Chapter 30: Asthma and COPD AQ

A patient with asthma performs a peak flow assessment, which is 60% of normal and in the yellow range, and has an oxygen saturation of 94% on room air. Which initial action should the nurse take? 1 Notify the Rapid Response Team. 2 Give the patient oxygen by nasal cannula. 3 Request an order for an oral corticosteroid medication. 4 Administer the ordered PRN short-acting beta 2 agonist

Administer the ordered PRN short-acting beta 2 agonist.

Inhaled corticosteroids are typically used to treat which symptom of asthma? 1 Bronchial spasms 2 Airway inflammation 3 Bronchial secretions 4 Airway hyperresponsiveness

Airway inflammation

What best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease?

Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness

A patient with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first? 1 Albuterol 2 inhalations 2 Salmeterol 2 inhalations 3 Ipratropium 2 inhalations 4 Fluticasone 2 inhalations

Albuterol 2 inhalations

The nurse is performing an admission history on a patient with COPD. The patient reports increased difficulty sleeping, eating, and dressing and has trouble walking even short distances. To facilitate completion of the assessment, what does the nurse do next? 1 Initiates oxygen therapy at a rate of 2 L/min with a nasal cannula 2 Addresses the remaining questions to the patient's family members 3 Assists the patient to put on a hospital gown and lie down as quickly as possible 4 Asks the patient to sit on the edge of the bed and lean forward over the bedside table

Asks the patient to sit on the edge of the bed and lean forward over the bedside table

Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease? 1 Cough 2 Dyspnea 3 Barrel chest 4 Reduced gas exchange

Barrel chest

What two assessment findings are changes secondary to chronic obstructive pulmonary disease (COPD)?

Barrel chest and finger clubbing

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults?

Because of decreased sensitivity of receptors

To some degree, most patients with chronic obstructive pulmonary disease (COPD) have which pathologic processes present? Select all that apply.

Bronchitis Emphysema

Which disorders are lung diseases that cause chronic airflow limitation? Select all that apply.

Chronic bronchitis Intermittent asthma

What are the two major categories of asthma medications?

Control and reliever

The nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD). Which intervention to facilitate adequate caloric intake for this patient is included in the plan of care? 1 Administer bronchodilator medications after meals. 2 Recommend a high-calorie, high-carbohydrate diet. 3 Include high-calorie protein drinks as part of each meal. 4 Encourage frequent rest periods, especially before meals.

Encourage frequent rest periods, especially before meals.

Which signs/symptoms are indicators of an asthma attack? Select all that apply. 1 Eosinophils in the sputum 2 Muscle retraction between the ribs 3 Audible wheeze, especially on exhalation 4 Increased, then decreased arterial carbon dioxide (PaCO 2) level 5 Decreased forced expiratory volume in the first second (FEV 1) on flowmeter

Eosinophils in the sputum Muscle retraction between the ribs Audible wheeze, especially on exhalation Decreased forced expiratory volume in the first second (FEV 1) on flowmeter

A patient admitted with chronic obstructive pulmonary disease (COPD) has a barrel chest with expiratory wheezes in the lower lobes, decreased fremitus, and hyperresonance with chest percussion. What does the nurse expect to see on this patient's chest X-ray?

Flattening of the diaphragm

The nurse is teaching a patient who has chronic obstructive pulmonary disease (COPD) about the need to prevent respiratory infections. Which topic does the nurse include in the patient's teaching? 1 Consuming a well-balanced diet 2 Reporting runny nose and cough 3 Avoiding exposure to cold weather 4 Getting an annual influenza vaccine

Getting an annual influenza vaccine.

A patient with chronic obstructive pulmonary disease (COPD) reports having off-and-on symptoms of dyspnea, coughing, and sputum production. The patient's FEV 1/FVC is 65% of predicted value and the FEV 1 is 55% of predicted value. Which level of COPD severity does this patient have?

II - moderate

Which chemical is responsible for a prolonged inflammatory response, leading to airway obstruction?

Leukotriene

What is the most important reason for ordering inhaled, rather than oral, corticosteroids for patients with asthma? 1 Inhaled corticosteroids are easier to use. 2 Inhaled corticosteroids are more effective. 3 Oral corticosteroids have more adverse effects. 4 Oral corticosteroids have less predictable effects

Oral corticosteroids have more adverse effects.

