COPD NCLEX Chronic.

A 7-year-old client is brought to the E.R. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? a. Acute asthma b. Bronchial pneumonia c. Chronic obstructive pulmonary disease (COPD) d. Emphysema

a acute asthma Rationale: Based on the client's history and symptoms, acute asthma is the most likely diagnosis. He's unlikely to have bronchial pneumonia without a productive cough and fever and he's too young to have developed COPD or emphysema.

Which of the following is a priority goal for the client with COPD? a. Maintaining functional ability b. Minimizing chest pain c. Increasing carbon dioxide levels in the blood d. Treating infectious agents

a. maintaining functional ability

The nurse is preparing to administer respiratory medications to a child hospitalized with asthma. By which most frequently used route will the medication be administered? a. Aerosol b. Intravenous c. Subcutaneous d. Oral

a. Aerosol Aerosol therapy such as a nebulizer is frequently used during hospitalization to admin medication

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following? a. Develop infections easily b. Maintain current status c. Require less supplemental oxygen d. Show permanent improvement.

a. Develop infections easily A client with COPD is at high risk for development of respiratory infections. COPD is a slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are

What explanation should the nurse give to a client and family regarding the development of COPD in a young adult? a. Hereditary deficiency of alpha-1-antitrypsin b. Onset of smoking during childhood c. Heavy secondary smoke exposure during childhood d. Use of smokeless tobacco during childhood

a. Hereditary deficiency of alpha-1-antitrypsin Rationale: Onset of the physiological changes compatible with COPD is most often associated with a hereditary deficiency of alpha-1-antitrypsin, an enzyme that protects lung tissue against loss of elasticity. The other explanations are not typically associated with early onset of the physiological alterations of COPD.

A 9-year-old child is admitted to the pediatric unit for treatment of cystic fibrosis. The nurse is assessing the child's respiratory status. Which of the following findings is consistent with cystic fibrosis? a. Production of thick, sticky mucous. b. Nonproductive, harsh cough. c. Stridor. d. Unilateral decrease in breath sounds.

a. Production of thick, sticky mucous Rationale: Cystic fibrosis is associated with the production of thick, sticky mucous. Children with cystic fibrosis often have repeated respiratory infections, including bronchitis and pneumonia. They may develop a chronic cough and wheezing because of obstruction of air passages, and sputum may be bloodstained at times. Other common symptoms include failure to thrive and loss of weight, abdominal discomfort and flatulence, clay-colored stools. Cystic fibrosis results in excessive loss of sodium in perspiration, so children may become easily dehydrated.

A client beginning medication therapy with montelukast (Singulair) asks the nurse how the medication is helping the symptoms. Which is the nurse's best response? a. "Singulair decreases inflammation and mucus secretion." b. "Singulair increases mucus secretion and bronchodilation" c. "Singulair prevents smooth muscle contraction by nervous system stimulation." d. "Singulair protects the airway from the effects of allergen exposure."

a. Singulair decreases inflammation and mucus secretion Rationale: Leukotriene modifiers such as montelukast block the action of leukotrienes, and therefore decrease mucous secretion and reduce inflammation, preventing bronchoconstriction. Montelukast blocks the action of leukotrienes and decreases mucous secretion. Leukotriene modifiers such as montelukast do not prevent smooth muscle contraction; they decrease mucous secretion and reduce inflammation. Leukotrienes are released when a client is exposed to an allergen. Leukotriene modifiers such as montelukast do not protect the airway from effects of allergen exposure.

A school-age child with CF asks the nurse what sports she can be involved in as she becomes older. Which of the following activities would be most appropriate for the nurse to suggest? a. swimming b. track c. baseball d. javelin throwing

a. Swimming Rationale: Swimming would be the most appropriate suggestion because it coordinates breathing and movement of all muscle groups and can be done on an individual basis or as a team sport. Because track events, baseball and javelin throwing usually are performed outdoors, the child would be breathing in large amounts of dust and dirt, which would be irritating to her mucous membranes and pulmonary system. The strenuous activity and increased energy expenditure associated with track events, in conjunction with the dust and possible heat, would play a role in placing the child at risk for an URTI and compromising her respiratory function.

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included? a. Take three deep abdominal breath, bend forward, and cough while saying the word "who" on exhalation. b. Lie flat on back, splint the thorax, take two deep breaths and cough. c. Take several rapid, shallow breaths and then cough forcefully. d. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

a. Take three deep abdominal breaths, bend forward, and cough while saying the word "who" Rationale: The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process 3 or 4 times, the client should take a deep abdominal breath, bend forward and cough while saying the word "WHO" . This intervention is called "huff" cough. Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.

The nurse who is explaining the pathophysiology of COPD to a client includes the fact that alveolar destruction results in which manifestations? Select all that apply. a. Decrease surface area for gas exchange b. Increased dead space air c. Development of pulmonary emboli d. Chronic dilation of bronchioles e. Airway collapse related to loss of elasticity

a. decrease surface area for gas exchange e. Airway collapse related to loss of elasticity Rationale: The loss of elasticity in the airway of a client with COPD can be airway attributed to repeated infections and inflammation, which leads to airway collapse. Airway collapse can cause alveolar destruction because of either over or under inflation of alveolar sacs. The impaired gas exchange occurring with COPD is caused by the loss of alveolar surface area available for gas exchange. Destruction of alveoli is not related to increased dead space air, pulmonary emboli, or chronic dilation of bronchioles.

