copd 6

1. A patient with ahistory of asthma isadmitted to thehospital in acuterespiratorydistress. Duringassessment of thepatient, the nursewould notify thehealth care providerimmediately abouta. a pulse oximetryreading of 90%.b. a peak expiratoryflow rate of 240ml/min.c. decreased breathsounds andwheezing.d. a respiratory rateof 26 breaths/min.

2. The nurserecognizes thatintubation andmechanicalventilation areindicated for apatient in statusasthmaticus whena. ventriculardysrhythmias anddyspnea occur.b. loud wheezes areaudible throughoutthe lungs.c. pulsus paradoxusis greater than 40mm Hg.d. fatigue and an O2saturation of 88%develop.

1. CRationale: Decreased breath soundsand wheezing would indicate that thepatient was experiencing an asthmaattack, and immediate bronchodilatortreatment would be indicated. Theother data indicate that the patientneeds ongoing monitoring andassessment but do not indicate a needfor immediate treatment.

Cognitive Level: Application TextReference: pp. 608, 612, 614Nursing Process: Assessment NCLEX:Physiological Integrity

2. DRationale: Although all of theassessment data indicate the need forrapid intervention, the fatigue andhypoxia indicate that the patient is nolonger able to maintain an adequaterespiratory effort and needsmechanical ventilation. The initialtreatment for the other clinicalmanifestations would initially beadministration of rapidly actingbronchodilators and oxygen.

Cognitive Level: Application TextReference: pp. 612-613Nursing Process: Assessment NCLEX:Physiological Integrity

3. An asthmatic patient whohas a new prescription forAdvair Diskus (combinedfluticasone and salmeterol)asks the nurse the purpose ofusing two drugs. The nurseexplains thata. Advair is a combination oflong-acting and slow-actingbronchodilators.b. the two drugs worktogether to block the effects ofhistamine on the bronchioles.c. one drug decreasesinflammation, and the otheris a bronchodilator.d. the combination of twodrugs works more quickly inan acute asthma attack.

4. The health care providerhas prescribed triamcinolone(Azmacort) metered-doseinhaler (MDI) two puffs every8 hours and pirbuterol(Maxair) MDI 2 puffs fourtimes a day for a patient withasthma. In teaching thepatient about the use of theinhalers, the best instructionby the nurse isa. "Use the Maxair inhalerfirst, wait a few minutes, thenuse the Azmacort inhaler." b. "Using a spacer with theMDIs will improve theinhalation of themedications."c. "To avoid side effects, theinhalers should not be usedwithin 1 hour of each other."d. "To maximize theeffectiveness of the drugs,inhale quickly when using theinhalers."

3. CRationale: Salmeterol is along-acting bronchodilator,and fluticasone is acorticosteroid; they worktogether to prevent asthmaattacks. Neither medicationis an antihistamine. Advairis not used during an acuteattack because themedications do not workrapidly.

Cognitive Level:Application Text Reference:pp. 621Nursing Process:Implementation NCLEX:Physiological Integrity

4. BRationale: More medicationreaches the bronchioleswhen a spacer is used alongwith an MDI. There is noevidence that using abronchodilator before acorticosteroid inhaler ishelpful. The medicationscan be used at the sametime. The patient shouldinhale slowly when usingan MDI.

Cognitive Level:Application Text Reference:p. 621Nursing Process:Implementation NCLEX:Physiological Integrity

COPD 6%Study online at quizlet.com/_bux5b

5. Whenpreparing apatient withpossible asthmafor pulmonaryfunction testing,the nurse willteach thepatient toa. avoid eatingor drinking for4 hours beforethe forcedexpiratoryvolume in 1second(FEV1)/forcedexpiratoryvolume (FEV)test.b. take oralcorticosteroidsat least 2 hoursbefore theexamination.c. withholdbronchodilatorsfor 6 to 12 hoursbefore theexamination.d. use rescuemedicationsimmediatelybefore theFEV1/FEVtesting.

