NCLEX Question Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema? 1. To promote oxygen intake 2. To strengthen the diaphragm 3. To strengthen the intercostal muscles 4. To promote carbon dioxide elimination ANSWER Answer: 4. 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. NCLEX Question 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? 1. Clubbing of nail beds 2. Hypertension 3. Peripheral edema 4. Increased appetite ANSWER Answer: 3. Peripheral edema 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. NCLEX Question 4. What is the most common form of aspiration pneumonia? A. Fungal infection. B. Bacterial infection. C. Myocardial infarction. D. Renal insufficiency. ANSWER Answer: B. Bacterial infection Bacterial infection from aspiration of bacteria that normally reside in the upper airways is the most common form of aspiration pneumonia. Option A: Fungal infection can cause fungal pneumonia in the immunocompromised host. Option C: Viral infection cannot cause aspiration pneumonia. Option D: Renal insufficiency is not a nursing diagnosis. NCLEX Question Which of the following physical assessment findings would the nurse expect to find in a client with advanced COPD? 1. Increased anteroposterior chest diameter 2. Underdeveloped neck muscles 3. Collapsed neck veins 4. Increased chest excursions with respiration ANSWER Answer: 1. Increased anteroposterior chest diameter 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. NCLEX Question 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? 1. Initiate oxygen therapy and reassess the client in 10 minutes. 2. Draw blood for an ABG analysis and send the client for a chest x-ray. 3. Encourage the client to relax and breathe slowly through the mouth 4. Administer bronchodilators ANSWER Answer: 4. 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. NCLEX Question When administering the methylxanthine theophylline, the nurse can expect: A. Decreased pulmonary function B. Increased pulmonary function C. Increased residual volume D. Decreased tidal volume ANSWER Answer: B. Increased pulmonary function Theophylline will improve ventilation so there will be an overall improvement of pulmonary measurements. Other choices are the opposite of what will actually occur with theophylline administration. NCLEX Question A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? 1. Corticosteroids promote bronchodilation 2. Corticosteroids act as an expectorant 3. Corticosteroids have an anti-inflammatory effect 4. Corticosteroids prevent development of respiratory infections. ANSWER Answer: 3. Corticosteroids have an anti-inflammatory effect 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.
