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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter24:ManagementofPatientsWithChronicPulmonaryDisease  1.

Aclinicnurseiscaringforapatientwhohasjustbeendiagnosedwithchronicobstructivepulmonary disease(COPD).Thepatientasksthenursewhathecouldhavedonetominimizetheriskofcontracting thisdisease.Whatwouldbethenursesbestanswer?

A)

ThemostimportantriskfactorforCOPDisexposuretooccupationaltoxins.

B)

ThemostimportantriskfactorforCOPDisinadequateexercise.

C)

ThemostimportantriskfactorforCOPDisexposuretodustandpollen.

D)

ThemostimportantriskfactorforCOPDiscigarettesmoking.

Ans:

D Feedback: ThemostimportantriskfactorforCOPDiscigarettesmoking.Lackofexerciseandexposuretodust andpollenarenotriskfactorsforCOPD.Occupationalrisksaresignificantbutarefarexceededby smoking.

2.

Anurseiscreatingahealthpromotioninterventionfocusedonchronicobstructivepulmonarydisease (COPD).WhatshouldthenurseidentifyasacomplicationofCOPD?

A)

Lungcancer

B)

Cysticfibrosis

C)

Respiratoryfailure

D)

Hemothorax

Ans:

C Feedback: ComplicationsofCOPDincluderespiratoryfailure,pneumothorax,atelectasis,pneumonia,and pulmonaryhypertension(corpulmonale).Lungcancer,cysticfibrosis,andhemothoraxarenotcommon complications.

3.

Anurseiscaringforayoungadultpatientwhosemedicalhistoryincludesanalpha1-antitrypsin deficiency.Thisdeficiencypredisposesthepatienttowhathealthproblem?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Pulmonaryedema

B)

Lobularemphysema

C)

Cysticfibrosis(CF)

D)

Empyema

Ans:

B

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Feedback: AhostriskfactorforCOPDisadeficiencyofalpha1-antitrypsin,anenzymeinhibitorthatprotectsthe lungparenchymafrominjury.Thisdeficiencypredisposesyoungpatientstorapiddevelopmentof lobularemphysemaevenintheabsenceofsmoking.Thisdeficiencydoesnotinfluencethepatientsrisk ofpulmonaryedema,CF,orempyema. 4.

Thenurseisassessingapatientwhoserespiratorydiseaseincharacterizedbychronichyperinflationof thelungs.Whatwouldthenursemostlikelyassessinthispatient?

A)

Signsofoxygentoxicity

B)

Chronicchestpain

C)

Abarrelchest

D)

Long,thinfingers

Ans:

C Feedback: InCOPDpatientswithaprimaryemphysematouscomponent,chronichyperinflationleadstothebarrel chestthoraxconfiguration.Thenursemostlikelywouldnotassesschestpainorlong,thinfingers;these arenotcharacteristicofemphysema.Thepatientwouldnotshowsignsofoxygentoxicityunlessheor shereceivedexcesssupplementaryoxygen.

5.

Apatientwithemphysemaisexperiencingshortnessofbreath.Torelievethispatientssymptoms,the nurseshouldassistherintowhatposition?

A)

Sittingupright,leaningforwardslightly

B)

LowFowlers,withtheneckslightlyhyperextended

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Prone

D)

Trendelenburg

Ans:

A

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Feedback: ThetypicalpostureofapersonwithCOPDistoleanforwardandusetheaccessorymusclesof respirationtobreathe.LowFowlerspositioningwouldbelesslikelytoaidoxygenation.Proneor Trendelenburgpositioningwouldexacerbateshortnessofbreath. 6.

Anurseisevaluatingthediagnosticstudydataofapatientwithsuspectedcysticfibrosis(CF).Whichof thefollowingtestresultsisassociatedwithadiagnosisofcysticfibrosis?

A)

Elevatedsweatchlorideconcentration

B)

Presenceofproteinintheurine

C)

Positivephenylketonuria

D)

Malignancyonlungbiopsy

Ans:

A Feedback: Genemutationsaffecttransportofchlorideions,leadingtoCF,whichischaracterizedbythick,viscous secretionsinthelungs,pancreas,liver,intestine,andreproductivetractaswellasincreasedsaltcontent insweatglandsecretions.Proteinuria,positivephenylketonuria,andmalignancyarenotdiagnosticfor CF.

7.

Aschoolnurseiscaringfora10-year-oldgirlwhoishavinganasthmaattack.Whatisthepreferred interventiontoalleviatethisclientsairflowobstruction?

