Chapter 31: Chronic Respiratory Disorders

MULTIPLE CHOICE

1. The nurse assesses wheezes in a patient with asthma and realizes that these breath sounds result from:1. increased thickness of respiratory secretions.2. use of accessory muscles of respiration.3. tachypnea and tachycardia.4. movement of air through narrowed airways.

ANS: 4Wheezes are adventitious sounds made by air passing through narrowed passages.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 551OBJ: 1 TOP: Asthma: WheezeKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The nurse is caring for an asthmatic patient with a nursing diagnosis of “Impaired gas exchange related to air trapping.” The intervention that would be appropriate to add to the nursing care plan is to:1. provide postural drainage.2. administer oxygen at 8 L/minute.3. position flat in bed with small pillow.4. increase fluid intake.

ANS: 4Increasing fluid intake thins mucus in the lungs, making it easier to cough up, which helps clear the bronchioles and decrease ventilation-perfusion mismatch. Increasing O2 is not helpful if there is no air path to the alveoli. Increasing O2 to 8 L is excessive.

PTS: 1 DIF: Cognitive Level: Analysis REF: 553OBJ: 4 TOP: Asthma KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

3. The characteristic of COPD that puts the patient at risk for the nursing diagnosis of “Imbalanced nutrition: less than body requirements” is:1. increased metabolism.2. anxiety.3. chronic constipation.4. excessive respiratory effort.

ANS: 4Respiratory effort interferes with swallowing, depletes energy, and increases calorie needs.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 560OBJ: 4 TOP: COPD: NutritionKEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

4. The nursing intervention that will enhance the nutritional status of a patient with COPD is to:1. offer small, frequent meals.2. encourage extra liquids with meals.3. assist the patient to exercise before meals.4. supply information about nutrition.

ANS: 1Small meals are not as tiring for the patient and are more appealing.

PTS: 1 DIF: Cognitive Level: Application REF: 560OBJ: 4 TOP: COPD: NutritionKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

5. As part of a progressive walking program, the obese patient with COPD is horrified when the nurse recommends walking for:1. 10 to 15 minutes a day.2. 20 to 30 minutes a day.3. 45 to 60 minutes a day.4. up to 2 hours a day.

ANS: 1Walking for as little as 10 to 15 minutes a day and progressing up to 45 minutes a day has proven beneficial for persons with COPD because it improves oxygenation and helps with weight loss.

PTS: 1 DIF: Cognitive Level: Application REF: 556OBJ: 4 TOP: Exercise for COPD PatientKEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

6. The nurse advises the parents of a child who is in status asthmaticus that if not corrected, the result could be:1. pneumothorax, severe hypoxemia, and respiratory arrest.2. hypertension, CVA, and cardiac arrest.3. respiratory alkalosis, pneumonia, and death.4. lung abscess, cor pulmonale, and respiratory failure.

ANS: 1Status asthmaticus, because of severe bronchospasms, can result in hypoxemia leading to pneumothorax and arrest.

PTS: 1 DIF: Cognitive Level: Application REF: 551OBJ: 3 TOP: Status AsthmaticusKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

7. In assessing for major sources of infection in a COPD patient, the nurse focuses on:1. stasis of respiratory secretions.2. low body weight.

3. episodes of postural hypotension.4. delayed antigen-antibody response.

ANS: 1Retained static secretions in the lungs are major sources of bacterial infiltration and infection.

PTS: 1 DIF: Cognitive Level: Application REF: 560OBJ: 3 TOP: COPD: InfectionKEY: Nursing Process Step: AssessmentMSC: NCLEX: Health Promotion and Maintenance

8. When the young AIDS patient complains of debilitating night sweats, the home health nurse suggests that he go to the clinic for:1. a prescription for antibiotics.2. a TB screen.3. complete blood count.4. treatment with an aerosol inhalant.

ANS: 2The symptoms of TB are low-grade fever, night sweats, and cough. AIDS patients are extremely prone to TB and should be monitored carefully for the development of the disease.

PTS: 1 DIF: Cognitive Level: Comprehension REF: 562OBJ: 3 TOP: TuberculosisKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

9. The nurse caring for an 80-year-old COPD patient suspects right-sided heart failure and assesses and records the data. A sign of right-sided heart failure is decreasing:1. blood pressure.2. urine output.3. respirations.4. heart rate.

