AH1: Ch24 Mgmt of Pt c Chronic Pulmonary Disease
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?
"I can't use a spacer or holding chamber with the MDI."
Which statement describes emphysema?
A disease of the airways characterized by destruction of the walls of overdistended alveoli
A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to
Exhale slowly
Which of the following is a symptom diagnostic of emphysema?
Dyspnea
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?
"Weigh yourself and report a gain of 2lb in 1 day."
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?
Assesses fasting blood glucose
A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse?
Collect sputum for C&S
Which measure may increase complications for a client with COPD?
Increased oxygen supply
The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply.
-Dyspnea and fatigue disproportionate to pulmonary function abnormalities -Right ventricular enlargement -Elevated plasma brain natriuretic peptide (BNP) -Enlargement of central pulmonary arteries
The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.
60 mm Hg; 90%
A client with a history of respiratory problems tells the nurse that he would like to explore strategies to reduce his risks. He also mentions being currently unemployed and not wanting to pursue costly strategies. What would the nurse emphasize as the single most cost-effective intervention to reduce the risk of developing COPD or slow its progression?
Cessation of smoking
A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client?
Increase walking distance around a city block without shortness of breath.
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
Respiratory acidosis
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?
Take ordered medications as scheduled.
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as
Atelectasis
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?
providing sufficient oxygen to improve oxygenation
The physician orders a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What medication does the nurse anticipate will be administered?
Brethine
A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply.
Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management.
Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply.
Compromised gas exchange Decreased airflow Wheezes
Which medication is contraindicated in acute asthma exacerbations? A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations?
Cromalyn sodium
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in?
III
A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant?
Proventil
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.
Sudden chest pain Asymmetry of chest movement Unilateral retractions Oxygen desaturation
Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test?
Sweat Chloride concentration
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?
RR of 22
The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?
Respiratory alkalosis
A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is:
Sharp, stabbing chest pain
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 25% for a patient with COPD. What stage should the nurse document the patient is in?
Stage IV
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes
implementing measures to clear pulmonary secretions.
