N4 test Lower Respiratory Problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition
Chapter 30: Interventions for Clients with Noninfectious Lower Respiratory Problems

1. How is asthma caused by bronchoconstriction different than asthma caused by inflammation?
A. Inflammation narrows the airways by internal luminal obstruction and bronchoconstriction narrows the airways by external bronchiolar smooth muscle contraction.
B. Inflammatory asthma is more common among children with asthma and bronchoconstriction is more common among adults with asthma.
C. Wheezing is present when asthma is caused by bronchoconstriction and is not present in asthma caused by inflammation.
D. Asthma as a result of bronchoconstriction is milder and less life-threatening than asthma as a result of inflammation.

2. What is the teaching priority for a client who is classified as having Step III-level asthma?
A. Activity limitations during an acute episode
B. Activity limitations between acute episodes
C. When to use short-acting inhaled beta agonist
D. Expected side effects of systemic corticosteroid therapy

3. The client with asthma had a peak expiratory flow value of 50% less than expected before you administered two puffs of the rescue inhaler medication. Five minutes later the client’s peak expiratory flow value is 40% less than expected. What is your best first action?
A. Document the change as the only action.
B. Repeat the rescue inhaler medication.
C. Prepare the client for intubation.
D. Administer IV Benadryl.

4. What is the priority nursing diagnosis for a client taking 30 mg of prednisone daily for chronic airflow limitation (CAL)?
A. Risk for infection
B. Body image disturbance
C. Risk for impaired skin integrity
D. Altered nutrition: more than body requirements

5. How does asthma differ from the chronic bronchitis and emphysema forms of CAL?
A. Asthma is rarely an adult disorder.
B. The chronic airflow limitation of asthma is reversible.
C. Inhalation irritants trigger chronic bronchitis and emphysema.
D. Bronchoconstriction is a major feature of asthma but not of chronic bronchitis or emphysema.

6. The 60-year-old client with centrilobular emphysema is concerned that his grown children also might develop the disease. What is your best response?
A. “This disease is a random event and there is no way to prevent it.”
B. “Because this disease is inherited as a dominant trait, your children have a 50% risk for developing it.”
C. “Cigarette smoking is the main cause of this disease, and helping your children not to smoke will decrease their risk.”
D. “Emphysema can be avoided by decreasing dietary intake of fats and increasing the amount of regular, aerobic exercise.”

7. Which statement made by the client with moderate to severe COPD who going home on oxygen therapy indicates a clear understanding of the important issues surrounding this form of treatment?
A. “I will increase the oxygen flow rate at night so I can sleep better.”
B. “We will keep the oxygen container out of the kitchen so there is no explosion.”
C. “We will keep our grandchildren out of the room when the oxygen is being used.”
D. “If my breathing goes below 10 breaths per minute, I will decrease the oxygen flow rate.”

8. The 60-year-old with severe emphysema and dyspnea would like to continue his hobby of woodworking. What energy conservation intervention would be most helpful for this situation?
A. Perform as many woodworking tasks as possible while in a sitting position at the workbench.
B. Wear a filter mask over the top of your nasal cannula while in the woodworking shop.
C. Work in the woodworking shop in the evening or after your largest meal.
D. Remove your oxygen when using electrical woodworking tools.

9. What is the priority nursing intervention for a client with COPD during the first 12 hours after lung reduction surgery?
A. Ensuring that the client coughs at least once every two hours while awake
B. Accurately measuring intake and output hourly
C. Positioning the client on the nonoperative side
D. Assessing the client’s pulmonary status hourly

10. Which nutritional intervention is most appropriate for the client with advanced COPD and severe dyspnea?
A. Modifying the diet so that 80% of the calories are derived from carbohydrate sources
B. Encouraging the client to drink at least 500 mL of milk with each meal
C. Offering smaller meals that are high in protein and high in calories
D. Counseling the client to avoid eating between meals

11. The client with CAL is receiving appropriate medications. Which parameter would indicate to you that the client is experiencing a good response to the medication? Increased:
A. PaCO2
B. peak flow rate
C. respiratory rate
D. use of accessory muscles

12. What specific behavior has the potential to prevent 85% of all cases of lung cancer?
A. Elimination of cigarette smoking
B. Avoidance of exposure to radon gas
C. Containment or removal of asbestos from homes, schools, and workplaces
D. Use of micropore masks in occupations with exposure to inhalation irritants

13. Which statement made by the client scheduled to undergo radiation therapy to the chest for lung cancer indicates a need for clarification of this type of therapy?
A. “I have purchased two wigs so that I can wear one while the other is being cleaned.”
B. “I plan to continue to play golf during the treatment and I will wear a thick shirt to avoid sun exposure.”
C. “I will plan to take a nap in the afternoon before I engage in any heavy physical activity.”
D. “I have made arrangements to take the last two weeks of my radiation therapy in Florida where my wife and I will be vacationing.”

14. The chest tube drainage system of the client 36 hours after a pneumonectomy has continuous bubbling in the water seal chamber (chamber 2). When you clamp the chest tube close to the client’s dressing, the bubbling continues. What is your interpretation of this finding?
A. The chest tube is no longer in the thoracic cavity.
B. The suction pressure applied to the system is too high.
C. The suction pressure applied to the system is too low.
D. There is an air leak somewhere in the drainage system.

15. The client who has had a pneumonectomy is going home. For which clinical manifestation should you instruct him to notify the physician?
A. Dyspnea on exertion
B. The need to use two pillows when in bed
C. Development of a fever greater than 101o F
D. Presence of a productive cough on getting out of bed in the morning