Comprehensive Respiratory System Disorders NCLEX C

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Comprehensive Respiratory System DisordersNCLEX Challenge Exam (Quiz #1: 50 Questions)UFC1ATED ON OCTOBER 17. 2DC3BY MATT VERA BSN.H.N.Hi! You Eire currently in Lhe quiz page. If you're dorte with this qui4 please ctieck outthe other exams by clicking here to go back to the Respiratory System DisordersNursing Test Bank page.Quiz GuidelinesBefore 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-pressureenviranment. These exams provide immed 3te Feedback and explanations, l e ang you grasp careconcepts, identify anpruvemerl areas, and build Confidence in your knowledge and ablies.2. Challenge txams: Take cur Cha eoge Exams La test you mastery and readiness undo sins atedexam conditions. These exams offer a rigorous uuesliar set to assess your urdei standing. piepareyou 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.jComplete the quizEnsure that you answer the er I re quiz. Only after you've answered every itemwill the scare and rationales be shown.4. Learn from the rationalesAfter each quiz, click on die 'View Questions" buttou to understand theexplanation fur each answer.5. Free accessGuess wiiat? Our test banks are 1 M % FREE. Skip the hassle■no sign-ups orreg straitens here. A sincere promise from Nurseslabs: we have not ard wort ever request yourcredit card details ar personal info for oca practice uuesliar s. We re dedicated 1o keepng thisservice accessible ard cost-free, espec ally for uui amazing students ard r arses. So. take the leapand elevate your career hassle-free6. Share truur tlKiuidilqWe d oveyoca feedback, scores, and questions! P ease share them in diecomments below.Results5Qnf 50 Questions answered correctlyYour lime. 00.10:44You have reached 50 of 50 point(s), (10DXJAverage scoreCrt,

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Would you like Io submit your quiz result to the leaderboard?NamftNameE Mail:E MailRqntflView Questions1. Question1 pointfs)Aminophylline iLheophy llinej is prescribed Tor a client with acute branchilis. A nurseadministers 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.CorrectCorrect Answer: C. Relax smooth muscles of lhe bronchial airwayAminophylline is a bronchodilator that directly relaxes the smooth muscles of thebranchial airway. Theophylline causes non'seleclive inhibition of type III and type IVisoenzyntes of phosphodiesterase, which leads to increased tissue cyclic adenosinemonophosphate (cAMP) and cyclic 3?.5? guanasine monophasphate concentrations,resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNSand cardiac stimulation.*Option A: Guaifenesin is an expectorant. It works by thinning arid looseningmucus in lhe airways, clearing congestion, and making breathing easier.Mucolytics are drugs belonging to lhe class of mucoactive agents. They exerttheir effect on lhe mucus layer lining Lhe respiratory trad with Lhe motive ofenhancing its clearance.*Option B: Antitussives are drugs that suppress lhe cough reflex. Persistentcoughing can be exhausting and can cause muscle strain and further irritationof Lhe respiratory trad. They act on the cough control center in the medulla tosuppress lhe cough reflex.

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*Option D; Antibiotics are powerful medicines that fight bacterial infections. Theyeither kill bacteria or stop them from reproducing, allowing the body's naturaldefenses 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 curinginfection and preventing the development of resistant bacteria.2Question1A client is receiving isoelharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitorsthe client for which side effect of this medication?A_ ConstipationB. DiarrheaC. BradycardiaD. TachycardiaCorrectCorrect Answer: D. TachycardiaSide effects that can occur from a beta 2 agonist include tremors, nausea,nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of therrrouth or throat Due to the vasodilatory effect of peripheral vasculature andsubsequent decrease in cardiac venous return, compensatory mechanisms manifestas tachycardia are relatively comment. especially within the first weeks of usage.-Option A: Constipation is not a side effect of isoetharine. Bela 2 agonists havebeen shown to decrease serum potassium levels via an inward shift ofpotassium into the cells due to an effect on the membrane bound Na/K ATPase,which can potentially result in hypokalemia. Beta 2 agonists also promoteglycogenolysis, which can lead to inadvertent elevations in serum glucose.•Option B: Adverse effects of beta 2 agonists most commonly involve thedesensitization of the beta 2 adrenergic receptor to the beta 2 agonist. Due Iothe similar properties between the classes of adrenergic receptors, beta 2agonists 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 involvethe cardiac, metabolic, or musculoskeletal system.-Option C: Arrhythmias are seen more commonly in fenoterol usage versusalbuterol, and arrhythmias have an increase in frequency in patients withunderlying heart disease or concomitant theophylline use. Several studies have

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also indicated hypoxemia and hypercapnia aS exacerbating factors to ti ecard atoxic effects of beta 2 agonists.3. Question1P*ln,WA nurse leaches a client about the useofa respiratory inhaler. Which action by the clientindicated 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.CorrectCorrect 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 heslowly counts to 10. This lets the medicine reach deep into the lungs. Tire client shouldbe instructed to hold his or her breath at least 10 to 15 seconds before exhaling themist.» Option A: If the client has not used the inhaler in a wfiile, he may need to primeit. 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 themouthpiece so that the mouth forms a light seal. As the client starts to slowlybreathe in through the mouth, press down on the inhaler one lime.» Option 0: If using inhaled, quick relief medicine (beta agonists), wail about 1minute before taking the next puff. You do not need to wait a minute betweenpuffs for other medicines.4. Question1A female client is scheduled Io have a chest radiograph. Which of the following questions is ofmost 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?"CorrectCorrect Answer: A. "It there any possibility lhai you could be pregnant?"The rrtosl important item to ask about is the client's pregnancy slatus becausepregnant women should not be exposed to radiation. The risk of Side effects of an Xray while the client is pregnant is extremely minimal but il is always important toprotect the developing fetus from harm.*Option B: Clients are also asked to remove any chains or mela I objects thatcould interfere with obtaining an adequate film. The client may be asked to stripdown and wear a hospital gown, or al least remove clothing on lhe part of thebody that needs to be X rayed.*Option C: & chest radiograph most often is done al full ir'spiration, which givesoptimal lung expansion.’Option D; if a lateral view of lhe chest is ordered, the client is asked to raise theamts above the head. The client will be asked to stay still so the image will be asclear as possible. This will provide lhe mosl accuale image. Mosl films aredone in posterior anterior view. The X ray test works by positioning Lhe part ofthe body being X rayed between Lhe soiMce of the X'ray and an X ray detector(such as a film}.5, Question1P°ln,<5)A client has just returned Io a nursing unit following bronchoscopy. A nurse would implementwhich of the following nursing interventions for this client?A. Encouraging additional fluids for the next 24 hoursBEnsuring the return of the gag reflex before offering foods or fluidsC. Administering atropine intravenously□. Administering small doses of midazolam (Versed).

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CorrectCorrect Answer: B. Ensuring the return of the gag reHex before offering foods or fluidsAfter bronchoscopy, the nurse keeps the client an NPO status until the gag reflexreturns because the preoperative sedation and the local anesthesia impair swallow ngand the protective laryngeal reflexes for a number of hours. Although bronchoscopycan be done without sedation, most procedures are done under moderate conscioussedation 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 usedthat would need to be flushed from die system. Regardless of the sedation oranesthesia used the physicians should be aware of the potential side effectsand 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 helpby drying secretions, producing bronchodilalion, or preventing vasovagalreactions.*Option 0: The administration of additional midazolam in small doses, until thetarget sedation level is achieved, Isa safe procedure that is associated withsignificantly less discomfort and pain during bronchoscopy and a grea terconsent to re?examination when compared with the administration of a fixeddose of midazolam.6. Question1 poin,(3)A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludesthe:A_ Brachial and radial arteries, and then releases them and observes the circulationof the hand.BRadial and ulnar arteries, releases one, evaluates the color of the hand, andrepeats 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.CorrectCorrect Answer: B, Radial and ulnar arteries, releases one, evaluates the color of thehand, 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 withAlien's lesL This involves compressing the radial and ulnar arteries and asking theclient Io cluse arrd open the fist. This should cause the hand to became pale. The nursethen releases pressure on one artery and observes wlrether Circulation is restoredquickly. The nurse repeals the process, releasing the other artery. The blood samplemay be taken safely If collateral circulation is adequate.•Option A: Puncture of the radial artery is usually preferred because of theaccessibility of the vessel, the presence of collateral circulation, artd the artery'ssuperficial course proximal to the wrist, which makes it easier fur the clinician toidentify the vascular structure and hold local pressure after the procedure isfinished.-Option C: The radial artery is most easily accessible medial to the radial styloidprocess and lateral to the flexor carpi radi alls tendon, 2 3 cm proximal to theventral surface of the wrist crease. Firm occlusive pressure is held on both theradial artery and the ulnar artery. The patient is asked to clench the fist severallimes until the palmar skin is blanched, then to unclench the fist.*Option D: if radial artery sampling is not feasible, femoral artery puncture Is apassible alternative. When femoral artery puncture is being considered, thepotential risk of infection at the entry site and the artery's proximity to thefemoral vein and nerve must be taken into7. Question1A 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 chronicairflow limitation?A_ Chronic obstructive bronchitisB. tmphysemaC. Bronchial asthma□. Branchial asthma and bronchitisCorrectCorrect Answer? B. EmphysemaThe client with emphysema has hyperinflation of the alveoli and flattening of thediaphragm. These lead Io increased anteroposterior diameter, which is referred to as"barrel chest.' The client also Iras dyspnea with prolonged expiration and hashyperresonanl 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 productiveCOugh,malaise, and symptoms of excessive coughing such as chest orabdominal pain.*Option C: Asthma is a condition of acute, fully reversible airway inflammation,often following exposure to an environmental trigger. The pathological processbegins 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 andan increase in mucus production. This leads to a significant increase in airwayresistance, which is most pronounced on expiration.*Option D: Acute bronchitis is the result of acute inflammation of the bronchisecondary 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. Altimes, a viral upper respiratory infection can progress to infection of the lowerrespiratory tract resulting in acute bronchitis.8. Question1poim(s)A client has been taking benzonalale (TessaIon Perles) as prescribed. A nurse concludes thatthe 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.CorrectCorrect Answer: 0. Decreased frequency and intensity of cough.Benzonalale is a locallyactingantitussive the effectiveness of which is measured bythe degree to which it decreases the intensity and frequency of cough withouteliminating the cough reflex. Benzonalale is an oral antitussive drug used in the reliefand suppression of cough in patients older than ten years of age. Currently,benzonalale is the only non narcotic antitussive available as a prescriptiondrug. Itworks to reduce the activity of cougli reflex by desensitizing the tissues of the lungsand pleura involved inthecough reflex.*Option A: Because its chemical structure resembles that of the anestheticagents in the para amino benzoic acid class (such as (procaine] and[tetracaine]), benzoriatafe exhibits anesthetic or numbing action. Althoughilisnot pronetodrug misuse or abuse, benzonalate is associated witharisk forsevere toxicity and overdose, especially in children.

