Comprehensive Respiratory System Disorders NCLEX C

Name: Comprehensive Respiratory System Disorders NCLEX C
Brand: Academic Documents Platform
Price: 4.5 USD
Availability: InStock
Author: Alice Edwards

NCLEX Challenge Exam Get instant feedback, rationales, and free access—no sign-ups needed. A great tool to assess your readiness under simulated exam conditions.

Alice Edwards

Contributor

4.4

3 months ago

Preview (54 of 180)

Comprehensive Respiratory System Disorders
NCLEX Challenge Exam (Quiz #1: 50 Questions)
UFC1ATED ON OCTOBER 17. 2DC3
BY MATT VERA BSN.H.N.
Hi! You Eire currently in Lhe quiz page. If you're dorte with this qui4 please ctieck out
the other exams by clicking here to go back to the Respiratory System Disorders
Nursing Test Bank page.
Quiz Guidelines
Before you start, here ate same examination guidelines and ranindets you must read:
1 Practice Exams- Engage wrth our Practice Exams Io liare your skills in 3 supportive. low-pressure
enviranment. These exams provide immed 3te Feedback and explanations, l e a ng you grasp care
concepts, identify anpruvemerl areas, and build Confidence in your knowledge and ab lies.
2. Challenge txams: Take cur Cha eoge Exams La test you mastery and readiness undo sins ated
exam conditions. These exams offer a rigorous uuesliar set to assess your urdei standing. piepare
you foi actual examine I an s, 3rd benchmark you performance.
+ You're given 2 miruLes per item.
* For Challenge Exams, click on the 'Start Quiz’ button Io start die quiz.
j Complete the quiz Ensure that you answer the er I re quiz. Only after you've answered every item
will the scare and rationales be shown.
4. Learn from the rationales After each quiz, click on die 'View Questions" buttou to understand the
explanation fur each answer.
5. Free access Guess wiiat? Our test banks are 1 M % FREE. Skip the hassle ■ no sign-ups or
reg straitens here. A sincere promise from Nurseslabs: we have not ard wort ever request your
credit card details ar personal info for oca practice uuesliar s. We re dedicated 1o keepng this
service accessible ard cost-free, espec ally for uui amazing students ard r arses. So. take the leap
and elevate your career hassle-free
6. Share truur tlKiuidilq We d oveyoca feedback, scores, and questions! P ease share them in die
comments below.
Results
5Qnf 50 Questions answered correctly
Your lime. 00.10:44
You have reached 50 of 50 point(s), (10DXJ
Average score Crt,

Would you like Io submit your quiz result to the leaderboard?
Namft Name E Mail: E Mail
Rqntfl
View Questions
1. Question 1 pointfs)
Aminophylline iLheophy llinej is prescribed Tor a client with acute branchilis. A nurse
administers the medication, knowing that the primary action of this medication is to:
A_ Promote expectoration.
B. Suppress Ute cough.
C. Relax smooth muscles of the bronchial airway.
D. Prevent infection.
Correct
Correct Answer: C. Relax smooth muscles of lhe bronchial airway
Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the
branchial airway. Theophylline causes non'seleclive inhibition of type III and type IV
isoenzyntes of phosphodiesterase, which leads to increased tissue cyclic adenosine
monophosphate (cAMP) and cyclic 3?.5? guanasine monophasphate concentrations,
resulting in smooth muscle relaxation in lungs and pulmonary vessels, diuresis, CNS
and cardiac stimulation.
* Option A: Guaifenesin is an expectorant. It works by thinning arid loosening
mucus in lhe airways, clearing congestion, and making breathing easier.
Mucolytics are drugs belonging to lhe class of mucoactive agents. They exert
their effect on lhe mucus layer lining Lhe respiratory trad with Lhe motive of
enhancing its clearance.
* Option B: Antitussives are drugs that suppress lhe cough reflex. Persistent
coughing can be exhausting and can cause muscle strain and further irritation
of Lhe respiratory trad. They act on the cough control center in the medulla to
suppress lhe cough reflex.

* Option D; Antibiotics are powerful medicines that fight bacterial infections. They
either kill bacteria or stop them from reproducing, allowing the body's natural
defenses to eliminate the pathogens. Used properly, antibiotics can save lives.
But growing antibiotic resistance is curbing the effectiveness of these drugs.
Taking an antibiotic as directed, even after symptoms disappear, is key to curing
infection and preventing the development of resistant bacteria.
2 Question 1
A client is receiving isoelharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors
the client for which side effect of this medication?
A_ Constipation
B. Diarrhea
C. Bradycardia
D. Tachycardia
Correct
Correct Answer: D. Tachycardia
Side effects that can occur from a beta 2 agonist include tremors, nausea,
nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the
rrrouth or throat Due to the vasodilatory effect of peripheral vasculature and
subsequent decrease in cardiac venous return, compensatory mechanisms manifest
as tachycardia are relatively comment. especially within the first weeks of usage.
- Option A: Constipation is not a side effect of isoetharine. Bela 2 agonists have
been shown to decrease serum potassium levels via an inward shift of
potassium into the cells due to an effect on the membrane bound Na/K ATPase,
which can potentially result in hypokalemia. Beta 2 agonists also promote
glycogenolysis, which can lead to inadvertent elevations in serum glucose.
• Option B: Adverse effects of beta 2 agonists most commonly involve the
desensitization of the beta 2 adrenergic receptor to the beta 2 agonist. Due Io
the similar properties between the classes of adrenergic receptors, beta 2
agonists can create an "off target" effect in stimulating either alpha 1, alpha 2,
or beta 1 receptors. The most common side effects of beta 2 agonists involve
the cardiac, metabolic, or musculoskeletal system.
- Option C: Arrhythmias are seen more commonly in fenoterol usage versus
albuterol, and arrhythmias have an increase in frequency in patients with
underlying heart disease or concomitant theophylline use. Several studies have

also indicated hypoxemia and hypercapnia aS exacerbating factors to ti e
card atoxic effects of beta 2 agonists.
3. Question 1 P*ln, W
A nurse leaches a client about the use of a respiratory inhaler. Which action by the client
indicated a need for further teaching?
A_ Removes the cap and shakes the inhaler well before use.
B. Press the canister down with your finger as he breathes in.
C. Inhales; the mist and quickly exhales.
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
Correct
Correct Answer: C. inhales the mist and tjuickly exhales.
Take the inhaler out of the mouth. If the client can, he should hold his breath as he
slowly counts to 10. This lets the medicine reach deep into the lungs. Tire client should
be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the
mist.
» Option A: If the client has not used the inhaler in a wfiile, he may need to prime
it. See the instructions that came with the inhaler for when and how to do this.
Shake the inhaler hard 10 to 15 limes before each use.
* Option 0: Hold the inhaler with the mouthpiece down. Place lips around the
mouthpiece so that the mouth forms a light seal. As the client starts to slowly
breathe in through the mouth, press down on the inhaler one lime.
» Option 0: If using inhaled, quick relief medicine (beta agonists), wail about 1
minute before taking the next puff. You do not need to wait a minute between
puffs for other medicines.
4. Question 1
A female client is scheduled Io have a chest radiograph. Which of the following questions is of
most importance Io the nurse assessing this client?
A. 'Is there any possibility that you could for pregnant?'

B. "Are you wearing any metal chains or jewelry?'
C. "Can you hold your breath easily?"
D. "Are you able Io hold your arms above your head?"
Correct
Correct Answer: A. "It there any possibility lhai you could be pregnant?"
The rrtosl important item to ask about is the client's pregnancy slatus because
pregnant women should not be exposed to radiation. The risk of Side effects of an X
ray while the client is pregnant is extremely minimal but il is always important to
protect the developing fetus from harm.
* Option B: Clients are also asked to remove any chains or mela I objects that
could interfere with obtaining an adequate film. The client may be asked to strip
down and wear a hospital gown, or al least remove clothing on lhe part of the
body that needs to be X rayed.
* Option C: & chest radiograph most often is done al full ir'spiration, which gives
optimal lung expansion.
’ Option D; if a lateral view of lhe chest is ordered, the client is asked to raise the
amts above the head. The client will be asked to stay still so the image will be as
clear as possible. This will provide lhe mosl accuale image. Mosl films are
done in posterior anterior view. The X ray test works by positioning Lhe part of
the body being X rayed between Lhe soiMce of the X'ray and an X ray detector
(such as a film}.
5, Question 1 P°ln, <5)
A client has just returned Io a nursing unit following bronchoscopy. A nurse would implement
which of the following nursing interventions for this client?
A. Encouraging additional fluids for the next 24 hours
B Ensuring the return of the gag reflex before offering foods or fluids
C. Administering atropine intravenously
□. Administering small doses of midazolam (Versed).

Correct
Correct Answer: B. Ensuring the return of the gag reHex before offering foods or fluids
After bronchoscopy, the nurse keeps the client an NPO status until the gag reflex
returns because the preoperative sedation and the local anesthesia impair swallow ng
and the protective laryngeal reflexes for a number of hours. Although bronchoscopy
can be done without sedation, most procedures are done under moderate conscious
sedation with the use of various sedatives based ori the clinician's preference (&.<].,
benzodiazepines, opioids, dexmedetomidine).
• Option A: Additional fluids are unnecessary because no contrast dye is used
that would need to be flushed from die system. Regardless of the sedation or
anesthesia used the physicians should be aware of the potential side effects
and how to manage patients receiving these medications.
- Option C: Atropine would be administered before the procedure, not after.
Atropine premedicalion is widely used for fiberoptic bronchoscopy and may help
by drying secretions, producing bronchodi lalion, or preventing vasovagal
reactions.
* Option 0: The administration of additional midazolam in small doses, until the
target sedation level is achieved, Isa safe procedure that is associated with
significantly less discomfort and pain during bronchoscopy and a grea ter
consent to re?examination when compared wi th the administration of a fixed
dose of midazolam.
6. Question 1 poin,(3)
A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes
the:
A_ Brachial and radial arteries, and then releases them and observes the circulation
of the hand.
B Radial and ulnar arteries, releases one, evaluates the color of the hand, and
repeats the process with the other artery,
C. Radial artery and observes for color changes in the affected hand.
D. Ulnar artery and observes for color changes in the affected hand.
Correct
Correct Answer: B, Radial and ulnar arteries, releases one, evaluates the color of the
hand, and repeals the process with the other artery.

Loading page 6...

