A) B)

1. The nurse informs the patient that the most preventable risk factor for COPD is: Adequate nutrition C) Exposure to dust and pollen Regular exercise D) Cigarette smoking Ans: D Difficulty: Easy 2. A nurse who is caring for a patient with COPD should assess the patient for a complication of COPD that includes: A) Bronchitis B) Bronchiectasis C) Pulmonary hypertension D) Hemothorax Ans: C Difficulty: Moderate

3. The nurse is caring for a 28-year-old nonsmoker with a deficiency in the enzyme antitrypsin. To what deficiency does this predispose the young patient? A) Pulmonary edema C) Cystic fibrosis B) Development of lobular emphysema D) Empyema Ans: B Difficulty: Moderate 4. The nurse doing a physical health assessment on a patient with lung disease and chronic hyperinflation of the lungs will likely assess which of the following in the patient? A) Dry, flaky skin C) A barrel chest B) Large, drooping eyes D) Long, thin fingers Ans: C Difficulty: Moderate 5. A nurse encourages a patient who is diagnosed with COPD not to smoke because smoking: A) Increases the amount of mucus production B) Oxygenates the hemoglobin C) Shrinks the alveoli in the lungs D) Collapses the alveoli in the lungs Ans: A Difficulty: Moderate 6. The patient having pulmonary function studies performed has a spirometry test and a FEV1/FVC ratio of 60%. What does this indicate? A) Strong exercise tolerance C) Healthy lung volumes B) Exhalation volume is normal D) Obstructive lung disease Ans: D Difficulty: Moderate 7. What is the best position for the patient experiencing orthopnea for relief of symptoms? A) Sitting upright leaning forward C) Prone slightly B) Low-Fowler's D) Trendelenburg Ans: A Difficulty: Moderate
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8. A family member of a patient with COPD asks the nurse why the patient is not receiving high oxygen flow rates. Which of the following statements best describes the rationale for giving only low levels of oxygen to a person with chronic lung disease? A) When low levels of oxygen are administered through nasal prong, the lungs receive 100% oxygenation. B) Low levels of oxygen prevent confusion. C) Raising the patient's blood oxygen level may suppress his or her respiratory drive, causing increased retention of carbon dioxide. D) With high levels of oxygen, a rebound effect occurs, resulting in decreased levels of carbon dioxide in the blood. Ans: C Difficulty: Moderate 9. The nurse is developing a teaching plan for a patient with COPD. Which of the following can encourage deep breathing in a patient and help to prevent atelectasis? A) A peak flow meter C) An incentive spirometry B) Deep suctioning D) Oxygen through nose prongs Ans: C Difficulty: Moderate 10. A patient with COPD who has been receiving oxygen therapy for an extended time on high flow may be at risk for which of the following acid-base imbalances? A) Respiratory acidosis C) Metabolic acidosis B) Respiratory alkalosis D) Metabolic alkalosis Ans: A Difficulty: Difficult 11. The nurse is planning to assist a patient who has COPD and limited energy with ADLs. When is the best time for the nurse to schedule the patient's activities? A) 1 hour before bed B) First thing in the morning C) 1 hour after the patient has been awake D) Late afternoon following visiting hours Ans: C Difficulty: Moderate 12. The patient has informed the nurse that she feels it is too late to stop smoking and that smoking cessation is futile at this time. How can the nurse best assist the patient to stop smoking? A) Have the patient decrease the number of cigarettes per day. B) Encourage the patient to quit cold turkey. C) Show the patient pictures of diseased lungs. D) Help the patient to develop a plan to quit and suggest a formalized program available in the community. Ans: D Difficulty: Moderate

