Adult 1 Exam 4 Ch. 24 Chronic Pulmonary Disease
A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this clients airflow obstruction?
-Administer an inhaled beta-adrenergic agonist *Quick-acting beta-adrenergic meds are used first for prompt relief of airflow obstruction. *Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication. (prednisone)
A nurse is assessing a pt who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply.
-Airway obstruction -Pulmonary infections -Genetic disorders
A nurse is caring for a pt who has been hospitalized w/ an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this pt to gain underlying control of persistent asthma?
-Anti-inflammatory drugs *Bc the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily w/ regular use of anti-inflammatory meds.
An interdisciplinary team is planning the care of a pt w/ bronchiectasis. What aspects of care should the nurse anticipate? Select all that apply.
-Antimicrobial therapy -Chest physiotherapy -Smoking cessation *Chest physiotherapy, antibiotics, and smoking cessation are cornerstones of the care of pts w/ bronchiectasis
A nurse is preparing to perform an admission assessment on a pt w/ COPD. It is most important for the nurse to review which of the following?
-Available diagnostic tests *In addition to the pts history, the nurse reviews the results of available diagnostic tests
A nurse is completing a focused respiratory assessment of a child w/ asthma. What assessment finding is most closely associated w/ the characteristic s/s of asthma?
-Bilateral wheezes *The 3 most common symptoms of asthma are cough, dyspnea, and wheezing
A nurse is working w/ a child who is undergoing a diagnostic workup for suspected asthma. What are the s/s that are consistent w/ a dx of asthma? Select all that apply.
-Chest tightness -Wheezing -Cough -Dyspnea
A nurse is documenting the results of assessment of a pt w/ bronchiectasis. What would the nurse most likely include in documentation?
-Clubbing of the fingers *Characteristic symptoms of bronchiectasis include chronic cough and production of purulent sputum in copious amounts. *Clubbing of the fingers also is common because of respiratory insufficiency
A nurse is caring for a pt who has been admitted w/ an exacerbation of chronic bronchiectasis. The nurse should expect to assess the pt for which of the following clinical manifestations?
-Copious sputum production *Hemoptysis (cough up blood), chronic cough, copious purulent sputum, and clubbing of the fingers *Bc of the copious production of sputum, the cough is rarely dry.
A student nurse is preparing to care for a pt w/ bronchiectasis. The student nurse should recognize that this pt is likely to experience respiratory difficulties related to what pathophysiologic process?
-Dilation of bronchi and bronchioles *Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue.
A nurse is evaluating the diagnostic study data of a pt w/ suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of CF?
-Elevated sweat chloride concentration *Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions.
A pts severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the pts statements suggests a need for further education?
-I'll make sure to use this each time I feel an asthma attack coming on. *LABAs are not used for management of acute asthma symptoms. Tachycardia is a potential adverse effect and decreased protection against exercise-induced bronchospasm may occur w/ regular use.
A nurse is caring for a pt w/ COPD. The pts med regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status? Select all that apply.
-Increased expiratory flow rate -Relief of dyspnea *The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes as well as by assessing the dyspnea and making sure that it has lessened
A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation bc smoking has what pathophysiologic effect?
-Increases the amount of mucus production *Smoking irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, which, in turn, produces more irritation, infection, and damage to the lung.
A nurse is caring for a young adult pt whose medical history includes an alpha1-antitrypsin deficiency. This deficiency predisposes the pt to what health problem?
-Lobular emphysema *A host risk factor for COPD is a deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking.
A pt is having pulmonary-function studies performed. The pt performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding?
-Obstructive lung disease *Obstructive lung disease is apparent when an FEV1/FVC ratio is less than 70%.
A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the child's nutritional status, what intervention should most likely be included in the plan of care?
-Pancreatic enzyme supplementation with meals *Nearly 90% of pts w/ CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals
A pediatric nurse practitioner is caring for a child who has just been dx w/ asthma. The nurse has provided the parents w/ info that includes potential causative agents for an asthmatic rx. What potential causative agent should the nurse describe?
-Pets *Common causative agents that may trigger an asthma attack: dust, dust mites, pets, soap, certain foods, molds, and pollen.