Before drawing an ABG, the nurse assesses the collateral circulation to the hand with
Alien's lesL This involves compressing the radial and ulnar arteries and asking the
client Io cluse arrd open the fist. This should cause the hand to became pale. The nurse
then releases pressure on one artery and observes wlrether Circulation is restored
quickly. The nurse repeals the process, releasing the other artery. The blood sample
may be taken safely If collateral circulation is adequate.
• Option A: Puncture of the radial artery is usually preferred because of the
accessibility of the vessel, the presence of collateral circulation, artd the artery's
superficial course proximal to the wrist, which makes it easier fur the clinician to
identify the vascular structure and hold local pressure after the procedure is
finished.
- Option C: The radial artery is most easily accessible medial to the radial styloid
process and lateral to the flexor carpi radi alls tendon, 2 3 cm proximal to the
ventral surface of the wrist crease. Firm occlusive pressure is held on both the
radial artery and the ulnar artery. The patient is asked to clench the fist several
limes until the palmar skin is blanched, then to unclench the fist.
* Option D: if radial artery sampling is not feasible, femoral artery puncture Is a
passible alternative. When femoral artery puncture is being considered, the
potential risk of infection at the entry site and the artery's proximity to the
femoral vein and nerve must be taken into
7. Question 1
A nurse is assessing a client with chronic airflow limitation and notes that the client has a
"barrel chest." The nurse interprets that this dlient has which of the following forms of chronic
airflow limitation?
A_ Chronic obstructive bronchitis
B. tmphysema
C. Bronchial asthma
□. Branchial asthma and bronchitis
Correct
Correct Answer? B. Emphysema
The client with emphysema has hyperinflation of the alveoli and flattening of the
diaphragm. These lead Io increased anteroposterior diameter, which is referred to as
"barrel chest.' The client also Iras dyspnea with prolonged expiration and has
hyperresonanl lungs to percussion.
• Option A; Chronic bronchitis is a type of chronic obstructive pulmonary disease
(C0PD1 that is defined as a productive cough of more than 3 months occurring

Loading page 7...

within a span of 2 years. Patients typically present with chronic productive
COugh, malaise, and symptoms of excessive coughing such as chest or
abdominal pain.
* Option C: Asthma is a condition of acute, fully reversible airway inflammation,
often following exposure to an environmental trigger. The pathological process
begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen),
which then, due to bronchial hypersensitivity, leads to airway inflammation and
an increase in mucus production. This leads to a significant increase in airway
resistance, which is most pronounced on expiration.
* Option D: Acute bronchitis is the result of acute inflammation of the bronchi
secondary to various triggers, most commonly viral infection, allergens,
pollutants, etc. Inflammation of the bronchial wall leads to mucosal thickening,
epithelial cell desquamation, and denudation of the basement membrane. Al
times, a viral upper respiratory infection can progress to infection of the lower
respiratory tract resulting in acute bronchitis.
8. Question 1 poim(s)
A client has been taking benzonalale (Tessa Ion Perles) as prescribed. A nurse concludes that
the medication is having the intended effect if the client experiences:
A. Decreased anxiety level.
B. Increased comfort level.
C. Reduction of N/V.
D. Decreased frequency and intensity of cough.
Correct
Correct Answer: 0. Decreased frequency and intensity of cough.
Benzonalale is a locally acting antitussive the effectiveness of which is measured by
the degree to which it decreases the intensity and frequency of cough without
eliminating the cough reflex. Benzonalale is an oral antitussive drug used in the relief
and suppression of cough in patients older than ten years of age. Currently,
benzonalale is the only non narcotic antitussive available as a prescription drug. It
works to reduce the activity of cougli reflex by desensitizing the tissues of the lungs
and pleura involved in the cough reflex.
* Option A: Because its chemical structure resembles that of the anesthetic
agents in the para amino benzoic acid class (such as (procaine] and
[tetracaine]), benzoriatafe exhibits anesthetic or numbing action. Although il is
not prone to drug misuse or abuse, benzonalate is associated with a risk for
severe toxicity and overdose, especially in children.

Loading page 8...

• Option B; Benzonalate suppresses cough associated with both acute and
chronic respiratory conditions. It works by desensitizing the pulmonary stretch
receptors involved in l i e cough reflex. There are limited clinical trials of
benzonalate; however, earlier studies demonstrated inhibition of experimentally
induced cough and subjectively measured pathological cough by benzonalate.
* Option C: Benzanatate is a synthetic bulylamino benzoate derivative related to
tetracaine and a peripherally acting a ntilussive, non narcotic Benzonalate
reduces the cough reflex by anesthetizing and depressing mecharroreceptors in
the respiratory passages, lungs, and pleura. It is recommended for cough relief
in the common coldl bronchitis, pneumonia, and for chronic cough such as in
asthma.
9. Question 1
Which of the fallowing would be an expected outcome for a client recovering from an upper
respiratory tract infection? The client will:
A. Maintain a fluid intake of 800 ml every 24 hours.
B. Experience chills only once a day.
C. Cough productively without chest discomfort.
□, EnperKnc* las* n**«l obstruction and discharge
Correct
Correct Answer: 0. Experience less nasal obstruction and discharge.
A client recovering from an URI should report decreasing or no nasal discharge and
obstruction. Decongestants and combination anlihistamine/decungestant medications
can limit cough, congestion, and other symptoms in adults. Avoid cough preparations
in children. Hl receptor antagonists may offer a modest reduction of rhi norrhea and
sneezing during the first 2 days of a cold in adults.
* Option A: Daily fluid intake should be increased to more than I L every 24 hours
to liquefy secretions. Topical and oral nasal decongestants (i.e., topical
oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and
adolescents in reducing nasal airway resistance. Evidence based data does not
support the u se of antibiotics in the treatment of the common cold because they
do not improve symptoms or shorten the course of illness.
* Option B: The temperature should be below l00*F (37.8*C) with no chills or
diaphoresis. According to a Cochrane Review, vitamin C used as daily
prophylaxis at doses of =0.2 grams or more had a "modest but consistent
effect" on the duration and severity of common cold symptoms (8% and 13%
decreases in duration for adults and children.. respectively).

Loading page 9...

* Option C: A productive cough with chest pain indicated pulmonary i nfeclion, not
an URL The presence of classical features Icr rhinovirus infection coupled with
the absence of signs of bacterial infection or serious respiratory illness, Is
sufficient to make the diagnosis of the common cold. The common cold is a
clinical diagnosis, and diagnostic testing is not necessary.
10. Question 1 P°i n l < s >
Which of the fallowing individuals would the nurse consider to have the highest priority for
receiving an influenza vaccination?
A. A 60 year' old man with a hiatal hernia.
B. A 36 year old woman with 3 children.
C. A 50-year-old Woman Caring fora spouse with cancer.
D. A 60 year old woman with osteoarthritis.
Correct
Correct Answer: C. A SO year- old woman caring for a spouse with cancer.
Individuals who are household members or home care providers for high risk
individuals are high priority targeted groups for immunization against influenza lo
prevent transmission to those who have a decreased capacity to deal with the disease.
The wife who is caring for a husband with cancer has the highest priority of the clients
described.
- Option A: In certain gioups, including the elderly, immune compromised
individuals and infants, the influenza vaccine is less effective, but it is beneficial
by reducing the incidence of severe disease, like bronchopneumonia, and
reduces hospital admission and mortality.
* Option B: Regarding immunization in pregnancy, a randomized controlled trial
conducted in South Africa has shown that when pregnant women receive the
influenza vaccine, it halves their risk of developing influenza while reducing the
risk of their infants (upto 24 weeks) contracting the illness.
’ Option D: Influenza vaccine conveys immunity against the influenza virus by
stimulating the production of antibodies specific to the disease. Antibodies to
NA act by aggregating viruses on the cell surface effectively and reducing the
amount of virus released from infected cells.

Loading page 10...

A client with allergic rhinitis asks the nurse what he should do Io decrease his symptoms.
Which of lhe following instructions 'would be appropriate tor the nurse to give the client?
A. "Use your nasal decongestant spray regularly to help clear your nasal passages."
B. "Ask lhe doctor for antibiotics. Antibiotics will help decrease lhe secretion.’
C. "It is ImpcrtanL to increase your activity. A daily brisk walk will help promote
rfrairiage."
0, "Keep fl diary when your symptoms occur. This can help you Identify what
precipitates your attacks?
Correct
Correct Answer: 0. 'Keep a diary when your symptoms occur. This can help you
identify what precipitates your attacks.’
Il is important for clients with allergic rhinitis to determine Lhe precipitating factors so
that they can be avoided. Keeping a diary can help identify these triggers. Patients
often underestimate the severity of this condition and fail to seek medical therapy. It is
important to adequately control AR especially due to lhe link between AR and asthma,
with poor control of rhinitis predicting poor control of asthma.
■ Option A: Nasal decongestant sprays should not be used regularly because they
can cause a rebound effect. If removing a pet from home is not feasible,
isolating lhe pel to a single room in the house may be an option Io minimize
dander exposure. It may take up to 20 weeks to eliminate cat dander from home
even after removing lhe animal.
* Option B: Antibiotics are not appropriate. Intranasal corticosteroid therapy can
be as monotherapy or in combination with oral anlihisla mines in patients with
mild, moderate, or severe symptoms. Studies have shown intranasal
corticosteroids are superior to antihistamines in effectively reducing nasal
inflammation and improving mucosal pathology.
• Option C; Increasing activity will not control the clienl's symptoms; in fact,
walking outdoors may increase them if the client is allergic to pollen. Avoidance
of triggers, especially in those with seasonal symptoms, is encouraged, although
it is not always practical. Precautions can be taken to avoid dust mites, animal
dander, and upholstery, though this can require significant lifestyle changes that
may not be acceptable to the patient.
12. Question 1 poln' )
An elderly dient has been ill with the flu, experiencing headache, fever, and chills. After 3 days,
she developed a cough productive of yellow sputum. The nurse auscultates her lungs and

Loading page 11...

hears diffuse crackles. How would the nurse best nterprel these assessment findings?
A. ft Is likely that the client Is developing a secondary bactenal pneumonia.
B. The assessment findings are consistent with Influenza and are to be expected.
C. The client is getting dehydrated and needs Io increase her fluid intake to
decrease secretions
D. The client has not been taking her decongestants and bronchodilators as
prescribed.
Correct
Correct Answer: A. II Is likely that the client is developing a secondary bacterial
pneumonia.
Pneumonia is the most common complication of influenza, especially in the elderly.
The development of a purulent cough and crackles may be indicative of a bacterial
infection that is not consistent with a diagnosis of influenza.
* Option B: Diagnosis of influenza can be reached clinically, especially during the
i nfl uenza season. Most of the cases will recover without medicaI treatment, and
they would not need a laboratory lest for the diagnosis. Signs and symptoms of
influenza in mild cases include a cough, fever, sore throat, myalgia, headache,
runny nose, and congested eyes. A frontal or retro orbital headache is a
common presentation with selected ocular symptoms that include photophobia
and pain with different qualities.
* Option C; These findings are not indicative of dehydration. Theclinical
presentation of influenza ranges from mild to severe depending on the age.,
comorbidities, vaccination status, and natural immunity Io the virus. Usually,
patients who received the seasonal vaccine present with milder symptoms, and
they are less likely to develop complications.
* Option D; Decongestants and bronchodilators are not typically prescribed for the
flu. Influenza infection is self-limited and mild in most healthy individuals who
do not have other comorbidilies. No antiviral treatment is needed during mild
infections in healthy individuals. Antiviral medications can be used to treat or
prevent influenza infection, especially during outbreaks In healthcare settings
such as hospitals and residential institutions.
13. Question 1
Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength
of the Iiquid is 2OTmg/5mI. How nrany mL should the nurse admini sler each dose? Fill in lhe
blank and record your final answer using one decimal place.

Loading page 12...

Answer: 7.5 rnL
Correct
Correct Answer: 7.5 ml
When tire medicine is a solution of specific strength, calculations can become more
complicated. Liquids (solutions, arid suspensions) are frequently used in childreris
nursing ■ for example for children who find swallowing tablets difficult or patients who
have medicines administered via a percutaneous endoscopic gastrostomy (PEG) tube.
14. Question 1
Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant Which of the
following is a possible side effect of this drug?
A. Constipation
B. Bradycardia
C. Diplopia
O. Restlessness
Correct
Correct Answer: 0. Restlessness
Side effects of pseudoephedrine are experienced primarily in the cardiovascular
system and through sympathetic effects on the CNS. The most common CNS effects
include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common
cardiovascular side effects include tachycardia, hypertension, palpitations, and
arrhythmias.
* Option A: Pseudoephedrine is used to relieve nasal congestion caused by colds,
allergies, and hay fever. It is also used to temporarily relieve sinus congestion
and pressure. Pseudoephedrine will relieve symptoms but will not treat the
cause of the symptoms or speed recovery. Pseudoephedrine is in a class of
medications Called nasal decongestants. Il works by causing narrowingof the
blood vessels in the nasal passages.
* Option B Tachycardia, not bradycardia, is a side effect of pseudoephedrine.
Nonprescription cough and cold combination products, including products that
contain pseudoephedrine, can cause serious Side effects or dealt: in young

Loading page 13...

