Nur1130-test2-ch24-wrong

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."

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? "Limit yourself to smoking only 2 cigarettes per day." "Eat a high-sodium diet." "Weigh yourself daily and report a gain of 2 lb in 1 day." "Maintain bed rest."

"Weigh yourself daily and report a gain of 2 lb in 1 day." COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy.The client shouldn't smoke at all.

Inspiratory reserve volume is normally

3000 mL.

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 arterial oxygen saturation (SaO2) of at least ___%. 54 mm Hg; 84% 56 mm Hg; 86% 58 mm Hg; 88% 60 mm Hg; 90%

60 mm Hg; 90% Explanation: The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

pleural effusion

A buildup of fluid between the tissues that line the lungs and the chest.

A nurse is caring for a 6yearold patient with cystic fibrosis. In order to enhance the child's nutritional status, what intervention should most likely be included in the plan of care? A) Pancreatic enzyme supplementation with meals B) Provision of five to six small meals per day rather than three larger meals C) Total parenteral nutrition (TPN) D) Magnesium, thiamine, and iron supplementation

A) Pancreatic enzyme supplementation with meals

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 Atrovent Albuterol Foradil Isuprel

Albuterol

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 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

An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value? A) Highest airflow during a forced inspiration B) Highest airflow during a forced expiration C) Airflow during a normal inspiration D) Airflow during a normal expiration

B) Highest airflow during a forced expiration

A nurse is caring for a young adult patient whose medical history includes an alpha antitrypsin deficiency. This deficiency predisposes the patient to what health problem? A) Pulmonary edema B) Lobular emphysema C) Cystic fibrosis (CF) D) Empyema

B) Lobular emphysema

+++The wife of a patient who was admitted 3 days ago with an exacerbation of chronic obstructive pulmonary disease (COPD) states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. Which of the following findings would indicate a need for further interventions? (Select all that apply.) BP 122/82, HR 102, R 24, noted barrel chest Patient states, "It always seems like I just can't catch my breath." Pale, paper-thin skin, O2 at 2L/min via nasal cannula BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F

BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F Explanation: Bronchopulmonary infections must be controlled to diminish inflammatory edema and to permit recovery of normal ciliary action. Minor respiratory infections of no consequence to people with normal lungs can be life-threatening to people with COPD. The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior.

A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? A) Shallow respirations B) Increased anteriorposterior (AP) diameter C) Bilateral wheezes D) Bradypnea

C) Bilateral wheezes

A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process? A) Intermittent episodes of acute bronchospasm B) Alveolar distention and impaired diffusion C) Dilation of bronchi and bronchioles D) Excessive gas exchange in the bronchioles

C) Dilation of bronchi and bronchioles

increased AP diameter is noted in patients with

COPD.

bronchiectasis cornerstones of patient care

Chest physiotherapy, antibiotics, smoking cessation

A nurse is caring for a patient with COPD. The patient's medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status? Select all that apply. A) Negative sputum culture B) Increased viscosity of lung secretions C) Increased respiratory rate D) Increased expiratory flow rate E) Relief of dyspnea

D) Increased expiratory flow rate E) Relief of dyspnea The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened.

The case manager for a group of patients with COPD is providing health education. What is most important for the nurse to assess when providing instructions on self management to these patients? A) Knowledge of alternative treatment modalities B) Family awareness functional ability and (ADLs) C) Knowledge of pathophysiology of disease process D) Knowledge about selfcare and therapeutic regiment

D) Knowledge about selfcare and therapeutic regiment

A patient is having pulmonaryfunction studies performed. The patient performs a spirometry test, revealing an FEV /FVC ratio of 60%. How should the nurse interpret this assessment finding? A) Strong exercise tolerance B) Exhalation volume is normal C) Respiratory infection D) Obstructive lung disease

D) Obstructive lung disease -is when an FEV /FVC ratio is less than 70%.

A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care? A) Taking prophylactic antibiotics as ordered B) Adhering to treatment regimen in order to cure disease C) Avoiding airplanes, buses, other crowded public places D) Setting realistic short term and long range goals

D) Setting realistic short term and long range goals

Grade IV (very severe) COPD :

FEV1/FVC < 70% and FEV1 < 30% predicted.

Grade III (severe) COPD :

FEV1/FVC < 70% and FEV1 < 30% to 50% predicted.

Grade I COPD : (mild),

FEV1/FVC < 70% and FEV1 ≥ 80% predicted.

