Question 1

Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD)?

Accepted Answer

A)   Audible wheezing on expiration
B)   Reduced expiratory flow rates
C)   Decreased tidal volume
D)   Normal forced expiratory volume C

Question 2

The mother of a 7-year-old boy who has recently been diagnosed with childhood asthma has come to the education center to learn more about her son's condition. Which of the following teaching points is most justifiable?

Accepted Answer

A)   "Research has shown that viruses may actually be a factor in many children's asthma."
B)   "The most reliable indicator that your child is having an asthma attack is audible wheezing."
C)   "Steroids that your child can inhale will likely be the first line of defense."
D)   "Your son will likely need to limit or avoid exercise and sports." A

Question 3

A physician is providing care for a child who has a diagnosis of cystic fibrosis (CF). Place the following events in the etiology of CF in ascending chronological order. Use all the options.

Accepted Answer

A)   Airway obstruction
B)   Recurrent pulmonary infections
C)   Impaired Cl- transport
D)   Decreased water content of mucociliary blanket
E)   Increased Na+ absorption C, E, D, A, B

Question 4

A patient with pulmonary hypertension may display which of the following clinical manifestations? Select all that apply.

Accepted Answer

A)   Shortness of breath
B)   Decreased exercise tolerance
C)   Nasal flaring
D)   Grunting on expiration
E)   Swelling (edema)  of the legs and feet

Question 5

Which of the following clients are displaying known risk factors for the development of pulmonary emboli? Select all that apply. A client who is:

Accepted Answer

A)   immobilized following orthopedic surgery.
B)   experiencing impaired Cl- and Na+ regulation.
C)   taking amiodarone for the treatment of premature ventricular contractions.
D)   a smoker and who takes oral contraceptives.
E)   undergoing radiation therapy for the treatment of breast cancer.

Question 6

A COPD patient asks the nurse what medications are prescribed to help his breathing. The nurse, looking at the list of medications, will educate the patient about which of the following medications to help his COPD in the long term? Select all that apply.

Accepted Answer

A)   Salmeterol (Serevent) , a bronchodilator
B)   Tiotropium (Spiriva) , anticholinergic
C)   Alprazolam (Xanax) , a benzodiazepine
D)   Sildenafil (Viagra) , a vasodilator
E)   Ketorolac (Toradol) , an NSAID

Question 7

A 41-year-old male client has presented to the emergency department with an acute onset of increased respiratory rate and difficulty breathing. STAT chest x-ray indicates diffuse bilateral infiltrates of his lung tissue, and ECG displays no cardiac dysfunction. What is this client's most likely diagnosis?

Accepted Answer

A)   Cor pulmonale
B)   Acute lung injury
C)   Pulmonary hypertension
D)   Sarcoidosis

Question 8

In the early morning, an African American woman brings her 5-year-old son to the emergency room. The boy is wheezing, is short of breath, and has a dry cough. The mother states that he has always been very healthy. He went to bed with only a slight cold and a runny nose but woke her with his coughing shortly after 4 AM. His symptoms worsened so dramatically that she brought him to the hospital. The care team would most likely suspect that he has

Accepted Answer

A)   respiratory syncytial virus.
B)   influenza.
C)   asthma.
D)   pneumonia.

Question 9

Which of the following statements best captures the etiology of the acute response phase of extrinsic (atopic) asthma?

Accepted Answer

A)   IgG production is heightened as a consequence of exposure to an allergen.
B)   Airway remodeling results in airflow limitations.
C)   Epithelial injury and edema occur along with changes in mucociliary function.
D)   Chemical mediators are released from presensitized mast cells.

Question 10

A 51-year-old female client who is 2 days postoperative in a surgical unit of a hospital is at risk of developing atelectasis as a result of being largely immobile. Which of the following teaching points by her nurse is most appropriate?

Accepted Answer

A)   "Being in bed increases the risk of fluid accumulating between your lungs and their lining, so it's important for you to change positions often."
B)   "You should breathe deeply and cough to help your lungs expand as much as possible while you're in bed."
C)   "Make sure that you stay hydrated and walk as soon as possible to avoid us having to insert a chest tube."
D)   "I'll proscribe bronchodilator medications that will help open up your airways and allow more oxygen in."

Question 11

Upon admission to the ICU, a patient with a history of cor pulmonale will likely be exhibiting which of the following clinical manifestations of right heart failure? Select all that apply.

