Chapter 24: Management of Patients With Chronic Pulmonary Disease

D (Correct Explanation: Short-acting beta2-adrenergic agonists (albuterol [AccuNeb, Proventil, Ventolin], levalbuterol [Xopenex HFA], and pirbuterol [Maxair]) are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. These medications are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists are not indicated for immediate relief of symptoms. These include theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus).)

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? a) Serevent b) Theo-Dur c) Cromolyn sodium d) Proventil

A (Assesses fasting blood glucose levels Explanation: Adverse effects of methylprednisolone include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.)

A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse: a) Assesses fasting blood glucose levels b) Encourages the client to decrease caloric intake due to increased appetite c) Informs the client to limit fluid intake due to fluid retention d) Aspirates for blood return before injecting the medication

A (Lung sounds Explanation: A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.)

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? a) Lung sounds b) Skin color c) Heart rate d) Respiratory rate

A (salmeterol/fluticasone (Seretide) MDI daily at 0800 Explanation: When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.)

A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? a) salmeterol/fluticasone (Seretide) MDI daily at 0800 b) azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 c) prednisone 5 mg oral daily at 0800 d) nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800

B (Oxygen through nasal cannula at 2 L/minute Explanation: All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.)

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? a) Ipratropium bromide (Alupent) by metered-dose inhaler b) Oxygen through nasal cannula at 2 L/minute c) Vancomycin 1 gram intravenously over 1 hour d) Intravenous methylprednisolone (Solu-Medrol) 120 mg

A (Anxiety Explanation: In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.)

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? a) Anxiety b) Impaired swallowing c) Unilateral neglect d) Imbalanced nutrition: More than body requirements

A (An inspiratory-expiratory (I:E) ratio of 2:1 Explanation: The normal I:E ratio is 1:2, meaning that expiration takes twice as long as inspiration. A ratio of 2:1 is seen in clients with COPD because inspiration is shorter than expiration. A client with COPD typically has a barrel chest in which the anteroposterior diameter is larger than the transverse chest diameter. A client with COPD usually has a respiratory rate greater than 12 breaths/minute and an oxygen saturation rate below 93%.)

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? a) An inspiratory-expiratory (I:E) ratio of 2:1 b) A transverse chest diameter twice that of the anteroposterior diameter c) A respiratory rate of 12 breaths/minute d) An oxygen saturation of 99%

C (Instruct the client to drink at least 2 L of fluid daily. Explanation: Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.)

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: a) administer anxiolytics, as ordered, to control anxiety. b) maintain the client on bed rest. c) instruct the client to drink at least 2 L of fluid daily. d) administer pain medication as ordered.

A ("Delay self-care activities for 1 hour." Explanation: Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.)

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? a) "Delay self-care activities for 1 hour." b) "Sit in a chair whenever doing an activity." c) "Drink fluids upon arising from bed." d) "Raise your arms over your head."

A ("I do not need to rinse my mouth with this type of inhaler." Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The patient should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.)

A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? a) "I do not need to rinse my mouth with this type of inhaler." b) "I will make sure to take a slow, deep breath as I push on my inhaler." c) "If I use the spacer, I know I am only supposed to push on the inhaler once." d) "After I breathe in, I will hold my breath for 10 seconds."

C (Increase walking distance around a city block without shortness of breath. Explanation: If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable.)

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? a) Maintain activity level of walking to the mailbox. b) Relieve shortness of breath to a level as close as possible to tolerable. c) Increase walking distance around a city block without shortness of breath. d) Continue with current level of mobility at home.

D (uses the sternocleidomastoid muscles. Explanation: Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.)

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: a) wants the head of the bed raised to a 90-degree level. b) has a pulse oximetry reading of 93%. c) sits in tripod position. d) uses the sternocleidomastoid muscles.

B (An inhaled beta2-adrenergic agonist Correct Explanation: An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.)

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? a) An inhaled corticosteroid b) An inhaled beta2-adrenergic agonist c) An I.V. beta2-adrenergic agonist d) An oral corticosteroid

D (You selected: II Correct Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.)

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in? a) IV b) III c) I d) II

D (Ineffective coping related to anxiety Explanation: Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior. Constant shortness of breath and fatigue may make the patient irritable and apprehensive to the point of panic. Although the other choices are correct, the most important psychosocial nursing diagnosis for a patient with COPD is ineffective coping related to a high level of anxiety.)

A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? a) Activity intolerance related to fatigue b) Disturbed sleep pattern related to cough c) High risk for ineffective therapeutic regimen management related to lack of knowledge d) Ineffective coping related to anxiety

A (Intal (Cromolyn Sodium) Intal is contraindicated in patients with acute asthma exacerbation. Indications for Intal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Intal is also a preventive treatment prior to exposure to exercise or known allergen. Proventil (albuterol), Xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms.)

