Term 2 MS Quiz 19 Chronic Respiratory Disorders & meds

A nurse assesses wheezes in a patient with asthma. What should the nurse know is the cause of wheezes?

a. Increased thickness of respiratory secretions

b. Use of accessory muscles of respiration

c. Tachypnea and tachycardia

d. Movement of air through narrowed airways

d. Movement of air through narrowed airways

Wheezes are adventitious sounds made by air passing through narrowed passages.

A nurse is caring for a patient with asthma with a nursing diagnosis of Impaired gas exchange, related to air trapping. Which intervention is the most appropriate to add to the nursing care plan?

a. Provide postural drainage.

b. Administer oxygen (O2) at 8 L/min.

c. Position the patient flat in bed with small pillow.

d. Increase fluid intake.

d. Increase fluid intake.

Increasing fluid intake thins the mucus in the lungs, making it easier to cough up, which helps clear the bronchioles and decrease ventilation-perfusion mismatch. Increasing O2 is not helpful if no air pathway exists to the alveoli. Increasing O2 to 8 L is excessive.

What is a characteristic of chronic obstructive pulmonary disease that places a patient at risk for the nursing diagnosis of Imbalanced nutrition: Less than body requirements?

a. Increased metabolism

b. Anxiety

c. Chronic constipation

d. Excessive respiratory effort

d. Excessive respiratory effort

Respiratory effort interferes with swallowing, depletes energy, and increases caloric needs.

Which nursing intervention enhances the nutritional status of a patient with COPD?

a. Offer small, frequent meals.

b. Encourage extra liquids with meals.

c. Assist the patient to exercise before meals.

d. Supply information about nutrition.

a. Offer small, frequent meals.

Small meals are not as tiring for the patient and are more appealing.

Which walking program would be the most effective for the nurse to recommend as part of a progressive walking program for an obese patient with COPD?

a. 10 to 15 minutes a day

b. 20 to 30 minutes a day

c. 45 to 60 minutes a day

d. Up to 2 hours a day

a. 10 to 15 minutes a day

Walking for as little as 10 to 15 minutes a day and progressing up to 45 minutes a day has proven beneficial for persons with COPD because it improves oxygenation and helps with weight loss.

What is the result of status asthmaticus that is not corrected?

a. Pneumothorax, severe hypoxemia, and respiratory arrest

b. Hypertension, cerebrovascular accident (CVA), and cardiac arrest

c. Respiratory alkalosis, pneumonia, and death

d. Lung abscess, cor pulmonale, and respiratory failure

a. Pneumothorax, severe hypoxemia, and respiratory arrest

Status asthmaticus, because of severe bronchospasms, can result in hypoxemia, which could lead to pneumothorax and arrest.

What should a nurse focus on when assessing for major sources of infection in a patient with COPD?

a. Stasis of respiratory secretions

b. Low body weight

c. Episodes of postural hypotension

d. Delayed antigen-antibody response

a. Stasis of respiratory secretions

Retained static secretions in the lungs are major sources of bacterial infiltration and infection.

A young patient with acquired immunodeficiency syndrome (AIDS) reports debilitating night sweats. Why should the home health nurse suggest that the patient visit the clinic?

a. To get a prescription for antibiotics

b. Tuberculosis (TB) screening

c. Complete blood count (CBC)

d. Treatment with an aerosol inhalant

b. Tuberculosis (TB) screening

The symptoms of TB are low-grade fever, night sweats, and cough. Patients with AIDS and anyone who is immunosuppressed are extremely prone to TB and should be carefully monitored for the development of the disease.

A nurse is caring for an 80-year-old patient with COPD and suspects right-sided heart failure after assessing and recording the data. What should decrease with right-sided heart failure?

a. Blood pressure

b. Urine output

c. Respirations

d. Heart rate

b. Urine output

The decreasing urine output is one of the signs. The fluid, instead of being excreted as urine, is trapped in the tissues as edema. Blood pressure, respirations, and heart rate will increase with right-sided heart failure.

A patient with TB asks the nurse how long he will have to take his TB medications. What is the nurses best response?

a. Generally about 2 weeks.

b. Depending on the drug, it may be as long as 2 years.

c. TB drugs are usually taken throughout the lifespan.

d. People frequently ask that question. It depends on many things.

b. Depending on the drug, it may be as long as 2 years.

