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Asthma and COPD

1. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A

nurse administers the medication, knowing that the primary action of this
medication is to:

1. Promote expectoration
2. Suppress the cough
3. Relax smooth muscles of the bronchial airway
4. Prevent infection

2. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The

nurse monitors the client for which side effect of this medication?

1. Constipation
2. Diarrhea
3. Bradycardia
4. Tachycardia

3. A nurse teaches a client about the use of a respiratory inhaler. Which action by
the client indicated a need for further teaching?

1. Removes the cap and shakes the inhaler well before use.
2. Presses the canister down with finger as he breathes in.
3. Inhales the mist and quickly exhales.
4. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

4. A female client is scheduled to have a chest radiograph. Which of the following

questions is of most importance to the nurse assessing this client?

Asthma and COPD

1. Is there any possibility that you could be pregnant?
2. Are you wearing any metal chains or jewelry?
3. Can you hold your breath easily?
4. Are you able to hold your arms above your head?

5. A client has just returned to a nursing unit following bronchoscopy. A nurse would
implement which of the following nursing interventions for this client?

1. Encouraging additional fluids for the next 24 hours

2. Ensuring the return of the gag reflex before offering foods or fluids
3. Administering atropine intravenously
4. Administering small doses of midazolam (Versed).

6. A client has an order to have radial ABG drawn. Before drawing the sample, a
nurse occludes the:

1. Brachial and radial arteries, and then releases them and observes the circulation
of the hand.
2. Radial and ulnar arteries, releases one, evaluates the color of the hand, and
repeats the process with the other artery.
3. Radial artery and observes for color changes in the affected hand.
4. Ulnar artery and observes for color changes in the affected hand.

7. A nurse is assessing a client with chronic airflow limitation and notes that the
client has a barrel chest. The nurse interprets that this client has which of the
following forms of chronic airflow limitation?

1. Chronic obstructive bronchitis

2. Emphysema

Asthma and COPD

3. Bronchial asthma
4. Bronchial asthma and bronchitis

8. A client has been taking benzonatate (Tessalon Perles) as prescribed. A nurse

concludes that the medication is having the intended effect if the client

1. Decreased anxiety level

2. Increased comfort level
3. Reduction of N/V
4. Decreased frequency and intensity of cough

9. Which of the following would be an expected outcome for a client recovering from
an upper respiratory tract infection? The client will:

1. Maintain a fluid intake of 800 ml every 24 hours.

2. Experience chills only once a day
3. Cough productively without chest discomfort.
4. Experience less nasal obstruction and discharge.

10. Which of the following individuals would the nurse consider to have the highest
priority for receiving an influenza vaccination?

1. A 60-year-old man with a hiatal hernia

2. A 36-year-old woman with 3 children
3. A 50-year-old woman caring for a spouse with cancer
4. a 60-year-old woman with osteoarthritis

Asthma and COPD

11. A client with allergic rhinitis asks the nurse what he should do to decrease his
symptoms. Which of the following instructions would be appropriate for the nurse to
give the client?

1. Use your nasal decongestant spray regularly to help clear your nasal passages.
2. Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.
3. It is important to increase your activity. A daily brisk walk will help promote
4. Keep a diary if when your symptoms occur. This can help you identify what
precipitates your attacks.

12. An elderly client has been ill with the flu, experiencing headache, fever, and
chills. After 3 days, she develops a cough productive of yellow sputum. The nurse
auscultates her lungs and hears diffuse crackles. How would the nurse best
interpret these assessment findings?

1. It is likely that the client is developing a secondary bacterial pneumonia.

2. The assessment findings are consistent with influenza and are to be expected.
3. The client is getting dehydrated and needs to increase her fluid intake to
decrease secretions.
4. The client has not been taking her decongestants and bronchodilators as

13. Guaifenesin 300 mg four times daily has been ordered as an expectorant. The
dosage strength of the liquid is 200mg/5ml. How many mL should the nurse
administer each dose?

