MSN FOR ASTHMA

Text Mode – Text version of the exam

1. Asthma is basically:

A. An infectious disease

B. An autoimmune disease

C. An atopic disease

D. A malignant disease

2. The characteristic feature of persistent asthma is:

A. Family history of disease

B. Airway inflammation

C. Need for oral steroids

D. Nocturnal wheezing

3. simple instrument to roughly determine lung function is

a:

A. Barometer

B. Manometer

C. Peak flow meter

D. Sphygmomanometer

4. The following drug cannot cause asthma:

A. Beta-blocker
B. Histamine

C. Ibuprofen

D. Atropine

5. Which of the following tests cannot detect airway

inflammation?

A. Bronchial mucosal biopsy

B. Sputum eosinophil counts

C. Bronchoalveolar lavage

D. Spirometry

6. The parameter to detect reversibility in airflow

obstruction on a spirometry test is:

A. FEV1

B. FVC

C. MVV

D. RV

7. The following bronchodilator is most commonly used when

doing a reversibility test:

A. Salbutamol

B. Adrenaline

C. Theophylline anhydrous

D. Atropine
8. Bronchoprovocation tests usually use histamine to

challenge the airways. Besides histamine, ____________

can also be used:

A. Ipratropium bromide

B. Adrenocorticotrophic hormone

C. Prednisolone

D. Metracholine

9. In an acute severe attack of asthma, it is important to

get a chest x-ray done to rule out:

A. A pleural effusion

B. A pneunothorax

C. Lung malignancy

D. COPD

10. The following are helpful in determining the severity of

an acute attack except:

A. Use of accersoy muscles of respiration

B. Ability to complete sentences

C. Peak expiratory flow rate

D. Pedal edema

Answers

1. C. An atopic disease
2. B. Airway inflammation

3. C. Peak flow meter

4. D. Atropine

5. D. Spirometry

6. A. FEV1

7. A. Salbutamol

8. D. Metracholine

9. B. A pneunothorax

10. D. Pedal edema

Text Mode Asthma and COPD

Text Mode – Text version of the exam

1. An elderly client with pneumonia may appear with which

of the following symptoms first?

A. Altered mental status and dehydration

B. fever and chills

C. Hemoptysis and dyspnea

D. Pleuretic chest pain and cough

2. Which of the following pathophysiological mechanisms

that occurs in the lung parenchyma allows pneumonia to

develop?
A. Atelectasis

B. Bronchiectasis

C. Effusion

D. Inflammation

3. A 7-year-old client is brought to the E.R. He’s

tachypneic and afebrile and has a respiratory rate of 36

breaths/minute and a nonproductive cough. He recently had

a cold. From his history, the client may have which of the

following?

A. Acute asthma

B. Bronchial pneumonia

C. Chronic obstructive pulmonary disease (COPD)

D. Emphysema

4. Which of the following assessment findings would help

confirm a diagnosis of asthma in a client suspected of

having the disorder?

A. Circumoral cyanosis

B. Increased forced expiratory volume

C. Inspiratory and expiratory wheezing

D. Normal breath sounds

5. Which of the following types of asthma involves an acute

asthma attack brought on by an upper respiratory

infection?

A. Emotional

B. Extrinsic

C. Intrinsic

D. Mediated

6. A client with acute asthma showing inspiratory and

expiratory wheezes and a decreased expiratory volume

should be treated with which of the following classes of

medication right away?

A. Beta-adrenergic blockers

B. Bronchodilators

C. Inhaled steroids

D. Oral steroids

7. A 19-year-old comes into the emergency department

with acute asthma. His respiratory rate is 44 breaths/

minute, and he appears to be in acute respiratory distress.

Which of the following actions should be taken first?

A. Take a full medication history

B. Give a bronchodilator by neubulizer

C. Apply a cardiac monitor to the client

D. Provide emotional support to the client.

8. A 58-year-old client with a 40-year history of smoking

one to two packs of cigarettes a day has a chronic cough

producing thick sputum, peripheral edema, and cyanotic nail

beds. Based on this information, he most likely has which of

the following conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

9. The term “blue bloater” refers to which of the following

conditions?

A. Adult respiratory distress syndrome (ARDS)

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

10. The term “pink puffer” refers to the client with which

of the following conditions?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

11. A 66-year-old client has marked dyspnea at rest, is

thin, and uses accessory muscles to breathe. He’s

tachypneic, with a prolonged expiratory phase. He has no

cough. He leans forward with his arms braced on his knees

to support his chest and shoulders for breathing. This client

has symptoms of which of the following respiratory

disorders?

A. ARDS

B. Asthma

C. Chronic obstructive bronchitis

D. Emphysema

12. It’s highly recommended that clients with asthma,

chronic bronchitis, and emphysema have Pneumovax and flu

vaccinations for which of the following reasons?

A. All clients are recommended to have these vaccines

B. These vaccines produce bronchodilation and improve

oxygenation.

C. These vaccines help reduce the tachypnea these clients

experience.

D. Respiratory infections can cause severe hypoxia and

possibly death in these clients.

13. Exercise has which of the following effects on clients

with asthma, chronic bronchitis, and emphysema?

A. It enhances cardiovascular fitness.

B. It improves respiratory muscle strength.

C. It reduces the number of acute attacks.

D. It worsens respiratory function and is discouraged.

14. Clients with chronic obstructive bronchitis are given

diuretic therapy. Which of the following reasons best

explains why?

A. Reducing fluid volume reduces oxygen demand.

B. Reducing fluid volume improves clients’ mobility.

C. Restricting fluid volume reduces sputum production.

D. Reducing fluid volume improves respiratory function.

15. A 69-year-old client appears thin and cachectic. He’s

short of breath at rest and his dyspnea increases with the

slightest exertion. His breath sounds are diminished even

with deep inspiration. These signs and symptoms fit which of

the following conditions?

A. ARDS

B. Asthma
C. Chronic obstructive bronchitis

D. Emphysema

16. A client with emphysema should receive only 1 to 3 L/

minute of oxygen, if needed, or he may lose his hypoxic

drive. Which of the following statements is correct about

hypoxic drive?

A. The client doesn’t notice he needs to breathe.

B. The client breathes only when his oxygen levels climb

above a certain point.

C. The client breathes only when his oxygen levels dip

below a certain point.

D. The client breathes only when his carbon dioxide level

dips below a certain point.

17. Teaching for a client with chronic obstructive

pulmonary disease (COPD) should include which of the

following topics?

A. How to have his wife learn to listen to his lungs with

a stethoscope from Wal-Mart.

B. How to increase his oxygen therapy.

C. How to treat respiratory infections without going to

the physician.
D. How to recognize the signs of an impending

respiratory infection.

18. Which of the following respiratory disorders is most

common in the first 24 to 48 hours after surgery?

A. Atelectasis

B. Bronchitis

C. Pneumonia

D. Pneumothorax

19. Which of the following measures can reduce or prevent

the incidence of atelectasis in a post-operative client?

A. Chest physiotherapy

B. Mechanical ventilation

C. Reducing oxygen requirements

D. Use of an incentive spirometer

20. Emergency treatment of a client in status asthmaticus

includes which of the following medications?

A. Inhaled beta-adrenergic agents

B. Inhaled corticosteroids

C. I.V. beta-adrenergic agents

D. Oral corticosteroids

21. Which of the following treatment goals is best for the

client with status asthmaticus?

