Chapter 61: Management of Clients with Lower Airway and Pulmonary Vessel Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 61: Management of Clients with Lower Airway and Pulmonary Vessel

Disorders

MULTIPLE CHOICE

1. A nurse is drawing a blood sample from a clients central line and the client suddenly becomes dyspneic and complains of chest pain. The priority action by the nurse is to

a.

obtain blood pressure readings in both arms.

b.

notify the physician immediately.

c.

put the client in a left lateral Trendelenburg position.

d.

terminate the procedure and clamp the central line.

ANS: D

This client is probably experiencing a venous air embolism from the open central line. The priority action is to stop the procedure and clamp the line. Then the nurse should position the client in Trendelenburg and rotate the client to the left side to trap the air in the apex of the heart. The nurse can attempt to aspirate the air from the distal port of the catheter. Someone else should notify the physician while the nurse remains with the client.

DIF: Analysis/Analyzing REF: p. 1594 OBJ: Assessment

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

2. A nurse is auscultating the lungs of a client who presented to the emergency department complaining of an asthma attack. The nurse hears no wheezing. The nurse should conclude that the client

a.

does not really have asthma.

b.

is not having a bad attack.

c.

may have severe airway constriction.

d.

needs increased IV fluids.

ANS: C

The inability to auscultate wheezing in an asthmatic client with acute respiratory distress may be an ominous sign. It may indicate that the small airways are too constricted to allow any air flow. The client may require immediate, aggressive medical intervention.

DIF: Analysis/Analyzing REF: p. 1571 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

3. The nurse performing a brief physical assessment of an anxious client with asthma would carefully inspect the chest wall primarily to

a.

evaluate the use of intercostal muscles.

b.

gain time to calm the client.

c.

observe the client for diaphoresis.

d.

verify bilateral chest expansion.

ANS: A

The ongoing assessment of an asthmatic client includes evaluation of the accessory muscles of respiration. The nurse should assess the client frequently, observing the respiratory rate and depth. The breathing pattern is assessed for shortness of breath, pursed-lip breathing, nasal flaring, sternal and intercostal retractions, and a prolonged expiratory phase.

DIF: Application/Applying REF: pp. 1573, 1574, 1575

OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

4. A client receives a beta-adrenergic bronchodilator and supplemental oxygen when entering the ED for treatment of asthma, but the clients condition remains unchanged. The nurse would anticipate that the client will

a.

be coached immediately in pursed-lip breathing.

b.

receive increased intravenous fluids.

c.

receive intravenous (IV) steroids.

d.

undergo stat pulmonary function tests.

ANS: C

Emergency management of the asthmatic client begins with inhaled beta-adrenergic drugs. If the asthma does not abate, nebulized atropine sulfate or IV steroids may be given. None of the other three options are related; pulmonary function tests (PFTs) can be done when the client is stable. Pursed-lip breathing might be helpful in the setting of an acute attack when no medications are nearby.

DIF: Comprehension/Understanding REF: p. 1573 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Medical Emergencies

5. The nurse caring for a client with asthma would place the client in the

a.

Fowler position.

b.

lithotomy position.

c.

side-lying position.

d.

supine position.

ANS: A

The nurse should place the client in the Fowler position and give oxygen as ordered.

DIF: Application/Applying REF: p. 1575 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

6. A nurse is conducting community wellness seminars and teaches that a primary prevention activity for chronic obstructive pulmonary disease (COPD) is

a.

avoiding alcohol.

b.

genetic testing.

c.

not smoking.

d.

regular exercise.

ANS: C

Smoking is the primary risk factor for COPD. Other risk factors include air pollution, second-hand smoke, a history of childhood respiratory tract infections, and heredity. Occupational exposure to certain industrial pollutants may also be a risk factor.

DIF: Application/Applying REF: p. 1578 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

7. A client tells the nurse that he read something about dead space in an article about emphysema and asks the nurse to explain it to him. The nurses most accurate answer would be the following:

a.

Any part of your lungs that contains mucous secretions is called dead space.

b.

Dead space is an area of your lung that does not participate in air exchange.

c.

Parts of the lower airway that serve as a conduit for fresh air.

d.

This is a small area of necrotic tissue that can cause infection.