1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml

Asthma and COPD

14. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of

the following is a possible side effect of this drug?

1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness

15. A client with COPD reports steady weight loss and being too tired from just
breathing to eat. Which of the following nursing diagnoses would be most
appropriate when planning nutritional interventions for this client?

1. Altered nutrition: Less than body requirements related to fatigue.

2. Activity intolerance related to dyspnea.
3. Weight loss related to COPD.
4. Ineffective breathing pattern related to alveolar hypoventilation.

16. When developing a discharge plan to manage the care of a client with COPD,
the nurse should anticipate that the client will do which of the following?

1. Develop infections easily

2. Maintain current status
3. Require less supplemental oxygen
4. Show permanent improvement.

17. Which of the following outcomes would be appropriate for a client with COPD
who has been discharged to home? The client:

Asthma and COPD

1. Promises to do pursed lip breathing at home.

2. States actions to reduce pain.
3. States that he will use oxygen via a nasal cannula at 5 L/minute.
4. Agrees to call the physician if dyspnea on exertion increases.

18. Which of the following physical assessment findings would the nurse expect to
find in a client with advanced COPD?

1. Increased anteroposterior chest diameter

2. Underdeveloped neck muscles
3. Collapsed neck veins
4. Increased chest excursions with respiration

19. Which of the following is the primary reason to teach pursed-lip breathing to
clients with emphysema?

1. To promote oxygen intake

2. To strengthen the diaphragm
3. To strengthen the intercostal muscles
4. To promote carbon dioxide elimination

20. Which of the following is a priority goal for the client with COPD?

1. Maintaining functional ability

2. Minimizing chest pain
3. Increasing carbon dioxide levels in the blood

Asthma and COPD

4. Treating infectious agents

21. A clients arterial blood gas levels are as follows: pH 7.31; PaO2 80 mm Hg,
PaCO2 65 mm Hg; HCO3- 36 mEq/L. Which of the following signs or symptoms
would the nurse expect?

1. Cyanosis
2. Flushed skin
3. Irritability
4. Anxiety

22. When teaching a client with COPD to conserve energy, the nurse should teach
the client to lift objects:

1. While inhaling through an open mouth.

2. While exhaling through pursed lips
3. After exhaling but before inhaling.
4. While taking a deep breath and holding it.

23. The nurse teaches a client with COPD to assess for s/s of right-sided heart
failure. Which of the following s/s would be included in the teaching plan?

1. Clubbing of nail beds

2. Hypertension
3. Peripheral edema
4. Increased appetite

Asthma and COPD

24. The nurse assesses the respiratory status of a client who is experiencing an
exacerbation of COPD secondary to an upper respiratory tract infection. Which of
the following findings would be expected?

1. Normal breath sounds

2. Prolonged inspiration
3. Normal chest movement
4. Coarse crackles and rhonchi

25. Which of the following ABG abnormalities should the nurse anticipate in a client
with advanced COPD?

1. Increased PaCO2
2. Increased PaO2
3. Increased pH.
4. Increased oxygen saturation

26. Which of the following diets would be most appropriate for a client with COPD?

1. Low fat, low cholesterol

2. Bland, soft diet
3. Low-Sodium diet
4. High calorie, high-protein diet

27. The nurse is planning to teach a client with COPD how to cough effectively.
Which of the following instructions should be included?

Asthma and COPD

1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on
2. Lie flat on back, splint the thorax, take two deep breaths and cough.
3. Take several rapid, shallow breaths and then cough forcefully.
4. Assume a side-lying position, extend the arm over the head, and alternate deep
breathing with coughing.

28. A 34-year-old woman with a history of asthma is admitted to the emergency

department. The nurse notes that the client is dyspneic, with a respiratory rate of
35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the
lung fields reveals greatly diminished breath sounds. Based on these findings, what
action should the nurse take to initiate care of the client?

