Chapter 24: Management of Patients With Chronic Pulmonary Disease
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? Heart rate Respiratory rate Skin color Lung sounds
Lung sounds
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: "I can refer you to the American Lung Association." "Nicotine patches would be appropriate for you." "Have you tried to quit smoking before?" "Many options are available for you."
"Have you tried to quit smoking before?"
Histamine, a mediator that supports the inflammatory process in asthma, is secreted by Lymphocytes Neutrophils Mast cells Eosiniphils
Mast cells
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis
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 nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Take ordered medications as scheduled. Avoid contact with fur-bearing animals. Change filters on heating and air conditioning units frequently. Avoid goose down pillows.
Take ordered medications as scheduled.
Which statement describes emphysema? Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years A disease that results in reversible airflow obstruction, a common clinical outcome A disease of the airways characterized by destruction of the walls of overdistended alveoli Chronic dilatation of a bronchus or bronchi
A disease of the airways characterized by destruction of the walls of overdistended alveoli
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. Mucus secretions that block airways Decreased numbers of goblet cells Inflamed airways that obstruct airflow Overinflated alveoli that impair gas exchange Dry airways that obstruct airflow
Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Respiratory acidosis Metabolic acidosis Respiratory alkalosis Metabolic alkalosis
Respiratory acidosis
The classification of Stage II of COPD is defined as moderate COPD. mild COPD. very severe COPD. at risk for COPD. severe COPD.
moderate COPD.
A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? "I will make sure to take a slow, deep breath as I push on my inhaler." "If I use the spacer, I know I am only supposed to push on the inhaler once." "After I breathe in, I will hold my breath for 10 seconds." "I do not need to rinse my mouth with this type of inhaler."
"I do not need to rinse my mouth with this type of inhaler."
Which statement describes emphysema? Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years 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 Chronic dilatation of a bronchus or bronchi
A disease of the airways characterized by destruction of the walls of overdistended alveoli
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 Foradil Isuprel Atrovent
Albuterol
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. Prednisone is a corticosteroid. Ciprofloxacin is an antibiotic. Dexamethasone is an antibiotic. Cotrimoxazole is a bronchodilator. Albuterol is a bronchodilator.
Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.
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 Pneumonia Pleurisy
Atelectasis
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? Emphysema Atelectasis Pneumonia Pleurisy
Atelectasis
You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what? Side effects of medication therapy Atelectasis Pain Impaired physical mobility
Atelectasis For a client with obstructive pulmonary disease, atelectasis is one of the conditions for which nursing actions are identified to detect, manage, and minimize the unexpected outcomes.
Which statement is true about both lung transplant and bullectomy? Both aim to cure COPD. Both aim to treat end-stage emphysema. Both are used to treat clients with bullous emphysema. Both aim to improve the overall quality of life of a client with COPD.
Both aim to improve the overall quality of life of a client with COPD.
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.
Which symptoms are considered primary symptoms of COPD? Dyspnea upon exertion Sputum production Weight gain Cough
COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Weight loss is common with COPD.
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? Infectious agents Air pollution Cigarette smoking Allergens
Cigarette smoking
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Jugular vein distention Wheezes Decreased airflow Ascites Compromised gas exchange
Compromised gas exchange Decreased airflow Wheezes
A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. Crackles Wheezing Dyspnea Cough
Cough Wheezing Dyspnea
A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? Theophylline Cromolyn sodium Budesonide Albuterol
Cromolyn sodium
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 Levalbuterol HFA Albuterol Ipratropium
Cromolyn sodium
A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to Exhale slowly Perform upper chest breaths Increase the flow of oxygen Take deep breaths
Exhale slowly When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.
Which exposure accounts for most cases of COPD? Passive smoking Occupational exposure Ambient air pollution Exposure to tobacco smoke
Exposure to tobacco smoke
An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure? Highest airflow during a forced expiration Highest airflow during a forced inspiration Highest airflow during a normal inspiration Highest airflow during a normal expiration
Highest airflow during a forced expiration
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? III IV I II
II All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%. Page 622
Asthma is cause by which type of response? IgM-mediated IgA-mediated IgD-mediated IgE-mediated
IgE-mediated
Which measure may increase complications for a client with COPD? Administration of antibiotics Increased oxygen supply Decreased oxygen supply Administration of antitussive agents
Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications. Page 626
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? Intravenous methylprednisolone (Solu-Medrol) 120 mg Vancomycin 1 gram intravenously over 1 hour Ipratropium bromide (Alupent) by metered-dose inhaler Oxygen through nasal cannula at 2 L/minute
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.