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•Option B; Benzonalate suppresses cough associated with both acute andchronic respiratory conditions. It works by desensitizing the pulmonary stretchreceptors involved in l i e cough reflex. There are limited clinical trials ofbenzonalate; however, earlier studies demonstrated inhibition of experimentallyinduced cough and subjectively measured pathological cough by benzonalate.*Option C: Benzanatate is a synthetic bulylamino benzoate derivative related totetracaine and a peripherally acting antilussive, non narcotic Benzonalatereduces the cough reflex by anesthetizing and depressing mecharroreceptors inthe respiratory passages, lungs, and pleura. It is recommended for cough reliefin the common coldl bronchitis, pneumonia, and for chronic cough such as inasthma.9. Question1Which of the fallowing would be an expected outcome for a client recovering from an upperrespiratory 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 dischargeCorrectCorrect Answer: 0. Experience less nasal obstruction and discharge.A client recovering from an URI should report decreasing or no nasal discharge andobstruction. Decongestants and combination anlihistamine/decungestant medicationscan limit cough, congestion, and other symptoms in adults. Avoid cough preparationsin children. Hlreceptor antagonists may offer a modest reduction of rhinorrhea andsneezing 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 hoursto liquefy secretions. Topical and oral nasal decongestants (i.e., topicaloxymetazoline, oral pseudoephedrine) have moderate benefit in adults andadolescents in reducing nasal airway resistance. Evidence based data does notsupport the u se of antibiotics in the treatment of the common cold because theydo not improve symptoms or shorten the course of illness.*Option B: The temperature should be below l00*F (37.8*C) with no chills ordiaphoresis. According to a Cochrane Review, vitamin C used as dailyprophylaxis at doses of =0.2 grams or more had a "modest but consistenteffect" 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, notan URL The presence of classical features Icr rhinovirus infection coupled withthe absence of signs of bacterial infection or serious respiratory illness, Issufficient to make the diagnosis of the common cold. The common cold is aclinical diagnosis, and diagnostic testing is not necessary.10. Question1P°i n l < s>Which of the fallowing individuals would the nurse consider to have the highest priority forreceiving 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.CorrectCorrectAnswer: C. ASO year- old woman caring for a spouse with cancer.Individualswhoare household members or home care providers for high riskindividuals are high priority targeted groups for immunization against influenza loprevent 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 clientsdescribed.-OptionA:In certain gioups, includingtheelderly, immune compromisedindividuals and infants, the influenza vaccine is less effective, but it is beneficialby reducing the incidence of severe disease, like bronchopneumonia, andreduces hospital admission and mortality.*Option B: Regarding immunization in pregnancy, a randomized controlled trialconducted in South Africa has shown that when pregnant women receive theinfluenza vaccine, it halves their risk of developing influenza while reducing therisk of their infants (upto 24 weeks) contracting the illness.’Option D: Influenza vaccine conveys immunity against the influenza virus bystimulating the production of antibodies specific to the disease. Antibodies toNA act by aggregating viruses on the cell surface effectively and reducing theamount 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 appropriatetorthe 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 promoterfrairiage."0, "Keep fl diary when your symptoms occur. This can help you Identify whatprecipitates your attacks?CorrectCorrect Answer: 0. 'Keep a diary when your symptoms occur. This can help youidentify what precipitates your attacks.’Il is important for clients with allergic rhinitis to determine Lhe precipitating factors sothat they can be avoided. Keeping a diary can help identify these triggers. Patientsoften underestimate the severity of this condition and fail to seek medical therapy. It isimportant to adequately control AR especially due to lhe link between AR and asthma,with poor control of rhinitis predicting poor control of asthma.■OptionA:Nasal decongestant sprays should not be used regularly because theycan cause a rebound effect. If removing a petfromhome is not feasible,isolating lhe pel toasingle room in the house may be an option Io minimizedander exposure. It may take up to 20 weeks to eliminate cat dander from homeeven after removing lhe animal.*Option B: Antibiotics are not appropriate. Intranasal corticosteroid therapy canbe as monotherapy or in combination with oral anlihislamines in patients withmild, moderate, or severe symptoms. Studies have shown intranasalcorticosteroids are superior to antihistamines in effectively reducing nasalinflammation 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. Avoidanceof triggers, especially in those with seasonal symptoms, is encouraged, althoughit is not always practical. Precautions can be taken to avoid dust mites, animaldander, and upholstery, though this can require significant lifestyle changes thatmay not be acceptable to the patient.12. Question1 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 todecrease secretionsD. The client has not been taking her decongestants and bronchodilators asprescribed.CorrectCorrect Answer: A. II Is likely that the client is developing a secondary bacterialpneumonia.Pneumonia is the most common complication of influenza, especially in the elderly.The development of a purulent cough and crackles maybeindicative of a bacterialinfection that is not consistent with a diagnosis of influenza.*Option B: Diagnosis of influenza can be reached clinically, especially during thei nfluenza season. Most of the cases will recover without medicaI treatment, andtheywould not need a laboratory lest for the diagnosis. Signs and symptoms ofinfluenza in mild cases include a cough, fever, sore throat, myalgia, headache,runny nose, and congested eyes. A frontal or retro orbital headache is acommon presentationwithselected ocular symptomsthatinclude photophobiaand pain with different qualities.*Option C;These findings are not indicative of dehydration. Theclinicalpresentation of influenza rangesfrommild 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, andtheyare less likelytodevelop complications.*Option D; Decongestants and bronchodilators are not typically prescribed for theflu. Influenza infection is self-limited and mild in most healthy individuals whodo not have other comorbidilies. No antiviral treatment is needed during mildinfections in healthy individuals. Antiviral medications can be used to treat orprevent influenza infection, especially during outbreaks In healthcare settingssuch as hospitals and residential institutions.13. Question1Guaifenesin 300 mg four times daily has been ordered as an expectorant.Thedosage strengthof the Iiquid is 2OTmg/5mI. How nrany mL shouldthenurse admini sler each dose?Fill inlheblankand record your final answer using one decimal place.

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Answer:7.5rnLCorrectCorrect Answer: 7.5 mlWhen tire medicine is a solution of specific strength, calculations can become morecomplicated. Liquids (solutions, arid suspensions) are frequently used in childrerisnursing■for example for children who find swallowing tablets difficult or patients whohave medicines administered via a percutaneous endoscopic gastrostomy (PEG) tube.14. Question1Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant Which of thefollowing is a possible side effect of this drug?A. ConstipationB. BradycardiaC. DiplopiaO. RestlessnessCorrectCorrect Answer: 0. RestlessnessSide effects of pseudoephedrine are experienced primarily in the cardiovascularsystem and through sympathetic effects on the CNS. The most common CNS effectsinclude restlessness, dizziness, tension, anxiety, insomnia, and weakness. Commoncardiovascular side effects include tachycardia, hypertension, palpitations, andarrhythmias.*Option A: Pseudoephedrine is used to relieve nasal congestion caused by colds,allergies, and hay fever. It is also used to temporarily relieve sinus congestionand pressure. Pseudoephedrine will relieve symptoms but will not treat thecause of the symptoms or speed recovery. Pseudoephedrine is in a class ofmedications Called nasal decongestants. Il works by causing narrowingof theblood vessels in the nasal passages.*Option BTachycardia, not bradycardia, is a side effect of pseudoephedrine.Nonprescription cough and cold combination products, including products thatcontain pseudoephedrine, can cause serious Side effectsor dealt:in young

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children. Do not give nonprescription pseudoephedrine products to childrenyounger than 4 years of age.*Option C: Diplopia is not a side effect of pseudoephedrine. Tell your doctor if youhave or have ever had high blood pressure, glaucoma (a condition in whichincreased pressure intheeye can lead to gradual loss of vision), diabetes,difficulty urinating (due to an enlarged prostate gland), cr thyroid or heartdisease. If you plan to take the24hour extended release tablets, tell your doctorif you have had a narrowing or blockage of your digestive system.15. Question1A client with CORD reports steady weight loss and being "tootiredfrom just breathing to eat."Which of the following nursing diagnoses would be most appropriate when planningnutritional 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.CorrectCorrect Answer: A. Altered nutrition; Lessthanbody requirements related to fatigue.The client's problem is altered nutrition—specifically, less than required. The cause, asslated by the client, is the fatigue associated with the disease process. Instruct thepatient to frequently eat high caloric foods in smaller portions. COPD patients expendan extraordinary amount of energy simply on breathing and require high caloric mealsto maintain body weight and muscle mass.*OptionB:Activity intolerance is a likely diagnosis but is not related to the Client'snutritional problems. Providealleast 9tJ minutes of undisturbed rest in betweenactivities. Allotmenlof undisturbed rest reduces demand for oxygen and allowsadequate physiologic recovery.*Option Ct Weight loss is not a nursing diagnosis. Encourage a rest period of 1 hrbefore and after meals. Helps reduce fatigue during mealtime and provides anopportunity to increase total caloric intake. Avoid gas producing foodsandcarbonated beverages. Can produce abdominal distension., which hampersabdominal breathing and diaphragmatic movement and can increase dyspnea.*Option D: Ineffective breathing pattern may be a problem, but this diagnosisdoes not specifically address the problem of weigfil loss described by the client.Instruct how to splintthechest wallwitha pillow for comfort during coughing

