Test Bank:Respiratory Function Meiner: Gerontologic Nursing, 6th Edition
MULTIPLE CHOICE
1. The nurse best maximizes an older adult’s potential
... [Show More] to avoid developing a postsurgical respiratory infection with which intervention?
a. Walking the patient to the bathroom instead of using the bedside commode
b. Encouraging compliance with prescribed antibiotic therapy
c. Evaluating the patient’s ability to effectively cough and deep breathe
d. Offering fluids every hour while the patient is awake
ANS: C
Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection but evaluating the patient’s ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively.
DIF: Remembering OBJ: 20-1
TOP: Nursing Process: Assessment MSC: Physiologic Integrity
2. An older adult’s pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. Where does the nurse know these changes will manifest?
a. Ineffective cough reflex
b. Shallow breathing
c. Slow respiratory rate NURSINGTB.COM
d. Frequent respiratory infections
ANS: B
Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate.
DIF: Remembering OBJ: 20-1
TOP: Nursing Process: Assessment MSC: Health Promotion and Maintenance
3. Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse would assess which patient further?
a. An afebrile patient with a nonproductive cough
b. Irritability in a usually pleasant patient
c. Pale nail beds in a patient of color
d. Has an elevated white blood cell (WBC) ANS: B
An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer. Mental status changes may include subtle increases in forgetfulness and irritability. The other options do not address the age-related change.
DIF: Applying OBJ: 20-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity
4. The nurse is preparing information for the caregivers of a patient with chronic respiratory issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patient’s emotional well-being by including what information?
a. Suggestions regarding proper nutrition and exercise
b. An explanation on how to preserve the patient’s sense of autonomy
c. Encouragement for the primary caregiver to take care of themselves
d. Referrals to pulmonary rehabilitation or support groups
ANS: B
Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over one’s life. Proper nutrition and exercise, referrals, and the caregiver taking care of him- or herself will not do as much to
maintain the patient’s emotional well-being as finding ways to give the patient control.
DIF: Applying OBJ: 20-3 TOP: Integrated Process: Teaching-Learning MSC: Psychosocial Integrity
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5. An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg
daily, rifampin 600 mg daily, and pyrazinamide 1,500 mg daily. What information is the priority for the nurse to give the patient?
a. Wear tinted glasses when out in the sun.
b. Minimize contact with children younger than 3 years old.
c. Avoid alcohol while on the drug therapy.
d. Eat and drink dairy sparingly.
ANS: C
Isoniazid can lead to toxic hepatitis which could be compounded by alcohol intake. Patients should not drink alcohol while taking this medication. The other information is not related to isoniazid.
DIF: Understanding OBJ: 20-3 TOP: Integrated Process: Teaching-Learning
MSC: Physiologic Integrity
6. An 80-year-old patient is concerned about contracting pneumonia. What information is the most important for the nurse to share with the patient?
a. Early recognition of the symptoms
b. Being vaccinated per government guidelines
c. Minimizing contact with the public during the winter months
d. Supplementing one’s daily diet with vitamin C
ANS: B
The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination.
Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population but would appear after the patient contracted pneumonia. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits.
DIF: Understanding OBJ: 20-3 TOP: Integrated Process: Teaching-Learning
MSC: Health Promotion and Maintenance
7. The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition?
a. Substernal chest pain
b. A history of panic attacks
c. Any known allergies
d. Bruising on the chest
ANS: A
The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others.
DIF: Applying OBJ: 20-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity
8. An older patient with severNe UpeRriSphIeNraGl aTrtBer.iaCl dOiMsease wishes to quit smoking. The nurse provide education to this patient on which of the following?
a. “Cold turkey” method
b. Gradual reduction
c. Nicotine patches
d. Bupropion hydrochloride
ANS: D
Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Bupropion hydrochloride is an appropriate choice.
DIF: Applying OBJ: 20-4 TOP: Integrated Process: Teaching-Learning MSC: Health Promotion and Maintenance
9. An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit smoking now. What response by the nurse is best?
a. “It will keep your disease from getting worse.”
b. “There are many benefits to quitting even now.”
c. “It will decrease the risk of getting cancer too.”
d. “You’re right; there really isn’t a reason to quit.” ANS: B
There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer. Telling the patient that there really isn’t a reason to quit not only is inaccurate, it’s dismissive of the patient’s desire to improve health habits.
DIF: Understanding OBJ: 20-4 TOP: Integrated Process: Teaching-Learning
MSC: Health Promotion and Maintenance
10. A patient has been taught about nutrition related to COPD. Which menu selection may indicate a need for further teaching?
a. Bagel and cream cheese
b. Broiled chicken breast
c. Beans and peas
d. Tofu stir-fry
ANS: A
Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection.
DIF: Evaluating OBJ: 20-3 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance
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11. An older patient is hospitalized on the general medical floor with pneumonia secondary to
influenza and is prescribed antibiotics. What assessment finding would indicate a higher level of care is needed for this patient?
a. Spreading infiltrates on chest x-ray
b. Creatinine 3.2 mg/dL
c. White blood cell count 18,000/mm3
d. Positive sputum cultures for pneumococcus
ANS: A
Spreading infiltrates on x-ray or extrapulmonary sites of infection seen on chest x-ray is an indication that the patient needs a higher level of care, perhaps even mechanical ventilation. The creatinine is high, reflecting a renal disorder. The elevated white blood cell count is indicative of infection although many older adults do not mount such an immune response. The type of pneumonia is not a definitive criterion for intensive care placement.
