COPD
2. A client with COPD is receiving oxygen at 4 L/min via nasal cannula. The nurse notes the client’s oxygen saturation is 88% and respiratory rate is 8 breaths/min with shallow respirations. What is the priority action?
A. Increase oxygen to 6 L/min via nasal cannula
B. Apply a non-rebreather mask at 10 L/min
C. Stimulate the client and prepare for possible assisted ventilation
D. Encourage pursed-lip breathing and tripod positioning
C. Stimulate the client and prepare for possible assisted ventilation
The nurse is caring for a hospitalized patient with moderate OSA who refuses to wear their CPAP mask because of claustrophobia. Which is the priority intervention?
A. Encourage the patient to sleep upright in a recliner.
B. Teach the patient relaxation techniques and start CPAP at a lower pressure.
C. Contact the provider to request sedative-hypnotics to induce sleep.
D. Document refusal and continue routine monitoring of oxygen saturation.
B. Teach the patient relaxation techniques and start CPAP at a lower pressure.
Which conditions are contraindications to attempting NPPV (noninvasive positive pressure ventilation)? (Select all that apply)
A. Severe agitation and inability to tolerate the mask
B. Profuse oral secretions with ineffective cough
C. Hemodynamically stable patient with acute pulmonary edema, alert and cooperative
D. Cardiac arrest with need for immediate chest compressions
E. Facial trauma with unstable facial bones
A. Severe agitation and inability to tolerate the mask
B. Profuse oral secretions with ineffective cough
D. Cardiac arrest with need for immediate chest compressions
A client with a total laryngectomy accidentally dislodges their tracheostomy tube. Which action is most appropriate?
A. Provide ventilation with a bag-valve-mask over the nose and mouth
B. Cover the stoma with sterile gauze until respiratory therapy arrives
C. Ventilate the client through the stoma with a bag-valve-mask
D. Insert an oral airway and prepare for intubation
C. Ventilate the client through the stoma with a bag-valve-mask
A patient with acute hypoxemic respiratory failure on mechanical ventilation has ABGs trending: earlier pH 7.45 PaCO₂ 30 PaO₂ 80; now pH 7.30 PaCO₂ 52 PaO₂ 65 on same ventilator settings. The patient is tachypneic and anxious. Which interpretation and action are most appropriate?
A. Worsening ventilation (rising PaCO₂) and oxygenation — assess for ventilator malfunction, secretions, and consider increasing minute ventilation/FiO₂.
B. Improved ventilation; extubate now.
C. Metabolic acidosis developing — start insulin therapy.
D. Normal variation — no change.
A. Worsening ventilation (rising PaCO₂) and oxygenation — assess for ventilator malfunction, secretions, and consider increasing minute ventilation/FiO₂.
3. A client with chronic bronchitis is admitted with worsening dyspnea, cyanosis, and bilateral ankle edema. Which assessment finding would best support the nurse’s suspicion of cor pulmonale?
A. Diminished breath sounds with expiratory wheezes
B. Jugular venous distension at 45° angle
C. Increased anteroposterior chest diameter
D. Increased sputum production
B. Jugular venous distension at 45° angle
A patient is undergoing evaluation for suspected pulmonary hypertension. The nurse explains the role of right heart catheterization. Which statement by the patient indicates correct understanding?
A. “It measures how well my lungs are moving air in and out.”
B. “It tells the doctor the pressure in my pulmonary artery and right heart chambers.”
C. “It checks my blood for signs of clotting problems.”
D. “It shows if my coronary arteries are narrowed.”
B. “It tells the doctor the pressure in my pulmonary artery and right heart chambers.”
A 62-year-old man with COPD arrives in respiratory distress with increased work of breathing, pH 7.28, PaCO₂ 64 mmHg, PaO₂ 58 mmHg on room air. The respiratory therapist recommends initiation of BiPAP. Which physiologic rationale best supports using BiPAP instead of CPAP for this patient?
A. BiPAP provides continuous airway splinting that prevents upper airway collapse.
B. BiPAP delivers two pressure levels to augment ventilation (reduce CO₂) while also improving oxygenation.
C. BiPAP eliminates the need for an artificial airway in patients with excessive secretions.
D. BiPAP maintains a fixed fraction of inspired oxygen to prevent hypoxemia.
B. BiPAP delivers two pressure levels to augment ventilation (reduce CO₂) while also improving oxygenation.
The nurse is caring for a client with a chronic tracheostomy who wishes to begin oral intake and use a speaking valve. Which tracheostomy tube type is most appropriate to request from the provider?
