Respiratory - Management of Patients With COPD

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:

USES THE STERNOCLEIDOMASTOID MUSCLES

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct (3) of the following options.

- INCREASE OXYGEN DISTRIBUTION - ALTER SMOOTH MUSCLE TONE - REDUCE AIRWAY OBSTRUCTION

Which of the following is a symptom diagnostic of emphysema?

DYSPNEA

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 DO NOT NEED TO RINSE MY MOUTH WITH THIS TYPE OF INHALER"

The classification of grade I COPD is defined as:

MILD COPD

The classification of Stage II of COPD is defined as:

MODERATE COPD

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse?

"YOU AND YOUR PHYSICIAN SHOULD DISCUSS THE OPTIONS THATARE AVAILABLE FOR TREATMENT"

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? (2)

- AIR POLLUTION - TRACHEOBRONCHIAL INFECTION

A nursing instructor is discussing asthma and its complications with med-surg nursing students. Which of the following would the group identify as complications of asthma?

- ATELECTASIS - RESPIRATORY FAILURE - STATUS ASTHMATICUS

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

- MONTELUKAST (singulair) - ZAFIRLUKAST (accolate) - ZILEUTON (zyflo)

A nursing student is taking a pathophysiology exam. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of COPD? Choose all that apply.

- MUCUS SECRETIONS THAT BLOCK AIRWAYS - INFLAMED AIRWAYS THAT OBSTRUCT AIRFLOW - OVERINFLATED ALVEOLI THAT IMPAIR GAS EXCHANGE

The diagnosis of pulmonary hypertension associated with COPD is suspected when which of the following is noted?

- RIGHT VENTRICULAR ENLARGEMENT - ELEVATED PLASMA BRAIN NATRIURETIC PEPTIDE (BNP) - DYSPNEA AND FATIGUE DISPROPORTIONATE TO PULMONARY FXN ABNORMALITIES - ENLARGEMENT OF CENTRAL PULMONARY ARTERIES

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 aterial oxygen saturation (SaO2) of at least ___%

60 mm Hg; 90%

A client is prescribed metaproterenol 20 mg four times each day. How many mg of metaproterenol does the client take each day?

80

Which of the following is accurate regarding status asthmaticus?

A SEVERE ASTHMA EPISODE THAT IS REFRACTORY TO INITIAL THERAPY

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

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

At 11 pm, 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 11:30pm, the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

ALBUTEROL (PROVENTIL)

Which is the strongest predisposing factor for asthma?

ALLERGY

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

The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the highest priority action?

ASSESS VITAL SIGNS EVERY 2 HOURS INCLUDING O2 SATURATIONS AND ABG RESULTS.

Which of the following is the most common chronic disease of childhood?

ASTHMA

The nurse should be alert for a complication of bronchiectasis from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as:

ATELECTASIS

e 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

A physician orders trimacinolone (Azmacort) and salmeterol (Serevent) 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 triamcinoclone.

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

BARREL CHEST

Which statement is true about both lung transplant and bullectomy?

BOTH PROCEDURES 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

A client with a history of respiratory problems tells teh nurse that he would like to explore strategies to reduce his risks. He also mentions being currently uneploywed and not wanting to pursue costly strategies. What would the nurse emphasize as the single most cost-effective intervention to reduce the risk of developing COPD or slow its progression?

CESSATION OF SMOKING

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?

CIGARETTE SMOKING

Which drug is second-line pharmacotherapy for smoking abstinence?

CLONIDINE

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:

COLLECTS SPUTUM FOR CULTURE & SENSITIVITY

Which symptoms are considered primary symptoms of COPD?

COUGH

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?

EMPHYSEMA (over-inflation of the airs sacs of the lungs #alveoli)

Which of the following is a common irritant that acts as a trigger of asthma?

ESOPHAGEAL REFLUX

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

EXHALES HARD AND FAST WITH A SINGLE BLOW

Which exposure accounts for most cases of COPD?

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)?

EXPOSURE TO TOBACCO SMOKE

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 nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What staged would the nurse document that patient is in?

III

In which grade of COPD is the forced expiratory volume (FEV) less than 30%?

III

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes:

IMPLEMENTING MEASURES TO CLEAR PULMONARY SECRETIONS

Which measure may increase complications for a client with COPD?