A. Avoiding intubation

B. Determining the cause of the attack

C. Improving exercise tolerance

D. Reducing secretions

22. Dani was given dilaudid for pain. She’s sleeping and her

respiratory rate is 4 breaths/minute. If action isn’t taken

quickly, she might have which of the following reactions?

A. Asthma attack

B. Respiratory arrest

C. Be pissed about receiving Narcan

D. Wake up on her own

23. Which of the following additional assessment data

should immediately be gathered to determine the status of a

client with a respiratory rate of 4 breaths/minute?

A. Arterial blood gas (ABG) and breath sounds

B. Level of consciousness and a pulse oximetry value.

C. Breath sounds and reflexes

D. Pulse oximetry value and heart sounds

24. A client is in danger of respiratory arrest following the

administration of a narcotic analgesic. An arterial blood gas

value is obtained. The nurse would expect to PaCO2 to be

which of the following values?

A. 15 mm Hg

B. 30 mm Hg

C. 40 mm Hg

D. 80 mm Hg

25. A client has started a new drug for hypertension.

Thirty minutes after he takes the drug, he develops chest

tightness and becomes short of breath and tachypneic. He

has a decreased level of consciousness. These signs indicate

which of the following conditions?

A. Asthma attack

B. Pulmonary embolism

C. respiratory failure

D. Rheumatoid arthritis

26. Emergency treatment for a client with impending

anaphylaxis secondary to hypersensitivity to a drug should

include which of the following actions first?

A. Administering oxygen

B. Inserting an I.V. catheter

C. Obtaining a complete blood count (CBC)

D. Taking vital signs

27. Following the initial care of a client with asthma and

impending anaphylaxis from hypersensitivity to a drug, the

nurse should take which of the following steps next?

A. Administer beta-adrenergic blockers

B. Administer bronchodilators

C. Obtain serum electrolyte levels

D. Have the client lie flat in the bed.

28. A client’s ABG results are as follows: pH: 7.16; PaCO2

80 mm Hg; PaO2 46 mm Hg; HCO3– 24 mEq/L; SaO2 81%. This

ABG result represents which of the following conditions?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

29. A nurse plans care for a client with chronic obstructive

pulmonary disease, knowing that the client is most likely to

experience what type of acid-base imbalance?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis
D. Metabolic alkalosis

30. A nurse is caring for a client who is on a mechanical

ventilator. Blood gas results indicate a pH of 7.50 and a

PCO2 of 30 mm Hg. The nurse has determined that the client

is experiencing respiratory alkalosis. Which laboratory value

would most likely be noted in this condition?

A. Sodium level of 145 mEq/L

B. Potassium level of 3.0 mEq/L

C. Magnesium level of 2.0 mg/L

D. Phosphorus level of 4.0 mg/dl

31. A nurse reviews the arterial blood gas results of a

patient and notes the following: pH 7.45; PCO2 30 mm Hg;

and bicarbonate concentration of 22 mEq/L. The nurse

analyzes these results as indicating:

A. Metabolic acidosis, compensated.

B. Metabolic alkalosis, uncompensated.

C. Respiratory alkalosis, compensated.

D. Respiratory acidosis, compensated.

32. A client is scheduled for blood to be drawn from the

radial artery for an ABG determination. Before the blood is

drawn, an Allen’s test is performed to determine the

adequacy of the:

A. Popliteal circulation

B. Ulnar circulation

C. Femoral circulation

D. Carotid circulation

33. A nurse is caring for a client with a nasogastric tube

that is attached to low suction. The nurse monitors the

client, knowing that the client is at risk for which acid-

base disorder?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

34. A nurse is caring for a client with an ileostomy

understands that the client is most at risk for developing

which acid-base disorder?

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

35. A nurse is caring for a client with diabetic ketoacidosis

and documents that the client is experiencing Kussmaul’s

respirations. Based on this documentation, which of the

following did the nurse observe?

A. Respirations that are abnormally deep, regular, and

increased in rate.

B. Respirations that are regular but abnormally slow.

C. Respirations that are labored and increased in depth

and rate

D. Respirations that cease for several seconds.

36. A nurse understands that the excessive use of oral

antacids containing bicarbonate can result in which acid-

base disturbance?

A. Respiratory alkalosis

B. Respiratory acidosis

C. Metabolic acidosis

D. Metabolic alkalosis

37. A nurse is caring for a client with renal failure. Blood

gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and

a bicarbonate concentration of 20 mEq/L. The nurse has

determined that the client is experiencing metabolic

acidosis. Which of the following laboratory values would the

nurse expect to note?

A. Sodium level of 145 mEq/L

B. Magnesium level of 2.0 mg/dL

C. Potassium level of 5.2 mEq/L

D. Phosphorus level of 4.0 mg/dL

38. A nurse is preparing to obtain an arterial blood gas

specimen from a client and plans to perform the Allen’s test

on the client. Number in order of priority the steps for

performing the Allen’s test (#1 is first step).

A. Ask the client to open and close the hand repeatedly.

B. Apply pressure over the ulnar and radial arteries.

C. Assess the color of the extremity distal to the

pressure point

D. Release pressure from the ulnar artery

E. Explain the procedure to the client.

39. A nurse is preparing to obtain a sputum specimen from

a client. Which of the following nursing actions will

facilitate obtaining the specimen?

A. Limiting fluids

B. Having the client take 3 deep breaths.

C. Asking the client to spit into the collection container.

D. Asking the client to obtain the specimen after eating.

40. A nurse is caring for a client after a bronchoscopy and

biopsy. Which of the following signs if noted in the client

should be reported immediately to the physician?

A. Blood-streaked sputum

B. Dry cough

C. Hematuria

D. Bronchospasm

41. A nurse is suctioning fluids from a client via a

tracheostomy tube. When suctioning, the nurse must limit

the suctioning to a maximum of:

A. 5 seconds

B. 10 seconds

C. 30 seconds

D. 1 minute

42. A nurse is suctioning fluids from a client through an

endotracheal tube. During the suctioning procedure, the

nurse notes on the monitor that the heart rate decreases.

Which of the following is the most appropriate nursing

intervention?

A. Continue to suction
B. Ensure that the suction is limited to 15 seconds

C. Stop the procedure and reoxyenate the client

D. Notify the physician immediately.

43. An unconscious client is admitted to an emergency

room. Arterial blood gas measurements reveal a pH of 7.30,

a low bicarbonate level, a normal carbon dioxide level, and a

normal oxygen level. An elevated potassium level is also

present. These results indicate the presence of:

A. Metabolic acidosis

B. Respiratory acidosis

C. Combined respiratory and metabolic acidosis

D. overcompensated respiratory acidosis

44. A nurse is caring for a client hospitalized with acute

exacerbation of COPD. Which of the following would the

nurse expect to note on assessment of this client?

A. Increased oxygen saturation with exercise

B. Hypocapnia

C. A hyperinflated chest on x-ray film

D. A widened diaphragm noted on chest x-ray film

45. An oxygenated delivery system is prescribed for a client

with COPD to deliver a precise oxygen concentration. Which

of the following types of oxygen delivery systems would the

nurse anticipate to be prescribed?

A. Venturi mask

B. Aerosol mask

C. Face tent

D. Tracheostomy collar

46. Theophylline (Theo-Dur) tablets are prescribed for a

client with chronic airflow limitation, and the nurse

instructs the client about the medication. Which statement

by the client indicates a need for further teaching?

A. “I will take the medication on an empty stomach.”

B. “I will take the medication with food.”

C. “I will continue to take the medication even if I am

feeling better.”

