Comprehensive Respiratory System Disorders NCLEX C
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Comprehensive Respiratory System Disorders NCLEX Challenge Exam (Quiz #1: 50 Questions) UFC1ATED ON OCTOBER 17. 2DC3 BY MATT VERA BSN.H.N. Hi! You Eire currently in Lhe quiz page. If you're dorte with this qui4 please ctieck out the other exams by clicking here to go back to the Respiratory System Disorders Nursing Test Bank page. Quiz Guidelines Before you start, here ate same examination guidelines and ranindets you must read: 1 Practice Exams- Engage wrth our Practice Exams Io liare your skills in 3 supportive. low-pressure enviranment. These exams provide immed 3te Feedback and explanations, l e a ng you grasp care concepts, identify anpruvemerl areas, and build Confidence in your knowledge and ab lies. 2. Challenge txams: Take cur Cha eoge Exams La test you mastery and readiness undo sins ated exam conditions. These exams offer a rigorous uuesliar set to assess your urdei standing. piepare you foi actual examine I an s, 3rd benchmark you performance. + You're given 2 miruLes per item. * For Challenge Exams, click on the 'Start Quiz’ button Io start die quiz. j Complete the quiz Ensure that you answer the er I re quiz. Only after you've answered every item will the scare and rationales be shown. 4. Learn from the rationales After each quiz, click on die 'View Questions" buttou to understand the explanation fur each answer. 5. Free access Guess wiiat? Our test banks are 1 M % FREE. Skip the hassle ■ no sign-ups or reg straitens here. A sincere promise from Nurseslabs: we have not ard wort ever request your credit card details ar personal info for oca practice uuesliar s. We re dedicated 1o keepng this service accessible ard cost-free, espec ally for uui amazing students ard r arses. So. take the leap and elevate your career hassle-free 6. Share truur tlKiuidilq We d oveyoca feedback, scores, and questions! P ease share them in die comments below. Results 5Qnf 50 Questions answered correctly Your lime. 00.10:44 You have reached 50 of 50 point(s), (10DXJ Average score Crt,
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Would you like Io submit your quiz result to the leaderboard? Namft Name E Mail: E Mail Rqntfl View Questions 1. Question 1 pointfs) Aminophylline iLheophy llinej is prescribed Tor a client with acute branchilis. A nurse administers the medication, knowing that the primary action of this medication is to: A_ Promote expectoration. B. Suppress Ute cough. C. Relax smooth muscles of the bronchial airway. D. Prevent infection. Correct Correct Answer: C. Relax smooth muscles of lhe bronchial airway Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the branchial airway. Theophylline causes non'seleclive inhibition of type III and type IV isoenzyntes of phosphodiesterase, which leads to increased tissue cyclic adenosine monophosphate (cAMP) and cyclic 3?.5? guanasine monophasphate concentrations, resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS and cardiac stimulation. * Option A: Guaifenesin is an expectorant. It works by thinning arid loosening mucus in lhe airways, clearing congestion, and making breathing easier. Mucolytics are drugs belonging to lhe class of mucoactive agents. They exert their effect on lhe mucus layer lining Lhe respiratory trad with Lhe motive of enhancing its clearance. * Option B: Antitussives are drugs that suppress lhe cough reflex. Persistent coughing can be exhausting and can cause muscle strain and further irritation of Lhe respiratory trad. They act on the cough control center in the medulla to suppress lhe cough reflex.
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* Option D; Antibiotics are powerful medicines that fight bacterial infections. They either kill bacteria or stop them from reproducing, allowing the body's natural defenses to eliminate the pathogens. Used properly, antibiotics can save lives. But growing antibiotic resistance is curbing the effectiveness of these drugs. Taking an antibiotic as directed, even after symptoms disappear, is key to curing infection and preventing the development of resistant bacteria. 2 Question 1 A client is receiving isoelharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? A_ Constipation B. Diarrhea C. Bradycardia D. Tachycardia Correct Correct Answer: D. Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the rrrouth or throat Due to the vasodilatory effect of peripheral vasculature and subsequent decrease in cardiac venous return, compensatory mechanisms manifest as tachycardia are relatively comment. especially within the first weeks of usage. - Option A: Constipation is not a side effect of isoetharine. Bela 2 agonists have been shown to decrease serum potassium levels via an inward shift of potassium into the cells due to an effect on the membrane bound Na/K ATPase, which can potentially result in hypokalemia. Beta 2 agonists also promote glycogenolysis, which can lead to inadvertent elevations in serum glucose. • Option B: Adverse effects of beta 2 agonists most commonly involve the desensitization of the beta 2 adrenergic receptor to the beta 2 agonist. Due Io the similar properties between the classes of adrenergic receptors, beta 2 agonists can create an "off target" effect in stimulating either alpha 1, alpha 2, or beta 1 receptors. The most common side effects of beta 2 agonists involve the cardiac, metabolic, or musculoskeletal system. - Option C: Arrhythmias are seen more commonly in fenoterol usage versus albuterol, and arrhythmias have an increase in frequency in patients with underlying heart disease or concomitant theophylline use. Several studies have
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also indicated hypoxemia and hypercapnia aS exacerbating factors to ti e card atoxic effects of beta 2 agonists. 3. Question 1 P* ln, W A nurse leaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? A_ Removes the cap and shakes the inhaler well before use. B. Press the canister down with your finger as he breathes in. C. Inhales; the mist and quickly exhales. D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed. Correct Correct Answer: C. inhales the mist and tjuickly exhales. Take the inhaler out of the mouth. If the client can, he should hold his breath as he slowly counts to 10. This lets the medicine reach deep into the lungs. Tire client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist. » Option A: If the client has not used the inhaler in a wfiile, he may need to prime it. See the instructions that came with the inhaler for when and how to do this. Shake the inhaler hard 10 to 15 limes before each use. * Option 0: Hold the inhaler with the mouthpiece down. Place lips around the mouthpiece so that the mouth forms a light seal. As the client starts to slowly breathe in through the mouth, press down on the inhaler one lime. » Option 0: If using inhaled, quick relief medicine (beta agonists), wail about 1 minute before taking the next puff. You do not need to wait a minute between puffs for other medicines. 4. Question 1 A female client is scheduled Io have a chest radiograph. Which of the following questions is of most importance Io the nurse assessing this client? A. 'Is there any possibility that you could for pregnant?'
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B. "Are you wearing any metal chains or jewelry?' C. "Can you hold your breath easily?" D. "Are you able Io hold your arms above your head?" Correct Correct Answer: A. "It there any possibility lhai you could be pregnant?" The rrtosl important item to ask about is the client's pregnancy slatus because pregnant women should not be exposed to radiation. The risk of Side effects of an X ray while the client is pregnant is extremely minimal but il is always important to protect the developing fetus from harm. * Option B: Clients are also asked to remove any chains or mela I objects that could interfere with obtaining an adequate film. The client may be asked to strip down and wear a hospital gown, or al least remove clothing on lhe part of the body that needs to be X rayed. * Option C: & chest radiograph most often is done al full ir'spiration, which gives optimal lung expansion. ’ Option D; if a lateral view of lhe chest is ordered, the client is asked to raise the amts above the head. The client will be asked to stay still so the image will be as clear as possible. This will provide lhe mosl accuale image. Mosl films are done in posterior anterior view. The X ray test works by positioning Lhe part of the body being X rayed between Lhe soiMce of the X'ray and an X ray detector (such as a film}. 5, Question 1 P° ln, < 5 ) A client has just returned Io a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously □ . Administering small doses of midazolam (Versed).
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Correct Correct Answer: B. Ensuring the return of the gag reHex before offering foods or fluids After bronchoscopy, the nurse keeps the client an NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallow ng and the protective laryngeal reflexes for a number of hours. Although bronchoscopy can be done without sedation, most procedures are done under moderate conscious sedation with the use of various sedatives based ori the clinician's preference (&.<]., benzodiazepines, opioids, dexmedetomidine). • Option A: Additional fluids are unnecessary because no contrast dye is used that would need to be flushed from die system. Regardless of the sedation or anesthesia used the physicians should be aware of the potential side effects and how to manage patients receiving these medications. - Option C: Atropine would be administered before the procedure, not after. Atropine premedicalion is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodi lalion, or preventing vasovagal reactions. * Option 0: The administration of additional midazolam in small doses, until the target sedation level is achieved, Isa safe procedure that is associated with significantly less discomfort and pain during bronchoscopy and a grea ter consent to re?examination when compared wi th the administration of a fixed dose of midazolam. 6. Question 1 poin,(3) A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the: A_ Brachial and radial arteries, and then releases them and observes the circulation of the hand. B Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process with the other artery, C. Radial artery and observes for color changes in the affected hand. D. Ulnar artery and observes for color changes in the affected hand. Correct Correct Answer: B, Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeals the process with the other artery.
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Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Alien's lesL This involves compressing the radial and ulnar arteries and asking the client Io cluse arrd open the fist. This should cause the hand to became pale. The nurse then releases pressure on one artery and observes wlrether Circulation is restored quickly. The nurse repeals the process, releasing the other artery. The blood sample may be taken safely If collateral circulation is adequate. • Option A: Puncture of the radial artery is usually preferred because of the accessibility of the vessel, the presence of collateral circulation, artd the artery's superficial course proximal to the wrist, which makes it easier fur the clinician to identify the vascular structure and hold local pressure after the procedure is finished. - Option C: The radial artery is most easily accessible medial to the radial styloid process and lateral to the flexor carpi radi alls tendon, 2 3 cm proximal to the ventral surface of the wrist crease. Firm occlusive pressure is held on both the radial artery and the ulnar artery. The patient is asked to clench the fist several limes until the palmar skin is blanched, then to unclench the fist. * Option D: if radial artery sampling is not feasible, femoral artery puncture Is a passible alternative. When femoral artery puncture is being considered, the potential risk of infection at the entry site and the artery's proximity to the femoral vein and nerve must be taken into 7. Question 1 A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this dlient has which of the following forms of chronic airflow limitation? A_ Chronic obstructive bronchitis B. tmphysema C. Bronchial asthma □ . Branchial asthma and bronchitis Correct Correct Answer? B. Emphysema The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead Io increased anteroposterior diameter, which is referred to as "barrel chest.' The client also Iras dyspnea with prolonged expiration and has hyperresonanl lungs to percussion. • Option A; Chronic bronchitis is a type of chronic obstructive pulmonary disease (C0PD1 that is defined as a productive cough of more than 3 months occurring
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within a span of 2 years. Patients typically present with chronic productive COugh, malaise, and symptoms of excessive coughing such as chest or abdominal pain. * Option C: Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration. * Option D: Acute bronchitis is the result of acute inflammation of the bronchi secondary to various triggers, most commonly viral infection, allergens, pollutants, etc. Inflammation of the bronchial wall leads to mucosal thickening, epithelial cell desquamation, and denudation of the basement membrane. Al times, a viral upper respiratory infection can progress to infection of the lower respiratory tract resulting in acute bronchitis. 8. Question 1 poim(s) A client has been taking benzonalale (Tessa Ion Perles) as prescribed. A nurse concludes that the medication is having the intended effect if the client experiences: A. Decreased anxiety level. B. Increased comfort level. C. Reduction of N/V. D. Decreased frequency and intensity of cough. Correct Correct Answer: 0. Decreased frequency and intensity of cough. Benzonalale is a locally acting antitussive the effectiveness of which is measured by the degree to which it decreases the intensity and frequency of cough without eliminating the cough reflex. Benzonalale is an oral antitussive drug used in the relief and suppression of cough in patients older than ten years of age. Currently, benzonalale is the only non narcotic antitussive available as a prescription drug. It works to reduce the activity of cougli reflex by desensitizing the tissues of the lungs and pleura involved in the cough reflex. * Option A: Because its chemical structure resembles that of the anesthetic agents in the para amino benzoic acid class (such as (procaine] and [tetracaine]), benzoriatafe exhibits anesthetic or numbing action. Although il is not prone to drug misuse or abuse, benzonalate is associated with a risk for severe toxicity and overdose, especially in children.
