Chapter 24 Chronic Respiratory problems Final exam

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patients O2 level at or above what percent?

90%

What is the recommended management of asthma?

Adrenergics (beta 2 agonists, albuterol), steroids, theophylline, hydration, oxygen, and anti-cholinergics

What is the incomplete emptying of alveoli during expiration due to loss of lung tissue elasticity (emphysema), bronchospasm (asthma), or airway destruction?

Air trapping

You notice your patient has a barrel chest, what is the cause of the alteration in the chest shape and size?

Air trapping in the lungs

What is the strongest predisposing factor for asthma?

Allergies

What is the genetic disorder resulting from deficiency of alpha-1 antirypsin,a protective agent of the long; increases patient's risk for developing panacinar emphysema even in the absence of smoking?

Alpha 1 antitrypsin deficiency (keeps the alveoli compliant and elastic)

Name a genetic risk factor for COPD.

Alpha-1 anti-trypsin deficiency

What are the three ways that bronchodilators relieve bronchospasm?

Alter smooth muscle tone, reduce airway obstruction, and improve alveolar ventilation

What types of medications are used in treatment of cystic fibrosis?

Antibiotics, supplemental vitamins, bronchodilators, mucolytics, and pancreatic enzymes

The home care nurse observes white patches on the oral mucosa of a patient with severe, chronic airflow limitation. What is the nurses best action?

Ask the patient weather here she uses a steroid inhaler

The nurse is assessing a patient with asthma. Scattered wheezes are noted, and the patient's oxygen saturation is 88%. What other assessments are essential for the nurse to perform?

Assess accessory muscle use, assess inspiration/expiration ratios, assess the suprasternal notch, assess mucous membranes

A patient with asthma reports not being able to take deep breath's. The nurse auscultates decreased breath sounds in the bases, and no wheezes. What is the nurses best action?

Assess the patient's oxygen saturation, decreased wheezing accompanied by decreased breath sounds mean airway occlusion

What is the disease with multiple precipitating mechanisms resulting in a common clinical outcome a reversible airflow obstruction?

Asthma

Patient with COPD is hospitalized for heart failure. The patient is weak and cannot cough, so the nurse should watch closely for the development of what?

Atelectasis

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complications to the nurse manager for?

Atelectasis

What type of chest configuration is typical for the patient with COPD?

Barrel chest

Why does a patient with cystic fibrosis always have constant hunger?

Because of poor food absorption

What stimulates the beta receptors in the long, resulting in the relaxation of bronchial smooth muscle. This action results in an increase vital capacity which allows clients to breathe easier?

Beta 2-adrenergic agonists

What is a chronic, your reversible dilation of the bronchi and bronchioles that results from construction of muscle and elastic connective tissue; dilated airways become secular and are a medium for chronic infection?

Bronchiectasis

What is a disease state characterized by airflow limitation that is not fully reversible; sometimes referred to as chronic obstructive lung disease?

COPD

A patient with COPD is feeling short of breath and has an oxygen saturation of 86% on room air. The nurse auscultates inspiratory and expiratory wheezes. The nurse supplies a nasal cannula at a rate of 2 L per minute. What should the nurse do next?

Call respiratory therapy to administer the prescribe levalbuterol nebulizer treatment

The single most cost effective intervention to reduce the risk of developing COPD or slow its progression is _________________.

Cessation of smoking

What disease process is known as the "blue bloaters"?

Chronic bronchitis

What is a disease of the airway is defined as the presence of cough and student production for at least a combined total of three months and each of two consecutive years?

Chronic bronchitis

A patient is it knitted to the hospital with exacerbation of COPD. The nurse understands which pathological changes to be occurring?

Chronic inflammation of airways, fibrosis, and mucus gland hyperplasia

A patient with COPD is receiving discharge instructions from the nurse. The nurse should include what should be avoided by the patient?

Cigarette smoke, cleaning products, and cold air

The nurse is assessing a patient with asthma. What would indicate that the patient is asthma is severe persistent?

Continuous symptoms require limitations of physical activity

___________, one of the complications of emphysema, is right-sided heart failure brought on by long-term high blood pressure in the pulmonary arteries.

Cor Pulmonale

A patient diagnosed with asthma is preparing for discharge. The nurse is educating the patient on proper use of a peek flowmeter. The nurse will instruct the patient to complete which of the following?

Coughing occurs during procedure repeat it

Name a mast cell stabilizer

Cromolyn sodium

What are the G.I. symptoms that accommodate cystic fibrosis?

Decreased digestive enzymes, rectal prolapse, steatorrhea (fatty, foul stools), abdominal distention

What is a precipitous drop in the saturation of hemoglobin with oxygen?