D. “Periodic blood levels will need to be obtained.”

47. A nurse is caring for a client with emphysema. The

client is receiving oxygen. The nurse assesses the oxygen

flow rate to ensure that it does not exceed

A. 1 L/min

B. 2 L/min

C. 6 L/min
D. 10 L/min

48. The nurse reviews the ABG values of a client. The

results indicate respiratory acidosis. Which of the following

values would indicate that this acid-base imbalance exists?

A. pH of 7.48

B. PCO2 of 32 mm Hg

C. pH of 7.30

D. HCO3– of 20 mEq/L

49. A nurse instructs a client to use the pursed lip method

of breathing. The client asks the nurse about the purpose

of this type of breathing. The nurse responds, knowing that

the primary purpose of pursed lip breathing is:

A. Promote oxygen intake

B. Strengthen the diaphragm

C. Strengthen the intercostal muscles

D. Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a pH of 7.50,

a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The nurse

interprets these values as indicating:

A. Respiratory acidosis uncompensated

B. Respiratory alkalosis uncompensated

C. Metabolic acidosis uncompensated

D. Metabolic acidosis partially compensated.

51. Aminophylline (theophylline) is prescribed for a client

with acute bronchitis. A nurse administers the medication,

knowing that the primary action of this medication is to:

A. Promote expectoration

B. Suppress the cough

C. Relax smooth muscles of the bronchial airway

D. Prevent infection

52. A client is receiving isoetharine hydrochloride

(Bronkosol) via a nebulizer. The nurse monitors the client

for which side effect of this medication?

A. Constipation

B. Diarrhea

C. Bradycardia

D. Tachycardia

53. A nurse teaches a client about the use of a respiratory

inhaler. Which action by the client indicated a need for

further teaching?

A. Removes the cap and shakes the inhaler well before

use.
B. Presses the canister down with 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.

54. A female client is scheduled to have a chest radiograph.

Which of the following questions is of most importance to

the nurse assessing this client?

A. “Is there any possibility that you could be pregnant?”

B. “Are you wearing any metal chains or jewelry?”

C. “Can you hold your breath easily?”

D. “Are you able to hold your arms above your head?”

55. A client has just returned to a nursing unit following

bronchoscopy. A nurse would implement which of the

following nursing interventions for this client?

A. Encouraging additional fluids for the next 24 hours

B. Ensuring the return of the gag reflex before offering

foods or fluids

C. Administering atropine intravenously

D. Administering small doses of midazolam (Versed).

56. A client has an order to have radial ABG drawn. Before

drawing the sample, a nurse occludes the:

A. Brachial and radial arteries, and then releases them

and observes the circulation of the hand.

B. Radial and ulnar arteries, releases one, evaluates the

color of the hand, and repeats the process with the

other artery.

C. Radial artery and observes for color changes in the

affected hand.

D. Ulnar artery and observes for color changes in the

affected hand.

57. A nurse is assessing a client with chronic airflow

limitation and notes that the client has a “barrel chest.”

The nurse interprets that this client has which of the

following forms of chronic airflow limitation?

A. Chronic obstructive bronchitis

B. Emphysema

C. Bronchial asthma

D. Bronchial asthma and bronchitis

58. A client has been taking benzonatate (Tessalin Perles)

as prescribed. A nurse concludes that the medication is

having the intended effect if the client experiences:

A. Decreased anxiety level

B. Increased comfort level

C. Reduction of N/V

D. Decreased frequency and intensity of cough

59. Which of the following would be an expected outcome

for a client recovering from an upper respiratory tract

infection? The client will:

A. Maintain a fluid intake of 800ml every 24 hours.

B. Experience chills only once a day

C. Cough productively without chest discomfort.

D. Experience less nasal obstruction and discharge.

60. Which of the following individuals would the nurse

consider to have the highest priority for receiving an

influenza vaccination?

A. A 60-year-old man with a hiatal hernia

B. A 36-year-old woman with 3 children

C. A 50-year-old woman caring for a spouse with cancer

D. a 60-year-old woman with osteoarthritis

61. A client with allergic rhinitis asks the nurse what he

should do to decrease his symptoms. Which of the following

instructions would be appropriate for the nurse to give the

client?

A. “Use your nasal decongestant spray regularly to help

clear your nasal passages.”

B. “Ask the doctor for antibiotics. Antibiotics will help

decrease the secretion.”

C. “It is important to increase your activity. A daily

brisk walk will help promote drainage.”

D. “Keep a diary if when your symptoms occur. This can

help you identify what precipitates your attacks.”

62. An elderly client has been ill with the flu, experiencing

headache, fever, and chills. After 3 days, she develops a

cough productive of yellow sputum. The nurse auscultates

her lungs and hears diffuse crackles. How would the nurse

best interpret these assessment findings?

A. It is likely that the client is developing a secondary

bacterial pneumonia.

B. The assessment findings are consistent with influenza

and are to be expected.

C. The client is getting dehydrated and needs to increase

her fluid intake to decrease secretions.

D. The client has not been taking her decongestants and

bronchodilators as prescribed.

63. Guaifenesin 300 mg four times daily has been ordered

as an expectorant. The dosage strength of the liquid is

200mg/5ml. How many mL should the nurse administer each

dose?

A. 5.0 ml

B. 7.5 ml

C. 9.5 ml

D. 10 ml

64. Pseudoephedrine (Sudafed) has been ordered as a nasal

decongestant. Which of the following is a possible side

effect of this drug?

A. Constipation

B. Bradycardia

C. Diplopia

D. Restlessness

65. A client with COPD reports steady weight loss and being

“too tired from just breathing to eat.” Which of the

following nursing diagnoses would be most appropriate when

planning nutritional interventions for this client?

A. Altered nutrition: Less than body requirements related

to fatigue.

B. Activity intolerance related to dyspnea.

C. Weight loss related to COPD.

D. Ineffective breathing pattern related to alveolar

hypoventilation.

66. When developing a discharge plan to manage the care of

a client with COPD, the nurse should anticipate that the

client will do which of the following?

A. Develop infections easily

B. Maintain current status

C. Require less supplemental oxygen

D. Show permanent improvement.

67. Which of the following outcomes would be appropriate

for a client with COPD who has been discharged to home?

The client:

A. Promises to do pursed lip breathing at home.

B. States actions to reduce pain.

C. States that he will use oxygen via a nasal cannula at

5 L/minute.

D. Agrees to call the physician if dyspnea on exertion

increases.
68. Which of the following physical assessment findings

would the nurse expect to find in a client with advanced

COPD?

A. Increased anteroposterior chest diameter

B. Underdeveloped neck muscles

C. Collapsed neck veins

D. Increased chest excursions with respiration

69. Which of the following is the primary reason to teach

pursed-lip breathing to clients with emphysema?

A. To promote oxygen intake

B. To strengthen the diaphragm

C. To strengthen the intercostal muscles

D. To promote carbon dioxide elimination

70. Which of the following is a priority goal for the client

with COPD?

A. Maintaining functional ability

B. Minimizing chest pain

C. Increasing carbon dioxide levels in the blood

D. Treating infectious agents

71. A client’s arterial blood gas levels are as follows: pH

7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3– 36 mEq/L.

Which of the following signs or symptoms would the nurse

expect?