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• Option B; Benzonalate suppresses cough associated with both acute and chronic respiratory conditions. It works by desensitizing the pulmonary stretch receptors involved in l i e cough reflex. There are limited clinical trials of benzonalate; however, earlier studies demonstrated inhibition of experimentally induced cough and subjectively measured pathological cough by benzonalate. * Option C: Benzanatate is a synthetic bulylamino benzoate derivative related to tetracaine and a peripherally acting a ntilussive, non narcotic Benzonalate reduces the cough reflex by anesthetizing and depressing mecharroreceptors in the respiratory passages, lungs, and pleura. It is recommended for cough relief in the common coldl bronchitis, pneumonia, and for chronic cough such as in asthma. 9. Question 1 Which of the fallowing would be an expected outcome for a client recovering from an upper respiratory tract infection? The client will: A. Maintain a fluid intake of 800 ml every 24 hours. B. Experience chills only once a day. C. Cough productively without chest discomfort. □ , EnperKnc* las* n**«l obstruction and discharge Correct Correct Answer: 0. Experience less nasal obstruction and discharge. A client recovering from an URI should report decreasing or no nasal discharge and obstruction. Decongestants and combination anlihistamine/decungestant medications can limit cough, congestion, and other symptoms in adults. Avoid cough preparations in children. Hl receptor antagonists may offer a modest reduction of rhi norrhea and sneezing during the first 2 days of a cold in adults. * Option A: Daily fluid intake should be increased to more than I L every 24 hours to liquefy secretions. Topical and oral nasal decongestants (i.e., topical oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and adolescents in reducing nasal airway resistance. Evidence based data does not support the u se of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of illness. * Option B: The temperature should be below l00*F (37.8*C) with no chills or diaphoresis. According to a Cochrane Review, vitamin C used as daily prophylaxis at doses of =0.2 grams or more had a "modest but consistent effect" on the duration and severity of common cold symptoms (8% and 13% decreases in duration for adults and children.. respectively).
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* Option C: A productive cough with chest pain indicated pulmonary i nfeclion, not an URL The presence of classical features Icr rhinovirus infection coupled with the absence of signs of bacterial infection or serious respiratory illness, Is sufficient to make the diagnosis of the common cold. The common cold is a clinical diagnosis, and diagnostic testing is not necessary. 10. Question 1 P° i n l < s > Which of the fallowing individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A. A 60 year' old man with a hiatal hernia. B. A 36 year old woman with 3 children. C. A 50-year-old Woman Caring fora spouse with cancer. D. A 60 year old woman with osteoarthritis. Correct Correct Answer: C. A SO year- old woman caring for a spouse with cancer. Individuals who are household members or home care providers for high risk individuals are high priority targeted groups for immunization against influenza lo prevent transmission to those who have a decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the highest priority of the clients described. - Option A: In certain gioups, including the elderly, immune compromised individuals and infants, the influenza vaccine is less effective, but it is beneficial by reducing the incidence of severe disease, like bronchopneumonia, and reduces hospital admission and mortality. * Option B: Regarding immunization in pregnancy, a randomized controlled trial conducted in South Africa has shown that when pregnant women receive the influenza vaccine, it halves their risk of developing influenza while reducing the risk of their infants (upto 24 weeks) contracting the illness. ’ Option D: Influenza vaccine conveys immunity against the influenza virus by stimulating the production of antibodies specific to the disease. Antibodies to NA act by aggregating viruses on the cell surface effectively and reducing the amount of virus released from infected cells.
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A client with allergic rhinitis asks the nurse what he should do Io decrease his symptoms. Which of lhe following instructions 'would be appropriate tor the nurse to give the client? A. "Use your nasal decongestant spray regularly to help clear your nasal passages." B. "Ask lhe doctor for antibiotics. Antibiotics will help decrease lhe secretion.’ C. "It is ImpcrtanL to increase your activity. A daily brisk walk will help promote rfrairiage." 0, "Keep fl diary when your symptoms occur. This can help you Identify what precipitates your attacks? Correct Correct Answer: 0. 'Keep a diary when your symptoms occur. This can help you identify what precipitates your attacks.’ Il is important for clients with allergic rhinitis to determine Lhe precipitating factors so that they can be avoided. Keeping a diary can help identify these triggers. Patients often underestimate the severity of this condition and fail to seek medical therapy. It is important to adequately control AR especially due to lhe link between AR and asthma, with poor control of rhinitis predicting poor control of asthma. ■ Option A: Nasal decongestant sprays should not be used regularly because they can cause a rebound effect. If removing a pet from home is not feasible, isolating lhe pel to a single room in the house may be an option Io minimize dander exposure. It may take up to 20 weeks to eliminate cat dander from home even after removing lhe animal. * Option B: Antibiotics are not appropriate. Intranasal corticosteroid therapy can be as monotherapy or in combination with oral anlihisla mines in patients with mild, moderate, or severe symptoms. Studies have shown intranasal corticosteroids are superior to antihistamines in effectively reducing nasal inflammation and improving mucosal pathology. • Option C; Increasing activity will not control the clienl's symptoms; in fact, walking outdoors may increase them if the client is allergic to pollen. Avoidance of triggers, especially in those with seasonal symptoms, is encouraged, although it is not always practical. Precautions can be taken to avoid dust mites, animal dander, and upholstery, though this can require significant lifestyle changes that may not be acceptable to the patient. 12. Question 1 poln ' ) An elderly dient has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and
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hears diffuse crackles. How would the nurse best nterprel these assessment findings? A. ft Is likely that the client Is developing a secondary bactenal pneumonia. B. The assessment findings are consistent with Influenza and are to be expected. C. The client is getting dehydrated and needs Io increase her fluid intake to decrease secretions D. The client has not been taking her decongestants and bronchodilators as prescribed. Correct Correct Answer: A. II Is likely that the client is developing a secondary bacterial pneumonia. Pneumonia is the most common complication of influenza, especially in the elderly. The development of a purulent cough and crackles may be indicative of a bacterial infection that is not consistent with a diagnosis of influenza. * Option B: Diagnosis of influenza can be reached clinically, especially during the i nfl uenza season. Most of the cases will recover without medicaI treatment, and they would not need a laboratory lest for the diagnosis. Signs and symptoms of influenza in mild cases include a cough, fever, sore throat, myalgia, headache, runny nose, and congested eyes. A frontal or retro orbital headache is a common presentation with selected ocular symptoms that include photophobia and pain with different qualities. * Option C; These findings are not indicative of dehydration. Theclinical presentation of influenza ranges from mild to severe depending on the age., comorbidities, vaccination status, and natural immunity Io the virus. Usually, patients who received the seasonal vaccine present with milder symptoms, and they are less likely to develop complications. * Option D; Decongestants and bronchodilators are not typically prescribed for the flu. Influenza infection is self-limited and mild in most healthy individuals who do not have other comorbidilies. No antiviral treatment is needed during mild infections in healthy individuals. Antiviral medications can be used to treat or prevent influenza infection, especially during outbreaks In healthcare settings such as hospitals and residential institutions. 13. Question 1 Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the Iiquid is 2OTmg/5mI. How nrany mL should the nurse admini sler each dose? Fill in lhe blank and record your final answer using one decimal place.