DIF: Analyzing OBJ: 20-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity
12. A frail, older patient is in the emergency department in severe respiratory distress. The patient has had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate?
a. Determine what the patient’s end-of-life wishes are.
b. Assess the family caregiver for compliance with treatment.
c. Administer intravenous (IV) fluids at a rapid rate.
d. Prepare to vaccinate the patient against pneumonia.
ANS: A
Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patient’s end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure.
The patient should receive an immunization against pneumonia per guidelines.
DIF: Applying OBJ: 20-3 TOP: Integrated Process: Caring MSC: Safe and Effective Care Environment
13. A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin infusion. What response by the nurse is best?
a. “It helps dissolve the clot in your lungs.”
b. “It keeps you from getting septic.”
c. “It prevents the clot from getting bigger.”
d. “It prevents clots from forming in your heart.”
ANS: C
Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming. It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis.
DIF: Understanding
NURSINGTB.OCBOJ:M 20-3
TOP: Integrated Process: Teaching-Learning MSC: Physiologic Integrity
14. The nurse caring for patients using continuous positive airway pressure (CPAP) knows what about treatment effectiveness?
a. Effectiveness depends on compliance.
b. It’s too expensive for many older adults.
c. It is rarely effective for sleep apnea.
d. Complicated settings make it hard to use.
ANS: A
Effectiveness is determined by compliance for nearly any regime, and unfortunately noncompliance with CPAP is 29–83%. The other statements are incorrect.
DIF: Remembering OBJ: 20-3
TOP: Nursing Process: Assessment MSC: Physiologic Integrity
MULTIPLE RESPONSE
1. To minimize an older adult’s risk for developing postsurgical atelectasis, the nurse does which of the following? (Select all that apply.)
a. Regularly assesses and medicates for pain.
b. Teaches effective deep-breathing techniques.
c. Provides oxygen via nasal cannula.
d. Encourages the patient to drink all fluids on meal trays.
e. Assesses lung sounds frequently.
ANS: A, B, D
Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis.
Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring.
DIF: Applying OBJ: 20-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity
2. When teaching older adult asthmatic patients, the nurse stresses the importance of which of the following? (Select all that apply.)
a. Being alert for the early signs of breathing problems
b. Fostering an effective relationship with your health care provider
c. Identifying and avoid personal triggers
d. Incorporating regular rest periods into your daily routine
e. Increasing vitamin C consumption, especially during winter months
ANS: A, B, C
The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C
may have immune system bNeneRfitsI.
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DIF: Understanding OBJ: 20-3 TOP: Integrated Process: Teaching-Learning
MSC: Health Promotion and Maintenance
3. The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patient’s corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.)
a. The name of the patient’s hypertension medication
b. What the patient uses to manage arthritic pain
c. Whether the patient feels the asthma is well controlled
d. Whether the patient takes low-dose aspirin regularly
e. Whether the patient has ever had glaucoma-related surgery
ANS: A, B, D
Asthma may be exacerbated by the use of nonsteroidal anti-inflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related.
DIF: Applying OBJ: 20-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity
4. The nurse is evaluating the effectiveness of an older patient’s self-management of asthma. What does the nurse assess as the priority? (Select all that apply.)
a. How many times a week a rescue inhaler treatment is needed
b. How well the patient is able to avoid the known triggers
c. Whether the patient experience frequent respiratory infections
d. Whether the patient requires rest periods during the day
e. Whether the patient believes he or she has the support of family and friends
ANS: A, B
The evaluation of self-management is based on the patient’s success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patient’s ability to monitor and address lifestyle changes.
DIF: Evaluating OBJ: 20-3 TOP: Nursing Process: Evaluation MSC: Health Promotion and Maintenance
5. The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of the program, including which of the following? (Select all that apply.)
a. Socialization
b. Decreased cardiac risks
c. Nutrition counseling
d. Weight management
e. Sports participation
ANS: A, B, C, D
There are many aspects to pulmonary rehabilitation, including socialization, decreased cardiac risks, nutrition counsUelinSg, aNnd wTeight mOanagement. Sports are not included,
although exercise is.
DIF: Remembering OBJ: 20-6 TOP: Integrated Process: Teaching-Learning
MSC: Health Promotion and Maintenance
6. The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma. What does the nurse teach about this medication? (Select all that apply.)
a. Taken just before retiring for the night
b. Reserved for acute attacks only
c. Used in increasing doses as needed
d. How to use and rinse the inhaler
e. There are few side effects to worry about.
ANS: C, D
Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. Inhaled corticosteroids have side effects such as a reduction in bone mineral content. They are not usually taken just before bed and they are considered long-term control medications and so would not be used in an acute attack.
DIF: Applying OBJ: 20-3 TOP: Integrated Process: Teaching-Learning MSC: Physiologic Integrity
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