INCREASED OXYGEN SUPPLY

Which of the following is the key underlying feature of asthma?

INFLAMMATION

What vaccine should a nurse encourage a client with COPD to receive?

INFLUENZA

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

Asthma is cased by which type of response?

IgE-MEDIATED

A client has a history of 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?

LUNG SOUNDS

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by:

MAST CELLS

A client being seen in the emergency department has labored respirations. Auscultation reveals inspiratory and expiratory wheezes. Oxygen saturation is 86%. The client was nonresponsive to an albuterol (Ventolin) inhaler and intravenous methylprednisolone (Solu-Medrol). THe nurse administers the following prescribed treatment first:

OXYGEN THERAPY THROUGH A NON-REBREATHER MASK

A client is being seen in the emergency department for exacerbation of COPD. The first action of the nurse is to administer which of the following prescribed treatments?

OXYGEN THROUGH NASAL CANNULA AT 2L/MINUTE

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis. Which nursing intervention will be included in the client's care plan?

PERFORMING CHEST PHYSIOTHERAPY AS ORDERED

A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse assesses the child's medication information and tells the parent to use which inhalant?

PROVENTIL

The patient with asthma is prescribed a SABA for quick relief. Which of the following is the most likely drug to be prescribed?

PROVENTIL

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

RESPIRATORY ACIDOSIS

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

RESPIRATORY ACIDOSIS

In COPD, decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

RESPIRATORY ACIDOSIS

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

RESPIRATORY ACIDOSIS

A client is being admitted to an acute helathcare facility with an exacerbation of COPD. The client has been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home meds with the client .The nurse is placing this info on the Medication Reconciliation Record. Which of the following is incomplete information?

SALMETEROL/FLUTICASONE (Seretide) MDI Daily at 0800

The classification of Stage III of COPD is defined as:

SEVERE COPD

A patient comes into clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

SPUTUM & PRODUCTIVE COUGH

To help prevent infections in client with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccines?

STREPTOCOCCUS PNEUMONIA & HAEMOPHILUS INFLUENZAE

A nurse developing a teaching plan for client with asthma. Which teaching point has the highest priority?

TAKE ORDERED MEDICATIONS AS SCHEDULED

The classification of Stage IV of COPD is defined as:

VERY SEVERE COPD or END-STAGE COPD

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guys

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sorry :(((

A client with COPD expresses a desire to quit smoking. The first appropriate response from the nurse is:

"HAVE YOU TRIED TO QUIT SMOKING BEFORE?"

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

"I CAN'T USE A SPACE OR HOLDING CHAMBER WITH THE MDI"

A home health nurse cisits a client with COPD who requires O2. Which statement by the client indicates the need for additional teaching about home oxygen use?

"I MAKRE SURE MY OXYGEN MASK IS ON TIGHTLY SO IT WON'T FALL OFF WHILE I NAP"

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 = ANTIBIOTIC - ALBUTEROL = BRONCHODILATOR - PREDNISONE = CORTICOSTEROID

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

- COMPROMISED GAS EXCHANGE - DECREASED AIRFLOW - WHEEZES

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 puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply:

- CONTROL THE RATE & DEPTH OF RESPIRATIONS - RELEASE AIR TRAPPED IN THE LUNGS - PREVENT AIRWAY COLLAPSE

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

- WHEEZES - DECREASED AIRFLOW - COMPROMISED GAS EXCHANGE

A client with COPD reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?

DELAY SELF-CARE ACTIVITIES FOR 1 HOUR

A nurse 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:

DIMINISHED OR ABSENT BREATH SOUNDS ON THE AFFECTED SIDE

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client:

HAS WHEEZES IN THE RIGHT LUNG LOBES

A nurse consulting with a nutrition specialist know it's important to consider a special diet for a client with chronic COPD. Which diet is appropriate for this client?

HIGH-PROTEIN

The nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 25% for a patient with COPD. What stage should the nurse document the patient is in?

IV

The classification of Stage I of COPD is defined as:

MILD COPD

The nurse is assigned to care for a patient 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

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

The nurse is caring for a patient with status asthmaticus in the ICU. What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?

RESPIRATORY ALKALOSIS

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