1. True or False: COPD is reversible and tends to happens gradually.

2. A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic
productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and
high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and
edema in the abdomen and legs. Based on your nursing knowledge and the patient’s
symptoms, you suspect the patient suffers from what type of COPD?
A. Emphysema
B. Pneumonia
C. Chronic bronchitis
D. Pneumothorax

3. A patient with emphysema may present with all of the following symptoms EXCEPT?
A. Barrel chest
B. Hyperinflation of the lung
C. Hypoventilation
D. Hypercapnia

4. The term blue bloater is used to describe patients with?

A. Pulmonary hypertension
B. Left-sided heart failure
C. Chronic Bronchitis
D. Emphysema

5. A patient is newly diagnosed with COPD due to chronic bronchitis. You’re providing education
to the patient about this disease process. Which statement by the patient indicates they
understood your teaching about this condition?
A. “If I stop smoking, it will cure my condition.”
B. “Complications from this condition can lead to pulmonary hypertension and right-sided heart
failure.”
C. “I’m at risk for low levels of red blood cells due to hypoxia and may require blood transfusions
during acute illnesses.”
D. “My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than
low oxygen levels, as with people who have healthy lungs.

6. An alarm beeps notifying you that one of your patient’s oxygen saturation is reading 89%.
You arrive to the patient’s room, and see the patient comfortably resting in bed watching
television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for
COPD exacerbation. Your next nursing action would be:
A. Continue to monitor the patient
B. Increase the patient’s oxygen level to 3 L
C. Notify the doctor for further orders
D. Turn off the alarm settings

7. You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic
breathing. This technique helps do the following:
A. Increase the breathing rate to prevent hypoxemia
B. Decrease the use of the abdominal muscles
C. Encourages the use of accessory muscles to help with breathing
D. Strengthen the diaphragm
8. A patient with severe COPD is having an episode of extreme shortness of breath and
requests their inhaler. Which type of inhaler ordered by the physician would provide the
FASTEST relief for the patient based on this particular situation?
A. Spiriva
B. Salmeterol
C. Symbicort
D. Albuterol

9. Which of the following statements are incorrect about discharge teaching that you would
provide to a patient with COPD? Select-all-that-apply:
A. “It is best to eat three large meals a day that are relatively low in calories.”
B. “Avoid going outside during extremely hot or cold days.”
C. “It is important to receive the Pneumovax vaccine annually.”
D. “Smoking cessation can help improve your symptoms.”

10. A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should
the patient take this medication?
A. The patient should use the medications every 2 hours for acute episodes of shortness of
breath.
B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort.
C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
D. The patient should use the medications at the same exact time, regardless of the order.

11. In regards to question 10, which action by the patient demonstrates they know how to
properly use this medication?
A. The patient rinses their mouth after using the Spiriva inhaler.
B. The patient rinses their mouth after using the Pulmicort inhaler.
C. The patient dispenses of the inhalers.
D. The patient coughs 2 times after using the Pulmicort inhaler.

12. A patient with COPD is reporting depression and thoughts of suicide. The patient states, “I
just feel like ending it all.” You assess the patient’s health history and note that the patient was
recently started on which medication that could cause this side effect:
A. Atrovent
B. Prednisone
C. Roflumilast
D. Theophylline

13. A patient is ordered at 1400 to take Theophylline. You’re assessing the patient’s morning lab
results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You’re next
nursing action is to?
A. Administer the dose at 1400 as ordered
B. Notify the physician for further orders
C. Hold the 1400 dose
D. Collect another blood sample to confirm the level

14. You are providing care to a patient with COPD who is receiving medical treatment for
exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The
patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of
bruising on the arms and legs. Which medication ordered for this patient can cause
hyperglycemia and bruising?
A. Prednisone
B. Atrovent
C. Flagyl
D. Levaquin

