Ch. 24 PrepU

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

What are the primary causes for an acute exacerbation of COPD?

Air pollution Tracheobronchial infection

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

A nurse is teaching a client about bronchodilators. What bronchodilator actions that relieve bronchospasm should the nurse include in the client teaching?

Alter smooth muscle tone Reduce airway obstruction Increase oxygen distribution

The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first?

An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctors office

A client with asthma is being treated with albuterol. Which of the findings from the client's history would indicate to the nurse the need to administer this drug with caution?

Angina

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

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?

Cromolyn sodium

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

Decreased oxygen requirements

The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted?

Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries

Which measure may increase complications for a client with COPD?

Increased oxygen supply

A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home?

Inhaled beclomethasone

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

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?

Release air trapped in the lungs Control the rate and depth of respirations Prevent airway collapse

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:

Respiratory acidosis

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

Why would a client with COPD report feeling fatigued?

The client is using all expendable energy just to breathe Lung function gradually decreases over time in clients with COPD

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

A commonly prescribed methylxanthine used as a bronchodilator is which of the following?

Theophylline

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

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?

To combat dehydration To loosen secretions to facilitate expectoration

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in?

I

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

I

A nurse is admitting a client with emphysema. What are presenting findings the nurse should assess?

chronic cough, dyspnea

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?

cromolyn sodium

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?

Administer the salmeterol and then administer the triamcinilone

A client is being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs?

Administration of antibiotics

The physician has ordered albuteral for the patient in respiratory distress. The nurse recognizes this drug is in what class of medications?

Adrenergic antagonist

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

An inhaled beta2- adrenergic agonist

A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD).

Asks the client, "what are your allergies?"

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

Bullae

A nurse is teaching a client about asthma. What symptoms should be included with the teaching?

Chest tightness, Wheezing, Dyspnea, Productive cough

Which drug is second-line pharmacotherapy for smoking abstinence?

Clonidine

Which exposure accounts for most cases of COPD?

Exposure to tobacco smoke

A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use?

I make sure my oxygen mask is on tightly so it won't fall off while I nap

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 need to hold my breath as long as possible after i take a deep inhalation

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?

Ineffective coping related to 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)?

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange

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

Montelukast Zafirlukast Zileuton

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications?

Nicotine gum Bupropion SR Nortriptyline

A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals?

Provide medical support for the current exacerbation Treat the underlying cause of the event Return the client to their original functioning abilities Provide long-term support for medical management

Which diagnostic test is most accurate in assessing acute airway obstruction?

Pulmonary function studies

Which diagnostic test is the most accurate in assessing acute airway obstruction?

Pulmonary function studies

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

Which of the following is a clinical manifestation of a pneumothorax?

Sudden chest pain Asymmetry of the chest movement Unilateral retractions Oxygen desaturation

Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test?

Sweat chloride concentration

A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed?

With meals

Which statement describes emphysema?

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

A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions?

BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3*F

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 grade of COPD is the forced expiratory volume in 1 second (FEV1) less than 30% predicted?

IV

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?

If coughing occurs during the procedure, repeat it

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