Chapter 31: Chronic Respiratory Disorders

MULTIPLE CHOICE
1. The nurse assesses wheezes in a patient with asthma and realizes that these breath sounds
result from:
1. increased thickness of respiratory secretions.
2. use of accessory muscles of respiration.
3. tachypnea and tachycardia.
4. movement of air through narrowed airways.

ANS: 4
Wheezes are adventitious sounds made by air passing through narrowed passages.

2. The nurse is caring for an asthmatic patient with a nursing diagnosis of “Impaired gas
exchange related to air trapping.” The intervention that would be appropriate to add to the
nursing care plan is to:
1. provide postural drainage.
2. administer oxygen at 8 L/minute.
3. position flat in bed with small pillow.
4. increase fluid intake.
ANS: 4
Increasing fluid intake thins mucus in the lungs, making it easier to cough up, which helps clear
the bronchioles and decrease ventilation-perfusion mismatch. Increasing O2 is not helpful if there
is no air path to the alveoli. Increasing O2 to 8 L is excessive.

3. The characteristic of COPD that puts the patient at risk for the nursing diagnosis of
“Imbalanced nutrition: less than body requirements” is:
1. increased metabolism.
2. anxiety.
3. chronic constipation.
4. excessive respiratory effort.
ANS: 4
Respiratory effort interferes with swallowing, depletes energy, and increases calorie needs.

4. The nursing intervention that will enhance the nutritional status of a patient with COPD is to:
1. offer small, frequent meals.
2. encourage extra liquids with meals.
3. assist the patient to exercise before meals.
4. supply information about nutrition.
ANS: 1
Small meals are not as tiring for the patient and are more appealing.

5. As part of a progressive walking program, the obese patient with COPD is horrified when the
nurse recommends walking for:
1. 10 to 15 minutes a day.
2. 20 to 30 minutes a day.
3. 45 to 60 minutes a day.
4. up to 2 hours a day.
ANS: 1
Walking for as little as 10 to 15 minutes a day and progressing up to 45 minutes a day has proven
beneficial for persons with COPD because it improves oxygenation and helps with weight loss.

6. The nurse advises the parents of a child who is in status asthmaticus that if not corrected, the
result could be:
1. pneumothorax, severe hypoxemia, and respiratory arrest.
2. hypertension, CVA, and cardiac arrest.
3. respiratory alkalosis, pneumonia, and death.
4. lung abscess, cor pulmonale, and respiratory failure.
ANS: 1
Status asthmaticus, because of severe bronchospasms, can result in hypoxemia leading to
pneumothorax and arrest.

7. In assessing for major sources of infection in a COPD patient, the nurse focuses on:
1. stasis of respiratory secretions.
2. low body weight.
3. episodes of postural hypotension.
4. delayed antigen-antibody response.
ANS: 1
Retained static secretions in the lungs are major sources of bacterial infiltration and
infection.

8. When the young AIDS patient complains of debilitating night sweats, the home health nurse
suggests that he go to the clinic for:
1. a prescription for antibiotics.
2. a TB screen.
3. complete blood count.
4. treatment with an aerosol inhalant.
ANS: 2
The symptoms of TB are low-grade fever, night sweats, and cough. AIDS patients are
extremely prone to TB and should be monitored carefully for the development of the
disease.

9. The nurse caring for an 80-year-old COPD patient suspects right-sided heart failure and
assesses and records the data. A sign of right-sided heart failure is decreasing:
1. blood pressure.
2. urine output.
3. respirations.
4. heart rate.
ANS: 2
The decreasing urine output is one of the signs. The fluid, instead of being excreted as urine, is
not trapped in the tissues as edema. Blood pressure, respirations, and heart rate will increase with
right-sided heart failure.

10. When asked by a tubercular patient how long he will have to take his TB medications, the
nurse’s best response would be:
1. “Generally about 2 weeks.”
2. “Depending on the drug, it may be as long as 2 years.”
3. “TB drugs are usually taken throughout the life span.”
4. “People ask that frequently; it depends on many things.”
ANS: 2
Some TB drugs are continued over the course of several years.