What should the nurse include when teaching health maintenance strategies to the client with COPD? Select all that apply. a. Yearly influenza immunizations b. Immunization against pneumonia c. Limitation of physical activity d. Oral fluid restrictions e. Adequate caloric intake

a. yearly influenza immunizations b. immunization against pneumonia e. Adequate caloric intake Rationale: Clients with COPD are highly susceptible to respiratory infections such as influenza, so they should be immunized yearly. Clients with COPD use a large amount of calories because of labored respiratory function; increased caloric intake is necessary to maintain a healthy weight. Clients with COPD should undergo a progressive rehabilitation program to increase their activity tolerance. Fluid restriction is not needed with COPD unless there is a fluid retention from another etiology.

The nurse is caring for a client hospitalized with acute exacerbation of COPD. Which finding would the nurse expect to note on assessment of this client? Select all that apply: a. Hypocapnia b. A hyperinflated chest noted on the chest x-ray c. Decreased oxygen saturation with mild exercise d. A widened diaphragm noted on the chest x-ray e. Pulmonary function tests that demonstrate increased vital capacity

b. A hyperinflated chest noted on the chest x-ray c. Decreased oxygen saturation with mild exercise Rationale: clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray reveal a hyper inflated chest and flattened diaphragm if the decease is advanced. Pulmonary function test will demonstrate decreased vital capacity.

The patient asks the nurse why the physician ordered beclomethasone (Beclovent) for his COPD. Which statement by the nurse is most appropriate? a. "Beclovent prevents airway dilation." b. "Beclovent decreases inflammation, and makes it easier to breathe." c. "Beclovent suppresses the immune response." d. "Beclovent decreases responsiveness to medications that dilate the airway."

b. Beclovent decreases inflammation and makes it easier to breathe Rationale: Beclovent is an inhaled corticosteroid that is thought to decrease inflammation and dilate the airway. Preventing airway dilation is undesirable for this patient, and the exact opposite action of Beclovent. The exact mechanism of action is unknown. Becolvent, like any other corticosteroid, does suppress the immune response, but this is not the rationale for administration of the medication. Inhaled corticosteroids are thought to increase responsiveness of bronchial smooth muscle to beta-agonist drugs.

A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? a. Beta-adrenergic blockers b. Bronchodilators c. Inhaled steroids d. Oral steroids

b. Bronchodilators Rationale: Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers rant used to treat asthma and can cause bronchoconstriction. inhaled or oral steroids may be given to reduce the inflammation but aren't used for emergency relief.

A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? a. Take a full medication history b. Give an ordered bronchodilator by nebulizer c. Apply a cardiac monitor to the client d. Provide emotional support to the client.

b. Giver an ordered bronchodilator by neb.

The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to administer multiple medications by inhalation. Which statement by the client indicates an understanding of the instruction? Select all that apply. a. "If my symptoms get worse, I can double my dosage." b. "I will wait at least one minute between use of my different inhalers." c. "I should consult my physician before using over-the-counter medications." d. "I cannot rinse my inhaler equipment, because it is not supposed to get wet." e. "I should store my inhaler in the refrigerator door between uses."

b. I will wait at least one minute between use of my different inhalers. c. I should consult my physician before using OTC meds. Rationale: the client should wait at least one minute between inhalations. OTC products should not be added without consulting the physician . Dosages should be taken exactly as prescribed. Inhaler equip should deb cleaned with mild soap, rinsed, and dried daily. The inhaler should deb stored at room temp.

An oxygen delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? a. Face tent b. Venturi mask c. Aerosol mask d. Tracheostomy collar

b. Venturi mask Rationale: The venturi mask delivers the most accurate O2 conc. It is the best O2 delivery system for the client with chronic airflow limitation because it delivers a precise o2 conc. the face tent, aerosol mask, and teach collar are also high flow o2 deliver systems but most often are used to admin at high humidity.

A 10-year-old child with asthma is treated for acute exacerbation in the emergency department. The nurse caring for the child should monitor for which sign, knowing that it indicates a worsening of the condition? a. Warm, dry skin b. Decreased wheezing c. Pulse rate of 90 beats/minute d. Respirations of 18 breaths/minute

b. decreased wheezing Rationale: Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a child with asthma may be interpreted incorrectly as a positive sign when it may actually signal an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With treatment, increased wheezing actually may signal that the child's condition is improving. Warm, dry skin indicates an improvement in the child's condition because the child is normally diaphoretic during exacerbation. The normal pulse rate in a 10 year old is 70-110 beats/min and normal respiratory rate is 16-20 breaths/minute.

