PrepU - Chapter 11 - Nursing Management of Patients Diagnosed with COPD and Asthma

Long-term oxygen therapy has been prescribed for a patient whose chronic obstructive pulmonary disease (COPD) has recently increased in severity. When teaching this patient about this treatment modality, what information should the nurse provide? "Try to predict those situations where you'll need oxygen and apply your nasal prongs 30 minutes ahead of time." "In time, you will learn to effectively adjust your flow rates depending on the dyspnea you are experiencing or that you anticipate." "A good rule of thumb is to temporarily stop your oxygen whenever you feel like you could comfortably go without it." "It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time."

"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time." Explanation: Patients requiring oxygen therapy need to be taught the importance of adhering to the oxygen prescription. Patients often think they can tell when they need oxygen by their symptoms. The presence or absence of dyspnea is unreliable in detecting the need for supplemental oxygen. Many hypoxemic patients do not feel dyspnea. Additionally, many patients who are dyspneic do not have significant hypoxemia or oxygen desaturation.

A client's plan of care specifies postural drainage. Which action should the nurse perform when providing this noninvasive therapy? Administer the treatment with the client in a high Fowler or semi-Fowler position. Perform the procedure immediately following the client's meals. The client is instructed to avoid coughing during the therapy. Assist the client into a position that will allow gravity to move secretions.

Assist the client into a position that will allow gravity to move secretions. Explanation: In postural drainage, the client assumes a position that allows gravity to facilitate the draining of secretions from all areas of the lungs. Postural drainage is usually performed two to four times per day, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Because the client usually sits in an upright position (i.e., high- or semi-Fowler position), secretions are likely to accumulate in the lower parts of the lungs. Several other positions are used in postural drainage so that the force of gravity helps move secretions from the smaller bronchial airways to the main bronchi and trachea. The client is encouraged to cough and remove secretions during postural drainage.

A nurse is teaching a client about asthma. Which symptom should be included with the teaching? Select all that apply. Chest tightness Dyspnea Crackles Wheezing Cough

Chest tightness Wheezing Dyspnea Cough Explanation: The common symptoms of asthma are cough, chest tightness, dyspnea, and wheezing. In some instances, cough may be the only symptom. Crackles are not generally seen with asthma; they are associated with excess fluid in the lungs as with pneumonia.

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." "I can refer you to the American Lung Association." "Have you tried to quit smoking before?" "Many options are available for you."

Correct response: "Have you tried to quit smoking before?" Explanation: 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.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "I will take a slow, deep breath in after pushing down on the MDI." "I will shake the MDI container before I use it." "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."

Correct response: "I can't use a spacer or holding chamber with the MDI." Explanation: 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 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? "If I use the spacer, I know I am only supposed to push on the inhaler once." "I will make sure to take a slow, deep breath as I push on my inhaler." "I do not need to rinse my mouth with this type of inhaler." "After I breathe in, I will hold my breath for 10 seconds."

Correct response: "I do not need to rinse my mouth with this type of inhaler." Explanation: Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

Which statement describes emphysema? A disease of the airways characterized by destruction of the walls of overdistended alveoli Chronic dilatation of a bronchus or bronchi 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

Correct response: A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: 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.

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? Albuterol Fluticasone propionate Ipratropium bromide Ipratropium bromide and albuterol sulfate

Correct response: Albuterol Explanation: 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.

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? Imbalanced nutrition: More than body requirements Impaired swallowing Anxiety Unilateral neglect

Correct response: Anxiety Explanation: 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.

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 Pneumonia Pleurisy Emphysema

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

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.

Correct response: Both procedures improve the overall quality of life of a client with COPD. Explanation: 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.

A patient's history, physical exam, and pulmonary function testing have culminated in a diagnosis of chronic obstructive bronchitis. The nurse who is providing care for this patient will understand that the effects of the disease are primarily attributable to: Autoimmune of alveoli Decreased respiratory drive Chronic mucus hypersecretion A reduction in oxygen binding sites on erythrocytes

Correct response: Chronic mucus hypersecretion Explanation: In patients with chronic obstructive bronchitis, chronic mucus hypersecretion causes lung function decline, exacerbations, and infections. The disease does not have an autoimmune etiology and is not caused by a reduction in respiratory drive. As well, red cells do not lack oxygen binding sites in patients with bronchitis.

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? Increased sputum production Hyperthermia Decreased activity tolerance Decreased oxygen requirements

Correct response: Decreased oxygen requirements Explanation: A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements.

The admitting nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse the need to monitor the patient for what related signs and symptoms? Bronchospasm and clubbing of the fingers Dyspnea and hypoxemia Hypoxemia and clubbing of the fingers Clubbing of the fingers and cyanosis

Correct response: Dyspnea and hypoxemia Explanation: These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Clubbing of the fingers is not a sign of COPD. Cyanosis is a sign of hypoxemia.

n 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 normal expiration Highest airflow during a normal inspiration Highest airflow during a forced expiration Highest airflow during a forced inspiration

Correct response: Highest airflow during a forced expiration Explanation: A peak flow meter is a small hand-held device that measures the fastest flow the patient can generate after taking a deep breath in and blowing out as hard and fast as possible.

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

Correct response: I Explanation: 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.

Asthma is cause by which type of response? IgE-mediated IgM-mediated IgD-mediated IgA-mediated

Correct response: IgE-mediated Explanation: Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.

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? Inhaled cromolyn sodium (Intal) Oxygen therapy Inhaled albuterol (Ventolin) Oral theophylline (Theo-Dur)

Correct response: Inhaled albuterol (Ventolin) Explanation: For intermittent asthma, the preferred treatment is with an inhaled short-acting beta2-agonist. The other treatments are for persistent asthma.