Some TB drugs are continued over the course of several years.

A patient with TB asks how to protect family members from the disease. Which discharge instruction given by the nurse is most informative?

a. Your family will need to take treatments to prevent infection.

b. You will need to wear a mask at home to protect your family members.

c. You should always cover your mouth and nose if coughing or sneezing.

d. You should avoid intimate contact with everyone.

c. You should always cover your mouth and nose if coughing or sneezing.

Covering the mouth and nose to prevent droplet spread and carefully disposing of tissues are two significant way to control the spread of infection. Masks or isolation is not necessary because before discharge, the patient will have been stabilized on an anti-TB medication.

A nurse is providing education to a patient taking rifampin as a result of an exposure to TB. What side effect of this drug should the nurse include?

a. Extreme drowsiness

b. Illness if aged cheese or smoked meats are consumed

c. Body fluids to become red-orange

d. Oral contraceptive pills to become ineffective

c. Body fluids to become red-orange

Rifampin will color body fluids red-orange and will result in stained clothing and soft contact lenses.

A patient with asthma asks the purpose of learning how to use a peak expiratory flow rate (PEFR) device. What is the nurses best response regarding PEFR?

a. Dilates the bronchi to relieve dyspnea

b. Measures expired air to evaluate ventilation

c. Soothes inflamed bronchi, reducing spasm

d. Liquefies sputum for easier expectoration

b. Measures expired air to evaluate ventilation

The PEFR measures expired air. When the PEFR rate decreases 20% below the baseline, adjustments are usually made in the medications.

A nurse is assigned to care for a patient with the diagnosis of centriacinar (centrilobar) emphysema. What is a characteristic of this type of emphysema?

a. No significant smoking history in the patient

b. Enlarged and broken down bronchioles with intact alveoli

c. Hypoelastic bronchi and bronchioles

d. Deficiency of the enzyme inhibitor alpha1-antitrypsin.

b. Enlarged and broken down bronchioles with intact alveoli

This type of emphysema is characterized by a long smoking history, enlarged and broken down bronchioles, and hypoelastic bronchi.

A 25-year-old patient with cystic fibrosis (CF) tells the home health nurse that he wants to take a nice vacation. What is the best suggestion for the nurse to make?

a. Greece in July

b. Colorado in May

c. New York in November

d. The Mexican coast in August

c. New York in November

New York is the best choice because individuals with CF sweat profusely and lose many salts, leading to significant electrolyte imbalance. Those with CF also have impaired respiration and should avoid heat (Greece in July, Mexico in August) and higher altitudes (Colorado at any time).

Which assessment made by a nurse indicates that respiratory arrest is imminent in a patient with asthma?

a. Agitation

b. Tachycardia

c. Absence of wheezing

d. Flaring nares

c. Absence of wheezing

An absence of wheezing indicates a diminished ventilation effort.

A patient with COPD has a nursing diagnosis of Activity intolerance, related to inability to meet O2 needs. Which intervention is inappropriate for this diagnosis?

a. Bunch all nursing activities and treatments close together.

b. Schedule rest periods during the day.

c. Assist the patient only when needed to encourage independence.

d. Provide daily ambulation to build tolerance.

a. Bunch all nursing activities and treatments close together.

Bunching nursing activities is tiring to the patient with COPD. Assisting only when needed saves patient energy, as well as enhancing independence. Activities should be spread out to allow for uninterrupted rest periods. Progressive ambulation is an acceptable way to build tolerance.

A nurse recognizes that a patient diagnosed with COPD has a rising level of partial pressure of carbon dioxide (CO2) in arterial blood (PaCO2). How should the nurse interpret this assessment?

a. More arterial O2 is available than is needed.

b. The ventilation-perfusion ratio is becoming balanced.

c. Respiratory acidosis has begun.

d. The anticholinergic medications are effective.

c. Respiratory acidosis has begun.

A rising PaCO2 level is acidic in nature and causes respiratory acidosis.

Which early characteristic in a patient with emphysema gives rise to the term pink puffer?

a. Dyspnea

b. Barrel chest

c. Thin body

d. Normal arterial blood gases (ABGs)

d. Normal arterial blood gases (ABGs)

The normal ABGs give the patient with emphysema a normal pink color early in the onset of the disease process, rather than a cyanotic color, as observed in a blue bloater.

