CNUR 203 NCLEX Review Exam Questions
With Correct Answers
An asthmatic patient who has a new prescription for Advair Diskus (combined
fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The
nurse explains that
a.) Advair is a combination of long-acting and slow-acting bronchodilators.
b.) the two drugs work together to block the effects of histamine on the
bronchioles.
c.) one drug decreases inflammation, and the other is a bronchodilator.
d.) the combination of two drugs works more quickly in an acute asthma attack. -
ANSWER C
Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a
corticosteroid; they work together to prevent asthma attacks. Neither
medication is an antihistamine. Advair is not used during an acute attack
because the medications do not work rapidly.
When preparing a patient with possible asthma for pulmonary function testing,
the nurse will teach the patient to
a.) avoid eating or drinking for 4 hours before the forced expiratory volume in 1
second (FEV1)/forced expiratory volume (FEV) test.
b.) take oral corticosteroids at least 2 hours before the examination.
c.) withhold bronchodilators for 6 to 12 hours before the examination.
d.) use rescue medications immediately before the FEV1/FEV testing. - ANSWER
C
Rationale: Bronchodilators are held before pulmonary function testing so that a
baseline assessment of airway function can be determined. Testing is repeated
after bronchodilator use to determine whether the decrease in lung function is
reversible. There is no need for the patient to be NPO. Oral corticosteroids
should also be held before the examination and corticosteroids given 2 hours
before the examination would be at a high level. Rescue medications (which are
bronchodilators) would not be given until after the baseline pulmonary function
was assessed.
When teaching a patient with chronic obstructive pulmonary disease (COPD)
about reasons to quit smoking, the nurse will explain that long-term exposure to
tobacco smoke leads to a
a.) weakening of the smooth muscle lining the airways.
b.) decrease in the area available for oxygen absorption.
c.) lesser number of red blood cells for oxygen delivery.
d.) decreased production of protective respiratory secretions. - ANSWER B
,Rationale: Tobacco smoke leads to an increase in proteolytic enzymes, which
break down alveolar walls and lead to less alveolar surface area for gas
exchange. Bronchial smooth muscle is not weakened by chronic smoking.
Polycythemia is a common compensatory mechanism for patients with COPD.
The quantity of respiratory secretions increases as a result of smoking.
Which of these is the best goal for the patient admitted with chronic bronchitis
who has a nursing diagnosis of ineffective airway clearance?
a.) Patient denies having dyspnea.
b.) Patient's mental status is improved.
c.) Patient has a productive cough.
d.) Patient's O2 saturation is 90%. - ANSWER C
Rationale: The goal for the nursing diagnosis of ineffective airway clearance is
to maintain a clear airway by coughing effectively. The other goals may be
appropriate for the patient with COPD, but they do not address the problem of
ineffective airway clearance.
The nurse identifies the nursing diagnosis of imbalanced nutrition: less than
body requirements for a patient with COPD. An appropriate intervention for this
problem is to:
a.) have the patient exercise for 10 minutes before meals.
b.) offer high calorie snacks between meals and at bedtime.
c.) assist the patient in choosing foods with a lot of texture.
d.) increase the patient's intake of fruits and fruit juices. - ANSWER B
Rationale: Eating small amounts more frequently (as occurs with snacking) will
increase caloric intake by decreasing the fatigue and feelings of fullness
associated with large meals. Patients with COPD should rest before meals.
Foods that have a lot of texture may take more energy to eat and lead to
decreased intake. Although fruits and juices are not contraindicated, foods high
in protein are a better choice.
A patient is seen in the clinic with COPD. Which information given by the patient
would help most in confirming a diagnosis of chronic bronchitis?
a.) The patient tells the nurse about a family history of bronchitis.
b.) The patient denies having any respiratory problems until the last 6 months.
c.) The patient's history indicates a 40 pack-year cigarette history.
d.) The patient complains about having a productive cough every winter for 2
months. - ANSWER D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a
productive cough for several months for at least 2 consecutive years. There is
no familial tendency for chronic bronchitis. Although smoking is the major risk
factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse teaches a patient with COPD how to perform pursed-lip breathing,
explaining that this technique will assist respiration by
a.) loosening secretions so that they may be coughed up more easily.
