TB9781975161002/TEST BANK/TG - Chapter16

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1. After completing an assessment of an older adult client, the nurse interprets

which finding as a pathological process rather than age-related respiratory
changes?
A. Posture is slightly kyphotic
B. Slight wheeze on exhalation
C. Uses accessory muscles on expiration
D. Mucous membranes drier than younger clients'
Answer: B
Rationale: While some use of accessory muscles, kyphosis, and drying of

mucous membranes occur as part of the aging process, a wheeze would not be
considered a normal, age-related change and could indicate a pathological
process.
Question format: Multiple Choice
Chapter 16: Respiration
Cognitive Level: Understand
G R A D E S B O O S T . C O M
Client Needs: Physiological Integrity: Physiological Adaptation

Integrated Process: Nursing Process
Reference: p. 232
2. The nurse is facilitating a health promotion class at a senior center. Which

statement made by a participant requires additional teaching from the nurse?
A. "My spouse and I both get our flu shots like clockwork each fall."
B. "I am vigilant about staying away from anyone who has a cold or flu."
C. "I use my puffer regularly to prevent any problems with my breathing in the
future."
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D. "I have found that doing deep breathing exercises helps expand my lungs."
Answer: C
Rationale: Older people should be advised against treating respiratory problems

themselves. Many over-the-counter cold and cough remedies can have serious
effects in older adults and can interact with other medications being taken.
These drugs also can mask symptoms of serious problems, thereby delaying
diagnosis and treatment. Getting influenza and pneumonia vaccinations as well
as performing deep breathing exercises are valid health promotion activities.
Avoiding others with a cold or the flu is a good disease prevention strategy and
should be reinforced by the nurse.
Client Needs: Health Promotion and Maintenance
Integrated Process: Teaching/Learning
Reference: p. 235
3. A nurse is assessing several older clients. Which older client would the nurse
suspect is displaying the effects associated with overusing bronchodilating
nebulizers?
A. A client with acute delirium
B. A client with complaints of chest pain
C. A client with shortness of breath on exertion
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D. A client with new onset of a cardiac arrhythmia
Answer: D
Rationale: Overuse of sympathomimetic bronchodilating nebulizers creates a risk

of cardiac arrhythmias leading to sudden death. Chest pain, delirium, and
shortness of breath are not noted to be markers of their overuse.
Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Reference: p. 236
4. A nurse is teaching an older adult with a history of bronchitis how to reduce

his signs and symptoms. The nurse determines that the teaching was successful
when the client identifies which action? Select all that apply.
A. Maintaining a high fluid intake
B. Maintaining a healthy body weight

C. Consciously expectorating secretions
D. Avoiding respiratory infections
E. Using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs)
regularly
Answer: A, C, D
Rationale: Older adults living with bronchitis may need encouragement to

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expectorate secretions and maintain adequate fluid intake. It is also important
for these clients to avoid respiratory infections. NSAIDs are not used in the
treatment of bronchitis and a healthy body weight is unlikely to directly affect
the course of the health problem.
Question format: Multiple Select
Cognitive Level: Analyze
Reference: p. 237
5. A gerontological nurse is teaching a group of staff nurses about the

differences in presentation and course of pneumonia in older adults. Which
difference would the nurse include in the discussion?
A. "Older adults may not experience chest pain or exhibit a high fever."
B. "Older adults usually develop sepsis before symptoms of pneumonia are
evident."
C. "Older adults more often develop lung consolidation instead of producing
secretions."
D. "Exposure to environmental toxins over the course of a lifetime is a common
cause."
Answer: A
Rationale: Frequently, older adults may not experience chest pain associated
with pneumonia to the same degree as younger adults do, and their normally
lower body temperature can cause an atypical appearance of fever (i.e., at lower

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levels than would occur for younger adults). Thus, by the time symptoms are
visible to others, pneumonia can be in an advanced stage. Older adults do not
develop sepsis before other symptoms of pneumonia occur and do not develop
lung consolidation rather than secretions. Pneumonia is not often linked to
exposure to toxins over the lifetime.
Cognitive Level: Apply
Reference: p. 242
6. An older adult client requires oxygen therapy. Which guideline would the
nurse integrate when implementing this intervention?
A. Oxygen therapy should be used with older adults but only as a last resort.
B. Oxygen therapy should be used with caution to prevent carbon dioxide
retention and narcosis.
C. Inhaled or nebulized medications are contraindicated with ongoing oxygen

