Airway-Obstruction NCLEX Questions

7/28/2019 Airway-Obstruction NCLEX Questions

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1. An elderly client with pneumonia may appear with which of the following symptoms first?A. Altered mental status and dehydrationB. fever and chillsC. Hemoptysis and dyspneaD. Pleuretic chest pain and cough

2. Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows

pneumonia to develop?

1. Atelectasis2. Bronchiectasis3. Effusion4. Inflammation

3. A 7-year-old client is brought to the E.R. Hes tachypneic and afebrile and has a respiratory rate of 36

breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have

which of the following?

1. Acute asthma2. Bronchial pneumonia3. Chronic obstructive pulmonary disease (COPD)4. Emphysema

4. Which of the following assessment findings would help confirm a diagnosis of asthma in a client

suspected of having the disorder?

1.

Circumoral cyanosis2. Increased forced expiratory volume3. Inspiratory and expiratory wheezing4. Normal breath sounds

5. Which of the following types of asthma involves an acute asthma attack brought on by an upper

respiratory infection?

1. Emotional2. Extrinsic3. Intrinsic4. Mediated6. A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory

volume should be treated with which of the following classes of medication right away?

1. Beta-adrenergic blockers2. Bronchodilators3. Inhaled steroids


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4. Oral steroids

7. A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44

breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should

be taken first?

1. Take a full medication history2. Give a bronchodilator by neubulizer3. Apply a cardiac monitor to the client4. Provide emotional support to the client.

8. A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a

chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this

information, he most likely has which of the following conditions?

1. Adult respiratory distress syndrome (ARDS)2. Asthma3. Chronic obstructive bronchitis4. Emphysema

9. The term blue bloater refers to which of the following conditions?

1. Adult respiratory distress syndrome (ARDS)2. Asthma3. Chronic obstructive bronchitis4. Emphysema

10. The term pink puffer refers to the client with which of the following conditions?

1. ARDS2. Asthma3. Chronic obstructive bronchitis4. Emphysema

11. A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. Hes

tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced

on his knees to support his chest and shoulders for breathing. This client has symptoms of which of thefollowing respiratory disorders?



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12. Its highly recommended that clients with asthma, chronic bronchitis, and emphysema have

Pneumovax and flu vaccinations for which of the following reasons?

1. All clients are recommended to have these vaccines2. These vaccines produce bronchodilation and improve oxygenation.3. These vaccines help reduce the tachypnea these clients experience.4. Respiratory infections can cause severe hypoxia and possibly death in these clients.

13. Exercise has which of the following effects on clients with asthma, chronic bronchitis, and

emphysema?

1. It enhances cardiovascular fitness.2. It improves respiratory muscle strength.3. It reduces the number of acute attacks.4. It worsens respiratory function and is discouraged.

14. Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons

best explains why?

1. Reducing fluid volume reduces oxygen demand.2. Reducing fluid volume improves clients mobility.3. Restricting fluid volume reduces sputum production.4. Reducing fluid volume improves respiratory function.

15. A 69-year-old client appears thin and cachectic. Hes short of breath at rest and his dyspnea increases

with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and

symptoms fit which of the following conditions?


16. A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose

his hypoxic drive. Which of the following statements is correct about hypoxic drive?

1. The client doesnt notice he needs to breathe.2.

The client breathes only when his oxygen levels climb above a certain point.

3. The client breathes only when his oxygen levels dip below a certain point.4. The client breathes only when his carbon dioxide level dips below a certain point.

17. Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of

the following topics?

1. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.


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2. How to increase his oxygen therapy.3. How to treat respiratory infections without going to the physician.4. How to recognize the signs of an impending respiratory infection.

18. Which of the following respiratory disorders is most common in the first 24 to 48 hours after

surgery?

1. Atelectasis2. Bronchitis3. Pneumonia4. Pneumothorax

19. Which of the following measures can reduce or prevent the incidence of atelectasis in a post-

operative client?

1. Chest physiotherapy2. Mechanical ventilation3. Reducing oxygen requirements4. Use of an incentive spirometer

20. Emergency treatment of a client in status asthmaticus includes which of the following medications?

1. Inhaled beta-adrenergic agents2. Inhaled corticosteroids3. I.V. beta-adrenergic agents4. Oral corticosteroids

21. Which of the following treatment goals is best for the client with status asthmaticus?

1. Avoiding intubation2. Determining the cause of the attack3. Improving exercise tolerance4. Reducing secretions

22. Dani was given dilaudid for pain. Shes sleeping and her respiratory rate is 4 breaths/minute. If action

isnt taken quickly, she might have which of the following reactions?

1. Asthma attack2. Respiratory arrest3. Be pissed about receiving Narcan4. Wake up on her own

23. Which of the following additional assessment data should immediately be gathered to determine the

status of a client with a respiratory rate of 4 breaths/minute?


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1. Arterial blood gas (ABG) and breath sounds2. Level of consciousness and a pulse oximetry value.3. Breath sounds and reflexes4. Pulse oximetry value and heart sounds

24. A client is in danger of respiratory arrest following the administration of a narcotic analgesic. Anarterial blood gas value is obtained. The nurse would expect to PaCO2 to be which of the following values?

1. 15 mm Hg2. 30 mm Hg3. 40 mm Hg4. 80 mm Hg

25. A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops

chest tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness.

These signs indicate which of the following conditions?

1. Asthma attack2. Pulmonary embolism3. respiratory failure4. Rheumatoid arthritis

26. Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drugshould include which of the following actions first?

