COPD (emphysema & chronic bronchitis)

A nurse teaches a client who has chronic obstructive pulmonary disease. Which statements related to nutri- tion should the nurse include in this client's teaching? (Select all that apply.) a. "Avoid drinking fluids just before and during meals." b. "Rest before meals if you have dyspnea." c. "Have about six small meals a day." d. "Eat high-fiber foods to promote gastric emptying." e. "Increase carbohydrate intake for energy."

A,B,C; Fluids can make a client feel bloated and should be avoided with meals. Resting before the meal will help a client with dyspnea. Six small meals a day also will help to decrease bloating. Fibrous foods can produce gas, which can cause abdominal bloating and can increase shortness of breath. The client should increase calorie and protein intake to prevent malnourishment. The client should not increase carbohydrate intake as this will increase carbon dioxide production and increase the client's risk of for acidosis.

A nurse plans care for a client who has chronic obstructive pulmonary disease and thick, tenacious secre- tions. Which interventions should the nurse include in this client's plan of care? (Select all that apply.) a. Ask the client to drink 2 liters of fluids daily. b. Add humidity to the prescribed oxygen. c. Suction the client every 2 to 3 hours. d. Use a vibrating positive expiratory pressure device. e. Encourage diaphragmatic breathing.

A,B,D; Interventions to decrease thick tenacious secretions include maintaining adequate hydration and providing hu- midified oxygen. These actions will help to thin secretions, making them easier to remove by coughing. The use of a vibrating positive expiratory pressure device can also help clients remove thick secretions. Although suc- tioning may assist with the removal of secretions, frequent suctioning can cause airway trauma and does not support the client's ability to successfully remove secretions through normal coughing. Diaphragmatic breath- ing is not used to improve the removal of thick secretions.

A nurse assesses a client with chronic obstructive pulmonary disease. Which questions should the nurse ask to determine the client's activity tolerance? (Select all that apply.) a. "What color is your sputum?" b. "Do you have any difficulty sleeping?" c. "How long does it take to perform your morning routine?" d. "Do you walk upstairs every day?" e. "Have you lost any weight lately?"

B, C, E; Difficulty sleeping could indicate worsening breathlessness, as could taking longer to perform activities of daily living. Weight loss could mean increased dyspnea as the client becomes too fatigued to eat. The color of the client's sputum would not assist in determining activity tolerance. Asking whether the client walks upstairs every day is not as pertinent as determining if the client becomes short of breath on walking upstairs, or if the client goes upstairs less often than previously.

The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which ac- tion by the patient indicates good understanding of the teaching? A. The patient attaches a spacer before using the inhaler. B. The patient coughs vigorously after using the inhaler. C. The patient activates the inhaler at the onset of expiration. D. The patient removes the facial mask when misting has ceased.

D; A nebulizer is used to administer aerosolized medication. A mist is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. The other options refer to inhaler use. Coughing vigorously after inhaling and activating the inhaler at the onset of expiration are both incorrect techniques when using an inhaler.

What information about nutrition does the nurse teach a client with chronic obstructive pulmonary dis- ease (COPD)? (Select all that apply.) a. "Avoid drinking fluids just before and during meals." b. "Rest before meals if you have dyspnea." c. "Have about six small meals a day." d. "Practice diaphragmatic breathing against resistance four times daily." e. "Eat high-fiber foods to promote gastric emptying." f. "Eat dry foods rather than wet foods, which are heavier." g. "Increase carbohydrate intake for energy."

a, b, c; Fluids can make a client feel bloated and should be avoided with meals. Resting before the meal will help a client with dyspnea. Six small meals a day also will help to decrease bloating. Dry foods can cause coughing. Fibrous foods can produce gas, which can cause abdominal bloating and can increase shortness of breath. Diaphragmatic breathing will not necessarily help nutrition.

In assessing a client for emphysema, the nurse would know that a physical finding commonly associ- ated with this condition is a. barrel chest. b. bulbous nose. c. spider angiomas. d. varicose veins.

a; Clients with emphysema develop barrel-shaped chests. The anteroposterior (AP) diameter of the chest is enlarged, and the chest has hyperresonant sounds during percussion.

