Deck 16: The Respiratory System

Question 1

Grant funding has been decreased for community disease-prevention programs. Which programs are the nurse's priority to implement, without modification, for the community of older-adult clients? Select all that apply.
1) Smoking cessation program for lung cancer prevention for an assisted living group.
2) Seasonal influenza vaccine clinic for the groups at the senior citizen's center.
3) Biannual pneumonia vaccine clinic at the local grocery store on senior discount day.
4) Antituberculosis vaccine and tuberculosis prevention education at the refugee center.
5) Weekly gathering of an older adult group for walking at the park together.

Answer 1

2, 5

Question 2

The nurse plans teaching for the older adult client about prevention of respiratory illnesses. What is the most important strategy for the client to use?
1) Obtain vaccinations as scheduled
2) Reduce use of inhaled tobacco
3) Wear a mask when mowing the lawn
4) Use hand sanitizer after shopping

Answer 2

1

Question 3

Which respiratory system assessment finding of an older client does the nurse determine is most concerning?
1) Coughing during the night while sleeping
2) Purposefully sitting up straighter to get a deep breath
3) Shortness of breath when crossing a large parking lot
4) Three episodes of diagnosed bronchitis in twelve months

Answer 3

1

Question 4

Which finding in the older client with chronic obstructive pulmonary disease (COPD) most concerns the nurse?
1) Controlled atrial fibrillation on the heart monitor
2) Cyanotic nail beds and clubbed fingers
3) Chronic cigarette smoking while at home reported
4) Cough in the morning producing clear sputum

Question 5

What steps will the nurse follow when administering a two-step purified protein derivative (PPD) tuberculin skin test to an older client? Select all that apply.
1) Repeat the PPD test in 1 to 2 weeks.
2) Ask the client about exposure risks.
3) Measure the area of injection in 72 hours.
4) Administer 5 units of the BCG vaccination serum.
5) Give an injection of 0.1 mL of 5 TU intradermally.

Question 6

An older client is scheduled for diagnostic testing. What is the best indication for the client to undergo pulmonary function tests?
1) Chest x-ray demonstrating bilateral infiltrates
2) Abnormal arterial blood gas analysis results
3) The presence of hemoptysis and fatigue
4) Chronic wheezing with an undiagnosed cause

Question 7

The nurse cares for a client admitted to rule out active tuberculosis. What manifestations best indicate that the client has active tuberculosis? Select all that apply.
1) Chronic, drenching night sweats
2) Frequent respiratory infections
3) Hypoxia and hypotension
4) Hemoptysis and chest pain
5) Loss of appetite and weight loss

Question 8

The nurse is caring for a frail older client with chronic obstructive pulmonary disease (COPD) who is having difficulty clearing secretions from the respiratory tract. Which actions can the nurse take to help this client? Select all that apply.
1) Offer only hot beverages.
2) Use postural drainage.
3) Perform chest percussion.
4) Teach controlled coughing.
5) Perform tracheal suctioning.

Question 9

What should the nurse keep in mind when teaching an older client about smoking cessation?
1) Most people quit smoking several times before they are successful.
2) Bupropion (Zyban) is effective when used alone to decrease cravings.
3) A piece of nicotine gum should be chewed for 5 minutes of every waking hour.
4) Use of a nicotine patch is considered safe for anyone who has smoked regularly.

Question 10

An older client is prescribed an inhaled corticosteroid as part of treatment for asthma. What will the nurse instruct the client about the use of this medication? Select all that apply.
1) It can cause oral thrush or candidiasis.
2) Use a spacer when taking this medication.
3) It has no effect on any other health problems.
4) Rinse the mouth and spit after using this medication.
5) It is the most effective anti-inflammatory treatment for asthma.

Question 11

The nurse instructs an older client with asthma about use of a peak flow meter. The nurse instructs the client to use the meter at which times? Select all that apply.
1) After eating dinner in the evening
2) If feeling like cold symptoms are occurring
3) If wheezing or tightness in the chest occurs
4) In the morning after awakening and in the early afternoon
5) Every day for the first two weeks after medication changes

Question 12

The nurse is caring for an older client with asthma that has a respiratory rate of 28 breaths per minute and audible wheezes on inspiration. Which nursing diagnosis is most important for this client?
1) Activity intolerance
2) Altered peripheral tissue perfusion
3) Ineffective airway clearance
4) Ineffective breathing pattern

