Exemplar 15.C - COPD

The nurse is planning care for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which interventions should the nurse select to meet nutritional needs? Select all that apply. A) Encourage a diet high in protein and fats. B) Keep snacks to a minimum. C) Provide frequent small meals with between-meal supplements. D) Encourage carbohydrate-rich foods to provide needed calories for energy. E) Suggest the client eat three meals per day to maintain energy needs.

A) Encourage a diet high in protein and fats. C) Provide frequent small meals with between-meal supplements. A diet high in protein and fats without excess carbohydrates is recommended to minimize carbon dioxide production during metabolism. Frequent small meals with between-meal supplements, not three meals with minimal snacking, help maintain intake and reduce fatigue associated with eating.

The nurse is assigned to care for a client admitted to the hospital with chronic obstructive pulmonary disease (COPD). Which medication does the nurse anticipate to decrease this client's risk for developing a respiratory infection? A) A broad-spectrum antibiotic B) A bronchodilator C) A corticosteroid D) An influenza vaccine

D) An influenza vaccine An influenza vaccine may be ordered to reduce the risk of respiratory infections. A broad-spectrum antibiotic may be prescribed if infection is suspected but would not be ordered to reduce the risk of developing an infection. Bronchodilators and corticosteroid therapy are not used to prevent infections.

What is one genetic cause of COPD? A) Alpha-1 antitrypsin deficiency B) A defect in the CFTR gene C) A mutation in the superoxide dismutase 1 gene D) Mutations in the human leukocyte antigen

A) Alpha-1 antitrypsin deficiency In 1% of cases, COPD is caused by a genetic deficiency in alpha-1 antitrypsin, which is necessary for normal lung development and function. A defect in the CFTR gene causes cystic fibrosis. A mutation in the superoxide dismutase 1 gene causes amyotrophic lateral sclerosis (ALS), a neuromuscular disease that can reduce an individual's ability to control breathing muscles. Certain mutations in the human leukocyte antigen (HLA) allele are associated with increased risk of sarcoidosis, which causes inflammatory cells to collect in the lungs.

The nurse is evaluating care provided to a client diagnosed with chronic obstructive pulmonary disease (COPD). Which observation would indicate that care provided to this client has been effective? A) Client conducts morning care and ambulates in room while maintaining an oxygen saturation of 92% on room air per oximetry reading. B) Client needs assistance with morning care and meals due to shortness of breath. C) Client states family members are discussing admission to a nursing home for continuing care. D) Client leaves hospital unit to smoke outside four times a day.

A) Client conducts morning care and ambulates in room while maintaining an oxygen saturation of 92% on room air per oximetry reading. Evidence that care provided to a client with COPD was successful would be the client conducting morning care and ambulating in the room while maintaining an oxygen saturation of 92%. This outcome identifies the client's ability to maintain adequate oxygenation and perform activities of daily living. The client's leaving the unit to smoke suggests that care has not been effective. The client who needs assistance with morning care and meals because of shortness of breath needs additional interventions. The client who states that his family would prefer he go to a nursing home may or may not have been positively affected by the interventions; not enough information is provided to know.

The nurse is planning care for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which interventions should the nurse select to address the client's ineffective breathing pattern? Select all that apply. A) Instruct in pursed-lip breathing B) Teach visualization and meditation C) Deep breathing and coughing every hour D) Instruct in abdominal breathing E) Provide oxygen 2 liters nasal cannula.

A) Instruct in pursed-lip breathing B) Teach visualization and meditation D) Instruct in abdominal breathing Techniques used to instruct a client to control the breathing pattern include pursed-lip breathing, abdominal breathing, and relaxation such as visualization and meditation. Providing oxygen 2 liters per nasal cannula will not improve the client's breathing pattern. Deep breathing and coughing should be done every 2 hours to help keep the airway clear and prevent the pooling of secretions, not to control the breathing pattern.

The nurse is planning care for a client diagnosed with chronic obstructive pulmonary disease (COPD). When planning care for this client, which interventions are appropriate to enhance the client's breathing pattern? Select all that apply. A) Provide adequate rest periods. B) Assist with activities of daily living (ADLs). C) Educate on relaxation techniques. D) Educate on pursed-lip breathing. E) Administer a cough suppressant.

A) Provide adequate rest periods. B) Assist with activities of daily living (ADLs). C) Educate on relaxation techniques. D) Educate on pursed-lip breathing. Providing adequate rest periods and assisting with ADLs prevents fatigue and reduces oxygen demands. Relaxation techniques reduce anxiety and its effect on the respiratory rate. Pursed-lip breathing helps keep airways open by maintaining positive pressure. A cough suppressant is not an appropriate medication for a client with COPD as it is important for the client to expel mucus to maintain adequate oxygenation.

What is the best way nurses can help clients reduce the risk of COPD? A) Providing smoking cessation resources B) Encouraging clients to receive vaccinations C) Referring clients to a nutritionist D) Providing references to local fitness facilities

A) Providing smoking cessation resources The primary cause of COPD is smoking, so nurses can reduce the risk of clients developing COPD by providing smoking cessation resources and encouraging clients to follow through with plans to stop smoking. Vaccinations, proper nutrition, and healthy exercise habits may reduce the risk of COPD, but smoking cessation is the best way to prevent COPD.