5. CRationale: Bronchodilators are held beforepulmonary function testing so that abaseline assessment of airway function canbe determined. Testing is repeated afterbronchodilator use to determine whetherthe decrease in lung function is reversible.There is no need for the patient to be NPO.Oral corticosteroids should also be heldbefore the examination and corticosteroidsgiven 2 hours before the examinationwould be at a high level. Rescuemedications (which are bronchodilators)would not be given until after the baselinepulmonary function was assessed.

Cognitive Level: Application TextReference: p. 614Nursing Process: Planning NCLEX:Physiological Integrity

6. The nurseidentifies thenursingdiagnosis ofactivityintolerance for apatient withasthma. Acommonetiologic factorfor this nursingdiagnosis inpatients withasthma isa. anxiety aboutdyspnea.b. side effects ofmedications.c. work ofbreathing.d. fear ofsuffocation.

7. Which findingwould be the bestindication to thenurse that thepatient havingan acute asthmaattack wasresponding tothe prescribedbronchodilatortherapy?a. Wheezes aremore easilyheard.b. The oxygensaturation is89%.c. Vesicularbreath soundsresolve.d. Therespiratoryeffort decreases.

6. CRationale: The activity intolerancepatients with asthma experience is relatedto the increased effort needed to breathewhen airways are inflamed and narrowedand interventions are focused ondecreasing inflammation andbronchoconstriction. The other listedetiologies are not as appropriate for thisdiagnosis but would be appropriate fordiagnoses seen in patients with asthma,such as social isolation, knowledge deficit,and anxiety.

Cognitive Level: Application TextReference: pp. 612, 624Nursing Process: Diagnosis NCLEX:Physiological Integrity

7. ARationale: Louder wheezes indicate thatmore air is moving through the airwaysand that the bronchodilator therapy isworking. An oxygen saturation level lessthan 90% indicates continued hypoxemia.Vesicular breath sounds are normal. Adecreased respiratory effort may indicatethat the patient is becoming too fatigued tobreathe effectively and needs mechanicalventilation.

Cognitive Level: Application TextReference: p. 617Nursing Process: Evaluation NCLEX:Physiological Integrity

8. A patient who has mildpersistent asthma uses analbuterol (Proventil) inhalerfor chest tightness andwheezing has a newprescription for cromolyn(Intal). To increase thepatient's management andcontrol of the asthma, thenurse should teach thepatient toa. use the cromolyn when thealbuterol does not relievesymptoms.b. use the cromolyn toprevent inflammatory airwaychanges.c. administer the cromolynfirst for chest tightness orwheezing.d. administer the albuterolregularly to prevent airwayinflammation.

9. During assessment of apatient with a history ofasthma, the nurse noteswheezing and dyspnea. Thenurse will anticipate givingmedications to reducea. laryngospasm.b. pulmonary edema.c. airway narrowing.d. alveolar distention.

8. BRationale: Cromolyn isprescribed to reduce airwayinflammation. It takesseveral weeks for maximaleffect and is not used totreat acute asthmasymptoms Albuterol is usedas a rescue medication inmild persistent asthma andwill not decreaseinflammation.

Cognitive Level: ApplicationText Reference: p. 620Nursing Process:Implementation NCLEX:Physiological Integrity

9. CRationale: The symptoms ofasthma are caused byinflammation and spasm ofthe bronchioles, leading toairway narrowing.Treatment forlaryngospasm or pulmonaryedema would not beappropriate. There are nomedications used to treatalveolar distention.

Cognitive Level:Comprehension TextReference: pp. 608, 611-612Nursing Process:Assessment NCLEX:Physiological Integrity

10. A patient with anacute attack ofasthma comes to theemergencydepartment, whereABGs are drawn. Thenurse determinesthe patient is in theearly phase of theattack, based on theABG results ofa. pH 7.0, PaCO2 50mm Hg, and PaO2 74mm Hg.b. pH 7.4, PaCO2 32mm Hg, and PaO2 70mm Hg.c. pH 7.36, PaCO2 40mm Hg, and PaO2 80mm Hg.d. pH 7.32, PaCO2 58mm Hg, and PaO2 60mm Hg.

