NUR 301-- PrepU Quiz #2

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?"

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem?

- Thick mucus - Swelling of bronchial membranes - Airway remodeling

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)?

- Tobacco smoke - Occupational dust - Air pollution - Infection - Second-hand smoke

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?

Oxygen through nasal cannula at 2 L/minute

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 mmHg-- 90%

Emphysema is described by which of the following statements?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?

Emphysema

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

The classification of Stage III of COPD is defined as

severe COPD

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?

"Delay self-care activities for 1 hour."

Which of the following occupy space in the thorax, but do not contribute to ventilation?

Bullae

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 clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response?

"It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs."

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema:

An abnormal distention of the air spaces with destruction of the alveolar walls

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

"You and your physician should discuss the options that are available for treatment."

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways.

- Alter smooth muscle tone - Reduce airway obstruction - Increase oxygen distribution

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

- Compromised gas exchange - Decreased airflow - Wheezes

It is important to teach patients how to manage an acute episode of dyspnea. Which of the following teaching points should be included in the lesson?

- Keep arms supported and relaxed with pillows - Breathe out through pursed lips - Make each breath longer and longer

Which of the following medications are classified as leukotriene modifiers (inhibitors)?

- Montelukast (Singulair) - Zafirlukast (Accolate) - Zileuton (Zyflo)

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be

Albuterol

Which of the following is the strongest predisposing factor for asthma?

Allergy

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?

Atelectasis

You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what?

Atelectasis

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 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 client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema?

Cigarette smoking

For patients with mild, intermittent asthma the pharmacologic treatment of choice is:

Corticosteroids

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client

Exhales hard and fast with a single blow

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)?

Exposure to tobacco smoke

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?

II

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

In which stage of COPD is the forced expiratory volume (FEV) less than 30%?

III

Asthma is cause by which type of response?

IgE-mediated

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

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?

Proventil

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

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

Respiratory acidosis

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 nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

Respiratory rate of 22 breaths/minute

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 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?

Sputum and a productive cough

To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations?

Streptococcus pneumonia and Haemophilus influenzae

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?

The patient should take the medication an hour before meals or 2 hours after a meal

Which of the following would not be considered a primary symptom of COPD?

Weight gain

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

atelectasis

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by

mast cells

The classification of Stage I of COPD is defined as

mild COPD

The classification of Stage II of COPD is defined as

moderate COPD

The classification of Stage IV of COPD is defined as

very severe COPD

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?

Anxiety

Which of the following is a symptom diagnostic of emphysema?

Dyspnea

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

albuterol (Proventil)

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:

the airways are so swollen that no air can get through