Ignatavicius: Medical-Surgical Nursing, 8th Edition

Chapter 30: Care of Patients with Noninfectious Lower Respiratory Problems

Answer Key NCLEX Examination Challenges and Clinical Judgment Challenges
Answer KeyNCLEX Examination Challenges
p. 557, Safe and Effective Care Environment
Which parameter indicates to the nurse that the short-acting beta-adrenergic agonist the client used 5
minutes ago for an acute asthma attack is effective?
A. A.
SpO2 decreased from 85% to 78%
B. B.
Peak expiratory flow increase from 50% to 70%
C. C.
The obvious use of accessory muscles during inhalation
D. D.
Active bubbling in the humidifier chamber of the oxygen delivery system
Answer: B
Rationale: Peak flow measures the effectiveness of expiratory efforts. An increased peak flow rate
indicates less obstruction and greater movement of air with expiratory effort. Decreased SpO2 would
indicate a worsening of the condition, not effectiveness of the therapy. The use of accessory muscles
indicates that the work of breathing has increased. The active bubbling in the humidification chamber is
not related to the clients respiratory effort or the drug therapys effectiveness.
p. 564, Health Promotion and Maintenance
A client with chronic obstructive pulmonary disease (COPD) prescribed a long-acting inhaled beta2
agonist reports hating the inhaler and asks why the drug cant be taken as a pill. What is the nurses best
response?
A. A.
Drugs taken by inhaler work more slowly and remain in the system longer.
B. B.
Drugs taken by inhaler have no side effects and are less expensive.
C. C.
Drugs taken by mouth are more expensive because they must be sterile.
D. D.
Drugs taken by mouth have systemic side effects and are harder to control.
Answer: D
Rationale: When used as prescribed, inhaler drugs go more to the site where the intended responses are
needed (the airways), and less drug is absorbed systemically. Thus, inhaled drugs have fewer side effects
(but still have side effects). Oral drugs always have systemic side effects.
p. 569, Health Promotion and Maintenance
Which precaution is most important for the nurse to teach a client who has cystic fibrosis?
A. A.
Report a weight change of 2 pounds to your health care provider immediately.
B. B.
Use supplemental oxygen whenever your oxygen saturation is less than 95%.

C. C.
D. D.

Eat six small meals each day instead of only three larger ones.
Avoid crowds and people who are ill.

Answer: D
Rationale: The most common cause of death for a client with CF is respiratory failure from a respiratory
infection. Avoiding infection in this population is critical for survival. Although many clients who have
CF are underweight and need to maintain good nutrition, changes in weight and food intake patterns are
not as critical as avoiding infection. Supplemental oxygen use is based on client manifestations. Its use
is not as critical as avoiding infection.
p. 579, Safe and Effective Care Environment
The chest tube of a client 16 hours postoperative from a lobectomy is accidentally pulled out by a
portable x-ray machine. What is the nurses best first action?
A. A.
Clamp the tubing with padded clamps as close as possible to the insertion site.
B. B.
Reposition the client on the nonoperative side and support the tube(s) with pillows.
C. C.
Cover the insertion site with a sterile occlusive dressing and tape down on three sides.
D. D.
Don sterile gloves and attempt to reinsert the chest tube at the original insertion site.
Answer: C
Rationale: Although the client had a pneumonectomy and sometimes chest tubes are not even used, the
insertion site should be covered immediately to prevent infection. If this were a chest tube placed for any
other reason, the action of covering the insertion site is still the best first action to prevent air from being
sucked into the chest cavity. Clamping the tubing that has already fallen out of the chest does nothing to
help the client or prevent a problem. Repositioning the client would cause neither harm nor benefit.
Reinserting a contaminated chest tube is wrong and beyond the scope of nursing practice.
Answer KeyClinical Judgment Challenges
p. 567, Patient-Centered Care; Safety
The patient is a 64-year-old man with COPD who lives with his wife of 35 years. He retired 2 years ago
when his disease interfered with his with his job as a carpenter. He also quit smoking a year ago. Since
then, his disease has remained stable; however, he now reports that he thinks his wife is preparing for
widowhood by taking over all the home chores that he always performed (including driving and bill
paying), limiting his interaction with friends, and making all decisions. He is angry and depressed.
Routine assessment with pulmonary function testing show his FEV1 to be 40% of his predicted value,
which is an improvement over the 32% value of FEV1 last year.
1. 1.
What severity classification is his COPD? Provide a rationale for your choice.
2. 2.
How should you respond to his statement about the wife probably preparing for
widowhood?
3. 3.
Should he continue to drive and pay bills? Why or why not?
4. 4.
What psychosocial assessment of this patient and his situation should you make?
5. 5.
Should you include the wife in any part of this discussion? Why or why not?