A. Cyanosis

B. Flushed skin

C. Irritability

D. Anxiety

72. When teaching a client with COPD to conserve energy,

the nurse should teach the client to lift objects:

A. While inhaling through an open mouth.

B. While exhaling through pursed lips

C. After exhaling but before inhaling.

D. While taking a deep breath and holding it.

73. The nurse teaches a client with COPD to assess for s/s

of right-sided heart failure. Which of the following s/s

would be included in the teaching plan?

A. Clubbing of nail beds

B. Hypertension

C. Peripheral edema

D. Increased appetite

74. The nurse assesses the respiratory status of a client

who is experiencing an exacerbation of COPD secondary to

an upper respiratory tract infection. Which of the following

findings would be expected?

A. Normal breath sounds

B. Prolonged inspiration

C. Normal chest movement

D. Coarse crackles and rhonchi

75. Which of the following ABG abnormalities should the

nurse anticipate in a client with advanced COPD?

A. Increased PaCO2

B. Increased PaO2

C. Increased pH.

D. Increased oxygen saturation

76. Which of the following diets would be most appropriate

for a client with COPD?

A. Low fat, low cholesterol

B. Bland, soft diet

C. Low-Sodium diet

D. High calorie, high-protein diet

77. The nurse is planning to teach a client with COPD how

to cough effectively. Which of the following instructions

should be included?
A. Take a deep abdominal breath, bend forward, and

cough 3 to 4 times on exhalation.

B. Lie flat on back, splint the thorax, take two deep

breaths and cough.

C. Take several rapid, shallow breaths and then cough

forcefully.

D. Assume a side-lying position, extend the arm over the

head, and alternate deep breathing with coughing.

78. A 34-year-old woman with a history of asthma is

admitted to the emergency department. The nurse notes

that the client is dyspneic, with a respiratory rate of 35

breaths/minute, nasal flaring, and use of accessory

muscles. Auscultation of the lung fields reveals greatly

diminished breath sounds. Based on these findings, what

action should the nurse take to initiate care of the client?

A. Initiate oxygen therapy and reassess the client in 10

minutes.

B. Draw blood for an ABG analysis and send the client for

a chest x-ray.

C. Encourage the client to relax and breathe slowly

through the mouth

D. Administer bronchodilators

79. The nurse would anticipate which of the following ABG

results in a client experiencing a prolonged, severe asthma

attack?

A. Decreased PaCO2, increased PaO2, and decreased pH.

B. Increased PaCO2, decreased PaO2, and decreased pH.

C. Increased PaCO2, increased PaO2, and increased pH.

D. Decreased PaCO2, decreased PaO2, and increased pH.

80. A client with acute asthma is prescribed short-term

corticosteroid therapy. What is the rationale for the use of

steroids in clients with asthma?

A. Corticosteroids promote bronchodilation

B. Corticosteroids act as an expectorant

C. Corticosteroids have an anti-inflammatory effect

D. Corticosteroids prevent development of respiratory

infections.

81. The nurse is teaching the client how to use a metered

dose inhaler (MDI) to administer a Corticosteroid drug.

Which of the following client actions indicates that he us

using the MDI correctly? Select all that apply.

A. The inhaler is held upright.

B. Head is tilted down while inhaling the medication

C. Client waits 5 minutes between puffs.

D. Mouth is rinsed with water following administration

E. Client lies supine for 15 minutes following

administration.

82. A client is prescribed metaproterenol (Alupent) via a

metered dose inhaler (MDI), two puffs every 4 hours. The

nurse instructs the client to report side effects. Which of

the following are potential side effects of metaproterenol?

A. Irregular heartbeat

B. Constipation

C. Petal edema

D. Decreased heart rate.

83. A client has been taking flunisolide (Aerobid), two

inhalations a day, for treatment of asthma. He tells the

nurse that he has painful, white patches in his mouth. Which

response by the nurse would be the most appropriate?

A. “This is an anticipated side-effect of your medication.

It should go away in a couple of weeks.”

B. “You are using your inhaler too much and it has

irritated your mouth.”

C. “You have developed a fungal infection from your

medication. It will need to be treated with an

antibiotic.”

D. “Be sure to brush your teeth and floss daily. Good oral

hygiene will treat this problem.”

84. Which of the following health promotion activities

should the nurse include in the discharge teaching plan for

a client with asthma?

A. Incorporate physical exercise as tolerated into the

treatment plan.

B. Monitor peak flow numbers after meals and at

bedtime.

C. Eliminate stressors in the work and home environment

D. Use sedatives to ensure uninterrupted sleep at night.

85. The client with asthma should be taught that which of

the following is one of the most common precipitating

factors of an acute asthma attack?

A. Occupational exposure to toxins

B. Viral respiratory infections

C. Exposure to cigarette smoke

D. Exercising in cold temperatures

86. A female client comes into the emergency room

complaining of SOB and pain in the lung area. She states

that she started taking birth control pills 3 weeks ago and

that she smokes. Her VS are: 140/80, P 110, R 40. The

physician orders ABG’s, results are as follows: pH: 7.50;

PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3– 24 mEq/L; SaO2

86%. Considering these results, the first intervention is to:

A. Begin mechanical ventilation

B. Place the client on oxygen

C. Give the client sodium bicarbonate

D. Monitor for pulmonary embolism.

87. Basilar crackles are present in a client’s lungs on

auscultation. The nurse knows that these are discrete,

noncontinuous 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 primarily in the pleura.

88. A cyanotic client with an unknown diagnosis is admitted

to the E.R. In relation to oxygen, the first nursing action

would be to:

A. Wait until the client’s lab work is done.

B. Not administer oxygen unless ordered by the

physician.

C. Administer oxygen at 2 L flow per minute.

D. Administer oxygen at 10 L flow per minute and check

the client’s nailbeds.

89. Immediately following a thoeacentesis, which clinical

manifestations indicate that a complication has occurred

and the physician should be notified?

A. Serosanguineous drainage from the puncture site

B. Increased temperature and blood pressure

C. Increased pulse and pallor

D. Hypotension and hypothermia

90. If a client continues to hypoventilate, the nurse will

continually assess for a complication of:

A. Respiratory acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

91. A client is admitted to the hospital with acute

bronchitis. While taking the client’s VS, the nurse notices

he has an irregular pulse. The nurse understands that

cardiac arrhythmias in chronic respiratory distress are

usually the result of:

A. Respiratory acidosis

B. A build-up of carbon dioxide

C. A build-up of oxygen without adequate expelling of

carbon dioxide.

D. An acute respiratory infection.

92. Auscultation of a client’s lungs reveals crackles in the

left posterior base. The nursing intervention is to:

A. Repeat auscultation after asking the client to deep

breathe and cough.

B. Instruct the client to limit fluid intake to less than

2000 ml/day.

C. Inspect the client’s ankles and sacrum for the

presence of edema

D. Place the client on bedrest in a semi-Fowlers position.

93. 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.

C. Listen and feel the air movement.

D. Determine the presence of a femoral pulse.

94. A client with COPD has developed secondary

polycythemia. Which nursing diagnosis would be included in

the plan of care because of the polycythemia?

A. Fluid volume deficit related to blood loss.

B. Impaired tissue perfusion related to thrombosis

C. Activity intolerance related to dyspnea

D. Risk for infection related to suppressed immune

response.