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13. Which of the following is a priority nursing diagnosis for a patient with COPD? A) Ineffective breathing patterns related to ineffective respiratory mechanisms of the chest wall B) Self-care deficit related to activity intolerance C) Altered sleeping pattern related to insufficient ventilation D) Ineffective individual coping related to decreased socialization Ans: A Difficulty: Moderate 14. The nurse is planning to assess the effectiveness of a patient's coughing and deep breathing exercises. What assessment will provide the nurse with information on the effectiveness of the patient's coughing and deep breathing? A) Assessing activity tolerance C) Auscultating the lungs B) Checking nail bed perfusion D) Monitoring pulse Ans: C Difficulty: Moderate 15. The nurse providing information to a parent of a child with asthma informs them that which of the following is a potential cause of an asthmatic reaction? A) Stuffed toys B) Watching television C) Hot shower D) Rainstorm Ans: A Difficulty: Moderate 16. A 10-year-old girl is having an asthma attack on the school grounds at recess. Which of the following is the preferred treatment to alleviate her airflow obstruction? A) Corticosteroids C) Beta-adrenergics B) Anticholinergics D) Peak flow monitoring device Ans: C Difficulty: Moderate 17. The nurse is evaluating the diagnostic study data on a patient with suspected pulmonary fibrosis. Which of the following tests is associated with a diagnosis of cystic fibrosis? A) An elevated sweat chloride concentration test B) Presence of ketones in the urine C) Positive phenylketonuria D) Lung biopsy Ans: A Difficulty: Moderate 18. A 15-year-old boy with cystic fibrosis is admitted with a bacterial infection of the lung and requires physiotherapy every 2 hours. His respiratory rate has been 24 breaths/min. During his therapy, the nurse notes his respiratory rate increases to 38 breaths/min. The nurse should: A) Suction the patient and continue with the physiotherapy.

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B) C) D)

Finish the treatment and reposition the patient. Stop the physiotherapy treatment. Vigorously percuss the lobe for an additional 2 minutes. Ans: C Difficulty: Moderate

19. The nurse is caring for a patient experiencing an acute asthma attack who stops wheezing and has inaudible breath sounds. The reason for this change is: A) The attack is over. B) The airways are so swollen that no air can get through. C) The swelling has decreased. D) Crackles have replaced wheezes. Ans: B Difficulty: Moderate 20. The nurse is teaching a patient with chronic bronchitis about breathing exercises. Which of the following should the nurse include in the teaching? A) Make inhalation longer than exhalation. B) Exhale through an open mouth. C) Use diaphragmatic breathing. D) Use chest breathing. Ans: C Difficulty: Moderate 21. The nurse is developing a teaching plan for a patient with asthma. Which of the following teaching points has the highest priority? A) Avoid contact with furry animals. B) Change filters on heating and air conditioning units frequently. C) Take prescribed medications, as scheduled. D) Avoid goose down pillows. Ans: C Difficulty: Difficult 22. The nurse is caring for a patient with asthma. Asthma may best be defined as which of the following? A) An acute inflammatory disease of the larynx B) A chronic inflammatory disease of the lungs C) An acute inflammatory disease of the airway D) A chronic inflammatory disease of the airway Ans: D Difficulty: Moderate 23. During an admission assessment, the patient informs the nurse that he smokes one and a half packs of cigarettes a day. The nurse is aware that the patient is at an increased risk of developing which of the following diseases? A) Emphysema B) Depression C) Alcoholism D) Obesity

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Ans: A Difficulty: Easy 24. A nurse who is caring for a patient with chronic bronchiectasis should assess the patient for which of the following clinical manifestations? A) Hemoptysis B) Angina C) Pigeon chest D) Pulmonary hypertension Ans: A Difficulty: Moderate 25. A collaborative problem in caring for patients with COPD includes the potential for respiratory failure. An important indicator on an arterial blood gas (ABG) analysis that respiratory failure is occurring includes which of the following? A) O2 saturation of 95% C) HCO3 of 24 mEq/L B) pH of 7.36 D) PaCO2 of 70 mm Hg Ans: D Difficulty: Moderate 26. The nurse who is completing an admission history on a patient diagnosed with COPD understands that the major risk factor associated with this disease process includes exposure to which of the following? A) Toxic fumes B) Dust particles C) Cigarette smoking D) Animal dander Ans: C Difficulty: Moderate 27. When assessing a patient with COPD, the nurse would most likely expect which of the following clinical manifestations? A) Peripheral edema C) Weight gain B) Barrel chest D) Shoulder droop during inspiration Ans: B Difficulty: Moderate 28. A nurse preparing to care for a patient with asthma would anticipate that which of the following will be ordered for this patient? A) Antihypertensives C) Corticosteroids B) Potassium supplements D) Diuretics Ans: C Difficulty: Moderate 29. When teaching a patient with asthma how to use a metered dose inhaler (MDI) correctly, it is important to emphasize which of the following? A) Rapid breathing during treatment to facilitate more medication in lungs B) Allow 5 minutes between each puff C) Hold breath as medication is released D) Position inhaler approximately 1 to 2 inches from the open mouth Ans: D Difficulty: Moderate