Desaturation

The nurse is conducting a health education group for a retired clients with chronic obstructive pulmonary disease to help them improve their respiratory effort and gas exchange. The nurse should place the most emphasis on which of the following?

Do not shovel snow

A patient with emphysema receives discharge instructions regarding home oxygen use via nasal cannula. Which of the following statement should the nurse include?

Do not smoke or be around others who smoke

What is the disease of the airways characterized by distraction of the walls of over distended alveoli?

Emphysema

Which disorder is referred to as the "pink puffers"?

Emphysema

What are some of the characteristic symptoms of cystic fibrosis?

Fatigue, chronic cough, re-current upper respiratory infections, thick sticky mucus, chronic hypoxia

What type of diet should a patient with cystic fibrosis follow?

High in calories and high in protein

What is the sweat test for cystic fibrosis?

High salt content is a good indicator of cystic fibrosis, adequate salt intake is important

A nurse is preparing to administer a dose of a new prescription of prednisone to a patient who has COPD. The nurse should monitor for which of the following adverse effects of this medication?

Hypokalemia, fluid retention, and black tarry stool's

A nurse is providing discharge teaching to a patient who has COPD and a new prescription for albuterol. Which of the following statements by the patient indicates an understanding of the teaching?

I can have an increase in my heart rate while taking this medication

The nurse is caring for a patient with asthma and is instructing the patient on the proper use of a spacer device. Which of the following statements by the patient indicates the need for further instruction?

I can use my medication half as often

The nurse is reviewing metered dose inhaler instructions with a patient. Which of the following patient statements indicates the need for further instruction?

I can't use a spacer or holding chamber with the MDI

A nurse is reinforcing teaching with a patient on the purpose of taking a bronchodilator. Which of the following client statements indicates an understanding of the teaching?

I take this medication to prevent asthma attacks

A nurse is providing discharge teaching to a patient who has a new prescription for prednisone for asthma. Which of the following patient statements indicates an understanding of the teaching?

I will take my medication with meals

Patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions

Describe the results of chronic airway inflammation and COPD.

Increased goblet cells and enlarged submucosal glands, inflammation and airway narrowing, and narrowing of the airway lumen

What measures may increase complications for a patient with COPD?

Increased oxygen supply

Name a anti-cholinergic agent.

Ipatropium bromide

What is a patient activated medication canister that provides aerosolized medication that the patient and heels into the Longs?

Metered dose inhaler

Name leukotryine modifier.

Montelukast

The nurse is teaching a patient about different medications for asthma. Which medication is the nurse to teach the patient to administer to control the prolonged inflammatory response?

Montelukast (Singulair)

A patient with dark skin is experiencing respiratory distress due to an asthma exacerbation. The nurse assesses the patient for sinuses my inspecting the what?

Mucous membranes

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a patient diagnosed with COPD. The nurse correctly includes which of the following medications?

Nicotine gum, Zyban, Wellbutrin

The nurse is caring for a patient with COPD. In COPD, the body attempts to improve oxygen carrying capacity by increasing the amount of red blood cells. Which of the following is the term for this process?

Polycythemia

What is the increase in the red blood cells concentration in the blood, and COPD, the body attempts to improve oxygen carrying capacity by producing increasing amounts of red blood cells?

Polycythemia

A patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's education. What are some therapy goals?

Provide medical support for the current exacerbation, treat the underlying cause of the event, return the patient to their original functional abilities, return the patient to his original functioning abilities

The nurse is assigned to care for a patient with COPD with hypoxia 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

What diagnostic test is the most accurate in assessing acute airway obstruction?

Pulmonary function studies

A nurse is preparing to administer omulizumab (Xolair) for the first time. It is an immune modulator that prevents allergens from binding to receptors sites on ourselves and basil fills. What is the priority nursing action?

Remain with the patient and assess for anaphylaxis, the risk for anaphylaxis is very high with this medication

A patient is being treated for status asthmaticus. What danger signs as a nurse observe that could indicate impending respiratory failure?

Respiratory acidosis

As status asthmaticus worsens, the nurse would expect the patient to develop which of the following acid-base imbalances?

Respiratory acidosis

The nurse is caring for a patient with status asthmaticus in the intensive care unit. What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?

Respiratory alkalosis

Patients with COPD are at risk for _______ and _______which in turn increase the risk of acute and chronic respiratory failure.

Respiratory insufficiency, chronic respiratory failure

In cystic fibrosis what can be used as a source of energy?

Simple sugars

____________ depresses the activity of scavenger cells and affects the respiratory tract ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter.

Smoking

What is a pulmonary function test that measures specific long volumes and rates; may be measured before and after bronchodilator administration?

