Respiratory NCLEX Questions Asthma and More

Respiratory NCLEX Questions Asthma and More 5.0 (6 reviews) Students also studied Terms in this set (41) George Brown College Nursing Save Pneumonia NCLEX practice questio...34 terms Daniel_Griffiths2 Preview COPD NCLEX Chronic.32 terms MilohmylovePreview COPD & Asthma NCLEX 33 terms LauraRNtobePreview Respira 43 terms Set

• A patient with a history of asthma is admitted to the

hospital in acute respiratory distress. During assessment of the patient, the nurse would notify the health care provider immediately about

• a pulse oximetry reading of 90%.
• a peak expiratory flow rate of 240 ml/min.
• decreased breath sounds and wheezing.
• a respiratory rate of 26 breaths/min.

C

Rationale: Decreased breath sounds and wheezing would indicate that the patient

was experiencing an asthma attack, and immediate bronchodilator treatment would be indicated. The other data indicate that the patient needs ongoing monitoring and assessment but do not indicate a need for immediate treatment.Cognitive Level: Application Text Reference: pp. 608, 612, 614 Nursing Process: Assessment NCLEX: Physiological Integrity

• The nurse recognizes that intubation and mechanical

ventilation are indicated for a patient in status asthmaticus when

• ventricular dysrhythmias and dyspnea occur.
• loud wheezes are audible throughout the lungs.
• pulsus paradoxus is greater than 40 mm Hg.
• fatigue and an O2 saturation of 88% develop.

D

Rationale: Although all of the assessment data indicate the need for rapid

intervention, the fatigue and hypoxia indicate that the patient is no longer able to maintain an adequate respiratory effort and needs mechanical ventilation. The initial treatment for the other clinical manifestations would initially be administration of rapidly acting bronchodilators and oxygen.Cognitive Level: Application Text Reference: pp. 612-613 Nursing Process: Assessment NCLEX: Physiological Integrity

• An asthmatic patient who has a new prescription for

Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that

• Advair is a combination of long-acting and slow-acting

bronchodilators.

• the two drugs work together to block the effects of

histamine on the bronchioles.

• one drug decreases inflammation, and the other is a

bronchodilator.

• the combination of two drugs works more quickly in an

acute asthma attack.C

Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a

corticosteroid; they work together to prevent asthma attacks. Neither medication is an antihistamine. Advair is not used during an acute attack because the medications do not work rapidly.Cognitive Level: Application Text Reference: pp. 621 Nursing Process: Implementation NCLEX: Physiological Integrity

• The health care provider has prescribed triamcinolone

(Azmacort) metered-dose inhaler (MDI) two puffs every

• hours and pirbuterol (Maxair) MDI 2 puffs four times a

day for a patient with asthma. In teaching the patient about the use of the inhalers, the best instruction by the nurse is

• "Use the Maxair inhaler first, wait a few minutes, then

use the Azmacort inhaler."

• "Using a spacer with the MDIs will improve the

inhalation of the medications."

• "To avoid side effects, the inhalers should not be used

within 1 hour of each other."

• "To maximize the effectiveness of the drugs, inhale

quickly when using the inhalers." B

Rationale: More medication reaches the bronchioles when a spacer is used along

with an MDI. There is no evidence that using a bronchodilator before a corticosteroid inhaler is helpful. The medications can be used at the same time.The patient should inhale slowly when using an MDI.Cognitive Level: Application Text Reference: p. 621 Nursing Process: Implementation NCLEX: Physiological Integrity

• When preparing a patient with possible asthma for

pulmonary function testing, the nurse will teach the patient to

• avoid eating or drinking for 4 hours before the forced

expiratory volume in 1 second (FEV1)/forced expiratory volume (FEV) test.

• take oral corticosteroids at least 2 hours before the

examination.

• withhold bronchodilators for 6 to 12 hours before the

examination.