1. Initiate oxygen therapy and reassess the client in 10 minutes.

2. Draw blood for an ABG analysis and send the client for a chest x-ray.
3. Encourage the client to relax and breathe slowly through the mouth
4. Administer bronchodilators

29. The nurse would anticipate which of the following ABG results in a client
experiencing a prolonged, severe asthma attack?

1. Decreased PaCO2, increased PaO2, and decreased pH.

2. Increased PaCO2, decreased PaO2, and decreased pH.
3. Increased PaCO2, increased PaO2, and increased pH.
4. Decreased PaCO2, decreased PaO2, and increased pH.

30. A client with acute asthma is prescribed short-term corticosteroid therapy. What
is the rationale for the use of steroids in clients with asthma?

Asthma and COPD

1. Corticosteroids promote bronchodilation
2. Corticosteroids act as an expectorant
3. Corticosteroids have an anti-inflammatory effect
4. Corticosteroids prevent development of respiratory infections.

31. The nurse is teaching the client how to use a metered dose inhaler (MDI) to
administer a Corticosteroid drug. Which of the following client actions indicates that
he is using the MDI correctly? Select all that apply.

1. The inhaler is held upright.

2. Head is tilted down while inhaling the medication
3. Client waits 5 minutes between puffs.
4. Mouth is rinsed with water following administration
5. Client lies supine for 15 minutes following administration.

32. A client is prescribed metaproterenol (Alupent) via a metered dose inhaler

(MDI), two puffs every 4 hours. The nurse instructs the client to report side effects.
Which of the following are potential side effects of metaproterenol?

1. Irregular heartbeat
2. Constipation
3. Pedal edema
4. Decreased heart rate.

33. A client has been taking flunisolide (Aerobid), two inhalations a day, for
treatment of asthma. He tells the nurse that he has painful, white patches in his
mouth. Which response by the nurse would be the most appropriate?

Asthma and COPD

1. This is an anticipated side-effect of your medication. It should go away in a
couple of weeks.
2. You are using your inhaler too much and it has irritated your mouth.
3. You have developed a fungal infection from your medication. It will need to be
treated with an antibiotic.
4. Be sure to brush your teeth and floss daily. Good oral hygiene will treat this

34. Which of the following health promotion activities should the nurse include in
the discharge teaching plan for a client with asthma?

1. Incorporate physical exercise as tolerated into the treatment plan.

2. Monitor peak flow numbers after meals and at bedtime.
3. Eliminate stressors in the work and home environment
4. Use sedatives to ensure uninterrupted sleep at night.

35. The client with asthma should be taught that which of the following is one of the
most common precipitating factors of an acute asthma attack?

1. Occupational exposure to toxins

2. Viral respiratory infections
3. Exposure to cigarette smoke
4. Exercising in cold temperatures

36. A female client comes into the emergency room complaining of SOB and pain in
the lung area. She states that she started taking birth control pills 3 weeks ago and
that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABGs,
results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24
mEq/L; SaO2 86%. Considering these results, the first intervention is to:

Asthma and COPD

1. Begin mechanical ventilation
2. Place the client on oxygen
3. Give the client sodium bicarbonate
4. Monitor for pulmonary embolism.

37. Basilar crackles are present in a clients lungs on auscultation. The nurse knows
that these are discrete, non continuous sounds that are:

1. Caused by the sudden opening of alveoli

2. Usually more prominent during expiration
3. Produced by airflow across passages narrowed by secretions
4. Found primarily in the pleura.

38. A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to
oxygen, the first nursing action would be to:

1. Wait until the clients lab work is done.

2. Not administer oxygen unless ordered by the physician.
3. Administer oxygen at 2 L flow per minute.
4. Administer oxygen at 10 L flow per minute and check the clients nail beds.

39. Immediately following a thoracentesis, which clinical manifestations indicate

that a complication has occurred and the physician should be notified?