11. While teaching apatient with asthmathe appropriate useof a peak flow meter,the nurse instructsthe patient toa. take and recordpeak flow readingswhen having asthmasymptoms or anattack.b. increase the dosesof long-term controlmedications for peakflows in the red zone.c. use the flow metereach morning aftertaking asthmamedications.d. empty the lungsand then inhalerapidly through themouthpiece.

10. BRationale: The initial response tohypoxemia caused by airwaynarrowing in a patient having anacute asthma attack is an increase inrespiratory rate, which causes a dropin PaCO2. The other PaCO2 levelsare normal or elevated, which wouldindicate that the attack wasprogressing and that the patient isdecompensating.

Cognitive Level: Application TextReference: pp. 614, 626Nursing Process: AssessmentNCLEX: Physiological Integrity

11. ARationale: It is recommended thatpatients check peak flows whenasthma symptoms or attacks occur tocompare the peak flow with thebaseline. Increased doses of rapidlyacting �2-agonists are indicated forpeak flows in the red zone. Peakflows should be checked everymorning before using medications.Peak flows are assessed during rapidexhalation.

Cognitive Level: Application TextReference: pp. 625, 628Nursing Process: ImplementationNCLEX: Physiological Integrity

12. A 32-year-oldpatient is seen inthe clinic fordyspnea associatedwith the diagnosisof emphysema. Thepatient denies anyhistory of smoking.The nurse willanticipate teachingthe patient abouta. �1-antitrypsintesting.b. use of thenicotine patch.c. continuous pulseoximetry.d. effects ofleukotrienemodifiers.

13. When teachinga patient withchronic obstructivepulmonary disease(COPD) aboutreasons to quitsmoking, the nursewill explain thatlong-term exposureto tobacco smokeleads to aa. weakening of thesmooth musclelining the airways.b. decrease in thearea available foroxygen absorption.c. lesser number ofred blood cells foroxygen delivery.d. decreasedproduction ofprotectiverespiratorysecretions.

12. ARationale: When emphysema occursin young patients, especially without asmoking history, a congenitaldeficiency in �1-antitrypsin should besuspected. Because the patient doesnot smoke, a nicotine patch would notbe ordered. There is no indication thatthe patient requires continuous pulseoximetry. Leukotriene modifiers wouldbe used in patients with asthma, notwith emphysema.


13. BRationale: Tobacco smoke leads to anincrease in proteolytic enzymes, whichbreak down alveolar walls and lead toless alveolar surface area for gasexchange. Bronchial smooth muscle isnot weakened by chronic smoking.Polycythemia is a commoncompensatory mechanism for patientswith COPD. The quantity ofrespiratory secretions increases as aresult of smoking.

Cognitive Level: Application TextReference: p. 633Nursing Process: ImplementationNCLEX: Physiological Integrity

14. Which of these is thebest goal for the patientadmitted with chronicbronchitis who has anursing diagnosis ofineffective airwayclearance?a. Patient denies havingdyspnea.b. Patient's mentalstatus is improved.c. Patient has aproductive cough.d. Patient's O2saturation is 90%.

15. A patient with anacute exacerbation ofCOPD has the followingABG analysis: pH 7.32,PaO2 58 mm Hg, PaCO255 mm Hg, and SaO286%. The nurserecognizes these valuesas evidence ofa. normal acid-basebalance withhypoxemia.b. normal acid-basebalance withhypercapnia.c. respiratory acidosis.d. respiratory alkalosis.

14. CRationale: The goal for thenursing diagnosis of ineffectiveairway clearance is to maintaina clear airway by coughingeffectively. The other goals maybe appropriate for the patientwith COPD, but they do notaddress the problem ofineffective airway clearance.

Cognitive Level: Application TextReference: p. 660Nursing Process: EvaluationNCLEX: Physiological Integrity

15. CRationale: The elevated PaCO2and low pH indicate respiratoryacidosis. The patient ishypoxemic and hypercapnic, butthe pH indicates acidosis, not anormal acid-base balance.