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. Peripheral edema b. Elevated temperature c. Clubbing of the fingers d. Complaints of chest pain

a; Cor pulmonale causes clinical manifestations of right ventricular failure, such as peripheral edema. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.

A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and de- pendent edema. Which physiologic process should the nurse correlate with this client's history and clinical manifestations? a. Increased pulmonary pressure creating a higher workload on the right side of the heart b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles c. Increased number and size of mucus glands producing large amounts of thick mucus d. Left ventricular hypertrophy creating a decrease in cardiac output

a; Smoking increases pulmonary hypertension, resulting in cor pulmonale, or right-sided heart failure. Increased pressures in the lungs make it more difficult for blood to flow through the lungs. Blood backs up into the right side of the heart and then into the peripheral venous system, creating distended neck veins and dependent edema. Inflammation in bronchi and bronchioles creates an airway obstruction which manifests as wheezes. Thick mucus in the lungs has no impact on distended neck veins and edema. Left ventricular hypertrophy is as- sociated with left heart failure and is not caused by a 40-year smoking history.

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

a; The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible but do not require interventions as quickly as the 22-year-old.

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Obtain oxygen saturation using pulse oximetry. b. Monitor for increased oxygen need with exercise. c. Teach the patient about safe use of oxygen at home. d. Adjust oxygen to keep saturation in prescribed parameters.

a; UAP can obtain oxygen saturation (after being trained and evaluated in the skill). The other actions re- quire more education and a scope of practice that licensed practical/vocational nurses (LPN/LVNs) or registered nurses (RNs) would have.

Important health promotion measures the nurse should encourage the client with COPD to consider are a. getting influenza and pneumonia vaccinations. b. increasing ambient humidity in the house or apartment. c. installing a UV filter in the heating and air conditioning system. d. moving to an area of the country with a dry climate.

a; Vaccinations are recommended to help prevent infectious illness. Influenza vaccination should be given annually. The pneumonia vaccine is recommended for clients 65 years and older and for those younger than 65 if their VEV1 is <40% of predicted value.

A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). It is most appropriate for the nurse to teach the patient about a. a1-antitrypsin testing. b. use of the nicotine patch. c. continuous pulse oximetry. d. effects of leukotriene modifiers.

a; When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in a1- antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be or- dered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with COPD.

A nurse caring for an elderly client with COPD alters care knowing that in the older population (Se- lect all that apply) a. COPD is not a common problem in the elderly. b. impaired nutrition is a common problem in the elderly. c. multiple co-morbidities may be present that complicate care. d. sensory disturbances may hinder their ability to provide self-care. e. there may be more problems with drug-drug interactions.

b,c,d,e; COPD is a common problem in the elderly; it is a leading cause of hospitalizations in older persons. Op- tions b through e are all correct statements about COPD and age-related considerations.

The nurse working with a depressed client who has COPD realizes that many factors negatively affect the client's quality of life, including (Select all that apply) a. familial support systems. b. loss of control over their bodies. c. reduced activity tolerance. d. social isolation.

b,c,d; Familial support systems should help with quality of life.

The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) to determine activ- ity tolerance. Which questions elicit the most important information? (Select all that apply.) a. "What color is your sputum?" b. "Do you have any difficulty sleeping?" c. "How long does it take to perform your morning routine?" d. "Do you walk upstairs every day?" e. "Have you lost any weight lately?"

b,c,e; Difficulty sleeping could indicate worsening breathlessness, as could taking longer to perform activities of daily living. Weight loss could mean increased dyspnea as the client becomes too fatigued to eat. The color of the client's sputum would not assist in determining activity tolerance. Asking whether the client walks upstairs every day is not as pertinent as determining if the client becomes short of breath on walk- ing upstairs, or if the client goes upstairs less often than previously.

