Chapter 15: Care of Patients with Disorders of the Lower Respiratory System My Nursing Test Banks

Chapter 15: Care of Patients with Disorders of the Lower Respiratory System

MULTIPLE CHOICE

1. The patient with acute bronchitis asks if antibiotics will be ordered for the condition. The best response by the nurse would be:

a.

Yes. Antibiotics are the best treatment option.

b.

No. Antibiotics will not help a viral condition.

c.

Antibiotics will be given if the sputum culture indicates your bronchitis is caused by bacteria.

d.

I dont think so because antibiotics will inhibit the inflammatory response of your body to the invasion of this infection.

ANS: C

Bronchitis is treated symptomatically with humidification and cough medications. Antibiotics are only given if the sputum culture suggests it.

DIF: Cognitive Level: Comprehension REF: 293-294 OBJ: 1 (theory)

TOP: Bronchitis: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. The nurse is assessing the patient with influenza and notes general malaise and aching muscles, which have continued for 2 weeks. The nurse is aware that the patient may have developed which complication of influenza?

a.

Bronchitis

b.

Bacterial pneumonia

c.

Urinary infection

d.

Encephalitis

ANS: B

Bacterial pneumonia is a common complication of influenza and may present with atypical symptoms of only general malaise and muscle aches, making it difficult to recognize the symptoms of pneumonia. Bronchitis, urinary infections, and encephalitis are not commonly complications of influenza.

DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory)

TOP: Complications of Influenza: Pneumonia

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

3. The nurse explains that treatment with amantadine (Symmetrel) will:

a.

prevent viral pneumonia if taken regularly.

b.

stop viral spread of avian flu if taken at the first signs and symptoms of disease.

c.

lessen the severity of type A flu symptoms if taken within 48 hours of exposure.

d.

reduce irritation of bronchitis if taken weekly.

ANS: C

Amantadine (Symmetrel) is an antiviral medication that may be given within 48 hours of exposure or within 48 hours of the onset of influenza symptoms. It is not a drug that is taken regularly and will not stop the spread of the avian flu.

DIF: Cognitive Level: Application REF: 295 OBJ: 1 (theory)

TOP: Treatment: Amantadine KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. The nurse differentiates viral from bacterial pneumonia in that viral pneumonia causes:

a.

elevation in white count.

b.

consolidation of lung tissue.

c.

interstitial inflammation.

d.

copious exudate.

ANS: C

Viral pneumonia causes interstitial inflammation with attendant edema. White count will not be elevated, and no exudate is consolidating the lung as with bacterial pneumonia.

DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory)

TOP: Pneumonia: Viral KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

5. The 79-year-old patient with bacterial pneumonia becomes increasingly restless and confused. Temperature is 100 F and pulse, blood pressure, and respirations are elevated since the last assessment 6 hours ago. The initial intervention by the nurse should be to:

a.

take the patient off oral fluids.

b.

assess oxygen saturation.

c.

give the ordered mild sedative.

d.

administer an NSAID for discomfort.

ANS: B

Assessing the oxygen saturation will reveal the level of oxygenation. These are early signs of hypoxia in the older adult. Medications for sedation or discomfort do not address the patients current condition. There is no indication for stopping oral fluids.

DIF: Cognitive Level: Analysis REF: 297 | Clinical Cues

OBJ: 2 (theory) TOP: Hypoxia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

6. The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. The nurses most helpful reply is:

a.

Yes. Pneumovax protects you for your lifetime.

b.

No. The immunity afforded you by Pneumovax lasts only 2 years.

c.

Yes, but it loses strength and may not protect you from all 23 pneumococcal organisms anymore.

d.

No. A second dose is needed 6 years after the first for full immunity.

ANS: D

Pneumovax, an immunization that protects against 23 pneumococcal organisms, is repeated 6 years after the first dose.

DIF: Cognitive Level: Application REF: 296 OBJ: 1 (theory)

TOP: Pneumonia Immunization: Pneumovax

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. The 75-year-old resident in the nursing home who cares for 40 birds in an aviary complains of shortness of breath and fatigue and a dry cough. Based on this information, the nurse suspects the resident may be suffering from:

a.

coccidioidomycosis.

b.

histoplasmosis.

c.

tuberculosis.

d.

atypical pneumonia.

ANS: B

Histoplasmosis is caused by a fungus that lives in bird droppings. The symptoms are dry cough, shortness of breath, and fatigue. Coccidioidomycosis is contracted by people who engage in desert recreational activities or are working in occupations that require digging in the earth. Tuberculosis and atypical pneumonia are not supported by the residents history and symptoms.