• use rescue medications immediately before the

FEV1/FEV testing.C

Rationale: Bronchodilators are held before pulmonary function testing so that a

baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should also be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.Cognitive Level: Application Text Reference: p. 614 Nursing Process: Planning NCLEX: Physiological Integrity

• The nurse identifies the nursing diagnosis of activity

intolerance for a patient with asthma. A common etiologic factor for this nursing diagnosis in patients with asthma is

• anxiety about dyspnea.
• side effects of medications.
• work of breathing.
• fear of suffocation.

C Rationale: The activity intolerance patients with asthma experience is related to the increased effort needed to breathe when airways are inflamed and narrowed and interventions are focused on decreasing inflammation and bronchoconstriction. The other listed etiologies are not as appropriate for this diagnosis but would be appropriate for diagnoses seen in patients with asthma, such as social isolation, knowledge deficit, and anxiety.Cognitive Level: Application Text Reference: pp. 612, 624 Nursing Process: Diagnosis NCLEX: Physiological Integrity

• Which finding would be the best indication to the nurse

that the patient having an acute asthma attack was responding to the prescribed bronchodilator therapy?

• Wheezes are more easily heard.
• The oxygen saturation is 89%.
• Vesicular breath sounds resolve.
• The respiratory effort decreases.

A

Rationale: Louder wheezes indicate that more air is moving through the airways

and that the bronchodilator therapy is working. An oxygen saturation level less than 90% indicates continued hypoxemia. Vesicular breath sounds are normal. A decreased respiratory effort may indicate that the patient is becoming too fatigued to breathe effectively and needs mechanical ventilation.Cognitive Level: Application Text Reference: p. 617 Nursing Process: Evaluation NCLEX: Physiological Integrity

• A patient who has mild persistent asthma uses an

albuterol (Proventil) inhaler for chest tightness and wheezing has a new prescription for cromolyn (Intal). To increase the patient's management and control of the asthma, the nurse should teach the patient to

• use the cromolyn when the albuterol does not relieve

symptoms.

• use the cromolyn to prevent inflammatory airway

changes.

• administer the cromolyn first for chest tightness or

wheezing.

• administer the albuterol regularly to prevent airway

inflammation.B Rationale: Cromolyn is prescribed to reduce airway inflammation. It takes several weeks for maximal effect and is not used to treat acute asthma symptoms Albuterol is used as a rescue medication in mild persistent asthma and will not decrease inflammation.Cognitive Level: Application Text Reference: p. 620 Nursing Process: Implementation NCLEX: Physiological Integrity

• During assessment of a patient with a history of asthma,

the nurse notes wheezing and dyspnea. The nurse will anticipate giving medications to reduce

• laryngospasm.
• pulmonary edema.
• airway narrowing.
• alveolar distention.

C

Rationale: The symptoms of asthma are caused by inflammation and spasm of the

bronchioles, leading to airway narrowing. Treatment for laryngospasm or pulmonary edema would not be appropriate. There are no medications used to treat alveolar distention.Cognitive Level: Comprehension Text Reference: pp. 608, 611-612 Nursing Process: Assessment NCLEX: Physiological Integrity

• A patient with an acute attack of asthma comes to the

emergency department, where ABGs are drawn. The nurse determines the patient is in the early phase of the attack, based on the ABG results of

• pH 7.0, PaCO2 50 mm Hg, and PaO2 74 mm Hg.
• pH 7.4, PaCO2 32 mm Hg, and PaO2 70 mm Hg.
• pH 7.36, PaCO2 40 mm Hg, and PaO2 80 mm Hg.
• pH 7.32, PaCO2 58 mm Hg, and PaO2 60 mm Hg.

B

Rationale: The initial response to hypoxemia caused by airway narrowing in a

patient having an acute asthma attack is an increase in respiratory rate, which causes a drop in PaCO2. The other PaCO2 levels are normal or elevated, which would indicate that the attack was progressing and that the patient is decompensating.Cognitive Level: Application Text Reference: pp. 614, 626 Nursing Process: Assessment NCLEX: Physiological Integrity

• While teaching a patient with asthma the appropriate

use of a peak flow meter, the nurse instructs the patient to

• take and record peak flow readings when having

asthma symptoms or an attack.

• increase the doses of long-term control medications

for peak flows in the red zone.