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30. When discussing the pathophysiology of COPD with a newly admitted patient, the nurse would be correct in emphasizing which of the following? A) Bronchial plugging by purulent secretions B) Obstruction of the pulmonary vasculature with an embolus C) Chronic dilation of a bronchus or bronchi D) Airflow limitation causing chronic inflammation Ans: D Difficulty: Moderate 31. The nurse who is caring for a 6-year-old patient with cystic fibrosis nurse knows that the key feature in the presentation of cystic fibrosis includes which of the following? A) Airway obstruction C) Salty sweat B) Obstructed bowel D) Clubbing of the extremities Ans: A Difficulty: Moderate 32. When suspecting a diagnosis of cystic fibrosis, the nurse would expect which of the following priority tests to be ordered? A) Sweat chloride concentration test C) Arterial blood gas (ABG) analysis B) Pulse oximetry D) Electrolyte panel Ans: A Difficulty: Moderate 33. A nurse is caring for a patient in the pediatric unit who is having an exacerbation of his cystic fibrosis. It is most important that nursing care includes which of the following therapies at this time? A) Chemotherapeutic B) Antibiotic C) Diuretic D) Anticoagulant Ans: B Difficulty: Moderate 34. A patient arrives in the emergency room with an acute asthma attack. The nurse knows that the principal pathological finding in the diagnosis of asthma includes which of the following? A) Increase in the red blood cell concentration in the blood B) Leakage of fluid into the alveolar interstitial spaces C) Reversible and diffuse airway inflammation D) Obstruction of the pulmonary vasculature by a clot Ans: C Difficulty: Moderate 35. When auscultating the lungs of a child with asthma, the nurse would expect to note which of the following most common symptoms? A) Shallow respirations C) Bilateral wheezes B) Increased A-P diameter D) Rhonchi in the lower bases Ans: C

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Difficulty: Moderate 36. An important component to emphasize for the nurse developing the teaching portion of a care plan for a patient with COPD includes which of the following? A) Smoking a half a pack weekly is allowable. B) Chronic inhalation of indoor toxins causes lung damage. C) Minor respiratory infections are not treated. D) ADLs should be completed in the waking hours. Ans: B Difficulty: Moderate 37. A nurse caring for a patient newly diagnosed with COPD would be correct in educating the him on which of the following? A) Weight control C) Rigorous exercise plan B) Smoking cessation D) Oxygen addiction Ans: B Difficulty: Moderate 38. When caring for a patient with emphysema, the nurse would include which of the following diagnoses as priority in the plan of care? A) Ineffective coping C) Activity intolerance B) Self-care deficit D) Impaired gas exchange Ans: D Difficulty: Moderate 39. A nurse is assessing a patient with bronchiectasis. Which of the following would the nurse expect to note in her documentation? A) Sudden, pleuritic chest pain C) Increased A-P diameter B) Wheezes on auscultation D) Clubbing of the fingers Ans: D Difficulty: Moderate 40. A patient is admitted to the medical unit with a diagnosis of severe asthma. The physician has ordered peak flow monitoring. The nurse knows that this type of monitoring measures which of the following? A) Oxygen saturation in the blood B) Highest airflow during a forced expiration C) Inspiratory reserve volume D) Tidal volume Ans: B Difficulty: Moderate 41. A patient is receiving a corticosteroid inhaler for treatment of asthma. When teaching the patient regarding possible complications of this form of treatment, the nurse would include which of the following? A) Weight loss B) Skin rash C) Thrush D) Hypoglycemia

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Ans: C Difficulty: Moderate 42. A nurse providing educational information to a patient with COPD emphasizes which of the following as a risk factor in the development of the disease? A) Ultraviolet light exposure C) Previous chest surgery B) Occupational exposure D) Right-sided heart failure Ans: B Difficulty: Moderate 43. A patient with COPD has a nursing diagnosis of ineffective breathing pattern related to shortness of breath (SOB). It would be important for the nurse to implement which of the following to alleviate SOB in this patient? A) Administer supplemental oxygen only PRN B) Group strenuous activities in the morning C) Pursed-lip breathing D) Passive range-of motion-exercises Ans: C Difficulty: Moderate 44. A goal in the plan of care of a patient with COPD includes prevention of pulmonary hypertension. The nurse knows that which of the following is a common manifestation of pulmonary hypertension? A) Left-sided heart failure C) Clubbing of extremities B) Right-sided heart failure D) Increased A-P diameter Ans: B Difficulty: Moderate

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