Chapter 33Obstructive Pulmonary Disease: Nursing Management My Nursing Test Banks

Chapter 33Obstructive Pulmonary Disease: Nursing Management

MULTIPLE CHOICE

1.A client states, I dont know why I should quit smoking. It cant improve anything. The nurse responds by informing the client about the decrease in lung cancer rates over time after a person quits smoking. Which of the following is correct?

1.

The lung cancer rate corresponds to that of nonsmokers 1 year after quitting smoking.

2.

The lung cancer rate corresponds to that of nonsmokers 2 years after quitting smoking.

3.

The lung cancer rate corresponds to that of nonsmokers 5 years after quitting smoking.

4.

The lung cancer rate corresponds to that of nonsmokers 10 years after quitting smoking.

ANS: 4

Ten years after quitting smoking, the clients lung cancer rate will correspond to a nonsmokers rate. After 1 year of no smoking, the risk of coronary heart disease decreases to half that of a smoker. After 2 years of no smoking, the risk of coronary heart disease equals that of a nonsmoker. After 5 years of no smoking, the lung cancer rate drops by half.

PTS:1DIF:Apply

REF: Table 33-4 Changes in Physiological Function of Patients after Smoking Cessation

2.A client has been smoking for the last 40 years and has a history of emphysema. Which of the following findings would the nurse not expect to find?

1.

Decreased forced vital capacity (FVC)

2.

Increased anterior-posterior chest diameter

3.

Increased forced expiratory volume (FEV1)

4.

Pursed lip breathing

ANS: 3

The FEV1 does not increase; it decreases. The FVC does decrease, and the client can exhibit increased anterior-posterior chest diameter and pursed lip breathing.

PTS:1DIF:Apply

REF: Chronic Obstructive Pulmonary Disease: Assessment with Clinical Manifestations

3.A client is being treated for exacerbation of chronic obstructive pulmonary disease. Which of the following nursing interventions will the nurse expect to be completed?

1.

Initiate oxygen at 1 L/min via nasal cannula.

2.

Limit fluids.

3.

Place on respiratory isolation.

4.

Schedule all activities at one time.

ANS: 1

Oxygen for a client diagnosed with COPD should be low flow so as not to diminish the clients drive to breath. Fluids are encouraged, and activities should be interspersed with rest periods so the client will not become overtired. Isolation is not necessary at this time.

PTS:1DIF:Apply

REF:Chronic Obstructive Pulmonary Disease: Oxygen Therapy

4.A client has been diagnosed with chronic obstructive pulmonary disease. Which of the following nursing diagnoses would be the most important at this time?

1.

Activity intolerance

2.

Anxiety

3.

Impaired gas exchange

4.

Nutrition, imbalance

ANS: 3

Airway and breathing are always a top priority for a client. Once gas exchange is ensured for the client, the other diagnoses of activity intolerance and nutrition imbalance can be addressed. Anxiety would be addressed last for this client.

PTS:1DIF:Apply

REF:Chronic Obstructive Pulmonary Disease: Nursing Diagnoses

5.The nurse is caring for a client who has completed pulmonary function testing. Which of the following indicates the amount of air inhaled or exhaled with each breath during normal breathing?

1.

Expiratory reserve volume

2.

Minute volume

3.

Tidal volume

4.

Vital capacity

ANS: 3

Tidal volume is the amount of air inhaled or exhaled with each breath during normal breathing. The expiratory reserve volume is the maximum amount of air exhaled forcefully after a normal exhalation. Minute volume is the amount of air breathed per minute. Vital capacity is the maximum amount of air exhaled after maximum inspiration.

PTS:1DIF:Analyze

REF: Table 33-3 Pulmonary Function Spirometry Measures

6.The nurse is caring for a client diagnosed with chronic obstructive pulmonary disease. Which of the following interventions require extra care by the nurse?

1.

Administering pain medications

2.

Applying a cardiac monitor

3.

Encouraging fluids

4.

Teaching the client diaphragmatic breathing

ANS: 1

Administering pain medications (narcotics) requires extra care by the nurse because these medications can depress respiratory status and worsen hypercapnia. Increasing fluids helps thin the clients secretions and is encouraged. Applying a cardiac monitor and monitoring the rhythm is part of a normal assessment. Teaching diaphragmatic breathing does not require extra care.