1. Administering oxygen2. Inserting an I.V. catheter3.

Obtaining a complete blood count (CBC)4. Taking vital signs

27. Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to

a drug, the nurse should take which of the following steps next?

1. Administer beta-adrenergic blockers2. Administer bronchodilators3. Obtain serum electrolyte levels4. Have the client lie flat in the bed.

28. A clients ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L;

SaO2 81%. This ABG result represents which of the following conditions?

1. Metabolic acidosis2. Metabolic alkalosis3. Respiratory acidosis4. Respiratory alkalosis


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29. A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is

most likely to experience what type of acid-base imbalance?

1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis

30. A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of

7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory

alkalosis. Which laboratory value would most likely be noted in this condition?

1. Sodium level of 145 mEq/L2. Potassium level of 3.0 mEq/L3. Magnesium level of 2.0 mg/L4. Phosphorus level of 4.0 mg/dl

31. A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30

mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating:

1. Metabolic acidosis, compensated.2. Metabolic alkalosis, uncompensated.3. Respiratory alkalosis, compensated.4. Respiratory acidosis, compensated.

32. A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before

the blood is drawn, an Allens test is performed to determine the adequacy of the:

1.

Popliteal circulation2. Ulnar circulation3. Femoral circulation4. Carotid circulation

33. A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse

monitors the client, knowing that the client is at risk for which acid-base disorder?

1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4.

Metabolic alkalosis

34. A nurse is caring for a client with an ileostomy understands that the client is most at risk for

developing which acid-base disorder?

1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis


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4. Metabolic alkalosis

35. A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing

Kussmauls respirations. Based on this documentation, which of the following did the nurse observe?

1. Respirations that are abnormally deep, regular, and increased in rate.2. Respirations that are regular but abnormally slow.3. Respirations that are labored and increased in depth and rate4. Respirations that cease for several seconds.

36. A nurse understands that the excessive use of oral antacids containing bicarbonate can result in whichacid-base disturbance?

1. Respiratory alkalosis2. Respiratory acidosis3. Metabolic acidosis4. Metabolic alkalosis

37. A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32

mm Hg, and a bicarbonate concentration of 20 mEq/L. The nurse has determined that the client is

experiencing metabolic acidosis. Which of the following laboratory values would the nurse expect to

note?

1. Sodium level of 145 mEq/L2. Magnesium level of 2.0 mg/dL3. Potassium level of 5.2 mEq/L4. Phosphorus level of 4.0 mg/dL

38. A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the

Allens test on the client. Number in order of priority the steps for performing the Allens test (#1 is first

step).

1. Ask the client to open and close the hand repeatedly.2. Apply pressure over the ulnar and radial arteries.3. Assess the color of the extremity distal to the pressure point4. Release pressure from the ulnar artery5. Explain the procedure to the client.

39. A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing

actions will facilitate obtaining the specimen?

1. Limiting fluids2. Having the client take 3 deep breaths.3. Asking the client to spit into the collection container.4. Asking the client to obtain the specimen after eating.


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40. A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted

in the client should be reported immediately to the physician?

1. Blood-streaked sputum2. Dry cough3. Hematuria4. Bronchospasm

41. A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must

limit the suctioning to a maximum of:

1. 5 seconds2. 10 seconds3. 30 seconds4. 1 minute

42. A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning

procedure, the nurse notes on the monitor that the heart rate decreases. Which of the following is the most

appropriate nursing intervention?

1. Continue to suction2. Ensure that the suction is limited to 15 seconds3. Stop the procedure and reoxyenate the client4. Notify the physician immediately.

43. An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a

pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. Anelevated potassium level is also present. These results indicate the presence of:

1. Metabolic acidosis2. Respiratory acidosis3. Combined respiratory and metabolic acidosis4. overcompensated respiratory acidosis

44. A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the followingwould the nurse expect to note on assessment of this client?

1.

Increased oxygen saturation with exercise2. Hypocapnia3. A hyperinflated chest on x-ray film4. A widened diaphragm noted on chest x-ray film

45. An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen

concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be

prescribed?


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1. Venturi mask2. Aerosol mask3. Face tent4. Tracheostomy collar

46. Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and thenurse instructs the client about the medication. Which statement by the client indicates a need for further

teaching?

1. I will take the medication on an empty stomach. 2. I will take the medication with food.3. I will continue to take the medication even if I am feeling better.4. Periodic blood levels will need to be obtained.

47. A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the

oxygen flow rate to ensure that it does not exceed

1. 1 L/min2. 2 L/min3. 6 L/min4. 10 L/min

48. The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the

following values would indicate that this acid-base imbalance exists?

1. pH of 7.482.

PCO2 of 32 mm Hg3. pH of 7.30

4. HCO3- of 20 mEq/L

49. A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about

the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip

breathing is:

1. Promote oxygen intake2. Strengthen the diaphragm3. Strengthen the intercostal muscles4.

Promote carbon dioxide elimination

50. A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25

mEq/L. The nurse interprets these values as indicating:

1. Respiratory acidosis uncompensated2. Respiratory alkalosis uncompensated3. Metabolic acidosis uncompensated4. Metabolic acidosis partially compensated.


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51. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse administers the

medication, knowing that the primary action of this medication is to:

1. Promote expectoration2. Suppress the cough3. Relax smooth muscles of the bronchial airway4. Prevent infection

52. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the

client for which side effect of this medication?