The nurse receives a change-of-shift report on the following patients with chronic obstructive pul- monary disease (COPD). Which patient should the nurse assess first? a. A patient with loud expiratory wheezes b. A patient with a respiratory rate of 38/minute c. A patient who has a cough productive of thick, green mucus d. A patient with jugular venous distention and peripheral edema

b; A respiratory rate of 38/minute indicates severe respiratory distress, and the patient needs immediate as- sessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the tachypneic patient.

A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the oxygen flow rate to the highest prescribed rate. b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.

b; Airway clearance devices assist with moving mucus into larger airways where it can more easily be ex- pectorated. The other actions may be appropriate for some patients with COPD, but they are not indicat- ed for this patient's problem of thick mucus secretions.

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? a. "I will drink lots of fluids with my meals." b. "I can 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 and poultry."

b; High-calorie foods like ice cream are an appropriate snack for patients 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 patient 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 patient with COPD.

A client with COPD has severe shortness of breath at rest and arterial oxygen tension (PaO2) of 35 mm Hg. When oxygen via nasal cannula is prescribed, the nurse would assess the client cautiously because a. regulating oxygen settings can be done by unlicensed staff. b. some clients with COPD have CO2 narcosis. c. skin damage under the nasal cannula is common. d. the client may try to sneak a cigarette and get burned.

b; Some clients with COPD and hypercapnia may be oxygen-sensitive; that is, their PaCO2 levels may rise when given supplemental oxygen, leading to suppression of the central nervous system and lethargy. This phenomenon is known as CO2 narcosis. Clients with hypercapnia need to be monitored closely for their response to oxygen administration.

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pul- monary disease (COPD).What is the best way for the nurse 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 patient's level of dyspnea. d. Avoid administration of oxygen at a rate of more than 2 L/minute.

b; The best way to determine the appropriate oxygen flow rate is by monitoring the patient's oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An oxygen saturation of 90% indicates ade- quate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use im- proves survival rate in patients with COPD, there is no concern about oxygen dependency. The patient's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? a. A 46-year-old with a 30-pack-year history of smoking b. A 52-year-old in a tripod position using accessory muscles to breathe c. A 68-year-old who has dependent edema and clubbed fingers d. A 74-year-old with a chronic cough and thick, tenacious secretions

b; The client who is in a tripod position and using accessory muscles is working to breathe. This client must be as- sessed first to establish how well the client is breathing and provide interventions to minimize respiratory fail- ure. The other clients are not in acute distress.

The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? a. The patient inhales slowly through the nose. b. The patient puffs up the cheeks while exhaling. c. The patient practices by blowing through a straw. d. The patient's ratio of inhalation to exhalation is 1:3.

b; The patient should relax the facial muscles without puffing the cheeks while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.

A client has chronic obstructive pulmonary disease (COPD). In reviewing this client's laboratory val- ues, the nurse would not be surprised to see a/an a. decreased sedimentation rate. b. elevated RBC count. c. normochromic anemia. d. therapeutic INR.

b; To compensate for chronic hypoxia, the client will develop polycythemia (increased RBCs).

Which instruction should the nurse include in an exercise teaching plan for a patient with chronic ob- structive pulmonary disease (COPD)? 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."

b; Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Short- ness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can im- prove the mechanics of breathing in patients with COPD.

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? a. Even, unlabored respirations b. Pulse oximetry reading of 92% c. Respiratory rate of 18 breaths/minute d. Absence of wheezes, rhonchi, or crackles

b;For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most helpful in confirming a diagnosis of chronic bronchitis? a. The patient tells the nurse about a family history of bronchitis. b. The patient's history indicates a 30 pack-year cigarette history. c. The patient complains about a productive cough every winter for 3 months. d. The patient denies having any respiratory problems until the last 12 months.

c; 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 family tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure? a. Give the rescue medication immediately before testing. b. Administer oral corticosteroids 2 hours before the procedure. c. Withhold bronchodilators for 6 to 12 hours before the examination. d. Ensure that the patient has been NPO for several hours before the test.

