Respiratory System | Asthma & COPD NCLEX Quiz 36

1. 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 ABG's. 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:

Begin mechanical ventilation

Place the client on oxygen

Give the client sodium bicarbonate

Monitor for pulmonary embolism.

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 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.

Explanation

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 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.

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

Wait until the client’s lab work is done.

Not administer oxygen unless ordered by the physician.

Administer oxygen at 2 L flow per minute.

Administer oxygen at 10 L flow per minute and check the client’s nail beds.

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.

Explanation

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.

3. 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?

Irregular heartbeat

Constipation

Pedal edema

Decreased heart rate.

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.

Explanation

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.

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

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis represents an increase in the acid component. carbon dioxide. and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood.

Explanation

Respiratory acidosis represents an increase in the acid component. carbon dioxide. and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood.

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

Incorporate physical exercise as tolerated into the treatment plan.

Monitor peak flow numbers after meals and at bedtime.

Eliminate stressors in the work and home environment

Use sedatives to ensure uninterrupted sleep at night.

Physical exercise is beneficial and should be incorporated as tolerated into the client’s 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 client’s 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.

Explanation

Physical exercise is beneficial and should be incorporated as tolerated into the client’s 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 client’s 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.

6. 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?

“This is an anticipated side-effect of your medication. It should go away in a couple of weeks.”

“You are using your inhaler too much and it has irritated your mouth.”

“You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”

“Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”

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 the development of a fungal infection. it cannot be used alone to treat the problem.

Explanation

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 the development of a fungal infection. it cannot be used alone to treat the problem.

7. 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?

Occupational exposure to toxins

Viral respiratory infections

Exposure to cigarette smoke

Exercising in cold temperatures

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.

Explanation

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.

8. Immediately following a thoracentesis. which clinical manifestations indicate that a complication has occurred and the physician should be notified?

Serosanguineous drainage from the puncture site

Increased temperature and blood pressure

Increased pulse and pallor

Hypotension and hypothermia

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.

Explanation

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.

9. 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.

The inhaler is held upright.

Head is tilted down while inhaling the medication

Client waits 5 minutes between puffs.

Mouth is rinsed with water following administration

Client lies supine for 15 minutes following administration.

The inhaler is held upright to ensure that the medication is properly delivered to the lungs. Holding the inhaler at a 90-degree angle helps in the correct administration of the medication. Rinsing the mouth with water following administration helps to prevent any potential side effects such as oral thrush or hoarseness.

Explanation

The inhaler is held upright to ensure that the medication is properly delivered to the lungs. Holding the inhaler at a 90-degree angle helps in the correct administration of the medication. Rinsing the mouth with water following administration helps to prevent any potential side effects such as oral thrush or hoarseness.

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10. Basilar crackles are present in a client's lungs on auscultation. The nurse knows that these are discrete. non continuous sounds that are:

Caused by the sudden opening of alveoli

Usually more prominent during expiration

Produced by airflow across passages narrowed by secretions

Found primarily in the pleura.

All of the above

the characteristics of basilar crackles based on the nurse’s observations:

Caused by the sudden opening of alveoli: Basilar crackles result from the sudden opening of collapsed or fluid-filled alveoli during inspiration. These tiny air sacs in the lungs can “pop” open, creating the characteristic sound.

Usually more prominent during expiration: Basilar crackles are typically heard more clearly during expiration (when the patient breathes out) rather than during inspiration. This is because the alveoli collapse again during expiration.

Produced by airflow across passages narrowed by secretions: The crackling sound occurs when air flows across narrowed airways due to accumulated secretions (such as mucus or fluid). These narrowed passages create turbulence, leading to the crackling noise.

Found primarily in the pleura: Basilar crackles are commonly heard at the lung bases (lower regions) and are associated with conditions affecting the pleura (the thin membrane covering the lungs).

In summary, basilar crackles are discrete, non-continuous sounds caused by alveolar opening, more noticeable during expiration, related to narrowed air passages due to secretions, and primarily found in the pleura. These findings can provide valuable information for the nurse’s assessment and guide further clinical management.

Explanation

the characteristics of basilar crackles based on the nurse’s observations:

Caused by the sudden opening of alveoli: Basilar crackles result from the sudden opening of collapsed or fluid-filled alveoli during inspiration. These tiny air sacs in the lungs can “pop” open, creating the characteristic sound.

Usually more prominent during expiration: Basilar crackles are typically heard more clearly during expiration (when the patient breathes out) rather than during inspiration. This is because the alveoli collapse again during expiration.

Produced by airflow across passages narrowed by secretions: The crackling sound occurs when air flows across narrowed airways due to accumulated secretions (such as mucus or fluid). These narrowed passages create turbulence, leading to the crackling noise.

Found primarily in the pleura: Basilar crackles are commonly heard at the lung bases (lower regions) and are associated with conditions affecting the pleura (the thin membrane covering the lungs).

In summary, basilar crackles are discrete, non-continuous sounds caused by alveolar opening, more noticeable during expiration, related to narrowed air passages due to secretions, and primarily found in the pleura. These findings can provide valuable information for the nurse’s assessment and guide further clinical management.