CH 24 COPD PrepU

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: a. instruct the client to drink at least 2 L of fluid daily. b. maintain the client on bed rest. c. administer anxiolytics, as ordered, to control anxiety. d. administer pain medication as ordered.

a. instruct the client to drink at least 2 L of fluid daily. Rationale: Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? a. "Raise your arms over your head." b. "Delay self-care activities for 1 hour." c. "Sit in a chair whenever doing an activity." d. "Drink fluids upon arising from bed."

b. "Delay self-care activities for 1 hour." Rationale: Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.

A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? a. Albuterol b. Budesonide c. Cromolyn sodium d. Theophylline

c. Cromolyn sodium Rationale: Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. The other medications listed are not mast cell stabilizers.

A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? a. Maintain activity level of walking to the mailbox. b. Continue with current level of mobility at home. c. Increase walking distance around a city block without shortness of breath. d. Relieve shortness of breath to a level as close as possible to tolerable.

c. Increase walking distance around a city block without shortness of breath. Rationale: If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable.

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education? a. The patient should take the medication with meals since it may cause nausea. b. The patient should take the medication separately without other medications. c. The patient should take the medication an hour before meals or 2 hours after a meal. d. The patient should take the medication with a small amount of liquid.

c. The patient should take the medication an hour before meals or 2 hours after a meal. Rationale: The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) less than 30% predicted? a. I b. II c. III d. IV

d. IV Rationale: COPD is classified into four grades depending on the severity measured by pulmonary function tests. However, pulmonary function is not the only way to assess or classify COPD; pulmonary function is evaluated in conjunction with symptoms, health status impairment, and the potential for exacerbations. Grade I (mild): FEV1/FVC <70% and FEV1 ≥80% predicted. Grade II (moderate): FEV1/FVC <70% and FEV1 50% to 80% predicted. Grade III (severe): FEV1/FVC <70% and FEV1 <30% to 50% predicted. Grade IV (very severe): FEV1/FVC <70% and FEV1 <30% predicted.

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis

d. Respiratory alkalosis Rationale: Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? a. Theophylline b. Levalbuterol c. Terbutaline d. Albuterol

a. Theophylline Rationale: Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? a. Encouraging the client to drink three glasses of fluid daily b. Keeping the client in semi-Fowler's position c. Using a Venturi mask to deliver oxygen as ordered d. Administering a sedative as ordered

c. Using a Venturi mask to deliver oxygen as ordered Rationale: The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

Which of the following occupy space in the thorax, but do not contribute to ventilation? a. Bullae b. Alveoli c. Lung parenchyma d. Mast cells

a. Bullae Rationale: Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? a. It helps prevent early airway collapse. b. It increases inspiratory muscle strength. c. It decreases use of accessory breathing muscles. d. It prolongs the inspiratory phase of respiration.

a. It helps prevent early airway collapse. Rationale: Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include a. the importance of blood tests to monitor serum concentrations. b. taking the medication at least 1 hour prior to meals. c. monitoring liver function studies as prescribed. d. development of hyperkalemia.

a. the importance of blood tests to monitor serum concentrations. Rationale: The nurse should inform clients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The client is at risk of developing hypokalemia.

Which medication is contraindicated in acute asthma exacerbations? a. Albuterol b. Cromolyn sodium c. Levalbuterol d. Ipratropium bromide

b. Cromolyn sodium Rationale: Cromolyn sodium is contraindicated in clients with acute asthma exacerbation.