, b.) promoting maximal inhalation for better oxygenation of the lungs.
c.) preventing airway collapse and air trapping in the lungs during expiration.
d.) decreasing anxiety by giving the patient control of respiratory patterns. -
ANSWER C
Rationale: Pursed-lip breathing increases the airway pressure during the
expiratory phase and prevents collapse of the airways, allowing for more
complete exhalation. Although loosening of secretions, improving inhalation,
and decreasing anxiety are desirable outcomes for the patient with COPD,
pursed-lip breathing does not directly impact these.
The nurse makes a diagnosis of impaired gas exchange for a patient with COPD
in acute respiratory distress, based on the assessment finding of
a.) a pulse oximetry reading of 86%.
b.) dyspnea and respiratory rate of 36.
c.) use of the accessory respiratory muscles.
d.) the presence of crackles in both lungs. - ANSWER A
Rationale: The best data to support the diagnosis of impaired gas exchange are
abnormalities in the ABGs or pulse oximetry. The other data would support a
diagnosis of risk for impaired gas exchange.
When a patient with COPD is receiving oxygen, the best action by the nurse is to:
a.) avoid administration of oxygen at a rate of more than 2 L/min.
b.) minimize oxygen use to avoid oxygen dependency.
c.) administer oxygen according to the patient's level of dyspnea.
d.) maintain the pulse oximetry level at 90% or greater. - ANSWER D
Rationale: The best way to determine the appropriate oxygen flow rate is by
monitoring the patient's oxygenation either by ABGs or pulse oximetry; an
oxygen saturation of 90% indicates adequate blood oxygen level without the
danger of suppressing the respiratory drive. For patients with an exacerbation
of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen
use improves survival rate in patients with COPD, there is not a concern about
oxygen dependency. The patient's perceived dyspnea level may be affected by
other factors (such as anxiety) besides blood oxygen level.
A patient with COPD asks the home health nurse about home oxygen use. The
nurse should teach the patient that long-term home O2 therapy
a.) can improve the patient's prognosis and quality of life.
b.) may cause oxygen dependency in patients with COPD.
c.) is used only for patients who have severe end-stage respiratory disease.
d.) should never be used at night because the patient cannot monitor its effect. -
ANSWER A
Rationale: Research supports the use of home oxygen to improve quality of life
and prognosis. Oxygen dependency is not an issue for patients with COPD.
Although most patients using home oxygen have SpO2 levels less than 89% on
room air, it would not be appropriate to tell the patient that he or she was at the
With Correct Answers
An asthmatic patient who has a new prescription for Advair Diskus (combined
fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The
nurse explains that
a.) Advair is a combination of long-acting and slow-acting bronchodilators.
b.) the two drugs work together to block the effects of histamine on the
bronchioles.
c.) one drug decreases inflammation, and the other is a bronchodilator.
d.) the combination of two drugs works more quickly in an acute asthma attack. -
ANSWER C
Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a
corticosteroid; they work together to prevent asthma attacks. Neither
medication is an antihistamine. Advair is not used during an acute attack
because the medications do not work rapidly.
When preparing a patient with possible asthma for pulmonary function testing,
the nurse will teach the patient to
a.) avoid eating or drinking for 4 hours before the forced expiratory volume in 1
second (FEV1)/forced expiratory volume (FEV) test.
b.) take oral corticosteroids at least 2 hours before the examination.
c.) withhold bronchodilators for 6 to 12 hours before the examination.
d.) use rescue medications immediately before the FEV1/FEV testing. - ANSWER
C
Rationale: Bronchodilators are held before pulmonary function testing so that a
baseline assessment of airway function can be determined. Testing is repeated
after bronchodilator use to determine whether the decrease in lung function is
reversible. There is no need for the patient to be NPO. Oral corticosteroids
should also be held before the examination and corticosteroids given 2 hours
before the examination would be at a high level. Rescue medications (which are
bronchodilators) would not be given until after the baseline pulmonary function
was assessed.
When teaching a patient with chronic obstructive pulmonary disease (COPD)
about reasons to quit smoking, the nurse will explain that long-term exposure to
tobacco smoke leads to a
a.) weakening of the smooth muscle lining the airways.
b.) decrease in the area available for oxygen absorption.
c.) lesser number of red blood cells for oxygen delivery.
d.) decreased production of protective respiratory secretions. - ANSWER B
,Rationale: Tobacco smoke leads to an increase in proteolytic enzymes, which
break down alveolar walls and lead to less alveolar surface area for gas
exchange. Bronchial smooth muscle is not weakened by chronic smoking.
Polycythemia is a common compensatory mechanism for patients with COPD.
The quantity of respiratory secretions increases as a result of smoking.
