PrepU Chapter 24: Chronic Pulmonary Disease (Exam 2)

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

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

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 -Emphysema -Pleurisy -Pneumonia

-Atelectasis In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

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 -Inhales deeply and holds the breath -Records in a diary the number achieved after one breath -Sits in a straight-back chair and leans forward

-Exhales hard and fast with a single blow 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.

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? -Eosiniphils -Lymphocytes -Mast cells -Neutrophils

-Mast cells Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.

A nursing student understands that emphysema is directly related to which of the following? -Diminished alveolar surface area -Hypercapnia resulting from decreased carbon dioxide tension -Hypoxemia secondary to impaired oxygen diffusion -Respiratory acidosis from airway obstruction

-Respiratory acidosis from airway obstruction In the later stages of emphysema, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) leading to respiratory acidosis.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? -"Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." -"I can't use a spacer or holding chamber with the MDI." -"I will take a slow, deep breath in after pushing down on the MDI." -"I will shake the MDI container before I use it."

-"I can't use a spacer or holding chamber with the MDI." The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly.

A cient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed? -After meals and at bedtime -Before meals -With meals -Three times a day regardless of meal time

-With meals Nearly 90% of clients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals.

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include -the importance of blood tests to monitor serum concentrations. -taking the medication at least 1 hour prior to meals. -monitoring liver function studies as prescribed. -development of hyperkalemia.

-the importance of blood tests to monitor serum concentrations. The nurse should inform clients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The client is at risk of developing hypokalemia.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? -Exposure to tobacco smoke -Occupational exposure -Passive smoking -Ambient air pollution

-Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors but do not account for the majority.

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? -Varicella -Influenza -Hepatitis B -Human papilloma virus (HPV)

-Influenza Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for women ages 9 to 26.

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 -Avoiding the use of oxygen to decrease the hypoxic drive -Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise -Increasing pH

-Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

The classification of grade I COPD is defined as -mild COPD. -moderate COPD. -severe COPD. -very severe COPD.

-mild COPD. Grade I is mild COPD. Grade II is moderate COPD. Grade III is severe COPD. Grade IV is very severe COPD.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as -Atelectasis -Emphysema -Pleurisy -Pneumonia

-Atelectasis Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).

The classification of Stage II of COPD is defined as -at risk for COPD. -moderate COPD. -severe COPD. -very severe COPD. -mild COPD.

-moderate COPD. Stage II is moderate COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage III is severe COPD. Stage IV is very severe 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? -Full-liquid -High-protein -1,800-calorie ADA -Low-fat

-High-protein 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.

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? -Emphysema -Asthma -Polycythemia -Bronchitis

-Polycythemia Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take? -Aspirates for blood return before injecting the medication -Assesses fasting blood glucose levels -Encourages the client to decrease caloric intake due to increased appetite -Informs the client to limit fluid intake due to fluid retention

-Assesses fasting blood glucose levels Adverse effects of methylprednisolone (Solu-Medrol) 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 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? -"Raise your arms over your head." -"Delay self-care activities for 1 hour." -"Sit in a chair whenever doing an activity." -"Drink fluids upon arising from bed."

-"Delay self-care activities for 1 hour." 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) expresses a desire to quit smoking. The first appropriate response from the nurse is: -"Nicotine patches would be appropriate for you." -"Have you tried to quit smoking before?" -"I can refer you to the American Lung Association." -"Many options are available for you."

-"Have you tried to quit smoking before?" All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

Which statement is true about both lung transplant and bullectomy? -Both procedures cure COPD. -Both procedures treat end-stage emphysema. -Both procedures treat patients with bullous emphysema. -Both procedures improve the overall quality of life of a client with COPD.

-Both procedures improve the overall quality of life of a client with COPD. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client 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 clients with bullous emphysema.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? -Respiratory alkalosis -Metabolic alkalosis -Respiratory acidosis -Metabolic acidosis

-Respiratory acidosis As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? -Theophylline -Levalbuteral -Terbutaline -Albuteral

-Theophylline Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.

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? -nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 -salmeterol/fluticasone (Seretide) MDI daily at 0800 -azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 -prednisone 5 mg oral daily at 0800

-salmeterol/fluticasone (Seretide) MDI daily at 0800 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.

Which of the following is the key underlying feature of asthma? -Inflammation -Shortness of breath -Productive cough -Chest tightness

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

The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.) -Take a slow, deep inhalation from the device. -Use normal inhalations with the device. -Activate the MDI once. -The device may increase delivery of the MDI medication. -It is not necessary to hold your breath after using.

-Take a slow, deep inhalation from the device. -Activate the MDI once. -The device may increase delivery of the MDI medication. The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

Which statement describes emphysema? -A disease of the airways characterized by destruction of the walls of overdistended alveoli -A disease that results in reversible airflow obstruction, a common clinical outcome -Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years -Chronic dilatation of a bronchus or bronchi

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

Which of the following is accurate regarding status asthmaticus? -A severe asthma episode that is refractory to initial therapy -Patients have a productive cough. -Usually occurs with warning -Usually does not progress to severe obstruction

-A severe asthma episode that is refractory to initial therapy Status asthmaticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.