Spirometry

_____________, Is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FCV)

Spirometry

A patient comes to the clinic for the third time in two months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and productive cough

A nurse notes that the FEV1 and FVC ratio is less than 70% for a patient with COPD. What stage should the nurse document the patient is in?

Stage one

What are some undesirable effects of beta 2 adrenergic agonists?

Tachycardia, irregular heartbeat, hypertension, cardiac dysrhythmias, nervousness, tremors, restlessness, insomnia, headache, and nausea or vomiting

A nurse is planning to instruct patient on how to perform pursed lip breathing. Which of the following should the nurse include in the plan of care?

Take a deep breath in through your nose

The patient was recently diagnosed with emphysema. What interventions should the nurse implement when caring for this patient?

Teach postural drainage

What is an appropriate goal for a patient with COPD and a nursing diagnosis of activity intolerance related to alterations an oxygen transport?

The patient can identify and use two strategies to conserve energy

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in education?

The patient should take the medication and hour before meals and two hours after a meal

Name a methylxanthine drug

Theophylline

A nurse is just charging a patient who has COPD. Upon discharge, the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse?

There are portable oxygen delivery systems that you can take with you

The nurse is providing discharge instructions to a patient with chronic obstructive pulmonary disease. The nurse should include instructions and breathing exercises that involve what?

Using diaphragmatic breathing

What vitamins need to be supplemented for a patient with cystic fibrosis?

Vitamins Kay, a, D, E, which are all fat soluble vitamins

A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed?

With meals

What is the most important risk factor for development of COPD?

Cigarette smoking

What is a combination short acting beta 2 adrenergic agonist agent??

Combivent

The nurse is assigned to care for a patient in the intensive care unit who is diagnosed with status asthmaticus. Why does the nurse include fluid intake of being an important aspect of the plan of care?

To combat dehydration, to loosen secretions, and to facilitate expectoration

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurses concern?

Compromised gas exchange, decreased airflow, and wheezes

A male patient diagnosed with COPD tells the nurse "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? What is the nurses best response?

"Other symptoms you may develop are shortness of breath on exertion, and sputum production"

A nurse is educating a patient with emphysema that requires oxygen use at home via nasal cannula. The nurse should instruct the patient not to exceed which flow rate?

2 L per minute

The median survival age for individuals diagnosed with cystic fibrosis is now ________ years.

37

For a patient with emphysema what delivery system does the nurse know will be the most effective for oxygen?

A Venturi mask that delivers a predictable oxygen flow at about 24%

Emphysema is described by which of the following statements?

A disease of the airways characterized by distraction of the walls of over distended alveoli

A patient diagnosed with asthma has not responding well to medication. The patient is concerned and asked the nurse, what is wrong with me and why am I not getting better? What is the nurses best response?

It is possible that genetic testing may help, some genetic variations may cause the activity of a beta adrenergic receptor could change meaning the patient would not respond as expected

How will diaphragmatic breathing help a patient with emphysema?

It will decrease the respiratory rate, increased alveolar ventilation, reduction of functional residual capacity

The nurse is teaching a patient with asthma about self management. What statement by the nurse is best?

Keep a daily symptom and intervention diary

A patient with asthma has been having frequent asthma attacks. What is the nurses best action?

Administer montelukast (Singulair)

The nurse assesses the patient with asthma and finds wheezing throughout the lung fields and decreased pulse oxygen saturation. In addition, the nurse notes suprasternal retraction on inhalation. What is the nurses best action?

Administer oxygen and a rescue inhaler

Patient is being treated in the emergency department for respiratory distress, coupled with pneumonia. Patient has no past medical history. However, the patient works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which of the following orders based on immediate needs for the patient?

Administration of antibiotics

A child is having an asthma attack and the parent cannot remember which inhaler to use for quick relief. The nurse assesses the child's medication information and tells the parents to use which inhalent?

Albuterol

Name a beta 2 adrenergic agonist agent.

Albuterol

The strongest predisposing factor for asthma is___________; The three most common symptoms are ___________, ____________, and ___________.

Allergies, cough, wheezing, and dyspnea

The patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly use medication with the nurse educated patient about?

Cromolyn sodium

The nurse is caring for an older adult who reports experiencing frequent asthma attacks and severe arthritic pain. What action by the nurse is most appropriate?

Assess use of medication for arthritis, aspirin and other NSAIDs can trigger asthma and some people

The nurse is evaluating a patient's response to medication therapy for asthma. The patient has a peak flow meter reading in the yellow zone. What does the nurse do next?

Assist the patient to use a rescue inhaler

What information about nutrition does the nurse teach a patient with COPD?