children. Do not give nonprescription pseudoephedrine products to children
younger than 4 years of age.
* Option C: Diplopia is not a side effect of pseudoephedrine. Tell your doctor if you
have or have ever had high blood pressure, glaucoma (a condition in which
increased pressure in the eye can lead to gradual loss of vision), diabetes,
difficulty urinating (due to an enlarged prostate gland), cr thyroid or heart
disease. If you plan to take the 24 hour extended release tablets, tell your doctor
if you have had a narrowing or blockage of your digestive system.
15. Question 1
A client with CORD reports steady weight loss and being "too tired from just breathing to eat."
Which of the following nursing diagnoses would be most appropriate when planning
nutritional interventions for this client?
A. Altered nutrition: Less than body requirements related to fatigue.
B. Activity intolerance related Io dyspnea.
C. Weight loss related to COPD.
□. Ineffective breathing pattern related to alveolar hypoventilation.
Correct
Correct Answer: A. Altered nutrition; Less than body requirements related to fatigue.
The client's problem is altered nutrition— specifically, less than required. The cause, as
slated by the client, is the fatigue associated with the disease process. Instruct the
patient to frequently eat high caloric foods in smaller portions. COPD patients expend
an extraordinary amount of energy simply on breathing and require high caloric meals
to maintain body weight and muscle mass.
* Option B: Activity intolerance is a likely diagnosis but is not related to the Client's
nutritional problems. Provide al least 9tJ minutes of undisturbed rest in between
activities. Allotmenlof undisturbed rest reduces demand for oxygen and allows
adequate physiologic recovery.
* Option Ct Weight loss is not a nursing diagnosis. Encourage a rest period of 1 hr
before and after meals. Helps reduce fatigue during mealtime and provides an
opportunity to increase total caloric intake. Avoid gas producing foodsand
carbonated beverages. Can produce abdominal distension., which hampers
abdominal breathing and diaphragmatic movement and can increase dyspnea.
* Option D: Ineffective breathing pattern may be a problem, but this diagnosis
does not specifically address the problem of weigfil loss described by the client.
Instruct how to splint the chest wall with a pillow for comfort during coughing

Loading page 14...

and elevation of head aver the body as appropriate. Promotes physiological
ease of maximal inspiration.
16. Question 1
When developing a discharge plan to manage the care of a clien t with COPD, the nurse should
anticipate that the dient will do which of the following?
A. Develop infections easily.
B. Maintain current status.
C. Require less supplemental oxygen.
D. Show permanent improvenrent.
CWTKt
Correct Answer: A. Develop Infections easily.
A client with CDPD is at high risk for development of respiratory infections. In
emphysema, an irritant (e.g., smoking) causes an inflammatory response. Neutrophils
and macrophages are recruited arid release multiple inflammatory mediators. Oxidants
and excess proteases leading to the destruction of the air sacs. The protease mediated
destruction of elastin leads Io a loss of elastic recoil and results in airway collapse
during exhalation.
* Option B: COPD is slowly progressive; therefore, maintaining current status is an
unrealistic expectation. CDPD is an inflammatory condition involving the
airways, lung parenchyma, and pulmonary vasculature. The process is thought
to involve oxidative stress and protease antiprotease imbalances. Emphysema
describes one of the structural changes seen in COPD where there is destruction
of the alveolar air sacs (gas exchanging surfaces of the lungs) leading to
obstructive physiology.
* Option C“ This is an unrealistic expectation. The prognosis of COPD is variable
based on adherence to treatment including smoking cessation and avoidance of
other harmful gases. Patients with other comorbidities (e.g., pulmonary
hypertension, cardiovascular disease, lung cancer) typically have a poorer
prognosis. The airflow limitation and dyspnea are usually progressive.
* Option D: Treatment may slow progression of the disease, but permanent
improvement is highly unlikely. As the disease progresses impairment of gas
exchange is often seen. The reduction in ventilation or increase in physiologic

Loading page 15...

dead space leads to COZ retention. Pulmonary hypertension may occur due lo
diffuse vasoconslriclion from hypoxemia.
17. Question 1 p<tln1
Which of the fallowing outcomes would be appropriate for a client with COPD who has been
discharged to home? The client:
A_ Promises to do pursed Up breathing at home.
B. States actions lo reduce pain.
C. Slates that he will use oxygen via a nasal cannula at 5 U/minule.
0. Agrees to call the physician if dyspnea on exertion increases.
CWTKt
Correct Answer: 0 Agrees lo call the physician If dyspnea on exertion increases.
Increasing dyspnea on exertion indicates that the client may be experiencing
complications of COPD, and therefore the physician should be notified. There are
things that everyone with COPD should do lo manage their disease; quitting smoking (If
they smoke] is lhe most important. In addition there are other non medication
treatments that can help relieve symptoms and improve quality of life.
• Option A: Extracting promises from clients is not an outcome criterion.
Pulmonary rehabilitation programs have been shown to improve a person's
ability to exercise. enhance quality of life, and decrease the frequency of COPD
exacerbations (when symptoms flare up more than usual). Even people with
severe shortness of breath can benefit from a rehabilitation program.
« Option 0: Pain is not a common symptom of COPD. Although COPD usually
worsens over time, it is difficult to predict how quickly it will progress and how
long the client will live (the prognosis). A number of factors play a role in the
severity of COPD symptoms, including whether the client continues to smoke,
are underweight, or have other medical problems, and how the lungs function
during exercise. People with COPD who have less severe symptoms, are a
healthy weight, and do not smoke lend lo live longer.
’ Option C: Clients with COPD use low-flow oxygen supplementation (1 to 2
L/minule) lo avoid suppressing lhe respiratory drive, which, for these clients, is
stimulated by hypoxia. People with severe or advanced COPD can have low
oxygen levels in the blood. This condition, known as hypoxemia, can occur even
if the client does nol feel short of breath cr have other symptoms. The oxygen
level can be measured with a device placed on lhe finger (pulse oximeter) or

Loading page 16...

with a blood lest (arterial blood gas). People with hypoxemia may be placed on
Oxygen therapy, which can improve survival and quality of life.
13. Question 1 p o l n '<5)
Which of the following physical assessment findings would the nurse expect Io find in a client
with advanced CORD?
A. Increased anteroposterior chest diameter.
B. Underdeveloped neck muscles.
C. Collapsed neck veins.
□. Increased chest excursions with respiration.
Correct
Correct Answer: A. Increased anteroposterior chest diameter-
increased anteroposterior chest diameter is characteristic of advanced COPD. Air is
trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The
result is the typical barrekchesled appearance. In addition, coarse crackles beg inning
w ith inspiration may be heard.
* Option 0: Overly developed, not underdeveloped, neck muscles are associated
with COPD because of their increased use in the work of breathing. Use of
accessory respiratory muscles and paradoxical indrawing of lower intercostal
spaces is evident (known as the Hoover sign).
- Option C: Distended, not collapsed., neck veins are associated with COPD as a
symptom of the heart failure that the client may experience secondary to the
increased workload on the heart to pump into pulmonary vasculature. In
advanced disease, cyanosis, elevated jugular venous pulse (JVP), and peripheral
edema can be observed.
* Option Dl Diminished, not Increased., chest excursion Is associated with COPD.
The sensitivity of a physical examination in detecting mild to moderate COPD is
relatively poor; however, physical signs are quite specific and sensitive for
severe disease. Patients with severe disease experience lachypmea and
respiratory distress with simple activities.
1 poinl(s)
19. Question
Which of the fallowing is the primary reason Io teach pursed lip breathing to clients with
emphysema?

Loading page 17...

A_ To prorriole oxygen intake.
B. Ta strengthen the diaphragm.
C. To strengthen the intercostal muscles.
D. To promote carbon dioxide elimination.
Correct
Correct Answer: D. To promote carbon dioxide elimination.
Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and helping the
client relax, pursed lip breathing helps the client learn to control the rate and depth of
respiration. Pursed lip breathing does not promote the intake of oxygen, strengthen the
diaphragm, or strengthen intercostal muscles.
- Option A: Fo r those suffering from chronic obstructive pulmonary disease, the
ability to take in oxygen is a constant struggle. It's possible to increase oxygen
levels in other ways, such as cellular therapy. Cellular ifterapy may promote the
healing of lung tissue, potentially improving lung function. When lung function
improves; the client is able to take in more oxygen as well as expel carbon
dioxide because the lungs are working more effectively.
- Option B: Diaphragmatic breathing is a type of a breathing exercise that fieIps
strengthen the diaphragm, an important muscle that helps us breathe. This
breathing exercise is also sometimes called belly breathing or abdominal
breathing.
• Option C; Breathing exercises slowly fill the lings with air to expand the chest
and work the intercostal muscles. To do this exercise, it is typically
recommended to sit or stand with the back straight if ten take a full breath from
the bottom of the lungs. It can help Io think of breathing from the diaphragm, by
slowly expanding the abdominal muscles while inhaling, then pushing air from
the lungs using these same muscles.
i pointfs)
20. Question
Which of the following is a priority goal for the client with CORD?
A. Maintaining functional ability.
B. Minimizing chest pain.

Loading page 18...

C. Increasing carbon dioxide levels in the blood.
D. Treating infectious agents.
Correct
Correct Answer: A. Maintaining funclional ability
A priority goal for the client with COPD is to manage the s/s of the disease process so
as to nraintain the client's functional ability. Evaluate the level of activity tolerance.
Provide a calm, quiet environment Limit a patient's activity or encourage bed or chair
rest during the acute phase. Have patient resume activity gradually and increase as
individually tolerated.
* Option 0: Chest pain is not a typical sign of COPD. Assess and record
respiratory rate, depth. Note the use of accessory muscles, pursed lip breath ing.
inability Io speak or converse. Useful in evaluating the degree of respiratory
distress or chronicity of the disease process.
* Option C: The carbon dioxide concentration in the blood is increased to an
abnormal level in clients with COPD; it would not be a goal to increase the level
further. Monitor arterial blood gasses values as ordered. As the patient's
condition progresses, PaD2 usually decreases. For patients with chronic carbon
dioxide retention may have chronically compensated respiratory acidosis with a
low normal pH and a PaCo2 higher than 50 mm Hg.
* Option D: Preventing infection woul d be a goaI of care for the client with COP D.
Demonstrate and assist the patient in the disposal of tissues and sputum.
Stress proper handwashing (nurse and patient), and use gloves when handling
or disposing of tissues, sputum containers. Prevents spread of fluid borne
pathogens.
1 polnl(s)
21. Question
A client's arterial blood gas levels are as follows: pH 7.31: Pa 02 SO mm Hg. PaC02 65 mm Hg;
HC03 36 inEq/L Which of the fallowing signs or symptoms would the nurse expect?
A. Cyanosis
B. Flushed skin
C. Irritability

Loading page 19...

D. Anxiety
Correct
Correct Answer: B. Flushed skin
The high PaCO2 level causes flushing due to vasodilation. The client also becomes
drowsy and lethargic because carbon dioxide has a depressant effect on the CNS. On
the contrary, chronic respiratory acidosis may be caused by CORD where there is a
decreased responsiveness of (tie reflexes to states of hypoxia and hypercapnia.
• Option Aj Cyanosis is a la Le sign of hypoxia. In respiratory acidosis, the slight
increase in bicarbonate serves as a buffer for the increase in H+ ions, which
t eips minimize the drop in pH. In some cases, patients may present with
cyanosis due to hypoxemia.
« Option C: Irritability is net common with a PaCCK level of 65 mm Hg but is
associated with hypoxia. If the respiratory acidosis is severe and accompanied
by prolonged hypoventilation, the patient may have additional symptoms such
as altered mental status, myoclonus, and possibly even seizures.
- Option D: The clinical presentation of respiratory acidosis is usually a
manifestation of its underlying cause. Signs and symptoms vary based on the
length, severity, and progression of the disorder. Patients can present with
dyspnea, anxiety, wheezing, and sleep disturbances.
22. Question 1 F” in, (9 )
When teaching a client with COPD to conserve energy, the nurse should teach the client to lift
objects:
A. While inhaling through an open mouth.
B. While exhaling through pursed lips.
C. After exhaling but before inhaling.
□. While taking a deep breath and holding it.
Correct
Correct Answer; B. While exhaling through pursed lips.
Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves
energy and reduces perceived dyspnea. When one practices regularly, breathing

Loading page 20...

exercises cart help exert oneself less during dai ly activities. They can also potentially
aid in return to exercising, which can lead to feeling more energetic overall.
• Option A: Pursing the lips prolongs exhalation and provides the client with more
control over breathing. It's been shown to reduce flow hard one has Io work to
breathe. It helps release air trapped in the lungs. It promotes relaxation. IL
reduces shortness of breath.
• Option C: Lifting after exhalation but before inhaling is similar to lifting with the
breath held. The purpose of pursed lip breathing is to help keep the airways
open. This helps your airways to remain open. Pursed lip breathing also slows
down the breathing rale and calms the patient down.
• Option D: This should not be recommended because it is similar to the Valsalva
maneuver, which can stimulate cardiac dysrhythmias. The purpose of
coordinated breathing is to help assure adequate oxygen to the working
muscles and to prevent the client from holding the breath.
23, Question 1
The nurse teaches a dient with COPD to assess for s/s of right sided heart failure. Which of
the following s/s would be included in the Leaching plan?
A. Clubbing of nail beds
B. Hypertension
C. Peripheral edema
D. Increased appetite
Correct
Correct Answer: C, Peripheral edema
Right sided heart failure is a complication of CQPD that occurs because of pulmonary
hypertension. Signs and symptoms of right sided heart failure include peripheral
edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid
volume. Right heart failure is most commonly a result of left ventricular failure via
volume and pressure overload. Clinically, patients will present with signs and
symptoms of chest discomfort, breathlessness, palpitations, and body swelling.
* Option At Clubbing of nail beds is associated with conditions of chronic hypoxia.
Clubbing is a medical condition first described by Hippocrates in which the
fingers (and/or toes) have the appearance of upside down spoons. Il is caused
by a build up of tissue in the distant part of the fingers (terminal phalanges), that
causes the end of the fingers to become enlarged and the nails Io curve
downward.