DIF: Cognitive Level: Analysis REF: 298 OBJ: 2 (theory)

TOP: Fungal Infection: Histoplasmosis KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

8. The 30-year-old American Indian female who is taking Rifater, a drug containing rifampin, isoniazid, and pyrazinamide, complains that she is tired of taking medicine and having to spit in a bottle all the time. She asks, When can I stop all this and get on with my life? The nurses best response is that she will no longer be considered contagious when:

a.

the sputum culture comes back negative.

b.

the medication has been taken for 9 months.

c.

three consecutive sputum cultures are negative.

d.

the tuberculin skin test (TST) is no longer positive.

ANS: C

This drug is given to treat active tuberculosis. The active tuberculosis patient is considered noncontagious when three consecutive sputum cultures are negative. Taking the medication for a given period of time does not make the patient noncontagious. The TST will always be positive.

DIF: Cognitive Level: Analysis REF: 301 OBJ: 3 (theory)

TOP: Tuberculosis: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9. The nurse reading a tuberculin skin test (TST) on a new employee who lives in the Midwest, is 20 years old, and has no known history of contact with any persons with tuberculosis (TB) will record it as positive if the area around the injection site has an area of swelling of _____ mm _____ hours after the injection.

a.

15; 48

b.

10; 72

c.

5; 48

d.

0 to 5; 72

ANS: A

All TSTs are read at 48 to 72 hours after the injection. A positive reading of a TST for a person who is low risk for exposure is an area of swelling 15 mm or more. For individuals who are at high risk for TB (such as recent immigrants from countries where TB is prevalent, medically underserved groups, and the homeless), swelling of more than 10 mm is considered positive. Individuals with a history of contact with infectious TB or who are immunocompromised are considered to have a positive TST if there is more than 5 mm of swelling.

DIF: Cognitive Level: Analysis REF: 299 OBJ: 3 (theory)

TOP: Tuberculosis: TST KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

10. The nurse explains that a serious complication of a patients chronic obstructive pulmonary disease (COPD) is cor pulmonale, which is exhibited by:

a.

distended neck veins.

b.

weight loss.

c.

confusion and disorientation.

d.

excessive coughing.

ANS: A

Cor pulmonale is exhibited by distended neck veins, enlarged right side of the heart, liver engorgement, and edema.

DIF: Cognitive Level: Application REF: 304-305 OBJ: 2 (theory)

TOP: COPD Complication: Cor Pulmonale

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

11. The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair). The nurse points out that the major advantage of this drug is it:

a.

has no GI side effects.

b.

provides bronchodilation and anti-inflammatory effects.

c.

controls acute asthma episodes.

d.

can be substituted for all other asthma remedies.

ANS: B

Singulair provides both bronchodilation and anti-inflammatory effects, but it has numerous GI side effects and is not effective in controlling acute asthmatic attacks.

DIF: Cognitive Level: Application REF: 309 | Table 15-4

OBJ: 3 (clinical) TOP: Asthma: Treatment

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The patient with chronic airflow limitation (CAL) changed to the use of a simple face mask from a nasal cannula delivery system. The nasal equipment oxygen was set at 3 L/min. The nurse instructs the patient that, with the change in delivery systems, the oxygen should be _____ L/min.

a.

decreased to 2

b.

decreased to 1

c.

increased to 4

d.

increased to 6

ANS: D

When changing to a mask from a nasal cannula, the oxygen should be increased by approximately 100% to get the same concentration. Simple face masks deliver approximately the same range of concentration of oxygen as the nasal cannula. However, the nasal cannula flow rates range from 1 L to 6 L, delivering 24% to 44% oxygen, whereas the simple face mask delivers 35% to 50% oxygen which is achieved with flow rates from 6 L to 12 L.

DIF: Cognitive Level: Analysis REF: 323 | Table 15-5

OBJ: 1 (clinical) TOP: Oxygen Delivery Systems

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. A patient who has had a left pneumonectomy to remove a lung cancer is returned to the unit from surgery. The nurse should position the patient in a _____ position.

a.

high Fowlers

b.

semi-Fowlers

c.

right side-lying

d.

left side-lying

ANS: D

Postoperative positioning after a pneumonectomy is on the operated side to prevent the threat of tension pneumothorax with mediastinal shift and leakage from the amputated bronchial stump. The physicians order should always be checked before turning the patient or raising the head of the bed.

DIF: Cognitive Level: Application REF: 316 OBJ: 6 (theory)

TOP: Pneumonectomy: Positioning KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. When caring for a patient who is on a closed-chest drainage system with chest tubes, the nurse can confirm that the system is intact and working when:

a.

the water level in the water-seal chamber fluctuates.

b.

the level of fluid in the collection chamber rises.

c.

there are constant bubbles in the water-seal chamber.

d.

the suction has been attached.

ANS: A

If the level of the water in the water-seal chamber rises and falls with the patients respiration, the system is intact. Constant bubbles in the water-seal chamber indicate a leak in the system. The fluid in the collection container drains by gravity whether the closed-chest drainage system is intact or not. Suction is not significant with respect to whether the system is intact.