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and elevation of head aver the body as appropriate. Promotes physiologicalease of maximal inspiration.16. Question1When developing a discharge plan to manage the care of a clien t with COPD, the nurse shouldanticipate thatthedient will do which ofthefollowing?A. Develop infections easily.B. Maintain current status.C. Require less supplemental oxygen.D. Show permanent improvenrent.CWTKtCorrect Answer: A. Develop Infections easily.A client with CDPD is at high risk for development of respiratory infections. Inemphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophilsand macrophages are recruited arid release multiple inflammatory mediators. Oxidantsand excess proteases leadingto thedestruction of the air sacs. The protease mediateddestruction of elastin leads Io a loss of elastic recoil and results in airway collapseduring exhalation.*Option B: COPD is slowly progressive; therefore, maintaining current status is anunrealistic expectation. CDPD is an inflammatory condition involving theairways, lung parenchyma, and pulmonary vasculature. The process is thoughtto involve oxidative stress and protease antiprotease imbalances. Emphysemadescribes one of the structural changes seen in COPD where there is destructionof the alveolar air sacs (gas exchanging surfaces of the lungs) leading toobstructive physiology.*Option C“ This is an unrealistic expectation. The prognosis of COPD is variablebased on adherence to treatment including smoking cessation and avoidance ofother harmful gases. Patients with other comorbidities (e.g., pulmonaryhypertension, cardiovascular disease, lung cancer) typically have a poorerprognosis. The airflow limitation and dyspnea are usually progressive.*Option D: Treatment may slow progression of the disease,butpermanentimprovement is highly unlikely. As the disease progresses impairment of gasexchange 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 lodiffuse vasoconslriclion from hypoxemia.17. Question1 p<tln1Which of the fallowing outcomes would be appropriate for a client with COPD who has beendischarged 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.CWTKtCorrect Answer: 0Agrees lo call the physician If dyspnea on exertion increases.Increasing dyspnea on exertion indicates that the client may be experiencingcomplications of COPD, and thereforethephysician should be notified. There arethingsthateveryone with COPD should do lo manage their disease; quitting smoking(Ifthey smoke] is lhe most important. In addition there are other non medicationtreatments 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'sability to exercise. enhance quality of life, and decrease the frequency of COPDexacerbations (when symptoms flare up more than usual). Even people withsevere shortness of breath can benefit from a rehabilitation program.« Option 0:Pain is not a common symptom of COPD. Although COPD usuallyworsens over time, it is difficult to predict how quickly it will progress and howlong the client will live (the prognosis). Anumberof factors play a role in theseverity of COPD symptoms, including whether the client continues to smoke,are underweight, or have other medical problems, and how the lungs functionduring exercise. People with COPD who have less severe symptoms, are ahealthy weight, and do not smoke lend lo live longer.’Option C:Clients with COPD use low-flow oxygen supplementation (1 to 2L/minule) lo avoid suppressing lhe respiratory drive, which, for these clients, isstimulated by hypoxia. People with severe or advanced COPD can have lowoxygen levels in the blood. This condition, known as hypoxemia, can occur evenif the client does nol feel short of breathcrhave other symptoms. The oxygenlevel 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 onOxygen therapy, which can improve survival and quality of life.13. Question1 p o l n'<5)Which of the following physical assessment findings would the nurse expect Io find in a clientwith advanced CORD?A. Increased anteroposterior chest diameter.B. Underdeveloped neck muscles.C. Collapsed neck veins.□. Increased chest excursions with respiration.CorrectCorrect Answer: A. Increased anteroposterior chest diameter-increased anteroposterior chest diameter is characteristic of advanced COPD. Air istrapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. Theresult is the typical barrekchesled appearance. In addition, coarse crackles beg inningwith inspiration may be heard.*Option 0: Overly developed, not underdeveloped, neck muscles are associatedwith COPD because of their increased use in the work of breathing. Use ofaccessory respiratory muscles and paradoxical indrawing of lower intercostalspaces is evident (known as the Hoover sign).-Option C: Distended, not collapsed., neck veins are associated with COPD as asymptom of the heart failure that the client may experience secondary to theincreased workload on the heart to pump into pulmonary vasculature. Inadvanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheraledema 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 isrelatively poor; however, physical signs are quite specific and sensitive forsevere disease. Patients with severe disease experience lachypmea andrespiratory distress with simple activities.1 poinl(s)19. QuestionWhich of the fallowing is the primary reason Io teach pursed lip breathing to clients withemphysema?

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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.CorrectCorrect 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 helpingtheclient relax, pursed lip breathing helpstheclient learntocontrol therateand depth ofrespiration. Pursed lipbreathingdoes not promote the intake ofoxygen, strengthen thediaphragm,or strengthenintercostal muscles.-Option A:Fo rthose sufferingfromchronic obstructive pulmonary disease, theability totake in oxygen is a constant struggle. It's possible to increase oxygenlevels in other ways, such as cellular therapy. Cellular ifterapy may promote thehealing of lung tissue, potentially improving lung function. When lung functionimproves; the client is able to take in more oxygen as well as expel carbondioxide because the lungs are working more effectively.-OptionB: Diaphragmatic breathing is a type of a breathing exercise that fieIpsstrengthen the diaphragm, an important muscle that helps usbreathe. Thisbreathing exercise is also sometimes called belly breathing or abdominalbreathing.•Option C;Breathing exercises slowly fill the lings with air to expandthe chestandwork the intercostal muscles. To do this exercise, it is typicallyrecommended to sit or standwith theback straight iftentakeafull breathfromthebottomofthe lungs.Itcan help Iothinkof breathing fromthediaphragm, byslowly expanding the abdominal muscles while inhaling, then pushing air fromthe lungs using these same muscles.i pointfs)20. QuestionWhich 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.CorrectCorrect Answer:A.Maintaining funclional abilityA priority goal forthe client withCOPD isto managethe s/s ofthedisease process soas 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 chairrest duringtheacute phase. Have patient resume activity gradually and increase asindividually tolerated.*Option 0:Chest pain is not a typical sign of COPD. Assess and recordrespiratory rate, depth. Note the use of accessory muscles, pursed lip breathing.inability Io speak or converse. Usefulinevaluating the degree of respiratorydistress or chronicity ofthedisease process.*Option C: The carbon dioxide concentration in the blood is increased to anabnormal level in clients with COPD; it would not be a goal to increase the levelfurther. Monitor arterial blood gasses values as ordered. As the patient'scondition progresses, PaD2 usually decreases. For patients with chronic carbondioxide retention may have chronically compensated respiratory acidosis with alow 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 COPD.Demonstrate and assistthepatientin thedisposal of tissues and sputum.Stress proper handwashing (nurse and patient), and use gloves when handlingor disposing of tissues, sputum containers. Prevents spread of fluid bornepathogens.1 polnl(s)21. QuestionA client's arterial blood gas levels are as follows: pH 7.31: Pa02 SOmmHg. PaC02 65 mm Hg;HC0336 inEq/L Which of the fallowing signs or symptoms would the nurse expect?A. CyanosisB. Flushed skinC. Irritability

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D. AnxietyCorrectCorrect Answer: B. Flushed skinThe high PaCO2 level causes flushing due to vasodilation. The client also becomesdrowsy and lethargic because carbon dioxide has a depressant effect on the CNS. Onthe contrary, chronic respiratory acidosis may be caused by CORD where there is adecreased responsiveness of (tie reflexes to states of hypoxia and hypercapnia.•Option Aj Cyanosis is a laLe sign of hypoxia. In respiratory acidosis, the slightincrease in bicarbonate serves as a buffer for the increase in H+ ions, whicht eips minimize the drop in pH. In some cases, patients may present withcyanosis due to hypoxemia.« Option C: Irritability is net common with a PaCCK level of 65 mm Hg but isassociated with hypoxia. If the respiratory acidosis is severe and accompaniedby prolonged hypoventilation, the patient may have additional symptoms suchas altered mental status, myoclonus, and possibly even seizures.-Option D: The clinical presentation of respiratory acidosis is usually amanifestation of its underlying cause. Signs and symptoms vary based on thelength, severity, and progression of the disorder. Patients can present withdyspnea, anxiety, wheezing, and sleep disturbances.22. Question1F”in,(9)When teaching a client with COPD to conserve energy, the nurse should teach the client to liftobjects: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.CorrectCorrect Answer; B. While exhaling through pursed lips.Exhaling requires less energy than inhaling. Therefore, lifting while exhaling savesenergy 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 potentiallyaid in return to exercising, which can lead to feeling more energetic overall.•Option A: Pursing the lips prolongs exhalation and provides the client with morecontrol over breathing. It's been shown to reduce flow hard one has Io work tobreathe. It helps release air trapped in the lungs. It promotes relaxation. ILreduces shortness of breath.•Option C: Lifting after exhalation but before inhaling is similar to lifting with thebreath held. The purpose of pursed lip breathing is to help keep the airwaysopen. This helps your airways to remain open. Pursed lip breathing also slowsdown the breathing rale and calms the patient down.•Option D: This should not be recommended because it is similar to the Valsalvamaneuver, which can stimulate cardiac dysrhythmias. The purpose ofcoordinated breathing is to help assure adequate oxygen to the workingmuscles and to prevent the client from holding the breath.23, Question1The nurse teaches a dient with COPD to assess for s/s of right sided heart failure. Which ofthe following s/s would be included in the Leaching plan?A. Clubbing of nail bedsB. HypertensionC. Peripheral edemaD. Increased appetiteCorrectCorrect Answer: C, Peripheral edemaRight sided heart failure is a complication of CQPD that occurs because of pulmonaryhypertension. Signs and symptoms of right sided heart failure include peripheraledema, jugular venous distention, hepatomegaly, and weight gain due to increased fluidvolume. Right heart failure is most commonly a result of left ventricular failure viavolume and pressure overload. Clinically, patients will present with signs andsymptoms 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 thefingers (and/or toes) have the appearance of upside down spoons. Il is causedby a build up of tissue in the distant part of the fingers (terminal phalanges), thatcauses the end of the fingers to become enlarged and the nails Io curvedownward.

