmatic client begins with inhaled beta-adrenergic drugs. If the asthma does not abate, nebulized atropine sulfate or IV steroids may be given. None of the other three options are related; pulmonary function tests (PFTs) can be done when the client is stable. Pursed-lip breathing might be helpful in the setting of an acute attack when no medications are nearby.

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.

Accepted Answer

When invasive studies such as ABGs are necessary, pressure is applied to the site for at least 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."

Accepted Answer

Through appropriate use of the peak flow meter and medications, clients with asthma should be able to anticipate most exacerbations. Peak flow values fall about 24 hours before manifestations develop. Clients should be taught to increase their routine medications in anticipation of asthma exacerbations. Coughing at night is an indicator of poor control. Follow-up visits need to be planned every 1-6 months.

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.

Accepted Answer

To compensate for chronic hypoxia, the client will develop polycythemia (increased RBCs).

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.

Accepted Answer

Clients with emphysema develop barrel-shaped chests. The anteroposterior (AP) diameter of the chest is enlarged, and the chest has hyperresonant sounds during percussion.

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.

Accepted Answer

Emotional support can reduce anxiety and lessen dyspnea. This helps reduce oxygen demand. The nurse should stay with the client and provide calm, efficient nursing care. The other measures are not necessarily wrong, and might work for some clients, but staying in the room and offering a comforting presence is the best alternative.

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.

Accepted Answer

Smoking is the primary risk factor for COPD. Other risk factors include air pollution, second-hand smoke, a history of childhood respiratory tract infections, and heredity. Occupational exposure to certain industrial pollutants may also be a risk factor.

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

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

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

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

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

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

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 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

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

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

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

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

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

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