1. Serosanguineous drainage from the puncture site

2. Increased temperature and blood pressure
3. Increased pulse and pallor

Asthma and COPD

4. Hypotension and hypothermia

40. If a client continues to hypoventilate, the nurse will continually assess for a
complication of:

1. Respiratory acidosis
2. Respiratory alkalosis
3. Metabolic acidosis
4. Metabolic alkalosis

41. A client is admitted to the hospital with acute bronchitis. While taking the
clients VS, the nurse notices he has an irregular pulse. The nurse understands that
cardiac arrhythmias in chronic respiratory distress are usually the result of:

1. Respiratory acidosis
2. A build-up of carbon dioxide
3. A build-up of oxygen without adequate expelling of carbon dioxide.
4. An acute respiratory infection.

42. Auscultation of a clients lungs reveals crackles in the left posterior base. The
nursing intervention is to:

1. Repeat auscultation after asking the client to deep breathe and cough.
2. Instruct the client to limit fluid intake to less than 2000 ml/day.
3. Inspect the clients ankles and sacrum for the presence of edema
4. Place the client on bedrest in a semi-Fowlers position.

43. The most reliable index to determine the respiratory status of a client is to:

Asthma and COPD

1. Observe the chest rising and falling

2. Observe the skin and mucous membrane color.
3. Listen and feel the air movement.
4. Determine the presence of a femoral pulse.

44. A client with COPD has developed secondary polycythemia. Which nursing
diagnosis would be included in the plan of care because of the polycythemia?

1. Fluid volume deficit related to blood loss.

2. Impaired tissue perfusion related to thrombosis
3. Activity intolerance related to dyspnea
4. Risk for infection related to suppressed immune response.

45. The physician has scheduled a client for a left pneumonectomy. The position
that will most likely be ordered postoperatively for his is the:

1. Nonoperative side or back

2. Operative side or back
3. Back only
4. Back or either side.

46. Assessing a client who has developed atelectasis postoperatively, the nurse will
most likely find:

1. A flushed face
2. Dyspnea and pain

Asthma and COPD

3. Decreased temperature
4. Severe cough and no pain.

47. A fifty-year-old client has a tracheostomy and requires tracheal suctioning. The
first intervention in completing this procedure would be to:

1. Change the tracheostomy dressing

2. Provide humidity with a trach mask
3. Apply oral or nasal suction
4. Deflate the tracheal cuff

48. A client states that the physician said the tidal volume is slightly diminished and
asks the nurse what this means. The nurse explains that the tidal volume is the
amount of air:

1. Exhaled forcibly after a normal expiration

2. Exhaled after there is a normal inspiration
3. Trapped in the alveoli that cannot be exhaled
4. Forcibly inspired over and above a normal respiration.

49. An acceleration in oxygen dissociation from hemoglobin, and thus oxygen

delivery to the tissues, is caused by:

1. A decreasing oxygen pressure in the blood

2. An increasing carbon dioxide pressure in the blood
3. A decreasing oxygen pressure and/or an increasing carbon dioxide pressure in the
4. An increasing oxygen pressure and/or a decreasing carbon dioxide pressure in the

Asthma and COPD

50. The best method of oxygen administration for client with COPD uses:

1. Cannula
2. Simple Face mask
3. Non rebreather mask
4. Venturi mask

Answers and Rationale

1. Answer: 3. Relax smooth muscles of the bronchial airway

Aminophylline is a bronchodilator that directly relaxes the smooth muscles of the

bronchial airway.

2. Answer: 4. Tachycardia

Side effects that can occur from a beta 2 agonist include tremors, nausea,
nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the
mouth or throat.

3. Answer: 3. Inhales the mist and quickly exhales.

The client should be instructed to hold his or her breath at least 10 to 15 seconds
before exhaling the mist.