Loading page 21...

* Option B. Hypertension is associated with left sided heart failure. When
hemodynamic instability is present, vasopressors are indicated. Norepinephrine
is the pressor of choice to improve systemic hypotension and restore cerebral
cardiac and end organ perfusion.
’ Option D: clients with heart failure have decreased appetites. A poor appetite
can also result from the accumulation of fluid in the liver and digestive system.
Fluid accumulation, edenra, is a common symptom of heart failure. The
accumulation of fluid that is responsible for the abdominal swelling can
decrease the appetite and result in nausea as well as discomfort from the
weight gain.
24. Question 1 pOln,(s)
The nurse assesses the respiratory status of a client who is experiencing an exacerbation of
COPD secondary to an upper respiratory tract infection. Which of the following findings would
be expected?
1. Normal breath sounds
A. Normal breath sounds
B. Prolonged inspiration
C. Normal chest movement
D. Coarse crackles and rhonchr
Correct
Correct Answer: D. Course crackles and rtwnchi
Exacerbations of CDPD are frequently caused by respiratory infections. Coarse
crackles and rhonchi would be auscultated as air moves through airways obstructed
with secretions. Crackles are usually due to airway secretions within a large airway and
disappear on coughing. These crackles are scanty, gravity 'Independent, usually audible
at the mouth, and strongly associated with severe airway obstruction.
’ Option A; |n CDPD, breath sounds are diminished because of an enlarged
anteroposterior diameter of the chest. A reduction In breath sound intensity
(BSI) is often seen in patients with COPD. Pardee et al. developed a scoring
system for BSI. According to this system the clinician listens sequentially over
Six locations on the patient's chest: bilaterally over the upper anterior portion of
the chest, in the midax illary, and al the posterior bases.
’ Option B: Expiration, not inspiration, becomes prolonged. Patients with CDPD
often present with diminished breath sounds, prolonged expiratory time, and
expiratory wheezing that initially may occur only on forced expiration.

Loading page 22...

* Option Ct Chest movement is decreased as lungs became overdislended.
Additional findings on physical examination include hyperinflation of the lungs
with an increased anteroposterior chest diameter ("barrel c+iest"); use of
accessory muscles of respiration; and distant heart sounds, sometimes best
heard in the epigastrium.
25, Question 1 P°ln, <5)
Which of the following ABG abnormalities should the nurse anticipate in a client with
advanced COPD?
A. Increased PaC02
B. Increased Pa02
C. Increased pH
D. Increased oxygen saturation
Correct
Correct Answer: A. Increased PaC02
As COPD progresses, the client typically develops increased PaC02 levels and
decreased PaD2 levels. This results in decreased pH and decreased oxygen saturation.
These changes are the result of air trapping and hypoventilation. Arterial blood gas
(AEG) analysis provides the best clues as to acuteness and severity of disease
exacerbation.
* Option B: Patients with mild COPD have mild to moderate hypoxemia without
hypercapnia. As the disease progresses, hypoxemia worsens and hypercapnia
may develop, with the latter commonly being observed as the FEV1 falls below 1
L/s or 30% of the predicted value. Lung mechanics and gas exchange worsen
dur ing acute exacerbations.
■ Option C: In general renal compensation occurs even in chronic C02 retainers
(ie, bronchitis); thus, pH usually is near normal. Generally, consider any pH below
7.3 to be a sign of acute respiratory compromise.
* Option D: The compensation ta respiratory acidosis consists in a secondary
increase in bicarbonate concentration, and the arterial blood gas analysis is
characterized by a reduced pH, increased pCO2 (initial variation), and increased
bicaibonate levels (compensatory response).

Loading page 23...

Which of lhe fol lowing diets would be most appropriate for a client with COPD?
A. Low fat, low cholesterol
B. Bland, soft di el
C. Low Sodium diet
D. High calorie, high- protein diet
Correct
Correct Answer: 0. High-caiorie, higtv-protem diet
The client should eat high calorie, high protein meals to maintain nutritional status and
prevent weight lass that results from the increased work of breathing. The client should
be encouraged to eat small, frequent meals. Eat 2D to 30 grams of Fiber each day, front
items such as bread, pasta, nuts, seeds, fruits and vegetables. Eat a good source of
protein al least twice a day to help maintain strong respiratory muscles. Good choices
include milk, eggs, cheese, meat fish. poultry, nuts and dried beans or peas.
* Option A: A low fa L, low cholesterol diet is indicated for clients with coronary
artery disease. Choose mono and poly unsaturated fats, which du not contain
cholesterol. These are fats that are often liquid at room temperature and come
from plant sources, such as canola, safflower and com oils.
’ Option 0: Metabolism of carbohydrates produces lhe most carbon dioxide for
the amount of oxygen used; metabolismof fat produces the least. For some
people with COPD, eating a diet with fewer carbohydrates and more fat helps
them breathe easier.
* Option C: The client with COPD does not necessarily need to follow a sodium'
restricted diet, unless otherwise medically indicated. Choose complex
carbohydrates, such as whole cpain bread and pasta, fresh fruits, and
vegetables. Limit simple carbohydrates, including table sugar, candy, cake, and
regular soft drinks.
27. Question 1
The nurse is planning to leach a client with COPD how to cough effectively. Which of the
following instructions should be included?
A. Take a deep abdominal breath, bend forward . and cough 3 to 4 times on
exhalation.

Loading page 24...

B. Lie flat cn beck, splint the thorax. Lake two deep breaths and cough.
C. Take several rapid, shallow breaths and then cough forcefully.
D. Assume a side lying position, extend (tie arm over the head, and alternate deep
breathing with coughing.
Correct
Correct Answer: A. Take a deep abdominal breath, bend forward, and cough 3 to 4
limes on exhalation.
The goal of effective coughing is to conserve energy, facilitate the removal of
secretions, and minimize airway collapse. The client should assume a sitting position
with feet on the floor if possible. The client should bend forward slightly and, using
pursed lip breathing, exhale. After resuming an upright position, the client should use
abdominal breathing to slowly and deeply inhale. After repeating this process 3 or -1
times, the client should lake a deep abdominal breath, bend forward and cough 3 or -1
times upon exhalation { ' h u f f ' cough).
• Option B: Lying flat does not enhance lung expansion; silting upright promotes
full expansion of the thorax. Sit on a chair or on the edge of the bed, with both
feet on the floor. Lean slightly forward. Relax. The patient should breathe in
through their nose and out through their nose or mouth until they are ready to
progress to the next stage.
- Option C: Shallow breathing does not facilitate removal of secretions, and
forceful coughing promotes Collapse of airways. The client should lean forward,
press the arms against the abdomen. Cough 2 3 times through a slightly open
mouth. Coughs should be short and sharp. The first cough loosens the mucus
and moves it through the airways. The second and third cough enables the client
to cough the mucus up and out.
- Option D: A side lying position does not allow for adequate chest expansion to
promote deep breathing. Silting the patient out of bed c< up in bed optimizes
lung expansion. Critical care patients can sit out of bed if they are
hemodynamical ly stable (this allows for better lung expansion). Ensure you have
two to three clinicians assisting with any intravenous lines cardiac monitoring,
drain tubes et£-
28. Question 1 polni(s)
A 34 year old woman with a history of asthma is admitted to the emergency department The
nurse notes that the client is dyspneic, with a respiratory rale of 35 breaths/minute, nasal
flaring, and use of accessory muscles. Auscultation of the lung fields reveals cjeatly
diminished breath sounds. Based on these findings, what action should the nurse take to
initiate care of the client?

Loading page 25...

A. Initiate Oxygen therapy and reassess the client in TO minutes.
B. Draw blood for an ABG analysis and send the client tor a chest x ray.
C. Encourage the client to relax and breathe s lowly through tire mouth.
D. Administer bronchodilators.
Correct
Correct Answer: U. Administer bronchodilators .
In an acute asthma attack, diminished or absent breath sounds can be an ominous
sign indicating lack of air movement in the lungs and impending respiratory failure. The
client requires immediate intervention with inhaled bronchodilators, intravenous
corticosteroids, and possibly intravenous theophylline.
• Option A Administering oxygen and reassessing the client ID minutes later
would delay reeded medical intervention. A favorable response to initial
treatment of status asthmaticus should be a visible improvement in symptoms
that sustains 30 minutes or beyond the last bronchodilator dose and a PEFR
greater than 70% of predicted.
- Option B: Drawing an ABG and obtaining a chest x ray would be a delay. The
a bsoluLe val ue of PEFR less than 1 20 L per minute and FEVI less than 1 L
corresponds with the proportional reduction. These absolute numbers should
prompt an assessment of arterial blood gas (ABG) immediately. Initial blood gas
results indicate respiratory alkalosis with hypoxemia.
* Option C: IL would be futile to encourage the client to relax and breathe slowly
without providing necessary pharmaco logic intervention. An initial aggressive
treatment trial of beta agonists, corticosteroids, and anticholinergics lias to be
tried, followed by adjunct rrteasures, which may not be based on robust
guidelines but evidence.
29, Question 1
The nurse would anticipate which of the following ABG results in a client experiencing a
prolonged, severe asthma attack?
A. Decreased PaCD2, increased Pa02, and decreased pH.
B increased P«C02, decimated and decr«a$4d pH.

Loading page 26...

C. Increased PaC02, increased PaO2, and increased pH.
D. Decreased PaC02, decreased PaO2, and increased pH.
Correct
Correct Answer: B increased PaCO2, decreased PaOZ, and decreased pH
As the severe asthma a Hack worsens, the client becomes fatigued arid alveolar
hypotension develops. This leads lo carbon dioxide retention and hypoxemia. The
client develops respiratory acidosis. Tfnerefore, the PaC02 level increases, the PaO2
level decreases, and the pH decreases, indicating acidosis.
* Option A: Respiratory acidosis is a very common acid base disturbance in acute
severe asthma and is widely considered to be an ominous finding. Its early
recognition and treatment are important and decisive for the final outcome, as it
can lead to respiratory failure and arrest if prolonged.
* Option C: Hypercapnia in asthma, in addition lo the severity of the disease, is
also associated with the therapeutic administration of oxygen. Thus, in patients
with severe asthma exacerbation, a significant increase (?4 mmHg) in
transcutaneous PCD2 (PIC02) was observed in a higher proportion in those
receiving high oxygen mixtures (>8 L/min), compared to those who received
titrated oxygen (to achieve oxygen saturation of 93 95%)
* Option D: Lee el al. noted that PaCO2 was significantly higher and the arterial
blood pH lower in asthmatics who died, and delays in providing mechanical
ventilation led lo worse outcomes. Another mechanism implicates the Haldane
effect, in which oxygen displaces the 002 dissociation curve lo the right,
increasing PaC02, which cannot be normalized as patients with severe COPD
are unable lo increase ventilation.
30. Question 1 P°ln1(®)
A client with acute asthma is prescribed short term corticosteroid therapy. What is the
rationale for the use of steroids in clients with asthma?
A_ Corticosteroids promote bronchodilalkm.
B. Corticosteroids act as an expectorant.
C. Corficosletoids have an anti-inflammatory affect.