Cognitive Level: ComprehensionText Reference: p. 650Nursing Process: AssessmentNCLEX: Physiological Integrity

16. The nurseidentifies thenursingdiagnosis ofimbalancednutrition: lessthan bodyrequirements fora patient withCOPD. Anappropriateintervention forthis problem is toa. have thepatient exercisefor 10 minutesbefore meals.b. offer highcalorie snacksbetween mealsand at bedtime.c. assist thepatient inchoosing foodswith a lot oftexture.d. increase thepatient's intakeof fruits and fruitjuices.

16. BRationale: Eating small amounts morefrequently (as occurs with snacking) willincrease caloric intake by decreasing thefatigue and feelings of fullnessassociated with large meals. Patientswith COPD should rest before meals.Foods that have a lot of texture may takemore energy to eat and lead to decreasedintake. Although fruits and juices are notcontraindicated, foods high in proteinare a better choice.

Cognitive Level: Application TextReference: pp. 649,652Nursing Process: Planning NCLEX:Physiological Integrity

17. A patient isseen in the clinicwith COPD. Whichinformation givenby the patientwould help most inconfirming adiagnosis ofchronicbronchitis?a. The patient tellsthe nurse about afamily history ofbronchitis.b. The patientdenies having anyrespiratoryproblems until thelast 6 months.c. The patient'shistory indicates a40 pack-yearcigarette history.d. The patientcomplains abouthaving aproductive coughevery winter for 2months.

17. DRationale: A diagnosis of chronicbronchitis is based on a history ofhaving a productive cough for severalmonths for at least 2 consecutive years.There is no familial tendency forchronic bronchitis. Although smokingis the major risk factor for chronicbronchitis, a smoking history does notconfirm the diagnosis.

Cognitive Level: Application TextReference: p. 629Nursing Process: Assessment NCLEX:Physiological Integrity

18. The nurseteaches apatient withCOPD how toperformpursed-lipbreathing,explaining thatthis techniquewill assistrespiration bya. looseningsecretions sothat they may becoughed upmore easily.b. promotingmaximalinhalation forbetteroxygenation ofthe lungs.c. preventingairway collapseand airtrapping in thelungs duringexpiration.d. decreasinganxiety by givingthe patientcontrol ofrespiratorypatterns.

18. CRationale: Pursed-lip breathing increasesthe airway pressure during the expiratoryphase and prevents collapse of theairways, allowing for more completeexhalation. Although loosening ofsecretions, improving inhalation, anddecreasing anxiety are desirable outcomesfor the patient with COPD, pursed-lipbreathing does not directly impact these.

Cognitive Level: Comprehension TextReference: p. 646Nursing Process: Implementation NCLEX:Physiological Integrity

19. The nurse makes adiagnosis of impairedgas exchange for apatient with COPD inacute respiratorydistress, based on theassessment finding ofa. a pulse oximetryreading of 86%.b. dyspnea andrespiratory rate of 36.c. use of the accessoryrespiratory muscles.d. the presence ofcrackles in both lungs.

20. When reading thechart for a patient withCOPD, the nurse notesthat the patient has corpulmonale. To assessfor cor pulmonale, thenurse will monitor thepatient fora. elevatedtemperature.b. complaints of chestpain.c. jugular veindistension.d. clubbing of thefingers.

19. ARationale: The best data tosupport the diagnosis of impairedgas exchange are abnormalitiesin the ABGs or pulse oximetry.The other data would support adiagnosis of risk for impaired gasexchange.

Cognitive Level: Application TextReference: pp. 650-651Nursing Process: DiagnosisNCLEX: Physiological Integrity

20. CRationale: Cor pulmonale causesclinical manifestations of rightventricular failure, such asjugular vein distension. The otherclinical manifestations may occurin the patient with othercomplications of COPD but arenot indicators of cor pulmonale.

Cognitive Level: Application TextReference: pp. 635-636Nursing Process: AssessmentNCLEX: Physiological Integrity

21. When apatient withCOPD isreceivingoxygen, thebest action bythe nurse is to a. avoidadministrationof oxygen at arate of morethan 2 L/min.b. minimizeoxygen use toavoid oxygendependency. c. administeroxygenaccording tothe patient'slevel ofdyspnea.d. maintain thepulse oximetrylevel at 90% orgreater.