therapy.
D. Oxygen therapy is appropriate for use in all clients at risk for developing lung
disease.
Answer: B
Rationale: Oxygen therapy should be used with prudence to prevent the effects
of carbon dioxide narcosis. It is not a treatment of last resort but neither should
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it be used with all clients at risk for lung disease or who have lung disease. It is
possible, and indeed common, to use both oxygen and medications in the
treatment of respiratory illnesses.
Reference: p. 242
7. The nurse is preparing to implement a new postural drainage order for an

older client with copious secretions caused by community-acquired pneumonia.
Which action by the nurse would be most appropriate?
A. Teach the client to expect some dyspnea and distress during postural
drainage
B. Ask the health care provider to reconsider the order for postural drainage due
to the client's age
C. Perform postural drainage allowing adequate periods of rest between position
changes
D. Suggest the health care provider consider the use of bronchodilators instead
Answer: C
Rationale: Postural drainage is often prescribed for removing bronchial

secretions in certain respiratory conditions. It necessitates a gentle approach
with adequate periods of rest. Postural drainage is not contraindicated for older

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adults. Bronchodilators would not provide an alternative to postural drainage but

rather would likely be used in conjunction. Dyspnea and distress should not
accompany properly performed postural drainage and if they are present,
postural drainage should be stopped.
Reference: p. 243
8. An older adult client is diagnosed with chronic obstructive pulmonary disease.

The client has no specific dietary restrictions or limitations. Which food would the
nurse most likely recommend?
A. Dairy products
B. Spicy foods and garlic
C. Green leafy vegetables
D. Low-carbohydrate, high-protein foods
Answer: B
Rationale: Spicy foods and garlic are noted to open airway passages, whereas
dairy products promote mucus production and should be avoided. Vegetables
and low-carbohydrate, high-protein foods are not known to affect the airways.
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Reference: p. 244
9. The nurse is preparing discharge instructions for an older client with chronic
obstructive pulmonary disease. Which instruction would the nurse include about
using inhaled bronchodilators?
A. "Usually, when you take one or two puffs, you should have relief for around
four hours."
B. "It's important to take these medications only when you experience serious
symptoms."
C. "These medications can make your shortness of breath worse if you take
them too often."
D. "If you develop any sort of heart disease or circulatory problems in the future,
these inhalers will be discontinued."
Answer: A
Rationale: One or two inhalations of bronchodilators normally brings relief for

around 4 hours. The use of bronchodilators is not limited to periods of severe
shortness of breath. The overuse of bronchodilators can cause cardiac
arrhythmias but they are not necessarily contraindicated in all individuals with
underlying heart or circulatory problems. Overuse is not known to exacerbate
shortness of breath.

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Reference: p. 245
10. During a home visit, the nurse notes that an older adult client has increased
joint pain and shortness of breath since moving in with an adult child 6 months
ago. Which factor might the nurse identify as contributing to this client's
condition?
A. Age-related changes
B. Increase in pulmonary disease
C. Family assistance limiting mobility
D. Increase in arthritic changes to the joints
Answer: C
Rationale: Immobility is a major threat to pulmonary health. Well-meaning

families can sometimes limit activity rather than promote it, which can
contribute to the client's condition. An increase in joint pain and shortness of
breath are not considered age-related changes. There is not enough information
to determine that the client has pulmonary disease or arthritic changes in the
joints.
Client Needs: Physiological Integrity: Basic Care and Comfort
Reference: p. 235
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11. An older client has been treated for three episodes of respiratory infections
related to chronic bronchitis within 6 months. The client complains of shortness
of breath when walking outside in the cold weather. Which recommendation by
the nurse would be appropriate?
A. Drink plenty of water
B. Avoid going outdoors
C. Call the health care provider for antibiotics
D. Increase the use of bronchial medications
Answer: A
Rationale: Management of chronic bronchitis is aimed at removing bacterial

secretions and preventing airway obstruction. Drinking fluids is an important
activity for this client. It would be inappropriate to encourage the client to
increase medication dosages or stay indoors. Antibiotics may or may not be
necessary.
Reference: p. 237
12. The nurse is teaching a client with emphysema to progressively increase

activity. When should the nurse instruct the client to stop activity?
A. When there is a decrease in respiratory rate and pulse

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B. When there is an increase in respiratory rate and pulse