A client with asthma has started to take a beta-adrenergic agent. The client also takes a monoamine oxidase inhibitor (MAOI). For what complication should the nurse asses the client? a. Hypotension b. Hypertension c. Tachycardia d. Bradycardia

b. hypertension Rationale: Concurrent use of an MAOI and a beta-agonist can lead to hypertensive crisis. Hypotension is not of concern with this combination of medications; the client is at risk for a hypertensive crisis. The beta-agonist could lead to tachycardia, but since no specific agent is listed the nurse should consider the potential interaction of the MAOI and the beta-agonist first. Bradycardia is not of concern with this combination of medication; it is more likely that the client will experience tachycardia.

A 6-year-old child is hospitalized following an acute asthmatic episode. Which statement by the parents indicates that further teaching is needed? a. "Next time, we'll be sure he takes his cromolyn before soccer." b. "After the episode, he will need to quit the swim team." c. "We think this was an exercise-induced asthma episode." d. "We need to make sure he has his inhaler at all times."

b.. Apter the episode, he will need to quit the swim team. Rationale: Swimming is recommended for children with asthma because prolonged expiration under water is beneficial. Cromolyn sodium is used prophylactically to prevent exercise-induced asthma. When an asthma episode occurs in conjunction with high-level physical activity, it is considered to be an exercise-induced episode. Immediate access to a rescue inhaler is recommended.

A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? a. Corticosteroids promote bronchodilation b. Corticosteroids act as an expectorant c. Corticosteroids have an anti-inflammatory effect d. Corticosteroids prevent development of respiratory infections.

c. Corticosteroids have an anti-inflammatory effect Rationale: Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

When taking the nursing history of a child with cystic fibrosis, what piece of information about the child's newborn period would the nurse expect the mother to report? a. That the child required resuscitation in the delivery room b. That labor was longer than 24 hours c. That the child had a meconium ileus d. That labor was less than 4 hours

c. That the child had a meconium ileus Rationale: Meconium ileus in the newborn period is often the first indication of CF. - fatty stinky poop due to clogged panc duct.

A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate? a. "This is an anticipated side-effect of your medication. It should go away in a couple of weeks." b. "You are using your inhaler too much and it has irritated your mouth." c. "You have developed a fungal infection from your medication. It will need to be treated with an antibiotic." d. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."

c. You have developed a fungal infection from your meds, you will need to be treated with an anti-fungal

The nurse teaches a client with COPD to assess for s/sx of right-sided heart failure. Which of the following s/sx would be included in the teaching plan? a. Clubbing of nail beds b. Hypertension c. Peripheral edema d. Increased appetite

c. peripheral edema Rationale: Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.

A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client? a. Initiate oxygen therapy and reassess the client in 10 minutes. b. Draw blood for an ABG analysis and send the client for a chest x-ray. c. Encourage the client to relax and breathe slowly through the mouth d. Administer ordered bronchodilators

d. Administer ordered bronchodilators Rationale: In an acute asthma attack, diminished or absent breath sounds can be an ominous sign of indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing an ABG and obtaining a chest x-ray. It would be futile to encourage the client to relax and breathe slowly without providing necessary pharmacologic intervention.

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? a. Normal breath sounds b. Prolonged inspiration c. Normal chest movement d. Coarse crackles and rhonchi

d. Coarse crackles and rhonchi Rationale: Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become over-distended.

A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is: a. Promote oxygen intake b. Strengthen the diaphragm c. Strengthen the intercostal muscles d. Promote carbon dioxide elimination

d. Promote carbon dioxide elimination Rationale: Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.

A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? a. Constipation b. Diarrhea c. Bradycardia d. Tachycardia

d. Tachycardia Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat.

The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for the child. Which statement should the nurse make to the parent? a. "The immunization schedule will need to be altered." b. "The child should not receive any hepatitis vaccines." c. "The child should receive all the immunizations except for the polio series." d. "The child should receive the recommended basic series of immunizations along with yearly influenza vaccination."

d. The child should receive the recommended basic series of immunizations along with yearly influenza vaccine. Rationale: Cystic fibrosis is a chronic multisystem disorder characterized by exocrine gland dysfunction. The mucus produced by the exocrine glands is abnormally thick, tenacious, and copious, causing obstruction of the small passageways of the affected organs, particularly in the respiratory, gastrointestinal, and reproductive systems. Adequately protecting children with cystic fibrosis from communicable diseases by immunization is essential. In addition to the basic series of immunizations, a yearly influenza immunization is recommended for a child with cystic fibrosis.

When teaching the parents of an older infant with CF (cystic fibrosis) about the type of diet the child should consume, which of the following would be most appropriate? a. low protein diet b. high fat diet c. low carbohydrate diet d. high calorie diet

d. high calorie diet Rationale: CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction, a moderate fat, high calorie diet is indicated.

Which of the following outcomes would be appropriate for a client with COPD who has been discharged to home? The client: a. Promises to do pursed lip breathing at home. b. States actions to reduce pain. c. States that he will use oxygen via a nasal cannula at 5 L/minute. d. Knows to call the physician if dyspnea on exertion increases.

d. knows to call the physician if dyspnea on exertion increases Rationale: Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia.

A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching? a. Removes the cap and shakes the inhaler well before use. b. Presses the canister down with finger as he breathes in. c. Inhales the mist and quickly exhales. d. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.

inhales the mist and quickly exhales