Pulmonary Disorders

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Sample questions from Pulmonary Disorders

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 68-year-old client with COPD is admitted to the medical unit with increased dyspnea and purulent sputum. The client is alert, has an oxygen saturation of 84% on room air, respiratory rate 28/min, and is using accessory muscles. Which action should the nurse take first?

   • A.Apply prescribed oxygen and titrate to the target saturation of 88% to 92%
   • B.Place the client supine and encourage oral fluids
   • C.Obtain a sputum culture before initiating any intervention
   • D.Administer the client's scheduled inhaled corticosteroid

   Rationale: The client has significant hypoxemia and increased work of breathing, so oxygen should be applied promptly and titrated to the prescribed target. Positioning supine can worsen ventilation, and fluids do not correct the immediate oxygen deficit. A sputum culture may be useful but should not delay stabilization; a scheduled inhaled corticosteroid is not the priority rescue treatment. In acute COPD exacerbation, treat immediate breathing threats while avoiding unnecessary excessive oxygen.

2. 2.A 72-year-old client with COPD is receiving oxygen at 2 L/min by nasal cannula. The client becomes increasingly drowsy; respiratory rate is 10/min, and arterial blood gases show pH 7.28, PaCO2 68 mm Hg, and PaO2 58 mm Hg. Which action is most appropriate?

   • A.Remove the oxygen and reassess in 30 minutes
   • B.Notify the rapid response team and prepare for noninvasive ventilatory support
   • C.Increase oxygen to 10 L/min by simple mask
   • D.Encourage coughing and deep breathing, then repeat the blood gas in 2 hours

   Rationale: Acidosis, hypercapnia, hypoxemia, and declining alertness indicate acute ventilatory failure requiring urgent escalation and likely noninvasive ventilation if the client can protect the airway. Removing oxygen risks worsening hypoxemia, while increasing it substantially without assessment may worsen CO2 retention in a susceptible client. Coughing and delayed reassessment are inadequate for this deterioration. The exam priority is rapid support of ventilation and escalation of care.

3. 3.A 59-year-old client with asthma arrives in the emergency department with severe wheezing, respiratory rate 32/min, and oxygen saturation 90% on room air. The client can speak only one or two words at a time. Which prescription should the nurse implement first?

   • A.Administer inhaled short-acting beta2 agonist
   • B.Obtain a peak expiratory flow measurement
   • C.Teach the client to use an inhaled corticosteroid
   • D.Collect a sputum specimen

   Rationale: A short-acting inhaled beta2 agonist is rapid rescue therapy for acute bronchospasm and should be given promptly. Peak flow may help assess severity but must not delay treatment in a client with severe distress. An inhaled corticosteroid is controller therapy rather than immediate rescue therapy, and a sputum specimen does not address the airway emergency. Treat acute airflow obstruction first, then reassess response.

4. 4.A 24-year-old client with asthma is prescribed albuterol and fluticasone inhalers. The client asks how to use them during morning treatment. Which instruction is best?

   • A.Use fluticasone first so it coats the airways before albuterol
   • B.Use albuterol first, then use fluticasone after the prescribed interval
   • C.Use both inhalers at exactly the same time
   • D.Skip albuterol whenever wheezing is present

   Answer and rationale are in the full material.

5. 5.A 31-year-old client with asthma has a peak expiratory flow reading of 45% of personal best and is speaking in short phrases. The client used the prescribed rescue inhaler without relief. Which action should the nurse recommend?

   • A.Repeat peak flow in 4 hours before deciding what to do
   • B.Follow the asthma action plan's emergency instructions and seek emergency care
   • C.Begin a long walk to improve lung expansion
   • D.Take an extra dose of the inhaled corticosteroid and remain at home

   Answer and rationale are in the full material.