95. The physician has scheduled a client for a left

pneumonectomy. The position that will most likely be ordered

postoperatively for his is the:

A. Unoperative side or back

B. Operative side or back

C. Back only

D. Back or either side.

96. Assessing a client who has developed atelectasis

postoperatively, the nurse will most likely find:

A. A flushed face
B. Dyspnea and pain

C. Decreased temperature

D. Severe cough and no pain.

97. A fifty-year-old client has a tracheostomy and requires

tracheal suctioning. The first intervention in completing

this procedure would be to:

A. Change the tracheostomy dressing

B. Provide humidity with a trach mask

C. Apply oral or nasal suction

D. Deflate the tracheal cuff

98. A client states that the physician said the tidal volume

is slightly diminished and asks the nurse what this means.

The nurse explains that the tidal volume is the amount of

air:

A. Exhaled forcibly after a normal expiration

B. Exhaled after there is a normal inspiration

C. Trapped in the alveoli that cannot be exhaled

D. Forcibly inspired over and above a normal respiration.

99. An acceleration in oxygen dissociation from hemoglobin,

and thus oxygen delivery to the tissues, is caused by:

A. A decreasing oxygen pressure in the blood

B. An increasing carbon dioxide pressure in the blood

C. A decreasing oxygen pressure and/or an increasing

carbon dioxide pressure in the blood.

D. An increasing oxygen pressure and/or a decreasing

carbon dioxide pressure in the blood.

100. Lisa is newly diagnosed with asthma and is being

discharged from the hospital after an episode of status

asthmaticus. Discharge teaching should include which of the

following:

A. Limitations in sports that will be imposed by the

illness

B. Specific instructions on staying cal during an attack

C. The relationship of symptoms and a specific trigger

such as physical exercise

D. Incidence of status asthmaticus in children and teens

Answers and Rationales

1. A. Fever, chills, hemoptysis, dyspnea, cough, and

pleuric chest pain are the common symptoms of

pneumonia, but elderly clients may first appear with

only an altered mental status and dehydration due to

a blunted immune response.

2. D. The most common feature of all types of pneumonia

is an inflammatory pulmonary response to the

offending organism or agent. Atelectasis and

brochiectasis indicate a collapse of a portion of the

airway that doesn’t occur with pneumonia. An

effusion is an accumulation of excess pleural fluid in

the pleural space, which may be a secondary response

to pneumonia.

3. A. Based on the client’s history and symptoms, acute

asthma is the most likely diagnosis. He’s unlikely to

have bronchial pneumonia without a productive cough

and fever and he’s too young to have developed COPD

or emphysema.

4. C. Inspiratory and expiratory wheezes are typical

findings in asthma. Circumoral cyanosis may be

present in extreme cases of respiratory distress. The

nurse would expect the client to have a decreased

forced expiratory volume because asthma is an

obstructive pulmonary disease. Breath sounds will be

“tight” sounding or markedly decreased; they won’t

be normal.
5. C. Intrinsic asthma doesn’t have an easily identifiable

allergen and can be triggered by the common cold.

Asthma caused be emotional reasons is considered to

be in the extrinsic category. Extrinsic asthma is

caused by dust, molds, and pets; easily identifiable

allergens. Mediated asthma doesn’t exist.

6. B. Bronchodilators are the first line of treatment for

asthma because bronchoconstriction is the cause of

reduced airflow. Beta-adrenergic blockers aren’t used

to treat asthma and can cause bronchoconstriction.

Inhaled or oral steroids may be given to reduce the

inflammation but aren’t used for emergency relief.

7. B. The client is having an acute asthma attack and

needs to increase oxygen delivery to the lung and

body. Nebulized bronchodilators open airways and

increase the amount of oxygen delivered. First resolve

the acute phase of the attack ad how to prevent

attacks in the future. It may not be necessary to

place the client on a cardiac monitor because he’s

only 19-years-old, unless he has a past medical

history of cardiac problems.

8. C. Because of his extensive smoking history and

symptoms, the client most likely has chronic

obstructive bronchitis. Clients with ARDS have acute

symptoms of and typically need large amounts of

oxygen. Clients with asthma and emphysema tend not

to have a chronic cough or peripheral edema.

9. C. Clients with chronic obstructive bronchitis appear

bloated; they have large barrel chests and peripheral

edema, cyanotic nail beds and, at times, circumoral

cyanosis. Clients with ARDS are acutely short of

breath and frequently need intubation for mechanical

ventilation and large amounts of oxygen. Clients with

asthma don’t exhibit characteristics of chronic

disease, and clients with emphysema appear pink and

cachectic (a state of ill health, malnutrition, and

wasting).

10. D. Because of the large amount of energy it takes to

breathe, clients with emphysema are usually cachectic.

They’re pink and usually breathe through pursed lips,

hence the term “puffer”. Clients with ARDS are

usually acutely short of breath. Clients with asthma

don’t have any particular characteristics, and clients

with chronic obstructive bronchitis are bloated and

cyanotic in appearance.

11. D. These are classic signs and symptoms of a client

with emphysema. Clients with ARDS are acutely short

of breath and require emergency care; those with

asthma are also acutely short of breath during an

attack and appear very frightened. Clients with

chronic obstructive bronchitis are bloated and cyanotic

in appearance.

12. D. It’s highly recommended that clients with

respiratory disorders be given vaccines to protect

against respiratory infection. Infections can cause

these clients to need intubation and mechanical

ventilation, and it may be difficult to wean these

clients from the ventilator. The vaccines have no

effect on bronchodilation or respiratory care.

13. A. Exercise can improve cardiovascular fitness and

help the client tolerate periods of hypoxia better,

perhaps reducing the risk of heart attack. Most

exercise has little effect on respiratory muscle

strength, and these clients can’t tolerate the type of

exercise necessary to do this. Exercise won’t reduce

the number of acute attacks. In some instances,

exercise may be contraindicated, and the client should

check with his physician before starting any exercise

program.

14. A. Reducing fluid volume reduces the workload of the

heart, which reduces oxygen demand and, in turn,

reduces the respiratory rate. It may also reduce

edema and improve mobility a little, but exercise

tolerance will still be harder to clear airways.

Reducing fluid volume won’t improve respiratory

function, but may improve oxygenation.

15. D. In emphysema, the wall integrity of the individual

air sacs is damaged, reducing the surface area

available for gas exchange. Very little air movement

occurs in the lungs because of bronchiole collapse, as

well. In ARDS, the client’s condition is more acute

and typically requires mechanical ventilation. In

asthma and bronchitis, wheezing is prevalent.

16. C. Clients with emphysema breathe when their oxygen

levels drop to a certain level; this is known as the

hypoxic drive. They don’t take a breath when their

levels of carbon dioxide are higher than normal, as do

those with healthy respiratory physiology. If too much

oxygen is given, the client has little stimulus to take

another breath. In the meantime, his carbon dioxide

levels continue to climb, and the client will pass out,

leading to a respiratory arrest.

17. D. Respiratory infection in clients with a respiratory

disorder can be fatal. It’s important that the client

understands how to recognize the signs and symptoms

of an impending respiratory infection. It isn’t

appropriate for the wife to listen to his lung sounds,

besides, you can’t purchase stethoscopes from Wal-

Mart. If the client has signs and symptoms of an

infection, he should contact his physician at once.

18. A. Atelectasis develops when there’s interference with

the normal negative pressure that promotes lung

expansion. Clients in the postoperative phase often

splint their breathing because of pain and positioning,

which causes hypoxia. It’s uncommon for any of the

other respiratory disorders to develop.

19. D. Using an incentive spirometer requires the client to

take deep breaths and promotes lung expansion. Chest

physiotherapy helps mobilize secretions but won’t

prevent atelectasis. Reducing oxygen requirements or

placing someone on mechanical ventilation doesn’t

affect the development of atelectasis.