A)

Administercorticosteroidsbymetereddoseinhaler

B)

Administerinhaledanticholinergics

C)

Administeraninhaledbeta-adrenergicagonist

D)

Utilizeapeakflowmonitoringdevice

Ans:

C

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

476

Feedback: Asthmaexacerbationsarebestmanagedbyearlytreatmentandeducationofthepatient.Quick-acting beta-adrenergicmedicationsarethefirstusedforpromptreliefofairflowobstruction.Systemic corticosteroidsmaybenecessarytodecreaseairwayinflammationinpatientswhofailtorespondto inhaledbeta-adrenergicmedication.Apeakflowdevicewillnotresolveshort-termshortnessofbreath. 8.

Astudentnurseisdevelopingateachingplanforanadultpatientwithasthma.Whichteachingpoint shouldhavethehighestpriorityintheplanofcarethatthestudentisdeveloping?

A)

Graduallyincreaselevelsofphysicalexertion.

B)

Changefiltersonheatersandairconditionersfrequently.

C)

Takeprescribedmedicationsasscheduled.

D)

Avoidgoose-downpillows.

Ans:

C Feedback: Althoughallofthemeasuresareappropriateforaclientwithasthma,takingprescribedmedicationson timeisthemostimportantmeasureinpreventingasthmaattacks.

9.

Astudentnurseispreparingtocareforapatientwithbronchiectasis.Thestudentnurseshouldrecognize thatthispatientislikelytoexperiencerespiratorydifficultiesrelatedtowhatpathophysiologicprocess?

A)

Intermittentepisodesofacutebronchospasm

B)

Alveolardistentionandimpaireddiffusion

C)

Dilationofbronchiandbronchioles

D)

Excessivegasexchangeinthebronchioles

Ans:

C Feedback: Bronchiectasisisachronic,irreversibledilationofthebronchiandbronchiolesthatresultsfrom destructionofmusclesandelasticconnectivetissue.Itisnotcharacterizedbyacutebronchospasm, alveolardistention,orexcessivegasexchange.

10. Anurseiscaringfora6-year-oldpatientwithcysticfibrosis.Inordertoenhancethechildsnutritional

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

477

status,whatinterventionshouldmostlikelybeincludedintheplanofcare? A)

Pancreaticenzymesupplementationwithmeals

B)

Provisionoffivetosixsmallmealsperdayratherthanthreelargermeals

C)

Totalparenteralnutrition(TPN)

D)

Magnesium,thiamine,andironsupplementation

Ans:

A Feedback: Nearly90%ofpatientswithCFhavepancreaticexocrineinsufficiencyandrequireoralpancreatic enzymesupplementationwithmeals.Frequent,smallmealsorTPNarenotnormallyindicated.Vitamin supplementsarerequired,butspecificreplacementofmagnesium,thiamine,andironisnottypical.

Apatientarrivesintheemergencydepartmentwithanattackofacutebronchiectasis.Chestauscultation 11. revealsthepresenceofcopioussecretions.Whatinterventionshouldthenurseprioritizeinthispatients care? A)

Oraladministrationofdiuretics

B)

Intravenousfluidstoreducetheviscosityofsecretions

C)

Posturalchestdrainage

D)

Pulmonaryfunctiontesting

Ans:

C Feedback: Posturaldrainageispartofalltreatmentplansforbronchiectasis,becausedrainingofthebronchiectatic areasbygravityreducestheamountofsecretionsandthedegreeofinfection.DiureticsandIVfluids willnotaidinthemobilizationofsecretions.Lungfunctiontestingmaybeindicated,butthisassessment willnotrelievethepatientssymptoms.

12. Anurseiscompletingafocusedrespiratoryassessmentofachildwithasthma.Whatassessmentfinding ismostcloselyassociatedwiththecharacteristicsignsandsymptomsofasthma? A) B)

Shallowrespirations Increasedanterior-posterior(A-P)diameter

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Bilateralwheezes

D)

Bradypnea

Ans:

C

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Feedback: Thethreemostcommonsymptomsofasthmaarecough,dyspnea,andwheezing.Theremaybe generalizedwheezing(thesoundofairflowthroughnarrowedairways),firstonexpirationandthen, possibly,duringinspirationaswell.RespirationsarenotusuallyslowandthechildsA-Pdiameterdoes notnormallychange. 13. AnurseisdevelopingtheteachingportionofacareplanforapatientwithCOPD.Whatwouldbethe mostimportantcomponentforthenursetoemphasize? A)

Smokinguptoone-halfofapackofcigarettesweeklyisallowable.