ANS: B

As the alveoli and septa collapse, pockets of air form between the alveolar spaces (blebs) and within the lung parenchyma (bullae). This process leads to increased ventilatory dead space, resulting from areas that do not participate in gas or blood exchange.

DIF: Comprehension/Understanding REF: pp. 1580-1586

OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

8. In assessing a client for emphysema, the nurse would know that a physical finding commonly associated with this condition is

a.

barrel chest.

b.

bulbous nose.

c.

spider angiomas.

d.

varicose veins.

ANS: A

Clients with emphysema develop barrel-shaped chests. The anteroposterior (AP) diameter of the chest is enlarged, and the chest has hyperresonant sounds during percussion.

DIF: Application/Applying REF: p. 1586 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

9. A client has chronic obstructive pulmonary disease (COPD). In reviewing this clients laboratory values, the nurse would not be surprised to see a/an

a.

decreased sedimentation rate.

b.

elevated RBC count.

c.

normochromic anemia.

d.

therapeutic INR.

ANS: B

To compensate for chronic hypoxia, the client will develop polycythemia (increased RBCs).

DIF: Analysis/Analyzing REF: p. 1580 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

10. Important health promotion measures the nurse should encourage the client with COPD to consider are

a.

getting influenza and pneumonia vaccinations.

b.

increasing ambient humidity in the house or apartment.

c.

installing a UV filter in the heating and air conditioning system.

d.

moving to an area of the country with a dry climate.

ANS: A

Vaccinations are recommended to help prevent infectious illness. Influenza vaccination should be given annually. The pneumonia vaccine is recommended for clients 65 years and older and for those younger than 65 if their VEV1 is <40% of predicted value.

DIF: Application/Applying REF: p. 1588 OBJ: Assessment

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Disease Prevention

11. The nurse would prepare a client with emphysema who has a ruptured emphysematous bleb for

a.

chest percussion.

b.

chest tube insertion.

c.

incentive spirometry.

d.

intubation.

ANS: B

Spontaneous pneumothorax may develop from rupture of an emphysematous bleb. This results in a closed pneumothorax and requires chest tube insertion for reexpansion of the lung.

DIF: Application/Applying REF: p. 1586 OBJ: Intervention

MSC: Physiological Integrity Physiological Adaptation-Illness Management

12. A client with COPD has severe shortness of breath at rest and arterial oxygen tension (PaO2) of 35 mm Hg. When oxygen via nasal cannula is prescribed, the nurse would assess the client cautiously because

a.

regulating oxygen settings can be done by unlicensed staff.

b.

some clients with COPD have CO2 narcosis.

c.

skin damage under the nasal cannula is common.

d.

the client may try to sneak a cigarette and get burned.

ANS: B

Some clients with COPD and hypercapnia may be oxygen-sensitive; that is, their PaCO2 levels may rise when given supplemental oxygen, leading to suppression of the central nervous system and lethargy. This phenomenon is known as CO2 narcosis. Clients with hypercapnia need to be monitored closely for their response to oxygen administration.

DIF: Application/Applying REF: pp. 1587-1588

OBJ: Assessment

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

13. A client is being worked up for possible pulmonary hypertension. The nurse prepares the client for the definitive diagnostic test for this condition, which is

a.

arterial blood gas measurements.

b.

pulmonary function studies.

c.

right heart catheterization.

d.

spiral computed tomography.

ANS: C

Right heart catheterization is required both to diagnose pulmonary hypertension and to stage its severity.

DIF: Knowledge/Remembering REF: p. 1595 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

14. A nurse evaluates that goals for self-care teaching have been met when the client with asthma states

a.

Coughing at night is an expected side effect of bronchodilators.

b.

Follow up visits with the doctor every year are important for monitoring.

c.

I wont change the dosages of my medications without talking to the doctor.

d.

If my peak flow measurements drop I will increase my medications.

ANS: D

Through appropriate use of the peak flow meter and medications, clients with asthma should be able to anticipate most exacerbations. Peak flow values fall about 24 hours before manifestations develop. Clients should be taught to increase their routine medications in anticipation of asthma exacerbations. Coughing at night is an indicator of poor control. Follow-up visits need to be planned every 1-6 months.

