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)