The nurse is providing care to a client diagnosed with chronic obstructive pulmonary disease (COPD). Which factors in the client's history support the current diagnosis? Select all that apply. A) Working in an industrial environment B) Working in an office setting with air conditioning C) History of asthma D) Current cigarette smoking E) Playing golf several times a week

A) Working in an industrial environment C) History of asthma D) Current cigarette smoking Risk factors associated with the development of COPD include working in an industrial environment, a history of asthma, and cigarette smoking. Working in an office setting with air conditioning and playing golf several times a week are not risk factors for the development of COPD.

The nurse caring for a client diagnosed with chronic obstructive pulmonary disease (COPD) is educating the client on effective coughing techniques. Which statement made by the client indicates a need for further teaching? A) "I should inhale by sniffing." B) "I should exhale sharply with a 'huff."' C) "I should limit my fluid intake to 1-1.5 quarts daily." D) "I should cough twice and then rest."

C) "I should limit my fluid intake to 1-1.5 quarts daily." Adequate fluid intake is at least 2-2.5 quarts of fluid daily, so the statement about drinking 1-1.5 quarts daily indicates the need for further teaching. The other statements are accurate so do not indicate a need for further teaching.

The nurse is providing care to a client diagnosed with chronic obstructive pulmonary disease (COPD) after years of experiencing emphysema. Which clinical manifestation does the nurse anticipate when assessing this client? A) Tachycardia B) Cough C) Barrel chest D) Wheezing

C) Barrel chest Barrel chest occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded. While coughing, wheezing, and tachycardia may also be experienced by a client diagnosed with COPD, these are not specific to COPD caused by emphysema.

The nurse is providing care to a client recently diagnosed with chronic obstructive pulmonary disease (COPD). Which conditions will you include when you teach the client's family about the types of COPD? A) Asthma and bronchitis B) Asthma and emphysema C) Bronchitis and emphysema D) Emphysema and atelectasis

C) Bronchitis and emphysema Although one or the other may dominate, COPD typically includes components of both chronic bronchitis and emphysema, two distinctly different processes. Asthma and atelectasis are not types of COPD, although asthma is a risk factor for COPD.

A client diagnosed with chronic obstructive pulmonary disease (COPD) has a pulse oximetry reading of 93%, increased red blood and white blood cell count, temperature of 101°F, pulse 100 bpm, respirations 35 bpm, and a chest x-ray that showed a flattened diaphragm with infiltrates. Based on this data, which order does the nurse question for this client? A) Antibiotic therapy B) Nonsteroidal anti-inflammatory agents (NSAIDs) C) Oxygen by nasal cannula at 3-4 liters/minute D) Bronchodilators such as an adrenergic stimulating drugs or anticholinergic agents

C) Oxygen by nasal cannula at 3-4 liters/minute Based on the hypoxic drive theory and the need for hypoxia to stimulate breathing, oxygen saturation for clients with COPD should be between 88% and 92%. Therefore, this client may not require oxygen administration at this time, and oxygen at 3-4 L/min may lead to respiratory depression or respiratory failure. The prescriptions for antibiotics, NSAIDs, and bronchodilators are expected for this client's condition.

Which assessment finding by the nurse supports the diagnosis that a client is in the early stages of chronic obstructive pulmonary disease (COPD)? A) Dysrhythmias B) Cyanotic nail beds C) Clubbing of the fingers D) Cough in the morning producing clear sputum

D) Cough in the morning producing clear sputum The earliest-presenting symptom of COPD is coughing in the morning with clear sputum unless the client develops an infection, in which case the sputum would become yellow or green in color. With the progression of COPD, the body compensates by producing extra red blood cells. These extra blood cells clog the small blood vessels of the fingers, leading to the development of cyanotic nail beds and clubbing of the fingertips. Enlargement and thickening of the right ventricle of the heart often results in dysrhythmias.

The nurse is planning care for the client diagnosed with chronic obstructive pulmonary disease (COPD) who has a breathing rate of 32 per minute, elevated blood pressure, and fatigue. Which nursing diagnosis is the priority for this client? A) Ineffective Coping B) Ineffective Airway Clearance C) Anxiety D) Ineffective Breathing Pattern

D) Ineffective Breathing Pattern The client's respiratory rate of 32 per minute is an indication of an ineffective breathing pattern. The elevated blood pressure and fatigue are indications of a compromised respiratory status. The diagnosis of Ineffective Breathing Pattern would be the priority for the client at this time. There is no information to support Ineffective Airway Clearance, as there is no mention that the client is coughing. There is no information to support Anxiety or Ineffective Coping.

The nurse is caring for a Spanish-speaking client admitted for exacerbation of chronic obstructive pulmonary disease (COPD). The client speaks very little English and is a smoker. Which action would be the most beneficial for this client? A) Have the adult child of the client translate during the assessment process B) Encourage aerobic activity C) Encourage the client to write down questions prior to seeing the healthcare provider D) Obtain educational materials about smoking cessation written in Spanish.

D) Obtain educational materials about smoking cessation written in Spanish. A Spanish-speaking client who smokes and is diagnosed with COPD requires information regarding smoking cessation. For clients who do not speak English, it is appropriate for the nurse to obtain written education material for the client in the client's native language, Spanish. Relatives should not be used as medical interpreters because of the need for knowledge of medical terminology. Encouraging aerobic activity is not an appropriate intervention for a client diagnosed with COPD. Writing down questions might be appropriate for an English-speaking client but will not be appropriate for a Spanish-speaking client being treated in an English-speaking healthcare environment.