20. A. Inhaled beta-adrenergic agents help promote

bronchodilation, which improves oxygenation. I.V.

beta-adrenergic agents can be used but have to be

monitored because of their greater systemic effects.

They’re typically used when the inhaled beta-

adrenergic agents don’t work. Corticosteriods are

slow-acting, so their use won’t reduce hypoxia in the

acute phase.

21. A. Inhaled beta-adrenergic agents, I.V.

corticosteroids, and supplemental oxygen are used to

reduce bronchospasm, improve oxygenation, and avoid

intubation. Determining the trigger for the client’s

attack and improving exercise tolerance are later

goals. Typically, secretions aren’t a problem in status

asthmaticus.

22. B. Narcotics can cause respiratory arrest if given in

large quantities. Its unlikely Dani will have an asthma

attack or wake up on her own. She may be pissed for

a minute, but then she’d be grateful for saving her

butt.

23. B. First, the nurse should attempt to rouse the client

because this should increase the client’s respiratory

rate. If available, a spot pulse oximetry check should

be done and breath sounds should be checked. The

physician should be notified immediately if of the

findings. He’ll probably order ABG analysis to

determine specific carbon dioxide and oxygen levels,

which will indicate the effectiveness of ventilation.

Reflexes and heart sounds will be part of the more

extensive examination done after these initial actions

are completed.

24. D. A client about to go into respiratory arrest will

have inefficient ventilation and will be retaining

carbon dioxide. The value expected would be around 80

mm Hg. All other values are lower than expected.

25. C. The client was reacting to the drug with

respiratory signs of impending anaphylaxis, which

could lead to eventual respiratory failure. Although

the signs are also related to an asthma attack or a

pulmonary embolism, consider the new drug first.

Rheumatoid arthritis doesn’t manifest these signs.

26. A. Giving oxygen would be the best first action in this

case. Vital signs then should be checked and the

physician immediately notified. If the client doesn’t

already have an I.V. catheter, one may be inserted

now if anaphylactic shock is developing. Obtaining a

CBC wouldn’t help the emergency situation.

27. B. Bronchodilators would help open the client’s airway

and improve his oxygenation status. Beta-adrenergic

blockers aren’t indicated in the management of

asthma because they may cause bronchospasm.

Obtaining laboratory values wouldn’t be done on an

emergency basis, and having the client lie flat in bed

could worsen his ability to breathe.

28. C. You all should know this. Practice some problems if

you got this wrong.

29. A. Respiratory acidosis is most often due to

hypoventilation. Chronic respiratory acidosis is most

commonly caused by COPD. In end-stage disease,

pathological changes lead to airway collapse, air

trapping, and disturbance of ventilation-perfusion

relationships.

30. B. Clinical manifestations of respiratory alkalosis

include headache, tachypnea, paresthesias, tetany,

vertigo, convulsions, hypokalemia, and hypocalcemia.

Options A, C, and D identify normal laboratory values.

Option B identifies the presence of hypokalemia.

31. C. The normal pH is 7.35 to 7.45. In a respiratory

condition, an opposite (see-saw) will be seen between

the pH and the PCO2. In this situation, the pH is at

the high end of the normal value and the PCO2 is low.

In an alkalotic condition, the pH is up. Therefore, the

values identified in the question indicate a respiratory

alkalosis. Compensation occurs when the pH returns to

a normal value. Because the pH is in the normal range

at the high end, compensation has occurred.

32. B. Before radial puncture for obtaining an ABG, you

should perform an Allen’s test to determine adequate

ulnar circulation. Failure to determine the presence of

adequate collateral circulation could result in severe

ischemic injury o the hand if damage to the radial

artery occurs with arterial puncture.

33. D. Loss of gastric fluid via nasogastric suction or

vomiting causes metabolic alkalosis as a result of the

loss of hydrochloric acid.

34. C. Intestinal secretions are high in bicarbonate and

may be lost through enteric drainage tubes or an

ileostomy or with diarrhea (remember, diarrhea is

coming out of thebase). These conditions result in

metabolic acidosis.

35. A. Kussmaul’s respirations are abnormally deep,

regular, and increased in rate.

36. D. Increases in base components occur as a result of

oral or parenteral intake of bicarbonates, carbonates,

acetates, citrates, or lactates. Excessive use of oral

antacids containing bicarbonate can cause metabolic

alkalosis.

37. C. Clinical manifestations of metabolic acidosis include

hyperpnea with Kussmaul’s respirations; headache; N/

V, and diarrhea; fruity-smelling breath resulting from

improper fat metabolism; CNS depression, including

mental dullness, drowsiness, stupor, and coma;

twitching, and coma. Hyperkalemia will occur.

38. E, B, A, D, and then C.

39. B. To obtain a sputum specimen, the client should

rinse the mouth to prevent contamination, breathe

deeply, and then cough unto a sputum specimen

container. The client should be encouraged to cough

and not spit so as to obtain sputum. Sputum can be

thinned by fluids or by a respiratory treatment such

as inhalation of nebulized saline or water. The optimal

time to obtain a specimen is on arising in the

morning.

40. D. If a biopsy was performed during a bronchoscopy,

blood streaked sputum is expected for several hours.

Frank blood indicates hemorrhage. A dry cough may be

expected. The client should be assessed for signs of

complications, which would include cyanosis, dyspnea,

stridor, bronchospasm, hemoptysis, hypotension,

tachycardia, and dysrhythmias. Hematuria is

unrelated to this procedure.

41. B. Hypoxemia can be caused by prolonged suctioning,

which stimulates the pacemaker cells within the heart.

A vasovagal response may occurm causing bradycardia.

The nurse must preoxygenate the client before

suctioning and limit the suctioning pass to 10 seconds.

42. C. During suctioning, the nurse should monitor the

client closely for side effects, including hypoxemia,

cardiac irregularities such as a decrease in HR

resulting from vagal stimulation, mucousal trauma,

hypotension, and paroxysmal coughing. If side effects

develop, especially cardiac irregularities, this

procedure is stopped and the client is reoxygenated.

43. A. In an acidotic condition the pH would be low,

indicating the acidosis. In addition, a low bicarbonate

level along with the pH would indicate a metabolic

state.

44. C. Clinical manifestations of COPD include hypoxemia,

hypercapnia, dyspnea on exertion and at rest, oxygen

desaturation with exercise, and the use of accessory

muscles of respiration. Chest x-ray films reveal a

hyperinflated chest and a flattened diaphragm is the

disease is advanced.

45. A. The venture mask delivers the most accurate

oxygen concentration. The Venturi mask is the best

oxygen delivery system for the client with chronic

airflow limitation because it delivers a precise oxygen

concentration. The face tent, the aerosol mask, and

the tracheostomy collar are also high-flow oxygen

delivery systems but most often are used to

administer high humidity.

46. A. Theo-Dur is a bronchodilator. The medication should

be administered with food such as milk and crackers to

prevent GI irritation.

47. B. One to 3 L/min of oxygen by nasal cannula may be

required to raise to PaO2 to 60 to 80 mm Hg. However,

oxygen is used cautiously and should not exceed 2 L/

min. Because of the long-standing hypercapnia, the

respiratory drive is triggered by low oxygen levels

rather than increased carbon dioxide levels, as is the

case in normal respiratory system.

48. C.

49. D. Pursed lip breathing facilitates maximum expiration

for clients with obstructive lung disease. This type of

breathing allows better expiration by increasing

airway pressure that keeps air passages open during

exhalation.