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Answer: 7.5 r nL Correct Correct Answer: 7.5 ml When tire medicine is a solution of specific strength, calculations can become more complicated. Liquids (solutions, arid suspensions) are frequently used in childreris nursing ■ for example for children who find swallowing tablets difficult or patients who have medicines administered via a percutaneous endoscopic gastrostomy (PEG) tube. 14. Question 1 Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant Which of the following is a possible side effect of this drug? A. Constipation B. Bradycardia C. Diplopia O. Restlessness Correct Correct Answer: 0. Restlessness Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia, hypertension, palpitations, and arrhythmias. * Option A: Pseudoephedrine is used to relieve nasal congestion caused by colds, allergies, and hay fever. It is also used to temporarily relieve sinus congestion and pressure. Pseudoephedrine will relieve symptoms but will not treat the cause of the symptoms or speed recovery. Pseudoephedrine is in a class of medications Called nasal decongestants. Il works by causing narrowingof the blood vessels in the nasal passages. * Option B Tachycardia, not bradycardia, is a side effect of pseudoephedrine. Nonprescription cough and cold combination products, including products that contain pseudoephedrine, can cause serious Side effects or dealt: in young
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children. Do not give nonprescription pseudoephedrine products to children younger than 4 years of age. * Option C: Diplopia is not a side effect of pseudoephedrine. Tell your doctor if you have or have ever had high blood pressure, glaucoma (a condition in which increased pressure in the eye can lead to gradual loss of vision), diabetes, difficulty urinating (due to an enlarged prostate gland), cr thyroid or heart disease. If you plan to take the 24 hour extended release tablets, tell your doctor if you have had a narrowing or blockage of your digestive system. 15. Question 1 A client with CORD reports steady weight loss and being "too tired from just breathing to eat." Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? A. Altered nutrition: Less than body requirements related to fatigue. B. Activity intolerance related Io dyspnea. C. Weight loss related to COPD. □ . Ineffective breathing pattern related to alveolar hypoventilation. Correct Correct Answer: A. Altered nutrition; Less than body requirements related to fatigue. The client's problem is altered nutrition— specifically, less than required. The cause, as slated by the client, is the fatigue associated with the disease process. Instruct the patient to frequently eat high caloric foods in smaller portions. COPD patients expend an extraordinary amount of energy simply on breathing and require high caloric meals to maintain body weight and muscle mass. * Option B: Activity intolerance is a likely diagnosis but is not related to the Client's nutritional problems. Provide al least 9tJ minutes of undisturbed rest in between activities. Allotmenlof undisturbed rest reduces demand for oxygen and allows adequate physiologic recovery. * Option Ct Weight loss is not a nursing diagnosis. Encourage a rest period of 1 hr before and after meals. Helps reduce fatigue during mealtime and provides an opportunity to increase total caloric intake. Avoid gas producing foodsand carbonated beverages. Can produce abdominal distension., which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea. * Option D: Ineffective breathing pattern may be a problem, but this diagnosis does not specifically address the problem of weigfil loss described by the client. Instruct how to splint the chest wall with a pillow for comfort during coughing
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and elevation of head aver the body as appropriate. Promotes physiological ease of maximal inspiration. 16. Question 1 When developing a discharge plan to manage the care of a clien t with COPD, the nurse should anticipate that the dient will do which of the following? A. Develop infections easily. B. Maintain current status. C. Require less supplemental oxygen. D. Show permanent improvenrent. CWTKt Correct Answer: A. Develop Infections easily. A client with CDPD is at high risk for development of respiratory infections. In emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils and macrophages are recruited arid release multiple inflammatory mediators. Oxidants and excess proteases leading to the destruction of the air sacs. The protease mediated destruction of elastin leads Io a loss of elastic recoil and results in airway collapse during exhalation. * Option B: COPD is slowly progressive; therefore, maintaining current status is an unrealistic expectation. CDPD is an inflammatory condition involving the airways, lung parenchyma, and pulmonary vasculature. The process is thought to involve oxidative stress and protease antiprotease imbalances. Emphysema describes one of the structural changes seen in COPD where there is destruction of the alveolar air sacs (gas exchanging surfaces of the lungs) leading to obstructive physiology. * Option C“ This is an unrealistic expectation. The prognosis of COPD is variable based on adherence to treatment including smoking cessation and avoidance of other harmful gases. Patients with other comorbidities (e.g., pulmonary hypertension, cardiovascular disease, lung cancer) typically have a poorer prognosis. The airflow limitation and dyspnea are usually progressive. * Option D: Treatment may slow progression of the disease, but permanent improvement is highly unlikely. As the disease progresses impairment of gas exchange is often seen. The reduction in ventilation or increase in physiologic
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dead space leads to COZ retention. Pulmonary hypertension may occur due lo diffuse vasoconslriclion from hypoxemia. 17. Question 1 p<tln1 Which of the fallowing outcomes would be appropriate for a client with COPD who has been discharged to home? The client: A_ Promises to do pursed Up breathing at home. B. States actions lo reduce pain. C. Slates that he will use oxygen via a nasal cannula at 5 U/minule. 0. Agrees to call the physician if dyspnea on exertion increases. CWTKt Correct Answer: 0 Agrees lo call the physician If dyspnea on exertion increases. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified. There are things that everyone with COPD should do lo manage their disease; quitting smoking (If they smoke] is lhe most important. In addition there are other non medication treatments that can help relieve symptoms and improve quality of life. • Option A: Extracting promises from clients is not an outcome criterion. Pulmonary rehabilitation programs have been shown to improve a person's ability to exercise. enhance quality of life, and decrease the frequency of COPD exacerbations (when symptoms flare up more than usual). Even people with severe shortness of breath can benefit from a rehabilitation program. « Option 0: Pain is not a common symptom of COPD. Although COPD usually worsens over time, it is difficult to predict how quickly it will progress and how long the client will live (the prognosis). A number of factors play a role in the severity of COPD symptoms, including whether the client continues to smoke, are underweight, or have other medical problems, and how the lungs function during exercise. People with COPD who have less severe symptoms, are a healthy weight, and do not smoke lend lo live longer. ’ Option C: Clients with COPD use low-flow oxygen supplementation (1 to 2 L/minule) lo avoid suppressing lhe respiratory drive, which, for these clients, is stimulated by hypoxia. People with severe or advanced COPD can have low oxygen levels in the blood. This condition, known as hypoxemia, can occur even if the client does nol feel short of breath cr have other symptoms. The oxygen level can be measured with a device placed on lhe finger (pulse oximeter) or
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with a blood lest (arterial blood gas). People with hypoxemia may be placed on Oxygen therapy, which can improve survival and quality of life. 13. Question 1 p o l n ' <5) Which of the following physical assessment findings would the nurse expect Io find in a client with advanced CORD? A. Increased anteroposterior chest diameter. B. Underdeveloped neck muscles. C. Collapsed neck veins. □ . Increased chest excursions with respiration. Correct Correct Answer: A. Increased anteroposterior chest diameter- increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrekchesled appearance. In addition, coarse crackles beg inning w ith inspiration may be heard. * Option 0: Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Use of accessory respiratory muscles and paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign). - Option C: Distended, not collapsed., neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump into pulmonary vasculature. In advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral edema can be observed. * Option Dl Diminished, not Increased., chest excursion Is associated with COPD. The sensitivity of a physical examination in detecting mild to moderate COPD is relatively poor; however, physical signs are quite specific and sensitive for severe disease. Patients with severe disease experience lachypmea and respiratory distress with simple activities. 1 poinl(s) 19. Question Which of the fallowing is the primary reason Io teach pursed lip breathing to clients with emphysema?
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A_ To prorriole oxygen intake. B. Ta strengthen the diaphragm. C. To strengthen the intercostal muscles. D. To promote carbon dioxide elimination. Correct Correct Answer: D. To promote carbon dioxide elimination. Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the client relax, pursed lip breathing helps the client learn to control the rate and depth of respiration. Pursed lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles. - Option A: F o r those suffering from chronic obstructive pulmonary disease, the ability to take in oxygen is a constant struggle. It's possible to increase oxygen levels in other ways, such as cellular therapy. Cellular ifterapy may promote the healing of lung tissue, potentially improving lung function. When lung function improves; the client is able to take in more oxygen as well as expel carbon dioxide because the lungs are working more effectively. - Option B: Diaphragmatic breathing is a type of a breathing exercise that fieIps strengthen the diaphragm, an important muscle that helps us breathe. This breathing exercise is also sometimes called belly breathing or abdominal breathing. • Option C; Breathing exercises slowly fill the lings with air to expand the chest and work the intercostal muscles. To do this exercise, it is typically recommended to sit or stand with the back straight if ten take a full breath from the bottom of the lungs. It can help Io think of breathing from the diaphragm, by slowly expanding the abdominal muscles while inhaling, then pushing air from the lungs using these same muscles. i pointfs) 20. Question Which of the following is a priority goal for the client with CORD? A. Maintaining functional ability. B. Minimizing chest pain.
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C. Increasing carbon dioxide levels in the blood. D. Treating infectious agents. Correct Correct Answer: A. Maintaining funclional ability A priority goal for the client with COPD is to manage the s/s of the disease process so as to nraintain the client's functional ability. Evaluate the level of activity tolerance. Provide a calm, quiet environment Limit a patient's activity or encourage bed or chair rest during the acute phase. Have patient resume activity gradually and increase as individually tolerated. * Option 0: Chest pain is not a typical sign of COPD. Assess and record respiratory rate, depth. Note the use of accessory muscles, pursed lip breath ing. inability Io speak or converse. Useful in evaluating the degree of respiratory distress or chronicity of the disease process. * Option C: The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Monitor arterial blood gasses values as ordered. As the patient's condition progresses, PaD2 usually decreases. For patients with chronic carbon dioxide retention may have chronically compensated respiratory acidosis with a low normal pH and a PaCo2 higher than 50 mm Hg. * Option D: Preventing infection woul d be a goaI of care for the client with COP D. Demonstrate and assist the patient in the disposal of tissues and sputum. Stress proper handwashing (nurse and patient), and use gloves when handling or disposing of tissues, sputum containers. Prevents spread of fluid borne pathogens. 1 polnl(s) 21. Question A client's arterial blood gas levels are as follows: pH 7.31: Pa 02 SO mm Hg. PaC02 65 mm Hg; HC03 36 inEq/L Which of the fallowing signs or symptoms would the nurse expect? A. Cyanosis B. Flushed skin C. Irritability
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D. Anxiety Correct Correct Answer: B. Flushed skin The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On the contrary, chronic respiratory acidosis may be caused by CORD where there is a decreased responsiveness of (tie reflexes to states of hypoxia and hypercapnia. • Option Aj Cyanosis is a la Le sign of hypoxia. In respiratory acidosis, the slight increase in bicarbonate serves as a buffer for the increase in H+ ions, which t eips minimize the drop in pH. In some cases, patients may present with cyanosis due to hypoxemia. « Option C: Irritability is net common with a PaCCK level of 65 mm Hg but is associated with hypoxia. If the respiratory acidosis is severe and accompanied by prolonged hypoventilation, the patient may have additional symptoms such as altered mental status, myoclonus, and possibly even seizures. - Option D: The clinical presentation of respiratory acidosis is usually a manifestation of its underlying cause. Signs and symptoms vary based on the length, severity, and progression of the disorder. Patients can present with dyspnea, anxiety, wheezing, and sleep disturbances. 22. Question 1 F” in, ( 9 ) When teaching a client with COPD to conserve energy, the nurse should teach the client to lift objects: A. While inhaling through an open mouth. B. While exhaling through pursed lips. C. After exhaling but before inhaling. □ . While taking a deep breath and holding it. Correct Correct Answer; B. While exhaling through pursed lips. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. When one practices regularly, breathing
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exercises cart help exert oneself less during dai ly activities. They can also potentially aid in return to exercising, which can lead to feeling more energetic overall. • Option A: Pursing the lips prolongs exhalation and provides the client with more control over breathing. It's been shown to reduce flow hard one has Io work to breathe. It helps release air trapped in the lungs. It promotes relaxation. IL reduces shortness of breath. • Option C: Lifting after exhalation but before inhaling is similar to lifting with the breath held. The purpose of pursed lip breathing is to help keep the airways open. This helps your airways to remain open. Pursed lip breathing also slows down the breathing rale and calms the patient down. • Option D: This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac dysrhythmias. The purpose of coordinated breathing is to help assure adequate oxygen to the working muscles and to prevent the client from holding the breath. 23, Question 1 The nurse teaches a dient with COPD to assess for s/s of right sided heart failure. Which of the following s/s would be included in the Leaching plan? A. Clubbing of nail beds B. Hypertension C. Peripheral edema D. Increased appetite Correct Correct Answer: C, Peripheral edema Right sided heart failure is a complication of CQPD that occurs because of pulmonary hypertension. Signs and symptoms of right sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Right heart failure is most commonly a result of left ventricular failure via volume and pressure overload. Clinically, patients will present with signs and symptoms of chest discomfort, breathlessness, palpitations, and body swelling. * Option At Clubbing of nail beds is associated with conditions of chronic hypoxia. Clubbing is a medical condition first described by Hippocrates in which the fingers (and/or toes) have the appearance of upside down spoons. Il is caused by a build up of tissue in the distant part of the fingers (terminal phalanges), that causes the end of the fingers to become enlarged and the nails Io curve downward.