1. Constipation2. Diarrhea3. Bradycardia4. Tachycardia

53. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a

need for further teaching?

1. Removes the cap and shakes the inhaler well before use.2. Presses the canister down with finger as he breathes in.3. Inhales the mist and quickly exhales.4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

54. A female client is scheduled to have a chest radiograph. Which of the following questions is of mostimportance to the nurse assessing this client?

1. Is there any possibility that you could be pregnant?2. Are you wearing any metal chains or jewelry?3. Can you hold your breath easily?4. Are you able to hold your arms above your head?

55. A client has just returned to a nursing unit following bronchoscopy. A nurse would implement whichof the following nursing interventions for this client?

1.

Encouraging additional fluids for the next 24 hours2. Ensuring the return of the gag reflex before offering foods or fluids3. Administering atropine intravenously4. Administering small doses of midazolam (Versed).

56. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse occludes the:

1. Brachial and radial arteries, and then releases them and observes the circulation of the hand.


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2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats the process withthe other artery.

3. Radial artery and observes for color changes in the affected hand.4. Ulnar artery and observes for color changes in the affected hand.

57. A nurse is assessing a client with chronic airflow limitation and notes that the client has a barrelchest. The nurse interprets that this client has which of the following forms of chronic airflow limitation?

1. Chronic obstructive bronchitis2. Emphysema3. Bronchial asthma4. Bronchial asthma and bronchitis

58. A client has been taking benzonatate (Tessalin Perles) as prescribed. A nurse concludes that the

medication is having the intended effect if the client experiences:

1. Decreased anxiety level2. Increased comfort level3. Reduction of N/V4. Decreased frequency and intensity of cough

59. Which of the following would be an expected outcome for a client recovering from an upperrespiratory tract infection? The client will:

1. Maintain a fluid intake of 800ml every 24 hours.2. Experience chills only once a day3.

Cough productively without chest discomfort.4. Experience less nasal obstruction and discharge.

60. Which of the following individuals would the nurse consider to have the highest priority for receiving

an influenza vaccination?

1. A 60-year-old man with a hiatal hernia2. A 36-year-old woman with 3 children3. A 50-year-old woman caring for a spouse with cancer4. a 60-year-old woman with osteoarthritis

61. A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of

the following instructions would be appropriate for the nurse to give the client?

1. Use your nasal decongestant spray regularly to help clear your nasal passages. 2. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.3. It is important to increase your activity. A daily brisk walk will help promote drainage. 4. Keep a diary if when your symptoms occur. This can help you identify what precipitates your

attacks.


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62. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she

develops a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse

crackles. How would the nurse best interpret these assessment findings?

1. It is likely that the client is developing a secondary bacterial pneumonia.2. The assessment findings are consistent with influenza and are to be expected.3. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions.4. The client has not been taking her decongestants and bronchodilators as prescribed.

63. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of theliquid is 200mg/5ml. How many mL should the nurse administer each dose?

1. 5.0 ml2. 7.5 ml3. 9.5 ml4. 10 ml

64. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a

possible side effect of this drug?

1. Constipation2. Bradycardia3. Diplopia4. Restlessness

65. A client with COPD reports steady weight loss and being too tired from just breathing to eat.

Which of the following nursing diagnoses would be most appropriate when planning nutritional

interventions for this client?

1. Altered nutrition: Less than body requirements related to fatigue.2. Activity intolerance related to dyspnea.3. Weight loss related to COPD.4. Ineffective breathing pattern related to alveolar hypoventilation.

66. When developing a discharge plan to manage the care of a client with COPD, the nurse should

anticipate that the client will do which of the following?

1. Develop infections easily2. Maintain current status3. Require less supplemental oxygen4. Show permanent improvement.


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67. Which of the following outcomes would be appropriate for a client with COPD who has been

discharged to home? The client:

1. Promises to do pursed lip breathing at home.2. States actions to reduce pain.3. States that he will use oxygen via a nasal cannula at 5 L/minute.4. Agrees to call the physician if dyspnea on exertion increases.

68. Which of the following physical assessment findings would the nurse expect to find in a client with

advanced COPD?

1. Increased anteroposterior chest diameter2. Underdeveloped neck muscles3. Collapsed neck veins4. Increased chest excursions with respiration

69. Which of the following is the primary reason to teach pursed-lip breathing to clients with

emphysema?

1. To promote oxygen intake2. To strengthen the diaphragm3. To strengthen the intercostal muscles4. To promote carbon dioxide elimination

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

1.

Maintaining functional ability2. Minimizing chest pain3. Increasing carbon dioxide levels in the blood4. Treating infectious agents

71. A clients arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg, PaCO2 65 mm Hg; HCO3-

36 mEq/L. Which of the following signs or symptoms would the nurse expect?

1. Cyanosis2. Flushed skin3. Irritability4. Anxiety

72. When teaching a client with COPD to conserve energy, the nurse should teach the client to lift

objects:

1. While inhaling through an open mouth.2. While exhaling through pursed lips3. After exhaling but before inhaling.4. While taking a deep breath and holding it.


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73. The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the

following s/s would be included in the teaching plan?

1. Clubbing of nail beds2. Hypertension3. Peripheral edema4. Increased appetite

74. The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD

secondary to an upper respiratory tract infection. Which of the following findings would be expected?

1. Normal breath sounds2. Prolonged inspiration3. Normal chest movement4. Coarse crackles and rhonchi

75. Which of the following ABG abnormalities should the nurse anticipate in a client with advanced

COPD?