ANS: 2The decreasing urine output is one of the signs. The fluid, instead of being excreted as urine, is not trapped in the tissues as edema. Blood pressure, respirations, and heart rate will increase with right-sided heart failure.

PTS: 1 DIF: Cognitive Level: Application REF: 561OBJ: 3 TOP: Dyspnea KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

10. When asked by a tubercular patient how long he will have to take his TB medications, the nurse’s best response would be:1. “Generally about 2 weeks.”2. “Depending on the drug, it may be as long as 2 years.”3. “TB drugs are usually taken throughout the life span.”4. “People ask that frequently; it depends on many things.”

ANS: 2Some TB drugs are continued over the course of several years.

PTS: 1 DIF: Cognitive Level: Application REF: 563OBJ: 3 TOP: TB Drug ProtocolKEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

11. The discharge instruction given by the nurse that would be informative to a tuberculosis patient who asks how to protect his family members from his disease is:1. “Your family will need to take treatment to prevent infection.”2. “You will need to wear a mask at home to protect your family members.”3. “You should cover your mouth and nose if coughing or sneezing.”4. “You should avoid intimate contact with everyone.”

ANS: 3Covering the mouth and nose to prevent droplet spread and careful disposal of tissues is a major method of infection control. There is no need for masks or isolation, because on discharge the TB patient will have been stabilized on anti-TB medication.

PTS: 1 DIF: Cognitive Level: Application REF: 564OBJ: 3 TOP: TB Infection ControlKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

12. A patient with a history of smoking two packs of cigarettes a day for the past 20 years says that he is not alarmed by his cough. He says, “I get this cough and spit up mucus every winter.” The nurse recognizes these symptoms as being suggestive of:1. chronic bronchitis.2. emphysema.3. sarcoidosis.4. diffuse interstitial fibrosis.

ANS: 1Chronic bronchitis in smokers is a common finding that results in inflamed bronchi, with chronic cough for at least 4 months of the year.

PTS: 1 DIF: Cognitive Level: Application REF: 553OBJ: 3 TOP: Chronic BronchitisKEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. An asthma patient asks the purpose of learning to use a PEFR (peak expiratory flow rate) device. The nurse’s best response is that the PEFR:1. dilates the bronchi to relieve dyspnea.2. measures expired air to evaluate ventilation.3. soothes inflamed bronchi, reducing spasm.4. liquefies sputum for easier expectoration.

ANS: 2

The PEFR measures expired air. When the PEFR rate decreases 20% below the baseline, adjustments are usually made in the medications.

PTS: 1 DIF: Cognitive Level: Analysis REF: 553OBJ: 4 TOP: PEFR KEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

14. When the nurse reads the diagnosis of centrilobar emphysema, the nurse recognizes that this type of emphysema is characterized by:1. no significant smoking history in the patient.2. enlarged and broken down bronchioles, with intact alveoli.3. hypoelastic bronchi and bronchioles.4. deficiency of the enzyme inhibitor alpha1-antitrypsin.

ANS: 2Centrilobar emphysema is characterized by a long smoking history, enlarged and broken down bronchioles, and hypoelastic bronchi.

PTS: 1 DIF: Cognitive Level: Analysis REF: 554OBJ: 3 TOP: Emphysema KEY: Nursing Process Step: AssessmentMSC: NCLEX: Physiological Integrity

15. When the 25-year-old cystic fibrosis (CF) patient tells the home health nurse that he wants to take a nice vacation, a safe suggestion by the nurse would be a week:1. in Greece in July.2. in Colorado in May.3. in New York in November.4. on the Mexican coast in August.

ANS: 3New York is the best choice because persons with CF sweat profusely and lose many salts, leading to significant electrolyte imbalance. CF patients also have impaired respiration. CF patients should avoid heat (Greece in July, Mexico in August) and higher altitudes (Colorado any time).