21. DRationale: The best way to determine theappropriate oxygen flow rate is bymonitoring the patient's oxygenation eitherby ABGs or pulse oximetry; an oxygensaturation of 90% indicates adequate bloodoxygen level without the danger ofsuppressing the respiratory drive. Forpatients with an exacerbation of COPD, anoxygen flow rate of 2 L/min may not beadequate. Because oxygen use improvessurvival rate in patients with COPD, thereis not a concern about oxygen dependency.The patient's perceived dyspnea level maybe affected by other factors (such asanxiety) besides blood oxygen level.

Cognitive Level: Application TextReference: p. 640Nursing Process: Implementation NCLEX:Physiological Integrity

22. A patientwith COPDasks the homehealth nurseabout homeoxygen use.The nurseshould teachthe patientthat long-termhome O2therapya. can improvethe patient'sprognosis andquality of life.b. may causeoxygendependency inpatients withCOPD.c. is used onlyfor patientswho havesevere end-stagerespiratorydisease.d. shouldnever be usedat nightbecause thepatient cannotmonitor itseffect.

22. ARationale: Research supports the use ofhome oxygen to improve quality of life andprognosis. Oxygen dependency is not anissue for patients with COPD. Althoughmost patients using home oxygen haveSpO2 levels less than 89% on room air, itwould not be appropriate to tell the patientthat he or she was at the end stage of thedisease. Oxygen use at night can improvesleep quality and is frequentlyrecommended.

Cognitive Level: Application Text Reference:p. 644Nursing Process: Implementation NCLEX:Physiological Integrity

23. A patient isreceiving 35%oxygen via aVenturi mask.To ensure thecorrect amountof oxygendelivery, it ismostimportant thatthe nursea. give a highenough flowrate to keep thebag fromcollapsing.b. use anappropriateadaptor toensureadequateoxygendelivery.c. drainmoisturecondensationfrom theoxygen tubingevery hour.d. keep the airentrainmentports clean andunobstructed.

23. DRationale: The air entrainment portsregulate the oxygen percentage delivered tothe patient, so they must be unobstructed. Ahigh oxygen flow rate is needed whengiving oxygen by partial rebreather or non-rebreather masks. The use of an adaptorcan improve humidification but not oxygendelivery. Draining oxygen tubing isnecessary when caring for a patientreceiving mechanical ventilation.

Cognitive Level: Comprehension TextReference: p. 642Nursing Process: Implementation NCLEX:Physiological Integrity

24. Posturaldrainage withpercussion andvibration isordered bid for apatient withchronicbronchitis. Thenurse will plan toa. carry out theprocedure 3hours after thepatient eats.b. maintain thepatient in thelateral positionsfor 20 minutes.c. performpercussion andvibration beforeplacing thepatient in thedrainageposition.d. give theordered albuterol(Proventil) afterthe patient hasreceived thetherapy.

25. Whendeveloping ateaching plan tohelp increaseactivity toleranceat home for a 70-year-old withsevere COPD, thenurse shouldteach the patientthat anappropriateexercise goal is toa. exercise untilshortness ofbreath occurs.b. walk for a totalof 20 minutesdaily.c. limit exercise toactivities of dailyliving (ADLs).d. walk until pulserate exceeds 150.

24. ARationale: Postural drainage,percussion, and vibration should bedone 1 hour before or 3 hours aftermeals. Patients remain in each posturaldrainage position for 5 to 15 minutes.Percussion and vibration are done afterthe postural drainage. Bronchodilatorsare administered before chestphysiotherapy.


25. BRationale: The goal for exerciseprograms for patients with COPD is toincrease exercise time gradually to atotal of 20 minutes daily. Shortness ofbreath is normal with exercise and notan indication that the patient shouldstop. Limiting exercise to ADLs will notimprove the patient's exercise tolerance.A 70-year-old patient should have apulse rate of 120 or less with exercise(80% of the maximal heart rate of 150).