1. Increased PaCO22. Increased PaO23. Increased pH.4. Increased oxygen saturation

76. Which of the following diets would be most appropriate for a client with COPD?

1. Low fat, low cholesterol2. Bland, soft diet3. Low-Sodium diet4. High calorie, high-protein diet

77. The nurse is planning to teach a client with COPD how to cough effectively. Which of the following

instructions should be included?

1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation.2.

Lie flat on back, splint the thorax, take two deep breaths and cough.

3. Take several rapid, shallow breaths and then cough forcefully.4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with

coughing.

78. A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse

notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of


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accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on

these findings, what action should the nurse take to initiate care of the client?

1. Initiate oxygen therapy and reassess the client in 10 minutes.2. Draw blood for an ABG analysis and send the client for a chest x-ray.3. Encourage the client to relax and breathe slowly through the mouth4. Administer bronchodilators

79. The nurse would anticipate which of the following ABG results in a client experiencing a prolonged,

severe asthma attack?

1. Decreased PaCO2, increased PaO2, and decreased pH.2. Increased PaCO2, decreased PaO2, and decreased pH.3. Increased PaCO2, increased PaO2, and increased pH.4. Decreased PaCO2, decreased PaO2, and increased pH.

80. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for

the use of steroids in clients with asthma?

1. Corticosteroids promote bronchodilation2. Corticosteroids act as an expectorant3. Corticosteroids have an anti-inflammatory effect4. Corticosteroids prevent development of respiratory infections.

81. The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a

Corticosteroid drug. Which of the following client actions indicates that he us using the MDI correctly?

Select all that apply.

1. The inhaler is held upright.2. Head is tilted down while inhaling the medication3. Client waits 5 minutes between puffs.4. Mouth is rinsed with water following administration5. Client lies supine for 15 minutes following administration.

82. A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4

hours. The nurse instructs the client to report side effects. Which of the following are potential side

effects of metaproterenol?

1. Irregular heartbeat2. Constipation3. Petal edema4. Decreased heart rate.


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83. A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He

tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the

most appropriate?

1. This is an anticipated side-effect of your medication. It should go away in a couple of weeks.2. You are using your inhaler too much and it has irritated your mouth.3. You have developed a fungal infection from your medication. It will need to be treated with an

antibiotic.

4. Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.

84. Which of the following health promotion activities should the nurse include in the discharge teaching

plan for a client with asthma?

1. Incorporate physical exercise as tolerated into the treatment plan.2. Monitor peak flow numbers after meals and at bedtime.3. Eliminate stressors in the work and home environment4. Use sedatives to ensure uninterrupted sleep at night.

85. The client with asthma should be taught that which of the following is one of the most common

precipitating factors of an acute asthma attack?

1. Occupational exposure to toxins2. Viral respiratory infections3. Exposure to cigarette smoke4. Exercising in cold temperatures

86. A female client comes into the emergency room complaining of SOB and pain in the lung area. Shestates that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P

110, R 40. The physician orders ABGs, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm

Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:

1. Begin mechanical ventilation2. Place the client on oxygen3. Give the client sodium bicarbonate4. Monitor for pulmonary embolism.

87. Basilar crackles are present in a clients lungs on auscultation. The nurse knows that these are

discrete, noncontinuous sounds that are:

1. Caused by the sudden opening of alveoli2. Usually more prominent during expiration3. Produced by airflow across passages narrowed by secretions4. Found primarily in the pleura.

88. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first

nursing action would be to:


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1. Wait until the clients lab work is done.2. Not administer oxygen unless ordered by the physician.3. Administer oxygen at 2 L flow per minute.4. Administer oxygen at 10 L flow per minute and check the clients nailbeds.

89. Immediately following a thoeacentesis, which clinical manifestations indicate that a complication hasoccurred and the physician should be notified?

1. Serosanguineous drainage from the puncture site2. Increased temperature and blood pressure3. Increased pulse and pallor4. Hypotension and hypothermia

90. If a client continues to hypoventilate, the nurse will continually assess for a complication of:

1. Respiratory acidosis2. Respiratory alkalosis3. Metabolic acidosis4. Metabolic alkalosis

91. A client is admitted to the hospital with acute bronchitis. While taking the clients VS, the nurse

notices he has an irregular pulse. The nurse understands that cardiac arrhythmias in chronic respiratorydistress are usually the result of:

1. Respiratory acidosis2. A build-up of carbon dioxide3.

A build-up of oxygen without adequate expelling of carbon dioxide.4. An acute respiratory infection.

92. Auscultation of a clients lungs reveals crackles in the left posterior base. The nursing intervention is

to:

1. Repeat auscultation after asking the client to deep breathe and cough.2. Instruct the client to limit fluid intake to less than 2000 ml/day.3. Inspect the clients ankles and sacrum for the presence of edema4. Place the client on bedrest in a semi-Fowlers position.

93. The most reliable index to determine the respiratory status of a client is to:

1. Observe the chest rising and falling2. Observe the skin and mucous membrane color.3. Listen and feel the air movement.4. Determine the presence of a femoral pulse.


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94. A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be

included in the plan of care because of the polycythemia?

1. Fluid volume deficit related to blood loss.2. Impaired tissue perfusion related to thrombosis3. Activity intolerance related to dyspnea4. Risk for infection related to suppressed immune response.