Grade II (moderate) COPD :

FEV1/FVC1 < 70% and FEV1 50% to 80% predicted.

T/F: Bronchiectasis = COPD.

False

T/F: Chest vibration is the technique of applying manual compression and tremor to the chest wall while the patient is deeply inhaling during respiration.

False

T/F: Complications of COPD include Lung cancer, cystic fibrosis, and hemothorax

False

T/F: Routine deflation of an endotracheal cuff is recommended to prevent trauma to the tissue of the tracheal lining.

False

COPD Grades

Grade I COPD : (mild), FEV1/FVC < 70% and FEV1 ≥ 80% predicted. Grade II (moderate) COPD : FEV1/FVC1 < 70% and FEV1 50% to 80% predicted. Grade III (severe) COPD : FEV1/FVC < 70% and FEV1 < 30% to 50% predicted. Grade IV (very severe) COPD : FEV1/FVC < 70% and FEV1 < 30% predicted.

What's part of all treatment plans for bronchiectasis & why?

Postural drainage/ because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection.

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Atrovent Flovent Combivent Proventil

Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

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 Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/minute

Respiratory rate of 22 breaths/minute Explanation: In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect. Reference:

T/F: Inspirometer and peak flow meters measure opposite flows

TRUE

After a pneumonectomy, a patient should be turned every hour from the back to the operative side and should not be completely turned to the unoperated side.

True

T/F: The water level in the water seal chamber of a chest drainage system reflects the negative pressure present in the intrathoracic cavity.

True

The Venturi mask is the most reliable and accurate method for delivering a precise concentration of oxygen through noninvasive means.

True

Ascites

accumulation of fluid in the peritoneal cavity, causing abdominal swelling.

LABAs are not used for management of

acute asthma symptoms.

Spirometry is used to evaluate

airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:

airways are so swollen that no air can get through.

At 11 p.m., 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 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer: alprazolam (Xanax). propranolol (Inderal). morphine. albuterol (Proventil).

albuterol (Proventil). Explanation: The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.

Short-acting beta2-adrenergic agonists include /work by

albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

A host risk factor for COPD is a deficiency of

alpha antitrypsin,

Alprazolam is an

anxiolytic and central nervous system depressant, which could suppress the client's breathing.

The cuff on an endotracheal or tracheostomy tube should be inflated if the patient requires mechanical ventilation or is at high risk for ______________.

aspiration

Two major postoperative complications of thoracic surgery are atelectasis and

aspiration pneumonia

Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard.

auscultation with a stethoscope when wheezing or diminished breath sounds are heard

The hallmark pathology of CF i

bronchial mucus plugging, inflammation, and eventual bronchiectasis.(which begins in the upper lobes and progresses to involve all lobes)

Clubbing of the fingers is associated with

bronchiectasis -b/c of respiratory insufficiency

Theophylline, albuterol, and atropine are

bronchodilators.

Muffled or distant heart sounds occur in

cardiac tamponade.

Stage 0 is

characterized by normal spirometry/0 risk

rhonchi is associated with

chronic bronchitis.

Characteristic symptoms of bronchiectasis include

chronic cough and production of purulent sputum in copious amounts.

Bronchiectasis is a

chronic, irreversible dilation of the bronchi and bronchioles

Dexamethasone (Decadron) and prednisone are

corticosteroids.

Describe most common asthma symptoms

cough, dyspnea, and wheezing. .

Stage III

demonstrate an FEV less than 30% with respiratory failure or clinical signs of right heart failure

A nurse is 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. paradoxical chest wall movement with respirations. tracheal deviation to the unaffected side. muffled or distant heart sounds.

diminished or absent breath sounds on the affected side. auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side.

Wheezing on inspiration or expiration?

first on expiration and then, possibly, during inspiration as well

Bronchiectasis may be caused by

including airway obstruction diffuse airway injury, pulmonary infections obstruction of the bronchu complications of longterm pulmonaryinfections, or genetic disorders such as cystic fibrosis.

Smoking has what pathophysiologic effect?

irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, -->more irritation, infection, and damage

Treatment options for patients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are

limited, although lung volume reduction surgery is a palliative surgical option that is approved by Medicare in selected patients. This includes patients with homogenous disease or disease that is focused in one area and not widespread throughout the lungs.

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

mast cells

Stage I is

mild COPD with an FEV less than 70%.