Suggested responses:
1. 1.
What severity classification is his COPD? Provide a rationale for your choice.
He meets the GOLD 3 criteria for severe COPD in that his FEV1 is less than 50% of predicted but
greater than 30% of predicted. The fact that his FEV1 has improved during the past year is a positive
sign, probably related to quitting smoking.
1. 1.
How should you respond to his statement about his wife probably preparing for
widowhood?
Ask him if he thinks there might be any other reason for her to take over chores, limit social
interactions, and make all the decision. Try to steer the conversation for him to understand his wifes
concern for him.
1. 2.
Should he continue to drive and pay bills? Why or why not?
If he is cognitively intact, without dizziness, and has sufficient endurance to steer the car correctly
and stop appropriately, he should be allowed to continue to drive. He could be evaluated by the state
highway patrol or the state drivers licensing bureau to ensure that his driving is safely performed.
Bill paying is not a strenuous physical activity and could make him feel as though he were a
contributing member of the family.
1. 3.
What psychosocial assessment of this patient and his situation should you make?
Ask the patient to rank, in terms of importance to him, the chores, activities, and decisions he wants
to continue to perform.
1. 4.
Should you include the patients wife in any part of this discussion? Why or why not?
Yes, his wife should be included and should be encouraged to express her true feelings about the
situation. Most likely, she is concerned that her husbands health will deteriorate faster if he exerts
himself. Stress the concept that muscle strength and endurance can be maintained or even improved
over time with some structured physical activity, although the basic disease will not improve. Also
remind them that total inactivity will result in faster deconditioning.
p. 580, Patient-Centered Care; Evidence-Based Practice
The patient is a 60-year-old man who has just been diagnosed with nonsmall cell lung cancer. He
smoked cigarettes for about 25 years starting when he was 16 years old and quit when he was 41 years
old. His lung cancer is at stage I in the left lower lobe. He is distraught, saying that he cant die now
because he has one child in college and two in high school. He also fears chemotherapy and seems bitter
that he quit smoking and got lung cancer anyway. His next statement is: Why couldnt I get prostate
cancer like most men? At least they survive. No one beats lung cancer.
1. 1.
What can you tell him about lung cancer survival?
2. 2.
What can you tell him about the benefits of having quit smoking?
3. 3.
For this cancer stage and type, what is/are the most likely therapy/therapies?
4. 4.
What resources could you recommend to help him at this time?
Suggested responses:

1. 1.
What can you tell him about lung cancer survival?
Help him understand that diagnosing lung cancer, especially NSCLC, at an early stage is beatable.
1. 2.
What can you tell him about the benefits of having quit smoking?
If he had continued to smoke, he may have had more advanced lung cancer at this time. In addition,
his stamina and gas exchange are considerably better than they would be had he continued to smoke.
He will better tolerate his cancer therapy with fewer complications because he does not now smoke.
If he has surgery, he will have less problems with recovery from the surgery itself and the anesthesia.
1. 3.
For this cancer stage and type, what is/are the most likely therapy(ies)?
For stage I NSCLC, the treatment of choice is surgery with total removal of the tumor and probably
of the left lower lobe. This surgery can now result in a cure of the disease. Additionally, because it is
the left lung, which is smaller than the right and does not participate in gas exchange to the same
degree, removal of the left lower lobe would not greatly change his physical endurance.
1. 4.
What resources could you recommend to help him at this time?
The American Cancer Society, Canadian Cancer Society, and American Lung Association have
information regarding the positive outcome of lung cancer treated appropriately at this time. Also,
the National Cancer Institute has patient information and education resources that can be
downloaded from the website.