95. The physician has scheduled a client for a left pneumonectomy. The position that will most likely be

ordered postoperatively for his is the:

1. Unoperative side or back2. Operative side or back3. Back only4. Back or either side.

96. Assessing a client who has developed atelectasis postoperatively, the nurse will most likely find:

1. A flushed face2. Dyspnea and pain3. Decreased temperature4. Severe cough and no pain.

97. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The first intervention in

completing this procedure would be to:

1.

Change the tracheostomy dressing2. Provide humidity with a trach mask3. Apply oral or nasal suction4. Deflate the tracheal cuff

98. A client states that the physician said the tidal volume is slightly diminished and asks the nurse what

this means. The nurse explains that the tidal volume is the amount of air:

1. Exhaled forcibly after a normal expiration2. Exhaled after there is a normal inspiration3. Trapped in the alveoli that cannot be exhaled4.

Forcibly inspired over and above a normal respiration.

99. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen delivery to the tissues, is

caused by:

1. A decreasing oxygen pressure in the blood2. An increasing carbon dioxide pressure in the blood3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the blood.


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4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the blood.

1. 1. Fever, chills, hemoptysis, dyspnea, cough, and pleuric chest pain are the common symptoms ofpneumonia, but elderly clients may first appear with only an altered mental status and dehydration

due to a blunted immune response.

2. 4. The most common feature of all types of pneumonia is an inflammatory pulmonary response to theoffending organism or agent. Atelectasis and brochiectasis indicate a collapse of a portion of the

airway that doesnt occur with pneumonia. An effusion is an accumulation of excess pleural fluid in

the pleural space, which may be a secondary response to pneumonia.

3. 1. Based on the clients history and symptoms, acute asthma is the most likely diagnosis. Hesunlikely to have bronchial pneumonia without a productive cough and fever and hes too young to

have developed COPD or emphysema.

4. 3. Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may bepresent in extreme cases of respiratory distress. The nurse would expect the client to have a decreased

forced expiratory volume because asthma is an obstructive pulmonary disease. Breath sounds will be

tight sounding or markedly decreased; they wont be normal.

5. 3. Intrinsic asthma doesnt have an easily identifiable allergen and can be triggered by the commoncold. Asthma caused be emotional reasons is considered to be in the extrinsic category. Extrinsic

asthma is caused by dust, molds, and pets; easily identifiable allergens. Mediated asthma doesnt

exist.

6. 2. Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the causeof reduced airflow. Beta-adrenergic blockers arent used to treat asthma and can cause

bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but arent used

for emergency relief.

7. 2. The client is having an acute asthma attack and needs to increase oxygen delivery to the lung andbody. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. First

resolve the acute phase of the attack ad how to prevent attacks in the future. It may not be necessary

to place the client on a cardiac monitor because hes only 19 -years-old, unless he has a past medical

history of cardiac problems.8. 3. Because of his extensive smoking history and symptoms, the client most likely has chronicobstructive bronchitis. Clients with ARDS have acute symptoms of and typically need large amounts

of oxygen. Clients with asthma and emphysema tend not to have a chronic cough or peripheral

edema.

9. 3. Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests andperipheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are

acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of

oxygen. Clients with asthma dont exhibit characteristics of chronic disease, and clients with

emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting).

10. 4. Because of the large amount of energy it takes to breathe, clients with emphysema are usually

cachectic. Theyre pink and usually breathe through pursed lips, hence the term puffer. Clients with

ARDS are usually acutely short of breath. Clients with asthma dont have any particular characteristics,and clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.

11. 4. These are classic signs and symptoms of a client with emphysema. Clients with ARDS are acutely

short of breath and require emergency care; those with asthma are also acutely short of breath during an

attack and appear very frightened. Clients with chronic obstructive bronchitis are bloated and cyanotic in

appearance.


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12. 4. Its highly recommended that clients with respiratory disorders be given vaccines to protect against

respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and

it may be difficult to wean these clients from the ventilator. The vaccines have no effect on

bronchodilation or respiratory care.

13. 1. Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better,

perhaps reducing the risk of heart attack. Most exercise has little effect on respiratory muscle strength,and these clients cant tolerate the type of exercise necessary to do this. Exercise wont reduce the number

of acute attacks. In some instances, exercise may be contraindicated, and the client should check with his

physician before starting any exercise program.

14. 1. Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in

turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise

tolerance will still be harder to clear airways. Reducing fluid volume wont improve respiratory function,

but may improve oxygenation.

15. 4. In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area

available for gas exchange. Very little air movement occurs in the lungs because of bronchiole collapse,

as well. In ARDS, the clients condition is more acute and typically requires mechanical ventilation. In

asthma and bronchitis, wheezing is prevalent.

16. 3. Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as

the hypoxic drive. They dont take a breath when their levels of carbon dioxide are higher than normal, as

do those with healthy respiratory physiology. If too much oxygen is given, the client has little stimulus to

take another breath. In the meantime, his carbon dioxide levels continue to climb, and the client will passout, leading to a respiratory arrest.

17. 4. Respiratory infection in clients with a respiratory disorder can be fatal. Its important that the client

understands how to recognize the signs and symptoms of an impending respiratory infection. It isnt

appropriate for the wife to listen to his lung sounds, besides, you cant purchase stethoscopes from Wal-Mart. If the client has signs and symptoms of an infection, he should contact his physician at once.

18. 1. Atelectasis develops when theres interference with the normal negative pressure that promotes

lung expansion. Clients in the postoperative phase often splint their breathing because of pain and

positioning, which causes hypoxia. Its uncommon for any of the other respiratory disorders to develop.