50. B. In respiratory alkalosis the pH will be higher than

normal and the PCO2 will be low.

51. C. Aminophylline is a bronchodilator that directly

relaxes the smooth muscles of the bronchial airway.

52. D. Side effects that can occur from a beta 2 agonist

include tremors, nausea, nervousness, palpitations,

tachycardia, peripheral vasodilation, and dryness of

the mouth or throat.

53. C. The client should be instructed to hold his or her

breath at least 10 to 15 seconds before exhaling the

mist.

54. A. The most important item to ask about is the

client’s pregnancy status because pregnant women

should not be exposed to radiation. Clients are also

asked to remove any chains or metal objects that

could interfere with obtaining an adequate film. A

chest radiograph most often is done at full

inspiration, which gives optimal lung expansion. If a

lateral view of the chest is ordered, the client is

asked to raise the arms above the head. Most films

are done in posterior-anterior view.

55. B. After bronchoscopy, the nurse keeps the client on

NPO status until the gag reflex returns because the

preoperative sedation and the local anesthesia impair

swallowing and the protective laryngeal reflexes for a

number of hours. Additional fluids is unnecessary

because no contrast dye is used that would need to be

flushed from the system. Atropine and Versed would

be administered before the procedure, not after.

56. B. Before drawing an ABG, the nurse assesses the

collateral circulation to the hand with Allen’s test.

This involves compressing the radial and ulnar arteries

and asking the client to close and open the fist. This

should cause the hand to become pale. The nurse then

releases pressure on one artery and observes whether

circulation is restored quickly. The nurse repeats the

process, releasing the other artery. The blood sample

may be taken safely if collateral circulation is

adequate.

57. B. The client with emphysema has hyperinflation of

the alveoli and flattening of the diaphragm. These

lead to increased anteroposterior diameter, which is

referred to as “barrel chest.” The client also has

dyspnea with prolonged expiration and has

hyperresonant lungs to percussion.

58. D. Benzonatate is a locally acting antitussive the

effectiveness of which is measured by the degree to

which it decreases the intensity and frequency of

cough without eliminating the cough reflex.

59. D. A client recovering from an URI should report

decreasing or no nasal discharge and obstruction.

Daily fluid intake should be increase to more than 1 L

every 24 hours to liquefy secretions. The temperature

should be below 100*F (37.8*C) with no chills or

diaphoresis. A productive cough with chest pain

indicated pulmonary infection, not an URI.

60. C. Individuals who are household members or home

care providers for high-risk individuals are high-

priority targeted groups for immunization against

influenza to prevent transmission to those who have a

decreased capacity to deal with the disease. The wife

who is caring for a husband with cancer has the

highest priority of the clients described.

61. D. It is important for clients with allergic rhinitis to

determine the precipitating factors so that they can

be avoided. Keeping a diary can help identify these

triggers. Nasal decongestant sprays should not be

used regularly because they can cause a rebound

effect. Antibiotics are not appropriate. Increasing

activity will not control the client’s symptoms; in

fact, walking outdoors may increase them if the client

is allergic to pollen.

62. A. Pneumonia is the most common complication of

influenza, especially in the elderly. The development

of a purulent cough and crackles may be indicative of

a bacterial infection are not consistent with a

diagnosis of influenza. These findings are not

indicative of dehydration. Decongestants and

bronchodilators are not typically prescribed for the

flu.

63. B.

64. D. Side effects of pseudoephedrine are experienced

primarily in the cardiovascular system and through

sympathetic effects on the CNS. The most common

CNS effects include restlessness, dizziness, tension,

anxiety, insomnia, and weakness. Common

cardiovascular side effects include tachycardia,

hypertension, palpitations, and arrhythmias.

Constipation and diplopia are not side effects of

pesudoephedrine. Tachycardia, not bradycardia, is a

side effect of pseudoephedrine.

65. A. The client’s problem is altered nutrition—

specifically, less than required. The cause, as stated

by the client, is the fatigue associated with the

disease process. Activity intolerance is a likely

diagnosis but is not related to the client’s nutritional

problems. Weight loss is not a nursing diagnosis.

Ineffective breathing pattern may be a problem, but

this diagnosis does not specifically address the

problem of weight loss described by the client.

66. A. A client with COPD is at high risk for development

of respiratory infections. COPD is a slowly

progressive; therefore, maintaining current status

and establishing a goal that the client will require less

supplemental oxygen are unrealistic expectations.

Treatment may slow progression of the disease, but

permanent improvement is highly unlikely.

67. D. Increasing dyspnea on exertion indicates that the

client may be experiencing complications of COPD, and

therefore the physician should be notified. Extracting

promises from clients is not an outcome criterion.

Pain is not a common symptom of COPD. Clients with

COPD use low-flow oxygen supplementation (1 to 2 L/

minute) to avoid suppressing the respiratory drive,

which, for these clients, is stimulated by hypoxia.

68. A. Increased anteroposterior chest diameter is

characteristic of advanced COPD. Air is trapped in the

overextended alveoli, and the ribs are fixed in an

inspiratory position. The result is the typical barrel-

chested appearance. Overly developed, not

underdeveloped, neck muscles are associated with COPD

because of their increased use in the work of

breathing. Distended, not collapsed, neck veins are

associated with COPD as a symptom of the heart

failure that the client may experience secondary to

the increased workload on the heart to pump into

pulmonary vasculature. Diminished, not increased,

chest excursion is associated with COPD.

69. D. Pursed lip breathing prolongs exhalation and

prevents air trapping in the alveoli, thereby

promoting carbon dioxide elimination. By prolonged

exhalation and helping the client relax, pursed-lip

breathing helps the client learn to control the rate

and depth of respiration. Pursed-lip breathing does

not promote the intake of oxygen, strengthen the

diaphragm, or strengthen intercostal muscles.

70. A. A priority goal for the client with COPD is to

manage the s/s of the disease process so as to

maintain the client’s functional ability. Chest pain is

not a typical sign of COPD. The carbon dioxide

concentration in the blood is increased to an abnormal

level in clients with COPD; it would not be a goal to

increase the level further. Preventing infection would

be a goal of care for the client with COPD.

71. B. The high PaCO2 level causes flushing due to

vasodilation. The client also becomes drowsy and

lethargic because carbon dioxide has a depressant

effect on the CNS. Cyanosis is a late sign of hypoxia.

Irritability and anxiety are not common with a PaCO2

level of 65 mm Hg but are associated with hypoxia.

72. B. Exhaling requires less energy than inhaling.

Therefore, lifting while exhaling saves energy and

reduced perceived dyspnea. Pursing the lips prolongs

exhalation and provides the client with more control

over breathing. Lifting after exhalation but before

inhaling is similar to lifting with the breath held. This

should not be recommended because it is similar to the

Valsalva maneuver, which can stimulate cardiac

dysrhythmias.

73. C. Right-sided heart failure is a complication of COPD

that occurs because of pulmonary hypertension. Signs

and symptoms of right-sided heart failure include

peripheral edema, jugular venous distention,

hepatomegaly, and weight gain due to increased fluid

volume. Clubbing of nail beds is associated with

conditions of chronic hypoxia. Hypertension is

associated with left-sided heart failure. Clients with

heart failure have decreased appetites.