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*Option B. Hypertension is associated with left sided heart failure. Whenhemodynamic instability is present, vasopressors are indicated. Norepinephrineis the pressor of choice to improve systemic hypotension and restore cerebralcardiac and end organ perfusion.’Option D: clientswithheart failure have decreased appetites. A poor appetitecan also result from the accumulation of fluid in the liver and digestive system.Fluid accumulation, edenra, is a common symptom of heart failure.Theaccumulation of fluid that is responsible for the abdominal swelling candecrease the appetite and result in nausea as well as discomfort from theweight gain.24. Question1 pOln,(s)The nurse assessestherespiratory status ofaclient who is experiencing an exacerbation ofCOPD secondary to an upper respiratory tract infection. Which of the following findings wouldbe expected?1.Normal breath soundsA. Normal breath soundsB. Prolonged inspirationC. Normal chest movementD. Coarse crackles and rhonchrCorrectCorrect Answer: D. Course crackles and rtwnchiExacerbations of CDPD are frequently caused by respiratory infections. Coarsecrackles and rhonchi would be auscultated as air moves through airways obstructedwith secretions. Crackles are usually due to airway secretions within a large airway anddisappear on coughing. These crackles are scanty, gravity'Independent, usually audibleat the mouth, and strongly associated with severe airway obstruction.’Option A; |nCDPD,breath sounds are diminished because of an enlargedanteroposterior diameter ofthechest. A reduction In breath sound intensity(BSI) is often seen in patients with COPD. Pardee et al. developed a scoringsystem for BSI. According to this system the clinician listens sequentially overSix locations on the patient's chest: bilaterally over the upper anterior portion ofthechest, in the midax illary, and al the posterior bases.’Option B:Expiration, not inspiration, becomes prolonged. Patients with CDPDoften present with diminished breath sounds, prolonged expiratory time, andexpiratory 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 lungswith an increased anteroposterior chest diameter ("barrel c+iest"); use ofaccessory muscles of respiration; and distant heart sounds, sometimes bestheard in the epigastrium.25, Question1P°ln,<5)Which of the following ABG abnormalities should the nurse anticipate in a client withadvanced COPD?A.IncreasedPaC02B. Increased Pa02C. Increased pHD. Increased oxygen saturationCorrectCorrect Answer: A. Increased PaC02As COPD progresses, the client typically develops increased PaC02 levels anddecreased 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 diseaseexacerbation.*Option B: Patients with mild COPD have mild to moderate hypoxemia withouthypercapnia. As the disease progresses, hypoxemia worsens and hypercapniamay develop, with the latter commonly being observed as the FEV1 falls below 1L/s or 30% of the predicted value. Lung mechanics and gas exchange worsendur 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 below7.3 to be a sign of acute respiratory compromise.*Option D: The compensation ta respiratory acidosis consists in a secondaryincrease in bicarbonate concentration, and the arterial blood gas analysis ischaracterized by a reduced pH, increased pCO2 (initial variation), and increasedbicaibonate levels (compensatory response).

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Which oflhefol lowing diets would bemostappropriatefora client with COPD?A.Lowfat, low cholesterolB. Bland, soft di elC.LowSodium dietD. High calorie, high- protein dietCorrectCorrect Answer: 0. High-caiorie, higtv-protem dietThe client should eat high calorie, high protein meals to maintain nutritional status andprevent weight lass that resultsfromthe increased work of breathing. The client shouldbe encouraged to eat small, frequent meals. Eat 2D to 30 grams of Fiber each day, frontitems such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source ofprotein al least twice a day to help maintain strong respiratory muscles. Good choicesinclude milk, eggs, cheese, meat fish.poultry,nuts and dried beansorpeas.*Option A:A lowfaL,low cholesterol dietisindicated for clientswithcoronaryartery disease. Choose monoand poly unsaturated fats, which du not containcholesterol. These are fats that are often liquid at room temperature and comefrom plant sources, such as canola, safflower and com oils.’Option 0: Metabolism of carbohydrates produces lhe most carbon dioxide fortheamount of oxygen used; metabolismof fat produces the least. For somepeople with COPD, eating a diet with fewer carbohydrates and more fat helpsthembreathe easier.*Option C: The client with COPD does not necessarily need to follow a sodium'restricted diet, unless otherwise medically indicated. Choose complexcarbohydrates, such as whole cpain bread and pasta, fresh fruits, andvegetables. Limit simple carbohydrates, including table sugar, candy, cake, andregular soft drinks.27. Question1The nurse is planning to leach a client with COPD how to cough effectively. Which of thefollowing instructions should be included?A. Take a deep abdominal breath, bend forward . and cough 3 to 4 times onexhalation.

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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 (tiearmover the head, and alternate deepbreathing with coughing.CorrectCorrect Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4limes on exhalation.The goal of effective coughing is to conserve energy, facilitate the removal ofsecretions, and minimize airway collapse. The client should assume a sitting positionwith feet on the floor if possible. The client should bend forward slightly and, usingpursed lip breathing, exhale. After resuming an upright position, the client should useabdominal breathing to slowly and deeply inhale. After repeating this process 3 or -1times, the client should lake a deep abdominal breath, bend forward and cough 3 or -1times upon exhalation { ' h u f f ' cough).•Option B: Lying flat does not enhance lung expansion; silting upright promotesfull expansion of the thorax. Sit on a chair or on the edge of the bed, with bothfeet on the floor. Lean slightly forward. Relax.Thepatient should breathe inthrough their nose and out through their nose or mouth until they are ready toprogress to the next stage.-Option C: Shallow breathing does not facilitate removal of secretions, andforceful coughing promotes Collapse of airways.Theclient should lean forward,press the arms against the abdomen. Cough 2 3 times through a slightly openmouth. Coughs should be short and sharp. The first cough loosens the mucusand moves it through the airways. The second and third cough enables the clientto cough the mucus up and out.-Option D: A side lying position does not allow for adequate chest expansion topromote deep breathing. Silting the patient out of bed c< up in bed optimizeslung expansion. Critical care patients can sit out of bed if they arehemodynamically stable (this allows for better lung expansion). Ensure you havetwo to three clinicians assisting with any intravenous lines cardiac monitoring,drain tubes et£-28. Question1polni(s)A 34 year old woman with a history of asthma is admitted to the emergency department Thenurse notes that the client is dyspneic,witha respiratory rale of 35 breaths/minute, nasalflaring, and use of accessory muscles. Auscultation of the lung fields reveals cjeatlydiminished breath sounds. Based on these findings, what action should the nurse take toinitiate care of the client?

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A. Initiate Oxygen therapy and reassess the client in TOminutes.B. Draw bloodforan ABG analysis and send the client tor a chest x ray.C. Encourage the client to relax and breathe slowly through tire mouth.D. Administer bronchodilators.CorrectCorrectAnswer:U.Administer bronchodilators.In an acute asthma attack, diminished or absent breath sounds can be an ominoussign indicating lack of air movement in the lungs and impending respiratory failure. Theclient requires immediate intervention with inhaled bronchodilators, intravenouscorticosteroids, and possibly intravenous theophylline.•Option AAdministering oxygen and reassessing the client ID minutes laterwould delay reeded medical intervention. A favorable response to initialtreatment of status asthmaticus should be a visible improvement in symptomsthat sustains 30 minutes or beyond the last bronchodilator dose and a PEFRgreater than 70% of predicted.-Option B: Drawing an ABG and obtaining a chest x ray would be a delay. TheabsoluLe value of PEFR less than 120 L per minute and FEVI less than 1 Lcorresponds with the proportional reduction. These absolute numbers shouldprompt an assessment of arterial blood gas (ABG) immediately. Initial blood gasresults indicate respiratory alkalosis with hypoxemia.*Option C: IL would be futile to encourage the client to relax and breathe slowlywithout providing necessary pharmaco logic intervention. An initial aggressivetreatment trial of beta agonists, corticosteroids, and anticholinergics lias to betried, followed by adjunct rrteasures, which may not be based on robustguidelines but evidence.29, Question1The nurse would anticipate which of the following ABG results in a client experiencing aprolonged, severe asthma attack?A. Decreased PaCD2, increased Pa02, and decreased pH.B increasedP«C02, decimatedand decr«a$4dpH.