Avoid drinking fluids just before and during meals, rest before meals if you have dyspnea, have about six small meals a day

A patient with cystic fibrosis is being discharged home. What is the highest priority teaching need?

Avoiding infection

The nurse is performing a physical assessment on a patient with COPD. Which of the following signs and symptoms should the nurse expect to find?

Barrel chest, clubbed fingers, dyspnea on exertion

A nurse is caring for a client two hours after admission. The client has an SaO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer?

Beta 2 agonist

What is true about both lung transplant and bullectomy?

Both are aimed at improving the overall quality of life of a patient with COPD

A ____________ is a surgical option for select patients with bullous emphysema.

Bullectomy

What are the three primary symptoms associated with the progress of stage of COPD?

Chronic cough, sputum production, dyspnea on exertion

The nurse is assessing a patient with chronic obstructive pulmonary disease to determine activity tolerance. Which questions elicit the most important information?

Do you have any difficulty sleeping, how long does it take to perform your morning routine, have you lost any weight lately

What major presenting symptom should the nurse recognize in a patient with emphysema?

Dyspnea

What side effects should the nurse look for when giving bronchodilators?

Dysrhythmias, central nervous system excitement, and tachycardia

The nurse is assessing a patient with a barrel chest. The nurse explain to the patient that this is caused by which disease?

Emphysema

A nurse is assessing a patient who has a history of asthma. Which of the following factors should the nurse identify as a risk for asthma?

Environmental allergies

What exposures account for most of the risk factors of COPD?

Exposure to tobacco smoke

In which grade of COPD is the forced expiratory volume less than 30%?

Grade 4

A patient is demonstrating diaphragmatic breathing for the nurse. Which action by the patient shows adequate understanding of this breathing technique?

Having his or her hands on the abdomen

What are the major factors that determine the clinical course and survival of patients with COPD?

History of smoking, passive smoking exposure, age, rate of decline of FEV, hypoxemia, weight loss, reversibility of airflow obstruction, and pulmonary artery pressure

What statement indicates that a patient needs further teaching regarding therapy with solumeterol (Serevent)?

I will use the drug when I have an asthma attack,(this medication is not a rescue inhaler)

A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching?

I won't take in a deep breath and hold it before exhaling

A patient is being admitted to the medical surgical unit for the treatment of an exacerbation of acute asthma. Which of the following medications is contraindicated in the treatment of asthma exacerbations?

Intal (Cromolyn Sodium)

The nurse is teaching a patient with cystic fibrosis. What activity does the nurse teach as the priority?

Maintaining good nutrition

The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis. Which of the following nursing interventions will be included in the patient's plan of care?

Performing chest physiotherapy as ordered

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack?

Preparing a written action plan

Complications of asthma may include ____________, ___________, _________, and __________.

Status asthmaticus, respiratory failure, pneumonia, and atelectasis

To help prevent infections in patients with COPD, the nurse should recommend vaccination against to bacterial organisms ____________and__________.

Streptococcus pneumoniae, haemophilus influenzae

The physician prescribes a beta 2 adrenergic-agonist agent that is short acting and administered only by inhaler. What medication does the nurse anticipate will be administered?

Terbutaline

A patient is receiving theophylline for long-term control and prevention of asthma symptoms. Patient teaching related to this medication will include which of the following?

The importance of blood tests to monitor serum concentrations

Why would a patient report feeling fatigued?

The patient is using all expendable energy just to breath, there is a gradual decrease in lung function over time in a patient with COPD

A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instruct the patient to breathe in slowly through the nose, taking a normal breath. Then, the nurse asked the patient to Parker his lips as if preparing to whistle. Finally, the patient was told to exhale slowly and gently through the puckered lips. The nurse teaches the patient is breathing exercise to accomplish which of the following?

To prevent collapse of the airways, control the rate and depth respirations, and release trapped air in the lungs

What are the primary causes for an acute exacerbation of COPD?

Tracheobronchial infection, air pollution

A patient with COPD requires high oxygen supplementation with the precise oxygen concentration. The nurse should anticipate the physician order in which of the following?

Venturi mask

A patient with chronic obstructive pulmonary disease reports social isolation. What does the nurse encourage the patient to do?

Verbalize his or her thoughts and feelings

A nurse in the emergency department is caring for a client who is having an acute asthma attack. Which of the following assessment indicates that the respiratory status is declining?

Wheezing, retraction of sterno muscle, and premature ventricular complexes or PVCs

A patient with end stage COPD and heart failure asked the nurse about lung reduction surgery. What is the best response by the nurse?

You and your position should discuss the options that are available for treatment

The nurse is teaching a patient with asthma how to avoid attacks. What information does the nurse give the patient?

You should not dust your furniture, do not take aspirin