PTS:1DIF:Apply

REF: Chronic Obstructive Pulmonary Disease: Pharmacology

7.A client diagnosed with chronic obstructive pulmonary disease has the complication of cor pulmonale. Which of the following instructions will be included in the clients discharge teaching?

1.

Adjust oxygen higher depending on activity level.

2.

Increase sodium in the diet.

3.

Maintain bed rest.

4.

Weigh self daily, and call the physician with a weight gain of 2 pounds

ANS: 4

A weight gain of greater than 2 pounds would indicate fluid retention and need to be reported to the physician. Oxygen would not be increased past the prescribed level because this may eliminate the clients drive to breathe. Increasing sodium will encourage fluid retention. Moderate activity is desired to maintain a level of cardiovascular health.

PTS:1DIF:Apply

REF: Chronic Obstructive Pulmonary Disease: Patient and Family Teaching

8.A client is being admitted with the diagnosis of asthma. To facilitate breathing, in what position would the nurse place the client?

1.

Lateral

2.

Prone

3.

High-Fowlers

4.

Supine

ANS: 3

Only the high-Fowlers position facilitates breathing. The other positions could make breathing more difficult.

PTS: 1 DIF: Apply REF: Asthma: Assessment and Clinical Manifestations

9.A client diagnosed with asthma is having an acute episode at home. Which of the following medications should the client be instructed not to use during this episode?

1.

Albuterol

2.

Proventil

3.

Serevent

4.

Ventolin

ANS: 3

Serevent is a long-acting agent and is not to be used as rescue medication during acute episodes. Albuterol (also sold under the brand names Proventil and Ventolin) is a short-acting agent used as a rescue medication.

PTS: 1 DIF: Apply REF: Asthma: Pharmacology

10.A client diagnosed with asthma is receiving instructions about the use of albuterol. The client should be aware that albuterol may cause:

1.

bradycardia.

2.

drowsiness.

3.

nasal congestion.

4.

nervousness.

ANS: 4

Albuterol causes nervousness, tachycardia, insomnia, dizziness, tremors, hypertension, headache, and irritation to the nasal and throat passages. Albuterol does not cause bradycardia, drowsiness, or nasal congestion.

PTS: 1 DIF: Apply REF: Asthma: Complications

11.The nurse is assessing a client diagnosed with asthma. The clients breath sounds initially had wheezing but are diminishing until no audible sounds are heard. This has occurred because:

1.

swelling has increased, and it has blocked airways.

2.

the attack has passed.

3.

the client used an inhaler.

4.

no mucus is present.

ANS: 1

This client needs to be evaluated immediately and receive prompt treatment to reduce the airway obstruction and reverse inflammation. Lack of audible breath sounds does not mean that the attack has passed, the client has used an inhaler, or there is no mucus present.

PTS: 1 DIF: Analyze REF: Asthma: Complications

12.The parents of a child diagnosed with cystic fibrosis ask the nurse how their child developed the disease. Which of the following should the nurse explain to these parents?

1.

Cystic fibrosis is a disease that has an extra chromosome.

2.

Cystic fibrosis is an X-linked disorder.

3.

Cystic fibrosis is passed on by a defective gene from both parents.

4.

Cystic fibrosis is passed on by one defective gene from one parent.

ANS: 3

Cystic fibrosis is an inherited, autosomal recessive disease that is passed on by a defective gene from both parents and not one parent. This disease does not occur because of an extra chromosome. This disease is not an X-linked disorder. Cystic fibrosis is a chronic, progressive, and frequently fatal disease of the bodys exocrine mucus-producing glands that primarily affects the respiratory, digestive, intestinal systems, and the pancreas.

PTS:1DIF:ApplyREF:Cystic Fibrosis

13.The nurse is to collect a stool specimen from a client diagnosed with cystic fibrosis. The nurse would expect to see:

1.

black, tarry stool.

2.

bulky, foul-smelling stool.

3.

clay-colored stool.

4.

green stool.