C. When there is an increase in respiratory rate and a decrease in pulse
D. When there is a decrease in respiratory rate and an increase in pulse
Answer: A
Rationale: The client should be instructed to discontinue activity when

respiratory rate and pulse decrease. An increase in respiratory rate and pulse
would be expected with activity.
Client Needs: Physiological Integrity: Reduction of Risk Potential
Reference: p. 238
13. A client with dementia has difficulty swallowing and frequently coughs when
eating. Recently, the client has developed a nonproductive cough with a
temperature of 99 °F. The nurse is concerned that this client is at risk for
developing which health problem?
A. Lung cancer
B. Chronic bronchitis
C. Lung abscess
D. Chronic obstructive lung disease
Answer: C
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Rationale: Aspiration of foreign material can cause a lung abscess, which is a
risk in older people with decreased pharyngeal reflexes. Difficulty swallowing and
coughing are not typical manifestations of chronic bronchitis, lung cancer, or
chronic obstructive lung disease.
Reference: p. 241
14. The nurse is preparing to perform postural drainage with an older client.
Which action would the nurse perform first?
A. Ensuring an adequate rest period
B. Performing oral hygiene
C. Positioning the client for postural drainage
D. Administering aerosol medications
Answer: D
Rationale: Postural drainage is often prescribed for removing bronchial

secretions in certain respiratory conditions. The nurse would first provide the
client with any prescribed aerosol medications, then the client would be
positioned for postural drainage, followed by oral hygiene, and then rest.

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Reference: p. 243
15. A client, who is prescribed deep breathing and coughing every hour, has a
nonproductive cough and is easily fatigued. What can the nurse do to increase
the client's secretions?
A. Have the client blow the nose.
B. Encourage the client to rest for 30 minutes.
C. Provide the client with aerosol medication.
D. Give the client a piece of hard candy to eat.
Answer: D
Rationale: Coughing to remove secretions is important in the management of

respiratory problems; however, non-productive coughing may be a useless
expenditure of energy and stressful to the older patient. Various measures can
be used to promote productive coughing. Hard candy and other sweets increase
secretions, thereby helping to make the cough productive. Blowing the nose,
resting, or using aerosol medication will not help increase secretions.
Reference: p. 243
16. An older client with asthma is prescribed an inhaler. The nurse is assessing
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the client for possible factors that might impact the client's ability to comply with
this treatment. Which condition would the nurse identify as impacting the client's
compliance?
A. Severe arthritis
B. Type 2 diabetes
C. Cataracts
D. Ventricular tachycardia
Answer: A
Rationale: The client is required to manipulate the inhaler, coordinating the

spray with inhaling, which can be affected by severe arthritis in the hands.
Diabetes, cataracts and ventricular tachycardia would not impact the client's
ability to comply with this treatment.
Reference: p. 245
17. An older client with a terminal illness is extremely thin and is prescribed to
use oxygen via a face mask at home. To ensure that the client's oxygenation
needs are met, which intervention would be the priority?
A. Ensuring a tight seal around the face mask
B. Maintaining the patency of the nasal passages
C. Observing the client for signs of pneumonia

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D. Educating the family about risks of oxygen use
Answer: A
Rationale: If the client is emaciated, a face mask may leak. The proper
administration is the first consideration and would supersede family education
and potential pneumonia. Nasal passages should be cleaned regularly to
maintain patency but would not be the top priority over ensuring a tight seal of
the face mask.
Reference: p. 242
18. An older adult client develops rapid, shallow respirations, with retraction of
the respiratory muscles. Which action would the nurse do first to improve this
client's ineffective breathing pattern?

A. Administer oxygen via nasal cannula
B. Encourage deep breathing
C. Keep the nasal passages patent
D. Raise the head of the bed at least 30 degrees
Answer: D
Rationale: Although any of these interventions may be appropriate at one point

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or another, raising the head of the bed is the most immediate, effective
intervention. The nurse will need to receive a prescription from the health care
provider for oxygen. Encouraging deep breathing and keeping nasal passages
patent would not be the priority intervention.
Reference: p. 237
19. An older adult client with a history of environmental exposure to chemicals

reports shortness of breath. Assessment of which finding would lead the nurse to
suspect that the client has chronic obstructive pulmonary disease (COPD)?
A. Red, frothy sputum
B. Greenish, thick sputum
C. Purulent and foul-smelling sputum
D. Sticky, translucent, grayish white sputum
Answer: D
Rationale: Tenacious, translucent, and grayish white sputum is associated with

COPD. Purulent and foul-smelling sputum is associated with a lung abscess.
Greenish, thick sputum is associated with a lung infection. Red, frothy sputum is
associated with pulmonary edema or left-sided heart failure.

