Respiratory System | Asthma & COPD NCLEX Quiz 35

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

Increased PaCO2

Increased PaO2

Increased pH.

Increased oxygen saturation

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.

Explanation

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.

2. 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?

Normal breath sounds

Prolonged inspiration

Normal chest movement

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 anteroposterior diameter of the chest. Expiration. not inspiration. becomes prolonged. Chest movement is decreased as lungs become overdistended.

Explanation

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 anteroposterior diameter of the chest. Expiration. not inspiration. becomes prolonged. Chest movement is decreased as lungs become overdistended.

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

Take a deep abdominal breath. bend forward. and cough 3 to 4 times on exhalation.

Lie flat on back. splint the thorax. take two deep breaths and cough.

Take several rapid. shallow breaths and then cough forcefully.

Assume a side-lying position. extend the arm over the head. and alternate deep breathing with coughing.

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.

Explanation

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.

4. 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?

Clubbing of nail beds

Hypertension

Peripheral edema

Increased appetite

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.

Explanation

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.

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

While inhaling through an open mouth.

While exhaling through pursed lips

After exhaling but before inhaling.

While taking a deep breath and holding it.

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.

Explanation

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.

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

Low fat. low cholesterol

Bland. soft diet

Low-Sodium diet

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 indicated.

Explanation

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 indicated.

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

Decreased PaCO2. increased PaO2. and decreased pH.

Increased PaCO2. decreased PaO2. and decreased pH.

Increased PaCO2. increased PaO2. and increased pH.

Decreased PaCO2. decreased PaO2. and increased 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.

Explanation

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.

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

Corticosteroids promote bronchodilation

Corticosteroids act as an expectorant

Corticosteroids have an anti-inflammatory effect

Corticosteroids prevent development of respiratory infections.

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.

Explanation

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.

9. 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?

Initiate oxygen therapy and reassess the client in 10 minutes.

Draw blood for an ABG analysis and send the client for a chest x-ray.

Encourage the client to relax and breathe slowly through the mouth

Administer bronchodilators

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.

Explanation

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.

10. A client's 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?

Cyanosis

Flushed skin

Irritability

Anxiety

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.

Explanation

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.