PTS: 1 DIF: Cognitive Level: Analysis REF: 561OBJ: 3 TOP: Cystic Fibrosis: Avoiding HeatKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

16. Which of these assessments made by the nurse indicates that respiratory arrest is imminent in an asthmatic?1. Agitation2. Tachycardia3. Absence of wheezing4. Flaring nares

ANS: 3Absence of wheezing indicates diminished ventilation effort.

PTS: 1 DIF: Cognitive Level: Analysis REF: 551OBJ: 3 TOP: Asthma: Respiratory ArrestKEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment

17. The COPD patient has a nursing diagnosis of “Activity intolerance related to inability to meet oxygen needs.” The intervention that would be inappropriate for this diagnosis would be:1. bunch all nursing activities and treatments close together.2. schedule rest periods during the day.3. assist patient only when needed, to encourage independence.4. daily ambulation to build tolerance.

ANS: 1Bunching nursing activities is tiring to the patient with COPD. Assisting only when needed saves patient energy as well as enhancing independence. Activities should be spread out to allow for uninterrupted rest periods. Progressive ambulation is an acceptable way to build tolerance.

PTS: 1 DIF: Cognitive Level: Analysis REF: 560-561OBJ: 4 TOP: Activity Intolerance in COPDKEY: Nursing Process Step: ImplementationMSC: NCLEX: Physiological Integrity

18. The nurse recognizes that a rising PaCO2 level in a COPD patient means that:1. there is more arterial oxygen available than is needed.2. the ventilation-perfusion ratio is becoming balanced.3. respiratory acidosis has begun.4. the anticholinergics are effective.

ANS: 3A rising PaCO2 level (arterial carbon dioxide pressure) is acidic in nature and causes respiratory acidosis.

PTS: 1 DIF: Cognitive Level: Application REF: 554-555OBJ: 3 TOP: PaCO2 KEY: Nursing Process Step: AssessmentMSC: NCLEX: Safe, Effective Care Environment

19. The nurse is aware that the characteristic of emphysema that gives rise to the “Pink Puffer” label is the emphysemic patient’s:1. dyspnea.2. barrel chest.3. thin body.4. normal ABGs.

ANS: 4The normal ABGs give the emphysemic patient a normal pink color, rather than cyanosed, like the Blue Bloater.

PTS: 1 DIF: Cognitive Level: Application REF: 555, Figure 31-7

OBJ: 3 TOP: Emphysema KEY: Nursing Process Step: AssessmentMSC: NCLEX: Physiological Integrity

20. The COPD patient asks the nurse if nicotine patches are effective for smoking cessation. The nurse’s best response would be:1. “No. Only about 25% are successful.”2. “Yes. Success rate is about 50% to 60%”.3. “No. Prescriptions like Wellbutrin are 90% effective.”4. “Yes. Individual success has been obtained with combination of patches and gum.”

ANS: 1The patches have a lower than 25% success rate. Smoking addiction is too strong to be overcome by medication or gum without very unusual commitment from the patient. Successful smoking cessation is measured by 1 year of no smoking.

PTS: 1 DIF: Cognitive Level: Application REF: 557OBJ: 4 TOP: COPD: Smoking CessationKEY: Nursing Process Step: PlanningMSC: NCLEX: Health Promotion and Maintenance

21. The cystic fibrosis patient furiously refuses any more manual chest physiotherapy. The nurse could suggest which alternative?1. Flutter mucus device2. Increase ambulation to 1 to 2 hours/day3. Steam inhalator several times a day4. Drinking 3 quarts of fluid per day

ANS: 1A flutter mucus clearance device is a hand-held vibrating tool that helps loosen and evacuate secretions in the lung.

PTS: 1 DIF: Cognitive Level: Analysis REF: 561OBJ: 4 TOP: Cystic FibrosisKEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

22. The nurse assessing the CBC of a patient with chronic bronchitis identifies a typical feature of this disease, which is:1. decreased platelets.2. decreased white blood cells.3. increased eosinophils.4. increased red blood cells.

ANS: 4Chronic bronchitis patients show a large increase of red blood cells with an attendant higher hemoglobin level, because they must produce more RBCs for the transport of O2. Frequently, the WBCs are elevated because of the chronic inflammation. Decreased levels of platelets and eosinophils are indicative of pathology other than bronchitis.