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? a) Intal (Cromolyn Sodium) b) Atrovent (Ipratropium) c) Proventil (Albuterol) d) Xopenex (Levalbuterol HFA)

C (Respiratory acidosis Correct Explanation: In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.)

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory acidosis d) Respiratory alkalosis

A, B, C, E (Explanation: The goal is to have a stable patient with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the patient can live a reasonably normal life. With adequate management, patients should not have to give up their usual activities.)

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 condition. Which of the following are therapy goals? Select all that apply. a) Return the patient to his original functioning abilities. b) Treat the underlying cause of the event. c) Provide long-term support for medical management. d) Teach the patient to suspend activity. e) Provide medical support for the current exacerbation.

D (Correct Explanation: Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.)

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? a) Atrovent b) Flovent c) Combivent d) Proventil

B (Implementing measures to clear pulmonary secretions Explanation: Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.)

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following? a) Providing the patient with a low-calorie, high-fiber diet b) Implementing measures to clear pulmonary secretions c) Teaching the family how to perform postural drainage d) Instructing the patient on the signs of respiratory infection

B (Administer the salmeterol and then administer the triamcinolone. Explanation: A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone is a corticosteroid; Salmeterol is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.)

A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? a) Administer the triamcinolone and then administer the salmeterol. b) Administer the salmeterol and then administer the triamcinolone. c) Allow the client to choose the order in which the drugs are administered. d) Monitor the client's theophylline level before administering the medications.

A (Sharp, stabbing chest pain Explanation: The initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.)

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: a) Sharp, stabbing chest pain b) Dyspnea c) Tachycardia d) A dry, hacking cough

B (Collects sputum for culture and sensitivity Explanation: Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.)

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: a) Provides nebulized tobramycin (TOBI) b) Collects sputum for culture and sensitivity c) Gives oral pancreatic enzymes with meals d) Administers vancomycin intravenously

B (A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of COPD. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.)

Emphysema is described by which of the following statements? a) A disease that results in a common clinical outcome of reversible airflow obstruction b) A disease of the airways characterized by destruction of the walls of overdistended alveoli c) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years d) Chronic dilatation of a bronchus or bronchi

A, B, D (Explanation: The nurse also assesses the patient's skin turgor for signs of dehydration. Fluid intake is essential to combat dehydration, to loosen secretions, and to facilitate expectoration.)

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) a) To combat dehydration b) To facilitate expectoration c) To assist with the effectiveness of the corticosteroids d) To loosen secretions e) To relieve bronchospasm

C (Providing sufficient oxygen to improve oxygenation Explanation: The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.)

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? a) Avoiding the use of oxygen to decrease the hypoxic drive b) Increasing pH c) Providing sufficient oxygen to improve oxygenation d) Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise

C (The patient should take the medication an hour before meals or 2 hours after a meal. Explanation: The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.)

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 the education? a) The patient should take the medication with a small amount of liquid. b) The patient should take the medication with meals since it may cause nausea. c) The patient should take the medication an hour before meals or 2 hours after a meal. d) The patient should take the medication separately without other medications.

C (Atelectasis Explanation: Respiratory complications that may occur include atelectasis. An incentive spirometer and the use of deep breathing exercises are necessary to prevent atelectasis and pneumonia. Elevated blood sugar levels, hyperkalemia, UTI, and are complications that can occur but are unrelated to the respiratory system. (less))

The nurse plays an important role in monitoring and managing potential complications in the patient who has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which of the following respiratory complications? a) Urinary tract infection (UTI) b) Hyperkalemia c) Atelectasis d) Elevated blood glucose level

A (Atelectasis Explanation: In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (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 complication should the nurse monitor for? a) Atelectasis b) Emphysema c) Pneumonia d) Pleurisy

D (Atelectasis Explanation: In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (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 complication should the nurse monitor for? a) Emphysema b) Pleurisy c) Pneumonia d) Atelectasis

A (Respiratory acidosis. Explanation: Decreased carbon dioxide elimination results in increased carbon dioxide tension (hypercapnia), which leads to respiratory acidosis and chronic respiratory failure.)

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: a) Respiratory acidosis. b) Diminished alveolar surface area. c) Hypercapnia resulting from decreased carbon dioxide elimination. d) Hypoxemia secondary to impaired oxygen diffusion.

A, C, D (Correct Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.)

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) a) Mucus secretions block airways. b) Dry airways obstruct airflow. c) Inflamed airways obstruct airflow. d) Overinflated alveoli impair gas exchange.

A (Inflammation Explanation: Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.)

Which of the following is the key underlying feature of asthma? a) Inflammation b) Shortness of breath c) Productive cough d) Chest tightness

D (Both are aimed at improving the overall quality of life of a patient with COPD. Explanation: The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat patients with bullous emphysema.)

Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at curing COPD. b) Both are aimed at treating end-stage emphysema. c) Both are used to treat patients with bullous emphysema. d) Both are aimed at improving the overall quality of life of a patient with COPD.