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C. Increased PaC02, increased PaO2, and increased pH.D. Decreased PaC02, decreased PaO2, and increased pH.CorrectCorrect Answer: Bincreased PaCO2, decreased PaOZ, and decreased pHAs the severe asthma aHack worsens, the client becomes fatigued arid alveolarhypotension develops. This leads lo carbon dioxide retention and hypoxemia. Theclient develops respiratory acidosis. Tfnerefore, the PaC02 level increases, the PaO2level decreases, and the pH decreases, indicating acidosis.*Option A: Respiratory acidosis is a very common acid base disturbance in acutesevere asthma and is widely considered to be an ominous finding. Its earlyrecognition and treatment are important and decisive for the final outcome, as itcan lead to respiratory failure and arrest if prolonged.*Option C: Hypercapnia in asthma, in addition lo the severity of the disease, isalso associated with the therapeutic administration of oxygen. Thus, in patientswith severe asthma exacerbation, a significant increase (?4 mmHg) intranscutaneous PCD2 (PIC02) was observed in a higher proportion in thosereceiving high oxygen mixtures (>8 L/min), compared to those who receivedtitrated oxygen (to achieve oxygen saturation of 93 95%)*Option D: Lee el al. noted that PaCO2 was significantly higher and the arterialblood pH lower in asthmatics who died, and delays in providing mechanicalventilation led lo worse outcomes. Another mechanism implicates the Haldaneeffect, in which oxygen displaces the 002 dissociation curve lo the right,increasing PaC02, which cannot be normalized as patients with severe COPDare unable lo increase ventilation.30. Question1P°ln1(®)A client with acute asthma is prescribed short term corticosteroid therapy. What is therationale 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.CorrectCorrect Answer: C. Corticosteroids have an anti-inflammatory effect.Corticosteroids fiave an anti inflammatory effect and act to decrease edema in thebronchial airways and decrease mucus secretion. At a physiologic level, steroidsreduce airway inflammation and mucus production and potentiate beta agonist activityin smooth muscles and reduce beta agonists tachyphylaxis in patients with severeasthma. Corticosteroids do not fiave a bronchodilator effect, act as expectorants, orprevent respiratory infections.-Option A: Short acting inhaled beta agonists are the drug of the first choice inacute asthma. Albuterol is preferred over melaprolerer'ol in tfiat class becauseof its higher beta 2 selectivilies and longer duration of action. The doseresponse curve and deration of action of these medications are adverselyaffected by a combination of patient factors, including pre existingbroncfboconslriclion, airway inflammation, mucus plugging, poor patient effort,and coordination.-Option B: Anticholinergics have a variable response in acute exacerbation with asomewhat underwhelming bronchodilalory role. However they can be useful inpatients with bronchospasm induced by beta blockade or severe underlyingobstructive disease with FEVI less tfian 25% of predicted.*Option D: Graham el al. conducted a randomized double blinded trial anddemonstrated no difference in improvement in symptom score, spirometry, orlength of hospitalization with routine use of antibiotics in status aslhmalicus.That does not mean that patients with clinical signs of infection should not betreated with antimicrobials, or due diligence should not be pursued in obtainingrespiratory culture specimens early on.31. Questioni poim(s)The nurse is Leaching the client how to use a metered dose inhaler (MDI) to administer aCorticosteroid drug. Which of the following client actions indicates that he is using theMDIcorrectly?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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QD. Mouth is rinsed with waler following administration.E. Client lies supine for 15 minutes fol lowing administration.CorrectCorrect Answers? A & DInhaled respiratory medications are often taken by using a device called a metereddose inhaler, or MDI. The MCI is a pressurized canister of medicine Ina plastic holderwith a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication.■Option A: Remove the cap and hold the inhaler iright. Each inhaler consists ofa small canister of medicine connected Io a mouthpiece. The canister ispressurized. As the client presses down on the inhaler, it releases a mist ofmedicine. The client breathes that mist into the lungs. Its important to use tireinhaler correctly.•Option El: Tilt the head back slightly and breathe out all tire way. Keep the chinup 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 takingthe second puff. A delay of 10 20 minutes between successive doses of thebronchodilator drug has been suggested in order to lei the first act to improvethe penetration and effect of Hie second dose, but again lire evidence dial thisworks is Inconclusive. Many patients may forget to lake a second dose withsuch a long interval.•Option DSome inhalers (steroid) also recommend rinsing the rnouth out withwater and gargling with waler (spit out the water) after use. If using tills inhalerfor a corticosteroid preventer medication, wi th or without a spacer, rinse themouth with water and spit after inhaling the last dose to reduce Hie risk of Sideeffects•Option E: The client does not have Io be in the supine positron afteradministration. Proper instruction by a trained person with a placebo aerosol isessential to leach the correct inhaler technique. This should be followedsubsequently 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 onpatients’ skill. Even these devices, however, must be used properly to achieve asatisfactory effect.32, Question1P01"A client is prescribed melaproterenol (Alupent) via a metered dose inhaler (MDI), two puffsevery 4 hours. The nurse instructs the client to report side effects. Which of the following arepotential side effects of mefaproterenol?

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A. Irregular heartbeatB. ConstipationC. Pedal edemaD. Decreased hear! rate.CorrectCorrect Answer: A. Irregular heartbeatIrregular heart rales should be reported promptly Io lhe care provider. MeLapfolerenolmay cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergiceffect on lhe beta adrenergic receptors inlhe hearL IIis not recomntended for use inclients with known cardiac disorders, Metaproterenol does nut cause constipation,pedal edema, or bradycardia.’Option B: |nchildren, lhe most common side effects are diarrhea, nausea,laryngitis, pharyngitis, sinusitis, otitis, and viral infection. The most commonlyobserved 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 angioedema,hypersensitivity, fatigue, confusional state, abnormal dreams, epilepsy,aggression, immune system disorder, hemorrhage, excoriation, eosinophil countincrease, pain in extremity, and abdominal pain.*Option Di Tell lhe doctor right away if any of these unlikely but serious sideeffects occur: fast/pounding/iregular heartbeat, muscle cramps, weakness.33. Question1P°i n ,<5 )A client has been taking ftunlsolide (Aerobid),twoinhalations a day, for treatment of asthma.He tells the nurse that he has painfulwhilepatches in his mouth. Which response by thenurse would be the1™55* appropriate?A. "This is an anticipated side effect of your medication. IL should go away in acouple of weeks."B. "Youareusing 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 thisproblem."CorrectCorrect Answer:C.“You have devetoped a fungal inlectionfromyour medication.Itwill needto betreatedwith an antifungal.'Use of oral inhalant corticosteroids, Such as flurisolide, can lead to the development oforal thrush a Fungal infection. Oral candidiasis {thrush) is another common complaintamong users of inhaled corticosteroids (ICS). This risk increases in elderly patients andpatients who are also taking oral steroids, high dose ICS,orantibiotics.*Option A: Once developed, thrush must be treated by antibiotic therapy; it willnot resolve on its own. Il is advisable to have the patient rinse their mouth outafter ICS use to prevent oral candidiasis. Treatments for car'didiasis includeclotrimazole, miconazole, and nystatin.*Option 0: Fungal infections can develop even without overuse of tfrecorticosteroid inhaler. Attention to dosage is required as the amount of Candidaincreased with dose of fluticasone. Gargling with a 1:M dilution of amphotericinB is effective in treating oral cartdidiasis of asthmatic patients treated withinhaled steroids.*OptionD:Although good oral hygiene can help prevent the development of afungal infection, it cannot be used alone to treat the problem. Most cases of oralthrush will clear up in a couple of weeks. In general, a single dose of antifungalmedication may be enough Io cure the infection.34. Question1P°inlWhich of the following health promotion activities should the nurse include in the dischargeteaching 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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CorrectCorrect Answer: A. Incorporate physical exercise as tolerated into the treatment plan.Physical exercise is beneficial and should be incorporated as tolerated into the client'sschedule. Peak flow numbers should be monitored daily, usually in the morning {beforetaking medication). Encourage breathing exercises ar d controlled breathing andrelaxation. Prevents attack before it begins and increases ventilation.-Option B: Peak flow does not need Io be monitored after each meal. Monitorpeaked expiratory flow ralesand forced expiratory volume as taken by therespiratory therapist. The severity of the exacerbation can be measuredobjectively by ntonitoring these values. The peak expiratory flow rale is themaximum flow rate that can be genera ted du ring a farced expiratory maneuverwith fully inflated lungs.-Option C: Stressors in the client's life should be modified but cannot be totallyeliminated. 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 thatsedatives be routinely taken to induce sleep. Schedule and provide rest periodsin a calm peaceful environment. Promotes adequate rest and decreases stimuli.35. Question1The client with asthma should be taught which of the following is one of the most commonprecipitating factors of an acute asthma attack?A_ Occupational exposure to toxins.R, VIrat respiratory inf ectionsC. Exposure to cigarette smoke.D. Exercising in cold temperatures.CorrectCorrect Answer: B. Viral respiratory infections.The most common precipitator of asthma attacks is viral respiratory infection. Clientswith asthma should avoid people who have the flu or a cold and should get yearly fluvaccinations. Asthma is a condition of acute, fully reversible airway inflammation, oftenfollowing exposure to an environmental trigger. The pathological precess begins withthe inhalaticn of an irritant (e.g., cold air) or an aIlergen {e.g., pollen), which then, due tobranchial 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 mostpronounced on expiration.*Option A: Environmental exposure to toxins or heavy particulate matter cantrigger asthma attacks; however, far fewer asthmatics are exposed to Suchtoxins llian are exposed to viruses. Asthma comprises a range of diseases andhas a variety of heterogeneous phenotypes. The recognized factors that areassociated with asthma are a genetic predisposition, specifically a personal orfamily 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 lesserextent than viral respiratory infections. Asthma also is associated with exposurelo 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 itcomes lo being able to say which children with pediatric asthma will carry on tohave asthma as adults (up to 40% of children have a wheeze, only 1% of adultshave asthma), but it is agreed that it is a multifactorial pathology, influenced byboth genetics and environmental exposure.36Question1 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 pills3weeks ago and that she smokes. Her VSare: 140/80, P 1IQ, R 40. The physician orders ABG's, results are as follows: pH: 7.50; PaC0229 mm Hg; Pa02 60 mm Hgc HCOS 24 mEq/L; Sa02 86%. Considering these results, the firstintervention is to:A_ Begin mechanical ventilation.-BPlace the client on oxygen.C. Give the client sodium bicarbonate.D. Monitor for pulmonary embolism.CorrectCorrect Answer: BPlace the Client on oxygenThe 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 isbrought up to 95%. Encourage slow, regular breathing Lo decrease the amount of CO2she 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 modalityto support ventilation and avoid the need for anesthesia and sedation, as wt?ll astherisk of nosocomial infectionwithendotracheal intubation.*Option C: Sodium bicarbonate would be given to reverse acidosis. Sodiumbicarbonate infusion reduces plasma ionized calcium concentration in criticallyill patientswithmetabolic acidosis. In vitro, bicarbonate concentration has amajor effect reducing ionized calcium level in serum•Option D: This client may have pulmonary embolism so she should bemonitored for this condition, but it is notthefirst intervention. A timely diagnosisof a pulmonary embolism {PE) is crucial because of tire high associatedmortality and morbidity, which maybeprevented with early treatment. It isimportant tonote that30% of untreated patients with pulmonary embolism die,while onlydie after timely therapy.1 pointf s)37. QuestionBasilar crackles are present Ina client's ling son auscultation.Tirenurse knowsthatthesearediscrete, 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 primarilyin thepleura.CorrectCorrect Answer; A. Caused by the sudden opening of alveoliBasilar crackles are usually heard diving inspiration and are caused by sudden openingof the alveoli. Basilar crackles are a bubbling or crackling sound originating from thebase of the lungs. They may occur when the lungs inflate or deflate. They're usuallybrief, and may be described as sounding wet or dry. Excess fluid in the airways causesthese sounds.■Option H:Bronchial sounds (also called tubular sounds) normally arise from thetracheobronchial tree and vesicular sounds normally arise from the finer lungparenchyma. Loud, harsh, and highpitchedbronchial sounds are typically heardover the trachea or al the right apex. They are predominantly heard duringexpiration.*OptionC: Wheezes are musical sounds caused by air movement throughconstricted small airways, such as bronchioles. Wheezes and rhonchi, whichhavethesame pathology and are separated only by pilch,areproduced by thefluttering of narrowed airways and the air that flows through them.