Loading page 27...

D. Corticosteroids prevent development nt respiratory infections.
Correct
Correct Answer: C. Corticosteroids have an anti-inflammatory effect.
Corticosteroids fiave an anti inflammatory effect and act to decrease edema in the
bronchial airways and decrease mucus secretion. At a physiologic level, steroids
reduce airway inflammation and mucus production and potentiate beta agonist activity
in smooth muscles and reduce beta agonists tachyphylaxis in patients with severe
asthma. Corticosteroids do not fiave a bronchodilator effect, act as expectorants, or
prevent respiratory infections.
- Option A: Short acting inhaled beta agonists are the drug of the first choice in
acute asthma. Albuterol is preferred over melaprolerer'ol in tfiat class because
of its higher beta 2 selectivilies and longer duration of action. The dose
response curve and deration of action of these medications are adversely
affected by a combination of patient factors, including pre existing
broncfboconslriclion, airway inflammation, mucus plugging, poor patient effort,
and coordination.
- Option B: Anticholinergics have a variable response in acute exacerbation with a
somewhat underwhelming bronchodi lalory role. However they can be useful in
patients with bronchospasm induced by beta blockade or severe underlying
obstructive disease with F EVI less tfian 25% of predicted.
* Option D: Graham el al. conducted a randomized double blinded trial and
demonstrated no difference in improvement in symptom score, spirometry, or
length of hospitalization with routine use of antibiotics in status aslhmalicus.
That does not mean that patients with clinical signs of infection should not be
treated with antimicrobials, or due diligence should not be pursued in obtaining
respiratory culture specimens early on.
31. Question i poim(s)
The nurse is Leaching the client how to use a metered dose inhaler (MDI) to administer a
Corticosteroid drug. Which of the following client actions indicates that he is using the MDI
correctly? Select all that apply.
A. The inhaler is held upright.
B. Head Is tilled down while inhaling the medication.
C. Client wails 5 minutes between puffs.

Loading page 28...

Q D. Mouth is rinsed with waler following administration.
E. Client lies supine for 1 5 minutes fol lowing administration.
Correct
Correct Answers? A & D
Inhaled respiratory medications are often taken by using a device called a metered
dose inhaler, or MDI. The MCI is a pressurized canister of medicine Ina plastic holder
with a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication.
■ Option A: Remove the cap and hold the inhaler i right. Each inhaler consists of
a small canister of medicine connected Io a mouthpiece. The canister is
pressurized. As the client presses down on the inhaler, it releases a mist of
medicine. The client breathes that mist into the lungs. Its important to use tire
inhaler correctly.
• Option El: Tilt the head back slightly and breathe out all tire way. Keep the chin
up and the inhaler upright (not aimed at the roof of lire mouth or lire longue).
• Option Ct Repeat puffs as directed by the doctor. Wail 1 minute before taking
the second puff. A delay of 10 20 minutes between successive doses of the
bronchodilator drug has been suggested in order to lei the first act to improve
the penetration and effect of Hie second dose, but again lire evidence dial this
works is Inconclusive. Many patients may forget to lake a second dose with
such a long interval.
• Option D Some inhalers (steroid) also recommend rinsing the rnouth out with
water and gargling with waler (spit out the water) after use. If using tills inhaler
for a corticosteroid preventer medication, wi th or without a spacer, rinse the
mouth with water and spit after inhaling the last dose to reduce Hie risk of Side
effects
• Option E: The client does not have Io be in the supine positron after
administration. Proper instruction by a trained person with a placebo aerosol is
essential to leach the correct inhaler technique. This should be followed
subsequently by regular checks to locate any faults lliat may develop. Inevitably,
some patients will be unable to use an MDI, and for them, spacer attachments,
Or dry powder inhalers are preferable since they place fewer demands on
patients’ skill. Even these devices, however, must be used properly to achieve a
satisfactory effect.
32, Question 1 P01"
A client is prescribed melaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs
every 4 hours. The nurse instructs the client to report side effects. Which of the following are
potential side effects of mefaproterenol?

Loading page 29...

A. Irregular heartbeat
B. Constipation
C. Pedal edema
D. Decreased hear! rate.
Correct
Correct Answer: A. Irregular heartbeat
Irregular heart rales should be reported promptly Io lhe care provider. MeLapfolerenol
may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic
effect on lhe beta adrenergic receptors in lhe hearL II is not recomntended for use in
clients with known cardiac disorders, Metaproterenol does nut cause constipation,
pedal edema, or bradycardia.
’ Option B: |n children, lhe most common side effects are diarrhea, nausea,
laryngitis, pharyngitis, sinusitis, otitis, and viral infection. The most commonly
observed side effects in patients aged 15 years and over were headaches,
influenza infection, abdominal pain, cough, and dyspepsia.
* Option C: There are some reports of serious adverse events due to a ngi oedema,
hypersensitivity, fatigue, confusional state, abnormal dreams, epilepsy,
aggression, immune system disorder, hemorrhage, excoriation, eosinophil count
increase, pain in extremity, and abdominal pain.
* Option Di Tell lhe doctor right away if any of these unlikely but serious side
effects occur: fast/pounding/i regular heartbeat, muscle cramps, weakness.
33. Question 1 P°i n , <5 )
A client has been taking ftunlsolide (Aerobid), two inhalations a day, for treatment of asthma.
He tells the nurse that he has painful while patches in his mouth. Which response by the
nurse would be the 1
™55 * appropriate?
A. "This is an anticipated side effect of your medication. IL should go away in a
couple of weeks."
B. "You are using your inhaler loo much and it has irritated your mouth."
C. 'You have developed a fungal infection from your medication, ft wilt need Io be

Loading page 30...

treated with an antifungal,'
D. "Be sure to brush your teeth and floss dally. Good oral hygiene will treat this
problem."
Correct
Correct Answer: C. “You have d evetoped a fungal inlection from your medication. It
will need to be treated with an antifungal.'
Use of oral inhalant corticosteroids, Such as flurisolide, can lead to the development of
oral thrush a Fungal infection. Oral candidiasis {thrush) is another common complaint
among users of inhaled corticosteroids (ICS). This risk increases in elderly patients and
patients who are also taking oral steroids, high dose ICS, or antibiotics.
* Option A: Once developed, thrush must be treated by antibiotic therapy; it will
not resolve on its own. Il is advisable to have the patient rinse their mouth out
after ICS use to prevent oral candidiasis. Treatments for car'didiasis include
clotrimazole, miconazole, and nystatin.
* Option 0: Fungal infections can develop even without overuse of tfre
corticosteroid inhaler. Attention to dosage is required as the amount of Candida
increased with dose of fluticasone. Gargling with a 1:M dilution of amphotericin
B is effective in treating oral cartdidiasis of asthmatic patients treated with
inhaled steroids.
* Option D: Although good oral hygiene can help prevent the development of a
fungal infection, it cannot be used alone to treat the problem. Most cases of oral
thrush will clear up in a couple of weeks. In general, a single dose of antifungal
medication may be enough Io cure the infection.
34. Question 1 P°inl
Which of the following health promotion activities should the nurse include in the discharge
teaching plan for a client with asthma?
A. Incorporate physical exercise as tolerated into the treatment plan.
B. Monitor peak flow numbers after meals and at bedtime.
C. Eliminate stressors in the work and home environment.
D. Use sedatives to ensure uninterrupted sleep at night.

Loading page 31...

Correct
Correct Answer: A. Incorporate physical exercise as tolerated into the treatment plan.
Physical exercise is beneficial and should be incorporated as tolerated into the client's
schedule. Peak flow numbers should be monitored daily, usually in the morning {before
taking medication). Encourage breathing exercises ar d controlled breathing and
relaxation. Prevents attack before it begins and increases ventilation.
- Option B: Peak flow does not need Io be monitored after each meal. Monitor
peaked expiratory flow ralesand forced expiratory volume as taken by the
respiratory therapist. The severity of the exacerbation can be measured
objectively by ntonitoring these values. The peak expiratory flow rale is the
maximum flow rate that can be genera ted du ring a farced expiratory maneuver
with fully inflated lungs.
- Option C: Stressors in the client's life should be modified but cannot be totally
eliminated. Instruct folks to modify the home environment to reduce dust,
exposure to pels and indoor plants, foods {peanut, egg), changing of fillers.
* Option D: Although adequate sleep is important, it is not recommended that
sedatives be routinely taken to induce sleep. Schedule and provide rest periods
in a calm peaceful environment. Promotes adequate rest and decreases stimuli.
35. Question 1
The client with asthma should be taught which of the following is one of the most common
precipitating factors of an acute asthma attack?
A_ Occupational exposure to toxins.
R , VIrat respiratory inf ections
C. Exposure to cigarette smoke.
D. Exercising in cold temperatures.
Correct
Correct Answer: B. Viral respiratory infections.
The most common precipitator of asthma attacks is viral respiratory infection. Clients
with asthma should avoid people who have the flu or a cold and should get yearly flu
vaccinations. Asthma is a condition of acute, fully reversible airway inflammation, often
following exposure to an environmental trigger. The pathological precess begins with
the i nhalaticn of an irritant (e.g., cold air) or an aIlergen {e.g., pollen), wh ich then, due to
branchial hypersensitivity, leads to airway inflammation and an increase in mucus

Loading page 32...

production. This leads to a significant increase in airway resistance, which is most
pronounced on expiration.
* Option A: Environmental exposure to toxins or heavy particulate matter can
trigger asthma attacks; however, far fewer asthmatics are exposed to Such
toxins llian are exposed to viruses. Asthma comprises a range of diseases and
has a variety of heterogeneous phenotypes. The recognized factors that are
associated with asthma are a genetic predisposition, specifically a personal or
family history of atopy (propensity to allergy, usually seen as eczema, hay fever,
and asthma).
* Option C: Cigarette smoke can also trigger asthma attacks, but lo a lesser
extent than viral respiratory infections. Asthma also is associated with exposure
lo tobacco smoke and oilier inflammatory gases or particulate matter.
’ Option D: Some asthmatic attacks are triggered by exercising in cold weather.
The overall etiology is complex and still not fully understood, especially when it
comes lo being able to say which children with pediatric asthma will carry on to
have asthma as adults (up to 40% of children have a wheeze, only 1% of adults
have asthma), but it is agreed that it is a multifactorial pathology, influenced by
both genetics and environmental exposure.
36 Question 1 poin,(a)
A female client comes into the emergency room complaining of SOB and pain in the lung area.
She slates that she started taking birth control pills 3 weeks ago and that she smokes. Her VS
are: 140/80, P 1IQ, R 40. The physician orders ABG's, results are as follows: pH: 7.50; PaC02
29 mm Hg; Pa02 60 mm Hgc HCOS 24 mEq/L; Sa02 86%. Considering these results, the first
intervention is to:
A_ Begin mechanical ventilation.
- B Place the client on oxygen.
C. Give the client sodium bicarbonate.
D. Monitor for pulmonary embolism.
Correct
Correct Answer: B Place the Client on oxygen
The pH (7.501 re fleets alkalosis, and the low PaCO2 indicates the lungs are involved.
The client should immediately be placed on oxygen via mask so that lite SaO2 is
brought up to 95%. Encourage slow, regular breathing Lo decrease the amount of CO2
she is losing.
• Option. A: Mechanical ventilation may be ordered for acute respiratory acidosis.
In patients who are not significantly encephalopathic and have no excessive

Loading page 33...

secretiorts, noninvasive ventilation with CPAPor BIPAPcan be a useful modality
to support ventilation and avoid the need for anesthesia and sedation, as wt?ll as
the risk of nosocomial infection with endotracheal intubation.
* Option C: Sodium bicarbonate would be given to reverse acidosis. Sodium
bicarbonate infusion reduces plasma ionized calcium concentration in critical ly
ill patients with metabolic acidosis. In vitro, bicarbonate concentration has a
major effect reducing ionized calcium level in serum
• Option D: This client may have pulmonary embolism so she should be
monitored for this condition, but it is not the first intervention. A timely diagnosis
of a pulmonary embolism {PE) is crucial because of tire high associated
mortality and morbidity, which may be prevented with early treatment. It is
important to note that 30% of untreated patients with pulmonary embolism die,
while only die after timely therapy.
1 pointf s)
37. Question
Basilar crackles are present Ina client's ling son auscultation. Tire nurse knows that these are
discrete, non continuous sounds that are:
A. Caused by the sudden opening of alveoli.
B. Usually more prominent during expiration.
C. Produced by airflow across passages narrowed by secretions.
D. Found primari ly in the pleura.
Correct
Correct Answer; A. Caused by the sudden opening of alveoli
Basilar crackles are usually heard diving inspiration and are caused by sudden opening
of the alveoli. Basilar crackles are a bubbling or crackling sound originating from the
base of the lungs. They may occur when the lungs inflate or deflate. They're usually
brief, and may be described as sounding wet or dry. Excess fluid in the airways causes
these sounds.
■ Option H: Bronchial sounds (also called tubular sounds) normally arise from the
tracheobronchial tree and vesicular sounds normally arise from the finer lung
parenchyma. Loud, harsh, and high pitched bronchial sounds are typically heard
over the trachea or al the right apex. They are predominantly heard during
expiration.
* Option C: Wheezes are musical sounds caused by air movement through
constricted small airways, such as bronchioles. Wheezes and rhonchi, which
have the same pathology and are separated only by pilch, are produced by the
fluttering of narrowed airways and the air that flows through them.

