What action by the client would indicate that the client understands how to use an inhaler?

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Exam Prep Questions

1. When performing an assessment on the client with emphysema, the nurse finds that the client has a barrel chest. The alteration in the client’s chest is due to:

   	A.	Collapse of distal alveoli
   	B.	Hyperinflation of the lungs
   	C.	Long-term chronic hypoxia
   	D.	Use of accessory muscles

2. The nurse notes that a client with COPD demonstrates more dyspnea in certain positions. Which position is most likely to alleviate the client’s dyspnea?

   	A.	Lying supine with a single pillow
   	B.	Standing or sitting upright
   	C.	Side lying with the head elevated
   	D.	Lying with head slightly lowered

3. When reviewing the chart of a client with long standing lung disease, the nurse should pay close attention to the results of which pulmonary function test?

   	A.	Residual volume
   	B.	Total lung capacity
   	C.	FEV1/FVC ratio
   	D.	Functional residual capacity

4. The physician has ordered O2 at 3 liters/minute via nasal cannula. O2 amounts greater than 3 liters / minute are contraindicated in the client with COPD because:

   	A.	Higher concentrations result in severe headache.
   	B.	Hypercapnic drive is necessary for breathing.
   	C.	Higher levels will be required later to raise the pO2.
   	D.	Hypoxic drive is needed for breathing.

5. The client taking a bronchodilator tells the nurse that he is going to begin a smoking cessation program when he is discharged. The nurse should tell the client to notify the doctor if his smoking pattern changes because he will:

   	A.	Need his medication dosage adjusted
   	B.	Require an increase in antitussive medication
   	C.	No longer need annual influenza immunization
   	D.	Not derive as much benefit from inhaler use

6. Lab results indicate that the client’s serum aminophylline level is 17mcg/mL. The nurse recognizes that the aminophylline level is:

   	A.	Within therapeutic range
   	B.	Too high and should be reported
   	C.	Questionable and should be repeated
   	D.	Too low to be therapeutic

7. The morning weight for a client with emphysema indicates that the client has gained 5 pounds in less than a week, even though his oral intake has been modest. The client’s weight gain may reflect which associated complication of COPD?

   	A.	Polycythemia
   	B.	Cor pulmonale
   	C.	Left ventricular failure
   	D.	Compensated acidosis

8. The nurse is teaching the client the appropriate way to use a metered dose inhaler. Which action indicates the client needs additional teaching?

   	A.	The client takes a deep breath while depressing the inhaler.
   	B.	The client places the inhaler two fingers from the mouth.
   	C.	The client waits 15 seconds before using the inhaler a second time.
   	D.	The client exhales slowly using purse lipped breathing.

9. The client with COPD may lose weight despite having adequate caloric intake. When counseling the client in ways to maintain an optimal weight, the nurse should tell the client to:

   	A.	Continue the same caloric intake and increase the amount of fat intake
   	B.	Increase his activity level to stimulate his appetite
   	C.	Increase the amount of complex carbohydrates and decrease the amount of fat intake
   	D.	Decrease the amount of complex carbohydrates while increasing calories, protein, vitamins, and minerals

10. The client has been receiving garamycin 65 mg IVPB every 8 hours for the past 6 days. Which lab result indicates an adverse reaction to the medication?

    	A.	WBC 7500
    	B.	Serum glucose 92
    	C.	Protein 3.5
    	D.	Serum creatinine 2.0

Answer Rationales

1. Answer B is correct. Clients with emphysema develop a barrel chest due to the trapping of air in the lungs, causing them to hyperinflate. Answers C and D are common in those with emphysema but do not cause the chest to become barrel shaped. Answer A does not occur in emphysema.
2. Answer B is correct. The client with chronic obstructive pulmonary disease has increased difficulty breathing when lying down. His respiratory effort is improved by standing or sitting upright or by having the bed in high Fowler’s position. Answers A, C, and D do not alleviate the client’s dyspnea; therefore they are incorrect.
3. Answer C is correct. The FEV1/FVC ratio indicates disease progression. As COPD worsens, the ratio of FEV1 to FVC becomes smaller. Answers A and B reflect loss of elastic recoil due to narrowing and obstruction of the airway. Answer D is increased in clients with obstructive bronchitis.
4. Answer D is correct. In clients with COPD, respiratory effort is stimulated by hypoxemia. Answers A and C are incorrect because higher levels would rob the client of the drive to breathe. Answer B is an incorrect statement.
5. Answer A is correct. Changes in smoking patterns should be discussed with the physician because they have an impact on the amount of medication needed. Answer B is incorrect because clients with COPD are placed on expectorants, not antitussives. Answer C is incorrect because an annual influenza vaccine is recommended for all those with lung disease. Answer D is incorrect because benefits from inhaler use should be increased when the client stops smoking.
6. Answer A is correct. The therapeutic range for aminophylline is 10–20 mcg/ml. Answers B and D are incorrect. There are no indications that the results are questionable; therefore, repeating the test as offered by answer C is incorrect.
7. Answer B is correct. Cor pulmonale, or right sided heart failure, is a possible complication of emphysema. Answers A and D do not cause weight gain, so they’re incorrect. Answer C would be reflected in pulmonary edema, so it’s incorrect.
8. Answer C is correct. The client should wait 60 seconds before using the inhaler a second time. The client’s wait time of 15 seconds indicates that the client needs further teaching. Answers A, B, and D indicate that the client understands the correct use of the inhaler.
9. Answer D. The client with COPD needs additional calories, protein, vitamins, and minerals. Answer A is incorrect because the client needs more calories but not more fat. Answer B is not feasible, will increase the O2 demands, and will result in further weight loss. Answer C leads to excess acid production and an increased respiratory workload.
10. Answer D is correct. The serum creatinine is elevated, indicating renal impairment. Answers A, B, and C are within normal limits.

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