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* Option B. Hypertension is associated with left sided heart failure. When hemodynamic instability is present, vasopressors are indicated. Norepinephrine is the pressor of choice to improve systemic hypotension and restore cerebral cardiac and end organ perfusion. ’ Option D: clients with heart failure have decreased appetites. A poor appetite can also result from the accumulation of fluid in the liver and digestive system. Fluid accumulation, edenra, is a common symptom of heart failure. The accumulation of fluid that is responsible for the abdominal swelling can decrease the appetite and result in nausea as well as discomfort from the weight gain. 24. Question 1 pOln,(s) The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds A. Normal breath sounds B. Prolonged inspiration C. Normal chest movement D. Coarse crackles and rhonchr Correct Correct Answer: D. Course crackles and rtwnchi Exacerbations of CDPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. Crackles are usually due to airway secretions within a large airway and disappear on coughing. These crackles are scanty, gravity 'Independent, usually audible at the mouth, and strongly associated with severe airway obstruction. ’ Option A; | n CDPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. A reduction In breath sound intensity (BSI) is often seen in patients with COPD. Pardee et al. developed a scoring system for BSI. According to this system the clinician listens sequentially over Six locations on the patient's chest: bilaterally over the upper anterior portion of the chest, in the midax illary, and al the posterior bases. ’ Option B: Expiration, not inspiration, becomes prolonged. Patients with CDPD often present with diminished breath sounds, prolonged expiratory time, and expiratory wheezing that initially may occur only on forced expiration.
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* Option Ct Chest movement is decreased as lungs became overdislended. Additional findings on physical examination include hyperinflation of the lungs with an increased anteroposterior chest diameter ("barrel c+iest"); use of accessory muscles of respiration; and distant heart sounds, sometimes best heard in the epigastrium. 25, Question 1 P° ln, < 5 ) Which of the following ABG abnormalities should the nurse anticipate in a client with advanced COPD? A. Increased PaC02 B. Increased Pa02 C. Increased pH D. Increased oxygen saturation Correct Correct Answer: A. Increased PaC02 As COPD progresses, the client typically develops increased PaC02 levels and decreased PaD2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of air trapping and hypoventilation. Arterial blood gas (AEG) analysis provides the best clues as to acuteness and severity of disease exacerbation. * Option B: Patients with mild COPD have mild to moderate hypoxemia without hypercapnia. As the disease progresses, hypoxemia worsens and hypercapnia may develop, with the latter commonly being observed as the FEV1 falls below 1 L/s or 30% of the predicted value. Lung mechanics and gas exchange worsen dur ing acute exacerbations. ■ Option C: In general renal compensation occurs even in chronic C02 retainers (ie, bronchitis); thus, pH usually is near normal. Generally, consider any pH below 7.3 to be a sign of acute respiratory compromise. * Option D: The compensation ta respiratory acidosis consists in a secondary increase in bicarbonate concentration, and the arterial blood gas analysis is characterized by a reduced pH, increased pCO2 (initial variation), and increased bicaibonate levels (compensatory response).
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Which of lhe fol lowing diets would be most appropriate for a client with COPD? A. Low fat, low cholesterol B. Bland, soft di el C. Low Sodium diet D. High calorie, high- protein diet Correct Correct Answer: 0. High-caiorie, higtv-protem diet The client should eat high calorie, high protein meals to maintain nutritional status and prevent weight lass that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. Eat 2D to 30 grams of Fiber each day, front items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of protein al least twice a day to help maintain strong respiratory muscles. Good choices include milk, eggs, cheese, meat fish. poultry, nuts and dried beans or peas. * Option A: A low fa L, low cholesterol diet is indicated for clients with coronary artery disease. Choose mono and poly unsaturated fats, which du not contain cholesterol. These are fats that are often liquid at room temperature and come from plant sources, such as canola, safflower and com oils. ’ Option 0: Metabolism of carbohydrates produces lhe most carbon dioxide for the amount of oxygen used; metabolismof fat produces the least. For some people with COPD, eating a diet with fewer carbohydrates and more fat helps them breathe easier. * Option C: The client with COPD does not necessarily need to follow a sodium' restricted diet, unless otherwise medically indicated. Choose complex carbohydrates, such as whole cpain bread and pasta, fresh fruits, and vegetables. Limit simple carbohydrates, including table sugar, candy, cake, and regular soft drinks. 27. Question 1 The nurse is planning to leach a client with COPD how to cough effectively. Which of the following instructions should be included? A. Take a deep abdominal breath, bend forward . and cough 3 to 4 times on exhalation.
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B. Lie flat cn beck, splint the thorax. Lake two deep breaths and cough. C. Take several rapid, shallow breaths and then cough forcefully. D. Assume a side lying position, extend (tie arm over the head, and alternate deep breathing with coughing. Correct Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4 limes on exhalation. The goal of effective coughing is to conserve energy, facilitate the removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process 3 or -1 times, the client should lake a deep abdominal breath, bend forward and cough 3 or -1 times upon exhalation { ' h u f f ' cough). • Option B: Lying flat does not enhance lung expansion; silting upright promotes full expansion of the thorax. Sit on a chair or on the edge of the bed, with both feet on the floor. Lean slightly forward. Relax. The patient should breathe in through their nose and out through their nose or mouth until they are ready to progress to the next stage. - Option C: Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes Collapse of airways. The client should lean forward, press the arms against the abdomen. Cough 2 3 times through a slightly open mouth. Coughs should be short and sharp. The first cough loosens the mucus and moves it through the airways. The second and third cough enables the client to cough the mucus up and out. - Option D: A side lying position does not allow for adequate chest expansion to promote deep breathing. Silting the patient out of bed c< up in bed optimizes lung expansion. Critical care patients can sit out of bed if they are hemodynamical ly stable (this allows for better lung expansion). Ensure you have two to three clinicians assisting with any intravenous lines cardiac monitoring, drain tubes et£- 28. Question 1 polni(s) A 34 year old woman with a history of asthma is admitted to the emergency department The nurse notes that the client is dyspneic, with a respiratory rale of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals cjeatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?
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A. Initiate Oxygen therapy and reassess the client in TO minutes. B. Draw blood for an ABG analysis and send the client tor a chest x ray. C. Encourage the client to relax and breathe s lowly through tire mouth. D. Administer bronchodilators. Correct Correct Answer: U. Administer bronchodilators . In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline. • Option A Administering oxygen and reassessing the client ID minutes later would delay reeded medical intervention. A favorable response to initial treatment of status asthmaticus should be a visible improvement in symptoms that sustains 30 minutes or beyond the last bronchodilator dose and a PEFR greater than 70% of predicted. - Option B: Drawing an ABG and obtaining a chest x ray would be a delay. The a bsoluLe val ue of PEFR less than 1 20 L per minute and FEVI less than 1 L corresponds with the proportional reduction. These absolute numbers should prompt an assessment of arterial blood gas (ABG) immediately. Initial blood gas results indicate respiratory alkalosis with hypoxemia. * Option C: IL would be futile to encourage the client to relax and breathe slowly without providing necessary pharmaco logic intervention. An initial aggressive treatment trial of beta agonists, corticosteroids, and anticholinergics lias to be tried, followed by adjunct rrteasures, which may not be based on robust guidelines but evidence. 29, Question 1 The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack? A. Decreased PaCD2, increased Pa02, and decreased pH. B increased P«C02, decimated and decr«a$4d pH.
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C. Increased PaC02, increased PaO2, and increased pH. D. Decreased PaC02, decreased PaO2, and increased pH. Correct Correct Answer: B increased PaCO2, decreased PaOZ, and decreased pH As the severe asthma a Hack worsens, the client becomes fatigued arid alveolar hypotension develops. This leads lo carbon dioxide retention and hypoxemia. The client develops respiratory acidosis. Tfnerefore, the PaC02 level increases, the PaO2 level decreases, and the pH decreases, indicating acidosis. * Option A: Respiratory acidosis is a very common acid base disturbance in acute severe asthma and is widely considered to be an ominous finding. Its early recognition and treatment are important and decisive for the final outcome, as it can lead to respiratory failure and arrest if prolonged. * Option C: Hypercapnia in asthma, in addition lo the severity of the disease, is also associated with the therapeutic administration of oxygen. Thus, in patients with severe asthma exacerbation, a significant increase (?4 mmHg) in transcutaneous PCD2 (PIC02) was observed in a higher proportion in those receiving high oxygen mixtures (>8 L/min), compared to those who received titrated oxygen (to achieve oxygen saturation of 93 95%) * Option D: Lee el al. noted that PaCO2 was significantly higher and the arterial blood pH lower in asthmatics who died, and delays in providing mechanical ventilation led lo worse outcomes. Another mechanism implicates the Haldane effect, in which oxygen displaces the 002 dissociation curve lo the right, increasing PaC02, which cannot be normalized as patients with severe COPD are unable lo increase ventilation. 30. Question 1 P° ln1 (®) A client with acute asthma is prescribed short term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? A_ Corticosteroids promote bronchodilalkm. B. Corticosteroids act as an expectorant. C. Corficosletoids have an anti-inflammatory affect.
