Ch 24: Management of Patients with Chronic Pulmonary Disease

- to combat dehydration - to loosen secretions - 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?

providing 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?

"I can't use a spacer or holding chamber with the MDI."

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?

atelectasis

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

lung sounds

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?

inhaled albuterol (Ventolin)

A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?

impaired gas exchange related to airflow obstruction

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

oxygen through nasal cannula at 2 L/minute

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?

anxiety

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?

albuterol

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?

"Have you tried to quit smoking before?"

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

atelectasis

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:

give the nebulizer treatment herself

A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to:

emphysema

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?

collects sputum for culture and sensitivity

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?

respiratory acidosis

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

IgE-mediated

Asthma is cause by which type of response?

moderate COPD

The classification of Stage II of COPD is defined as

very severe COPD

The classification of Stage IV of COPD is defined as

exhales hard and fast with a single blow

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

- wheezes - decreased airflow - compromised gas exchange

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

mast cells

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?

exposure to tobacco smoke

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)?

allergy

Which is the strongest predisposing factor for asthma?

- sudden chest pain - asymmetry of chest movement - unilateral retractions - oxygen desaturation

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.

bronchitis

Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation?

a severe asthma episode that is refractory to initial therapy

Which of the following is accurate regarding status asthmaticus?

- Montelukast - Zafirlukast - Zileuton

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.

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

Which statement describes emphysema?

respiratory rate of 22 breaths per minute

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

FEV1>80%

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.)

"I do not need to rinse my mouth with this type of inhaler."

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

diminished or absent breath sounds on the affected side

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:

- prevent airway collapse - control the rate and depth of respirations - release air trapped in the lungs

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals?

an inhaled beta2-adrenergic agonist

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?

- status asthmaticus - respiratory failure - atelectasis

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply.

- inflamed airways that obstruct airflow - mucus secretions that block airways - overinflated alveoli that impair gas exchange

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)?

"I need to hold my breath as long as possible after I take a deep inhalation."

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?

performing chest physiotherapy as ordered

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?

both procedures improve the overall quality of life of a client with COPD

Which statement is true about both lung transplant and bullectomy?

barrel chest

Which type of chest configuration is typical of a client with COPD?