Loading page 34...

♦ Option D; Fluid ar air in the pleural space deflects sound waves away from the
chest wall back into the lung arid therefore breath sounds are reduced in
intensity.
1 polnl(s)
38. Question
A cyanotic Client with an unknown diagnosis Is admitted to the E.R. In relation to oxygen, the
first nursing action would be to:
A_ Wail until the client's lab work is done.
B. Not administer oxygen unless ordered by the physician.
C. Administer oxygen at 2 1 flow per minute.
D. Administer oxygen al 10 L flow per minute and check the client's nail beds.
Correct
Correct Answer: C. Administer oxygen at 2 L flow per minute.
Administer oxygen at 2 Uminule and no more, for if the client is emphysemic and
receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory
system will cease to function. With prolonged oxygen therapy there is an increase in
blood oxygen level, which suppresses peripheral chemoreceplors; depresses ventilator
drive and increase in PCO2. high blood oxygen level may also disrupt the ventilation:
perfusion balance (V/Q) and cause an increase in dead space to tidal volume ratio and
increase In PCO2.
- Option A: Tti is is the 'gold standard' rrvonitor of venli laticn. Arterial blood gases
are needed to obtain accurate data, in particular, evidence of hypoventilation
(raised PaCO2) as a reason for hypoxemia. Arterial blood gases may also give
an indication of the metabolic effects of clinically important hypoxemia.
* Option B: Although history taking and clinical examination may clarify the
diagnosis, oxygen at 40% 60% should be continued until blood gas results are
available unless the patient is drowsy or is known to have had previous episodes
of Hypercapnic respiratory failure.
* Option D: Low intravascular volume either due to acute blood loss as in trauma
can result in poor oxygen transport and tissue hypoxia. So, these patients should
be given high concentration oxygen to maintain oxygen saturation above 90%
until arrival at an emergency department. This can be achieved in most cases by
the use of approximately 40% 60% oxygen via a medium concentration mask at
a flow rate of 4 ID 1/ min.

Loading page 35...

39. Question 1 P°ln, (*)
Immediately fol lowing a thoracentesis, which clinical manifestations indicate that a
complication has occurred and the physician should be notified?
A_ Serosanguineous drainage from the puncture site.
B. Increased temperature and blood pressure.
C incrtMMi pulse nnci pnUor.
D. Hypotension and hypothermia.
Comet
Correct Answmi C. Increased pulse and pallor
Increased pulse and pallor are symptoms associated with shock. A compromised
venous return may occur if there is a mediastinal shift as a result of excessive fluid
removal. Usually, no more than 1 L of fluid is temoved atone lime to prevent this from
occurring.
* Option A: Complications include bleeding, pain, and infection at the poinlof
needle entry. If the approach is made too higti in the intercostal space damage
Io the coastal vasculalure and nerve injury is possible.
- Option B: If too much fluid is removed or if the fluid is removed too rapidly (eg
using negative pressure chambers) re expansion (aka post expansion)
pulmonary edema may occur. Removal of significant fluid volumes may also
induce vasovagal physiology.
* Option □' If the procedural needle/catheler is passed through diseased tissue
prior to entering the chest cavity, that process can be extended into the chest
space. For example, passing the needle through thoracic or pleural tumor can
seed the thoracic cavity or passing the needle through a chest wall abscess or
otherwise infected tissue can result in ernpyenta.
1 points &)
40. Question
If a client continues to hypovenlilate, the nurse will continually assess for a complication of:
A Respiratory acidosis

Loading page 36...

B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct
Correct Answer: A. Respiratory acidosis
Respiratory acidosis represents an increase in the acid component, carbon dioxide, and
an increase in the hydrogen ion concentration (decreased pH) ol the arterial blood. The
respiratory centers in the pons and medulla control alveolar ventilation.
Chemcreceplors tor PC02, PO2, and pH regulate ventilation. Central chemoreueptors in
the medulla are sensitive to changes in the pH level. Adecreased pH level influences
the mechanics ol ventilation and maintains proper levels ol carbon dioxide and oxygen.
When ventilation is disrupted, arterial PCQ2 increases and an acid base disorder
develops.
* Option B: |n almost every scenario, respiratory alkalosis is induced by a process
involving hyperventilation. These include central causes, hypoxemic causes,
pulmonary causes, and iatrogenic causes. Central sources are a head injury,
strake, hyperthyroidism, anxiety hyperventilation, pain, fear, stress, drugs,
medications such as salicylates, and various toxins. Hypoxic stimulation leads
to hyperventilation in an attempt to correct hypoxia at the expense ol a COZ
loss.
* Option C: Hydrogen ion concentration is determined by acid ingestion, acid
production, acid excretion, and renal and Gl bicarbonate losses. Buffers such as
bicarbonate minimize significant pH alterations. Further classification of
metabolic acidosis is based on the presence or absence of an anion gap, or
concentration o I unmeasured serum anions.
- Option □: In general the causes can be narrowed down to an intracellular shift
of hydrogen ions, gastrointestinal (Gl) loss of hydrogen ions, excessive renal
hydrogen ion loss, retention or addition of bicarbonate ions, or volume
contraction around a constant amount of extracellular bicarbonate known as
contraction alkalosis. All of which leads to the net result of increased levels of
bicarbonate in the blood.
41. Question 1 p®lm(«)
A client is admitted Ic the hospital with acute bronchitis. While taking the client's VS, the nurse
notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic
respiratory distress are usually the result of:

Loading page 37...

A. Respiratory acidosis
B. A build-up of carbon dioxide
C . A bui Id up of Oxygen without adequate expelling of carbon diox ide.
D. An acute respiratory infection.
Correct
Correct Answer: B. A build-up of carbon dioxide.
The arrhythmias are caused by a build up of carbon dioxide and not enough oxygen so
that the heart is in a constant slate of hypoxia. The majority of arrhythmias observed in
these patients appeared to take the form of premature ventricular and/or
supraventricular beats and less frequently of atrial fibrillation and/or attacks of
supraventricular paroxysmal tachycardia. Cardiac rhythm alterations were observed
using Holter monitoring in 70 90% of patients. No cardiac rhythm disorder is specific to
this pathological condition.
• Option A: The compensation to respiratory acidosis consists in a secondary
increase in bicarbonate concentration, and the arterial blood gas analysis is
characterized by a reduced pH, increased pC02 (initial variation), and increased
bicarbonate levels (compensatory response).
’ Option C: Acute bronchitis is a clinical diagnosis based on history, past medical
history, lung exam, and other physical findings. Oxygen saturation plays an
important role in judgirrg the severity of Ute disease along with the pulse rale,
temperature, and respiratory rate.
* Option D: Acute bronchitis is the result of acute inflammation of the brortchi
secondary to various triggers most commonly viral infection, allergens,
pollutants, etc. Inflammation of the bronchial wall leads Lu mucosal thickening,
epithelial cell desquamation, and denudation of the basement membrane. Al
limes, a viral upper respiratory infection can progress to infection of the lower
respiratory tract resulting in acute bronchitis.
42. Question 1
Auscultation of a client's lungs reveals crackles in the left posterior base. The nursing
intervention is to:
A. Repeat auscultation alter asking the client to deep breathe and cough.

Loading page 38...

B. Instruct the client to limit fluid intake to less than 2000 ml/day.
C. Inspect the client's ankles arid sacrum for the presence of edema.
□ . Place the client on bedrest in a semi Fowler's position.
Correct
Correct Answer: A. Repeat auscultation after asking the client to deep breathe and
cough.
Although Crackles often indicate fluid in the alveoli, they may also be related to
hypoventilation and will clear after a deep breath or a cough. Assess cough
effectiveness and productivity. Coughing is the most effective way to remove
secretions. Pneumonia may cause thick ar d tenacious secretions to patients.
* Option B; it jg premature to impose fluid or activity restrictions. Assess the rale,
rhythm and depth of respiration, chest movement, and use of accessory
muscles. Tachypnea, shallow respirations and asymmetric chest movement are
frequently present because of the discomfort of moving chest wall and/or fluid
in the lung doe to a compensatory response to airway obstruction. Altered
breathing patterns may occur together with use of accessory muscles to
increase chest excursion to facilitate effective breathing.
* Option C: Inspection for edema would be appropriate after re auscultation.
Auscultate lung fields, noting areas of decreased or absent airflow and
adventitious breath sounds: crackles, wheezes. Decreased airflow occurs in
areas with consolidated fluid. Bronchial breath soundlscan also occur in these
consolidated areas. Crackles, rhonchi, and wheezes are heard on inspiration
and/or expiration in response to fluid accumulation, thick secretions, and airway
spasms and obstruction.
* Option Dt Elevate the bead of bed, change position frequently. Doing so would
lower the diaphragm and promote chest expansion aeration of lung segments,
mcbil izalion, a nd expectoration of secretions.
43. Question 1 P°ln, <&)
The most reliable index to determine the respiratory status of a client is to:
A. Observe the chest rising and falling.
B. Observe the skin and mucous membrane color.

Loading page 39...

C, Listen and feel the air movement.
D. Determine the presence of a femoral pulse.
Correct
Correct Answers C Listen .md lecl the nlr movement.
To check for breathing, the nurse places her ear and cheek next to the client's mouth
and nose to listen and feel for air movement. During the inspection, the examiner
should pay attention to the pattern of breathing: thoracic breathing, thoracoabdominal
breathing, coastal markings, and use of accessory breathing muscles. The use of
accessory breathing muscles (i.e., scalenes, sternocleidomastoid muscle, intercostal
muscles) could point to excessive breathing effort caused by pathologies.
* Option A: The chest rising and falling is not conclusive of a patent airway. The
position of the patient should also be noted, patients with extreme pulmonary
dysfunction will often sit up right, and in distress, they assume the tripod
position (leaning forward, resting their hands on their knees).
• Option 0: Observing skin color is not an accurate assessment of respiratory
status. The body habitus of the patient could provide information regarding
chest compliance, especially in the case of severely obese patients where chest
mobility and compliance are reduced due to added weight from adipose tissue.
♦ Option D: Checking the femoral pulse is not an assessment of respiratory
status. Palpation should focus on delecting abnormalities like masses or bony
Crepitus. During palpation the examiner can evaluate tactile fremitus: the
examiner will place both of his hands on the patient’s back, medial to the
shoulder blades, and ask the patient to say "ninety nine."
44. Question 1 P°i n HE)
A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be
included in the plan of care because of the poly cylhernia?
A. Fluid volume deficit related Io blood loss.
B Impaired tissue perfusion related to thrombosis.
C. Activity intolerance related to dyspnea.
D. Risk for infection related to suppressed immune response.

Loading page 40...

