QUESTIONS AND ANSWERS

QUESTIONS AND ANSWERS

NCLEX practice exam 2023/ 65 questions and answers

TESTED AND CONFIRMED A+ ANSWERS

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NCLEX Practice Question Answers for Unit 3 Exam

Module 8: COPD, Asthma and Bronchitis

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• When instructing clients on how to decrease the risk of chronic obstructive pulmonary

disease (COPD), the nurse should emphasize which instruction?

Rationale:

a) Participate regularly in aerobic exercises.

b) Maintain a high-protein diet.

c) Avoid exposure to people with known respiratory infections.

d) Abstain from cigarette smoking.

Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.

• The nurse receives a change-of-shift report on the following four clients. Which client

should the nurse assess first?

Rationale:

• client with asthma who has an albuterol nebulizer treatment due in 10 minutes
• immobile client with a sudden onset of shortness of breath
• client with atrial fibrillation who has a dose of diltiazem due in 15 minutes
• client with influenza who has a temperature of 101.5°F (38.6°C)

Immobility places a client at high risk for deep vein thrombosis (DVT). Sudden onset of shortness of breath in an immobile client suggests the presence of a possible pulmonary embolism and requires immediate assessment and action, such as oxygen administration. The remaining clients are stable with expected symptoms, medications, and/or tests associated with their disease processes.

• A client with chronic obstructive pulmonary disease (COPD) has developed tachypnea,

dyspnea, and oxygen saturation (SaO2) of 90%. Which action by the nurse is most appropriate?

Rationale:

a) Place the client on bed rest.

b) Position the client in a low Fowler’s position with the knees flexed.

c) Assist the client to sit in a chair and lean slightly forward with hands on the

knees.

d) Place the client in the Trendelenburg position.

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Dyspnea is the primary disabling symptom of COPD and the most common. Persistent labored breathing is triggered by increased ventilation secondary to increased work of breathing.Dyspnea also has psychophysiologic components, triggered by such factors as anxiety and fear causing clients to avoid exercise and abandon activities, leading to a downward spiral of disability. To help manage dyspnea, teach clients activities that reduce or control it such as sitting up in the “tripod” position where the client sits or stands leaning forward with the arms supported, forces the diaphragm down and forward, and stabilizes the chest while reducing the work of breathing. COPD clients require exercise; better exercise capacity decreases dyspnea and improves quality of life. Continued bed rest is not recommended. If the client is in bed, the head should bed elevated to high Fowler's position and the client's arms should be supported on pillows or over the bed side table resting the elbows on a surface. This reduces competing demands of the arm, chest, and neck muscles needed for breathing. The Trendelenburg position is used for treatment of severe hypotension.

• A 21-year-old is admitted for treatment of an asthma attack. Which finding indicates

immediate intervention is needed?

a) Thin, copious mucous secretions

b) Productive cough

c) Intercostal retractions

d) Respiratory rate of 20 breaths/minute

Rationale:

Intercostal retractions indicate an increase in respiratory effort, which is a sign of respiratory distress. During an asthma attack, secretions are thick, the cough is tight, and respiration is difficult (and shortness of breath may occur). If mucous secretions are copious but thin, the client can expectorate them, which indicates an improvement in the condition. If the cough is productive it means the bronchospasms and the inflammation have been resolved to the extent that the mucus can be expectorated. A respiratory rate of 20 breaths/minute would be considered normal and no intervention would be needed.

• A client with acute asthma is experiencing inspiratory and expiratory wheezing and

decreased forced expiratory volume. What is the nurse’s priority intervention?

a) Beta-adrenergic blockers

b) Bronchodilators

c) Inhaled steroids

d) Oral steroids

Rationale:

Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce inflammation but aren’t used for emergency relief.

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• When assessing a client with asthma, which findings would most likely indicate the

presence of a respiratory infection?

• cough productive of yellow sputum
• bilateral expiratory wheezing
• chest tightness
• respiratory rate of 30 breaths/min

Rationale:

A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms—wheezing, chest tightness, and increased respiratory rate—are all findings associated with an asthma attack and do not necessarily mean an infection is present.

• A nurse is instructing a client with asthma on the use of an inhaler with a spacer. The

client asks what the purpose of the spacer is. The nurse's best response is

• "The spacer traps medicine from the inhaler, then breaks up and slows down the

medication particles, so you get more medication."

• "The physician has ordered the spacer and wants me to show you how to use it."
• "The spacer is a better way for you to receive the medication from the inhaler

and you don't have to inhale when using it."

• "You should ask your physician to explain the purpose of the spacer."

Rationale:

Describing how the spacer works accurately explains the purpose and benefit of an inhaler.Telling the client that the physician has ordered the spacer and instructed the nurse to explain its use doesn't answer the client's question. The nurse isn't correct in saying the client doesn't have to inhale when using a spacer; during administration, the client should inhale deeply and slowly for 3 to 5 seconds. The client doesn't need to ask the physician about the spacer; the nurse should be familiar with its purpose and proper use.

• A nurse is teaching a client with chronic bronchitis about breathing exercises. Which

instruction should the nurse include in the teaching?

• Make inhalation longer than exhalation.
• Exhale through an open mouth.
• Use diaphragmatic breathing.
• Use chest breathing.

Rationale:

In chronic bronchitis the diaphragm is flat and weak. Diaphragmatic breathing helps to strengthen the diaphragm and maximizes ventilation. Exhalation should be longer than inhalation to prevent collapse of the bronchioles. The client with chronic bronchitis should exhale through pursed lips to prolong exhalation, keep the bronchioles from collapsing, and