4. Answer: 1. Is there any possibility that you could be pregnant?

Asthma and COPD

The most important item to ask about is the clients pregnancy status because
pregnant women should not be exposed to radiation. Clients are also asked to
remove any chains or metal objects that could interfere with obtaining an adequate
film. A chest radiograph most often is done at full inspiration, which gives optimal
lung expansion. If a lateral view of the chest is ordered, the client is asked to raise
the arms above the head. Most films are done in posterior-anterior view.

5. Answer: 2. Ensuring the return of the gag reflex before offering foods or fluids

After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex
returns because the preoperative sedation and the local anesthesia impair
swallowing and the protective laryngeal reflexes for a number of hours. Additional
fluids is unnecessary because no contrast dye is used that would need to be flushed
from the system. Atropine and Versed would be administered before the procedure,
not after.

6. Answer: 2. Radial and ulnar arteries, releases one, evaluates the color of the
hand, and repeats the process with the other artery.

Before drawing an ABG, the nurse assesses the collateral circulation to the hand
with Allens test. This involves compressing the radial and ulnar arteries and asking
the client to close and open the fist. This should cause the hand to become pale.
The nurse then releases pressure on one artery and observes whether circulation is
restored quickly. The nurse repeats the process, releasing the other artery. The
blood sample may be taken safely if collateral circulation is adequate.

7. Answer: 2. Emphysema

The client with emphysema has hyperinflation of the alveoli and flattening of the
diaphragm. These lead to increased anteroposterior diameter, which is referred to
as barrel chest. The client also has dyspnea with prolonged expiration and has
hyperresonant lungs to percussion.

8. Answer: 4. Decreased frequency and intensity of cough

Asthma and COPD

Benzonatate is a locally acting antitussive the effectiveness of which is measured by

the degree to which it decreases the intensity and frequency of cough without
eliminating the cough reflex.

9. Answer: 4. Experience less nasal obstruction and discharge.

A client recovering from an URI should report decreasing or no nasal discharge and
obstruction. Daily fluid intake should be increase to more than 1 L every 24 hours to
liquefy secretions. The temperature should be below 100*F (37.8*C) with no chills or
diaphoresis. A productive cough with chest pain indicated pulmonary infection, not
an URI.

10. Answer: 3. A 50-year-old woman caring for a spouse with cancer

Individuals who are household members or home care providers for high-risk
individuals are high-priority targeted groups for immunization against influenza to
prevent transmission to those who have a decreased capacity to deal with the
disease. The wife who is caring for a husband with cancer has the highest priority of
the clients described.

11. Answer: 4. Keep a diary if when your symptoms occur. This can help you
identify what precipitates your attacks.

It is important for clients with allergic rhinitis to determine the precipitating factors
so that they can be avoided. Keeping a diary can help identify these triggers. Nasal
decongestant sprays should not be used regularly because they can cause a
rebound effect. Antibiotics are not appropriate. Increasing activity will not control
the clients symptoms; in fact, walking outdoors may increase them if the client is
allergic to pollen.

12. Answer: 1. It is likely that the client is developing a secondary bacterial


Asthma and COPD

Pneumonia is the most common complication of influenza, especially in the elderly.

The development of a purulent cough and crackles may be indicative of a bacterial
infection are not consistent with a diagnosis of influenza. These findings are not
indicative of dehydration. Decongestants and bronchodilators are not typically
prescribed for the flu.

13. Answer: 2. 7.5 ml

14. Answer: 4. Restlessness

Side effects of pseudoephedrine are experienced primarily in the cardiovascular

system and through sympathetic effects on the CNS. The most common CNS effects
include restlessness, dizziness, tension, anxiety, insomnia, and weakness. Common
cardiovascular side effects include tachycardia, hypertension, palpitations, and
arrhythmias. Constipation and diplopia are not side effects of pseudoephedrine.
Tachycardia, not bradycardia, is a side effect of pseudoephedrine.