26. A patient withsevere COPD tellsthe nurse, "I wishI were dead! Icannot doanything formyself anymore."Based on thisinformation, thenurse identifiesthe nursingdiagnosis ofa. hopelessnessrelated to presenceof long-termstress.b. anticipatorygrieving related toexpectation ofdeath.c. ineffectivecoping related tounknown outcomeof illness.d. disturbed self-esteem related tophysicaldependence.

27. A patient withCOPD is admittedto the hospital.How can the nursebest position thepatient to improvegas exchange?a. Sitting up at thebedside in a chairand leaningslightly forwardb. Resting in bedwith the headelevated to 45 to 60degreesc. In theTrendelenburg'sposition withseveral pillowsbehind the headd. Resting in bedin a high-Fowler'sposition with theknees flexed

26. DRationale: The patient's statementabout not being able to do anything forhimself or herself supports thisdiagnosis. Although hopelessness,anticipatory grieving, and ineffectivecoping may also be appropriatediagnoses for patients with COPD, thepatient does not mention long-termstress, death, or an unknown outcomeas being concerns.

Cognitive Level: Application TextReference: p. 655Nursing Process: Diagnosis NCLEX:Psychosocial Integrity

27. ARationale: Patients with COPD improvethe mechanics of breathing by sittingup in the "tripod" position. Resting inbed with the head elevated would be analternative position if the patient wasconfined to bed, but sitting in a chairallows better ventilation. TheTrendelenburg's position or sittingupright in bed with the knees flexedwould decrease the patient's ability toventilate well.


28. A patient with COPD tellsthe nurse, "At home, I onlyhave to use an albuterol(Proventil) inhaler. Why didthe doctor add anipratropium (Atrovent)inhaler while I'm in thehospital? The appropriateresponse by the nurse isa. "Atrovent will dilate theairways and allow theProventil to penetrate moredeeply."b. "Atrovent is being used todecrease airwayinflammation and sputumproduction."c. "Atrovent works differentlyto dilate the bronchi, and thetwo drugs together are moreeffective."d. "Atrovent is a potentbronchodilator and patientsneed to be hospitalized whenreceiving it."

29. The nurse has completedteaching a patient about MDIuse. Which patient statementindicates that further patientteaching is needed?a. "I will shake the MDI eachtime before giving themedication."b. "I will take a slow, deepbreath in after pushing downon the MDI."c. "I will float the canister inwater to decide whether Ineed to get a new MDI."d. "I will attach a spacer tothe MDI to make it easier forme to use."

28. CRationale: Combiningbronchodilators improveseffectiveness. Atrovent doesnot have to be used beforeProventil, it does notdecrease airwayinflammation, and it doesnot require hospitalization.

Cognitive Level:Application TextReference: p. 640Nursing Process:Implementation NCLEX:Physiological Integrity

29. CRationale: This method isno longer recommended asa means of determiningwhether the medicationneeds replacement. Theother patient statementsare accurate and indicatethe patient understandshow to use the MDI.

Cognitive Level:Application TextReference: p. 622Nursing Process:Evaluation NCLEX:Physiological Integrity

30. A 23-year-oldwith cysticfibrosis (CF) isadmitted to thehospital. Whichintervention willbe included inthe plan of care?a. Schedulesweat chloridetest to evaluatethe effectivenessof therapy.b. Arrange for ahospice nurse tovisit with thepatientregarding homecare.c. Place thepatient on a low-sodium diet toprevent corpulmonale.d. Perform chestphysiotherapyevery 4 hours tomobilizesecretions.

31. A 26-year-oldpatient has hadCF since birthand has severelung changesand corpulmonale as aresult of thedisease. Anappropriateexpectedoutcome is thatthe patient willa. engage inaerobic exercisewithoutdyspnea.b. be weanedfrom homeoxygen use.c. achieve arealistic attitudetowardtreatment.d. develop no CF-relatedcomplications.

