Respiratory System | Asthma & COPD NCLEX Quiz 34

1. 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?

5.0 ml

7.5 ml

9.5 ml

10 ml

The nurse should administer 7.5 ml of the liquid for each dose. This is calculated by dividing the ordered dosage strength (300 mg) by the dosage strength of the liquid (200 mg/5ml). This gives us 1.5, which means that each 5 ml of the liquid contains 1.5 doses. To administer a single dose of 300 mg, the nurse would need to give 1.5 times the volume, which is 7.5 ml.

Explanation

The nurse should administer 7.5 ml of the liquid for each dose. This is calculated by dividing the ordered dosage strength (300 mg) by the dosage strength of the liquid (200 mg/5ml). This gives us 1.5, which means that each 5 ml of the liquid contains 1.5 doses. To administer a single dose of 300 mg, the nurse would need to give 1.5 times the volume, which is 7.5 ml.

2. 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?

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

The assessment findings are consistent with influenza and are to be expected.

The client is getting dehydrated and needs to increase her fluid intake to decrease secretions.

The client has not been taking her decongestants and bronchodilators as prescribed.

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.

Explanation

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.

3. 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?

Altered nutrition: Less than body requirements related to fatigue.

Activity intolerance related to dyspnea.

Weight loss related to COPD.

Ineffective breathing pattern related to alveolar hypoventilation.

The client’s problem is altered nutrition—specifically. 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 client’s 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.

Explanation

The client’s problem is altered nutrition—specifically. 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 client’s 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.

4. 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?

“Use your nasal decongestant spray regularly to help clear your nasal passages.”

“Ask the doctor for antibiotics. Antibiotics will help decrease the secretion.”

“It is important to increase your activity. A daily brisk walk will help promote drainage.”

“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 client’s symptoms; in fact. walking outdoors may increase them if the client is allergic to pollen.

Explanation

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 client’s symptoms; in fact. walking outdoors may increase them if the client is allergic to pollen.

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

To promote oxygen intake

To strengthen the diaphragm

To strengthen the intercostal muscles

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.

Explanation

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.

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

Increased anteroposterior chest diameter

Underdeveloped neck muscles

Collapsed neck veins

Increased chest excursions with respiration

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.

Explanation

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.

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

Promises to do pursed lip breathing at home.

States actions to reduce pain.

States that he will use oxygen via a nasal cannula at 5 L/minute.

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 hypoxia.

Explanation

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 hypoxia.

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

Maintaining functional ability

Minimizing chest pain

Increasing carbon dioxide levels in the blood

Treating infectious agents

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

Explanation

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

9. Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

Constipation

Bradycardia

Diplopia

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.

Explanation

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.

10. 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?

Develop infections easily

Maintain current status

Require less supplemental oxygen

Show permanent improvement.

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.

Explanation

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.