Answer Key:
1. False COPD is irreversible
2. C. Chronic Bronchitis Key words: Cyanosis and Edema in the
abdomen and legs. Remember that Chronic
Bronchitis is sometimes referred to as “blue
bloaters”
3. C. Hypoventilation Pts with emphysema present with
hyperventilation because the body will try to
compensate for the low oxygen blood levels.
Emphysema pts are sometimes referred to as
“pink puffers”, so they will have barrel chest,
hyperinflation of the lungs (due to damaged
alveoli sacs and air trapping), and
hypercapnia (increased carbon dioxide
levels).
4. C. Chronic Bronchitis Blue bloaters- Chronic Bronchitis
Pink puffers- Emphysema
5. B. Smoking cessation does not cure the
condition, only slow down the progression of
it.
The patient may develop high levels of RBCs
due to the body trying to compensate for
hypoxia.
Pts with COPD are stimulated to breathe due
to low oxygen levels rather than high carbon
dioxide levels.
6. A The patient is not in distress. Pts with COPD
are stimulated to breathe due to low oxygen
levels therefore it is normal for patients who
have COPD to have O2 saturation between
88-93%
7. D Diaphragmatic breathing helps strengthen the
diaphragm
8. D The pt would best benefit from a short- acting
bronchodilator to help with the SOB, which is
Albuterol.
Spiriva- long- acting bronchodilator
Symbicort- combination of long- acting
bronchodilator and corticosteroid
Salmeterol- long- acting bronchodilator
9. A and C. The pt needs to eat high calorie and protein-
rich meals that are small but frequent.
The Pneumovax is definitely recommended
for pts with COPD but is given every 5 years
 10. B Bronchodilator first (Spiriva) to open the
airway, then corticosteroid (Pulmicort)
11. B. Rinse mouth after using any type of
corticosteroid inhaler to remove medication
from the mouth. If left in the mouth, the pt can
develop thrush
12. C Roflumilast- phosphodiestrace- 4 inhibitor
that is used for pts with severe COPD due to
chronic bronchitis, can cause suicidal
thoughts
13. A Normal Theophylline level is 10-20 mcg/mL
14. A Prednisone- corticosteroid, can cause
hyperglycemia and bruising

In approximately 50% of patients, the cause of bronchiectasis is:

a. Inhalation of a peanut
b. Inherited condition
c. Pneumonia
d. All of these
e. Unknown

The best test to diagnose bronchiectasis is

a. Mucus culture
b. Ct scan
c. Lung function tests
d. Chest x-ray

Bronchiectasis can sometimes be an unusual complication of _____, especially ulcerative colitis

a. Inflammatory bowel disease
b. Irritable bowel syndrome
c. Celiac disease
d. Colorectal cancer

The best way to avoid worsening of bronchiectasis is:

a. Antibiotics
b. Vaccination and annual flu vaccination
c. Daily physiotherapy
d. All of these
e. Prompt treatment of chest infections

Which drugs would a patient with bronchiectasis take via a nebulizer? Select 2
a. Cough suppressors
b. Bronchodilators
c. Steroids
d. Antibiotics
1. Aminophylline (theophylline) is prescribed for a client with acute bronchitis. A nurse
administers the medication, knowing that the primary action of this medication is to:
a. Promote expectoration
b. Suppress the cough
c. Relax smooth muscles of the bronchial airway
d. Prevent infection

2. A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse

monitors the client for which side effect of this medication?
a. Constipation
b. Diarrhea
c. Bradycardia
d. Tachycardia

3. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client
indicated a need for further teaching?
a. Removes the cap and shakes the inhaler well before use
b. Press the canister down with your finger as he breathes in
c. Inhales the mist and quickly exhales
d. Waits 1-2 minutes between puffs if more than one puff has been prescribed

4. A female client is schedules to have a chest radiograph. Which of the following

questions is of most importance to the nurse assessing this client?
a. Is there a possibility that you could be pregnant?
b. Are you wearing any metal chains or jewelry?
c. Can you hold your breath easily
d. Are you able to hold your arms above your head?

5. A client has just returned to a nursing unit following bronchoscopy. A nurse would
implement which of the following nursing interventions for this client?
a. Encouraging additional fluids for the next 24 hours
b. Ensuring the return of the gag reflex before offering foods or fluids
c. Administering atropine intravenously
d. Administering small doses of midazolam

6. A client has an order to have radial ABG drawn. Before drawing the sample, a nurse
occludes the:
a. Brachial and radial arteries, and then releases them and observes the circulation of
the hand
b. Radial and ulnar arteries, releases one, evaluates the color of the hand, and repeats
the process with the other artery
c. Radial artery and observes for color changes in the affected hand
d. Ulnar artery and observes for color changes in the affected hand

7. A client has been taking benzonatate as prescribed. A nurse concludes that the
medication is having the intended effect if the client experiences:
a. Decreased anxiety level
b. Increased comfort level
c. Reduction of nausea and vomiting
d. Decreased frequency and intensity of cough
8. Which of the following would be an expected outcome for a client recovering from an
upper respiratory tract infection? The client will:
a. Maintain a fluid intake of 800 ml every 24 hours
b. Experience chills only once a day
c. Cough productively without chest discomfort
d. Experience less nasal obstruction and discharge