15. Answer: 1. Altered nutrition: Less than body requirements related to fatigue.

The clients problem is altered nutritionspecifically, less than required. The cause,
as stated by the client, is the fatigue associated with the disease process. Activity
intolerance is a likely diagnosis but is not related to the clients nutritional problems.
Weight loss is not a nursing diagnosis. Ineffective breathing pattern may be a
problem, but this diagnosis does not specifically address the problem of weight loss
described by the client.

16. Answer: 1. Develop infections easily

A client with COPD is at high risk for development of respiratory infections. COPD is
a slowly progressive; therefore, maintaining current status and establishing a goal
that the client will require less supplemental oxygen are unrealistic expectations.
Treatment may slow progression of the disease, but permanent improvement is
highly unlikely.

Asthma and COPD

17. Answer: 4. Agrees to call the physician if dyspnea on exertion increases.

Increasing dyspnea on exertion indicates that the client may be experiencing

complications of COPD, and therefore the physician should be notified. Extracting
promises from clients is not an outcome criterion. Pain is not a common symptom of
COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/minute) to
avoid suppressing the respiratory drive, which, for these clients, is stimulated by

18. Answer: 1. Increased anteroposterior chest diameter

Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is

trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position.
The result is the typical barrel-chested appearance. Overly developed, not
underdeveloped, neck muscles are associated with COPD because of their increased
use in the work of breathing. Distended, not collapsed, neck veins are associated
with COPD as a symptom of the heart failure that the client may experience
secondary to the increased workload on the heart to pump into pulmonary
vasculature. Diminished, not increased, chest excursion is associated with COPD.

19. Answer: 4. To promote carbon dioxide elimination

Pursed lip breathing prolongs exhalation and prevents air trapping in the alveoli,
thereby promoting carbon dioxide elimination. By prolonged exhalation and helping
the client relax, pursed-lip breathing helps the client learn to control the rate and
depth of respiration. Pursed-lip breathing does not promote the intake of oxygen,
strengthen the diaphragm, or strengthen intercostal muscles.

20. Answer: 1. Maintaining functional ability

A priority goal for the client with COPD is to manage the s/s of the disease process
so as to maintain the clients functional ability. Chest pain is not a typical sign of
COPD. The carbon dioxide concentration in the blood is increased to an abnormal

Asthma and COPD

level in clients with COPD; it would not be a goal to increase the level further.
Preventing infection would be a goal of care for the client with COPD.

21. Answer: 2. Flushed skin

The high PaCO2 level causes flushing due to vasodilation. The client also becomes
drowsy and lethargic because carbon dioxide has a depressant effect on the CNS.
Cyanosis is a late sign of hypoxia. Irritability and anxiety are not common with a
PaCO2 level of 65 mm Hg but are associated with hypoxia.

22. Answer: 2. While exhaling through pursed lips

Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves
energy and reduced perceived dyspnea. Pursing the lips prolongs exhalation and
provides the client with more control over breathing. Lifting after exhalation but
before inhaling is similar to lifting with the breath held. This should not be
recommended because it is similar to the Valsalva maneuver, which can stimulate
cardiac dysrhythmias.

23. Answer: 3. Peripheral edema

Right-sided heart failure is a complication of COPD that occurs because of

pulmonary hypertension. Signs and symptoms of right-sided heart failure include
peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to
increased fluid volume. Clubbing of nail beds is associated with conditions of chronic
hypoxia. Hypertension is associated with left-sided heart failure. Clients with heart
failure have decreased appetites.

24. Answer: 4. Coarse crackles and rhonchi

Exacerbations of COPD are frequently caused by respiratory infections. Coarse

crackles and rhonchi would be auscultated as air moves through airways obstructed
with secretions. In COPD, breath sounds are diminished because of an enlarged

Asthma and COPD

antero-posterior diameter of the chest. Expiration, not inspiration, becomes
prolonged. Chest movement is decreased as lungs become overdistended.

25. Answer: 1. Increased PaCO2

As COPD progresses, the client typically develops increased PaCO2 levels and
decreased PaO2 levels. This results in decreased pH and decreased oxygen
saturation. These changes are the result of air trapping and hypoventilation.