Which of the following occupy space in the thorax, but do not contribute to ventilation? -Bullae -Alveoli -Lung parenchyma -Mast cells

-Bullae Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

The classification of Stage III of COPD is defined as -at risk for COPD. -mild COPD. -severe COPD. -very severe COPD. -moderate COPD.

-severe COPD. 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.

Which exposure accounts for most cases of COPD? -Exposure to tobacco smoke -Occupational exposure -Passive smoking -Ambient air pollution

-Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors, but they do not account for most cases.

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. -Status asthmaticus -Respiratory failure -Pertussis -Atelectasis -Thoracentesis

-Status asthmaticus -Respiratory failure -Atelectasis Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Pertussis and pneumothorax are not complications.

A client 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? -Ipratropium bromide -Fluticasone propionate -Ipratropium bromide and albuterol sulfate -Albuterol

-Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

Which diagnostic test is most accurate in assessing acute airway obstruction? -Arterial blood gases (ABGs) -Pulmonary function studies -Pulse oximetry -Spirometry

-Pulmonary function studies Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs and pulse oximetry are not the most accurate diagnostics for an airway obstruction. Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).

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

-Respiratory acidosis 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 client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes -teaching the family how to perform postural drainage. -instructing the client on the signs of respiratory infection. -implementing measures to clear pulmonary secretions. -providing the client a low-calorie, high-fiber diet.

-implementing measures to clear pulmonary secretions. Nursing management focuses on alleviating symptoms and helping clients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the client 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 client's appetite and result in inadequate dietary intake; therefore, the client's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

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: -instruct the client to drink at least 2 L of fluid daily. -maintain the client on bed rest. -administer anxiolytics, as ordered, to control anxiety. -administer pain medication as ordered.

-instruct the client to drink at least 2 L of fluid daily. 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 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.

0.25 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

In which statements regarding medications taken by a client diagnosed with COPD do the the drug name and the drug category correctly match? Select all that apply. -Albuterol is a bronchodilator. -Dexamethasone is an antibiotic. -Cotrimoxazole is a bronchodilator. -Ciprofloxacin is an antibiotic. -Prednisone is a corticosteroid.

-Albuterol is a bronchodilator. -Ciprofloxacin is an antibiotic. -Prednisone is a corticosteroid. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics. All of these drugs could be prescribed to a client with COPD.

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. -Alter smooth muscle tone -Reduce airway obstruction -Decrease alveolar ventilation -Increase oxygen distribution

-Alter smooth muscle tone -Reduce airway obstruction -Increase oxygen distribution Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse? -Collects sputum for culture and sensitivity -Administers vancomycin intravenously -Provides nebulized tobramycin (TOBI) -Gives oral pancreatic enzymes with meals

-Collects sputum for culture and sensitivity 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.

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? -I -II -III -IV

-I COPD is classified into four grades depending on the severity measured by pulmonary function tests. However, pulmonary function is not the only way to assess or classify COPD; pulmonary function is evaluated in conjunction with symptoms, health status impairment, and the potential for exacerbations. Grade I (mild): FEV1/FVC <70% and FEV1 ≥80% predicted. Grade II (moderate): FEV1/FVC <70% and FEV1 50% to 80% predicted. Grade III (severe): FEV1/FVC <70% and FEV1 <30% to 50% predicted. Grade IV (very severe): FEV1/FVC <70% and FEV1 <30% predicted.

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 -Respiratory alkalosis -Metabolic alkalosis -Metabolic acidosis

-Respiratory acidosis Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? -Encouraging the client to drink three glasses of fluid daily -Keeping the client in semi-Fowler's position -Using a Venturi mask to deliver oxygen as ordered -Administering a sedative as ordered

-Using a Venturi mask to deliver oxygen as ordered The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

The classification of Stage IV of COPD is defined as -at risk for COPD. -mild COPD. -severe COPD. -very severe COPD. -moderate COPD.

-very severe COPD. Stage IV is very severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage III is severe COPD.

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 -Intravenous methylprednisolone (Solu-Medrol) 120 mg -Ipratropium bromide (Alupent) by metered-dose inhaler -Vancomycin 1 gram intravenously over 1 hour

-Oxygen through nasal cannula at 2 L/minute 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.

Although many signs and symptoms lead to a diagnosis of emphysema, one symptom stands as the primary presenting symptom. Which of the following is the primary presenting symptom? -Chronic and persistent cough -Dyspnea -Tachypnea -Wheezing

-Dyspnea Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. Chronic cough and sputum production often precede the development of airflow limitation by many years. However, not all people with cough and sputum production develop COPD. The cough may be intermittent and unproductive in some patients.

A physician orders metaproterenol by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? -"I can stop using this drug when I begin to feel better." -"I should use this inhaler whenever I get short of breath." -"I need to hold my breath as long as possible after I take a deep inhalation." -"I need to call the physician right away if I feel my heart beating fast after using the drug."