Correct
Correct Answer: B. Impaired tissue perfusion related to thrombosis.
Chronic hypoxia associated with CDPD may stimulate excessive REC production;
(polycylhernia). This results in increased blood viscosity and the risk of thrombosis.
The other nursing diagnoses are not applicable in this situa lien. The most common
causes of secondary polycylhernia include obstructive sleep apnea, obesity
hypoventilation syndrome, and Chronic obstructive pulmonary disease (COPD).
- Option A: |n secondary polycythemia, the number of red blood cells (RBCs) is
increased as a result of an underlying condition. Secondary polycythemia would
mere accurately be called secondary erythrocytosis or erythrocythemia, as those
terms specifically denote increased red blood cells. No blood loss is evident in
the stem.
- Option C: increased red blood cell mass increases blood viscosity and
decreases tissue perfusion. With impaired circulation to the central nervous
system, patients may present with headaches, lethargy, and confusion or more
serious presentations, such as stroke and obtundation.
* Option D: Plethora manifests as increased redness of the skin and mucosal
membranes. This finding is easier to delect on the paints or soles, where the
skin is light in dark skinned individuals. Some patients may have acrocyanosis
caused by sluggish blood flow through small blood vessels.
45. Question 1 P° l n , <s >
The physician has scheduled a client fur a left pneumonectomy. The position that will m o s t
likely be ordered postoperatively for his is the:
A_ Nonoperative side or back
B Operative side or back
C. Back only
D. Back or either side.
Correct
Correct Answer: B. Operative side or back
Following pneumonectomy, the client is positioned on the operative side to allow the
fluid left in the lung space to consolidate and avoid the heart from shifting to the
operative side. Pneumonectomy is defined as the surgical removal of the entire lung.
Extrapleural pneumonectomy is an expanded procedure that also involves resection of

Loading page 41...

parietal and visceral pleura, ipsi lateral hemidiaphragm, pericardium, and mediastinal
lymph nodes.
* Option A: The patient is then usually positioned in a lateral decubitus position
with the operating side up. Proper positioning of the D LT w the bronchial blocker
is usually reconfirmed with the FOB„and single lung ventilation is then started.
Care should be taken to ensure proper positioning to avoid perioperative nerve
injury.
' Option C: Following pneumonectomy, pulmonary functions decrease but are
usually less than anticipated for removal of 50% of lung, especially for residual
volume, and this may be explained by overexpansion of the remaining lung
tissue. FEVT, FVC, DLOD, and lung compliance decrease. Airway resistance
increases.
’ Option D' Patients with no disease in the remaining lung usually do have normal
SaO2, PO2, and PaCO2 at rest. A chest X ray immediately following
pneumonectomy usually shows the trachea in the midline and the
poslpneumoriectomy space to be filled with air. Later that space becomes filled
gradually with fluid ata rate of 1 to 2 intercostal spaces,''day. The ipsi lateral
diaphragm becomes elevated, and the mediastinum is gradually shifted towards
the operative side.
46. Question 1 P°i n , < 5)
Assessing a client who has developed atelectasis postoperalively, the nurse will most likely
find:
A. A flushed face.
B. Dyspnea and pain.
C. Decreased temperature.
D. Severe cough and no pain.
Correct
Correct Answer: fi Dyspnea and pain
Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients
become short of breath, have a high temperature, and usually experience severe pain
but do not have a severe cough. The shortness of breath is a result of decreased
oxygen carbon dioxide exchange al the alveolar level. Postoperative atelectasis
typically occurs within 72 hours of general anesthesia and is a we ll-known
postoperative complication.
» Option A: The definition of atelectasis is a partial collapse of the lung. Il can
cause people to feel short of breath. It can be a consequence of several

Loading page 42...

different processes, most commonly when there is a poor inspiratory effort an
obstruction blocking airflow into the lung, extra pressure exerted on the outside
of the lung, or deficient production or function of a specific protein in the lung.
* Option C: Postoperative fever has historically been attributed to atelectasis, but
there is no evidence supporting the finding that atelectasis is a causative
rnecftanism for fever. For patients with atelectasis, the prognosis varies greatly,
and the primary determination Is the underlying etiology and patient CD'
morbidities.
* Option D: Inadequate pain control can contribute Io the development of
atelectasis by inducing shallow breathing ('splinting') and/or inhibiting
coughing Typically, atelectasis is asymptomatic. However, a patient might also
present with decreased or absent breath sounds, crackles, cough, sputum
production, dyspnea, tachypnea, and/or diminished chest expansion.
47. Question 1 P°int W
A fifty year old client has a tracheostomy and requires tracheal suctioning. The fi r 5l
Intervention in completing this procedure would be to:
A. Change the tracheostomy dressing.
B. Provide humidity with a trach mask.
C. Apply oral or nasal suction.
D. Deflate the tracheal cuff.
Correct
Correct Answer: C. Apply oral or nasal suction
Before deflating the tracheaI cuff, the nurse wiII apply oraI or nasal suction Io the
airway to prevent secretions from falling into the lung. Dressing change and humidity
do nut relate Io suctioning. Airway suctioning is a procedure routinely done in most
care sellings, including acute care, sub acute care, long term care, and home settings.
Suctioning is performed when the patient is unable Io effectively move secretions from
the respiratory tract.
- Option A: Airways suctioning is indicated for multiple reasons. Most commonly
suctioning is done for the removal of secretions from the respiratory tract, but
sometimes also for removal of blood or other materials like meconium in
specific cases. Airway suctioning is also performed for diagnostic purposes.
* Option B: Suctioning of the lower air ways should be done in a sterile manner
with single'use gloves and suction catheters to prevent contamination arrd
secondary infection. After preparation with appropriate equipment at the
bedside and monitoring continuous heart rate and oxygen saturation (as

Loading page 43...

available), the patient should be suctioned with appropriately Sized equipment
for their airway.
* Option D: After preparation with appropriate equipment at the bedside and
monitoring continuous heart rale and oxygen saturation {as available), the
patient should be suctioned with appropriately sized equipment for their airway.
48. Question 1 P° in1 <s >
A client stales that the physician said the tidal volume is slightly diminished and asks the
nurse what this means. The nurse explains that the tidal volume is the amount of air:
A. Exhaled forcibly after a normal expiration.
B. Exhaled after there is a normal inspiration
C. Trapped in the alveoli that cannot be exha led.
D. Forcibly inspired over and above a normal respiration.
Correct
Correct Answer: B. Exhaled after there is a ncrmaE inspiration.
Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.
Tidal volume is Ifte amount of air tha L moves in or out of the lungs with each
respiratory cycle. II measures around 500 mL in an average healthy adult male and
appr oximalely 400 mL in a heal thy fema le. 11 i s a vita I cl in ical para meter that al lows for
proper ventilation to lake place.
- Option A: The expiratory reserve volume (ERV). about 1,200 m L is the additional
air that can be forcibly exhaled after the expiration of a normal tidal volume.
When a person breathes in, oxygen from the surrounding atmosphere enters the
ungs. Il then diffuses across the alveolar capillary interface Io reach arterial
blood. Al the same time, carbon dioxide continuously forms as long as
metabolism lakes place. Expiration occurs to expel carbon dioxide and prevent it
from accumulating in the body.
- Option C: Residual volume (RV), about 1,200 m L is the volume of air still
remaining in the lungs after the expiratory reserve volume is exhaled. When
emphysema develops, the alveoli and lung tissue are destroyed. With this
damage, the alveoli canrral support the bronchial tubes. The Lubes collapse and
cause an 'obstruction" (a blockage), which traps air inside the lungs.
* Option D: The inspiratory reserve volume (IRV), about 3,100 m L is the additional
air that can be forcibly inhaled after the inspiration of a normal tidal volume. The
volume of air occupying the lungs at different phases of the respiratory cycle
subdivides into four volumes and foia capacities. The four lung volunes are
inspiratory reserve volume (IRV), expiratory reserve volume (ERV), tidal volume

Loading page 44...

(V). and residual volume (RV), while the four lung capacities include total lung
capacity (TLC), vital capacity (VC), inspiratory capacity ()C), and functional
residual capacity (FRC).
49. Question 1
An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the
tissues, is caused by:
A_ A decreasing oxygen pressure in the blood.
B. An increasing carbon dioxide pressure in the blood.
C. A decreasing oxygon pressure and/or an Increasing carbon dioxide pressure in
the blood.
D. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in
the blood.
Correct
Correct Answer: C. A decreasing oxygen pressure and/or an increasing carbon dioxide
pressure in the blood.
The lower the PO2 and the higher the PC02, the more rapidly oxygen dissociated from
the oxyhemoglobin molecule. Factors that contribute Io a right shift in the oxygen
dissociation curve and favor the unloading of oxygen correlate with exertion. These
include increased body temperature, decreased pH (due to increased production of
CO2), and increased 2,3 BPG. (Figure) This right shift of the oxyhemoglobin curve can
be viewed as an adaptation for physical exertion.
• Option A: In the setting of hypoxia or low blood oxygen levels, irreversible tissue
damage can rapidly occur. Hypoxia can be the result of an impaired oxygen
carrying capacity of the blood (e.g., anemia), impaired unloading of oxygen from
hemoglobin in target tissues (e.g., carbon monoxide toxicity), or from a
restriction of blood supply.
* Option B: Hemoglobin {Hgb or Hb) is the primary carrier of oxygen in humans.
Approximately 98% of total oxygen transported in the blood is bound to
hemog lobin. wh lie only 2% is dissolved directly in plasma. Hemoglobin is a
metalloprotein with four subunits, each composed of an iron containing heme
group attached to a globin polypeptide chain. One molecule of oxygen can bind
to the iron atom of a heme group, giving each hemoglobin the ability Io transport
four molecules of oxygen.
’ Option □: The body maintains adequate oxygenation of tissues in the setting of
decreased PO or increased demand for oxygen. These changes often express

Loading page 45...

shifts in the oxygen dissociation curve, which represents the percentage of
hemoglobin saturated with oxygen at varying levels of PO.
50, Question 1 lw l n '
The best method of oxygen administration for client with CORD uses:
A.. Cannula
B. Simple Face mask
C. Non rebreather mask
D. Venturi mask
Correct
Correct Answer: 0. Venturi mask
Venturi delivers controlled oxygen. An air enlrainrrwnt {also known as venturi) mask
can provide a pre set oxygen Io the patient using jet mixing. As the percent of inspired
oxygen increases using Such a mask, the air to oxygen ratio decreases, causing the
maximum concentration of oxygen provided by an air entrainment mask to be around
40%.
* Option A: A thin lube, often affixed behind the ears and used to deliver oxygen
directly to the nostrils from a source connected with tubing. This is Hie most
common method of delivery for home use and provides flow rales of 2 to 6 liters
per minute (LPM) comfortably., allowing the delivery of oxygen while maintaining
the patient's ability to utilize his of tier mccilh to talk eat, etc.
- Option B: Facemasks can be generally divided into simp e face masks, air
entrainment masks, and non rebreathers. A simple facemask is a mask with no
bag attached, which delivers oxygen at 5 to 8 LPM. A disadvantage of this and
other full face masks is the inability of the patient Io eat, drink, or easily
communicate while using such a device.
* Option C: Non rebreathing masks have a bag attached to the mask known as a
reservoir hag, which inhalation draws from to fill the mask through a one way
valve and features ports al each side for exhalation, resulting in an ability to
provide the patient with 100% oxygen al a higher LPM flow rale.

Loading page 46...