DIF: Evaluation/Evaluating REF: p. 1577 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

15. A client has a history of recurring respiratory tract infections and presents today with cough and purulent sputum. The client also complains of longstanding fatigue and weakness. The nurse would assess the client further for

a.

a viral infection.

b.

asthma.

c.

bronchiectasis.

d.

tracheobronchitis.

ANS: C

Bronchiectasis is an extreme form of obstructive bronchitis causing permanent abnormal dilation and distortion of bronchi and bronchioles. It occurs most often after recurrent inflammatory conditions. This client is presenting with the major manifestations and because of the history of recurrent infections, the nurse should be suspicious for this problem.

DIF: Application/Applying REF: p. 1590 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

16. The nurse is caring for a client with a pulmonary embolism who is receiving heparin and must have an arterial blood gas (ABG) sample drawn. The nurse would arrange to remain in the room to be available to hold pressure on the puncture site for at least

a.

1 minute.

b.

2 minutes.

c.

5 minutes.

d.

10 minutes.

ANS: D

When invasive studies such as ABGs are necessary, pressure is applied to the site for at least 10 minutes.

DIF: Application/Applying REF: pp. 1593-1594

OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Potential for Complications of Diagnostic Tests/Treatments/Procedures

17. A client experiencing severe chest pain from a pulmonary embolism has been medicated for pain but appears anxious and restless. The additional nursing measure that most likely would assist the client in dealing with fear is

a.

asking the client not to focus on the pain.

b.

explaining the monitoring devices to the client.

c.

reassuring the client the pain medication will work soon.

d.

remaining at the bedside with the client.

ANS: D

Emotional support can reduce anxiety and lessen dyspnea. This helps reduce oxygen demand. The nurse should stay with the client and provide calm, efficient nursing care. The other measures are not necessarily wrong, and might work for some clients, but staying in the room and offering a comforting presence is the best alternative.

DIF: Application/Applying REF: p. 1593 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Coping Mechanisms

18. A client experiencing a pulmonary embolus has pleuritic pain and hemoptysis. The nurse would assesses the presence of hemoptysis as an indication of

a.

alveolar damage.

b.

hemorrhage in the sinuses.

c.

hemothorax.

d.

ruptured vessels in the trachea.

ANS: A

Hemoptysis is an indication that the atelectasis has caused alveolar damage.

DIF: Analysis/Analyzing REF: p. 1592 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

19. A client who experienced a pulmonary embolus is receiving heparin therapy. The client will now also start receiving sodium warfarin (Coumadin). When the client asks the nurse why both medications are being given, the best response by the nurse is

a.

It takes several days for the warfarin to become therapeutic.

b.

Most clients go home on both drugs for maximal treatment.

c.

The heparin is not working to dissolve the blood clot, so we are adding warfarin.

d.

You are right to ask. You are at increased risk of bleeding with both drugs.

ANS: A

Administration of sodium warfarin is begun about 3 to 5 days before heparin is stopped to provide a transition to oral anticoagulants. Warfarin has a long half-life and if the heparin was stopped too early, the client would not be protected. It is important to note that heparin does not dissolve the blood clot.

DIF: Comprehension/Understanding REF: p. 1593 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Pharmacological Agents/Actions

20. The nurse is assessing the lab work of a client with a pulmonary embolism. The clients INR is 5.8. The most appropriate action by the nurse is to

a.

call the physician and ask to increase the Coumadin.

b.

document the findings as normal and continue care.

c.

encourage the client to order green leafy vegetables for dinner.

d.

institute safety precautions for the client.

ANS: D

The optimal INR ratio for heparin therapy is 2.5 to 3. A reading of 5.8 is much too high and puts the client at risk for bleeding episodes. The nurse should place the client on safety precautions. The next dose of Coumadin may need to be held or reduced. The client should not alter the amount of green leafy vegetables in the diet because they contain vitamin K, which works to antagonize the effects of Coumadin.

DIF: Analysis/Analyzing REF: pp. 1592-1593

OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Client Safety

21. The ambulatory care nurse would arrange for periodic monitoring of blood levels for a client with COPD who is beginning to use

a.

beclomethasone (Vanceril).

b.

ipratropium (Atrovent).

c.

theophylline (Theo-Dur).

d.

zafirlukast (Accolate).