DIF: Cognitive Level: Analysis REF: 316-317 OBJ: 6 (theory)

TOP: Closed-Chest Drainage KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

15. When the nurse assesses that the level of drainage has not increased over the last 3 hours on a first-day postoperative thoracotomy patient, the nurse should initially:

a.

inform the charge nurse.

b.

rearrange tubing to correct dependent loops.

c.

splint the patient with a pillow and coach to cough.

d.

gently massage the tube toward the collection bottle.

ANS: B

Dependent loops can capture drainage and plug the tube, not allowing any more drainage to leave the chest. Massaging (milking) the tube can be implemented after the dependent loops have been corrected. It would not be necessary to notify the charge nurse unless there is a problem, and having the patient cough would not correct the drainage problem.

DIF: Cognitive Level: Application REF: 316-317 OBJ: 6 (theory)

TOP: Closed-Chest Drainage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. The nurse schedules the postural drainage treatments to be done before breakfast because:

a.

fluids that have accumulated overnight can be expelled.

b.

bronchial openings are still more fully open after a nights rest.

c.

appetite will be stimulated for a meal after fluid is expelled.

d.

the empty stomach reduces gagging.

ANS: A

Morning postural drainage can expel the fluids collected overnight. After a postural drainage, the patient is tired and may not want to eat at all. The empty stomach prevents excessive vomiting but not gagging.

DIF: Cognitive Level: Application REF: 321 OBJ: 2 (theory)

TOP: Postural Drainage KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. The patient with sleep apnea is fitted with a continuous positive airway pressure (CPAP) mask and asks the nurse how this device will help. The nurse correctly responds with which statement?

a.

The device delivers constant positive pressure to keep your airway open.

b.

The device will require you to be intubated to open your airway.

c.

The device delivers oxygen only when you are apneic.

d.

The device delivers negative pressure to stimulate your respirations.

ANS: A

The CPAP mask delivers a constant positive pressure to keep the airway open. CPAP does not require intubation and does not deliver negative pressure.

DIF: Cognitive Level: Application REF: 326 OBJ: 6 (theory)

TOP: Continuous Positive Airway Pressure Mask

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. When caring for a patient with AIDS, the nurse is aware that this patient is most at risk for developing which type of pneumonia?

a.

Hypostatic

b.

Streptococcus pneumoniae

c.

Atypical

d.

Pneumocystis jiroveci

ANS: D

Pneumocystis jiroveci (formerly known as Pneumocystis carinii) is commonly seen in AIDS patients. Hypostatic pneumonia is related to inadequate aeration of the lungs seen frequently with immobile patients.Streptococcus pneumoniae is the most common causative organism for bacterial pneumonia in the general population. Atypical pneumonia refers to pneumonia that does not present with the typical symptoms of pneumonia.

DIF: Cognitive Level: Comprehension REF: 297-298 OBJ: 1 (theory)

TOP: Pneumonia KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

19. The nurse is teaching an asthma patient proper use of the peak flowmeter. The nurse determines further teaching is needed when observing which action by the patient?

a.

Repeating the procedure for a total of three readings

b.

Breathing in deeply through the mouthpiece

c.

Standing while performing the test

d.

Recording the highest reading on the peak flow sheet

ANS: B

Peak flow should be monitored on a daily basis to determine if the asthma patient has adequate airflow. The reading helps determine if treatment should be adjusted. The patient should stand to achieve adequate chest expansion while taking a deep breath. The patient then blows as hard and fast as possible into the device with the mouthpiece in the mouth and the lips clamped firmly around it for a tight seal. The procedure should be performed three times with the highest reading recorded.

DIF: Cognitive Level: Knowledge REF: 307 | Patient Teaching

OBJ: 3 (clinical) TOP: Patient Teaching: Peak Flowmeter

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

20. The nurse providing patient education states that influenza is spread by: (Select all that apply.)

a.

direct contact.

b.

indirect contact.

c.

vector.

d.

blood-borne method.

e.

droplets.

ANS: A, B, E

Influenza is not spread by vectors or the blood-borne method.

DIF: Cognitive Level: Comprehension REF: 294 OBJ: 1 (theory)

TOP: Influenza: Contagion KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21. The home health nurse making an initial call on a newly diagnosed tuberculosis patient who lives at home with his wife and child would give special instruction for infection control to: (Select all that apply.)

a.

place contaminated tissues in sealable plastic bag.

b.

take prescribed drug exactly as directed.

c.

take airborne precautions.

d.

wash hands frequently.

e.

wear mask when in crowds.

ANS: A, B, D, E

As the family is already exposed, taking airborne precautions is unnecessary.

