ATI Care of Patients
with Noninfectious Lower Respiratory Problems, Questions and Answers with
Explanations, 100% Correct, Download to Score A
Test Bank
MULTIPLE CHOICE
1. A client with asthma reports “not being able to take deep
breaths.” The nurse auscultates decreased breath sounds in the bases, and no
wheezes. What is the nurse’s best action?
a. Encourage
the client to stay calm and take deep breaths.
b. Document
the findings and continue to monitor.
c. Have the
client cough forcefully.
d. Assess the
client’s oxygen saturation.
ANS: D
Decreased wheezing accompanied by decreased breath sounds
can mean airway occlusion from mucus and from inflammation. The nurse should
assess the client’s oxygenation and determine whether additional interventions
are needed. Coughing forcefully may cause the smaller airways to collapse and
may not help the client. Encouraging the client to remain calm and to try to
take deep breaths is not helpful. Although providing documentation is
important, the nurse needs to do more than that.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Reduction of Risk Potential—Potential for Complications from Surgical
Procedures and Health Alterations)
MSC: Integrated Process: Nursing Process (Implementation)
2. A client with asthma has been having frequent asthma
attacks. What is the nurse’s best action?
a. Teach the
client to stay away from pets.
b. Assist
the client in using an incentive spirometer.
c. Administer
aspirin for its anti-inflammatory properties.
d. Administer
montelukast (Singulair).
ANS: D
A client who has been having increased attacks can have some
chronic inflammation occurring. This inflammation is probably stimulated by
mediators such as histamine and leukotriene and can be blocked by drugs like
diphenhydramine (Benadryl) and montelukast (Singulair).
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)
MSC: Integrated Process: Nursing Process (Implementation)
3. A client diagnosed with asthma has not responded well to
medication. The client is concerned and asks the nurse, “What is wrong with me,
and why am I not getting better?” What is the nurse’s best response?
a. “You just
weren’t used to the medication yet.”
b. “The
medication dose has to be increased.”
c. “It is
possible that genetic testing may help.”
d. “You
should try homeopathic medicine.”
ANS: C
Some genetic variations may cause the activity of
beta-adrenergic receptors to change, meaning that the client would not respond
as expected to beta agonists. Genetic testing may help to determine why the
drug therapy is not working and may help the clinician to identify new therapy
that will work.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)
MSC: Integrated Process: Nursing Process (Implementation)
4. The nurse is caring for four clients with asthma. Which
client does the nurse assess first?
a. Client
with a barrel chest and clubbed fingernails
b. Client
with an SaO2 level of 92% at rest
c. Client
whose expiratory phase is longer than the inspiratory phase
d. Client
whose heart rate is 120 beats/min
ANS: D
Tachycardia can indicate hypoxemia as the body tries to
circulate the oxygen that is available. A barrel chest is not an emergency
finding. Likewise a pulse oximetry level of 92% is not considered an acute
finding. The expiratory phase is expected to be longer than the inspiratory
phase in someone with airflow limitation.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Safe and Effective Care Environment
(Management of Care—Establishing Priorities) MSC: Integrated Process: Nursing
Process (Assessment)
5. The nurse is caring for an older adult who reports
experiencing frequent asthma attacks and severe arthritic pain. What action by
the nurse is most appropriate?
a. Review
pulmonary function test results.
b. Assess
use of medication for arthritis.
c. Assess
frequency of bronchodilator use.
d. Review
arterial blood gas results.
ANS: B
Aspirin and other NSAIDs can trigger asthma in some people.
This results from increased production of leukotriene when aspirin or NSAIDs
suppress other inflammatory pathways and is a high priority given the client’s
history. Reviewing pulmonary function test results will not address the
immediate problem of frequent asthma attacks. This is a good intervention for
reviewing response to bronchodilators. Questioning the client about the use of
bronchodilators will address interventions for the attacks but not their cause.
Reviewing arterial blood gas results would not be of use in a client between
attacks because many clients are asymptomatic when not having attacks.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Pharmacological and Parenteral Therapies—Adverse
Effects/Contraindications/Interactions/Side Effects)
MSC: Integrated Process: Nursing Process (Assessment)
6. The nurse is evaluating a client’s response to medication
therapy for asthma. The client has a peak flowmeter reading in the yellow zone.
What does the nurse do next?
a. Nothing;
this is an acceptable range.
b. Teach the
client to take deeper breaths.
c. Assist
the client to use a rescue inhaler.
d. Assess
the client’s lungs.
ANS: C
The client with a peak flow reading in the yellow zone needs
to use a rescue inhaler, then have a reading taken again within a few minutes.
The nurse has no reason to assess the client’s lungs at this point in time, nor
would the nurse take the time to teach at this moment.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Pharmacological and Parenteral Therapies—Expected Actions/Outcomes)
MSC: Integrated Process: Nursing Process (Implementation)
7. Which statement indicates that the client understands
teaching about the use of long-acting beta2 agonist medications?
a. “I will
not have to take this medication every day.”
b. “I will
take this medication when I have an asthma attack.”
c. “I will
take this medication daily to prevent an acute attack.”
d. “I will
eventually be able to stop using this medication.”
ANS: C
This medication will help prevent an acute asthma attack
because it is long acting. The client will take this medication every day for
best effect. This is not the medication the client will use during an acute
asthma attack because it does not have an immediate onset of action. The client
will not be weaned off this medication because this is likely to be one of his
or her daily medications.
DIF: Cognitive Level: Application/Applying or higher REF:
N/A
TOP: Client Needs Category: Physiological Integrity
(Pharmacological and Parenteral Therapies—Expected Actions/Outcomes) MSC:
Integrated Process: Nursing Process (Evaluation)
Category | ATI |
Release date | 2021-09-14 |
Pages | 24 |
Language | English |
Comments | 0 |
Sales | 0 |
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