Respiratory Questions Asthma COPD CF NCLEX

Respiratory Questions Asthma COPD CF NCLEX 5.0 (3 reviews) Students also studied Terms in this set (36) George Brown College Nursing Save COPD & Asthma NCLEX 33 terms LauraRNtobePreview COPD NCLEX Chronic.32 terms MilohmylovePreview NUR 150 TB NCLEX Questions 23 terms klh2774Preview Neurol 55 terms mar

• 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

• A patient is seen in the clinic with COPD. Which

information given by the patient would help most in confirming a diagnosis of chronic bronchitis?

• The patient tells the nurse about a family history of

bronchitis.

• The patient denies having any respiratory problems

until the last 6 months.

• The patient's history indicates a 40 pack-year cigarette

history.

• The patient complains about having a productive

cough every winter for 2 months.D

Rationale: A diagnosis of chronic bronchitis is based on a history of having a

productive cough for several months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.Cognitive Level: Application Text Reference: p. 629 Nursing Process: Assessment NCLEX: Physiological Integrity

• The nurse teaches a patient with COPD how to

perform pursed-lip breathing, explaining that this technique will assist respiration by

• loosening secretions so that they may be coughed up

more easily.

• promoting maximal inhalation for better oxygenation

of the lungs.

• preventing airway collapse and air trapping in the lungs

during expiration.

• decreasing anxiety by giving the patient control of

respiratory patterns.C

Rationale: Pursed-lip breathing increases the airway pressure during the

expiratory phase and prevents collapse of the airways, allowing for more complete exhalation. Although loosening of secretions, improving inhalation, and decreasing anxiety are desirable outcomes for the patient with COPD, pursed-lip breathing does not directly impact these.Cognitive Level: Comprehension Text Reference: p. 646 Nursing Process: Implementation NCLEX: Physiological Integrity

• The nurse makes a diagnosis of impaired gas exchange

for a patient with COPD in acute respiratory distress, based on the assessment finding of

• a pulse oximetry reading of 86%.
• dyspnea and respiratory rate of 36.
• use of the accessory respiratory muscles.
• the presence of crackles in both lungs.

A

Rationale: The best data to support the diagnosis of impaired gas exchange are

abnormalities in the ABGs or pulse oximetry. The other data would support a diagnosis of risk for impaired gas exchange.Cognitive Level: Application Text Reference: pp. 650-651 Nursing Process: Diagnosis NCLEX: Physiological Integrity

• When reading the chart for a patient with COPD, the

nurse notes that the patient has cor pulmonale. To assess for cor pulmonale, the nurse will monitor the patient for

• elevated temperature.
• complaints of chest pain.
• jugular vein distension.
• clubbing of the fingers.

C Rationale: Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the patient with other complications of COPD but are not indicators of cor pulmonale.Cognitive Level: Application Text Reference: pp. 635-636 Nursing Process: Assessment NCLEX: Physiological Integrity

• When a patient with COPD is receiving oxygen, the

best action by the nurse is to

• avoid administration of oxygen at a rate of more than 2

L/min.

• minimize oxygen use to avoid oxygen dependency.
• administer oxygen according to the patient's level of

dyspnea.

• maintain the pulse oximetry level at 90% or greater.

D

Rationale: The best way to determine the appropriate oxygen flow rate is by

monitoring the patient's oxygenation either by ABGs or pulse oximetry; an oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use improves survival rate in patients with COPD, there is not a concern about oxygen dependency. The patient's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.Cognitive Level: Application Text Reference: p. 640 Nursing Process: Implementation NCLEX: Physiological Integrity