A patient with COPD asks a nurse if nicotine patches are very effective for smoking cessation. What is the best response by the nurse?

a. No. Only about 25% are successful.

b. Yes. The success rate is between 50% and 60%.

c. No. Prescriptions such as Wellbutrin are 90% effective.

d. Yes. Individual success has been obtained with combination of patches and gum.

a. No. Only about 25% are successful.

The patches have a lower than 25% success rate. Smoking addiction is too strong to be overcome by medication or gum without a very unusual commitment from the patient. Successful smoking cessation is measured by 1 year of no smoking.

A patient with cystic fibrosis (CF) furiously refuses any more manual chest physiotherapeutic treatment. Which alternative is appropriate for the nurse to suggest?

a. Flutter mucus device

b. Increase ambulation to 1 to 2 hours a day

c. Steam inhalator several times a day

d. Drink 3 quarts of fluid per day

a. Flutter mucus device

A flutter mucus clearance device is a handheld vibrating tool that helps loosen and evacuate secretions in the lung.

What should a nurse expect when assessing the CBC results of a patient with chronic bronchitis?

a. Decreased platelets

b. Decreased white blood cells (WBCs)

c. Increased eosinophils

d. Increased red blood cells (RBCs)

d. Increased red blood cells (RBCs)

Patients with chronic bronchitis show a large increase of RBCs with an attendant higher hemoglobin level because they must produce more RBCs for the transport of O2. Frequently, the WBCs are elevated because of the chronic inflammation. Decreased levels of platelets and increased eosinophils are indicative of pathologic characteristics other than bronchitis.

A patient with COPD delightedly tells the nurse that he has quit smoking and is using chewing tobacco. What is the most appropriate nursing intervention?

a. Congratulate him on his quitting smoking.

b. Warn him of the dangers of oral cancer.

c. Suggest that he add nicotine patches in addition to the chewing tobacco.

d. Point out that he is still addicted and is using tobacco.

b. Warn him of the dangers of oral cancer.

Smokeless tobacco has adverse effects, including oral cancer.

A newly diagnosed patient with nonsmall cell lung carcinoma (NSCLC) is anxious about upcoming surgery. Which intervention by the nurse would be most helpful?

a. Support the patient in preparation for surgery.

b. Educate the patient regarding the high survival rate with this type of carcinoma.

c. Assure the patient that chemotherapy and radiation can be used in this sort of cancer.

d. Refer the patient to the American Cancer Society for postdischarge follow-up.

a. Support the patient in preparation for surgery.

Surgery is the treatment of choice of NSCLC carcinomas. The survival rate is only approximately 14%. Although referral may be in the long-range plan, the patients need is immediate for information that is within the scope of nursing.

A nurse documents and reports the presence of foul, bulky stool in a patient with cystic fibrosis (CF). What does this finding indicate about the patient?

a. Is being adequately maintained on the present dose of pancreatic enzyme

b. Is not adequately digesting food

c. Has diarrhea related to excess mucus in the bowel

d. Has inadequate hydration

b. Is not adequately digesting food

Foul, bulky stools are the result of inadequately digested food if oral pancreatic enzymes are inadequate.

What should a patient that had the BCG (Bacillus Calmette-Gurin) vaccine 2 years ago anticipate?

a. False-positive result from TB skin tests

b. Being at risk for contracting TB

c. 3-week prophylactic protocol of rifampin or isoniazid (isonicotinic acid hydrazide [INH])

d. Needing a booster every 2 years

a. False-positive result from TB skin tests

Inoculation with BCG causes a false-positive result on TB skin tests that may be administered afterward. BCG is not used very much in the United States, but it is administered in most other countries.

What nursing action should be implemented to help combat anorexia in a patient with COPD?

a. Recommend a large meal in the middle of the day.

b. Suggest taking only cold liquid nutritional drinks.

c. Perform oral hygiene before meals.

d. Gently exercise for 10 minutes before a meal.

c. Perform oral hygiene before meals.

Oral hygiene freshens the mouth and removes unpleasant tastes from medications or coughed-up secretions.