c; Bronchodilators are held before pulmonary function testing (PFT) so that a baseline assessment of air- way function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should be held before PFTs. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

After providing instructions to a client with newly diagnosed COPD who is learning to take a steroid medication by inhaler, the nurse would determine that proper technique has been learned when the client a. breathes out forcefully with an open mouth. b. gently rolls the canister in the hands before use. c. holds the breath for 5 to 10 seconds after inhalation. d. starts to discontinue the medication once manifestations subside.

c; The client should hold the aerosol vapor for 5 to 10 seconds after inhalation.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which informa- tion obtained from the patient would prompt the nurse to consult with the health care provider before ad- ministering the prescribed theophylline? a. The patient reports a recent 15-pound weight gain. b. The patient denies any shortness of breath at present. c. The patient takes cimetidine (Tagamet) 150 mg daily. d. The patient complains about coughing up green mucus.

c; Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.

A nurse cares for a client with chronic obstructive pulmonary disease (COPD) who appears thin and di- sheveled. Which question should the nurse ask first? a. "Do you have a strong support system?" b. "What do you understand about your disease?" c. "Do you experience shortness of breath with basic activities?" d. "What medications are you prescribed to take each day?"

c; Clients with severe COPD may not be able to perform daily activities, including bathing and eating, because of excessive shortness of breath. The nurse should ask the client if shortness of breath is interfering with basic activities. Although the nurse should know about the client's support systems, current knowledge, and medica- tions, these questions do not address the client's appearance.

The nurse is teaching a client with chronic obstructive pulmonary disease who has been prescribed contin- uous oxygen therapy at home. Which statement indicates the client correctly understands the teaching? a. "I plan to wear my oxygen when I exercise and feel short of breath." b. "I will use my portable oxygen when grilling burgers in the backyard." c. "I plan to use cotton balls to cushion the oxygen tubing on my ears." d. "I will only smoke while I am wearing my oxygen via nasal cannula."

c; Cotton balls can decrease pressure ulcers from the oxygen tubing. Continuous oxygen orders mean the client should wear the oxygen at all times. Oxygen fuels a fire. Wearing oxygen while grilling and smoking increases the risk for fire.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains. b.Increase the patient's intake of fruits and fruit juices. c. Offer high-calorie snacks between meals and at bedtime. d. Assist the patient in choosing foods with high vegetable and mineral content.

c; Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreas- ing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest be- fore meals. Foods that have a lot of texture like whole grains may take more energy to eat and get ab- sorbed and lead to decreased intake. Although fruits, juices, and vegetables are not contraindicated, foods high in protein are a better choice.

The ambulatory care nurse would arrange for periodic monitoring of blood levels for a client with COPD who is beginning to use a. beclomethasone (Vanceril). b. ipratropium (Atrovent). c. theophylline (Theo-Dur). d. zafirlukast (Accolate).

c; It is necessary to monitor blood levels in the client taking theophylline to prevent the client from devel- oping toxicity.

A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond? a. "There are a variety of support groups for people who have COPD." b. "I will ask your provider to prescribe you with an antianxiety agent." c. "Share any thoughts and feelings that cause you to limit social activities." d. "Friends can be a good support system for clients with chronic disorders."

c; Many clients with moderate to severe COPD become socially isolated because they are embarrassed by fre- quent coughing and mucus production. They also can experience fatigue, which limits their activities. The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interventions can be selected. Joining a support group would not decrease feelings of social isolation if the client does not verbal- ize feelings. Antianxiety agents will not help the client with social isolation. Encouraging a client to participate in activities without verbalizing concerns also would not be an effective strategy for decreasing social isolation.