A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 salmeterol/fluticasone (Seretide) MDI daily at 0800 azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 prednisone 5 mg oral daily at 0800

salmeterol/fluticasone (Seretide) MDI daily at 0800 Explanation: When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.

The classification of Stage III of COPD is defined as

severe COPD.

High or increased compliance

stretched out lungs - lost their elasticity , thorax is over distended as in emphysema, pneumothorax, pleural effusion, and acute respiratory distress syndrome (ARDS).

Tracheal deviation occurs in a

tension pneumothorax.

Bronchospasm, which occurs in many pulmonary diseases, reduces

the caliber of the small bronchi and may cause dyspnea, static secretions, and infection.

Peak flow meters measure

the highest airflow during a forced expiration.

Tidal volume is the

volume of air inhaled and exhaled with each breath.

The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen A 62 year old with emphysema who has 300 mL of intravenous fluid remaining A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office

An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD.

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: Collects sputum for culture and sensitivity Administers vancomycin intravenously Provides nebulized tobramycin (TOBI) Gives oral pancreatic enzymes with meals

Collects sputum for culture and sensitivit Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Compromised gas exchange Decreased airflow Wheezes Jugular vein distention Ascites

Compromised gas exchange Decreased airflow Wheezes

What kind of breathing, increases lung expansion?

Diaphragmatic breathing, not chest

Which of the following is a symptom diagnostic of emphysema?

Dyspnea

The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlarge of central pulmonary arteries Left ventricular hypertrophy

Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlarge of central pulmonary arteries

nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). What test results is associated with a diagnosis of cystic fibrosis?

Elevated sweat chloride concentration

High or increased compliance occurs in which disease process? Emphysema Pneumothorax Pleural effusion ARDS

Emphysema

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: "Nicotine patches would be appropriate for you." "Have you tried to quit smoking before?" "I can refer you to the American Lung Association." "Many options are available for you."

Have you tried to quit smoking before?" Explanation: All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in? I II III IV

II

In which stage of COPD is the forced expiratory volume (FEV) less than 30%? II I 0 III

III

***A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? Inhaled beclomethasone (Beconase) Oral sustained-release albuterol (Proventil) Subcutaneous omalizumab (Xolair) Oral prednisone (Deltasone)

Inhaled beclomethasone (Beconase) For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone. The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma.

A nurse is explaining to a patient with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give? A) To ensure longterm prevention of asthma exacerbations B) To cure any systemic infection underlying asthma attacks C) To prevent recurrent pulmonary infections D) To gain prompt control of inadequately controlled, persistent asthma

Prednisone is used for a short term (3-10 days) burst to gain prompt control of inadequately controlled, persistent asthma. It is not used to treat infection or to prevent exacerbations in the long term.

Which medications are the first used for prompt relief of airflow obstruction?

Quick acting beta adrenergic

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

Sputum and a productive cough

T/F: Rapid resumption of prediagnosis function and oxygen saturation above 98% are unrealistic goals.

TRUE

Bronchiectasis is

a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. Also, hemoptysis, chronic cough, copious purulent sputum, and clubbing of the fingers.

Sa02

amount of oxygen bound to hemoglobin in arterial blood. T

alpha antitrypsin is a __________ that protects _________________

an enzyme inhibitor / lung parenchyma from injury. without it, young patients are predispose to rapid development of lobular emphysema even in the absence of smoking.

Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are

antibiotics.

Paradoxical chest wall movements occur in

flail chest conditions.

FEV

forced expiration volume

FVC

forced vital capacity.

Expiratory reserve volume is the

maximum volume of air that can be exhaled forcibly after a normal exhalation.

COPD stages

mild COPD. Stage I is mild COPD. Stage 0 is at risk for COPD. Stage III is severe COPD. Stage IV is very severe COPD.

The classification of Stage I of COPD is defined as at risk for COPD. mild COPD. severe COPD. very severe COPD.

mild COPD. Stage I is mild COPD. Stage 0 is at risk for COPD. Stage III is severe COPD. Stage IV is very severe COPD.

classification of Stage II of COPD is defined as

moderate COPD

During Bronchospasm, increased ________ along with decreased _________, contributes to further reduction in the caliber of the bronchi and results in decreased _____ and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD

mucus production / mucociliary action /airflow

Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for

nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption

Sudden pleuritic chest pain is a common manifestation of

pulmonary embolism.