A. Cuffed, fenestrated
B. Uncuffed, fenestrated
C. Non-fenestrated, cuffed
D. Cuffed, non-fenestrated
B. Uncuffed, fenestrated
A previously healthy adult outpatient diagnosed with CAP, no recent antibiotics, is clinically stable. According to typical stewardship principles, which empiric outpatient antibiotic choice is most appropriate?
A. Broad-spectrum IV carbapenem at home infusion
B. Single-agent macrolide or doxycycline per guideline recommendations
C. Vancomycin PO for MRSA coverage
D. No antibiotic — observe for 2 weeks before starting therapy
B. Single-agent macrolide or doxycycline per guideline recommendations
5. The nurse provides education to a client newly prescribed tiotropium for COPD. Which statement by the client indicates need for further teaching?
A. “I should rinse my mouth after using this inhaler.”
B. “This medicine will help open up my airways long-term.”
C. “I will use this inhaler when I start wheezing suddenly.”
D. “I should take this medication at the same time every day.”
C. “I will use this inhaler when I start wheezing suddenly.”
A patient with pulmonary hypertension is prescribed nifedipine. Which nursing assessment is the priority before administering this medication?
A. Oxygen saturation
B. Serum potassium level
C. Blood pressure and heart rate
D. Signs of lower extremity edema
C. Blood pressure and heart rate
A ventilated patient’s low-pressure alarm sounds and the ventilator displays tidal volumes much lower than set. The patient is cyanotic and suddenly restless. What is the nurse’s immediate priority action?
A. Assess for disconnection and manually ventilate with bag-valve-mask while calling for help.
B. Check the endotracheal tube cuff pressure.
C. Suction the endotracheal tube to remove secretions.
D. Increase the ventilator tidal volume setting.
A. Assess for disconnection and manually ventilate with bag-valve-mask while calling for help.
The nurse is preparing to assist a client with a tracheostomy to begin oral feeding after prolonged mechanical ventilation. Which actions demonstrate appropriate collaboration with the interprofessional team? (Select all that apply.)
A. Requesting a bedside swallow evaluation by speech therapy
B. Deflating the cuff during meals as tolerated
C. Positioning the client upright at 90 degrees during eating
D. Administering thickened liquids per dietary recommendations
E. Replacing the trach with a cuffed, non-fenestrated tube before feeding
A. Requesting a bedside swallow evaluation by speech therapy
B. Deflating the cuff during meals as tolerated
C. Positioning the client upright at 90 degrees during eating
D. Administering thickened liquids per dietary recommendations
A patient suspected of community-acquired pneumonia has orders for blood cultures, sputum Gram stain/culture, chest x-ray, and procalcitonin. Which statements about these tests are true? (Select all that apply.)
A. Blood cultures are most likely to be positive in outpatient CAP and are always diagnostic.
B. Sputum Gram stain can guide empiric antibiotic choice if a good quality specimen is obtained.
C. Chest x-ray helps identify lobar consolidation and possible complications.
D. Elevated procalcitonin supports bacterial infection and can help guide antibiotic duration.
E. A normal chest x-ray rules out pneumonia in all patients.
B. Sputum Gram stain can guide empiric antibiotic choice if a good quality specimen is obtained.
C. Chest x-ray helps identify lobar consolidation and possible complications.
D. Elevated procalcitonin supports bacterial infection and can help guide antibiotic duration.
1. A client with severe COPD presents with increasing dyspnea and reports producing thick green sputum. ABG results show: pH 7.30, PaCO₂ 58 mmHg, PaO₂ 52 mmHg, HCO₃⁻ 28 mEq/L. Which intervention should the nurse anticipate as the priority?
A. Initiate high-flow oxygen at 10 L/min via non-rebreather mask
B. Obtain a sputum culture and start IV antibiotics
C. Begin non-invasive positive pressure ventilation as prescribed
D. Encourage pursed-lip breathing and increase fluid intake
C. Begin non-invasive positive pressure ventilation as prescribed
A patient is postoperative day 1 after uvulopalatopharyngoplasty (UPPP). Which nursing action takes priority?
A. Provide liquid analgesics for throat pain
B. Encourage use of normal saline mouthwash after meals
C. Assess for bleeding, swelling, and airway obstruction
D. Educate the patient about avoiding tongue brushing
C. Assess for bleeding, swelling, and airway obstruction
A 70-year-old patient with acute cardiogenic pulmonary edema is receiving CPAP in the ED. Blood pressure is 82/54 mmHg, HR 56, and the patient complains of worsening dizziness. Which is the best nursing action?