A nurse uses a picture to demonstrate the bullae and blebs associated with emphysema. How do blebs differ from bullae? (Select all that apply.)

a. They are between the alveolar spaces in the lungs.

b. They are in the lung parenchyma.

c. They can rupture, causing the lungs to collapse.

d. They are responsible for diaphragm flattening.

e. They are precancerous.

b. They are in the lung parenchyma.

c. They can rupture, causing the lungs to collapse.

Blebs are growths inside the organ of the lung that enlarge and rupture, causing lung collapse. Bullae are the lesions between the alveolar spaces. Neither are the cause of diaphragm flattening nor are they precancerous.

What signs and symptoms are characteristic of a patient with chronic blue bloater bronchitis? (Select all that apply.)

a. Productive cough

b. Peripheral edema

c. Discolored teeth

d. Exertional dyspnea

e. Elevated red blood cell count

a. Productive cough

b. Peripheral edema

d. Exertional dyspnea

e. Elevated red blood cell count

The blue bloater has a productive cough, peripheral edema, dyspnea, elevated RBCs, and cyanosis.

A nurse cautions a group of individuals with COPD that using O2 at levels greater than 1 to 3 L/min can cause the loss of their _____.

hypoxic drive

The hypoxic drive is the stimulus of CO2 in the system that drives respiration. If the CO2 level is reduced by excessive administration of O2, then the patient will cease to breathe.

A nurse explains to a family how the asthma attack progresses by using a progressive list of pathologic events. (Place the options in the correct sequence. Separate letters by a comma and space as follows: A, B, C, D.)

A. Bronchoconstriction

B. Ventilation-perfusion mismatch

C. Production of mucous plugs

D. Hypoxemia with compensatory hyperventilation

E. Triggering of inflammatory process

E, A, C, B, D

After the allergen has triggered the inflammatory response, bronchoconstriction occurs, which leads to the formation of mucous plugs in the bronchioles that block O2 from entering the alveoli, causing a ventilation-perfusion mismatch and resulting in hypoxemia and hyperventilation.

A patient has been diagnosed with tuberculosis and is being treated with rifampin. What is the HIGHEST priority instruction that the LPN should provide to the patient?

a. "Cover your mouth when coughing or sneezing."

b. "Expect your urine to be a reddish-orange color."

c. "Take your medication for the entire course of the therapy."

d. "Keep a list of foods that you should restrict from your diet."

b. "Expect your urine to be a reddish-orange color."

Rifampin turns the patient's urine a reddish-orange color and will also stain soft contact lenses. Covering the mouth when coughing or sneezing and taking the medication for the entire course of therapy are general instructions required of any treatment used by the patient. Isoniazid would require instructions regarding diet restrictions. REF: p. 614

An LPN is working with the local Public Health Department to educate and screen patients for evidence of tuberculosis. Which population of patients should be the HIGHEST priority for this effort?

a. Caucasians of all age ranges

b. Immigrants from developing countries

c. African Americans over the age 70 years

d. Caucasians who are 25 to 44 years of age

b. Immigrants from developing countries

In the United States, the incidence of tuberculosis is high among nonwhite Americans and immigrants from Asia, Mexico, Africa, the Caribbean, and Latin America. Caucasians over the age of 70 years have the greatest incidence of tuberculosis. In the African-American population, those who are 25 to 44 years of age have the greatest incidence of tuberculosis. REF: p. 613

What area of care of a patient with a chronic respiratory disease can be safely delegated to the certified nursing assistant (CNA)?

a. Auscultate breath sounds at every shift.

b. Count the respiratory rate every 4 hours.

c. Determine the position of the patient to prevent dyspnea.

d. Instruct the patient on the use of a metered-dose inhaler.

b. Count the respiratory rate every 4 hours.

The CNA is trained to check the patient's vital signs. Determining the position of the patient, instructing the patient on the use of a metered-dose inhaler, and auscultating breath sounds cannot be delegated to a CNA because these areas of care would require nursing judgment. REF: p. 611

A licensed practical nurse (LPN) is caring for a patient with active tuberculosis. What should be the HIGHEST priority action by the nurse to prevent spreading the infection?

a. Wear disposable gloves when providing care.

b. Wear isolation masks when caring for the patient.

c. Wear isolation gowns when caring for the patient.

d. Practice good hand-washing techniques when providing care.

b. Wear isolation masks when caring for the patient.