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♦OptionD;Fluid ar air in the pleural space deflects sound waves away from thechest wall back into the lung arid therefore breath sounds are reduced inintensity.1 polnl(s)38. QuestionA cyanotic Client with an unknown diagnosis Isadmittedto the E.R. In relation to oxygen,thefirst nursing action would be to:A_ Wail untiltheclient'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.CorrectCorrect Answer: C. Administer oxygen at 2 L flow per minute.Administer oxygen at 2 Uminule and no more, for if the client is emphysemic andreceives too high a level of oxygen, he will develop CO2 narcosis and the respiratorysystem will cease to function. With prolonged oxygen therapy there is an increase inblood oxygen level, which suppresses peripheral chemoreceplors; depresses ventilatordrive 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 andincrease In PCO2.-OptionA:Tti is is the 'gold standard' rrvonitor of venli laticn. Arterial blood gasesare needed to obtain accurate data, in particular, evidence of hypoventilation(raised PaCO2) as a reason for hypoxemia. Arterial blood gases may also givean indication of the metabolic effects of clinically important hypoxemia.*Option B: Although history taking and clinical examination may clarify thediagnosis, oxygen at 40% 60% should be continued until blood gas results areavailable unless the patient is drowsy or is known to have had previous episodesof Hypercapnic respiratory failure.*OptionD: Low intravascular volume either due to acute blood loss as in traumacan result in poor oxygen transport and tissue hypoxia. So, these patients shouldbe given high concentration oxygen to maintain oxygen saturation above 90%until arrival at an emergency department. This can be achieved in most cases bytheuse of approximately 40% 60% oxygen via a medium concentration mask ata flow rate of4 ID1/ min.

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39. Question1P°ln,(*)Immediately following a thoracentesis, which clinical manifestations indicate that acomplication has occurred and the physician should be notified?A_ Serosanguineous drainage from the puncture site.B. Increased temperature and blood pressure.C incrtMMi pulse nncipnUor.D. Hypotension and hypothermia.CometCorrect Answmi C. Increased pulse and pallorIncreased pulse and pallor are symptoms associated with shock. A compromisedvenous return may occur if there is a mediastinal shift as a result of excessive fluidremoval. Usually, no more than1 Lof fluid is temoved atone lime to prevent this fromoccurring.*OptionA:Complications include bleeding, pain, and infection atthepoinlofneedle entry. If the approach is made too higti in the intercostal space damageIo the coastal vasculalure andnerveinjuryispossible.-Option B: If too much fluid is removed or if the fluid is removed too rapidly (egusing negative pressure chambers) re expansion (aka post expansion)pulmonary edema may occur. Removal of significant fluid volumes may alsoinduce vasovagal physiology.*Option□' If the procedural needle/catheler is passed through diseased tissueprior to entering the chest cavity, that process can be extended intothechestspace. For example, passing the needle through thoracic or pleural tumor canseed the thoracic cavity or passingtheneedle through a chest wall abscess orotherwise infected tissue can result in ernpyenta.1 points &)40. QuestionIfa client continues to hypovenlilate,thenurse will continually assess for a complication of:ARespiratory acidosis

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B. Respiratory alkalosisC. Metabolic acidosisD. Metabolic alkalosisCorrectCorrect Answer: A. Respiratory acidosisRespiratory acidosis represents an increase in the acid component, carbon dioxide, andan increase in the hydrogen ion concentration (decreased pH) ol the arterial blood. Therespiratory centers in the pons and medulla control alveolar ventilation.ChemcreceplorstorPC02, PO2, and pH regulate ventilation. Central chemoreueptors inthe medulla are sensitive to changesinthe pH level. AdecreasedpHlevel influencesthe mechanics ol ventilation and maintains proper levels ol carbon dioxide and oxygen.When ventilation is disrupted, arterial PCQ2 increases and an acid base disorderdevelops.*Option B: |nalmost every scenario, respiratory alkalosis is induced by a processinvolving 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 leadsto hyperventilation in an attempt to correct hypoxia at the expense ol a COZloss.*Option C: Hydrogen ion concentration is determined by acid ingestion, acidproduction, acid excretion, and renal and Gl bicarbonate losses. Buffers such asbicarbonate minimize significant pH alterations. Further classification ofmetabolic acidosis is based on the presence or absence of an anion gap, orconcentration o I unmeasured serum anions.-Option□: In generalthecauses can be narroweddowntoanintracellular shiftof hydrogen ions, gastrointestinal (Gl) loss of hydrogen ions, excessive renalhydrogen ion loss, retention or addition of bicarbonate ions, or volumecontraction around a constant amount of extracellular bicarbonate known ascontraction alkalosis. All of which leads to the net result of increased levels ofbicarbonate in the blood.41. Question1 p®lm(«)A client is admitted Ic the hospital with acute bronchitis. While taking the client's VS, the nursenotices he has an irregular pulse.Thenurse understands that cardiac arrhythmias in chronicrespiratory distress are usually the result of:

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A. Respiratory acidosisB. A build-up of carbon dioxideC. A bui Id up of Oxygen without adequate expelling of carbon diox ide.D. An acute respiratory infection.CorrectCorrect Answer: B. A build-up of carbon dioxide.The arrhythmias are caused by a build up of carbon dioxide and not enough oxygen sothat the heart is in a constant slate of hypoxia. The majority of arrhythmias observed inthese patients appeared to take the form of premature ventricular and/orsupraventricular beats and less frequently of atrial fibrillation and/or attacks ofsupraventricular paroxysmal tachycardia. Cardiac rhythm alterations were observedusing Holter monitoring in 70 90% of patients. No cardiac rhythm disorder is specific tothis pathological condition.•Option A: The compensation to respiratory acidosis consists in a secondaryincrease in bicarbonate concentration, and the arterial blood gas analysis ischaracterized by a reduced pH, increased pC02 (initial variation), and increasedbicarbonate levels (compensatory response).’Option C: Acute bronchitis is a clinical diagnosis based on history, past medicalhistory, lung exam, and other physical findings. Oxygen saturation plays animportant 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 brortchisecondary 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. Allimes, a viral upper respiratory infection can progress to infection of the lowerrespiratory tract resulting in acute bronchitis.42. Question1Auscultation of a client's lungs reveals crackles in the left posterior base. The nursingintervention 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 sacrumfor thepresence of edema.□. Place the client on bedrest in a semi Fowler's position.CorrectCorrect Answer: A. Repeat auscultation after asking the client to deep breathe andcough.Although Crackles often indicate fluid in the alveoli, they may also be related tohypoventilation and will clear after a deep breath or a cough. Assess cougheffectiveness and productivity. Coughing is the most effective way to removesecretions. 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 accessorymuscles. Tachypnea, shallow respirations and asymmetric chest movement arefrequently present because of the discomfort of moving chest wall and/or fluidin the lung doe to a compensatory response to airway obstruction. Alteredbreathing patterns may occur together with use of accessory muscles toincrease 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 andadventitious breath sounds: crackles, wheezes. Decreased airflow occurs inareas with consolidated fluid. Bronchial breath soundlscan also occur in theseconsolidated areas. Crackles, rhonchi, and wheezes are heard on inspirationand/or expiration in response to fluid accumulation, thick secretions, and airwayspasms and obstruction.*Option Dt Elevate the bead of bed, change position frequently. Doing so wouldlower the diaphragm and promote chest expansion aeration of lung segments,mcbil izalion, and expectoration of secretions.43. Question1P°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. Determinethepresence of a femoral pulse.CorrectCorrect Answers C Listen.md lecl the nlr movement.To check for breathing, the nurse places her ear and cheek next to the client's mouthand nose to listen and feel for air movement. During the inspection, the examinershould pay attention to the pattern of breathing: thoracic breathing, thoracoabdominalbreathing, coastal markings, and use of accessory breathing muscles. The use ofaccessory breathing muscles (i.e., scalenes, sternocleidomastoid muscle, intercostalmuscles) could point to excessive breathing effort caused by pathologies.*OptionA:The chest rising and falling isnotconclusive of a patent airway. Theposition of the patient should also be noted, patients with extreme pulmonarydysfunction will often sit up right, and in distress, they assume the tripodposition (leaning forward, resting their hands on their knees).•Option 0:Observing skin color is not an accurate assessment of respiratorystatus. The body habitus of the patient could provide information regardingchest compliance, especially in the case of severely obese patients where chestmobility and compliance are reduced due to added weight from adipose tissue.♦OptionD:Checking the femoral pulse isnotan assessment of respiratorystatus. Palpation should focus on delecting abnormalities like masses or bonyCrepitus. During palpation the examiner can evaluate tactile fremitus: theexaminer will place both of his hands on the patient’s back, medial totheshoulder blades, and ask the patient to say "ninety nine."44. Question1P°i nHE)Aclient with COPD has developed secondary polycythemia. Which nursing diagnosis would beincluded in the plan of care because ofthepolycylhernia?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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CorrectCorrect 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 commoncauses of secondary polycylhernia include obstructive sleep apnea, obesityhypoventilation syndrome, and Chronic obstructive pulmonary disease (COPD).-Option A: |nsecondary polycythemia, the number of red blood cells (RBCs) isincreased as a result of an underlying condition. Secondary polycythemia wouldmere accurately be called secondary erythrocytosis or erythrocythemia, as thoseterms specifically denote increased red blood cells. No blood loss is evident inthe stem.-Option C: increased red blood cell mass increases blood viscosity anddecreases tissue perfusion. With impaired circulation to the central nervoussystem, patients may present with headaches, lethargy, and confusion or moreserious presentations, such as stroke and obtundation.*Option D: Plethora manifests as increased redness of the skin and mucosalmembranes. This finding is easier to delect on the paints or soles, where theskin is light in dark skinned individuals. Some patients may have acrocyanosiscaused by sluggish blood flow through small blood vessels.45. Question1P°l n ,<s>The physician has scheduled a client fur a left pneumonectomy. The position that willm o s tlikely be ordered postoperatively for his is the:A_ Nonoperative side or backB Operative side or backC. Back onlyD. Back or either side.CorrectCorrect Answer: B. Operative side or backFollowing pneumonectomy, the client is positioned on the operative side to allow thefluid left in the lung space to consolidate and avoid the heart from shifting to theoperative 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, ipsilateral hemidiaphragm, pericardium, and mediastinallymph nodes.*OptionA:The patient is then usually positioned in a lateral decubitus positionwith the operating side up. Proper positioning of the DLT wthe bronchial blockeris usually reconfirmed with the FOB„and single lung ventilation is then started.Care should be taken to ensure proper positioning to avoid perioperative nerveinjury.'Option C:Following pneumonectomy, pulmonary functions decrease but areusually less than anticipated for removal of 50% of lung, especially for residualvolume, and this may be explained by overexpansion of the remaining lungtissue. FEVT,FVC, DLOD, and lung compliance decrease. Airway resistanceincreases.’Option D'Patientswith nodisease in the remaining lung usually do have normalSaO2, PO2, and PaCO2 at rest. A chest X ray immediately followingpneumonectomy usually shows the trachea in the midline and theposlpneumoriectomy spacetobe filled with air. Laterthatspace becomes filledgradually with fluid ata rate of 1 to 2 intercostal spaces,''day. The ipsilateraldiaphragm becomes elevated, and the mediastinum is gradually shifted towardsthe operative side.46. Question1P°i n ,<5)Assessing a client who has developed atelectasis postoperalively, the nurse willmostlikelyfind:A. A flushed face.B. Dyspnea and pain.C. Decreased temperature.D. Severe cough and no pain.CorrectCorrect Answer: fiDyspnea and painAtelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clientsbecome short of breath, have a high temperature, and usually experience severe painbut do not have a severe cough. The shortness ofbreathis a result of decreasedoxygen carbon dioxide exchange al the alveolarlevel.Postoperative atelectasistypically occurs within 72 hours of general anesthesia and is a well-knownpostoperative complication.» Option A:The definition of atelectasis is a partial collapse of the lung. Il cancause 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 effortanobstruction blocking airflow into the lung, extra pressure exerted on the outsideofthe lung,ordeficient production or function of a specific protein in the lung.*Option C: Postoperative fever has historically been attributed to atelectasis,butthere is no evidence supporting the finding that atelectasis is a causativernecftanism 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 ofatelectasis by inducing shallow breathing ('splinting') and/or inhibitingcoughing Typically, atelectasis is asymptomatic. However, a patient might alsopresentwithdecreasedorabsent breath sounds, crackles, cough, sputumproduction, dyspnea, tachypnea, and/or diminished chest expansion.47. Question1P°intWA fifty year old client has a tracheostomy and requires tracheal suctioning. The fir5lIntervention 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.CorrectCorrectAnswer: C. Apply oral ornasal suctionBefore deflating the tracheaI cuff,thenurse wiII apply oraI or nasal suction Iotheairway to prevent secretions from falling into the lung. Dressing change and humiditydo nut relate Io suctioning. Airway suctioning is a procedure routinely donein mostcare sellings, including acute care, sub acute care, longtermcare, and home settings.Suctioning is performed when the patient is unable Io effectively move secretions fromtherespiratory tract.-OptionA:Airways suctioning is indicated for multiple reasons. Most commonlysuctioning is done fortheremoval of secretions from the respiratory tract, butsometimes also for removal of blood or other materials like meconium inspecific cases. Airway suctioning is also performed for diagnostic purposes.*Option B: Suctioning of the lower air ways should be done in a sterile mannerwithsingle'use gloves and suction catheters to prevent contamination arrdsecondary infection. After preparation with appropriate equipment at thebedside and monitoring continuous heart rate and oxygen saturation (as

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available), the patient should be suctioned with appropriately Sized equipmentfor their airway.*Option D: After preparation with appropriate equipment at the bedside andmonitoring continuous heart rale and oxygen saturation {as available), thepatient should be suctioned with appropriately sized equipment for their airway.48. Question1P°in1<s>A client stales that the physician said the tidal volume is slightly diminished and asks thenurse 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 inspirationC. Trapped in the alveoli that cannot be exha led.D. Forcibly inspired over and above a normal respiration.CorrectCorrectAnswer: B. Exhaledafterthere isa ncrmaEinspiration.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 eachrespiratory cycle. II measures around 500 mL in an average healthy adult male andappr oximalely 400 mL in a heal thy fema le. 11i s a vita I cl in ical para meter that al lows forproper ventilation to lake place.-Option A: The expiratory reserve volume (ERV). about 1,200 m L is the additionalair that can be forcibly exhaled after the expiration of a normal tidal volume.When a person breathes in, oxygen from the surrounding atmosphere enters theungs. Il then diffuses across the alveolar capillary interface Io reach arterialblood. Al the same time, carbon dioxide continuously forms as long asmetabolism lakes place. Expiration occurs to expel carbon dioxide and prevent itfrom accumulating in the body.-Option C: Residual volume (RV), about 1,200 m L is the volume of air stillremaining in the lungs after the expiratory reserve volume is exhaled. Whenemphysema develops, the alveoli and lung tissue are destroyed. With thisdamage, the alveoli canrral support the bronchial tubes. The Lubes collapse andcause an 'obstruction" (a blockage), which traps air inside the lungs.*Option D: The inspiratory reserve volume (IRV), about 3,100 m Lis the additionalair that can be forcibly inhaled after the inspiration of a normal tidal volume. Thevolume of air occupying the lungs at different phases of the respiratory cyclesubdivides into four volumes and foia capacities. The four lung volunes areinspiratory 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 lungcapacity (TLC), vital capacity (VC), inspiratory capacity ()C), and functionalresidual capacity (FRC).49. Question1An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to thetissues, is caused by:A_ A decreasing oxygen pressure in the blood.B. An increasing carbon dioxide pressure in the blood.C.Adecreasing oxygon pressure and/or an Increasing carbon dioxide pressure inthe blood.D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure inthe blood.CorrectCorrect Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxidepressure in the blood.The lower the PO2 and the higher the PC02, the more rapidly oxygen dissociated fromthe oxyhemoglobin molecule. Factors that contribute Io a right shift in the oxygendissociation curve and favor the unloading of oxygen correlate with exertion. Theseinclude increased body temperature, decreased pH (due to increased production ofCO2), and increased 2,3 BPG. (Figure) This right shift of the oxyhemoglobin curve canbe viewed as an adaptation for physical exertion.•Option A: In the setting of hypoxia or low blood oxygen levels, irreversible tissuedamage can rapidly occur. Hypoxia can be the result of an impaired oxygencarrying capacity of the blood (e.g., anemia), impaired unloading of oxygen fromhemoglobin in target tissues (e.g., carbon monoxide toxicity), or from arestriction 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 tohemog lobin. whlie only 2% is dissolved directly in plasma. Hemoglobin is ametalloprotein with four subunits, each composed of an iron containing hemegroup attached to a globin polypeptide chain. One molecule of oxygen can bindto the iron atom of a heme group, giving each hemoglobin the ability Io transportfour molecules of oxygen.’Option□: The body maintains adequate oxygenation of tissues in the setting ofdecreased PO or increased demand for oxygen. These changes often express

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shifts in the oxygen dissociation curve, which represents the percentage ofhemoglobin saturated with oxygen at varying levels of PO.50, Question1lw l n'Thebestmethod of oxygen administration for client with CORD uses:A.. CannulaB. Simple Face maskC. Non rebreather maskD. Venturi maskCorrectCorrect Answer: 0. Venturi maskVenturi delivers controlled oxygen. An air enlrainrrwnt {also known as venturi) maskcan provide a pre set oxygen Iothepatient using jet mixing. As the percent of inspiredoxygen increases using Such a mask, the air to oxygen ratio decreases, causing themaximum concentration of oxygen provided by an air entrainment mask to be around40%.* Option A:A thin lube, often affixed behind the ears and used to deliver oxygendirectly to the nostrils from a source connectedwith tubing. Thisis Hie mostcommon method of delivery for home use and provides flow rales of 2 to 6 litersper minute (LPM) comfortably., allowing the delivery of oxygen while maintainingthepatient's ability to utilize hisoftier mccilh to talk eat, etc.-Option B: Facemasks can be generally divided into simp e face masks, airentrainment masks, and non rebreathers. A simple facemask is a mask with nobag attached, which delivers oxygen at 5 to 8 LPM. A disadvantage of this andother full face masks is the inability ofthepatient Io eat, drink, or easilycommunicate while using such a device.*Option C: Non rebreathing masks have a bag attached to the mask known as areservoir hag, which inhalation draws from to fill the mask through a one wayvalve and features ports al each side for exhalation, resulting in an ability toprovide the patient with 100% oxygen al a higher LPM flow rale.