A. Continue CPAP at the current pressure because it improves oxygenation.
B. Decrease CPAP pressure and notify the provider because hypotension and bradycardia may indicate poor tolerability.
C. Switch to BiPAP with higher IPAP to improve cardiac output.
D. Administer a rapid IV fluid bolus to raise blood pressure before changing respiratory support.
B. Decrease CPAP pressure and notify the provider because hypotension and bradycardia may indicate poor tolerability.
A client with a tracheostomy suddenly becomes restless with increasing respiratory distress. The nurse finds the tracheostomy tube lying on the bed. What is the priority nursing action?
A. Attempt to reinsert the tracheostomy tube immediately
B. Call the rapid response team
C. Cover the stoma with sterile gauze and ventilate with a bag-valve-mask via mouth and nose
D. Provide reassurance while notifying the respiratory therapist
C. Cover the stoma with sterile gauze and ventilate with a bag-valve-mask via mouth and nose
Which of the following are common causes or contributors to hypercapnic respiratory failure? (Select all that apply.)
A. Opioid overdose causing respiratory depression
B. Severe pulmonary embolism with massive V/Q mismatch
C. Advanced neuromuscular disease (ALS) with weak diaphragm
D. Obesity hypoventilation syndrome
E. Primary diffusion impairment from pulmonary fibrosis
A. Opioid overdose causing respiratory depression
C. Advanced neuromuscular disease (ALS) with weak diaphragm
D. Obesity hypoventilation syndrome
3. A client with bronchiectasis reports a sudden onset of increased hemoptysis. Which interventions should the nurse implement? Select all that apply.
A. Place the client on bed rest with the affected lung down
B. Notify the provider immediately
C. Obtain a sputum culture before taking further action
D. Maintain a patent airway with suction equipment available
E. Encourage huff coughing to mobilize secretions
A. Place the client on bed rest with the affected lung down
B. Notify the provider immediately
D. Maintain a patent airway with suction equipment available
The nurse is caring for a patient with newly diagnosed pulmonary hypertension. Which orders should the nurse question? (Select all that apply)
A. Administer nifedipine if SBP = 86 mmHg
B. Provide supplemental O2 via nasal cannula to keep SpO2 > 90%
C. Initiate diuretic therapy for peripheral edema
D. Start IV fluids at 125 mL/hr for hypotension
E. Withhold anticoagulation therapy due to risk of bleeding
A. Administer nifedipine if SBP = 86 mmHg
D. Start IV fluids at 125 mL/hr for hypotension
E. Withhold anticoagulation therapy due to risk of bleeding
A patient receiving BiPAP reports bloating, eye irritation, and dry mouth. What are appropriate nursing interventions? (Select all that apply)
A. Check mask fit and pressure setting; consider adding a chin strap if mouth leak present
B. Add humidification to the circuit to reduce dryness and eye irritation
C. Increase EPAP to prevent gastric insufflation
D. Teach paced swallowing and reduce eating while on BiPAP
E. Recommend bolus IV fluids to relieve eye irritati
A. Check mask fit and pressure setting; consider adding a chin strap if mouth leak present
B. Add humidification to the circuit to reduce dryness and eye irritation
D. Teach paced swallowing and reduce eating while on BiPAP
A nurse is assessing a client for planned tracheostomy decannulation. Which findings indicate readiness? (Select all that apply.)
A. Strong, effective cough with suctioning minimal secretions
B. Stable ABGs and adequate spontaneous tidal volume
C. Requires FiO₂ of 70% with PEEP of 10 cm H₂O
D. Alert, able to follow commands, and protect airway
E. Stable vital signs without vasopressor support
A. Strong, effective cough with suctioning minimal secretions
B. Stable ABGs and adequate spontaneous tidal volume
D. Alert, able to follow commands, and protect airway
E. Stable vital signs without vasopressor support
A patient with acute respiratory failure suddenly becomes confused, RR decreases from 28 to 8, and SpO₂ drops to 80% while on 4 L NC. Which set of actions should the nurse perform first?
A. Sit patient up, encourage deep breaths, and call family to calm patient.
B. Apply a nonrebreather at 15 L/min and prepare for intubation; notify provider.
C. Draw ABG and chest x-ray, then reassess in 30 minutes.
D. Offer bronchodilator via MDI and document findings.
B. Apply a nonrebreather at 15 L/min and prepare for intubation; notify provider.