A client with chronic obstructive pulmonary disease (COPD) reports social isolation. What does the nurse encourage the client to do? a. Join a support group for people with COPD. b. Ask the client's physician for an antianxiety agent. c. Verbalize his or her thoughts and feelings. d. Participate in community activities.

c; Many clients with moderate to severe COPD become socially isolated because they are embarrassed by frequent coughing and mucus production. They also can experience fatigue, which limits their activities. The nurse needs to encourage the client to verbalize thoughts and feelings so that appropriate interven- tions can be selected. Joining a support group would not decrease feelings of social isolation if the client does not verbalize feelings. Antianxiety agents will not help the client with social isolation. Encouraging a client to participate in activities without verbalizing concerns also would not be an effective strategy for decreasing social isolation.

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate? a.Have the patient rest in bed with the head elevated to 15 to 20 degrees. b.Ask the patient to rest in bed in a high-Fowler's position with the knees flexed. c.Encourage the patient to sit up at the bedside in a chair and lean slightly forward. d.Place the patient in the Trendelenburg position with several pillows behind the head.

c; Patients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated in a semi-Fowler's position would be an alternative position if the patient 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 patient's ability to ventilate well.

nurse is conducting community wellness seminars and teaches that a primary prevention activity for chronic obstructive pulmonary disease (COPD) is a. avoiding alcohol. b. genetic testing. c .not smoking. d. regular exercise.

c; Smoking is the primary risk factor for COPD. Other risk factors include air pollution, second-hand smoke, a history of childhood respiratory tract infections, and heredity. Occupational exposure to certain industrial pollutants may also be a risk factor.

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (com- bined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? A. The patient shakes the device before use. B. The patient attaches a spacer to the Diskus. C. The patient rapidly inhales the medication. D. The patient performs huff coughing after inhalation.

c; The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.

A client with COPD is in the hospital. When planning care, which diagnosis takes priority? a. Activity Intolerance b. Anxiety c. Imbalanced Nutrition d. Impaired Gas Exchange

d; All are pertinent diagnoses for the client with COPD. But following the ABCs (airway, breathing, circu- lation), Impaired Gas Exchange takes priority.

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bron- chitis. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Perform percussion before assisting the patient to the drainage position. d. Give the ordered albuterol (Proventil) before the patient receives the therapy.

d; Bronchodilators are administered before chest physiotherapy. Postural drainage, percussion, and vibra- tion should be done 1 hour before or 3 hours after meals. Patients remain in each postural drainage posi- tion for 5 minutes. Percussion is done while the patient is in the postural drainage position.

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be most appropriate for the nurse to include in the plan of care? a. Stop exercising when short of breath. b. Walk until pulse rate exceeds 130 beats/minute. c. Limit exercise to activities of daily living (ADLs). d. Walk 15 to 20 minutes daily at least 3 times/week.

d; Encourage the patient to walk 15 to 20 minutes a day at least three times a week with gradual increases. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patient's exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask? a. "Are you claustrophobic?" b. "Are you allergic to shellfish?" c. "Do you have any metal implants or prostheses?" d. "Have you taken any bronchodilators in the past 6 hours?"

d; Pulmonary function testing will help establish the COPD diagnosis. Bronchodilators should be avoided at least 6 hours before the test. PFTs do not involve being placed in an enclosed area such as for magnet- ic resonance imaging (MRI). Contrast dye is not used for PFTs. The patient may still have PFTs done if metal implants or prostheses are present, as these are contraindications for an MRI.

A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the patient. c. Suggest the use of over-the-counter sedative medications. d. Teach the patient how to effectively use pursed lip breathing.

d; Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which nursing diagnosis is most appropriate? a. Complicated grieving related to expectation of death b. ineffective coping related to unknown outcome of illness c. Deficient knowledge related to lack of education about COPD d. Chronic low self-esteem related to increased physical dependence

d; The patient's statement about not being able to do anything for himself or herself supports this diagno- sis. Although deficient knowledge, complicated grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching? 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 patient has more dyspnea. d. Oxygen use can improve the patient's prognosis and quality of life.

d; The use of home oxygen improves quality of life and prognosis. Because increased dyspnea may be a symptom of an acute process such as pneumonia, the patient should notify the physician rather than in- creasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual patient circumstances. Travel is possible using portable oxygen concentrators.