A partial __________ oxygen mask has a reservoir bag that must remain inflated during both inspiration and expiration.

re-breather

Lung volume reduction surgery involves

removal of a portion of the diseased lung parenchyma. This reduces hyperinflation and allows the functional tissue to expand, resulting in improved elastic recoil of the lung and improved chest wall and diaphragmatic mechanics. This type of surgery does not cure the disease nor improve life expectancy; however, it may decrease dyspnea, improve lung function and exercise tolerance, and improve the patient's overall quality of life

Morphine is a .

respiratory center depressant and is contraindicated in this situation

Complications of COPD include

respiratory failure, pneumothorax, atelectasis, pneumonia, and pulmonary hypertension (corpulmonale).

COPD is classified into four grades depending on

the severity measured by pulmonary function tests.

Residual volume is

the volume of air remaining in the lungs after a maximum exhalation

cystic fibrosis CF, which is characterized by

thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions.

Respiratory ___________ is the process of withdrawing the patient from dependence on the ventilator which takes place in three stages.

weaning

Propranolol is contraindicated in a client who's

wheezing because it's a beta2 adrenergic antagonist.

The 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 Emphysema Pleurisy Pneumonia

Atelectasis Explanation: In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

A nurse is assessing a patient who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply. A) Pulmonary hypertension B) Airway obstruction C) Pulmonary infections D) Genetic disorders E) Atelectasis

B) Airway obstruction C) Pulmonary infections D) Genetic disorders

A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma? A) Rescue inhalers B) Antiinflammatory drugs C) Antibiotics D) Antitussives

B) Anti inflammatory drugs Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of anti inflammatory medications. Rescue inhalers, antibiotics, and anti tussives do not aid in the first line control of persistent asthma.

An interdisciplinary team is planning the care of a patient with bronchiectasis. What aspects of care should the nurse anticipate? Select all that apply. A) Occupational therapy B) Antimicrobial therapy C) Positive pressure isolation D) Chest physiotherapy E) Smoking cessation

B) Antimicrobial therapy D) Chest physiotherapy E) Smoking cessation

A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize? A) Smoking up to onehalf of a pack of cigarettes weekly is allowable. B) Chronic inhalation of indoor toxins can cause lung damage. C) Minor respiratory infections are considered to be selflimited and are not treated. D) Activities of daily living (ADLs) should be clustered in the early morning hours.

B) Chronic inhalation of indoor toxins can cause lung damage.

An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients? A) Encouraging patients to carry a corticosteroid rescue inhaler at all times B) Educating patients about recognizing and avoiding asthma triggers C) Teaching patients to utilize alternative therapies in asthma management D) Ensuring that patients keep their immunizations up to date

B) Educating patients about recognizing and avoiding asthma triggers

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

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in? I II III IV

I Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.

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

IV

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Dry airways that obstruct airflow Decreased numbers of goblet cells

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.

FEV1/FVC

T(forced expiratory volume 1) is the volume of air forcefully exhaled in 1 second, whereas the FVC (forced vital capacity) is the volume of air that can be maximally forcefully exhaled - and therefore contains the FEV1 within it. If the FEV1/FVC ratio is <80%, it indicates that an obstructive defect is present

Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. Albuterol is a bronchodilator. Decadron is an antibiotic. Bactrim is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

These are all drugs that could be prescribed to a patient with COPD. Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

COPD goal PaO2 /Sa02

of at least 60 mm Hg and an SaO2 of 90%

Nearly 90% of patients with CF have ____________insufficiency and require oral ___________________ with meals

pancreatic exocrine / pancreatic enzyme supplementation

PaO2

partial pressure of O2 in arterial blood-- typically measured via ABG.

A nurse is planning the care of a client with bronchiectasis. What would be goal of care

patient will successfully mobilize pulmonary secretions.

Stage II

patients demonstrate an FEV of 30% to 80%. S

difference between atelectasis and pneumothorax

pneumothorax may be referred to as a collapsed lung, people sometimes use the term 'collapsed lung' to refer to atelectasis. Atelectasis refers to improper amounts of air in the alveoli (air sacs), resulting in a loss of volume in all or part of the lung. This loss of air in the alveoli can be due to obstruction.

parenchyma

portion of the lung involved in gas transfer—the alveoli, alveolar ducts and respiratory bronchioles.

COPD pulmonary function is evaluated in conjunction with symptoms, health status impairment with COPD, and the

potential for exacerbations.