B)

Chronicinhalationofindoortoxinscancauselungdamage.

C)

Minorrespiratoryinfectionsareconsideredtobeself-limitedandarenottreated.

D)

Activitiesofdailyliving(ADLs)shouldbeclusteredintheearlymorninghours.

Ans:

B Feedback: EnvironmentalriskfactorsforCOPDincludeprolongedandintenseexposuretooccupationaldustsand chemicals,indoorairpollution,andoutdoorairpollution.Smokingcessationshouldbetaughttoall patientswhoarecurrentlysmoking.Minorrespiratoryinfectionsthatareofnoconsequencetothe personwithnormallungscanproducefataldisturbancesinthelungsofthepersonwithemphysema. ADLsshouldbepacedthroughoutthedaytopermitpatientstoperformthesewithoutexcessivedistress.

14. Anursingisplanningthecareofapatientwithemphysemawhowillsoonbedischarged.Whatteaching shouldthenurseprioritizeintheplanofcare? A)

Takingprophylacticantibioticsasordered

B)

Adheringtothetreatmentregimeninordertocurethedisease

C)

Avoidingairplanes,buses,andothercrowdedpublicplaces

D)

Settingrealisticshort-termandlong-rangegoals

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

479

D Feedback: Amajorareaofteachinginvolvessettingandacceptingrealisticshort-termandlong-rangegoals. Emphysemaisnotconsideredcurableandantibioticsarenotusedonapreventativebasis.Thepatient doesnotnormallyneedtoavoidpublicplaces.

15. Anurseisdocumentingtheresultsofassessmentofapatientwithbronchiectasis.Whatwouldthenurse mostlikelyincludeindocumentation? A)

Suddenonsetofpleuriticchestpain

B)

Wheezesonauscultation

C)

Increasedanterior-posterior(A-P)diameter

D)

Clubbingofthefingers

Ans:

D Feedback: Characteristicsymptomsofbronchiectasisincludechroniccoughandproductionofpurulentsputumin copiousamounts.Clubbingofthefingersalsoiscommonbecauseofrespiratoryinsufficiency.Sudden pleuriticchestpainisacommonmanifestationofapulmonaryembolism.Wheezesonauscultationare commoninpatientswithasthma.AnincreasedA-PdiameterisnotedinpatientswithCOPD.

16. Apatientishavingpulmonary-functionstudiesperformed.Thepatientperformsaspirometrytest, revealinganFEV1/FVCratioof60%.Howshouldthenurseinterpretthisassessmentfinding? A)

Strongexercisetolerance

B)

Exhalationvolumeisnormal

C)

Respiratoryinfection

D)

Obstructivelungdisease

Ans:

D Feedback: Spirometryisusedtoevaluateairflowobstruction,whichisdeterminedbytheratioofforcedexpiration volumein1secondtoforcedvitalcapacity.ObstructivelungdiseaseisapparentwhenanFEV1/FVC ratioislessthan70%.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

480

17. AnursehasbeenaskedtogiveaworkshoponCOPDforalocalcommunitygroup.Thenurse emphasizestheimportanceofsmokingcessationbecausesmokinghaswhatpathophysiologiceffect? A)

Increasestheamountofmucusproduction

B)

Destabilizeshemoglobin

C)

Shrinksthealveoliinthelungs

D)

Collapsesthealveoliinthelungs

Ans:

A Feedback: Smokingirritatesthegobletcellsandmucousglands,causinganincreasedaccumulationofmucus, which,inturn,producesmoreirritation,infection,anddamagetothelung.

18. Apediatricnursepractitioneriscaringforachildwhohasjustbeendiagnosedwithasthma.Thenurse hasprovidedtheparentswithinformationthatincludespotentialcausativeagentsforanasthmatic reaction.Whatpotentialcausativeagentshouldthenursedescribe? A)

Pets

B)

Lackofsleep

C)

Psychosocialstress

D)

Bacteria

Ans:

A Feedback: Commoncausativeagentsthatmaytriggeranasthmaattackareasfollows:dust,dustmites,pets,soap, certainfoods,molds,andpollens.Lackofsleep,stress,andbacteriaarenotcommontriggersforasthma attacks.