ANS: C

It is necessary to monitor blood levels in the client taking theophylline to prevent the client from developing toxicity.

DIF: Application/Applying REF: p. 1575 OBJ: Assessment

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Adverse Effects/Contraindications

22. After providing instructions to a client with newly diagnosed COPD who is learning to take a steroid medication by inhaler, the nurse would determine that proper technique has been learned when the client

a.

breathes out forcefully with an open mouth.

b.

gently rolls the canister in the hands before use.

c.

holds the breath for 5 to 10 seconds after inhalation.

d.

starts to discontinue the medication once manifestations subside.

ANS: C

The client should hold the aerosol vapor for 5 to 10 seconds after inhalation.

DIF: Evaluation/Evaluating REF: p. 1578 OBJ: Evaluation

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

23. A client with COPD is in the hospital. When planning care, which diagnosis takes priority?

a.

Activity Intolerance

b.

Anxiety

c.

Imbalanced Nutrition

d.

Impaired Gas Exchange

ANS: D

All are pertinent diagnoses for the client with COPD. But following the ABCs (airway, breathing, circulation), Impaired Gas Exchange takes priority.

DIF: Analysis/Analyzing REF: pp. 1582-1585

OBJ: Diagnosis

MSC: Safe, Effective Care Environment Management of Care-Establishing Priorities

24. When counseling a client with asthma who has been advised to make several major life changes, the nurse should encourage the client to consider each suggestion carefully because

a.

clients may be able to simply increase their medications and not make changes.

b.

no doctor has all the answers about reducing exacerbations.

c.

the benefit of the change may be offset by the stress it causes.

d.

there are controversies about lifestyle changes needed in asthma.

ANS: C

There are many lifestyle suggestions a client might have recommended, but the nature of the changes often produces Decisional Conflict. Nurses need to respect their clients choices and realize that some major choices such as giving up a beloved pet may cause so much stress and upheaval that the benefits the client would receive are offset.

DIF: Analysis/Analyzing REF: p. 1577 OBJ: Intervention

MSC: Psychosocial Integrity Coping and Adaptation-Grief and Loss

MULTIPLE RESPONSE

1. A nonsmoking client has been diagnosed with mild asthma. The nurse instructs the client to try to identify and reduce or eliminate exposure to triggers, which may include (Select all that apply)

a.

being overly excited.

b.

household pets.

c.

physical exercise.

d.

perfumes.

e.

second-hand smoke.

ANS: A, B, C, D, E

All of the options can induce an asthma attack. When people with asthma are exposed to extrinsic allergens and irritants, their airways become inflamed, producing shortness of breath, chest tightness, and wheezing. Identification of irritants is essential, and irritants should be eliminated in a reasonable fashion, one at a time, to assess the effect of their removal on manifestations.

DIF: Application/Applying REF: p. 1570 OBJ: Intervention

MSC: Health Promotion and Maintenance Prevention and/or Early Detection of Health Problems-Self Care

2. A nurse caring for an elderly client with COPD alters care knowing that in the older population (Select all that apply)

a.

COPD is not a common problem in the elderly.

b.

impaired nutrition is a common problem in the elderly.

c.

multiple co-morbidities may be present that complicate care.

d.

sensory disturbances may hinder their ability to provide self-care.

e.

there may be more problems with drug-drug interactions.

ANS: B, C, D, E

COPD is a common problem in the elderly; it is a leading cause of hospitalizations in older persons. Options b through e are all correct statements about COPD and age-related considerations.

DIF: Analysis/Analyzing REF: p. 1590 OBJ: Intervention

MSC: Health Promotion and Maintenance Growth and Development Through the Lifespan-Age Related Differences

3. The nurse working with a depressed client who has COPD realizes that many factors negatively affect the clients quality of life, including (Select all that apply)

a.

familial support systems.

b.

loss of control over their bodies.

c.

reduced activity tolerance.

d.

social isolation.

ANS: B, C, D

Familial support systems should help with quality of life.

DIF: Knowledge/Remembering REF: p. 1589 OBJ: Assessment

MSC: Psychosocial Integrity Coping and Adaptation-Quality of Life

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

Leave a Reply