26. Answer: 4. High calorie, high-protein diet

The client should eat high-calorie, high-protein meals to maintain nutritional status
and prevent weight loss that results from the increased work of breathing. The client
should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is
indicated for clients with coronary artery disease. The client with COPD does not
necessarily need to follow a sodium-restricted diet, unless otherwise medically

27. Answer: 1. Take a deep abdominal breath, bend forward, and cough 3 to 4 times
on exhalation.

The goal of effective coughing is to conserve energy, facilitate removal of

secretions, and minimize airway collapse. The client should assume a sitting
position with feet on the floor if possible. The client should bend forward slightly
and, using pursed-lip breathing, exhale. After resuming an upright position, the
client should use abdominal breathing to slowly and deeply inhale. After repeating
this process 3 or 4 times, the client should take a deep abdominal breath, bend
forward and cough 3 or 4 times upon exhalation (huff cough). Lying flat does not
enhance lung expansion; sitting upright promotes full expansion of the thorax.
Shallow breathing does not facilitate removal of secretions, and forceful coughing
promotes collapse of airways. A side-lying position does not allow for adequate
chest expansion to promote deep breathing.

28. Answer: 4. Administer bronchodilators

Asthma and COPD

In an acute asthma attack, diminished or absent breath sounds can be an ominous

sign of indicating lack of air movement in the lungs and impending respiratory
failure. The client requires immediate intervention with inhaled bronchodilators,
intravenous corticosteroids, and possibly intravenous theophylline. Administering
oxygen and reassessing the client 10 minutes later would delay needed medical
intervention, as would drawing an ABG and obtaining a chest x-ray. It would be futile
to encourage the client to relax and breathe slowly without providing necessary
pharmacologic intervention.

29. Answer: 2. Increased PaCO2, decreased PaO2, and decreased pH.

As the severe asthma attack worsens, the client becomes fatigued and alveolar
hypotension develops. This leads to carbon dioxide retention and hypoxemia. The
client develops respiratory acidosis. Therefore, the PaCO2 level increase, the PaO2
level decreases, and the pH decreases, indicating acidosis.

30. Answer: 3. Corticosteroids have an anti-inflammatory effect

Corticosteroids have an anti-inflammatory effect and act to decrease edema in the

bronchial airways and decrease mucus secretion. Corticosteroids do not have a
bronchodilator effect, act as expectorants, or prevent respiratory infections.

31. Answer: 1 and 4.

32. Answer: 1. Irregular heartbeat

Irregular heart rates should be reported promptly to the care provider.

Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because
of its adrenergic effect on the beta-adrenergic receptors in the heart. It is not
recommended for use in clients with known cardiac disorders. Metaproterenol does
not cause constipation, petal edema, or bradycardia.

Asthma and COPD

33. Answer: 3. You have developed a fungal infection from your medication. It will
need to be treated with an antibiotic.

Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development
of oral thrush, a fungal infection. Once developed, thrush must be treated by
antibiotic therapy; it will not resolve on its own. Fungal infections can develop even
without overuse of the Corticosteroid inhaler. Although good oral hygiene can help
prevent development of a fungal infection, it cannot be used alone to treat the

34. Answer: 1. Incorporate physical exercise as tolerated into the treatment plan.

Physical exercise is beneficial and should be incorporated as tolerated into the

clients schedule. Peak flow numbers should be monitored daily, usually in the
morning (before taking medication). Peak flow does not need to be monitored after
each meal. Stressors in the clients life should be modified but cannot be totally
eliminated. Although adequate sleep is important, it is not recommended that
sedatives be routinely taken to induce sleep.

35. Answer: 2. Viral respiratory infections

The most common precipitator of asthma attacks is viral respiratory infection.