B, C, E (Explanation: Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.)

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. a) Tiotropium (Spiriva) b) Zafirlukast (Accolate) c) Montelukast (Singulair) d) Ipratropium HFA (Atrovent) e) Zileuton (Zyflo)

0.25 (Explanation: The volume to be infused is 2 mL over 2 minutes. There are 60 seconds in each minute. For every 15 seconds, the nurse will administer 0.25 mL. 2 mL/120 sec = x/15 sec. 0.25 mL = x)

A client is prescribed methylprednisolone (Solu-Medrol) 125 mg intravenously. The medication is available in a 125 mg single-dose vial containing 2 mL. The nurse will administer methylprednisolone over 2 minutes. How many mL will the nurse administer each 15 seconds? Write your answer to 2 decimal places. Starting with 0., enter the correct number ONLY.

C (Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.)

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? a) Disabled family coping related to knowledge deficit and a temporary change in family dynamics b) Anxiety related to an actual threat to health status, invasive procedures, and pain c) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction d) Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time

B (Theophylline Explanation: Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.)

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? a) Levalbuteral b) Theophylline c) Albuteral d) Terbutaline

C (High-protein Explanation: Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.)

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? a) 1,800-calorie ADA b) Low-fat c) High-protein d) Full-liquid

A (FEV1 > 80% Explanation: The FEV1 decreases as the severity of obstruction increases. Therefore, an FEV1 of more than 80% indicates an initial stage, and an FEV1 of 30% indicates a very severe stage.)

A nurse evaluates the results of a spirometry test to help confirm a diagnosis of obstructive lung disease. Which one of the following results indicates an initial early stage of COPD? (FEV1 refers to forced expired volume in 1 second.) a) FEV1 > 80% b) FEV1 = 50% c) FEV1 = 70% d) FEV1 = 30%

D (III Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.)

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? a) IV b) II c) I d) III

D (I Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.)

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in? a) IV b) II c) III d) I

A (Sputum and a productive cough Explanation: Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of consecutive years.)

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? a) Sputum and a productive cough b) Tachypnea and tachycardia c) Fever, chills, and diaphoresis d) Chest pain during respiration

C (With meals Explanation: Nearly 90% of patients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals (Warwick & Elston, 2011).)

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? a) Three times a day regardless of meal time b) Before meals c) With meals d) After meals and at bedtime

A (You selected: IgE-mediated Correct Explanation: Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.)

Asthma is cause by which type of response? a) IgE-mediated b) IgM-mediated c) IgA-mediated d) IgD-mediated

D (Sweat chloride concentration Explanation: Diagnosis of CF is based on an elevated sweat chloride concentration, together with clinical signs and symptoms consistent with the disease.)

Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which one of the following tests? a) Arterial blood gases (ABGs) b) Pulmonary function studies c) Lumbar puncture d) Sweat chloride concentration

A (A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.)

Emphysema is described by which of the following statements? a) A disease of the airways characterized by destruction of the walls of overdistended alveoli b) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years c) Chronic dilatation of a bronchus or bronchi d) A disease that results in a common clinical outcome of reversible airflow obstruction

A (Stage III patients demonstrate an FEV less than 30% with respiratory failure or clinical signs of right heart failure. Stage II patients demonstrate an FEV of 30% to 80%. Stage I is mild COPD with an FEV less than 70%. Stage 0 is characterized by normal spirometry)

In which stage of COPD is the forced expiratory volume (FEV) less than 30%? a) III b) II c) I d) 0

E (severe COPD. Explanation: Stage III is severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage IV is very severe COPD.)

The classification of Stage III of COPD is defined as a) moderate COPD. b) at risk for COPD. c) very severe COPD. d) mild COPD. e) severe COPD.

D (Exhales hard and fast with a single blow Explanation: To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.)

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client a) Records in a diary the number achieved after one breath b) Inhales deeply and holds the breath c) Sits in a straight-back chair and leans forward d) Exhales hard and fast with a single blow

C (90% Explanation: The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.)

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 patient's SaO2 level at or above what percent? a) 30% b) 70% c) 90% d) 50%

A, B, C, D (Explanation: Signs and symptoms of pneumothorax include sudden chest pain that is sharp and abrupt, a significant and sudden increase in shortness of breath, asymmetry of chest movement, unilateral retractions, bilateral differences in breath sounds, and/or oxygen desaturation. The patient with a pneumothorax would not have bilaterally equal breath sounds)

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. a) Oxygen desaturation b) Unilateral retractions c) Sudden chest pain d) Asymmetry of chest movement e) Bilaterally equal breath sounds

B (Dyspnea Explanation: Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.)

Which of the following is a symptom diagnostic of emphysema? a) Normal elastic recoil b) Dyspnea c) The occurrence of cor pulmonale d) Copious sputum production