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D. Corticosteroids prevent development nt respiratory infections. Correct Correct Answer: C. Corticosteroids have an anti-inflammatory effect. Corticosteroids fiave an anti inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. At a physiologic level, steroids reduce airway inflammation and mucus production and potentiate beta agonist activity in smooth muscles and reduce beta agonists tachyphylaxis in patients with severe asthma. Corticosteroids do not fiave a bronchodilator effect, act as expectorants, or prevent respiratory infections. - Option A: Short acting inhaled beta agonists are the drug of the first choice in acute asthma. Albuterol is preferred over melaprolerer'ol in tfiat class because of its higher beta 2 selectivilies and longer duration of action. The dose response curve and deration of action of these medications are adversely affected by a combination of patient factors, including pre existing broncfboconslriclion, airway inflammation, mucus plugging, poor patient effort, and coordination. - Option B: Anticholinergics have a variable response in acute exacerbation with a somewhat underwhelming bronchodi lalory role. However they can be useful in patients with bronchospasm induced by beta blockade or severe underlying obstructive disease with F EVI less tfian 25% of predicted. * Option D: Graham el al. conducted a randomized double blinded trial and demonstrated no difference in improvement in symptom score, spirometry, or length of hospitalization with routine use of antibiotics in status aslhmalicus. That does not mean that patients with clinical signs of infection should not be treated with antimicrobials, or due diligence should not be pursued in obtaining respiratory culture specimens early on. 31. Question i poim(s) The nurse is Leaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. A. The inhaler is held upright. B. Head Is tilled down while inhaling the medication. C. Client wails 5 minutes between puffs.
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Q D. Mouth is rinsed with waler following administration. E. Client lies supine for 1 5 minutes fol lowing administration. Correct Correct Answers? A & D Inhaled respiratory medications are often taken by using a device called a metered dose inhaler, or MDI. The MCI is a pressurized canister of medicine Ina plastic holder with a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication. ■ Option A: Remove the cap and hold the inhaler i right. Each inhaler consists of a small canister of medicine connected Io a mouthpiece. The canister is pressurized. As the client presses down on the inhaler, it releases a mist of medicine. The client breathes that mist into the lungs. Its important to use tire inhaler correctly. • Option El: Tilt the head back slightly and breathe out all tire way. Keep the chin up and the inhaler upright (not aimed at the roof of lire mouth or lire longue). • Option Ct Repeat puffs as directed by the doctor. Wail 1 minute before taking the second puff. A delay of 10 20 minutes between successive doses of the bronchodilator drug has been suggested in order to lei the first act to improve the penetration and effect of Hie second dose, but again lire evidence dial this works is Inconclusive. Many patients may forget to lake a second dose with such a long interval. • Option D Some inhalers (steroid) also recommend rinsing the rnouth out with water and gargling with waler (spit out the water) after use. If using tills inhaler for a corticosteroid preventer medication, wi th or without a spacer, rinse the mouth with water and spit after inhaling the last dose to reduce Hie risk of Side effects • Option E: The client does not have Io be in the supine positron after administration. Proper instruction by a trained person with a placebo aerosol is essential to leach the correct inhaler technique. This should be followed subsequently by regular checks to locate any faults lliat may develop. Inevitably, some patients will be unable to use an MDI, and for them, spacer attachments, Or dry powder inhalers are preferable since they place fewer demands on patients’ skill. Even these devices, however, must be used properly to achieve a satisfactory effect. 32, Question 1 P 01 " A client is prescribed melaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of mefaproterenol?
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A. Irregular heartbeat B. Constipation C. Pedal edema D. Decreased hear! rate. Correct Correct Answer: A. Irregular heartbeat Irregular heart rales should be reported promptly Io lhe care provider. MeLapfolerenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on lhe beta adrenergic receptors in lhe hearL II is not recomntended for use in clients with known cardiac disorders, Metaproterenol does nut cause constipation, pedal edema, or bradycardia. ’ Option B: | n children, lhe most common side effects are diarrhea, nausea, laryngitis, pharyngitis, sinusitis, otitis, and viral infection. The most commonly observed side effects in patients aged 15 years and over were headaches, influenza infection, abdominal pain, cough, and dyspepsia. * Option C: There are some reports of serious adverse events due to a ngi oedema, hypersensitivity, fatigue, confusional state, abnormal dreams, epilepsy, aggression, immune system disorder, hemorrhage, excoriation, eosinophil count increase, pain in extremity, and abdominal pain. * Option Di Tell lhe doctor right away if any of these unlikely but serious side effects occur: fast/pounding/i regular heartbeat, muscle cramps, weakness. 33. Question 1 P° i n , < 5 ) A client has been taking ftunlsolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful while patches in his mouth. Which response by the nurse would be the 1 ™ 55 * appropriate? A. "This is an anticipated side effect of your medication. IL should go away in a couple of weeks." B. "You are using your inhaler loo much and it has irritated your mouth." C. 'You have developed a fungal infection from your medication, ft wilt need Io be
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treated with an antifungal,' D. "Be sure to brush your teeth and floss dally. Good oral hygiene will treat this problem." Correct Correct Answer: C. “You have d evetoped a fungal inlection from your medication. It will need to be treated with an antifungal.' Use of oral inhalant corticosteroids, Such as flurisolide, can lead to the development of oral thrush a Fungal infection. Oral candidiasis {thrush) is another common complaint among users of inhaled corticosteroids (ICS). This risk increases in elderly patients and patients who are also taking oral steroids, high dose ICS, or antibiotics. * Option A: Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own. Il is advisable to have the patient rinse their mouth out after ICS use to prevent oral candidiasis. Treatments for car'didiasis include clotrimazole, miconazole, and nystatin. * Option 0: Fungal infections can develop even without overuse of tfre corticosteroid inhaler. Attention to dosage is required as the amount of Candida increased with dose of fluticasone. Gargling with a 1:M dilution of amphotericin B is effective in treating oral cartdidiasis of asthmatic patients treated with inhaled steroids. * Option D: Although good oral hygiene can help prevent the development of a fungal infection, it cannot be used alone to treat the problem. Most cases of oral thrush will clear up in a couple of weeks. In general, a single dose of antifungal medication may be enough Io cure the infection. 34. Question 1 P° inl Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? A. Incorporate physical exercise as tolerated into the treatment plan. B. Monitor peak flow numbers after meals and at bedtime. C. Eliminate stressors in the work and home environment. D. Use sedatives to ensure uninterrupted sleep at night.
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Correct Correct Answer: A. Incorporate physical exercise as tolerated into the treatment plan. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning {before taking medication). Encourage breathing exercises ar d controlled breathing and relaxation. Prevents attack before it begins and increases ventilation. - Option B: Peak flow does not need Io be monitored after each meal. Monitor peaked expiratory flow ralesand forced expiratory volume as taken by the respiratory therapist. The severity of the exacerbation can be measured objectively by ntonitoring these values. The peak expiratory flow rale is the maximum flow rate that can be genera ted du ring a farced expiratory maneuver with fully inflated lungs. - Option C: Stressors in the client's life should be modified but cannot be totally eliminated. Instruct folks to modify the home environment to reduce dust, exposure to pels and indoor plants, foods {peanut, egg), changing of fillers. * Option D: Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep. Schedule and provide rest periods in a calm peaceful environment. Promotes adequate rest and decreases stimuli. 35. Question 1 The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack? A_ Occupational exposure to toxins. R , VIrat respiratory inf ections C. Exposure to cigarette smoke. D. Exercising in cold temperatures. Correct Correct Answer: B. Viral respiratory infections. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological precess begins with the i nhalaticn of an irritant (e.g., cold air) or an aIlergen {e.g., pollen), wh ich then, due to branchial hypersensitivity, leads to airway inflammation and an increase in mucus
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production. This leads to a significant increase in airway resistance, which is most pronounced on expiration. * Option A: Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to Such toxins llian are exposed to viruses. Asthma comprises a range of diseases and has a variety of heterogeneous phenotypes. The recognized factors that are associated with asthma are a genetic predisposition, specifically a personal or family history of atopy (propensity to allergy, usually seen as eczema, hay fever, and asthma). * Option C: Cigarette smoke can also trigger asthma attacks, but lo a lesser extent than viral respiratory infections. Asthma also is associated with exposure lo tobacco smoke and oilier inflammatory gases or particulate matter. ’ Option D: Some asthmatic attacks are triggered by exercising in cold weather. The overall etiology is complex and still not fully understood, especially when it comes lo being able to say which children with pediatric asthma will carry on to have asthma as adults (up to 40% of children have a wheeze, only 1% of adults have asthma), but it is agreed that it is a multifactorial pathology, influenced by both genetics and environmental exposure. 36 Question 1 poin,(a) A female client comes into the emergency room complaining of SOB and pain in the lung area. She slates that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 1IQ, R 40. The physician orders ABG's, results are as follows: pH: 7.50; PaC02 29 mm Hg; Pa02 60 mm Hgc HCOS 24 mEq/L; Sa02 86%. Considering these results, the first intervention is to: A_ Begin mechanical ventilation. - B Place the client on oxygen. C. Give the client sodium bicarbonate. D. Monitor for pulmonary embolism. Correct Correct Answer: B Place the Client on oxygen The pH (7.501 re fleets alkalosis, and the low PaCO2 indicates the lungs are involved. The client should immediately be placed on oxygen via mask so that lite SaO2 is brought up to 95%. Encourage slow, regular breathing Lo decrease the amount of CO2 she is losing. • Option. A: Mechanical ventilation may be ordered for acute respiratory acidosis. In patients who are not significantly encephalopathic and have no excessive
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secretiorts, noninvasive ventilation with CPAPor BIPAPcan be a useful modality to support ventilation and avoid the need for anesthesia and sedation, as wt?ll as the risk of nosocomial infection with endotracheal intubation. * Option C: Sodium bicarbonate would be given to reverse acidosis. Sodium bicarbonate infusion reduces plasma ionized calcium concentration in critical ly ill patients with metabolic acidosis. In vitro, bicarbonate concentration has a major effect reducing ionized calcium level in serum • Option D: This client may have pulmonary embolism so she should be monitored for this condition, but it is not the first intervention. A timely diagnosis of a pulmonary embolism {PE) is crucial because of tire high associated mortality and morbidity, which may be prevented with early treatment. It is important to note that 30% of untreated patients with pulmonary embolism die, while only die after timely therapy. 1 pointf s) 37. Question Basilar crackles are present Ina client's ling son auscultation. Tire nurse knows that these are discrete, non continuous sounds that are: A. Caused by the sudden opening of alveoli. B. Usually more prominent during expiration. C. Produced by airflow across passages narrowed by secretions. D. Found primari ly in the pleura. Correct Correct Answer; A. Caused by the sudden opening of alveoli Basilar crackles are usually heard diving inspiration and are caused by sudden opening of the alveoli. Basilar crackles are a bubbling or crackling sound originating from the base of the lungs. They may occur when the lungs inflate or deflate. They're usually brief, and may be described as sounding wet or dry. Excess fluid in the airways causes these sounds. ■ Option H: Bronchial sounds (also called tubular sounds) normally arise from the tracheobronchial tree and vesicular sounds normally arise from the finer lung parenchyma. Loud, harsh, and high pitched bronchial sounds are typically heard over the trachea or al the right apex. They are predominantly heard during expiration. * Option C: Wheezes are musical sounds caused by air movement through constricted small airways, such as bronchioles. Wheezes and rhonchi, which have the same pathology and are separated only by pilch, are produced by the fluttering of narrowed airways and the air that flows through them.
