Chapter 32: Chronic Disorders of the Lower Respiratory Tract Nursing School Test Banks

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

DIF: Cognitive Level: Comprehension REF: p. 598-599 OBJ: 1
TOP: Asthma: Wheeze KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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.
ANS: D
Increasing fluid intake thins the 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 no air pathway exists to the alveoli. Increasing O2 to 8 L is excessive.

DIF: Cognitive Level: Application REF: p. 603 OBJ: 3
TOP: Asthma KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: D
Respiratory effort interferes with swallowing, depletes energy, and increases caloric needs.

DIF: Cognitive Level: Comprehension REF: p. 610 OBJ: 3
TOP: COPD: Nutrition KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Application REF: p. 610 OBJ: 3
TOP: COPD: Nutrition KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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
ANS: A
Walking 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.

DIF: Cognitive Level: Application REF: p. 611 OBJ: 3
TOP: Exercise for the Patient with COPD
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A
Status asthmaticus, because of severe bronchospasms, can result in hypoxemia, which could lead to pneumothorax and arrest.

DIF: Cognitive Level: Comprehension REF: p. 599 OBJ: 2
TOP: Status Asthmaticus KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

DIF: Cognitive Level: Application REF: p. 607 OBJ: 2
TOP: COPD: Infection KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: B
The symptoms of TB are low-grade fever, night sweats, and cough. Patients with AIDS and anyone who is immunosuppressed are extremely prone to TB and should be carefully monitored for the development of the disease.

DIF: Cognitive Level: Application REF: p. 613 OBJ: 2
TOP: Tuberculosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: B
The decreasing urine output is one of the signs. The fluid, instead of being excreted as urine, is trapped in the tissues as edema. Blood pressure, respirations, and heart rate will increase with right-sided heart failure.

DIF: Cognitive Level: Comprehension REF: p. 611 OBJ: 2
TOP: Dyspnea KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. A patient with TB asks the nurse how long he will have to take his TB medications. What is the nurses 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.
ANS: B
Some TB drugs are continued over the course of several years.

DIF: Cognitive Level: Knowledge REF: p. 613-614 OBJ: 2
TOP: TB Drug Protocol KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Pharmacological Therapies

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.
ANS: C
Covering the mouth and nose to prevent droplet spread and carefully disposing of tissues are two significant way to control the spread of infection. Masks or isolation is not necessary because before discharge, the patient will have been stabilized on an anti-TB medication.

DIF: Cognitive Level: Application REF: p. 615 OBJ: 2
TOP: TB Infection Control KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

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
ANS: C
Rifampin will color body fluids red-orange and will result in stained clothing and soft contact lenses.

DIF: Cognitive Level: Comprehension REF: p. 615 OBJ: 2
TOP: Rifampin KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

13. A patient with asthma asks the purpose of learning how to use a peak expiratory flow rate (PEFR) device. What is the nurses 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
ANS: B
The PEFR measures expired air. When the PEFR rate decreases 20% below the baseline, adjustments are usually made in the medications.

DIF: Cognitive Level: Comprehension REF: p. 601 OBJ: 3
TOP: Peak Expiratory Flow Rate (PEFR)
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: B
This type of emphysema is characterized by a long smoking history, enlarged and broken down bronchioles, and hypoelastic bronchi.

DIF: Cognitive Level: Knowledge REF: p. 604 OBJ: 2
TOP: Emphysema KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Application REF: p. 612 OBJ: 2
TOP: Cystic Fibrosis: Avoiding Heat KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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
ANS: C
An absence of wheezing indicates a diminished ventilation effort.

DIF: Cognitive Level: Comprehension REF: p. 599 OBJ: 2
TOP: Asthma: Respiratory Arrest KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: A
Bunching 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.

DIF: Cognitive Level: Application REF: p. 611 OBJ: 3
TOP: Activity Intolerance in COPD KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: C
A rising PaCO2 level is acidic in nature and causes respiratory acidosis.

DIF: Cognitive Level: Analysis REF: p. 604 OBJ: 2
TOP: PaCO2 KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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)
ANS: D
The normal ABGs give the patient with emphysema a normal pink color early in the onset of the disease process, rather than a cyanotic color, as observed in a blue bloater.

DIF: Cognitive Level: Comprehension REF: p. 605 OBJ: 2
TOP: Emphysema KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Comprehension REF: p. 609 OBJ: 3 | 4
TOP: COPD: Smoking Cessation KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

DIF: Cognitive Level: Application REF: p. 612 OBJ: 3
TOP: Cystic Fibrosis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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)
ANS: D
Patients with chronic bronchitis show a large increase of RBCs 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 increased eosinophils are indicative of pathologic characteristics other than bronchitis.

DIF: Cognitive Level: Comprehension REF: p. 604-605 OBJ: 2
TOP: Chronic Bronchitis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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

DIF: Cognitive Level: Application REF: p. 610 OBJ: 2
TOP: COPD: Quit Smoking KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

24. A newly diagnosed patient with nonsmall 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.
ANS: A
Surgery is the treatment of choice of NSCLC carcinomas. The survival rate is only approximately 14%. Although referral may be in the long-range plan, the patients need is immediate for information that is within the scope of nursing.

DIF: Cognitive Level: Comprehension REF: p. 618 OBJ: 3
TOP: NSCLC KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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
ANS: B
Foul, bulky stools are the result of inadequately digested food if oral pancreatic enzymes are inadequate.

DIF: Cognitive Level: Application REF: p. 612 OBJ: 3
TOP: Foul Stools with Cystic Fibrosis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

26. What should a patient that had the BCG (Bacillus Calmette-Gurin) 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
ANS: A
Inoculation with BCG causes a false-positive result on TB skin tests that may be administered afterward. BCG is not used very much in the United States, but it is administered in most other countries.

DIF: Cognitive Level: Comprehension REF: p. 613 OBJ: 3
TOP: Bacillus Calmette-Gurin (BCG) Vaccine
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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.
ANS: C
Oral hygiene freshens the mouth and removes unpleasant tastes from medications or coughed-up secretions.

DIF: Cognitive Level: Application REF: p. 611 OBJ: 3
TOP: Imbalanced Nutrition KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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.
ANS: B, C
Blebs 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.

DIF: Cognitive Level: Comprehension REF: p. 604 OBJ: 2
TOP: Blebs and Bullae of Emphysema KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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
ANS: A, B, D, E
The blue bloater has a productive cough, peripheral edema, dyspnea, elevated RBCs, and cyanosis.

DIF: Cognitive Level: Knowledge REF: p. 604-605 OBJ: 2
TOP: Chronic Bronchitis KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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 _____.

ANS:
hypoxic drive
The hypoxic drive is the stimulus of CO2 in the system that drives respiration. If the CO2 level is reduced by excessive administration of O2, then the patient will cease to breathe.

DIF: Cognitive Level: Comprehension REF: p. 606 OBJ: 2
TOP: Hypoxic Drive KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

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

ANS:
E, A, C, B, D
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.

DIF: Cognitive Level: Analysis REF: p. 599 OBJ: 2
TOP: Progression of Asthma Attack KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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