PTS: 1 DIF: Cognitive Level: Application REF: 555OBJ: 4 TOP: Chronic Bronchitis CBC

KEY: Nursing Process Step: AssessmentMSC: NCLEX: Health Promotion and Maintenance

23. The COPD patient delightedly tells the nurse that he has quit smoking and is using chewing tobacco. The nurse’s best intervention would be to:1. congratulate him on his quitting smoking.2. warn him of the dangers of oral cancer.3. suggest that he add nicotine patches in addition to the chewing tobacco.4. point out that he is still addicted and is using tobacco.

ANS: 2Smokeless tobacco has adverse effects, including oral cancer.

PTS: 1 DIF: Cognitive Level: Application REF: 559, Box 31-1OBJ: 3 TOP: COPD: Quit SmokingKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

24. A newly diagnosed patient with squamous cell lung carcinoma (SCLC) is anxious about having to take chemotherapy. The intervention by the nurse that would be helpful is to:1. support the patient in preparation for surgery.2. educate the patient regarding the high survival rate with this type of carcinoma.3. assure the patient that chemotherapy and radiation are seldom used in this sort of

cancer.4. refer the patient to the American Cancer Society for postdischarge follow-up.

ANS: 1Surgery is the treatment of choice of SCLC carcinomas. Options 2 and 3 are not correct, because SCLC tumors are sometimes treated by chemotherapy and radiation before or after surgery. The survival rate is only about 14%. Although referral may be in the long-range plan, the patient’s need is immediate for information that is in the scope of nursing.

PTS: 1 DIF: Cognitive Level: Analysis REF: 567-568OBJ: 4 TOP: Squamous Cell CarcinomaKEY: Nursing Process Step: ImplementationMSC: NCLEX: Psychosocial Integrity

25. The theophylline blood level is 13 mcg/mL. Which intervention is the most appropriate in light of this finding?1. Give the next dose of theophylline as ordered.2. Skip the next dose, and then resume.3. Call the charge nurse or physician.4. Take the patient’s blood pressure immediately.

ANS: 1The therapeutic range of theophylline is 5 to 15 mcg/mL. The drug should be administered. This drug is not the drug of choice today but is still in use, even though it causes cardiac problems.

PTS: 1 DIF: Cognitive Level: Application REF: 556

OBJ: 3 TOP: Theophylline LevelsKEY: Nursing Process Step: ImplementationMSC: NCLEX: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. The nurse uses a picture to demonstrate the bullae and blebs associated with emphysema. The nurse points out that the difference between the two is that blebs (select all that apply):1. are between the alveolar spaces in the lungs.2. are in the lung parenchyma.3. can rupture, causing the lungs to collapse.4. are responsible for diaphragm flattening.5. are precancerous.

ANS: 2, 3Blebs are growths inside the organ of the lung that enlarge and rupture, causing lung collapse. Bullae are the lesions between the alveolar spaces. Neither are the cause of diaphragm flattening nor are they precancerous.

PTS: 1 DIF: Cognitive Level: Analysis REF: 554OBJ: 3 TOP: Blebs and Bullae of EmphysemaKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

COMPLETION

1. The nurse cautions a group of persons with COPD that using O2 at levels greater than 1 to 3 L/minute can cause the loss of their _________________________.

ANS: Hypoxic drive

PTS: 1 DIF: Cognitive Level: Comprehension REF: 556OBJ: 3 TOP: Hypoxic DriveKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance

OTHER

1. The nurse explains to a family how the asthma attack progresses by using a progressive list of pathologic events (place the options in the correct sequence):

1.2. Ventilation-perfusion mismatch3. Production of mucous plug4. Hypoxemia with compensatory hyperventilation5. Triggering of inflammatory process

ANS:5, 1, 3, 2, 4

After the allergen has triggered the inflammatory response, bronchoconstriction occurs, which leads to the formation of mucous plugs in the bronchioles that block O2 from entering the alveoli, causing a ventilation-perfusion mismatch and resulting in hypoxemia and hyperventilation.

PTS: 1 DIF: Cognitive Level: Analysis REF: 550OBJ: 3 TOP: Progression of Asthma AttackKEY: Nursing Process Step: ImplementationMSC: NCLEX: Health Promotion and Maintenance