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NurseslabsMenuComprehensive Respiratory System DisordersNCLEX Challenge Exam (Quiz #2: 50 Questions)UPDATED DN OCTOBER 17 2DQSEV MATT VERA B5N, H.NHi! Ycxi Eire currently in the quiz page. If you're done with this quiz, please ctieck cutthe ether exams by clicking here Io go back to lhe Respiratory System DisordersNursing Test Bank page.Quiz GuidelinesBefore 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-pressiaeenviianment. These exams provide immed ale feedback and exp anal tins, l e u rig you grasp careconcepts, identify rnpravernert areas, and build conf deuce in your knowledge and abties.2.ChallengeExatna: T i tour Challenge Exams to Lest your mastery and readmess under simulatedexairi conditions. These exams offer a rigorous question set to assess your urdei stand rig. prepareyou for actual exannrial ions, and benchmark you performance.•You're given 2 minutes per item.■For CFallenge Exams, click on die "Start Quiz" button to start die quiz.2. Ctrnplelu lhe quizEnsure that you answer the er I re quiz. On y after you've answered every itemwill Lhe score and rationales be shown.4.LearnfromrherationaleeAfter each quiz, click on die "View Questions'' bcrtlcxi to undei stand theexplanation for each answer.5.FreeGuesswtiat?Our test banks are 100%FREE.Skip lhe hassle - no sign-ups oileg slialxins here. A sincere premise from Nurseslabs: we have not and won't ever request yourcredit card details or personal info fur our practice quest ons. Were dedicated to keep ng thisservice accessible and cost-free, espec ally Fur our amazing students and r arses. So. take the leapand elevate your career hassle-free6.$barnyoyr 1hppqht$A'edloveyourfeedback, scares, and quest ons! Please share them in diecomments below.

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1 pciint(s)1. QuestionDr. 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 congestionB. NervousnessC. Lethargy□. HyperkalemiaCorrectCorrect Answer: B. NervousnessAlbuterol may cause nervousness. The primary adverse effects of albuterol therapy aretremors and nervousness, mostly seen in Children who are 2 to 6 years of age, thoughcan be seen at any age. Tremors are the result of activation of the beta 2 receptorsfound on the motor nerve terminals which increases intracellular cAMP. These sideeffects occur in approximately one in every five patients. Other adverse effects ofalbuterol 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 thenose and throat, not nasal congestion. Monitoring parameters for albuterolinclude farced expiratory volume, peak flow, blood pressure, heart rale, centralnervous system stimulation, serum potassium, serum glucose, and asthmasymptoms.■Option C:Other side effects include insomnia and nausea, which occur inapproximately 1 in every ten patients. Less common adverse effects mayinclude fever, bronchospasm vomiting, headache, dizziness, cough, allergicreactions, 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.■OptionD; Albuterol also has been shown to increase blood pressure and maycause hypokalemia. Increased blood glucose concentrations and prolonged QTcinterval and ST segment depression have occurred although rarely.l pcintfs)2. QuestionMiriam, a college student with acute rhinitis sees the campus nurse because of excessivenasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis,nasal drainage normally is:A_ YellowB. Green•C. ClearD. GrayCorrectCorrect Answer: C. ClearNormally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically revealsswelling of the nasal mucosa and thin, dlear secretions. The inferior turbinates maytake on a bluish hue, and cobblesloning of the nasal mucosa may be present. Onphysical examination, clinicians may notice mouth breathing, frequent sniffling and/orthroat 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 takinghold. 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 cellshave done lheir work, they're discarded in the drainage and tinge it a yellowishbrown.•npiionB: Green drainage may also indicate infection.IfLhe immune systemkicks into high gear to fight infection, lhe drainage may turn green and becomeespeciallythick.The color comesfromdead white blood cells and otfier wasteproducts. Some sinus infections may be viral, not bacterial.*Oplion 0: Gray drainage may indicate a secondary infection. This could be afungal sinus infection. These are different from viral or bacterial infectionsbecause the fungi feeds on the nasal tissue-and reproduces. Fungal Sinusinfections may occur due to a previous nasal injury or long term nasalinflammation, as well as a weakened immune system. Growths called "fungusballs" develop in the cheek sinus as clumps of fungal spores. The fungus ballsmust be removed by surgery.3. Question1***■>A male adult patienl hospitalized for treatment of a pulmonary embolism develops respiratoryalkalosis. Which clinical findings commonly accompany respiratory alkalosis?A. Nausea or vomitingB. Abdominal pain or diarrheaC. Hallucinationsorllnnitus0. Lightheadedness or paresthesiaCorrectCorrect Answer: D. Lightheadedness or paresthesia

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The patient with respiratory alkalosis may complain of Iightfleadedness or paresthesia{numbness and tingling in the arms and legs). The exact history and physical examfirtdings are highly variable as there are many pathologies that induce the pHdisturbance. 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 ofthromboembolic disease, history of asthma, history of COPD, acute focal neurologicalsigns, numbness, paresthesia, abdominal pain, nausea, vomiting, tinnitus, or weightloss.< QpiionA:Nausea, vomiting, abdominal pain, ar-d diarrhea may accompanyrespiratory acidosis. Following a performance predominantly relying onanaerobic glycolysis, systemic acidosis may cause vomiting as a physiologicalresponse to drain H + and thereby allow the stomach to add bicarbonate to thebody■Optionth Hyperchloremic acidosis is caused by lhe loss of too much sodiumbicarbonate fromthebody, which can happen with severe diarrhea. Inpathologies with profuse watery diarrhea, bicarbonate within the intestines islost through lhe stool due to increased motility oftheguLThisleads to furthersecretion of bicarbonatefrom thepancreas and intestinal mucosa leading tonet acidification of the blood from bicarbonate loss.•Option C:Hallucinations and tinnitus are associated with respiratory alkalosis orany other acid base imbalance. Respiratory alkalosis in itself is not lifethreatening; however,theunderlying etiology may be. Always lock for and treatlhe source oflheillness. Interventions to reduce pH directly are typically notnecessary as there Is no mortality benefit to this therapy.4. Question1Before administering ephedrine, Nurse Tony assesses the patient's history. Because ofephedrine's central nervous system (CNS) effects, it is riot recommended for:A. Patients with an acute asthma attackB. Patients with narcolepsy.

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C. Patients under aye0.Elderly patients.CorrectCorrect Answer: D. Elderly patientsEphedrine ismlrecommended for elderly patients, who are particularly susceptible lbCNS reactions (such as confusion and anxiety) and Io cardiovascular reactions (suchas increased systolic blood pressure., coldness in the extremities, and anginal pain).Ephedrine is also arrhythrnoyenic, and caution should be used during administration topatients who are predisposed to arrhythmias or taking other arrhythmogenicmedications, particularly digitalis.■Option A:Ephedrine is used for its bronchodilator effects with acute and chronicastfima. Oral formulations of ephedrine have been used historically to treatasthma via pulmonary vasoconstriction and reduction in airway edema alongwith beta induced branchedilation,butit is rarelyusedfor this purpose inmodern medicine due to unwanted cardiac effects and availability of moreselective beta agonists such as albuterol■Option0: Ephedrine is used occasionally for its CNS stimulant actions fornarcolepsy. Ephedrine acts as both a direct and indirect sympathomimetic. Itbinds directly tobothalpha and beta receptors; however, its primarymodeofaction is achieved indirectly, by inhibiting neuronal norepinephrine reuptake andby displacing more norepinephrine from storage vesicles. This action allowsnorepinepfirine lo be present in the synapse longer lo bind poslsynaptic alphaand beta receptors.•Opliort C:It can be administered Lochi Idren age 2 and older. The FDA has notformally established safety and effectiveness in pediatric populations.Additional lyrephedrine is distributed bythemanufacturerin 50mg/mLvials andrequires 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. Thepatient's condition deteriorates rapidly, and endotracheal intubation and mechanicalventilation are initialed. When the high pressure alarm on the mechanical ventilator, alarmsounds, the nurse starts Io check for the cause. Which condition triggers the high pressurealarm?A. Kinking of the ventilator tubing.B. A disconnected ventilatortube.C. An endotracheal cuff leakD. A change in the oxygen concentration without resetting ti e oxygen level alarm.CorrectCorrect Answer: A Kinking of the ventilator tubing,Conditions that triggerthehigh' pressure alarm include kinking of the ventilator tubing,bronchospasm or pulmonary embolism, mucus plugging, water in the lube, coughing orbiting on endotracheal lube, and the patient's being out of breathing rhythm with theventilator. If an alarm occurs, the caregiver should always evaluate Hie patient beforechecking the ventilator.■OptionB: A disconnected ventilator tube would trigger the low pressure alarm. Ifthe pressure inside the breathing circuit drops below the Low Airway PressureAlarm limit set on the ventilator, an audible and/or visual alarm activates.•Option C:Some causes for low pressure alarms are: the patient becomesdisconnected from the ventilator circuit; inadequate inflation of thetracheostomy tube cuff; poorly fitting noninvasive masks or nasalpillows/prOngs; loose circuit and lubing connections; or the patient demandshigher levels of air than the ventilator is putting cut.•Option £>:Changing Lheoxygen concentration without reselling the oxygen levelalarm would trigger Hie oxygen alarm. Oxygen concentration is the amount of

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Comprehensive Respiratory System Disorders NCLEX C - Page 54 preview image

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. Question1P°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 anotherpancuronium dose?1. Leg movementA. Leg movementB. Finger movementC. Lip movementCLFighting the ventilatorCorrectCorrect Answer: D. Fighting the ventilatorPancuroniunxa nun depolarising blocking agent, is used fur muscle relaxation andparalysis. It assists mechanical ventilation by promoting endotracheal intubation andparalysing the patient so that the mechanical ventilator can do its work Fighting theventilator is a sign that the patient needs anolfier pancuronium dose. Tfie nurse shouldadminister 0.01 to 0.02 mg/kg LV. every 20 to 60 minutes. Movement of the legs, orlips has no effect on the ventilator and therefore is not used to determine the need foranother 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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