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♦ Option D; Fluid ar air in the pleural space deflects sound waves away from the chest wall back into the lung arid therefore breath sounds are reduced in intensity. 1 polnl(s) 38. Question A cyanotic Client with an unknown diagnosis Is admitted to the E.R. In relation to oxygen, the first nursing action would be to: A_ Wail until the client's lab work is done. B. Not administer oxygen unless ordered by the physician. C. Administer oxygen at 2 1 flow per minute. D. Administer oxygen al 10 L flow per minute and check the client's nail beds. Correct Correct Answer: C. Administer oxygen at 2 L flow per minute. Administer oxygen at 2 Uminule and no more, for if the client is emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function. With prolonged oxygen therapy there is an increase in blood oxygen level, which suppresses peripheral chemoreceplors; depresses ventilator drive and increase in PCO2. high blood oxygen level may also disrupt the ventilation: perfusion balance (V/Q) and cause an increase in dead space to tidal volume ratio and increase In PCO2. - Option A: Tti is is the 'gold standard' rrvonitor of venli laticn. Arterial blood gases are needed to obtain accurate data, in particular, evidence of hypoventilation (raised PaCO2) as a reason for hypoxemia. Arterial blood gases may also give an indication of the metabolic effects of clinically important hypoxemia. * Option B: Although history taking and clinical examination may clarify the diagnosis, oxygen at 40% 60% should be continued until blood gas results are available unless the patient is drowsy or is known to have had previous episodes of Hypercapnic respiratory failure. * Option D: Low intravascular volume either due to acute blood loss as in trauma can result in poor oxygen transport and tissue hypoxia. So, these patients should be given high concentration oxygen to maintain oxygen saturation above 90% until arrival at an emergency department. This can be achieved in most cases by the use of approximately 40% 60% oxygen via a medium concentration mask at a flow rate of 4 ID 1/ min.
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39. Question 1 P° ln, (*) Immediately fol lowing a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified? A_ Serosanguineous drainage from the puncture site. B. Increased temperature and blood pressure. C incrtMMi pulse nnci pnUor. D. Hypotension and hypothermia. Comet Correct Answmi C. Increased pulse and pallor Increased pulse and pallor are symptoms associated with shock. A compromised venous return may occur if there is a mediastinal shift as a result of excessive fluid removal. Usually, no more than 1 L of fluid is temoved atone lime to prevent this from occurring. * Option A: Complications include bleeding, pain, and infection at the poinlof needle entry. If the approach is made too higti in the intercostal space damage Io the coastal vasculalure and nerve injury is possible. - Option B: If too much fluid is removed or if the fluid is removed too rapidly (eg using negative pressure chambers) re expansion (aka post expansion) pulmonary edema may occur. Removal of significant fluid volumes may also induce vasovagal physiology. * Option □ ' If the procedural needle/catheler is passed through diseased tissue prior to entering the chest cavity, that process can be extended into the chest space. For example, passing the needle through thoracic or pleural tumor can seed the thoracic cavity or passing the needle through a chest wall abscess or otherwise infected tissue can result in ernpyenta. 1 points &) 40. Question If a client continues to hypovenlilate, the nurse will continually assess for a complication of: A Respiratory acidosis
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B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis Correct Correct Answer: A. Respiratory acidosis Respiratory acidosis represents an increase in the acid component, carbon dioxide, and an increase in the hydrogen ion concentration (decreased pH) ol the arterial blood. The respiratory centers in the pons and medulla control alveolar ventilation. Chemcreceplors tor PC02, PO2, and pH regulate ventilation. Central chemoreueptors in the medulla are sensitive to changes in the pH level. Adecreased pH level influences the mechanics ol ventilation and maintains proper levels ol carbon dioxide and oxygen. When ventilation is disrupted, arterial PCQ2 increases and an acid base disorder develops. * Option B: | n almost every scenario, respiratory alkalosis is induced by a process involving hyperventilation. These include central causes, hypoxemic causes, pulmonary causes, and iatrogenic causes. Central sources are a head injury, strake, hyperthyroidism, anxiety hyperventilation, pain, fear, stress, drugs, medications such as salicylates, and various toxins. Hypoxic stimulation leads to hyperventilation in an attempt to correct hypoxia at the expense ol a COZ loss. * Option C: Hydrogen ion concentration is determined by acid ingestion, acid production, acid excretion, and renal and Gl bicarbonate losses. Buffers such as bicarbonate minimize significant pH alterations. Further classification of metabolic acidosis is based on the presence or absence of an anion gap, or concentration o I unmeasured serum anions. - Option □ : In general the causes can be narrowed down to an intracellular shift of hydrogen ions, gastrointestinal (Gl) loss of hydrogen ions, excessive renal hydrogen ion loss, retention or addition of bicarbonate ions, or volume contraction around a constant amount of extracellular bicarbonate known as contraction alkalosis. All of which leads to the net result of increased levels of bicarbonate in the blood. 41. Question 1 p®lm(«) A client is admitted Ic the hospital with acute bronchitis. While taking the client's VS, the nurse notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratory distress are usually the result of:
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A. Respiratory acidosis B. A build-up of carbon dioxide C . A bui Id up of Oxygen without adequate expelling of carbon diox ide. D. An acute respiratory infection. Correct Correct Answer: B. A build-up of carbon dioxide. The arrhythmias are caused by a build up of carbon dioxide and not enough oxygen so that the heart is in a constant slate of hypoxia. The majority of arrhythmias observed in these patients appeared to take the form of premature ventricular and/or supraventricular beats and less frequently of atrial fibrillation and/or attacks of supraventricular paroxysmal tachycardia. Cardiac rhythm alterations were observed using Holter monitoring in 70 90% of patients. No cardiac rhythm disorder is specific to this pathological condition. • Option A: The compensation to respiratory acidosis consists in a secondary increase in bicarbonate concentration, and the arterial blood gas analysis is characterized by a reduced pH, increased pC02 (initial variation), and increased bicarbonate levels (compensatory response). ’ Option C: Acute bronchitis is a clinical diagnosis based on history, past medical history, lung exam, and other physical findings. Oxygen saturation plays an important role in judgirrg the severity of Ute disease along with the pulse rale, temperature, and respiratory rate. * Option D: Acute bronchitis is the result of acute inflammation of the brortchi secondary to various triggers most commonly viral infection, allergens, pollutants, etc. Inflammation of the bronchial wall leads Lu mucosal thickening, epithelial cell desquamation, and denudation of the basement membrane. Al limes, a viral upper respiratory infection can progress to infection of the lower respiratory tract resulting in acute bronchitis. 42. Question 1 Auscultation of a client's lungs reveals crackles in the left posterior base. The nursing intervention is to: A. Repeat auscultation alter asking the client to deep breathe and cough.
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B. Instruct the client to limit fluid intake to less than 2000 ml/day. C. Inspect the client's ankles arid sacrum for the presence of edema. □ . Place the client on bedrest in a semi Fowler's position. Correct Correct Answer: A. Repeat auscultation after asking the client to deep breathe and cough. Although Crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough. Assess cough effectiveness and productivity. Coughing is the most effective way to remove secretions. Pneumonia may cause thick ar d tenacious secretions to patients. * Option B; it jg premature to impose fluid or activity restrictions. Assess the rale, rhythm and depth of respiration, chest movement, and use of accessory muscles. Tachypnea, shallow respirations and asymmetric chest movement are frequently present because of the discomfort of moving chest wall and/or fluid in the lung doe to a compensatory response to airway obstruction. Altered breathing patterns may occur together with use of accessory muscles to increase chest excursion to facilitate effective breathing. * Option C: Inspection for edema would be appropriate after re auscultation. Auscultate lung fields, noting areas of decreased or absent airflow and adventitious breath sounds: crackles, wheezes. Decreased airflow occurs in areas with consolidated fluid. Bronchial breath soundlscan also occur in these consolidated areas. Crackles, rhonchi, and wheezes are heard on inspiration and/or expiration in response to fluid accumulation, thick secretions, and airway spasms and obstruction. * Option Dt Elevate the bead of bed, change position frequently. Doing so would lower the diaphragm and promote chest expansion aeration of lung segments, mcbil izalion, a nd expectoration of secretions. 43. Question 1 P° ln, < & ) The most reliable index to determine the respiratory status of a client is to: A. Observe the chest rising and falling. B. Observe the skin and mucous membrane color.
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C, Listen and feel the air movement. D. Determine the presence of a femoral pulse. Correct Correct Answers C Listen .md lecl the nlr movement. To check for breathing, the nurse places her ear and cheek next to the client's mouth and nose to listen and feel for air movement. During the inspection, the examiner should pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal breathing, coastal markings, and use of accessory breathing muscles. The use of accessory breathing muscles (i.e., scalenes, sternocleidomastoid muscle, intercostal muscles) could point to excessive breathing effort caused by pathologies. * Option A: The chest rising and falling is not conclusive of a patent airway. The position of the patient should also be noted, patients with extreme pulmonary dysfunction will often sit up right, and in distress, they assume the tripod position (leaning forward, resting their hands on their knees). • Option 0: Observing skin color is not an accurate assessment of respiratory status. The body habitus of the patient could provide information regarding chest compliance, especially in the case of severely obese patients where chest mobility and compliance are reduced due to added weight from adipose tissue. ♦ Option D: Checking the femoral pulse is not an assessment of respiratory status. Palpation should focus on delecting abnormalities like masses or bony Crepitus. During palpation the examiner can evaluate tactile fremitus: the examiner will place both of his hands on the patient’s back, medial to the shoulder blades, and ask the patient to say "ninety nine." 44. Question 1 P° i n H E ) A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan of care because of the poly cylhernia? A. Fluid volume deficit related Io blood loss. B Impaired tissue perfusion related to thrombosis. C. Activity intolerance related to dyspnea. D. Risk for infection related to suppressed immune response.