Nurseslabs Menu
Comprehensive Respiratory System Disorders
NCLEX Challenge Exam (Quiz #2: 50 Questions)
UPDATED DN OCTOBER 17 2DQS
EV MATT VERA B5N, H.N
Hi! Ycxi Eire currently in the quiz page. If you're done with this quiz, please ctieck cut
the ether exams by clicking here Io go back to lhe Respiratory System Disorders
Nursing Test Bank page.
Quiz Guidelines
Before you atari, here- are same examination guidelines anJ raniuders you must read:
1. Practice Eeamc: Engage w Ih our Practice Exams Io hone your skills in a support ve. ow-pressiae
enviianment. These exams provide immed ale feedback and exp anal tins, l e u rig you grasp care
concepts, identify rnpravernert areas, and build conf deuce in your knowledge and ab ties.
2.Challenge Exatna : T i t our Challenge Exams to Lest your mastery and readmess under simulated
exairi conditions. These exams offer a rigorous question set to assess your urdei stand rig. prepare
you for actual exannrial ions, and benchmark you performance.
• You're given 2 minutes per item.
■ For CF allenge Exams, click on die "Start Quiz" button to start die quiz.
2. Ctrnplelu lhe quiz Ensure that you answer the er I re quiz. On y after you've answered every item
will Lhe score and rationales be shown.
4. Learn from rhe rationalee After each quiz, click on die "View Questions'' bcrtlcxi to undei stand the
explanation for each answer.
5.Free G uess wtiat? Our test banks are 100% FREE. Skip lhe hassle - no sign-ups oi
leg slialxins here. A sincere premise from Nurseslabs: we have not and won't ever request your
credit card details or personal info fur our practice quest ons. We re dedicated to keep ng this
service accessible and cost-free, espec ally Fur our amazing students and r arses. So. take the leap
and elevate your career hassle-free
6. $barn yoyr 1hppqht$ A'e d love your feedback, scares, and quest ons! Please share them in die
comments below.

Loading page 47...

1 pciint(s)
1. Question
Dr. Janes prescribes albuterol sulfate {ProventiI) for a patient with newly diagnosed asthma.
When teaching the patient about this drug, the nurse should explain that it may cause:
A_ Nasal congestion
B. Nervousness
C. Lethargy
□. Hyperkalemia
Correct
Correct Answer: B. Nervousness
Albuterol may cause nervousness. The primary adverse effects of albuterol therapy are
tremors and nervousness, mostly seen in Children who are 2 to 6 years of age, though
can be seen at any age. Tremors are the result of activation of the beta 2 receptors
found on the motor nerve terminals which increases intracellular cAMP. These side
effects occur in approximately one in every five patients. Other adverse effects of
albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension,
heartburn, nausea, vomiting and muscle cramps.
■ Option A: Ttie inhaled form of the drug may cause dryness and irritation of the
nose and throat, not nasal congestion. Monitoring parameters for albuterol
include farced expiratory volume, peak flow, blood pressure, heart rale, central
nervous system stimulation, serum potassium, serum glucose, and asthma
symptoms.
■ Option C: Other side effects include insomnia and nausea, which occur in
approximately 1 in every ten patients. Less common adverse effects may
include fever, bronchospasm vomiting, headache, dizziness, cough, allergic
reactions, otitis media, epistaxis, increased appetite, urinary tract infections, dry

Loading page 48...

mouth. gas. hyperhidrosis, pain, dyspepsia, hyperactivity, chills,
lymphadenopathy, ocular pruritus, sweating, conjunctivitis, and dysphonia.
■ Option D; Albuterol also has been shown to increase blood pressure and may
cause hypokalemia. Increased blood glucose concentrations and prolonged QTc
interval and ST segment depression have occurred although rarely.
l pcintfs)
2. Question
Miriam, a college student with acute rhinitis sees the campus nurse because of excessive
nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis,
nasal drainage normally is:
A_ Yellow
B. Green
• C. Clear
D. Gray
Correct
Correct Answer: C. Clear
Normally, nasal drainage in acute rhinitis is clear. Anterior rhinoscopy typically reveals
swelling of the nasal mucosa and thin, dlear secretions. The inferior turbinates may
take on a bluish hue, and cobblesloning of the nasal mucosa may be present. On
physical examination, clinicians may notice mouth breathing, frequent sniffling and/or
throat clearing, transverse supra tip nasal crease., and dark circles under the eyes
(allergic shiners).
* Option A: Yellow drainage indicates spread of the infection to the sinuses.
Yellow mucus Is a sign that whatever virus or infection the client has is taking
hold. The body is fighting back. The yellow color comes from the cells — white

Loading page 49...

blood cells, for example — rushing Io kill the offending germs. Once the cells
have done lheir work, they're discarded in the drainage and tinge it a yellowish
brown.
• n piion B: Green drainage may also indicate infection. If Lhe immune system
kicks into high gear to fight infection, lhe drainage may turn green and become
especially thick. The color comes from dead white blood cells and otfier waste
products. Some sinus infections may be viral, not bacterial.
* Oplion 0: Gray drainage may indicate a secondary infection. This could be a
fungal sinus infection. These are different from viral or bacterial infections
because the fungi feeds on the nasal tissue-and reproduces. Fungal Sinus
infections may occur due to a previous nasal injury or long term nasal
inflammation, as well as a weakened immune system. Growths called "fungus
balls" develop in the cheek sinus as clumps of fungal spores. The fungus balls
must be removed by surgery.
3. Question 1 ***■>
A male adult patienl hospitalized for treatment of a pulmonary embolism develops respiratory
alkalosis. Which clinical findings commonly accompany respiratory alkalosis?
A. Nausea or vomiting
B. Abdominal pain or diarrhea
C. Hallucinations or llnnitus
0. Lightheadedness or paresthesia
Correct
Correct Answer: D. Lightheadedness or paresthesia

Loading page 50...

The patient with respiratory alka losis may complain of Iightfleadedness or paresthesia
{numbness and tingling in the arms and legs). The exact history and physical exam
firtdings are highly variable as there are many pathologies that induce the pH
disturbance. These may include acute onset dyspnea, fever, chills, peripheral edema.,
orthopnea, weakness, confusion, light headedness, dizziness, anxiety, chest pain,
wheezing, hemoptysis, trauma, history of central line catheter, recent surgery, history of
thromboembolic disease, history of asthma, history of COPD, acute focal neurological
signs, numbness, paresthesia, abdominal pain, nausea, vomiting, tinnitus, or weight
loss.
< Qpiion A: Nausea, vomiting, abdominal pain, ar- d diarrhea may accompany
respiratory acidosis. Following a performance predominantly relying on
anaerobic glycolysis, systemic acidosis may cause vomiting as a physiological
response to drain H + and thereby allow the stomach to add bicarbonate to the
body
■ Option th Hyperchloremic acidosis is caused by lhe loss of too much sodium
bicarbonate from the body, which can happen with severe diarrhea. In
pathologies with profuse watery diarrhea, bicarbonate within the intestines is
lost through lhe stool due to increased motility of the guL This leads to further
secretion of bicarbonate from the pancreas and intestinal mucosa leading to
net acidification of the blood from bicarbonate loss.
• Option C: Hallucinations and tinnitus are associated with respiratory alkalosis or
any other acid base imbalance. Respiratory alkalosis in itself is not life
threatening; however, the underlying etiology may be. Always lock for and treat
lhe source of lhe illness. Interventions to reduce pH directly are typically not
necessary as there Is no mortality benefit to this therapy.
4. Question 1
Before administering ephedrine, Nurse Tony assesses the patient's history. Because of
ephedrine's central nervous system (CNS) effects, it is riot recommended for:
A. Patients with an acute asthma attack
B. Patients with narcolepsy.

Loading page 51...

C. Patients under aye
0. Elderly patients.
Correct
Correct Answer: D. Elderly patients
Ephedrine is ml recommended for elderly patients, who are particularly susceptible lb
CNS reactions (such as confusion and anxiety) and Io cardiovascular reactions (such
as increased systolic blood pressure., coldness in the extremities, and anginal pain).
Ephedrine is also arrhythrnoyenic, and caution should be used during administration to
patients who are predisposed to arrhythmias or taking other arrhythmogenic
medications, particularly digitalis.
■ Option A: Ephedrine is used for its bronchodilator effects with acute and chronic
astfima. Oral formulations of ephedrine have been used historically to treat
asthma via pulmonary vasoconstriction and reduction in airway edema along
with beta induced branchedilation, but it is rarely used for this purpose in
modern medicine due to unwanted cardiac effects and availability of more
selective beta agonists such as albuterol
■ Option 0: Ephedrine is used occasionally for its CNS stimulant actions for
narcolepsy. Ephedrine acts as both a direct and indirect sympathomimetic. It
binds directly to both alpha and beta receptors; however, its primary mode of
action is achieved indirectly, by inhibiting neuronal norepinephrine reuptake and
by displacing more norepinephrine from storage vesicles. This action allows
norepinepfirine lo be present in the synapse longer lo bind poslsynaptic alpha
and beta receptors.
• Opliort C: It can be administered Lo chi Idren age 2 and older. The FDA has not
formally established safety and effectiveness in pediatric populations.
Additional lyr ephedrine is distributed by the manufacturer in 50mg/mL vials and
requires dilution before intravenous use.
1 pointfs)
5. Question

Loading page 52...

A female patient suffers acute respiratory distress syndrome as a consequence of shock. The
patient's condition deteriorates rapidly, and endotracheal intubation and mechanical
ventilation are initialed. When the high pressure alarm on the mechanical ventilator, alarm
sounds, the nurse starts Io check for the cause. Which condition triggers the high pressure
alarm?
A. Kinking of the ventilator tubing.
B. A disconnected ventilator tube.
C. An endotracheal cuff leak
D. A change in the oxygen concentration without resetting ti e oxygen level alarm.
Correct
Correct Answer: A Kinking of the ventilator tubing,
Conditions that trigger the high' pressure alarm include kinking of the ventilator tubing,
bronchospasm or pulmonary embolism, mucus plugging, water in the lube, coughing or
biting on endotracheal lube, and the patient's being out of breathing rhythm with the
ventilator. If an alarm occurs, the caregiver should always evaluate Hie patient before
checking the ventilator.
■ Option B: A disconnected ventilator tube would trigger the low pressure alarm. If
the pressure inside the breathing circuit drops below the Low Airway Pressure
Alarm limit set on the ventilator, an audible and/or visual alarm activates.
• Option C: Some causes for low pressure alarms are: the patient becomes
disconnected from the ventilator circuit; inadequate inflation of the
tracheostomy tube cuff; poorly fitting noninvasive masks or nasal
pillows/prOngs; loose circuit and lubing connections; or the patient demands
higher levels of air than the ventilator is putting cut.
• Option £>: Changing Lheoxygen concentration without reselling the oxygen level
alarm would trigger Hie oxygen alarm. Oxygen concentration is the amount of

Loading page 53...

oxygen delivered Lu the patient. When the patient is not receiving added oxygen,
the oxygen level will be the same as room air (21%).
6. Question 1 P°int (B >
A male adult patient on mechanical ventilation is receiving pancuronium bromide (Pavulon),
0.01 mg/kg I.V. as needed. Which assessment finding indicates that the patient needs another
pancuronium dose?
1. Leg movement
A. Leg movement
B. Finger movement
C. Lip movement
CL Fighting the ventilator
Correct
Correct Answer: D. Fighting the ventilator
Pancuroniunxa nun depolarising blocking agent, is used fur muscle relaxation and
paralysis. It assists mechanical ventilation by promoting endotracheal intubation and
paralysing the patient so that the mechanical ventilator can do its work Fighting the
ventilator is a sign that the patient needs anolfier pancuronium dose. Tfie nurse should
administer 0.01 to 0.02 mg/kg LV. every 20 to 60 minutes. Movement of the legs, or
lips has no effect on the ventilator and therefore is not used to determine the need for
another dose.
* Option A: Leg movement is not used as an indication for another dose.
Pancuronium bromide is a long acting, bis quaternary ami nosleroid, non'
depolarising, neuromuscular blocking drug (NMBD), which was first synthesized

Loading page 54...

51 more pages available. Scroll down to load them.

Preview Mode

100%

Study Now!

XY-Copilot AI

Unlimited Access

Secure Payment

Instant Access

24/7 Support

Document Chat

Document Details

Subject

National Council Licensure Examination

Comprehensive Respiratory System Disorders NCLEX C

Study Now!

Document Details

Related Documents

NSG 3160 NCLEX Review Chapter 15

NSG 3160 NCLEX Review Chapter 14

NSG 3160 NCLEX Review Chapter 24

Lippincott Style NCLEX Questions

NCLEX PN Test Practice Questions

Lecture Notes NCLEX

NCLEX Study Guide

Comprehensive NCLEX Review

NCLEX Style Questions Nutrition

Key Concepts for NCLEX

Company

Explore

Study Tools