30. DRationale: Routine scheduling of airwayclearance techniques is an essentialintervention for patients with CF. A sweatchloride test is used to diagnose CF, but itdoes not provide any information aboutthe effectiveness of therapy. There is noindication that the patient is terminallyill. Patients with CF lose excessivesodium in their sweat and require highamounts of dietary sodium.


31. CRationale: The patient's severe lungdisease and cor pulmonale are latecomplications of CF, and a realisticattitude about what outcome can beexpected from treatment is an appropriateoutcome. Exercising without dyspnea andweaning from home oxygen therapy arenot realistic outcomes for this patientwith end-stage disease. The patientalready has multiple CF-relatedcomplications and is likely to continue todevelop complications.

Cognitive Level: Application TextReference: pp. 657-658Nursing Process: Planning NCLEX: Health Promotion andMaintenance

32. A 19-year-oldmale patient withCF and his wife areconsidering havinga child. Whichstatement by thepatient indicatesthat the nurse'steaching has beeneffective?a. "We will plan onhaving geneticcounseling beforewe make adecision."b. "My erectiledysfunction willmake it moredifficult to have achild."c. "It is likely that Iwill die before anychildren we haveare grown."d. "There shouldnot be any problemsas long as I take mymedications."

33. The nursecaring for a patientwith CF recognizesthat themanifestations ofthe disease arecaused by thepathophysiologicprocesses ofa. inflammationand fibrosis of lungtissue.b. altered functionof exocrine glands.c. failure of themucus-producinggoblet cells.d. thickening andfibrosis of thepleural linings.

32. ARationale: Children of patients withCF are either CF carriers or have thedisease. Most men with CF are sterile,but erectile dysfunction is notassociated with CF. The lifeexpectancy for CF is getting longer,with a mean age of 35. Despiteappropriate therapy, the couple islikely to experience problemsbecoming pregnant.

Cognitive Level: Application TextReference: p. 659Nursing Process: Evaluation NCLEX: Health Promotion andMaintenance

33. BRationale: CF is characterized byabnormal secretions of exocrineglands, mainly of the lungs,pancreas, and sweat glands. Damageto lung tissue develops late in thedisease. The goblet cells continue toproduce mucus.

Cognitive Level: Comprehension TextReference: pp. 655-656Nursing Process: AssessmentNCLEX: Physiological Integrity

34. All of theseorders are receivedfor a patient havingan acute asthmaattack. Which onewill the nurseadminister first?a. IVmethylprednisolone(Solu-Medrol) 60mgb. triamcinolone(Azmacort) 2 puffsper MDIc. salmeterol(Serevent) 50 mcgper DPId. albuterol(Ventolin) 2.5 mgper nebulizer

35. Whichstatement by theCOPD patientindicates that thenurse's teachingabout nutrition hasbeen effective?a. "I will drink lotsof fluids with mymeals."b. "I will have icecream as a snackevery day."c. "I should exercisefor 15 minutesbefore meals."d. "I should avoidmuch meat or dairyproducts."

34. DRationale: Albuterol is a rapidlyacting bronchodilator and is the first-line medication to reverse airwaynarrowing in acute asthma attacks.The other medications work moreslowly.


35. BRationale: High-calorie foods like icecream are an appropriate snack forpatients with COPD. Fluid intake of 3L/day is recommended, but fluidsshould be taken between meals ratherthan with meals to improve oralintake of solid foods. The patientshould avoid exercise for an hourbefore meals to prevent fatigue whileeating. Meat and dairy products arehigh in protein and are good choicesfor the patient with COPD.


36. Whenteaching thepatient withCOPD aboutexercise,whichinformationshould thenurse include?a. "Stopexercising ifyou start to feelshort ofbreath."b. "Use thebronchodilatorbefore youstart toexercise."c. "Breathe inand outthrough themouth whileyou exercise."d. "Upper bodyexerciseshould beavoided topreventdyspnea."

36. BRationale: Use of a bronchodilator beforeexercise improves airflow for some patientsand is recommended. Shortness of breath isnormal with exercise and not a reason tostop. Patients should be taught to breathe inthrough the nose and out through themouth (using a pursed-lip technique).Upper-body exercise can improve themechanics of breathing in patients withCOPD.