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? Skin color Respiratory rate Lung sounds Heart rate

Correct response: Lung sounds Explanation: A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. Which method of oxygen delivery is most appropriate for the client's needs? Nonrebreathing mask Nasal cannula Partial-rebreathing mask Venturi mask

Correct response: Nasal cannula Explanation: A nasal cannula is used when the client requires a low to medium concentration of oxygen for which precise accuracy is not essential. The Venturi mask is used primarily for clients with COPD because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The client's respiratory status does not require a partial- or non-rebreathing mask.

The patient is having pulmonary function studies performed. The patient has a spirometry test and has a FEV1/FVC ratio of 60%. This finding suggests: Strong exercise tolerance. Exhalation volume is normal. Healthy lung volumes. Obstructive lung disease.

Correct response: Obstructive lung disease. Explanation: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is a FEV1/FVC ratio less than 70%.

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? Avoiding the use of oxygen to decrease the hypoxic drive Increasing pH Providing sufficient oxygen to improve oxygenation Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise

Correct response: Providing sufficient oxygen to improve oxygenation Explanation: The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

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

Correct response: Respiratory acidosis Explanation: 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 administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Heart rate of 100 beats/minute Dilated and reactive pupils Respiratory rate of 22 breaths/minute Urine output of 40 ml/hour

Correct response: Respiratory rate of 22 breaths/minute Explanation: 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.

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 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 with a small amount of liquid.

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

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) and is now performing discharge teaching with this patient. What should the nurse include in the teaching about breathing techniques? Make inhalation longer than exhalation. Exhale through a wide open mouth. Use diaphragmatic breathing. Use chest breathing.

Correct response: Use diaphragmatic breathing. Explanation: Inspiratory muscle training and breathing retraining may help improve breathing patterns. Pursed-lip breathing helps slow expiration, prevent collapse of small airways, and control the rate and depth of respiration. It also promotes relaxation, which allows patients to gain control of dyspnea and reduce feelings of panic. Diaphragmatic breathing, not chest breathing, increases lung expansion, although its benefits have been shown to be limited.

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

Correct response: implementing measures to clear pulmonary secretions. Explanation: 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.

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

Mast cells Explanation: 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.

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply. Nicotine gum Clonidine Caffeine Bupropion SR Acetaminophen

Nicotine gum Clonidine Bupropion SR Explanation: First-line therapy includes nicotine gum as well as the antidepressants bupropion SR and nortriptyline. Second-line pharmacotherapy includes the antihypertensive agent clonidine. However, the use of clonidine is limited by its side effects. Varenicline, a nicotinic acetylcholine receptor partial agonist, may also assist in smoking cessation.

The nurse is planning the care of a complex elderly patient who has been admitted to the medical ward for the treatment of cellulitis. The nurse notes that the patient has a longstanding history of chronic obstructive pulmonary disease (COPD). What assessment finding would most clearly indicate the need for oxygen therapy? SaO2 of 86% on room air Respiratory rate (RR) of 25 breaths per minute at rest Presence of an occasional productive cough Presence of bilateral fine crackles to lower lung fields on auscultation

SaO2 of 86% on room air Explanation: Crackles, coughing, and increased RR are all consistent with COPD. However, the decision on whether to apply oxygen therapy is most commonly made on the basis of oxygen levels as determined by pulse oximetry.

A student nurse is developing a teaching plan for a patient with chronic obstructive pulmonary disease (COPD). What should the student include as a priority area of teaching? Adopting a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity Setting and accepting realistic short-term and long-range goals Avoiding extremes of heat and cold Avoiding emotional disturbances and stressful situations that might trigger a coughing episode

Setting and accepting realistic short-term and long-range goals Explanation: A major area of teaching involves setting and accepting realistic short-term and long-range goals. The other options should also be included in the teaching plan, but they are not areas that are as significant as setting and accepting realistic goals.

The nurse recognizing a female patient's susceptibility to infection due to her history of chronic obstructive pulmonary disease (COPD). When teaching this patient to reduce her risk of infection in the community, what measure should the nurse emphasize to the patient? Washing her hands frequently and thoroughly Avoiding contact with individuals who have not received an influenza vaccination Avoiding abrupt transitions from cold air to hot air Remaining indoors when possible during allergy season

Washing her hands frequently and thoroughly Explanation: Patients with COPD should be encouraged to avoid sick individuals and to receive an annual flu vaccination. However, the most important infection-control measure is vigilant handwashing. Temperature transitions do not lead to infections. Allergens can exacerbate COPD, but they do not play a major role in the development of infection.

A hospital patient with a complex medical history that includes asthma has rung his call bell and states that he is having an asthma attack. The nurse has completed a rapid assessment of the patient and has identified the need for pharmacologic interventions. After consulting the patient's medication administration record, the nurse should administer a p.r.n. dose of: Ipratropium (Atrovent) Hydromorphone (Dilaudid) Albuterol (Ventolin) Fluticasone (Flovent)

Albuterol (Ventolin) Explanation: Short-acting beta-adrenergics (SABAs), such as Ventolin, are used as needed for quick relief. Opioids, anticholinergics, and corticosteroids are not used for this purpose.

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

Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

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

Correct response: severe COPD. Explanation: 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.

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? 1,800-calorie ADA Low-fat Full-liquid High-protein

High-protein Explanation: 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.

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 Explanation: 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.

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

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

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

very severe COPD. Explanation: 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.