9. A client with allergic rhinitis asks the nurse what he should do to decrease his
symptoms. Which of the following instructions would be appropriate for the nurse to give
the client?
a. Use your nasal decongestant spray regularly to help clear your nasal passages
b. Ask the doctor for antibiotics. Antibiotics will help clear the secretion
c. It is important to increase your activity. A daily brisk walk will help promote drainage
d. Keep a diary when your symptoms occur. This can help you identify what
precipitates your attacks

10. An elderly client has been ill with the flu, experiencing headache, fever, and chills. After
3 days, she developed a cough productive of yellow sputum. The nurse auscultates her
lungs and hears diffuse crackles. How would the nurse best interpret these assessment
findings?
a. It is likely that the client is developing a secondary bacterial pneumonia
b. The assessment findings are consistent with influenza and are to be expected
c. The client is getting dehydrated and needs to increase her fluid intake to decrease
secretions
d. The client has not been taking her decongestants and bronchodilators as prescribed

11. Pseudoephedrine has been ordered as a nasal decongestant. Which of the following is a
possible side effect of this drug?
a. Constipation
b. Bradycardia
c. Diplopia
d. Restlessness

1. C Aminophylline- bronchodilator; relaxes

smooth muscles of the bronchial airway

Expectorants- works by thinning and

loosening mucus in the airways, clearing
congestion. Example is Guaifenesin
Mucolytics- exert their effect on the mucus
layer lining the respiratory tract with the
motive of enhancing its clearance
Antitussives- suppress cough reflex
Antibiotics- fight bacterial infections
2. D Bronkosol is a beta 2 agonist. Side effects of
beta 2 agonists include tremor, nausea,
nervousness, palpitations, tachycardia,
peripheral vasodilation, and dryness of the
mouth or throat.
 Beta 2 agonists have been shown to
decrease serum potassium levels, which can
potentially result in hypokalemia. It also
promotes glycogenolysis, which can lead to
elevation in serum glucose

3. C The client should hold his breath as he slowly

counts to 10. This lets the medicine reach
deep into the lungs. The client should be
instructed to hold his or her breath at least 10
to 15 seconds before exhaling the mist
4. A Pregnant women should not be exposed to
radiation
5. B The preoperative sedation and the local
anesthesia impair swallowing and the
protective laryngeal reflexes for a number of
hours

Additional fluids are unnecessary because no

contrast dye is used that would need to be
flushed from the system

Atropine would be administered before the

procedure, not after. Atropine is widely used
for fiber optic bronchoscopy and may help by
drying secretions, producing bronchodilation,
or preventing vasovagal reactions.

6. B Before drawing an ABG, the nurse assesses

the collateral circulation to the hand with
Allen’s test. This involves compressing the
radial and ulnar arteries and asking the client
to close and open the fist. This should cause
the hand to become pale. The nurse then
releases pressure on one artery and
observes whether circulation is restored
quickly. The nurse repeats the process,
releasing the other artery. The blood sample
may be taken safely if collateral circulation is
adequate.
7. D Benzonatate is a locally acting antitussive the
effectiveness of which is measured by the
degree to which it decreases the intensity
and frequency of cough without eliminating
the cough reflex.
8. D A client recovering from an URI should report
decreasing or no nasal discharge and
obstruction. Decongestants and combination
 antihistamine/decongestant medications can
limit cough, congestion, and other symptoms
in adults.
9. D It is important for clients with allergic rhinitis
to determine the precipitating factors so that
they can be avoided. Keeping a diary can
help identify these triggers.

Nasal decongestant sprays should not be

used regularly because they can cause a
rebound effect.

Antibiotics are not appropriate.

Increasing activity will not control the client’s

symptoms; in fact, walking outdoors may
increase them if the client is allergic to pollen.
10. A Pneumonia is the most common complication
of influenza, especially in the elderly. The
development of a purulent cough and
crackles may be indicative of a bacterial
infection that is not consistent with a
diagnosis of influenza.
11. D Pseudoephedrine is used to relieve nasal
congestion caused by colds, allergies, and
hay fever. It is also used to temporarily
relieve sinus congestion and pressure. Side
effects of pseudoephedrine are experienced
primarily in the cardiovascular system and
through sympathetic effects on the CNS. The
most common CNS effects include
restlessness, dizziness, tension, anxiety,
insomnia, and weakness. Common
cardiovascular side effects include
tachycardia, hypertension, palpitations, and
arrhythmias.
12.