Question 13

An older client with chronic obstructive pulmonary disease (COPD) is admitted for nebulizer treatment, intravenous steroids, and antibiotics. The client develops a tachydysrhythmia. Which nursing diagnosis is the priority for this client?
1) Diminished activity
2) Inability to achieve airway clearance
3) Impaired gas exchange
4) Risk for decreased cardiac output

Question 14

The nurse cares for a group of clients at risk for lower respiratory infection. The nurse is most concerned about which clients? Select all that apply.
1) The client who reports feeling cold and having chills.
2) The client with a respiratory rate of 30 breaths/min.
3) The client with a heart rate of 120 beats/min.
4) The client with new onset confusion and incontinence.
5) The client with nighttime cough and nasal discharge.

Question 15

An older client asks the nurse what can be done to prevent a respiratory infection during the winter months. How should the nurse respond to this client? Select all that apply.
1) Stay active with daily exercise.
2) Don't smoke and avoid secondhand smoke.
3) Wash the hands often and get a flu vaccination.
4) Eat a healthy diet and maintain a normal weight.
5) Ask a family member to perform shopping duties.

Question 16

What is the most important teaching point from the nurse to the older client diagnosed with asthma?
1) It is essential to rinse out the mouth after use of inhaled medications, especially steroids.
2) Asthma is treated with the same types of medications in older clients as in younger clients.
3) Place several rescue inhalers around the house and label them with brightly colored tape.
4) If a metered-dose inhaler is too difficult to use, a nebulizer can be used for treatments.

Question 17

What should the nurse teach an older client with chronic obstructive pulmonary disease who is newly diagnosed with tuberculosis?
1) In the early stage, tuberculosis causes shortness of breath.
2) An infection related to human immunodeficiency virus (HIV) causes tuberculosis.
3) Tuberculosis spreads from persons who have few to no symptoms.
4) Immunosuppressants, like steroids, must be used cautiously with tuberculosis.

Question 18

An older client with asthma is prescribed a rescue inhaler of albuterol. What should the nurse instruct the client about using this medication? Select all that apply.
1) Refrigerate unused canisters until needed.
2) Metered dose inhalers must be used with a spacer.
3) Label each canister with bright red tape.
4) Obtain a prescription for extra canisters.
5) Keep inhalers in multiple areas in the home.

Question 19

The nurse is preparing a care plan for an older client with asthma. The client is receiving oxygen and has a respiratory rate of 28 breaths per minute, heart rate of 86 beats per minute, and blood pressure of 108/52 mmHg. Which nursing diagnosis would be the priority for this client?
1) Risk for Injury
2) Risk for Infection
3) Activity Intolerance
4) Ineffective Tissue Perfusion

Question 20

When admitting an older client with chronic obstructive lung disease (COPD), which finding most concerns the nurse?
1) Chronic cough with thick sputum
2) Calluses on both of the client's elbows
3) Lives with child and grandchildren
4) Use of fire place for winter heat

Question 21

The nurse has instructed an older client on ways to prevent the recurrence of pneumonia. Which client statement best indicates teaching was successful?
1) "I will get the influenza vaccine every year before February."
2) "Antivirals work best within one to two days of getting the flu virus."
3) "My allergy to eggs means I have to be monitored after I get any vaccination."
4) "I will get the pneumococcal vaccine before I am discharged from the hospital."

Question 22

An older client is prescribed isoniazid (INH) for 6 months. What should the nurse instruct the client about this medication?
1) Avoid vitamin supplements.
2) Use alcohol only in small amounts.
3) Report yellow eyes or skin immediately.
4) Expect the finger and toe tingling to occur.

Question 23

The nurse is reviewing new medication orders for an older client with asthma. Which medication should the nurse question before providing it to the client?
1) Aspirin
2) Levofloxacin
3) Coumadin
4) Amlodipine

Question 24

The nurse has identified the diagnosis of ineffective airway clearance for an older client with pneumonia. Which intervention is most important to include when planning care for this client?
1) Chest percussion on a schedule
2) Administer a cough suppressant
3) Teach smoking cessation
4) Administer the pneumococcal vaccine

Question 25

What will the nurse instruct an older client with asthma to do to control exposure to household allergens? Select all that apply.
1) Eliminate surfaces that collect dust.
2) Remove carpets from the bedroom.
3) Reduce indoor humidity to less than 50 percent.
4) Stay out of a room that is being vacuumed.
5) Do not sleep or lie on upholstered furniture.