-"I need to hold my breath as long as possible after I take a deep inhalation." The client demonstrates effective teaching if he states that he'll hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol (Alupent) needs to be used over an extended period for maximum effect. The client shouldn't use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardia is an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute.

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client -Has wheezes in the right lung lobes -Has a respiratory rate of 28 breaths/minute -Reports shortness of breath -Cannot perform activities of daily living

-Has wheezes in the right lung lobes Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

A client diagnosed with asthma is preparing for discharge. The nurse is educating the client on the proper use of a peak flow meter. The nurse instructs the client to complete which action? -Move the indicator to the top of the numbered scale. -Sit down while completing a peak flow reading. -Take and record peak flow readings three times daily. -If coughing occurs during the procedure, repeat it.

-If coughing occurs during the procedure, repeat it. Steps for using the peak flow meter correctly include (1) moving the indicator to the bottom of the numbered scale; (2) standing up; (3) taking a deep breath and filling the lungs completely; (4) placing the mouthpiece in the mouth and closing the lips around it; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the client coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.

Which statement describes emphysema? -A disease of the airways characterized by destruction of the walls of overdistended alveoli -A disease that results in reversible airflow obstruction, a common clinical outcome -Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years -Chronic dilatation of a bronchus or bronchi

-A disease of the airways characterized by destruction of the walls of overdistended alveoli 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 overdistended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of alveoli; 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 two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

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 -Imbalanced nutrition: More than body requirements -Impaired swallowing -Unilateral neglect

-Anxiety 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.

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. -Compromised gas exchange -Decreased airflow -Wheezes -Jugular vein distention -Ascites

-Compromised gas exchange -Decreased airflow -Wheezes Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2015).

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? -Albuterol -Cromolyn sodium -Levalbuterol HFA -Ipratropium

-Cromolyn sodium Cromolyn sodium is contraindicated in clients with acute asthma exacerbation. Indications for cromolyn sodium are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Cromolyn sodium is also a preventive treatment before exposure to exercise or a known allergen. Albuterol, levalbuterol HFA, and ipratropium can be used to relieve acute symptoms.

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? -Asthma -Bronchiectasis -Cystic fibrosis -Emphysema

-Emphysema COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or any combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of COPD are now classified as chronic pulmonary disorders. Asthma is now considered a distinct, separate disorder and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

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? -Disturbed sleep pattern related to cough -Ineffective coping related to anxiety -High risk for ineffective therapeutic regimen management related to lack of knowledge -Activity intolerance related to fatigue

-Ineffective coping related to anxiety 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 is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. -Inflamed airways that obstruct airflow -Mucus secretions that block airways -Overinflated alveoli that impair gas exchange -Dry airways that obstruct airflow -Decreased numbers of goblet cells

-Inflamed airways that obstruct airflow -Mucus secretions that block airways -Overinflated alveoli that impair gas exchange Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? -It helps prevent early airway collapse. -It increases inspiratory muscle strength. -It decreases use of accessory breathing muscles. -It prolongs the inspiratory phase of respiration.

-It helps prevent early airway collapse. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? -Restricting oral intake to 1,000 mL/day -Providing the client a low-sodium diet -Performing chest physiotherapy as ordered -Discussing palliative care and end-of-life issues with the client

-Performing chest physiotherapy as ordered Nursing care includes helping clients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

The client is prescribed albuterol 2 puffs as a metered-dose inhaler. Which action by the client demonstrates understanding of administration for this medication? -Positions the inhaler 2 finger widths away from the lips -Carefully holds the inhaler upright without shaking it -Holds the breath for 5 seconds after administering the medication -Immediately repeats the second puff after the first puff

-Positions the inhaler 2 finger widths away from the lips To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 2 finger widths away from lips. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.

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? -Cromolyn sodium -Theo-Dur -Serevent -Proventil

-Proventil 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 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 -Dilated and reactive pupils -Urine output of 40 ml/hour -Heart rate of 100 beats/minute

-Respiratory rate of 22 breaths/minute In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

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 -Dyspnea -A dry, hacking cough -Tachycardia

-Sharp, stabbing chest pain 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.

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 -Streptococcus pneumonia and varicella -Haemophilus influenzae and varicella -Haemophilus influenzae and Gardasil

-Streptococcus pneumonia and Haemophilus influenzae Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for females ages 9 to 26 years.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? -Avoid contact with fur-bearing animals. -Change filters on heating and air conditioning units frequently. -Take ordered medications as scheduled. -Avoid goose down pillows.

-Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.

Why would a client with COPD report feeling fatigued? Select all that apply. -The client is using all expendable energy just to breathe. -Muscle function gradually decreases over time in clients with COPD. -The client is using all expendable energy for activities of daily living (ADLs). -Lung function gradually decreases over time in clients with COPD.

-The client is using all expendable energy just to breathe. -Lung function gradually decreases over time in clients with COPD. The client is using all expendable energy just to breathe. Lung function, not muscle function, gradually decreases over time in clients with COPD. In a client with COPD, fatigue and a feeling of exhaustion stem directly from the disease, not from activity level.

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

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

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

-uses the sternocleidomastoid muscles. 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.