Chapter 27: Lower Respiratory Problems

Chapter 27: Lower Respiratory Problems

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. After assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. Which assessment data best supports this diagnosis?

a.	Weak cough effort
b.	Profuse green sputum
c.	Respiratory rate of 28 breaths/minute
d.	Resting pulse oximetry (SpO2) of 85%

 

 

ANS:  A

The weak, nonproductive cough indicates that the patient is unable to clear the airway effectively. The other data would be used to support diagnoses such as impaired gas exchange and ineffective breathing pattern.

 

DIF:    Cognitive Level: Analyze (analysis)                                  REF:   505

TOP:   Nursing Process: Diagnosis              MSC:  NCLEX: Physiological Integrity

 

2. The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect?

a.	Increased tactile fremitus	c.	Hyperresonance to percussion
b.	Dry, nonproductive cough	d.	A grating sound on auscultation

 

 

ANS:  A

Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias. Dullness to percussion would be expected. Pneumococcal pneumonia typically presents with a loose, productive cough. Adventitious breath sounds such as crackles and wheezes are typical. A grating sound is more representative of a pleural friction rub rather than pneumonia.

 

DIF:    Cognitive Level: Apply (application)           REF:               503

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Physiological Integrity

 

3. A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action should the nurse plan to promote airway clearance?

a.	Restrict oral fluids during the day.
b.	Teach pursed-lip breathing technique.
c.	Assist the patient to splint the chest when coughing.
d.	Encourage the patient to wear the nasal O2 cannula.

 

 

ANS:  C

Coughing is less painful and more likely to be effective when the patient splints the chest during coughing. Fluids should be encouraged to help liquefy secretions. Nasal O₂ will improve gas exchange, but will not improve airway clearance. Pursed-lip breathing is used to improve gas exchange in patients with chronic obstructive pulmonary disease but will not improve airway clearance.

 

DIF:    Cognitive Level: Apply (application)           REF:               505

TOP:   Nursing Process: Planning               MSC:  NCLEX: Physiological Integrity

 

4. The nurse provides discharge instructions to a patient who was hospitalized for pneumonia. Which statement, if made by the patient, indicates a good understanding of the instructions?

a.	“I will call my health care provider if I still feel tired after a week.”
b.	“I will continue to do deep breathing and coughing exercises at home.”
c.	“I will schedule two appointments for the pneumonia and influenza vaccines.”
d.	“I will cancel my follow-up chest x-ray appointment if I feel better next week.”

 

 

ANS:  B

Patients should continue to cough and deep breathe after discharge. Fatigue is expected for several weeks. The pneumococcal and influenza vaccines can be given at the same time in different arms. A follow-up chest x-ray needs to be done in 6 to 8 weeks to evaluate resolution of pneumonia.

 

DIF:    Cognitive Level: Apply (application)           REF:               506

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Physiological Integrity