19. 4. Using an incentive spirometer requires the client to take deep breaths and promotes lung

expansion. Chest physiotherapy helps mobilize secretions but wont prevent atelectasis. Reducing oxygen

requirements or placing someone on mechanical ventilation doesnt affect the development of atelectasis.

20. 1. Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation. I.V.

beta-adrenergic agents can be used but have to be monitored because of their greater systemic effects.Theyre typically used when the inhaled beta-adrenergic agents dont work. Corticosteriods are slow-

acting, so their use wont reduce hypoxia in the acute phase.

21. 1. Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen are used to reduce

bronchospasm, improve oxygenation, and avoid intubation. Determining the trigger for the clients attack

and improving exercise tolerance are later goals. Typically, secretions arent a problem in status

asthmaticus.


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22. 2. Narcotics can cause respiratory arrest if given in large quantities. Its unlikely Dani will have an

asthma attack or wake up on her own. She may be pissed for a minute, but then shed be grateful for

saving her butt.

23. 2. First, the nurse should attempt to rouse the client because this should increase the clients

respiratory rate. If available, a spot pulse oximetry check should be done and breath sounds should be

checked. The physician should be notified immediately if of the findings. Hell probably order ABGanalysis to determine specific carbon dioxide and oxygen levels, which will indicate the effectiveness of

ventilation. Reflexes and heart sounds will be part of the more extensive examination done after these

initial actions are completed.

24. A client about to go into respiratory arrest will have inefficient ventilation and will be retaining

carbon dioxide. The value expected would be around 80 mm Hg. All other values are lower thanexpected.

25. 3. The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could

lead to eventual respiratory failure. Although the signs are also related to an asthma attack or a pulmonary

embolism, consider the new drug first. Rheumatoid arthritis doesnt manifest these signs.

26. 1. Giving oxygen would be the best first action in this case. Vital signs then should be checked and

the physician immediately notified. If the client doesnt already have an I.V. catheter, one may be inserted

now if anaphylactic shock is developing. Obtaining a CBC wouldnt help the emergency situation.

27. 2. Bronchodilators would help open the clients airway and improve his oxygenation status. Beta -

adrenergic blockers arent indicated in the management of asthma because they may cause bronchospasm.

Obtaining laboratory values wouldnt be done on an emergency basis, and having the client lie flat in bed

could worsen his ability to breathe.

28. 3. You all should know this. Practice some problems if you got this wrong.

29. 1. Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most

commonly caused by COPD. In end-stage disease, pathological changes lead to airway collapse, air

trapping, and disturbance of ventilation-perfusion relationships.

30. 2. Clinical manifestations of respiratory alkalosis include headache, tachypnea, paresthesias, tetany,

vertigo, convulsions, hypokalemia, and hypocalcemia. Options 1, 3, and 4 identify normal laboratory

values. Option 2 identifies the presence of hypokalemia.

31. 3. The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite (see-saw) will be seen

between the pH and the PCO2. In this situation, the pH is at the high end of the normal value and the P CO2 is

low. In an alkalotic condition, the pH is up. Therefore, the values identified in the question indicate a

respiratory alkalosis. Compensation occurs when the pH returns to a normal value. Because the pH is inthe normal range at the high end, compensation has occurred.

32. 2. Before radial puncture for obtaining an ABG, you should perform an Allens test to determine

adequate ulnar circulation. Failure to determine the presence of adequate collateral circulation could result

in severe ischemic injury o the hand if damage to the radial artery occurs with arterial puncture.

33. 4. Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of

the loss of hydrochloric acid.


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34. 3. Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an

ileostomy or with diarrhea (remember, diarrhea is coming out of thebase). These conditions result in

metabolic acidosis.

35. 1. Kussmauls respirations are abnormally deep, regular, and increased in rate.

36. 4. Increases in base components occur as a result of oral or parenteral intake of bicarbonates,

carbonates, acetates, citrates, or lactates. Excessive use of oral antacids containing bicarbonate can causemetabolic alkalosis.

37. 3. Clinical manifestations of metabolic acidosis include hyperpnea with Kussmauls respirations;

headache; N/V, and diarrhea; fruity-smelling breath resulting from improper fat metabolism; CNS

depression, including mental dullness, drowsiness, stupor, and coma; twitching, and coma. Hyperkalemia

will occur.

38. 5, 2, 1, 4, and then 3.

39. 2. To obtain a sputum specimen, the client should rinse the mouth to prevent contamination, breathe

deeply, and then cough unto a sputum specimen container. The client should be encouraged to cough and

not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as

inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the

morning.

40. 4. If a biopsy was performed during a bronchoscopy, blood streaked sputum is expected for several

hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed

for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis,

hypotension, tachycardia, and dysrhythmias. Hematuria is unrelated to this procedure.

41. 2. Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells within

the heart. A vasovagal response may occurm causing bradycardia. The nurse must preoxygenate the client

before suctioning and limit the suctioning pass to 10 seconds.

42. 3. During suctioning, the nurse should monitor the client closely for side effects, including

hypoxemia, cardiac irregularities such as a decrease in HR resulting from vagal stimulation, mucousal

trauma, hypotension, and paroxysmal coughing. If side effects develop, especially cardiac irregularities,

this procedure is stopped and the client is reoxygenated.

43. 1. In an acidotic condition the pH would be low, indicating the acidosis. In addition, a low

bicarbonate level along with the pH would indicate a metabolic state.