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 Combivent Flovent Atrovent
Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.
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 Heart rate of 100 beats/minute Dilated and reactive pupils Urine output of 40 ml/hour
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 Dyspnea Tachycardia A dry, hacking cough
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.
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 Chest pain during respiration Tachypnea and tachycardia Fever, chills, and diaphoresis
Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
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. Pertussis Thoracentesis Respiratory failure Atelectasis Status asthmaticus
Status asthmaticus Respiratory failure Atelectasis
For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? Enforcing absolute bed rest Administering ordered sedatives regularly and in large amounts Teaching the client how to perform controlled coughing Restricting fluid intake to 1,000 ml/day
Teaching the client how to perform controlled coughing
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes providing the client a low-calorie, high-fiber diet. teaching the family how to perform postural drainage. instructing the client on the signs of respiratory infection. implementing measures to clear pulmonary secretions.
implementing measures to clear pulmonary secretions.
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 classification of Stage IV of COPD is defined as mild COPD. very severe COPD. at risk for COPD. severe COPD. moderate COPD.
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? High-protein Low-fat 1,800-calorie ADA Full-liquid
High-protein
Which drug is second-line pharmacotherapy for smoking abstinence? Clonidine Buproprion SR Nortriptyline Nicotine gum
Clonidine (Catapres) Second-line pharmacotherapy includes the antihypertensive agent clonidine. Alpha 2 agonist, peripheral vasodilation. However, its use is limited by its side effects. First-line therapy includes nicotine gum, nortriptyline, and buproprion SR.
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 ___%. 54 mm Hg; 84% 56 mm Hg; 86% 60 mm Hg; 90% 58 mm Hg; 88%
60 mm Hg; 90%
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.) FEV1 = 70% FEV1 = 30% FEV1 > 80% FEV1 = 50%
FEV1 > 80% The FEV1 decreases as the severity of obstruction increases. Therefore, an FEV1 of more than 80% indicates an initial stage, and an FEV1 of 30% indicates a very severe stage. Page 622
In which grade of COPD is the forced expiratory volume (FEV) less than 30%? I II III IV
III Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 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? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis
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.
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
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. Bilaterally equal breath sounds Sudden chest pain Unilateral retractions Asymmetry of chest movement Oxygen desaturation
Sudden chest pain Asymmetry of chest movement Unilateral retractions Oxygen desaturation
Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test? Lumbar puncture Arterial blood gases Pulmonary function studies Sweat chloride concentration
Sweat chloride concentration
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 Increase oxygen distribution Reduce airway obstruction Decrease alveolar ventilation
Alter smooth muscle tone Reduce airway obstruction Increase oxygen distribution
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 Pneumonia Atelectasis Emphysema Pleurisy
Atelectasis
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 Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Avoiding the use of oxygen to decrease the hypoxic drive 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.
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? "Limit yourself to smoking only 2 cigarettes per day." "Weigh yourself daily and report a gain of 2 lb in 1 day." "Maintain bed rest." "Eat a high-sodium diet."
"Weigh yourself daily and report a gain of 2 lb in 1 day."
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client Has a respiratory rate of 28 breaths/minute Cannot perform activities of daily living Has wheezes in the right lung lobes Reports shortness of breath
Has wheezes in the right lung lobes
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Metabolic alkalosis Respiratory acidosis Respiratory alkalosis Metabolic acidosis
Respiratory acidosis As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.
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 Impaired swallowing Unilateral neglect Imbalanced nutrition: More than body requirements
Anxiety
Which of the following is a symptom diagnostic of emphysema? Copious sputum production The occurrence of cor pulmonale Normal elastic recoil Dyspnea
Dyspnea Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis.
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 a small amount of liquid. The patient should take the medication an hour before meals or 2 hours after a meal. 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 nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.
Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply. Gastrointestinal viruses Hypertension Tracheobronchial infection Air pollution Fractured hip
Air pollution Tracheobronchial infection
Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. Ipratropium HFA (Atrovent) Zafirlukast (Accolate) Zileuton (Zyflo) Montelukast (Singulair) Tiotropium (Spiriva)
Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo) Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.
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: tracheal deviation to the unaffected side. muffled or distant heart sounds. paradoxical chest wall movement with respirations. diminished or absent breath sounds on the affected side.
diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.
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? Theo-Dur Serevent Proventil Cromolyn sodium
Proventil Short-acting beta2-adrenergic agonists (albuterol [AccuNeb, Proventil, Ventolin], levalbuterol are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium is an 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).