11. The discharge instruction given by the nurse that would be informative to a tuberculosis
patient who asks how to protect his family members from his disease is:
1. “Your family will need to take treatment to prevent infection.”
2. “You will need to wear a mask at home to protect your family members.”
3. “You should cover your mouth and nose if coughing or sneezing.”
4. “You should avoid intimate contact with everyone.”
ANS: 3
Covering the mouth and nose to prevent droplet spread and careful disposal of tissues is a major
method of infection control. There is no need for masks or isolation, because on discharge the
TB patient will have been stabilized on anti-TB medication.

12. A patient with a history of smoking two packs of cigarettes a day for the past 20 years says
that he is not alarmed by his cough. He says, “I get this cough and spit up mucus every winter.”
The nurse recognizes these symptoms as being suggestive of:
1. chronic bronchitis.
2. emphysema.
3. sarcoidosis.
4. diffuse interstitial fibrosis.
ANS: 1
Chronic bronchitis in smokers is a common finding that results in inflamed bronchi, with
chronic cough for at least 4 months of the year.

13. An asthma patient asks the purpose of learning to use a PEFR (peak expiratory flow rate)
device. The nurse’s best response is that the PEFR:
1. dilates the bronchi to relieve dyspnea.
2. measures expired air to evaluate ventilation.
3. soothes inflamed bronchi, reducing spasm.
4. liquefies sputum for easier expectoration.
ANS: 2
The PEFR measures expired air. When the PEFR rate decreases 20% below the
baseline,adjustments are usually made in the medications.

14. When the nurse reads the diagnosis of centrilobar emphysema, the nurse recognizes that this
type of emphysema is characterized by:
1. no significant smoking history in the patient.
2. enlarged and broken down bronchioles, with intact alveoli.
3. hypoelastic bronchi and bronchioles.
4. deficiency of the enzyme inhibitor alpha1-antitrypsin.
ANS: 2
Centrilobar emphysema is characterized by a long smoking history, enlarged and broken down
bronchioles, and hypoelastic bronchi.

15. When the 25-year-old cystic fibrosis (CF) patient tells the home health nurse that he wants to
take a nice vacation, a safe suggestion by the nurse would be a week:
1. in Greece in July.
2. in Colorado in May.
3. in New York in November.
4. on the Mexican coast in August.
ANS: 3
New York is the best choice because persons with CF sweat profusely and lose many salts,
leading to significant electrolyte imbalance. CF patients also have impaired respiration. CF
patients should avoid heat (Greece in July, Mexico in August) and higher altitudes (Colorado any
time).

16. Which of these assessments made by the nurse indicates that respiratory arrest is imminent in
an asthmatic?
1. Agitation
2. Tachycardia
3. Absence of wheezing
4. Flaring nares
ANS: 3
Absence of wheezing indicates diminished ventilation effort.

17. The COPD patient has a nursing diagnosis of “Activity intolerance related to inability to
meet oxygen needs.” The intervention that would be inappropriate for this diagnosis would be:
1. bunch all nursing activities and treatments close together.
2. schedule rest periods during the day.
3. assist patient only when needed, to encourage independence.
4. daily ambulation to build tolerance.
ANS: 1
Bunching nursing activities is tiring to the patient with COPD. Assisting only when needed saves
patient energy as well as enhancing independence. Activities should be spread out to allow for
uninterrupted rest periods. Progressive ambulation is an acceptable way to build tolerance.

18. The nurse recognizes that a rising PaCO2 level in a COPD patient means that:
1. there is more arterial oxygen available than is needed.
2. the ventilation-perfusion ratio is becoming balanced.
3. respiratory acidosis has begun.
4. the anticholinergics are effective.
ANS: 3
A rising PaCO2 level (arterial carbon dioxide pressure) is acidic in nature and causes
respiratory acidosis.

19. The nurse is aware that the characteristic of emphysema that gives rise to the “Pink Puffer”
label is the emphysemic patient’s:
1. dyspnea.
2. barrel chest.
3. thin body.
4. normal ABGs.

ANS: 4
The normal ABGs give the emphysemic patient a normal pink color, rather than cyanosed,
like the Blue Bloater.

20. The COPD patient asks the nurse if nicotine patches are effective for smoking cessation.
The nurse’s best response would be:
1. “No. Only about 25% are successful.”
2. “Yes. Success rate is about 50% to 60%”.
3. “No. Prescriptions like Wellbutrin are 90% effective.”
4. “Yes. Individual success has been obtained with combination of patches and gum.”
ANS: 1
The patches have a lower than 25% success rate. Smoking addiction is too strong to be
overcome by medication or gum without very unusual commitment from the patient.
Successful smoking cessation is measured by 1 year of no smoking.