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Correct Correct Answer: B. Impaired tissue perfusion related to thrombosis. Chronic hypoxia associated with CDPD may stimulate excessive REC production; (polycylhernia). This results in increased blood viscosity and the risk of thrombosis. The other nursing diagnoses are not applicable in this situa lien. The most common causes of secondary polycylhernia include obstructive sleep apnea, obesity hypoventilation syndrome, and Chronic obstructive pulmonary disease (COPD). - Option A: | n secondary polycythemia, the number of red blood cells (RBCs) is increased as a result of an underlying condition. Secondary polycythemia would mere accurately be called secondary erythrocytosis or erythrocythemia, as those terms specifically denote increased red blood cells. No blood loss is evident in the stem. - Option C: increased red blood cell mass increases blood viscosity and decreases tissue perfusion. With impaired circulation to the central nervous system, patients may present with headaches, lethargy, and confusion or more serious presentations, such as stroke and obtundation. * Option D: Plethora manifests as increased redness of the skin and mucosal membranes. This finding is easier to delect on the paints or soles, where the skin is light in dark skinned individuals. Some patients may have acrocyanosis caused by sluggish blood flow through small blood vessels. 45. Question 1 P° l n , < s > The physician has scheduled a client fur a left pneumonectomy. The position that will m o s t likely be ordered postoperatively for his is the: A_ Nonoperative side or back B Operative side or back C. Back only D. Back or either side. Correct Correct Answer: B. Operative side or back Following pneumonectomy, the client is positioned on the operative side to allow the fluid left in the lung space to consolidate and avoid the heart from shifting to the operative side. Pneumonectomy is defined as the surgical removal of the entire lung. Extrapleural pneumonectomy is an expanded procedure that also involves resection of
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parietal and visceral pleura, ipsi lateral hemidiaphragm, pericardium, and mediastinal lymph nodes. * Option A: The patient is then usually positioned in a lateral decubitus position with the operating side up. Proper positioning of the D LT w the bronchial blocker is usually reconfirmed with the FOB„and single lung ventilation is then started. Care should be taken to ensure proper positioning to avoid perioperative nerve injury. ' Option C: Following pneumonectomy, pulmonary functions decrease but are usually less than anticipated for removal of 50% of lung, especially for residual volume, and this may be explained by overexpansion of the remaining lung tissue. FEVT, FVC, DLOD, and lung compliance decrease. Airway resistance increases. ’ Option D' Patients with no disease in the remaining lung usually do have normal SaO2, PO2, and PaCO2 at rest. A chest X ray immediately following pneumonectomy usually shows the trachea in the midline and the poslpneumoriectomy space to be filled with air. Later that space becomes filled gradually with fluid ata rate of 1 to 2 intercostal spaces,''day. The ipsi lateral diaphragm becomes elevated, and the mediastinum is gradually shifted towards the operative side. 46. Question 1 P° i n , < 5 ) Assessing a client who has developed atelectasis postoperalively, the nurse will most likely find: A. A flushed face. B. Dyspnea and pain. C. Decreased temperature. D. Severe cough and no pain. Correct Correct Answer: fi Dyspnea and pain Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients become short of breath, have a high temperature, and usually experience severe pain but do not have a severe cough. The shortness of breath is a result of decreased oxygen carbon dioxide exchange al the alveolar level. Postoperative atelectasis typically occurs within 72 hours of general anesthesia and is a we ll-known postoperative complication. » Option A: The definition of atelectasis is a partial collapse of the lung. Il can cause people to feel short of breath. It can be a consequence of several
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different processes, most commonly when there is a poor inspiratory effort an obstruction blocking airflow into the lung, extra pressure exerted on the outside of the lung, or deficient production or function of a specific protein in the lung. * Option C: Postoperative fever has historically been attributed to atelectasis, but there is no evidence supporting the finding that atelectasis is a causative rnecftanism for fever. For patients with atelectasis, the prognosis varies greatly, and the primary determination Is the underlying etiology and patient CD' morbidities. * Option D: Inadequate pain control can contribute Io the development of atelectasis by inducing shallow breathing ('splinting') and/or inhibiting coughing Typically, atelectasis is asymptomatic. However, a patient might also present with decreased or absent breath sounds, crackles, cough, sputum production, dyspnea, tachypnea, and/or diminished chest expansion. 47. Question 1 P° int W A fifty year old client has a tracheostomy and requires tracheal suctioning. The fi r 5l Intervention in completing this procedure would be to: A. Change the tracheostomy dressing. B. Provide humidity with a trach mask. C. Apply oral or nasal suction. D. Deflate the tracheal cuff. Correct Correct Answer: C. Apply oral or nasal suction Before deflating the tracheaI cuff, the nurse wiII apply oraI or nasal suction Io the airway to prevent secretions from falling into the lung. Dressing change and humidity do nut relate Io suctioning. Airway suctioning is a procedure routinely done in most care sellings, including acute care, sub acute care, long term care, and home settings. Suctioning is performed when the patient is unable Io effectively move secretions from the respiratory tract. - Option A: Airways suctioning is indicated for multiple reasons. Most commonly suctioning is done for the removal of secretions from the respiratory tract, but sometimes also for removal of blood or other materials like meconium in specific cases. Airway suctioning is also performed for diagnostic purposes. * Option B: Suctioning of the lower air ways should be done in a sterile manner with single'use gloves and suction catheters to prevent contamination arrd secondary infection. After preparation with appropriate equipment at the bedside and monitoring continuous heart rate and oxygen saturation (as
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available), the patient should be suctioned with appropriately Sized equipment for their airway. * Option D: After preparation with appropriate equipment at the bedside and monitoring continuous heart rale and oxygen saturation {as available), the patient should be suctioned with appropriately sized equipment for their airway. 48. Question 1 P° in1 < s > A client stales that the physician said the tidal volume is slightly diminished and asks the nurse what this means. The nurse explains that the tidal volume is the amount of air: A. Exhaled forcibly after a normal expiration. B. Exhaled after there is a normal inspiration C. Trapped in the alveoli that cannot be exha led. D. Forcibly inspired over and above a normal respiration. Correct Correct Answer: B. Exhaled after there is a ncrmaE inspiration. Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration. Tidal volume is Ifte amount of air tha L moves in or out of the lungs with each respiratory cycle. II measures around 500 mL in an average healthy adult male and appr oximalely 400 mL in a heal thy fema le. 11 i s a vita I cl in ical para meter that al lows for proper ventilation to lake place. - Option A: The expiratory reserve volume (ERV). about 1,200 m L is the additional air that can be forcibly exhaled after the expiration of a normal tidal volume. When a person breathes in, oxygen from the surrounding atmosphere enters the ungs. Il then diffuses across the alveolar capillary interface Io reach arterial blood. Al the same time, carbon dioxide continuously forms as long as metabolism lakes place. Expiration occurs to expel carbon dioxide and prevent it from accumulating in the body. - Option C: Residual volume (RV), about 1,200 m L is the volume of air still remaining in the lungs after the expiratory reserve volume is exhaled. When emphysema develops, the alveoli and lung tissue are destroyed. With this damage, the alveoli canrral support the bronchial tubes. The Lubes collapse and cause an 'obstruction" (a blockage), which traps air inside the lungs. * Option D: The inspiratory reserve volume (IRV), about 3,100 m L is the additional air that can be forcibly inhaled after the inspiration of a normal tidal volume. The volume of air occupying the lungs at different phases of the respiratory cycle subdivides into four volumes and foia capacities. The four lung volunes are inspiratory reserve volume (IRV), expiratory reserve volume (ERV), tidal volume
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(V). and residual volume (RV), while the four lung capacities include total lung capacity (TLC), vital capacity (VC), inspiratory capacity ()C), and functional residual capacity (FRC). 49. Question 1 An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is caused by: A_ A decreasing oxygen pressure in the blood. B. An increasing carbon dioxide pressure in the blood. C. A decreasing oxygon pressure and/or an Increasing carbon dioxide pressure in the blood. D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood. Correct Correct Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood. The lower the PO2 and the higher the PC02, the more rapidly oxygen dissociated from the oxyhemoglobin molecule. Factors that contribute Io a right shift in the oxygen dissociation curve and favor the unloading of oxygen correlate with exertion. These include increased body temperature, decreased pH (due to increased production of CO2), and increased 2,3 BPG. (Figure) This right shift of the oxyhemoglobin curve can be viewed as an adaptation for physical exertion. • Option A: In the setting of hypoxia or low blood oxygen levels, irreversible tissue damage can rapidly occur. Hypoxia can be the result of an impaired oxygen carrying capacity of the blood (e.g., anemia), impaired unloading of oxygen from hemoglobin in target tissues (e.g., carbon monoxide toxicity), or from a restriction of blood supply. * Option B: Hemoglobin {Hgb or Hb) is the primary carrier of oxygen in humans. Approximately 98% of total oxygen transported in the blood is bound to hemog lobin. wh lie only 2% is dissolved directly in plasma. Hemoglobin is a metalloprotein with four subunits, each composed of an iron containing heme group attached to a globin polypeptide chain. One molecule of oxygen can bind to the iron atom of a heme group, giving each hemoglobin the ability Io transport four molecules of oxygen. ’ Option □ : The body maintains adequate oxygenation of tissues in the setting of decreased PO or increased demand for oxygen. These changes often express
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shifts in the oxygen dissociation curve, which represents the percentage of hemoglobin saturated with oxygen at varying levels of PO. 50, Question 1 l w l n ' The best method of oxygen administration for client with CORD uses: A.. Cannula B. Simple Face mask C. Non rebreather mask D. Venturi mask Correct Correct Answer: 0. Venturi mask Venturi delivers controlled oxygen. An air enlrainrrwnt {also known as venturi) mask can provide a pre set oxygen Io the patient using jet mixing. As the percent of inspired oxygen increases using Such a mask, the air to oxygen ratio decreases, causing the maximum concentration of oxygen provided by an air entrainment mask to be around 40%. * Option A: A thin lube, often affixed behind the ears and used to deliver oxygen directly to the nostrils from a source connected with tubing. This is Hie most common method of delivery for home use and provides flow rales of 2 to 6 liters per minute (LPM) comfortably., allowing the delivery of oxygen while maintaining the patient's ability to utilize his of tier mccilh to talk eat, etc. - Option B: Facemasks can be generally divided into simp e face masks, air entrainment masks, and non rebreathers. A simple facemask is a mask with no bag attached, which delivers oxygen at 5 to 8 LPM. A disadvantage of this and other full face masks is the inability of the patient Io eat, drink, or easily communicate while using such a device. * Option C: Non rebreathing masks have a bag attached to the mask known as a reservoir hag, which inhalation draws from to fill the mask through a one way valve and features ports al each side for exhalation, resulting in an ability to provide the patient with 100% oxygen al a higher LPM flow rale.
