Asthma and COPD (HESI)

To some degree, most patients with chronic obstructive pulmonary disease (COPD) have which pathologic processes present? Select all that apply.

Bronchitis Emphysema

A patient with asthma asks the nurse about engaging in exercise. What does the nurse tell this patient?

"Adjust your exercise routine as needed to avoid asthma triggers."

A patient has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this patient?

Mucolytics thin secretions, making them easier to expectorate

After receiving education on the correct use of emergency drug therapy for asthma, which statement by the patient indicates a correct understanding of the nurse's instructions?

"I must have my emergency inhaler with me at all times."

The nurse is teaching a patient with asthma about using a controller medication. Which statement by the patient indicates a need for further teaching?

"I should take this medication as needed when my symptoms become more severe."

A patient who has a history of asthma is prescribed a medicine to prevent further asthma attacks. Which statement made by the patient indicates ineffective learning about how to use the medication?

"I should use the inhaler only when I have an asthma attack."

The patient says, "I hate this stupid COPD." What is the best response by the nurse?

"What is bothering you?"

Inhaled corticosteroids are typically used to treat which symptom of asthma?

Airway inflammation

What best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease?

Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

The nurse is teaching a patient with asthma about using the following medications. Which medication does the nurse teach the patient to use first?

Albuterol 2 puffs (Albuterol, the short-acting beta2agonist [1] [2], should be administered first because the rapid bronchodilation induced by this medication will allow the other medications to be distributed deeper into the respiratory system. Montelukast is taken orally and will not be affected by the other medications; it is not a bronchodilator.)

Which signs/symptoms are indicators of an asthma attack? Select all that apply

Audible wheeze, especially on exhalation Muscle retraction between the ribs Decreased forced expiratory volume in the first second (FEV1) on flowmeter Eosinophils in the sputum

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease?

Barrel chest

The nurse is preparing to administer oxygen to a patient with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this patient?

By maintaining oxygen saturations greater than 88% (In the past, a patient with COPD was thought to be at risk for extreme hypoventilation with oxygen therapy because of a decreased drive to breathe as blood oxygen levels rose. However, recent evidence does not support this; this idea has been responsible for ineffective management of hypoxia in patients with COPD. All hypoxic patients, even those with COPD and hypercarbia, should receive oxygen therapy at rates appropriate to reduce hypoxia and bring SpO2 levels up between 88% and 92%)

Pulmonary function tests for a patient with chronic respiratory symptoms reveal an initial decrease in FEV1, but an increase in FEV1 of 5% after treatment with a bronchodilator medication. Which diagnosis does the nurse anticipate for this patient?

Chronic obstructive pulmonary disease (COPD)

Which statements are correct regarding the drug management of asthma? Select all that apply

Control therapy medications are used to prevent asthma attacks from occurring Control therapy medications are used to reduce airway responsiveness. Reliever medications are used to stop an asthma attack once it has started

The nurse is caring for a patient with COPD who reports increased fatigue and nausea. The nurse notes distended neck veins, bounding peripheral pulses, dependent edema, and cyanosis of the lips and hands. The nurse notifies the health care provider of which condition?

Cor pulmonale (Patients develop cor pulmonale when air trapping, airway collapse, and stiff alveolar walls increase lung tissue pressure and make blood flow through lung vessels more difficult. The right side of the heart eventually enlarges and thickens, leading to right-sided heart failure with backup of blood into the general venous system. Hypercapnea is an increase in partial pressure of arterial carbon dioxide (Paco2). Orthopnea (difficulty breathing while lying down) is often a symptom of cor pulmonale. Signs of respiratory distress include tachypnea, nasal flaring, anxiety, sternal retraction, shortness of breath, restlessness, decreased oxygen saturation, decreased level of consciousness, and stridor. )

The family of a patient having an asthma attack has called in seeking guidance for treatment recommendations on the STEP protocol. Which reported factor indicates the patient should go to the emergency department immediately ?

Decreasing PEF despite the use of reliever drugs

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults?

Due to decreased sensitivity of receptors

Which statements about chronic obstructive pulmonary disease (COPD) are correct? Select all that apply

Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue Most emphysema is associated with smoking or chronic exposure to other inhalation irritants COPD includes emphysema and chronic bronchitis. The increased risk of infection in COPD is related to increased mucus and poor oxygenation

The nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD). Which intervention to facilitate adequate caloric intake for this patient is included in the plan of care?

Encourage frequent rest periods, especially before meals

The rehabilitation unit nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). When the dinner tray arrives, the patient reports having no appetite. Which action by the nurse is correct?

Get the patient to the unit dining room with other patients to eat the meal

The nurse is assisting a patient who has severe emphysema with meal and snack choices for the next day. Which selection is appropriate for this patient?

Ice cream with fudge topping

A patient with moderate chronic obstructive pulmonary disease (COPD) has begun a pulmonary rehabilitation program. The patient usually has an oxygen saturation of 88% to 90% with 2 L/min of oxygen via nasal cannula and walks to the end of the driveway and back each day. The patient's ideal body weight is 150 pounds, but the patient currently weighs 130 pounds. What is an expected outcome for this patient?

Increase weight to at least 135 pounds

A patient who is admitted for treatment of an acute asthma exacerbation has a low Pao2 and an elevated Paco2. These lab values indicate which phase or type of asthma attack?

Late phase

What is the nurse's priority for care in the postoperative period for a patient with severe chronic obstructive pulmonary disease (COPD) who has undergone lung reduction surgery?

Monitor the patient's oxygen saturation levels continuously and use the incentive spirometer

A patient with asthma reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms. What does the nurse recommend for this patient?

Premedicating with a short-acting bronchodilator before exercise

A newly diagnosed patient with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do?

Repeat the peak flow test

Which medication is an example of a long-acting beta2agonist (LABA) used in asthma management?

Salmeterol (Salmeterol is a LABA. Albuterol, levalbuterol, and terbutaline are all short-acting beta2 agonists (SABAs))

A patient with severe chronic obstructive pulmonary disease (COPD) is using home oxygen at a flow rate of 4 L/min via nasal cannula. He calls the clinic to report only moderate improvement in shortness of breath. What does the nurse advise this patient?

Shortness of breath may continue even with oxygen therapy (Patients with COPD have irreversible lung damage that does not improve with oxygen therapy. The goal of oxygen therapy in patients with COPD is to maintain oxygen saturation of 88%, so dyspnea with activity is still likely. Increasing the oxygen flow rate is incorrect because patients with chronic lung disease rely on low Pao2 as a stimulus to breathe. Using the bronchodilator more frequently is not recommended. )

Why must patients with asthma avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain or fever?

They allow increased production of leukotrienes