Chapter 32: Chronic Disorders of the Lower Respiratory Tract
Linton: Introduction to Medical–Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. A nurse assesses wheezes in a patient with asthma. What should the nurse know is the cause
of wheezes?
a.
Increased thickness of respiratory secretions
b.
Use of accessory muscles of respiration
c.
Tachypnea and tachycardia
d.
Movement of air through narrowed airways
2. A nurse is caring for a patient with asthma with a nursing diagnosis of “Impaired gas
exchange, related to air trapping.” Which intervention is the most appropriate to add to the
nursing care plan?
a.
Provide postural drainage.
b.
Administer oxygen (O2) at 8 L/min.
c.
Position the patient flat in bed with small pillow.
d.
Increase fluid intake.
3. What is a characteristic of chronic obstructive pulmonary disease that places a patient at risk
for the nursing diagnosis of “Imbalanced nutrition: Less than body requirements”?
a.
Increased metabolism
b.
Anxiety
c.
Chronic constipation
d.
Excessive respiratory effort
4. Which nursing intervention enhances the nutritional status of a patient with COPD?
a.
Offer small, frequent meals.
b.
Encourage extra liquids with meals.
c.
Assist the patient to exercise before meals.
d.
Supply information about nutrition.
5. Which walking program would be the most effective for the nurse to recommend as part of a
progressive walking program for an obese patient with COPD?
a.
10 to 15 minutes a day
b.
20 to 30 minutes a day
c.
45 to 60 minutes a day
d.
Up to 2 hours a day
6. What is the result of status asthmaticus that is not corrected?
a.
Pneumothorax, severe hypoxemia, and respiratory arrest
b.
Hypertension, cerebrovascular accident (CVA), and cardiac arrest
c.
Respiratory alkalosis, pneumonia, and death
d.
Lung abscess, cor pulmonale, and respiratory failure
7. What should a nurse focus on when assessing for major sources of infection in a patient with
COPD?
a.
Stasis of respiratory secretions
b.
Low body weight
c.
Episodes of postural hypotension
d.
Delayed antigen-antibody response
8. A young patient with acquired immunodeficiency syndrome (AIDS) reports debilitating night
sweats. Why should the home health nurse suggest that the patient visit the clinic?
a.
To get a prescription for antibiotics
b.
Tuberculosis (TB) screening
c.
Complete blood count (CBC)
d.
Treatment with an aerosol inhalant
9. A nurse is caring for an 80-year-old patient with COPD and suspects right-sided heart failure
after assessing and recording the data. What should decrease with right-sided heart failure?
a.
Blood pressure
b.
Urine output
c.
Respirations
d.
Heart rate
10. A patient with TB asks the nurse how long he will have to take his TB medications. What is
the nurse’s best response?
a.
“Generally about 2 weeks.”
b.
“Depending on the drug, it may be as long as 2 years.”
c.
“TB drugs are usually taken throughout the lifespan.”
d.
“People frequently ask that question. It depends on many things.”
11. A patient with TB asks how to protect family members from the disease. Which discharge
instruction given by the nurse is most informative?
a.
“Your family will need to take treatments to prevent infection.”
b.
“You will need to wear a mask at home to protect your family members.”
c.
“You should always cover your mouth and nose if coughing or sneezing.”
d.
“You should avoid intimate contact with everyone.”
12. A nurse is providing education to a patient taking rifampin as a result of an exposure to TB.
What side effect of this drug should the nurse include?
a.
Extreme drowsiness
b.
Illness if aged cheese or smoked meats are consumed
c.
Body fluids to become red-orange
d.
Oral contraceptive pills to become ineffective
13. A patient with asthma asks the purpose of learning how to use a peak expiratory flow rate
(PEFR) device. What is the nurse’s best response regarding PEFR?
a.
Dilates the bronchi to relieve dyspnea
b.
Measures expired air to evaluate ventilation
c.
Soothes inflamed bronchi, reducing spasm
d.
Liquefies sputum for easier expectoration
14. A nurse is assigned to care for a patient with the diagnosis of centriacinar (centrilobar)
emphysema. What is a characteristic of this type of emphysema?
a.
No significant smoking history in the patient
b.
Enlarged and broken down bronchioles with intact alveoli
c.
Hypoelastic bronchi and bronchioles
d.
Deficiency of the enzyme inhibitor alpha1-antitrypsin.
15. A 25-year-old patient with cystic fibrosis (CF) tells the home health nurse that he wants to
take a nice vacation. What is the best suggestion for the nurse to make?
a.
Greece in July
b.
Colorado in May
c.
New York in November
d.
The Mexican coast in August
16. Which assessment made by a nurse indicates that respiratory arrest is imminent in a patient
with asthma?
a.
Agitation
b.
Tachycardia
c.
Absence of wheezing
d.