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Nurseslabs Menu Comprehensive Respiratory System Disorders NCLEX Challenge Exam (Quiz #2: 50 Questions) UPDATED DN OCTOBER 17 2DQS EV MATT VERA B5N, H.N Hi! Ycxi Eire currently in the quiz page. If you're done with this quiz, please ctieck cut the ether exams by clicking here Io go back to lhe Respiratory System Disorders Nursing Test Bank page. Quiz Guidelines Before you atari, here- are same examination guidelines anJ raniuders you must read: 1. Practice Eeamc: Engage w Ih our Practice Exams Io hone your skills in a support ve. ow-pressiae enviianment. These exams provide immed ale feedback and exp anal tins, l e u rig you grasp care concepts, identify rnpravernert areas, and build conf deuce in your knowledge and ab ties. 2. Challenge Ex atn a : T i t our Challenge Exams to Lest your mastery and readmess under simulated exairi conditions. These exams offer a rigorous question set to assess your urdei stand rig. prepare you for actual exannrial ions, and benchmark you performance. • You're given 2 minutes per item. ■ For CF allenge Exams, click on die "Start Quiz" button to start die quiz. 2. Ctrnplelu lhe quiz Ensure that you answer the er I re quiz. On y after you've answered every item will Lhe score and rationales be shown. 4. Learn from rhe rationalee After each quiz, click on die "View Questions'' bcrtlcxi to undei stand the explanation for each answer. 5. Free G uess wtiat? Our test banks are 100% FREE. Skip lhe hassle - no sign-ups oi leg slialxins here. A sincere premise from Nurseslabs: we have not and won't ever request your credit card details or personal info fur our practice quest ons. We re dedicated to keep ng this service accessible and cost-free, espec ally Fur our amazing students and r arses. So. take the leap and elevate your career hassle-free 6. $barn yoyr 1hppqht$ A'e d love your feedback, scares, and quest ons! Please share them in die comments below.
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1 pciint(s) 1. Question Dr. Janes prescribes albuterol sulfate {ProventiI) for a patient with newly diagnosed asthma. When teaching the patient about this drug, the nurse should explain that it may cause: A_ Nasal congestion B. Nervousness C. Lethargy □ . Hyperkalemia Correct Correct Answer: B. Nervousness Albuterol may cause nervousness. The primary adverse effects of albuterol therapy are tremors and nervousness, mostly seen in Children who are 2 to 6 years of age, though can be seen at any age. Tremors are the result of activation of the beta 2 receptors found on the motor nerve terminals which increases intracellular cAMP. These side effects occur in approximately one in every five patients. Other adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting and muscle cramps. ■ Option A: Ttie inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion. Monitoring parameters for albuterol include farced expiratory volume, peak flow, blood pressure, heart rale, central nervous system stimulation, serum potassium, serum glucose, and asthma symptoms. ■ Option C: Other side effects include insomnia and nausea, which occur in approximately 1 in every ten patients. Less common adverse effects may include fever, bronchospasm vomiting, headache, dizziness, cough, allergic reactions, otitis media, epistaxis, increased appetite, urinary tract infections, dry
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mouth. gas. hyperhidrosis, pain, dyspepsia, hyperactivity, chills, lymphadenopathy, ocular pruritus, sweating, conjunctivitis, and dysphonia. ■ Option D; Albuterol also has been shown to increase blood pressure and may cause hypokalemia. Increased blood glucose concentrations and prolonged QTc interval and ST segment depression have occurred although rarely. l pcintfs) 2. Question Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is: A_ Yellow B. Green • C. Clear D. Gray Correct Correct Answer: C. Clear Normally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically reveals swelling of the nasal mucosa and thin, dlear secretions. The inferior turbinates may take on a bluish hue, and cobblesloning of the nasal mucosa may be present. On physical examination, clinicians may notice mouth breathing, frequent sniffling and/or throat clearing, transverse supra tip nasal crease., and dark circles under the eyes (allergic shiners). * Option A: Yellow drainage indicates spread of the infection to the sinuses. Yellow mucus Is a sign that whatever virus or infection the client has is taking hold. The body is fighting back. The yellow color comes from the cells — white
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blood cells, for example — rushing Io kill the offending germs. Once the cells have done lheir work, they're discarded in the drainage and tinge it a yellowish brown. • n piion B: Green drainage may also indicate infection. If Lhe immune system kicks into high gear to fight infection, lhe drainage may turn green and become especially thick. The color comes from dead white blood cells and otfier waste products. Some sinus infections may be viral, not bacterial. * Oplion 0: Gray drainage may indicate a secondary infection. This could be a fungal sinus infection. These are different from viral or bacterial infections because the fungi feeds on the nasal tissue-and reproduces. Fungal Sinus infections may occur due to a previous nasal injury or long term nasal inflammation, as well as a weakened immune system. Growths called "fungus balls" develop in the cheek sinus as clumps of fungal spores. The fungus balls must be removed by surgery. 3. Question 1 *** ■ > A male adult patienl hospitalized for treatment of a pulmonary embolism develops respiratory alkalosis. Which clinical findings commonly accompany respiratory alkalosis? A. Nausea or vomiting B. Abdominal pain or diarrhea C. Hallucinations or llnnitus 0. Lightheadedness or paresthesia Correct Correct Answer: D. Lightheadedness or paresthesia
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The patient with respiratory alka losis may complain of Iightfleadedness or paresthesia {numbness and tingling in the arms and legs). The exact history and physical exam firtdings are highly variable as there are many pathologies that induce the pH disturbance. These may include acute onset dyspnea, fever, chills, peripheral edema., orthopnea, weakness, confusion, light headedness, dizziness, anxiety, chest pain, wheezing, hemoptysis, trauma, history of central line catheter, recent surgery, history of thromboembolic disease, history of asthma, history of COPD, acute focal neurological signs, numbness, paresthesia, abdominal pain, nausea, vomiting, tinnitus, or weight loss. < Qpiion A: Nausea, vomiting, abdominal pain, ar - d diarrhea may accompany respiratory acidosis. Following a performance predominantly relying on anaerobic glycolysis, systemic acidosis may cause vomiting as a physiological response to drain H + and thereby allow the stomach to add bicarbonate to the body ■ Option th Hyperchloremic acidosis is caused by lhe loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea. In pathologies with profuse watery diarrhea, bicarbonate within the intestines is lost through lhe stool due to increased motility of the guL This leads to further secretion of bicarbonate from the pancreas and intestinal mucosa leading to net acidification of the blood from bicarbonate loss. • Option C: Hallucinations and tinnitus are associated with respiratory alkalosis or any other acid base imbalance. Respiratory alkalosis in itself is not life threatening; however, the underlying etiology may be. Always lock for and treat lhe source of lhe illness. Interventions to reduce pH directly are typically not necessary as there Is no mortality benefit to this therapy. 4. Question 1 Before administering ephedrine, Nurse Tony assesses the patient's history. Because of ephedrine's central nervous system (CNS) effects, it is riot recommended for: A. Patients with an acute asthma attack B. Patients with narcolepsy.
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C. Patients under aye 0. Elderly patients. Correct Correct Answer: D. Elderly patients Ephedrine is ml recommended for elderly patients, who are particularly susceptible lb CNS reactions (such as confusion and anxiety) and Io cardiovascular reactions (such as increased systolic blood pressure., coldness in the extremities, and anginal pain). Ephedrine is also arrhythrnoyenic, and caution should be used during administration to patients who are predisposed to arrhythmias or taking other arrhythmogenic medications, particularly digitalis. ■ Option A: Ephedrine is used for its bronchodilator effects with acute and chronic astfima. Oral formulations of ephedrine have been used historically to treat asthma via pulmonary vasoconstriction and reduction in airway edema along with beta induced branchedilation, but it is rarely used for this purpose in modern medicine due to unwanted cardiac effects and availability of more selective beta agonists such as albuterol ■ Option 0: Ephedrine is used occasionally for its CNS stimulant actions for narcolepsy. Ephedrine acts as both a direct and indirect sympathomimetic. It binds directly to both alpha and beta receptors; however, its primary mode of action is achieved indirectly, by inhibiting neuronal norepinephrine reuptake and by displacing more norepinephrine from storage vesicles. This action allows norepinepfirine lo be present in the synapse longer lo bind poslsynaptic alpha and beta receptors. • Opliort C: It can be administered Lo chi Idren age 2 and older. The FDA has not formally established safety and effectiveness in pediatric populations. Additional ly r ephedrine is distributed by the manufacturer in 50mg/mL vials and requires dilution before intravenous use. 1 pointfs) 5. Question
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A female patient suffers acute respiratory distress syndrome as a consequence of shock. The patient's condition deteriorates rapidly, and endotracheal intubation and mechanical ventilation are initialed. When the high pressure alarm on the mechanical ventilator, alarm sounds, the nurse starts Io check for the cause. Which condition triggers the high pressure alarm? A. Kinking of the ventilator tubing. B. A disconnected ventilator tube. C. An endotracheal cuff leak D. A change in the oxygen concentration without resetting ti e oxygen level alarm. Correct Correct Answer: A Kinking of the ventilator tubing, Conditions that trigger the high' pressure alarm include kinking of the ventilator tubing, bronchospasm or pulmonary embolism, mucus plugging, water in the lube, coughing or biting on endotracheal lube, and the patient's being out of breathing rhythm with the ventilator. If an alarm occurs, the caregiver should always evaluate Hie patient before checking the ventilator. ■ Option B: A disconnected ventilator tube would trigger the low pressure alarm. If the pressure inside the breathing circuit drops below the Low Airway Pressure Alarm limit set on the ventilator, an audible and/or visual alarm activates. • Option C: Some causes for low pressure alarms are: the patient becomes disconnected from the ventilator circuit; inadequate inflation of the tracheostomy tube cuff; poorly fitting noninvasive masks or nasal pillows/prOngs; loose circuit and lubing connections; or the patient demands higher levels of air than the ventilator is putting cut. • Option £>: Changing Lheoxygen concentration without reselling the oxygen level alarm would trigger Hie oxygen alarm. Oxygen concentration is the amount of
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oxygen delivered Lu the patient. When the patient is not receiving added oxygen, the oxygen level will be the same as room air (21%). 6. Question 1 P° int ( B > A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon), 0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another pancuronium dose? 1. Leg movement A. Leg movement B. Finger movement C. Lip movement CL Fighting the ventilator Correct Correct Answer: D. Fighting the ventilator Pancuroniunxa nun depolarising blocking agent, is used fur muscle relaxation and paralysis. It assists mechanical ventilation by promoting endotracheal intubation and paralysing the patient so that the mechanical ventilator can do its work Fighting the ventilator is a sign that the patient needs anolfier pancuronium dose. Tfie nurse should administer 0.01 to 0.02 mg/kg LV. every 20 to 60 minutes. Movement of the legs, or lips has no effect on the ventilator and therefore is not used to determine the need for another dose. * Option A: Leg movement is not used as an indication for another dose. Pancuronium bromide is a long acting, bis quaternary ami nosleroid, non' depolarising, neuromuscular blocking drug (NMBD), which was first synthesized
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