A pt arrives in the ER w/ an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patients care?
-Postural chest drainage *Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection
A nurse is creating a health promotion intervention focused on COPD. What should the nurse identify as a complications of COPD?
-Respiratory failure, pneumothorax, atelectasis, pneumonia, and pulmonary hypertension (corpulmonale)
A clinic nurse is caring for a pt who has just been dx w/ COPD. The pt asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurses best answer?
-The most important risk factor for COPD is cigarette smoking. *Occupational risks are significant but are far exceeded by smoking. *Lack of exercise and exposure to dust and pollen are NOT risk factors for COPD.
A nurse is explaining to a pt w/ asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give?
-To gain prompt control of inadequately controlled, persistent asthma *Prednisone is used for a short-term (310 days) burst to gain prompt control of inadequately controlled, persistent asthma.
A nurse is providing dc teaching for a client w/ COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?
-Use diaphragmatic breathing *Inspiratory muscle training and breathing retraining may help improve breathing patterns in patients w/ COPD. Training in diaphragmatic breathing reduces the resp rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration
A nurses assessment reveals that a pt w/ COPD may be experiencing bronchospasm. What assessment finding would suggest that the pt is experiencing bronchospasm?
-Wheezes or diminished breath sounds on auscultation *Bronchospasm usually results in rapid, inefficient breathing and agitation.
The nurse is assessing a pt whose respiratory disease is characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
A barrel chest
Bronchiectasis is...
A chronic, irreversible dilation of the bronchi and bronchiole
Bronchiectasis may be caused by...
A variety of conditions, including airway obstruction, diffuse airway injury, pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections, or genetic disorders such as cystic fibrosis.
Wheezes on auscultation are common in patients w/
Asthma
A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF?
Bronchial mucus plugging, inflammation, and eventual bronchiectasis
An increased A-P diameter is noted in patients w/
COPD
A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize?
Chronic inhalation of indoor toxins can cause lung damage.
A nurse is teaching a pt w/ asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching?
Cough and oral thrush
Chloride levels are relevant to...
Cystic Fibrosis
Reduces the respiratory rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration...
Diaphragmatic breathing
An admitting nurse is assessing a pt w/ COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the pt for what?
Dyspnea and hypoxemia
An asthma nurse educator is working w/ a group of adolescent asthma pts. What intervention is most likely to prevent asthma exacerbations among these pts?
Educating pts about recognizing and avoiding asthma triggers
An asthma educator is teaching a pt newly dx w/ asthma and her family about the use of a peak flow meter. The educator should teach the pt that a peak flow meter measures what value?
Highest airflow during a forced expiration
The case manager for a group of pts w/ COPD is providing health education. What is most important for the nurse to assess when providing instructions on self-management to these pts?
Knowledge about self-care and their therapeutic regimen
Sudden pleuritic chest pain is a common manifestation of...
Pulmonary embolism
Helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration.
Pursed-lip breathing
A nurse is developing a teaching plan for a pt w/ COPD. What should the nurse include as the most important area of teaching?
Setting and accepting realistic short- and long-range goals
A nursing is planning the care of a pt w/ emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care?
Setting realistic short-term and long-range goals
A pt w/ emphysema is experiencing shortness of breath. To relieve this pts symptoms, the nurse should assist her into what position?
Sitting upright, leaning forward slightly
A student nurse is developing a teaching plan for an adult pt w/ asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
Take prescribed medications as scheduled.
A nurse is admitting a new pt who has been admitted w/ a dx of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
Teach the pt strategies for promoting diaphragmatic breathing.
A nurse is providing health education to the family of a pt w/ bronchiectasis. What should the nurse teach the pts family?
The correct technique for providing postural drainage
An older adult pt has been dx w/ COPD. What characteristic of the pts current health status would preclude(prevent) the safe and effective use of a metered-dose inhaler (MDI)?
The patient has severe arthritis in her hands.
A nurse is planning the care of a pt w/ bronchiectasis. What goal of care should the nurse prioritize?
The pt will successfully mobilize pulmonary secretions.