19. AnurseisprovidingdischargeteachingforaclientwithCOPD.Whenteachingtheclientabout breathingexercises,whatshouldthenurseincludeintheteaching? A)

Liesupinetofacilitateairentry

B)

Avoidpursedlipbreathing

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Usediaphragmaticbreathing

D)

Usechestbreathing

Ans:

C

481

Feedback: Inspiratorymuscletrainingandbreathingretrainingmayhelpimprovebreathingpatternsinpatientswith COPD.Trainingindiaphragmaticbreathingreducestherespiratoryrate,increasesalveolarventilation, and,sometimes,helpsexpelasmuchairaspossibleduringexpiration.Pursed-lipbreathinghelpsslow expiration,preventscollapseofsmallairways,andcontrolstherateanddepthofrespiration. Diaphragmaticbreathing,notchestbreathing,increaseslungexpansion.Supinepositioningdoesnotaid breathing. 20. Anurseiscaringforapatientwhohasbeenadmittedwithanexacerbationofchronicbronchiectasis. Thenurseshouldexpecttoassessthepatientforwhichofthefollowingclinicalmanifestations? A)

Copioussputumproduction

B)

Painoninspiration

C)

Pigeonchest

D)

Drycough

Ans:

A Feedback: Clinicalmanifestationsofbronchiectasisincludehemoptysis,chroniccough,copiouspurulentsputum, andclubbingofthefingers.Becauseofthecopiousproductionofsputum,thecoughisrarelydry.A pigeonchestisnotassociatedwiththediseaseandpatientsdonotnormallyexperiencepainon inspiration.

21. Anurseisreviewingthepathophysiologyofcysticfibrosis(CF)inanticipationofanewadmission.The nurseshouldidentifywhatcharacteristicaspectsofCF? A)

Alveolarmucusplugging,infection,andeventualbronchiectasis

B)

Bronchialmucusplugging,inflammation,andeventualbronchiectasis

C)

Atelectasis,infection,andeventualCOPD

D)

Bronchialmucusplugging,infection,andeventualCOPD

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

482

B Feedback: ThehallmarkpathologyofCFisbronchialmucusplugging,inflammation,andeventualbronchiectasis. Commonly,thebronchiectasisbeginsintheupperlobesandprogressestoinvolvealllobes.Infection, atelectasis,andCOPDarenothallmarkpathologiesofCF.

22. AnolderadultpatienthasbeendiagnosedwithCOPD.Whatcharacteristicofthepatientscurrenthealth statuswouldprecludethesafeandeffectiveuseofametered-doseinhaler(MDI)? A)

Thepatienthasnotyetquitsmoking.

B)

Thepatienthasseverearthritisinherhands.

C)

Thepatientrequiresbothcorticosteroidsandbeta2-agonists.

D)

Thepatienthascataracts.

Ans:

B Feedback: SafeandeffectiveMDIuserequiresthepatienttobeabletomanipulatethedeviceindependently,which maybedifficultifthepatienthasarthritis.SmokingdoesnotprecludeMDIuse.Amodestlossofvision doesnotprecludetheuseofanMDIandapatientcansafelyusemorethanoneMDI.

23. AnurseispreparingtoperformanadmissionassessmentonapatientwithCOPD.Itismostimportant forthenursetoreviewwhichofthefollowing? A)

Socialworkassessment

B)

Insurancecoverage

C)

Chloridelevels

D)

Availablediagnostictests

Ans:

D Feedback: Inadditiontothepatientshistory,thenursereviewstheresultsofavailablediagnostictests.Socialwork assessmentisnotapriorityforthemajorityofpatients.ChloridelevelsarerelevanttoCF,notCOPD. Insurancecoverageisnotnormallythedomainofthenurse.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

483

24. AnadmittingnurseisassessingapatientwithCOPD.Thenurseauscultatesdiminishedbreathsounds, whichsignifychangesintheairway.Thesechangesindicatetothenursetomonitorthepatientforwhat? A)

Kyphosisandclubbingofthefingers

B)

Dyspneaandhypoxemia

C)

Sepsisandpneumothorax

D)

Bradypneaandpursedlipbreathing

Ans:

B Feedback: Thesechangesintheairwayrequirethatthenursemonitorthepatientfordyspneaandhypoxemia. Kyphosisisamusculoskeletalproblem.Sepsisandpneumothoraxareatypicalcomplications.Tachypnea ismuchmorelikelythanbradypnea.Pursedlipbreathingcanrelievedyspnea.

25. Anurseisca...