Chapter 31 - COPD (Questions)
The nurse is admitting a client with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the client in to improve gas exchange? a. Resting in bed with the head elevated to 45-60 degrees b. Sitting up at the bedside in a chair and leaning slightly forward c. Resting in bed in a high Fowler's position with the knees flexed d. In the Trendelenburg position with several pillows behind the head
ANS: B Clients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated would be an alternative position if the client was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the client's ability to ventilate well.
After the nurse has completed diet teaching for a client with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following client statements indicate that the teaching has been effective? a. "I will drink lots of fluids with my meals." b. "I will have ice cream as a snack every day." c. "I will exercise for 15 minutes before meals." d. "I will decrease my intake of meat or poultry."
ANS: B High-calorie foods like ice cream are an appropriate snack for clients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The client should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the client with COPD.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement to determine the appropriate oxygen flow rate? a. Minimize oxygen use to avoid oxygen dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer oxygen according to the client's level of dyspnea. d. Avoid administration of oxygen at a rate of more than 2 L/minute.
ANS: B The best way to determine the appropriate oxygen flow rate is by monitoring the client's oxygenation either by arterial blood gases (ABGs) or pulse oximetry; an oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For clients with an exacerbation of COPD, an oxygen flow rate of 2 L/minute may not be adequate. Because oxygen use improves survival rate in clients with COPD, there is not a concern about oxygen dependency. The client's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.
Which of the following diagnostic tests should the nurse plan to discuss with a client who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)? a. Eosinophil count b. Spirometry c. Immunoglobin E (IgE) levels d. Radioallergosorbent test (RAST)
ANS: B The diagnosis of COPD is confirmed by spirometry regardless of whether the client has chronic symptoms. The other tests would be used to test for an allergic component for asthma, but will not be used in the diagnosis of COPD.
The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old client with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the client? a. Walk until pulse rate exceeds 130. b. Walk for a total of 20 minutes daily. c. Exercise until shortness of breath occurs. d. Limit exercise to activities of daily living (ADLs).
ANS: B The goal for exercise programs for clients with COPD is to increase exercise time gradually to a total of 20 minutes daily. Shortness of breath is normal with exercise and not an indication that the client should stop. Limiting exercise to ADLs will not improve the client's exercise tolerance. A 70-year-old client should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).
The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include? a. "Stop exercising if you start to feel short of breath." b. "Use the bronchodilator before you start to exercise." c. "Breathe in and out through the mouth while you exercise." d. "Upper body exercise should be avoided to prevent dyspnea."
ANS: B Use of a bronchodilator before exercise improves airflow for some clients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Clients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in clients with COPD.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which of the following nursing actions is best? a. Change the oxygen flow rate to the highest prescribed rate. b. Reinforce the ongoing use of pursed lip breathing techniques. c. Educate the client to use the Flutter airway clearance device. d. Teach the client about consistent use of inhaled corticosteroids.
ANS: C Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some clients with COPD, but they are not indicated for this client's problem of thick mucous secretions.
The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client? a. Elevated temperature b. Clubbing of the fingers c. Jugular vein distension d. Complaints of chest pain
ANS: C Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the client with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.
Which of the following information should the nurse teach a client with COPD? a. To exercise immediately before a meal. b. To eat a high-calorie, low-protein diet. c. To have 5 or 6 small meals a day. d. Avoid foods that are cooked in a microwave.
ANS: C Eating five to six small meals per day helps avoid feelings of bloating and early satiety. The use of frozen foods and a microwave oven may help conserve a client's energy in food preparation. Exercises should be avoided for at least 1 hour before and after eating. A high-calorie, high-protein diet is recommended.
The nurse is interviewing a client with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis? a. The client tells the nurse about a family history of bronchitis. b. The client's history indicates a 40 pack-year cigarette history. c. The client denies having any respiratory problems until the last 6 months. d. The client complains about a productive cough every winter for 3 months.
ANS: D A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
Which of the following information about a newly admitted client with chronic obstructive pulmonary disease (COPD) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline? a. The client has had a recent 10-pound weight gain. b. The client has a cough productive of green mucus. c. The client denies any shortness of breath at present. d. The client takes cimetidine 150 mg daily.
ANS: D Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other client information would not impact whether the theophylline should be administered or not.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem? a. Increase the client's intake of fruits and fruit juices. b. Have the client exercise for 10 minutes before meals. c. Assist the client in choosing foods with a lot of texture. d. Offer high calorie snacks between meals and at bedtime.
ANS: D Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Clients with COPD should rest before meals. Foods that have a lot of texture may take more energy to eat and lead to decreased intake. Although fruits and juices are not contraindicated, foods high in protein are a better choice.
Which of the following information should the nurse include in teaching a client with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy? a. Storage of oxygen tanks will require adequate space in the home. b. Travel opportunities will be limited because of the use of oxygen. c. Oxygen flow should be increased if the client has more dyspnea. d. Oxygen use can improve the client's prognosis and quality of life.
ANS: D Research supports the use of home oxygen to improve quality of life and prognosis. Since increased dyspnea may be a symptom of an acute process such as pneumonia, the client should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual client circumstances. Travel is possible by using portable oxygen concentrators.
The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, which of the following nursing diagnoses is best? a. Hopelessness related to chronic stress (expectation of death) b. Ineffective coping related to insufficient sense of control c. Deficient knowledge related insufficient information (education about COPD) d. Social isolation related to insufficient personal resources (increased physical dependence)
ANS: D The client's statement about not being able to do anything for himself or herself supports this diagnosis. Emotions frequently encountered include guilt, depression, anxiety, social isolation, denial, and dependence. Although deficient knowledge, hopelessness, and ineffective coping also may be appropriate diagnoses for clients with COPD, the data for this client do not support these diagnoses.
The nurse has received a change-of-shift report about the following clients with chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? a. A client with a respiratory rate of 38 b. A client with loud expiratory wheezes c. A client with jugular vein distension and peripheral edema d. A client who has a cough productive of thick, green mucus
ANS: A A respiratory rate of 38 indicates severe respiratory distress, and the client needs immediate assessment and intervention to prevent possible respiratory arrest. The other clients also need assessment as soon as possible, but they do not need to be assessed as urgently as the client with tachypnea.
After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicate that more teaching is needed? a. The client inhales slowly through the nose. b. The client tenses the neck muscles while exhaling. c. The client practises by blowing through a straw. d. The client's ratio of inhalation to exhalation is 1:3.
ANS: B The client should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the client indicate a good understanding of pursed lip breathing.
The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions? a. Keep the air entrainment ports clean and unobstructed. b. Give a high enough flow rate to keep the bag from collapsing. c. Use an appropriate adaptor to ensure adequate oxygen delivery. d. Drain moisture condensation from the oxygen tubing every hour.
ANS: A The air entrainment ports regulate the oxygen percentage delivered to the client, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or nonrebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a client receiving mechanical ventilation.