Clients with asthma should avoid people who have the flu or a cold and should get
yearly flu vaccinations. Environmental exposure to toxins or heavy particulate
matter can trigger asthma attacks; however, far fewer asthmatics are exposed to
such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma
attacks, but to a lesser extent than viral respiratory infections. Some asthmatic
attacks are triggered by exercising in cold weather.

36. Answer: 2. Place the client on oxygen

The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are involved.
The client should immediately be placed on oxygen via mask so that the SaO2 is
brought up to 95%. Encourage slow, regular breathing to decrease the amount of

Asthma and COPD

CO2 she is losing. This client may have pulmonary embolism, so she should be
monitored for this condition (4), but it is not the first intervention. Sodium
bicarbonate (3) would be given to reverse acidosis; mechanical ventilation (1) may
be ordered for acute respiratory acidosis.

37. Answer: 1. Caused by the sudden opening of alveoli

Basilar crackles are usually heard during inspiration and are caused by sudden
opening of the alveoli.

38. Answer: 3. Administer oxygen at 2 L flow per minute.

Administer oxygen at 2 L/minute and no more, for if the client if emphysemic and
receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory
system will cease to function.

39. Answer: 3. Increased pulse and pallor

Increased pulse and pallor are symptoms associated with shock. A compromised
venous return may occur if there is a mediastinal shift as a result of excessive fluid
removal. Usually no more than 1 L of fluid is removed at one time to prevent this
from occurring.

40. Answer: 1. Respiratory acidosis

Respiratory acidosis represents an increase in the acid component, carbon dioxide,

and an increase in the hydrogen ion concentration (decreased pH) of the arterial

41. Answer: 2. A build-up of carbon dioxide

Asthma and COPD

The arrhythmias are caused by a build-up of carbon dioxide and not enough oxygen
so that the heart is in a constant state of hypoxia.

42. Answer: 1. Repeat auscultation after asking the client to deep breathe and

Although crackles often indicate fluid in the alveoli, they may also be related to
hypoventilation and will clear after a deep breath or a cough. It is, therefore,
premature to impose fluid (2) or activity (4) restrictions (which Margaret would
totally do if Dani werent there to smack her). Inspection for edema (3) would be
appropriate after re-auscultation.

43. Answer: 3. Listen and feel the air movement.

To check for breathing, the nurse places her ear and cheek next to the clients
mouth and nose to listen and feel for air movement. The chest rising and falling (1)
is not conclusive of a patent airway. Observing skin color (2) is not an accurate
assessment of respiratory status, nor is checking the femoral pulse.

44. Answer: 2. Impaired tissue perfusion related to thrombosis

Chronic hypoxia associated with COPD may stimulate excessive RBC production
(polycythemia). This results in increased blood viscosity and the risk of thrombosis.
The other nursing diagnoses are not applicable in this situation.

45. Answer: 2. Operative side or back

Positioning the client on the operative side facilitates the accumulation of

serosanguineous fluid. The fluid forms a solid mass, which prevents the remaining
lung from being drawn into the space.

Asthma and COPD

46. Answer: 2. Dyspnea and pain

Atelectasis is a collapse of the alveoli due to obstruction or hypoventilation. Clients

become short of breath, have a high temperature, and usually experience severe
pain but do not have a severe cough (4). The shortness of breath is a result of
decreased oxygen-carbon dioxide exchange at the alveolar level.

47. Answer: 3. Apply oral or nasal suction

Before deflating the tracheal cuff (4), the nurse will apply oral or nasal suction to
the airway to prevent secretions from falling into the lung. Dressing change (1) and
humidity (2) do not relate to suctioning.

48. Answer: 2. Exhaled after there is a normal inspiration

Tidal volume (TV) is defined as the amount of air exhaled after a normal inspiration.

49. Answer: 3. A decreasing oxygen pressure and/or an increasing carbon dioxide

pressure in the blood.

The lower the PO2 and the higher the PCO2, the more rapidly oxygen dissociated
from the oxy-hemoglobin molecule.

50. Answer: 1. Cannula