DIF: Cognitive Level: Comprehension REF: 301 OBJ: 3 (theory)

TOP: Tuberculosis: Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse is working with a pulmonary specialist and is aware that the physician will most likely recommend that a full-year preventative protocol of isoniazid (INH) be given to people who: (Select all that apply.)

a.

are living with a person newly diagnosed as having tuberculosis.

b.

have had a positive tuberculin skin test but negative chest films.

c.

have had a positive tuberculin skin test and are on steroids.

d.

have had a positive tuberculin skin test and have diabetes.

e.

have had a positive tuberculin skin test and have had a gastrectomy.

ANS: A, B, C, D, E

All options are people for whom a protocol of isoniazid should be recommended.

DIF: Cognitive Level: Application REF: 301 OBJ: 3 (theory)

TOP: Tuberculosis: Prevention KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23. The signs the nurse would expect to see in a patient with advanced emphysema are: (Select all that apply.)

a.

productive cough.

b.

dyspnea.

c.

barrel chest.

d.

wheezing.

e.

cyanotic skin tone.

ANS: A, B, C, E

The emphysemic has a barrel chest and dyspnea. There is minimal coughing and mucus production until late in the disease. Wheezing usually does not occur in the emphysemic patient. Cyanosis is usually absent until late in the disease when the patient becomes hypoxic.

DIF: Cognitive Level: Analysis REF: 303 OBJ: 2 (theory)

TOP: Emphysema: Signs KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. The home health nurse recommends to the 60-year-old patient with emphysema who is anorexic to enhance her nutrition by the practices of: (Select all that apply.)

a.

resting before eating.

b.

avoiding gas-producing food.

c.

eating four to six small meals rather than three large ones.

d.

lying down after eating.

e.

taking small bites and chewing slowly.

ANS: A, B, C, E

Lying down after meals will likely increase shortness of breath. All other options will enhance her ability to increase her nutritional state.

DIF: Cognitive Level: Application REF: 304 | Nutrition Considerations

OBJ: 2 (theory) TOP: Emphysema: Anorexia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. The nurse explains to the patient on a mechanical ventilator that it is set on assist-control mode, which means that the machine will: (Select all that apply.)

a.

deliver a set tidal volume.

b.

deliver a set number of breaths if the patients rate falls.

c.

automatically cuts off if the patient is breathing independently.

d.

deliver more oxygen at the end of an inspiration.

e.

help to correct respiratory acidosis.

ANS: A, B

The assist-control mode delivers a set tidal volume on every respiration and will deliver a set number of breaths per minute should the patients rate drop. It does not cut off automatically or deliver more oxygen at the end of the inspiration, nor does it correct respiratory acidosis.

DIF: Cognitive Level: Analysis REF: 325 OBJ: 2 (clinical)

TOP: Mechanical Ventilation: Assist-Control Mode

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

26. The nurse is preparing a presentation highlighting the benefits of annual influenza vaccination. The nurse correctly targets which groups? (Select all that apply.)

a.

The parents of children 3 to 6 months of age

b.

Diabetics who are over 50 years old

c.

Pregnant women

d.

Home health aides

e.

CNAs who work in long-term care facilities

ANS: B, C, D, E

Children ages 6 to 59 months should receive the influenza vaccine, not children 3 to 6 months of age. The Advisory Committee on Immunization Practices also suggests that pregnant women, people over age 50, and people with certain chronic illnesses receive the vaccine. In addition, health care workers and those caring for persons in homes that are at high risk for contracting influenza should receive the vaccine.

DIF: Cognitive Level: Application REF: 295 | Health Promotion

OBJ: 1 (theory) TOP: Influenza Vaccination

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

MATCHING

Place the events of an asthma attack in proper sequence.

a.

Mast cellmediated inflammatory response in bronchi

b.

Mucus production

c.

Plugging of small airways

d.

Contact with precipitator

e.

Mucosal edema

27. Step 1

28. Step 2

29. Step 3

30. Step 4

31. Step 5

27. ANS: D DIF: Cognitive Level: Application REF: 305 | Concept Map 15-2

OBJ: 4 (theory) TOP: Asthma: Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

28. ANS: A DIF: Cognitive Level: Application REF: 305 | Concept Map 15-2

OBJ: 4 (theory) TOP: Asthma: Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

29. ANS: E DIF: Cognitive Level: Application REF: 305 | Concept Map 15-2

OBJ: 4 (theory) TOP: Asthma: Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

30. ANS: B DIF: Cognitive Level: Application REF: 305 | Concept Map 15-2

OBJ: 4 (theory) TOP: Asthma: Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

31. ANS: C DIF: Cognitive Level: Application REF: 305 | Concept Map 15-2

OBJ: 4 (theory) TOP: Asthma: Pathophysiology KEY: Nursing Process Step: NA

MSC: NCLEX: Health Promotion and Maintenance

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