Because tuberculosis is primarily airborne, the use of isolation masks will most effectively prevent its spread. Hand-washing techniques should be practiced and disposable gloves should be worn during many aspects of patient care, but they will not prevent the spread of tuberculosis. Isolation gowns will not need to be worn unless a gross contamination of the nurse's clothing may occur. REF: p. 614

A patient is scheduled to be treated with bupropion (Wellbutrin, Zyban) as part of a treatment for smoking cessation. The patient tells the nurse that she has a history of an eating disorder. Who should the nurse notify first?

a. Physician

b. Supervisor

c. Pharmacist

d. Charge nurse

a. Physician

The physician should be notified of the patient's history of an eating disorder because the medication would be contraindicated in a patient with this history. The pharmacist, supervisor, and charge nurse do not have to be notified of the patient's history because the situation requires a prescription change by the physician. REF: p. 610

A nurse observes that a patient with chronic obstructive pulmonary disease (COPD) has increased dyspnea over the past 12 hours, a heart rate of 98 beats/min, and edema in the lower extremities. What is the initial nursing intervention?

a. Increase the oxygen flow rate to 6 L/min.

b. Contact the health care provider to report the change of condition.

c. Document the findings and continue to monitor for further changes.

d. Encourage the patient to walk down the hallway to increase circulation.

b. Contact the health care provider to report the change of condition.

The most serious complications of COPD are respiratory failure and heart failure. Hypoventilation, dyspnea, and edema are all symptoms that the condition is worsening, and the change of condition needs to be reported immediately to the health care provider. Increasing the oxygen flow rate to 6 L/min could cause respiratory depression. Simply documenting the findings and monitoring for further changes is not in the patient's best interest. Walking down the hall will only worsen the patient's already compromised condition.REF: p. 604

Chronic obstructive pulmonary disease (COPD) is characterized as a combination of which conditions?

a. Emphysema, asthma, and pneumonia

b. Asthma, pneumothorax, and pneumonitis

c. Asthma, chronic bronchitis, and emphysema

d. Chronic bronchitis, emphysema, and pneumonia

c. Asthma, chronic bronchitis, and emphysema

COPD is characterized as varying combinations of asthma, chronic bronchitis, and emphysema. Pneumothorax is a condition requiring immediate attention. Pneumonia is caused by infection in the lungs.REF: p. 604

Which is a useful monitoring practice for a patient with moderate to severe persistent asthma?

a. Weekly chest radiographs

b. Daily peak-flow monitoring

c. Daily arterial blood gas analysis

d. Daily white blood cell count measure

b. Daily peak-flow monitoring

Daily peak-flow monitoring is advised for those with moderate to severe persistent asthma to evaluate symptoms and adjust therapy as needed before the condition worsens. Chest radiographs, arterial blood gases, and daily white blood cell counts are used based on symptom severity.REF: p. 600

The nurse is reviewing objective data from the physical examination of a patient with COPD. Which finding does not fit the usual pattern seen with COPD?

a. Barrel chest

b. Even and unlabored without diminished breath sounds

c. Overall skin pallor

d. Hands on knees to elevate shoulders

b. Even and unlabored without diminished breath sounds

Usually the patient with COPD presents with dyspnea, cough, and diminished breath sounds.REF: pp. 604-605

Therapy for lung cancer may consist of which treatments?

Select all that apply.

a. Lobectomy

b. Mastectomy

c. Brachytherapy

d. Chemotherapy

e. Bilateral pneumonectomy

a. Lobectomy

c. Brachytherapy

d. Chemotherapy

Lobectomy is one surgical intervention used for non-small cell lung cancer. Brachytherapy is direct irradiation by placement of the radiation source at the site of the tumor. Chemotherapy can be used alone or with radiation for small cell lung cancer. Mastectomy is removal of the breast. Bilateral pneumonectomy would involve removal of both lungs.REF: p. 618

With asthma, the early phase of an acute episode begins when triggers such as allergens cause which response?

a. Infiltration of the airways with red blood cells

b. Right-sided heart failure and respiratory failure

c. Infiltration of the airways with white blood cells

d. Activation of the inflammatory process constricting the airways

d. Activation of the inflammatory process constricting the airways

With asthma, the early phase of an acute episode begins when triggers activate the inflammatory process where airways constrict and become edematous. Infiltration of airways with red blood cells and white blood cells, right-sided heart failure, and respiratory failure can be seen in the late phase.REF: p. 598