44. 3. Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest,

oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray films

reveal a hyperinflated chest and a flattened diaphragm is the disease is advanced.

45. 1. The venture mask delivers the most accurate oxygen concentration. The Venturi mask is the best

oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen

concentration. The face tent, the aerosol mask, and the tracheostomy collar are also high-flow oxygen

delivery systems but most often are used to administer high humidity.

46. 1. Theo-Dur is a bronchodilator. The medication should be administered with food such as milk and

crackers to prevent GI irritation.


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47. 2. One to 3 L/min of oxygen by nasal cannula may be required to raise to PaO2 to 60 to 80 mm Hg.

However, oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing

hypercapnia, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide

levels, as is the case in normal respiratory system.

48. 3.

49. 4. Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. Thistype of breathing allows better expiration by increasing airway pressure that keeps air passages open

during exhalation.

50. 2. In respiratory alkalosis the pH will be higher than normal and the PCO2 will be low.

51. 3. Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the bronchial

airway.

52. 4. Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations,

tachycardia, peripheral vasodilation, and dryness of the mouth or throat.

53. 3. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling

the mist.

54. 1. The most important item to ask about is the clients pregnancy status because pregnant women

should not be exposed to radiation. Clients are also asked to remove any chains or metal objects that

could interfere with obtaining an adequate film. A chest radiograph most often is done at full inspiration,

which gives optimal lung expansion. If a lateral view of the chest is ordered, the client is asked to raise

the arms above the head. Most films are done in posterior-anterior view.

55. 2. After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because

the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes

for a number of hours. Additional fluids is unnecessary because no contrast dye is used that would need to

be flushed from the system. Atropine and Versed would be administered before the procedure, not after.

56. 2. Before drawing an ABG, the nurse assesses the collateral circulation to the hand with Allens test.

This involves compressing the radial and ulnar arteries and asking the client to close and open the fist.

This should cause the hand to become pale. The nurse then releases pressure on one artery and observes

whether circulation is restored quickly. The nurse repeats the process, releasing the other artery. The

blood sample may be taken safely if collateral circulation is adequate.

57. 2. The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm.

These lead to increased anteroposterior diameter, which is referred to as barrel chest. The client also hasdyspnea with prolonged expiration and has hyperresonant lungs to percussion.

58. 4. Benzonatate is a locally acting antitussive the effectiveness of which is measured by the degree towhich it decreases the intensity and frequency of cough without eliminating the cough reflex.

59. 4. A client recovering from an URI should report decreasing or no nasal discharge and obstruction.

Daily fluid intake should be increase to more than 1 L every 24 hours to liquefy secretions. The

temperature should be below 100*F (37.8*C) with no chills or diaphoresis. A productive cough with

chest pain indicated pulmonary infection, not an URI.


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60. 3. Individuals who are household members or home care providers for high-risk individuals are high-

priority targeted groups for immunization against influenza to prevent transmission to those who have a

decreased capacity to deal with the disease. The wife who is caring for a husband with cancer has the

highest priority of the clients described.

61. 4. It is important for clients with allergic rhinitis to determine the precipitating factors so that they

can be avoided. Keeping a diary can help identify these triggers. Nasal decongestant sprays should not beused regularly because they can cause a rebound effect. Antibiotics are not appropriate. Increasing

activity will not control the clients symptoms; in fact, walking outdoors may increase them if the client is

allergic to pollen.

62. 1. Pneumonia is the most common complication of influenza, especially in the elderly. The

development of a purulent cough and crackles may be indicative of a bacterial infection are not consistent

with a diagnosis of influenza. These findings are not indicative of dehydration. Decongestants and

bronchodilators are not typically prescribed for the flu.

63. 2.

64. 4. Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and

through sympathetic effects on the CNS. The most common CNS effects include restlessness, dizziness,

tension, anxiety, insomnia, and weakness. Common cardiovascular side effects include tachycardia,

hypertension, palpitations, and arrhythmias. Constipation and diplopia are not side effects of

pesudoephedrine. Tachycardia, not bradycardia, is a side effect of pseudoephedrine.

65. 1. The clients problem is altered nutritionspecifically, less than required. The cause, as stated by

the client, is the fatigue associated with the disease process. Activity intolerance is a likely diagnosis but

is not related to the clients nutritional problems. Weight loss is not a nursing diagnosis. Ineffective

breathing pattern may be a problem, but this diagnosis does not specifically address the problem of

weight loss described by the client.

66. 1. A client with COPD is at high risk for development of respiratory infections. COPD is a slowly

progressive; therefore, maintaining current status and establishing a goal that the client will require less

supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but

permanent improvement is highly unlikely.

67. 4. Increasing dyspnea on exertion indicates that the client may be experiencing complications of

COPD, and therefore the physician should be notified. Extracting promises from clients is not an outcome

criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen

supplementation (1 to 2 L/minute) to avoid suppressing the respiratory drive, which, for these clients, isstimulated by hypoxia.

68. 1. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in theoverextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-

chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD

because of their increased use in the work of breathing. Distended, not collapsed, neck veins are

associated with COPD as a symptom of the heart failure that the client may experience secondary to the

increased workload on the heart to pump into pulmonary vasculature. Diminished, not increased, chest

excursion is associated with COPD.


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69. 4. Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby

promoting carbon dioxide elimination. By prolonged exhalation and helping the client relax, pursed-lip

breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not

promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.