74. D. Exacerbations of COPD are frequently caused by

respiratory infections. Coarse crackles and rhonchi

would be auscultated as air moves through airways

obstructed with secretions. In COPD, breath sounds

are diminished because of an enlarged anteroposterior

diameter of the chest. Expiration, not inspiration,

becomes prolonged. Chest movement is decreased as

lungs become overdistended.

75. A. As COPD progresses, the client typically develops

increased PaCO2 levels and decreased PaO2 levels. This

results in decreased pH and decreased oxygen

saturation. These changes are the result of air

trapping and hypoventilation.

76. D. The client should eat high-calorie, high-protein

meals to maintain nutritional status and prevent

weight loss that results from the increased work of

breathing. The client should be encouraged to eat

small, frequent meals. A low-fat, low-cholesterol diet

is indicated for clients with coronary artery disease.

The client with COPD does not necessarily need to

follow a sodium-restricted diet, unless otherwise

medically indicated.

77. A. The goal of effective coughing is to conserve

energy, facilitate removal of secretions, and minimize

airway collapse. The client should assume a sitting

position with feet on the floor if possible. The client

should bend forward slightly and, using pursed-lip

breathing, exhale. After resuming an upright position,

the client should use abdominal breathing to slowly

and deeply inhale. After repeating this process 3 or 4

times, the client should take a deep abdominal breath,

bend forward and cough 3 or 4 times upon exhalation

(“huff” cough). Lying flat does not enhance lung

expansion; sitting upright promotes full expansion of

the thorax. Shallow breathing does not facilitate

removal of secretions, and forceful coughing promotes

collapse of airways. A side-lying position does not

allow for adequate chest expansion to promote deep

breathing.

78. D. In an acute asthma attack, diminished or absent

breath sounds can be an ominous sign of indicating

lack of air movement in the lungs and impending

respiratory failure. The client requires immediate

intervention with inhaled bronchodilators, intravenous

corticosteroids, and possibly intravenous theophylline.

Administering oxygen and reassessing the client 10

minutes later would delay needed medical intervention,

as would drawing an ABG and obtaining a chest x-ray.

It would be futile to encourage the client to relax and

breathe slowly without providing necessary

pharmacologic intervention.

79. B. As the severe asthma attack worsens, the client

becomes fatigued and alveolar hypotension develops.

This leads to carbon dioxide retention and hypoxemia.

The client develops respiratory acidosis. Therefore,

the PaCO2 level increase, the PaO2 level decreases,

and the pH decreases, indicating acidosis.

80. C. Corticosteroids have an anti-inflammatory effect

and act to decrease edema in the bronchial airways

and decrease mucus secretion. Corticosteroids do not

have a bronchodilator effect, act as expectorants, or

prevent respiratory infections.

81. A and D.

82. A. Irregular heart rates should be reported promptly

to the care provider. Metaproterenol may cause

irregular heartbeat, tachycardia, or anginal pain

because of its adrenergic effect on the beta-

adrenergic receptors in the heart. It is not

recommended for use in clients with known cardiac

disorders. Metaproterenol does not cause

constipation, petal edema, or bradycardia.

83. C. Use of oral inhalant corticosteroids, such as

flunisolide, can lead to the development of oral

thrush, a fungal infection. Once developed, thrush

must be treated by antibiotic therapy; it will not

resolve on its own. Fungal infections can develop even

without overuse of the Corticosteroid inhaler.

Although good oral hygiene can help prevent

development of a fungal infection, it cannot be used

alone to treat the problem.

84. A. Physical exercise is beneficial and should be

incorporated as tolerated into the client’s schedule.

Peak flow numbers should be monitored daily, usually

in the morning (before taking medication). Peak flow

does not need to be monitored after each meal.

Stressors in the client’s life should be modified but

cannot be totally eliminated. Although adequate sleep

is important, it is not recommended that sedatives be

routinely taken to induce sleep.

85. B. The most common precipitator of asthma attacks is

viral respiratory infection. Clients with asthma should

avoid people who have the flu or a cold and should get

yearly flu vaccinations. Environmental exposure to

toxins or heavy particulate matter can trigger asthma

attacks; however, far fewer asthmatics are exposed

to such toxins than are exposed to viruses. Cigarette

smoke can also trigger asthma attacks, but to a lesser

extent than viral respiratory infections. Some

asthmatic attacks are triggered by exercising in cold

weather.

86. B. The pH (7.50) reflects alkalosis, and the low PaCO2

indicated the lungs are involved. The client should

immediately be placed on oxygen via mask so that the

SaO2 is brought up to 95%. Encourage slow, regular

breathing to decrease the amount of CO2 she is

losing. This client may have pulmonary embolism, so

she should be monitored for this condition (D), but it

is not the first intervention. Sodium bicarbonate (C)

would be given to reverse acidosis; mechanical

ventilation (A) may be ordered for acute respiratory

acidosis.

87. A. Basilar crackles are usually heard during

inspiration and are caused by sudden opening of the

alveoli.

88. C. Administer oxygen at 2 L/minute and no more, for

if the client if emphysemic and receives too high a

level of oxygen, he will develop CO2 narcosis and the

respiratory system will cease to function.

89. C. Increased pulse and pallor are symptoms associated

with shock. A compromised venous return may occur if

there is a mediastinal shift as a result of excessive

fluid removal. Usually no more than 1 L of fluid is

removed at one time to prevent this from occurring.

90. A. Respiratory acidosis represents an increase in the

acid component, carbon dioxide, and an increase in the

hydrogen ion concentration (decreased pH) of the

arterial blood.

91. B. The arrhythmias are caused by a build-up of carbon

dioxide and not enough oxygen so that the heart is in

a constant state of hypoxia.

92. A. Although crackles often indicate fluid in the alveoli,

they may also be related to hypoventilation and will

clear after a deep breath or a cough. It is, therefore,

premature to impose fluid (B) or activity (D)

restrictions . Inspection for edema (C) would be

appropriate after reauscultation.

93. C. To check for breathing, the nurse places her ear

and cheek next to the client’s mouth and nose to

listen and feel for air movement. The chest rising and

falling (A) is not conclusive of a patent airway.

Observing skin color (B) is not an accurate assessment

of respiratory status, nor is checking the femoral

pulse.

94. B. Chronic hypoxia associated with COPD may stimulate

excessive RBC production (polycythemia). This results

in increased blood viscosity and the risk of

thrombosis. The other nursing diagnoses are not

applicable in this situation.

95. B. Positioning the client on the operative side

facilitates the accumulation of serisanguineous fluid.

The fluid forms a solid mass, which prevents the

remaining lung from being drawn into the space.

96. B. Atelectasis is a collapse of the alveoli due to

obstruction or hypoventilation. Clients become short

of breath, have a high temperature, and usually

experience severe pain but do not have a severe cough

(D). The shortness of breath is a result of decreased

oxygen-carbon dioxide exchange at the alveolar level.

97. C. Before deflating the tracheal cuff (D), the nurse

will apply oral or nasal suction to the airway to

prevent secretions from falling into the lung.

Dressing change (A) and humidity (B) do not relate to

suctioning.

98. B. Tidal volume (TV) is defined as the amount of air

exhaled after a normal inspiration.

99. C. The lower the PO2 and the higher the PCO2, the

more rapidly oxygen dissociated from the oxy-

hemoglobin molecule.

100. C. COPD clients have low oxygen and high carbon

dioxide levels. Therefore, hypoxia is the main stimulus

for ventilation is persons with chronic hypercapnea.

Increasing the level of oxygen would decrease the

stimulus to breathe.

MSN Exam for Asthma and COPD

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