A patient with asthma reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms. What does the nurse recommend for this patient? 1 Participating in a stretching and light calisthenics program 2 Avoiding aerobic exercise since it will make symptoms worse 3 Using oral corticosteroids to prevent severe asthma symptoms 4 Premedicating with a short-acting bronchodilator before exercise

Premedicating with a short-acting bronchodilator before exercise

Which medication is an example of a long-acting beta 2 agonist (LABA) used in asthma management? 1 Albuterol 2 Salmeterol 3 Terbutaline 4 Levalbuterol

Salmeterol

The patient is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? 1 Corticosteroids 2 Long-acting beta agonists 3 Short-acting beta agonists 4 Nonsteroidal anti-inflammatory drugs (NSAIDs)

Short-acting beta agonists

Which symptom would be found in a patient with respiratory muscle fatigue? 1 Silent chest on auscultation 2 Slow breathing with deep respirations 3 Respiratory rate of 25 to 35 per minute 4 Sucked-in abdominal wall during inspiration

Sucked-in abdominal wall during inspiration

Which nursing intervention will help prevent chronic fatigue in patients with chronic obstructive pulmonary diseases (COPD)? 1 Encouraging the patient to work with the arms raised 2 Teaching the patient to not rush through morning activities 3 Suggesting that the patient avoid high energy-use tasks such as walking 4 Allowing the patient to eat, bathe, and groom himself or herself during acute exacerbations

Teaching the patient to not rush through morning activities

A patient is admitted with asthma. How is this disease differentiated from other chronic lung disorders? 1 The patient is coughing. 2 The patient has dyspnea. 3 It affects only young people. 4 The patient is symptom-free between exacerbations.

The patient is symptom-free between exacerbations.

Which sign/symptom is significant in diagnosing asthma in a nonsmoker?

Wheezing

A patient with asthma reports having chronic pain. The nurse anticipates the provider will recommend which pain medication for this patient? 1 Aspirin 2 Ibuprofen 3 Hydrocodone 4 Acetaminophen

acetaminophen

The nurse is educating the parents of a child about asthma management. The asthma is often triggered by exercise. What statements of the parents indicate a need for further teaching? Select all that apply. 1 "Our child will not eat food containing metabisulfite." 2 "If our child's lips or fingertips turn gray, we will go to the hospital." 3 "Our child should not take aspirin, ibuprofen, acebutolol, or betaxolol unless recommended by our health care provider." 4 "After 30 minutes of exercise, our child will use the bronchodilator." 5 "We will wash all our child's bedding in cold water."

"After 30 minutes of exercise, our child will use the bronchodilator." "We will wash all our child's bedding in cold water."

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is experiencing anxiety. Which of the patient's statements indicates that teaching about anxiety has been successful? Select all that apply.

"I will perform diaphragmatic breathing when I am anxious." "I will attend counseling sessions during periods of emotional distress." "I will take my prescribed antianxiety medication if I begin to feel panicky."

A patient with chronic obstructive pulmonary disease (COPD) is using home oxygen at a flow rate of 4 L/min via nasal cannula, but experiencing only moderate improvement in shortness of breath. Which information would the nurse provide to this patient? 1 "Shortness of breath may continue even with oxygen therapy." 2 "Increase the oxygen flow rate to 6 L/min to improve dyspnea." 3 "Oxygen therapy will eventually reverse the symptoms of COPD." 4 "Use the bronchodilator medication more frequently to improve dyspnea."

"Shortness of breath may continue even with oxygen therapy."

Which statements are correct regarding the drug management of asthma? Select all that apply. 1 Anti-inflammatory medications are used to cause bronchodilation. 2 Long-acting beta agonists are indicated to relieve acute attack symptoms. 3 Reliever medications are used to stop an asthma attack once it has started. 4 Control therapy medications are used to prevent asthma attacks from occurring. 5 Control therapy medications are used to reduce airway responsiveness

- Reliever medications are used to stop an asthma attack once it has started. - Control therapy medications are used to prevent asthma attacks from occurring. - Control therapy medications are used to reduce airway responsiveness.

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly? 1 "I don't have to wait between the two puffs if I use a spacer." 2 "If the spacer makes a whistling sound, I am breathing in too rapidly." 3 "I should shake the inhaler only if I want to see whether it is empty." 4 "I should rinse my mouth and then swallow the water to get all of the medicine."

2 "If the spacer makes a whistling sound, I am breathing in too rapidly."

The nurse is administering oxygen to a patient with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. Which blood oxygen saturation percentage (SpO 2) would the nurse set as a target for therapy?

90%

A patient with status asthmaticus has an initial assessment revealing a respiratory rate of 35 breaths/min, a heart rate of 110 beats/min, high-pitched wheezes in all lung fields, and marked use of accessory muscles to breathe. The patient is receiving an intravenous steroid and a continuous nebulized bronchodilator medication. Which assessment reveals a worsening of this patient's condition?

Absence of wheezing