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Reference: p. 242
20. During an assessment, the nurse notes that an older client has a gray
discoloration of the skin. The nurse interprets this finding as associated with
which condition?
A. Emphysema
B. Lung abscess
C. Chronic bronchitis
D. Peripheral vascular disease
Answer: C
Rationale: In the presence of chronic bronchitis, the client can have a blue or
gray discoloration of the skin caused by a lack of oxygen binding to the

hemoglobin. Ruddy, pink complexions often occur with emphysema and are
associated with hypoxia from a high carbon dioxide level in the blood. Specific
skin color changes are not associated with lung abscess or peripheral vascular
disease.
Reference: p. 233
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21. While making a home visit, the nurse determines that the quality of a client's
indoor air environment needs to be improved. Which instruction(s) would the
nurse most likely include? Select all that apply.
A. Dust furniture with a damp cloth
B. Keep windows closed
C. Avoid smoking inside the home
D. Vacuum the floor coverings regularly
E. Install air filters in heating and air conditioning units
Answer: A, C, D, E
Rationale: Interventions to improve the quality of indoor air include dusting the
furniture with a damp cloth or sponge, avoiding smoking inside the home,
vacuuming the floor coverings regularly, and installing air filters in heating and
air conditioning units. Opening windows would improve the quality of air in the
home.
Reference: p. 236

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22. The nurse is performing a respiratory assessment of an older adult. Which

finding(s) will the nurse immediately report? Select all that apply.
A. Infrequent cough
B. Neck vein distention
C. Elevated blood pressure
D. Change in mental status
E. Clear drainage from the nose
Answer: B, C, D
Rationale: Manifestations of respiratory complications include elevated blood

pressure, which could indicate chronic hypoxia, neck vein distention, and a
change in mental status. Infrequent cough and clear drainage from the nose are
not symptoms that would indicate respiratory complications.
Client Needs: Physiological Integrity: Reduction of Risk Potential

Reference: p. 242
23. An older client with chronic bronchitis is having difficulty managing periods
of dyspnea and anxiety. Which action(s) by the nurse would be beneficial? Select
all that apply.
A. Teaching about the disease process
B. Discussing how to reduce environmental irritants
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C. Explaining how to use transportable oxygen
D. Encouraging the need to avoid temperature extremes
E. Recommending spending most time out of the home
Answer: A, B, C, D
Rationale: Respiratory problems can be frightening and cause anxiety. Clients

need a complete understanding of the disease to help reduce anxiety. Reducing
environmental irritants by encouraging the client to avoid temperature extremes
could help reduce the client's symptoms. Explaining how to use transportable
oxygen will increase the client's independence. Recommending that the client
spend most time out of the home could exacerbate the client's symptoms.
Reference: p. 245
24. An older adult client diagnosed with chronic obstructive pulmonary disease
(COPD), who has smoked 1 pack per day for 30 years, expresses regret about
ever starting smoking. Which response by the nurse would be appropriate?
A. "Even though you have smoked for a long time, there are still benefits to
quitting smoking."
B. "If you continue to smoke, any medical treatment for your COPD is likely to
be ineffective."

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C. "There is little you can do about the damage to your lungs now. There is
really no need for regret."
D. "Even though it will not affect the course of your COPD, quitting smoking
would probably make you feel better about yourself."
Answer: A
Rationale: There are health benefits to quitting smoking at any stage and doing
so would likely aid in the treatment of the client's COPD. Continuing to smoke,
while detrimental, would not necessarily render all medical treatments for COPD
ineffective. Quitting smoking could stop the progression of the client's disease.
The client may feel less short of breath and cough less, improving quality of life,
1 to 9 months after quitting.

Reference: p. 235
25. The nurse is caring for an older adult client with right-sided paralysis who
uses a wheelchair. Which intervention should the nurse include in this client's
care plan to promote respiratory health?
A. limiting abrupt changes in environmental temperature
B. frequent repositioning
C. performing range-of-motion exercises to the right arm
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D. encouraging deep-breathing exercises three times per day
Answer: D
Rationale: The nurse needs to identify interventions to promote respiratory

activity with this client. Encouraging deep-breathing exercises three times per
day would promote this client's respiratory health. Range-of-motion exercises
will not promote this client's respiratory health. Maintaining a stable
environmental temperature and frequent repositioning will not be as effective as
deep breathing exercises that expand the airways and air in lug clearance.
Client Needs: Safe, Effective Care Environment: Management of Care
Reference: p. 234
26. The nurse is visiting a client with asthma, whose spouse has recently died.
The client continues to live in the same home. The nurse notes the home is
stuffy and the client is experiencing a significant amount of wheezing. Which
action will the nurse take?
A. encouraging the client to use a prescribed bronchodilator
B. assisting the client to perform deep-breathing exercises
C. increasing the temperature in the house
D. improving the air quality in the house