21. The cystic fibrosis patient furiously refuses any more manual chest physiotherapy. Thenurse
could suggest which alternative?
1. Flutter mucus device
2. Increase ambulation to 1 to 2 hours/day
3. Steam inhalator several times a day
4. Drinking 3 quarts of fluid per day

ANS: 1
A flutter mucus clearance device is a hand-held vibrating tool that helps loosen and evacuate
secretions in the lung.

22. The nurse assessing the CBC of a patient with chronic bronchitis identifies a typical feature
of this disease, which is:
1. decreased platelets.
2. decreased white blood cells.
3. increased eosinophils.
4. increased red blood cells.

ANS: 4
Chronic bronchitis patients show a large increase of red blood cells with an attendant higher
hemoglobin level, because they must produce more RBCs for the transport of O2.
Frequently, the WBCs are elevated because of the chronic inflammation. Decreased levels of
platelets and eosinophils are indicative of pathology other than bronchitis.

23. The COPD patient delightedly tells the nurse that he has quit smoking and is using chewing
tobacco. The nurse’s best intervention would be to:
1. congratulate him on his quitting smoking.
2. warn him of the dangers of oral cancer.
3. suggest that he add nicotine patches in addition to the chewing tobacco.
4. point out that he is still addicted and is using tobacco.

ANS: 2
Smokeless tobacco has adverse effects, including oral cancer.

24. A newly diagnosed patient with squamous cell lung carcinoma (SCLC) is anxious about
having to take chemotherapy. The intervention by the nurse that would be helpful is to:
1. support the patient in preparation for surgery.
2. educate the patient regarding the high survival rate with this type of carcinoma.
3. assure the patient that chemotherapy and radiation are seldom used in this sort of
cancer.
4. refer the patient to the American Cancer Society for postdischarge follow-up.

ANS: 1
Surgery is the treatment of choice of SCLC carcinomas. Options 2 and 3 are not correct, because
SCLC tumors are sometimes treated by chemotherapy and radiation before or after surgery. The
survival rate is only about 14%. Although referral may be in the long-range plan, the patient’s
need is immediate for information that is in the scope of nursing.

25. The theophylline blood level is 13 mcg/mL. Which intervention is the most appropriate in
light of this finding?
1. Give the next dose of theophylline as ordered.
2. Skip the next dose, and then resume.
3. Call the charge nurse or physician.
4. Take the patient’s blood pressure immediately.

ANS: 1
The therapeutic range of theophylline is 5 to 15 mcg/mL. The drug should be administered.
This drug is not the drug of choice today but is still in use, even though it causes cardiac
problems.
MULTIPLE RESPONSE
1. The nurse uses a picture to demonstrate the bullae and blebs associated with emphysema.
The nurse points out that the difference between the two is that blebs (select all that apply):
1. are between the alveolar spaces in the lungs.
2. are in the lung parenchyma.
3. can rupture, causing the lungs to collapse.
4. are responsible for diaphragm flattening.
5. are precancerous.
ANS: 2, 3
Blebs are growths inside the organ of the lung that enlarge and rupture, causing lung
collapse. Bullae are the lesions between the alveolar spaces. Neither are the cause of
diaphragm flattening nor are they precancerous.
COMPLETION
1. The nurse cautions a group of persons with COPD that using O2 at levels greater than 1 to 3
L/minute can cause the loss of their _________________________.
ANS: Hypoxic drive
OTHER
1. The nurse explains to a family how the asthma attack progresses by using a progressive list
ofpathologic events (place the options in the correct sequence):
1.
2. Ventilation-perfusion mismatch
3. Production of mucous plug
4. Hypoxemia with compensatory hyperventilation
5. Triggering of inflammatory process
ANS:
5, 1, 3, 2, 4
After the allergen has triggered the inflammatory response, bronchoconstriction occurs,
which leads to the formation of mucous plugs in the bronchioles that block O2 from entering the
alveoli, causing a ventilation-perfusion mismatch and resulting in hypoxemia and
hyperventilation.