Chapter 27: Concepts of Care for Patients
with Non-infectious Lower Respiratory
Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who
appears thin and disheveled. Which question would the nurse ask first?
a. “Do you have a strong support system?”
b. “What do you understand about your disease?”
c. “Do you experience shortness of breath with basic activities?”
d. “What medications are you prescribed to take each day?”
ANS: C
Clients with severe COPD may not be able to perform daily activities, including
bathing and eating, because of excessive shortness of breath. The nurse would ask the
client if shortness of breath is interfering with basic activities. Although the nurse
would need to know about the client’s support systems, current knowledge, and
medications, these questions do not address the client’s appearance.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Respiratory disorders, Functional ability MSC: Client
Needs Category: Physiological Integrity: Basic Care and Comfort
2. A clinic nurse is reviewing care measures with a client who has asthma, Step 3. What
statement by the client indicates the need to review the information?
, a. “I still will use my rapid-acting inhaler for an asthma attack.”
b. “I will always use the spacer with my dry powder inhaler.”
c. “If I am stable for 3 months, I might be able to reduce my drugs.”
d. “My inhaled corticosteroid must be taken regularly to work well.”
ANS: B
Dry powder inhalers are not used with a spacer. The other statements are accurate.
DIF: Analyzing TOP: Integrated Process: Teaching/Learning
KEY: Respiratory disorders, Medications, Health teaching MSC:
Client Needs Category: Physiological Integrity: Pharmacological and
Parenteral Therapies
3. A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease
(COPD). Which client would the nurse assess first?
a. A 46 year old with a 30–pack-year history of smoking
b. A 52 year old in a tripod position using accessory muscles to breathe
c. A 68 year old who has dependent edema and clubbed fingers
d. A 74 year old with a chronic cough and thick, tenacious secretions
ANS: B
The client who is in a tripod position and using accessory muscles is working to
breathe. This client must be assessed first to establish how effectively the client is
breathing and provide interventions to minimize respiratory distress. The other clients
are not in acute distress.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Respiratory disorders, Nursing assessment MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
4. A nurse cares for a client who has a pleural chest tube. What action would the nurse
take to ensure safe use of this equipment?
, a. Strip the tubing to minimize clot formation and ensure patency.
b. Secure tubing junctions with clamps to prevent accidental disconnections.
c. Connect the chest tube to wall suction as prescribed by the primary health care
provider.
d. Keep padded clamps at the bedside for use if the drainage system is
interrupted.
ANS: D
Padded clamps would be kept at the bedside for use if the drainage system becomes
dislodged or is interrupted. The nurse would never strip the tubing. Tubing junctions
would be taped, not clamped. Wall suction would be set at the level indicated by the
device’s manufacturer, not the primary health care provider.
DIF: Remembering TOP: Integrated Process: Nursing Process:
Implementation KEY: Respiratory disorders, Chest tubes MSC:
Client Needs Category: Safe and Effective Care Environment: Safety and
Infection Control
5. A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency.
The client asks, “What does this mean?” How would the nurse respond?
a. “Your children will be at high risk for chronic obstructive pulmonary disease.”
b. “I will contact a genetic counselor to discuss your condition.”
c. “Your risk for chronic obstructive pulmonary disease is higher, especially if
you smoke.”
d. “This is a recessive gene and would have no impact on your health.”
ANS: C
Alpha1-antitrypsin deficiency is an important risk factor for COPD. The gene for
AAT is a recessive gene. Clients with only one allele produce enough AAT to prevent
COPD unless the client smokes or there is sufficient exposure to other inhalants. A
client with two alleles is at high risk for COPD even if not exposed to smoke or other
irritants. The client is a carrier, and children may or may not be at high risk depending
with Non-infectious Lower Respiratory
Problems
Ignatavicius: Medical-Surgical Nursing, 10th Edition
MULTIPLE CHOICE
1. A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who
appears thin and disheveled. Which question would the nurse ask first?
a. “Do you have a strong support system?”
b. “What do you understand about your disease?”
c. “Do you experience shortness of breath with basic activities?”
d. “What medications are you prescribed to take each day?”
ANS: C
Clients with severe COPD may not be able to perform daily activities, including
bathing and eating, because of excessive shortness of breath. The nurse would ask the
client if shortness of breath is interfering with basic activities. Although the nurse
would need to know about the client’s support systems, current knowledge, and
medications, these questions do not address the client’s appearance.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Respiratory disorders, Functional ability MSC: Client
Needs Category: Physiological Integrity: Basic Care and Comfort
2. A clinic nurse is reviewing care measures with a client who has asthma, Step 3. What
statement by the client indicates the need to review the information?
, a. “I still will use my rapid-acting inhaler for an asthma attack.”
b. “I will always use the spacer with my dry powder inhaler.”
c. “If I am stable for 3 months, I might be able to reduce my drugs.”
d. “My inhaled corticosteroid must be taken regularly to work well.”
ANS: B
Dry powder inhalers are not used with a spacer. The other statements are accurate.
DIF: Analyzing TOP: Integrated Process: Teaching/Learning
KEY: Respiratory disorders, Medications, Health teaching MSC:
Client Needs Category: Physiological Integrity: Pharmacological and
Parenteral Therapies
3. A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease
(COPD). Which client would the nurse assess first?
a. A 46 year old with a 30–pack-year history of smoking
b. A 52 year old in a tripod position using accessory muscles to breathe
c. A 68 year old who has dependent edema and clubbed fingers
d. A 74 year old with a chronic cough and thick, tenacious secretions
ANS: B
The client who is in a tripod position and using accessory muscles is working to
breathe. This client must be assessed first to establish how effectively the client is
breathing and provide interventions to minimize respiratory distress. The other clients
are not in acute distress.
DIF: Applying TOP: Integrated Process: Nursing Process: Assessment
KEY: Respiratory disorders, Nursing assessment MSC: Client
Needs Category: Safe and Effective Care Environment: Management of Care
4. A nurse cares for a client who has a pleural chest tube. What action would the nurse
take to ensure safe use of this equipment?
, a. Strip the tubing to minimize clot formation and ensure patency.
b. Secure tubing junctions with clamps to prevent accidental disconnections.
c. Connect the chest tube to wall suction as prescribed by the primary health care
provider.
d. Keep padded clamps at the bedside for use if the drainage system is
interrupted.
ANS: D
Padded clamps would be kept at the bedside for use if the drainage system becomes
dislodged or is interrupted. The nurse would never strip the tubing. Tubing junctions
would be taped, not clamped. Wall suction would be set at the level indicated by the
device’s manufacturer, not the primary health care provider.
DIF: Remembering TOP: Integrated Process: Nursing Process:
Implementation KEY: Respiratory disorders, Chest tubes MSC:
Client Needs Category: Safe and Effective Care Environment: Safety and
Infection Control
5. A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency.
The client asks, “What does this mean?” How would the nurse respond?
a. “Your children will be at high risk for chronic obstructive pulmonary disease.”
b. “I will contact a genetic counselor to discuss your condition.”
c. “Your risk for chronic obstructive pulmonary disease is higher, especially if
you smoke.”
d. “This is a recessive gene and would have no impact on your health.”
ANS: C
Alpha1-antitrypsin deficiency is an important risk factor for COPD. The gene for
AAT is a recessive gene. Clients with only one allele produce enough AAT to prevent
COPD unless the client smokes or there is sufficient exposure to other inhalants. A
client with two alleles is at high risk for COPD even if not exposed to smoke or other
irritants. The client is a carrier, and children may or may not be at high risk depending