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Answer: D
Rationale: The nurse will want to review those things that the client can do to
minimize breathing problems. The nurse should suggest ways to improve the air
quality in the home such as opening a window a small amount to increase
ventilation. The nurse should not assume that medication is what is needed.
Deep-breathing exercises may or may not be appropriate for the client at this
time. Increasing the temperature in the home might make the house stuffier.
Reference: p. 236
27. The nurse is caring for an older adult client with chronic pulmonary disease
and ineffective respirations. Which intervention will the nurse include in the plan
of care?
A. Teach the client to use a humidifier.
B. Keep nasal passages patent.
C. Perform daily deep-breathing exercises.
D. Avoid exposure to people with infections.
Answer: C
Rationale: Deep-breathing exercises can help improve some age-related changes

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in lung capacity and are an activity that even nonambulatory clients can do.
Increased humidity can be a trigger for breathing difficulty. Keeping the nasal
passages patent and avoiding exposure to those with infections would not
immediately help the clients' ineffective respirations.
Reference: p. 234
28. A nurse is reviewing the plans of care for several older adult clients on the
medical unit. While reviewing the clients' medical records, which finding(s) would
the nurse identify as supporting risk for infection? Select all that apply.
A. reduced vital capacity
B. reduced ciliary activity
C. increase in residual capacity
D. underinflation of lung bases
E. less efficient cough response
Answer: A, B, D, E
Rationale: A client with reduced vital capacity, reduced ciliary activity, less
efficient cough response or underinflation of lung bases is at risk of infection. A
client with an ineffective breathing pattern would have increased residual
capacity.

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Client Needs: Safe, Effective Care Environment: Management of Care
Reference: p. 233
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GRADESBOOST.

1. After completing an assessment of an older adult client, the nurse interprets

Rationale: While some use of accessory muscles, kyphosis, and drying of

Client Needs: Physiological Integrity: Physiological Adaptation

2. The nurse is facilitating a health promotion class at a senior center. Which

Rationale: Older people should be advised against treating respiratory problems

GRADESBOOST.COM #1 TEST BANKS WEBSITE

D. A client with new onset of a cardiac arrhythmia

Rationale: Overuse of sympathomimetic bronchodilating nebulizers creates a risk

4. A nurse is teaching an older adult with a history of bronchitis how to reduce

B. Maintaining a healthy body weight

Rationale: Older adults living with bronchitis may need encouragement to

5. A gerontological nurse is teaching a group of staff nurses about the

GRADESBOOST.COM #1 TEST BANKS WEBSITE

C. Inhaled or nebulized medications are contraindicated with ongoing oxygen

7. The nurse is preparing to implement a new postural drainage order for an

Rationale: Postural drainage is often prescribed for removing bronchial

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adults. Bronchodilators would not provide an alternative to postural drainage but

8. An older adult client is diagnosed with chronic obstructive pulmonary disease.

Rationale: One or two inhalations of bronchodilators normally brings relief for

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

Rationale: Immobility is a major threat to pulmonary health. Well-meaning

Rationale: Management of chronic bronchitis is aimed at removing bacterial

12. The nurse is teaching a client with emphysema to progressively increase

GRADESBOOST.COM #1 TEST BANKS WEBSITE

B. When there is an increase in respiratory rate and pulse

Rationale: The client should be instructed to discontinue activity when

Rationale: Postural drainage is often prescribed for removing bronchial

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Client Needs: Physiological Integrity: Physiological Adaptation

Rationale: Coughing to remove secretions is important in the management of

Rationale: The client is required to manipulate the inhaler, coordinating the

GRADESBOOST.COM #1 TEST BANKS WEBSITE

D. Educating the family about risks of oxygen use

client's ineffective breathing pattern?

Rationale: Although any of these interventions may be appropriate at one point

19. An older adult client with a history of environmental exposure to chemicals

Rationale: Tenacious, translucent, and grayish white sputum is associated with

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Chapter 16: Respiration

gray discoloration of the skin caused by a lack of oxygen binding to the

GRADESBOOST.COM #1 TEST BANKS WEBSITE

22. The nurse is performing a respiratory assessment of an older adult. Which

Rationale: Manifestations of respiratory complications include elevated blood

Client Needs: Physiological Integrity: Reduction of Risk Potential

Rationale: Respiratory problems can be frightening and cause anxiety. Clients

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Integrated Process: Teaching/Learning

Rationale: The nurse needs to identify interventions to promote respiratory

GRADESBOOST.COM #1 TEST BANKS WEBSITE

Rationale: Deep-breathing exercises can help improve some age-related changes

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Question format: Multiple Select

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