ANS: 2

Bulky, foul-smelling stool is characteristic of clients diagnosed with cystic fibrosis as a result of malabsorption. Black, tarry stool can be observed in a client with upper gastrointestinal bleeding. Clay-colored stool can indicate bile obstruction. Green stool may indicate gastrointestinal infection.

PTS: 1 DIF: Analyze REF: Box 33-3 Nutrition in CF

14.A client is experiencing a sudden onset of headache, nausea, cough, fever, myalgia, and fatigue. The nurse suspects this client is experiencing:

1.

seasonal influenza.

2.

chronic obstructive pulmonary disease.

3.

asthma.

4.

cystic fibrosis.

ANS: 1

Seasonal influenza has a sudden onset with a headache, nausea, cough, chills, fever, rhinitis, myalgia, and extreme fatigue. These symptoms are not seen in chronic obstructive pulmonary disease, asthma, or cystic fibrosis.

PTS:1DIF:AnalyzeREF:Seasonal Influenza

MULTIPLE RESPONSE

1.The nurse is caring for a client diagnosed with cystic fibrosis. Which of the following medications does the nurse realize are commonly used to help treat this disorder? (Select all that apply.)

1.

N-acetylcysteine (Mucomyst)

2.

Acetaminophen (Tylenol)

3.

Dornase alfa (Pulmozyme)

4.

Furosemide (Lasix)

5.

Ibuprofen (Motrin)

6.

Digitalis (Digoxin)

ANS: 1, 3, 5

Medications commonly used to treat cystic fibrosis include N-acetylcysteine (Mucomyst), Dornase alfa (Pulmozyme), and Ibuprofen (Motrin). Acetaminophen, furosemide, and digitalis are not routinely prescribed in the treatment of cystic fibrosis.

PTS: 1 DIF: Analyze REF: Cystic Fibrosis: Pharmacology

2.The nurse suspects a client is experiencing chronic obstructive pulmonary disease when which of the following is assessed? (Select all that apply.)

1.

Peripheral edema

2.

Jugular vein distention

3.

High blood pressure

4.

Dyspnea on exertion

5.

Sputum production

6.

Cough

ANS: 4, 5, 6

Chronic obstructive pulmonary disease is characterized by a history of three primary symptoms: 1) cough, 2) sputum production, and 3) dyspnea on exertion. Peripheral edema, jugular vein distention, and high blood pressure are not symptoms of chronic obstructive pulmonary disease.

PTS:1DIF:Analyze

REF: Chronic Obstructive Pulmonary Disease: Assessment with Clinical Manifestations

3.A client is diagnosed with stage I mild, chronic obstructive pulmonary disease. Which of the following assessment findings will support this diagnosis? (Select all that apply.)

1.

Chronic cough

2.

Sputum production

3.

Forced expiratory volume in 1 second of greater than 80%

4.

Mild airflow limitations

5.

Extreme dyspnea on exertion

6.

Right-sided heart failure

ANS: 3, 4

In stage I mild chronic obstructive pulmonary disease, the client will demonstrate mild airflow limitations and have a forced expiratory volume in 1 second of greater than 80%. Chronic cough and sputum production are signs of stage 0 of the disease. Extreme dyspnea on exertion and right-sided heart failure are indications of stage III severe chronic obstructive pulmonary disease.

PTS:1DIF:Analyze

REF:Table 33-2 Classification of Patients with COPD by Severity

4.A client diagnosed with chronic obstructive pulmonary disease is scheduled for diagnostic tests. Which of the following are used to aid in the diagnosis of this disorder? (Select all that apply.)

1.

Pulmonary function spirometry tests

2.

Chest x-ray

3.

Electrocardiogram

4.

Medication levels

5.

Sputum samples

6.

Electrolyte levels

ANS: 1, 2, 3, 4

Tests used to aid in the diagnosis of chronic obstructive pulmonary disease include pulmonary function spirometry tests, chest x-ray, electrocardiogram, and medication levels. Sputum samples are not useful and are not recommended in the diagnosis of chronic obstructive pulmonary disease. Electrolyte levels are not indicated.

PTS:1DIF:Analyze

REF:Chronic Obstructive Pulmonary Disease: Diagnostic Tests

Leave a Reply