Flaring nares
17. A patient with COPD has a nursing diagnosis of “Activity intolerance, related to inability to
meet O2 needs.” Which intervention is inappropriate for this diagnosis?
a.
Bunch all nursing activities and treatments close together.
b.
Schedule rest periods during the day.
c.
Assist the patient only when needed to encourage independence.
d.
Provide daily ambulation to build tolerance.
18. A nurse recognizes that a patient diagnosed with COPD has a rising level of partial pressure
of carbon dioxide (CO2) in arterial blood (PaCO2). How should the nurse interpret this
assessment?
a.
More arterial O2 is available than is needed.
b.
The ventilation-perfusion ratio is becoming balanced.
c.
Respiratory acidosis has begun.
d.
The anticholinergic medications are effective.
19. Which early characteristic in a patient with emphysema gives rise to the term pink puffer?
a.
Dyspnea
b.
Barrel chest
c.
Thin body
d.
Normal arterial blood gases (ABGs)
20. A patient with COPD asks a nurse if nicotine patches are very effective for smoking cessation.
What is the best response by the nurse?
a.
“No. Only about 25% are successful.”
b.
“Yes. The success rate is between 50% and 60%.”
c.
“No. Prescriptions such as Wellbutrin are 90% effective.”
d.
“Yes. Individual success has been obtained with combination of patches and gum.”
21. A patient with cystic fibrosis (CF) furiously refuses any more manual chest physiotherapeutic
treatment. Which alternative is appropriate for the nurse to suggest?
a.
Flutter mucus device
b.
Increase ambulation to 1 to 2 hours a day
c.
Steam inhalator several times a day
d.
Drink 3 quarts of fluid per day
22. What should a nurse expect when assessing the CBC results of a patient with chronic
bronchitis?
a.
Decreased platelets
b.
Decreased white blood cells (WBCs)
c.
Increased eosinophils
d.
Increased red blood cells (RBCs)
23. A patient with COPD delightedly tells the nurse that he has quit smoking and is using
chewing tobacco. What is the most appropriate nursing intervention?
a.
Congratulate him on his quitting smoking.
b.
Warn him of the dangers of oral cancer.
c.
Suggest that he add nicotine patches in addition to the chewing tobacco.
d.
Point out that he is still addicted and is using tobacco.
24. A newly diagnosed patient with non–small cell lung carcinoma (NSCLC) is anxious about
upcoming surgery. Which intervention by the nurse would be most helpful?
a.
Support the patient in preparation for surgery.
b.
Educate the patient regarding the high survival rate with this type of carcinoma.
c.
Assure the patient that chemotherapy and radiation can be used in this sort of
cancer.
d.
Refer the patient to the American Cancer Society for postdischarge follow-up.
25. A nurse documents and reports the presence of foul, bulky stool in a patient with cystic
fibrosis (CF). What does this finding indicate about the patient?
a.
Is being adequately maintained on the present dose of pancreatic enzyme
b.
Is not adequately digesting food
c.
Has diarrhea related to excess mucus in the bowel
d.
Has inadequate hydration
26. What should a patient that had the BCG (Bacillus Calmette-Guérin) vaccine 2 years ago
anticipate?
a.
False-positive result from TB skin tests
b.
Being at risk for contracting TB
c.
3-week prophylactic protocol of rifampin or isoniazid (isonicotinic acid hydrazide
[INH])
d.
Needing a booster every 2 years
27. What nursing action should be implemented to help combat anorexia in a patient with COPD?
a.
Recommend a large meal in the middle of the day.
b.
Suggest taking only cold liquid nutritional drinks.
c.
Perform oral hygiene before meals.
d.
Gently exercise for 10 minutes before a meal.
MULTIPLE RESPONSE
28. A nurse uses a picture to demonstrate the bullae and blebs associated with emphysema. How
do blebs differ from bullae? (Select all that apply.)
a.
They are between the alveolar spaces in the lungs.
b.
They are in the lung parenchyma.
c.
They can rupture, causing the lungs to collapse.
d.
They are responsible for diaphragm flattening.
e.
They are precancerous.
29. What signs and symptoms are characteristic of a patient with chronic blue bloater bronchitis?
(Select all that apply.)
a.
Productive cough
b.
Peripheral edema
c.
Discolored teeth
d.
Exertional dyspnea
e.
Elevated red blood cell count
COMPLETION
30. A nurse cautions a group of individuals with COPD that using O2 at levels greater than 1 to 3
L/min can cause the loss of their _____.
OTHER
31. A 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. Separate letters by a comma
and space as follows: A, B, C, D.)
A. Bronchoconstriction
B. Ventilation-perfusion mismatch
C. Production of mucous plugs
D. Hypoxemia with compensatory hyperventilation
E. Triggering of inflammatory process