70. 1. A priority goal for the client with COPD is to manage the s/s of the disease process so as to

maintain the clients functional ability. Chest pain is not a typical sign of COPD. The carbon dioxideconcentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal

to increase the level further. Preventing infection would be a goal of care for the client with COPD.

71. 2. The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and

lethargic because carbon dioxide has a depressant effect on the CNS. Cyanosis is a late sign of hypoxia.

Irritability and anxiety are not common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.

72. 2. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and

reduced perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control

over breathing. Lifting after exhalation but before inhaling is similar to lifting with the breath held. This

should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac

dysrhythmias.

73. 3. Right-sided heart failure is a complication of COPD that occurs because of pulmonary

hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous

distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is

associated with conditions of chronic hypoxia. Hypertension is associated with left-sided heart failure.

Clients with heart failure have decreased appetites.

74. 4. Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and

rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath

sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not

inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

75. 1. As COPD progresses, the client typically develops increased PaCO2 levels and decreasedPaO2 levels. This results in decreased pH and decreased oxygen saturation. These changes are the result of

air trapping and hypoventilation.

76. 4. The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent

weight loss that results from the increased work of breathing. The client should be encouraged to eat

small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease.

The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise

medically indicated.

77. 1. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and

minimize airway collapse. The client should assume a sitting position with feet on the floor if possible.

The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright

position, the client should use abdominal breathing to slowly and deeply inhale. After repeating thisprocess 3 or 4 times, the client should take a deep abdominal breath, bend forward and cough 3 or 4 times

upon exhalation (huff cough). Lying flat does not enhance lung expansion; sitting upright promotes full

expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful

coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion

to promote deep breathing.

78. 4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign of indicating

lack of air movement in the lungs and impending respiratory failure. The client requires immediate


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intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous

theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed

medical intervention, as would drawing an ABG and obtaining a chest x-ray. It would be futile to

encourage the client to relax and breathe slowly without providing necessary pharmacologic intervention.

79. 2. As the severe asthma attack worsens, the client becomes fatigued and alveolar hypotension

develops. This leads to carbon dioxide retention and hypoxemia. The client develops respiratory acidosis.Therefore, the PaCO2 level increase, the PaO2 level decreases, and the pH decreases, indicating acidosis.

80. 3. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial

airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as

expectorants, or prevent respiratory infections.

81. 1 and 4.

82. 1. Irregular heart rates should be reported promptly to the care provider. Metaproterenol may cause

irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on the beta-adrenergic

receptors in the heart. It is not recommended for use in clients with known cardiac disorders.

Metaproterenol does not cause constipation, petal edema, or bradycardia.

83. 3. Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush,

a fungal infection. Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its

own. Fungal infections can develop even without overuse of the Corticosteroid inhaler. Although good

oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the

problem.

84. 1. Physical exercise is beneficial and should be incorporated as tolerated into the clients schedule.

Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak

flow does not need to be monitored after each meal. Stressors in the clients life should be modified but

cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives

be routinely taken to induce sleep.

85. 2. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma

should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental

exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics

are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks,

but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising

in cold weather.

86. 2. The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are involved. The client

should immediately be placed on oxygen via mask so that the SaO2 is brought up to 95%. Encourage

slow, regular breathing to decrease the amount of CO2 she is losing. This client may have pulmonary

embolism, so she should be monitored for this condition (4), but it is not the first intervention. Sodiumbicarbonate (3) would be given to reverse acidosis; mechanical ventilation (1) may be ordered for acute

respiratory acidosis.

87. 1. Basilar crackles are usually heard during inspiration and are caused by sudden opening of the

alveoli.

88. 3. Administer oxygen at 2 L/minute and no more, for if the client if emphysemic and receives too

high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.


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89. 3. Increased pulse and pallor are symptoms associated with shock. A compromised venous return

may occur if there is a mediastinal shift as a result of excessive fluid removal. Usually no more than 1 L

of fluid is removed at one time to prevent this from occurring.

90. 1. Respiratory acidosis represents an increase in the acid component, carbon dioxide, and an increase

in the hydrogen ion concentration (decreased pH) of the arterial blood.

91. 2. The arrhythmias are caused by a build-up of carbon dioxide and not enough oxygen so that the

heart is in a constant state of hypoxia.

92. 1. Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation

and will clear after a deep breath or a cough. It is, therefore, premature to impose fluid (2) or activity (4)

restrictions (which Margaret would totally do if Dani werent there to smack her). Inspection for edema(3) would be appropriate after reauscultation.

93. 3. To check for breathing, the nurse places her ear and cheek next to the clients mouth and nose to

listen and feel for air movement. The chest rising and falling (1) is not conclusive of a patent airway.

Observing skin color (2) is not an accurate assessment of respiratory status, nor is checking the femoral

pulse.

94. 2. Chronic hypoxia associated with COPD may stimulate excessive RBC production (polycythemia).

This results in increased blood viscosity and the risk of thrombosis. The other nursing diagnoses are not

applicable in this situation.

95. 2. Positioning the client on the operative side facilitates the accumulation of serisanguineous fluid.The fluid forms a solid mass, which prevents the remaining lung from being drawn into the space.

96. 2. 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 (4).

The shortness of breath is a result of decreased oxygen-carbon dioxide exchange at the alveolar level.

97. 3. Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction to the airway to

prevent secretions from falling into the lung. Dressing change (1) and humidity (2) do not relate to

suctioning.

98. 2. Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.

99. 3. The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated from the oxy-

hemoglobin molecule.

Airway-Obstruction NCLEX Questions

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