Accepted Answer

A)   Fine crackles throughout both lung fields
B)   +4 pitting edema in lower extremities
C)   Expectorating copious amounts of frothy, pink sputum
D)   Jugular vein distension
E)   Altered level of consciousness

Question 12

A patient is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering

Accepted Answer

A)   a bronchodilator.
B)   a corticosteroid.
C)   aspirin.
D)   an albuterol inhaler.

Question 13

A nurse is providing care for a patient who has been admitted with a newly diagnosed bilateral pleural effusion. Which of the following findings from the nurse's initial assessment of the patient is incongruent with the patient's diagnosis and would require further investigation?

Accepted Answer

A)   The client complains of sharp pain exacerbated by deep inspiration.
B)   The client's breath sounds are diminished on auscultation.
C)   Pulse oximetry indicates that the client is hypoxemic.
D)   The client complains of dyspnea and increased work of breathing.

Question 14

A short, nonsmoking 44-year-old male presents to the emergency room with left-sided chest pain and a cough. He states that the pain started abruptly and worsens with deep breathing and coughing. He denies recent injury. Assessment includes shallow respirations with a rate of 36, normal breath sounds, and no cyanosis. Which condition is most likely causing his symptoms?

Accepted Answer

A)   Myocardial infarction
B)   Spontaneous pneumothorax
C)   Pleuritis related to infection
D)   Obstructive atelectasis

Question 15

As a consequence of a long-standing lung disease, a client is in a chronic state of hypoxia. Which of the following phenomena would the client's care team be most justified in anticipating? Select all that apply.

Accepted Answer

A)   Metabolic alkalosis
B)   Increased erythropoietin production
C)   Pulmonary vasodilation
D)   Hyperventilation
E)   Personality changes

Question 16

Which of the following residents of a long-term care facility is most likely to be exhibiting the signs and symptoms of chronic obstructive pulmonary disease (COPD)?

Accepted Answer

A)   A 79-year-old lifetime smoker who is complaining of shortness of breath and pain on deep inspiration
B)   An 81-year-old smoker who has increased exercise intolerance, a fever, and increased white blood cells
C)   An 81-year-old male who has a productive cough and recurrent respiratory infections
D)   An 88-year-old female who experiences acute shortness of breath and airway constriction when exposed to tobacco smoke

Question 17

A patient arrives in the ED after an automobile accident. Which of the following clinical manifestations lead the nurse to suspect a pneumothorax? Select all that apply.

Accepted Answer

A)   Respiratory rate 34
B)   Asymmetrical chest movements, especially on inspiration
C)   Diminished breath sounds over the painful chest area
D)   Pulse oximetry 98%
E)   ABG pH level of 7.38

Question 18

A nurse is providing care for a client who has been admitted to a medical unit with a diagnosis of bronchiectasis. Which of the following signs and symptoms should the nurse expect to find during physical assessment of the client and the review of the client's history? Select all that apply.

Accepted Answer

A)   Recurrent chest infections
B)   Production of purulent sputum
C)   A barrel chest
D)   Low hemoglobin levels
E)   Recent surgery

Question 19

While rock climbing, a 22-year-old male has endured a severe head injury. Which of the following statements best captures expected clinical manifestations and treatments for his immediate condition?

Accepted Answer

A)   Oxygen therapy is likely to decrease his respiratory drive and produce an increase in PCO2.
B)   Cheyne-Stokes breathing is likely but will respond to bronchodilators.
C)   The client is unlikely to respond to supplementary oxygen therapy due to impaired diffusion.
D)   Hypoventilation may exist, resulting in increased PCO2 and hypoxemia that may require mechanical ventilation.

Question 20

A patient who has been on a high-protein diet comes to the emergency department with respiratory symptoms. Upon analysis of arterial blood gases (ABGs), the patient is diagnosed with hypercapnia. The nurse will note the ABG results that confirm this diagnosis include: Select all that apply.

Accepted Answer

A)   pH 7.31 (normal 7.35 to 7.45) .
B)  PO2 of 97%
C)  CO2 of 58 mm Hg (normal 38 to 42) .
D)  Serum  HCO3 of  -33 mEq/L ( normal 22 to 28) 
E)  Serum K+ (potassium) of 3.6 mmol/L (normal 3.5 to 5.0) .

Exam 37: Disorders of Gastrointestinal Function

Which of the following clinical findings would be most closely associated with a client who has interstitial lung disease in comparison to chronic obstructive pulmonary disease (COPD) ?