Which of these is the best goal for the patient admitted with chronic bronchitis
who has a nursing diagnosis of ineffective airway clearance?
a.) Patient denies having dyspnea.
b.) Patient's mental status is improved.
c.) Patient has a productive cough.
d.) Patient's O2 saturation is 90%. - ANSWER C
Rationale: The goal for the nursing diagnosis of ineffective airway clearance is
to maintain a clear airway by coughing effectively. The other goals may be
appropriate for the patient with COPD, but they do not address the problem of
ineffective airway clearance.
The nurse identifies the nursing diagnosis of imbalanced nutrition: less than
body requirements for a patient with COPD. An appropriate intervention for this
problem is to:
a.) have the patient exercise for 10 minutes before meals.
b.) offer high calorie snacks between meals and at bedtime.
c.) assist the patient in choosing foods with a lot of texture.
d.) increase the patient's intake of fruits and fruit juices. - ANSWER B
Rationale: Eating small amounts more frequently (as occurs with snacking) will
increase caloric intake by decreasing the fatigue and feelings of fullness
associated with large meals. Patients with COPD should rest before meals.
Foods that have a lot of texture may take more energy to eat and lead to
decreased intake. Although fruits and juices are not contraindicated, foods high
in protein are a better choice.
A patient is seen in the clinic with COPD. Which information given by the patient
would help most in confirming a diagnosis of chronic bronchitis?
a.) The patient tells the nurse about a family history of bronchitis.
b.) The patient denies having any respiratory problems until the last 6 months.
c.) The patient's history indicates a 40 pack-year cigarette history.
d.) The patient complains about having a productive cough every winter for 2
months. - ANSWER D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a
productive cough for several months for at least 2 consecutive years. There is
no familial tendency for chronic bronchitis. Although smoking is the major risk
factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse teaches a patient with COPD how to perform pursed-lip breathing,
explaining that this technique will assist respiration by
a.) loosening secretions so that they may be coughed up more easily.
, b.) promoting maximal inhalation for better oxygenation of the lungs.
c.) preventing airway collapse and air trapping in the lungs during expiration.
d.) decreasing anxiety by giving the patient control of respiratory patterns. -
ANSWER C
Rationale: Pursed-lip breathing increases the airway pressure during the
expiratory phase and prevents collapse of the airways, allowing for more
complete exhalation. Although loosening of secretions, improving inhalation,
and decreasing anxiety are desirable outcomes for the patient with COPD,
pursed-lip breathing does not directly impact these.
The nurse makes a diagnosis of impaired gas exchange for a patient with COPD
in acute respiratory distress, based on the assessment finding of
a.) a pulse oximetry reading of 86%.
b.) dyspnea and respiratory rate of 36.
c.) use of the accessory respiratory muscles.
d.) the presence of crackles in both lungs. - ANSWER A
Rationale: The best data to support the diagnosis of impaired gas exchange are
abnormalities in the ABGs or pulse oximetry. The other data would support a
diagnosis of risk for impaired gas exchange.
When a patient with COPD is receiving oxygen, the best action by the nurse is to:
a.) avoid administration of oxygen at a rate of more than 2 L/min.
b.) minimize oxygen use to avoid oxygen dependency.
c.) administer oxygen according to the patient's level of dyspnea.
d.) maintain the pulse oximetry level at 90% or greater. - ANSWER D
Rationale: The best way to determine the appropriate oxygen flow rate is by
monitoring the patient's oxygenation either by ABGs or pulse oximetry; an
oxygen saturation of 90% indicates adequate blood oxygen level without the
danger of suppressing the respiratory drive. For patients with an exacerbation
of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen
use improves survival rate in patients with COPD, there is not a concern about
oxygen dependency. The patient's perceived dyspnea level may be affected by
other factors (such as anxiety) besides blood oxygen level.
A patient with COPD asks the home health nurse about home oxygen use. The
nurse should teach the patient that long-term home O2 therapy
a.) can improve the patient's prognosis and quality of life.
b.) may cause oxygen dependency in patients with COPD.
c.) is used only for patients who have severe end-stage respiratory disease.
d.) should never be used at night because the patient cannot monitor its effect. -
ANSWER A
Rationale: Research supports the use of home oxygen to improve quality of life
and prognosis. Oxygen dependency is not an issue for patients with COPD.
Although most patients using home oxygen have SpO2 levels less than 89% on
room air, it would not be appropriate to tell the patient that he or she was at the