Cognitive Level: Application TextReference: p. 653Nursing Process: Implementation NCLEX:Physiological Integrity

37. The nurse hasreceived achange-of-shiftreport aboutthese patientswith COPD.Which patientshould the nurseassess first?a. A patient withloud expiratorywheezesb. A patient whohas a coughproductive ofthick, greenmucusc. A patient withjugular veindistension andperipheraledemad. A patient witha respiratoryrate of 38

37. DRationale: A respiratory rate of 38indicates severe respiratory distress, andthe patient needs immediate assessmentand intervention to prevent possiblerespiratory arrest. The other patients alsoneed assessment as soon as possible, butthey do not need to be assessed asurgently as the tachypneic patient.

Cognitive Level: Application TextReference: pp. 612, 626Nursing Process: Assessment NCLEX: Safe and Effective CareEnvironment

38. Whichinformation givenby an asthmaticpatient during theadmissionassessment will beof most concern tothe nurse?a. The patient saysthat the asthmasymptoms areworse every spring.b. The patient'sonly asthmamedications arealbuterol(Proventil) andsalmeterol(Serevent).c. The patient usescromolyn (Intal)before any aerobicexercise.d. The patient'sheart rateincreases afterusing the albuterol(Proventil) inhaler.

39. When taking anadmission historyof a patient withpossible asthmawho has new-onsetwheezing andshortness ofbreath, the nursewill be mostconcerned aboutwhichinformation?a. The patient has ahistory ofpneumonia 2 yearsago.b. The patient takespropranolol(Inderal) forhypertension.c. The patient usesacetaminophen(Tylenol) forheadaches.d. The patient haschronicinflammatorybowel disease.

38. BRationale: Long-acting �2-agonistsshould be used only in patients whoare also using another medication forlong-term control (typically an inhaledcorticosteroid). Salmeterol should notbe used as the first-line therapy forlong-term control. The otherinformation given by the patientrequires further assessment by thenurse but is not unusual for a patientwith asthma.

Cognitive Level: Application TextReference: pp. 615, 621Nursing Process: Assessment NCLEX:Physiological Integrity

39. BRationale: �-blockers such aspropranolol can cause bronchospasmin some patients. The otherinformation will be documented in thehealth history but does not indicate aneed for a change in therapy.

Cognitive Level: Application TextReference: p. 610Nursing Process: Assessment NCLEX:Physiological Integrity

40. A patientwho isexperiencingan acuteasthma attackis admitted tothe emergencydepartment.The nurse'sfirst actionshould be toa. determinewhen thedyspneastarted.b. obtain theforcedexpiratoryflow rate.c. listen to thepatient'sbreathsounds.d. ask aboutinhaledcorticosteroiduse.

40. CRationale: Assessment of the patient's breathsounds will help to determine how effectivelythe patient is ventilating and whether rapidintubation may be necessary. The length oftime the attack has persisted is not asimportant as determining the patient's statusat present. Most patients having an acuteattack will be unable to cooperate with a FEVmeasurement. It is important to know aboutthe medications the patient is using but notas important as assessing the breath sounds.

Cognitive Level: Application Text Reference:p. 626Nursing Process: Assessment NCLEX:Physiological Integrity

41. Afterteaching thepatient withasthma abouthome care, thenurse willevaluate thatthe teachinghas beensuccessful if thepatient states,a. "I will use mycorticosteroidinhaler as soonas I start to getshort ofbreath."b. "I will onlyturn the homeoxygen level upafter checkingwith the doctorfirst."c. "Mymedicationsare working if Iwake up shortof breath onlyonce during thenight."d. "No changesin mymedicationsare needed ifmy peak flow isat 80% ofnormal."

41. DRationale: Peak flows of 80% or greaterindicate that the asthma is well controlled.Corticosteroids are long-acting,prophylactic therapy for asthma and arenot used to treat acute dyspnea. Becauseasthma is an acute and intermittentprocess, home oxygen is not used. Thepatient who has effective treatment shouldsleep throughout the night without wakingup with dyspnea.


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