• use the flow meter each morning after taking asthma

medications.

• empty the lungs and then inhale rapidly through the

mouthpiece.A

Rationale: It is recommended that patients check peak flows when asthma

symptoms or attacks occur to compare the peak flow with the baseline. Increased doses of rapidly acting 2-agonists are indicated for peak flows in the red zone.Peak flows should be checked every morning before using medications. Peak flows are assessed during rapid exhalation.Cognitive Level: Application Text Reference: pp. 625, 628 Nursing Process: Implementation NCLEX: Physiological Integrity

• A 32-year-old patient is seen in the clinic for dyspnea

associated with the diagnosis of emphysema. The patient denies any history of smoking. The nurse will anticipate teaching the patient about

• 1-antitrypsin testing.
• use of the nicotine patch.
• continuous pulse oximetry.
• effects of leukotriene modifiers.

A

Rationale: When emphysema occurs in young patients, especially without a

smoking history, a congenital deficiency in 1-antitrypsin should be suspected.Because the patient does not smoke, a nicotine patch would not be ordered.There is no indication that the patient requires continuous pulse oximetry.Leukotriene modifiers would be used in patients with asthma, not with emphysema.Cognitive Level: Application Text Reference: p. 632 Nursing Process: Planning NCLEX: Physiological Integrity

• When teaching a patient with chronic obstructive

pulmonary disease (COPD) about reasons to quit smoking, the nurse will explain that long-term exposure to tobacco smoke leads to a

• weakening of the smooth muscle lining the airways.
• decrease in the area available for oxygen absorption.
• lesser number of red blood cells for oxygen delivery.
• decreased production of protective respiratory

secretions.B

Rationale: Tobacco smoke leads to an increase in proteolytic enzymes, which

break down alveolar walls and lead to less alveolar surface area for gas exchange. Bronchial smooth muscle is not weakened by chronic smoking.Polycythemia is a common compensatory mechanism for patients with COPD. The quantity of respiratory secretions increases as a result of smoking.Cognitive Level: Application Text Reference: p. 633 Nursing Process: Implementation NCLEX: Physiological Integrity

• Which of these is the best goal for the patient

admitted with chronic bronchitis who has a nursing diagnosis of ineffective airway clearance?

• Patient denies having dyspnea.
• Patient's mental status is improved.
• Patient has a productive cough.
• Patient's O2 saturation is 90%.

C Rationale: The goal for the nursing diagnosis of ineffective airway clearance is to maintain a clear airway by coughing effectively. The other goals may be appropriate for the patient with COPD, but they do not address the problem of ineffective airway clearance.Cognitive Level: Application Text Reference: p. 660 Nursing Process: Evaluation NCLEX: Physiological Integrity

• A patient with an acute exacerbation of COPD has the

following ABG analysis: pH 7.32, PaO2 58 mm Hg, PaCO2

55 mm Hg, and SaO2 86%. The nurse recognizes these values as evidence of

• normal acid-base balance with hypoxemia.
• normal acid-base balance with hypercapnia.
• respiratory acidosis.
• respiratory alkalosis.

C

Rationale: The elevated PaCO2 and low pH indicate respiratory acidosis. The

patient is hypoxemic and hypercapnic, but the pH indicates acidosis, not a normal acid-base balance.Cognitive Level: Comprehension Text Reference: p. 650 Nursing Process: Assessment NCLEX: Physiological Integrity

• The nurse identifies the nursing diagnosis of

imbalanced nutrition: less than body requirements for a

patient with COPD. An appropriate intervention for this problem is to

• have the patient exercise for 10 minutes before meals.
• offer high calorie snacks between meals and at

bedtime.

• assist the patient in choosing foods with a lot of

texture.

• increase the patient's intake of fruits and fruit juices.

B

Rationale: Eating small amounts more frequently (as occurs with snacking) will

increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture may take more energy to eat and lead to decreased intake. Although fruits and juices are not contraindicated, foods high in protein are a better choice.Cognitive Level: Application Text Reference: pp. 649,652 Nursing Process: Planning NCLEX: Physiological Integrity