Ch 24 NCLEX
The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction? a) "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." b) "I will take a slow, deep breath in after pushing down on the MDI." c) "I can't use a spacer or holding chamber with the MDI." d) "I will shake the MDI container before I use it."
c) "I can't use a spacer or holding chamber with the MDI." Explanation: The patient can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining patient statements are accurate and indicate the patient understands how to use the MDI correctly.
The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a patient diagnosed with COPD. The nurse correctly includes which of the following medications? Select all that apply. a) Nicotine gum b) Wellbutrin c) Zyban d) Chantix e) Catapres
a) Nicotine gum, b) Wellbutrin, c) Zyban Explanation: First-line therapy includes nicotine gum, Zyban, and Wellbutrin. Second-line pharmacotherapy includes the antihypertensive agent clonidine (Catapres). However, the use of clonidine is limited by its side effects. Varenicline (Chantix), a nicotinic acetylcholine receptor partial agonist, may also assist in smoking cessation.
A patient is receiving theophylline (Theo-Dur) for long-term control and prevention of asthma symptoms. Patient teaching related to this medication will include which of the following? a) The importance of blood tests to monitor serum concentrations b) Taking the medication at least 1 hour prior to meals c) Development of hyperkalemia d) Monitoring liver function studies as prescribed
a) The importance of blood tests to monitor serum concentrations Explanation: The nurse should inform patients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The patient is at risk of developing hypokalemia.
Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at treating end-stage emphysema. b) Both are aimed at improving the overall quality of life of a patient with COPD. c) Both are aimed at curing COPD. d) Both are used to treat patients with bullous emphysema.
b) Both are aimed at improving the overall quality of life of a patient with COPD. Explanation: The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat patients with bullous emphysema.
Which of the following exposures accounts for most of the risk factors for COPD? a) Ambient air pollution b) Exposure to tobacco smoke c) Occupational exposure d) Passive smoking
b) Exposure to tobacco smoke Explanation: Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors, but they do not account for most cases.
Which of the following diagnostic test is the most accurate in assessing acute airway obstruction? a) Spirometry b) Pulmonary function studies c) Pulse oximetry d) Arterial blood gases (ABGs)
b) Pulmonary function studies Explanation: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC). Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs, and pulse oximetry are not the most accurate diagnostics for an airway obstruction.
Which of the following measures may increase complications for a patient with COPD? a) Decreased oxygen supply b) Administration of antibiotics c) Administration of antitussive agents d) Increased oxygen supply
d) Increased oxygen supply Explanation: Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.
Why would a patient with COPD report feeling fatigued? Select all that apply. a) The patient is using all expendable energy just to breathe. b) There is a gradual decrease in muscle function over time in a patient with COPD. c) There is a gradual decrease in lung function over time in a patient with COPD. d) The patient is using all expendable energy for activities of daily living (ADLs).
a) The patient is using all expendable energy just to breathe., c) There is a gradual decrease in lung function over time in a patient with COPD. Explanation: The patient is using all expendable energy just to breathe. There is a gradual decrease in lung function, not muscle function, over time in a patient with COPD. In the patient with COPD, fatigue and feeling of exhaustion stem directly from the disease, not from activity level.
Which of the following is the most important risk factor for development of COPD? a) Air pollution b) Cigarette smoking c) Occupational exposure d) Genetic abnormalities
b) Cigarette smoking Explanation: Risk factors for COPD include environmental exposures and host factors. The most important environmental risk factor for COPD worldwide is cigarette smoking. A dose-response relationship exists between the intensity of smoking (pack-year history) and the decline in pulmonary function. Other environmental risk factors include smoking pipes, cigars, and other types of tobacco. Passive smoking (i.e., second-hand smoke) also contributes to respiratory symptoms and COPD. Air pollution is a risk factor for development of COPD, but it is not the most important risk factor.
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. a) Ciprofloxacin is an antibiotic. b) Decadron is an antibiotic. c) Bactrim is a bronchodilator. d) Albuterol is a bronchodilator. e) Prednisone is a corticosteroid.
a) Ciprofloxacin is an antibiotic., d) Albuterol is a bronchodilator., e) Prednisone is a corticosteroid. Explanation: Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.
A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following? a) Implementing measures to clear pulmonary secretions b) Providing the patient with a low-calorie, high-fiber diet c) Teaching the family how to perform postural drainage d) Instructing the patient on the signs of respiratory infection
a) Implementing measures to clear pulmonary secretions Explanation: Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.
The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care? a) Performing chest physiotherapy as ordered b) Restricting oral intake to 1,000 mL/day c) Discussing palliative care and end-of-life issues with the patient d) Providing the patient with a low sodium diet
a) Performing chest physiotherapy as ordered Explanation: Nursing care includes helping patients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. The patient with CF also experiences increased salt content in sweat gland secretions; thus, it is important to ensure the patient consumes a diet that is adequate in sodium. As the disease progresses, the patient will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the patient terminally ill.
A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instructs the patient to breathe in slowly through the nose, taking in a normal breath. Then, the nurse asks the patient to pucker his lips as if preparing to whistle. Finally, the patient is told to exhale slowly and gently through the puckered lips. The nurse teaches the patient this breathing exercise to accomplish which of the following? Select all that apply. a) Release trapped air in the lungs b) Strengthen the diaphragm c) Prevent collapse of the airways d) Condition the inspiratory muscles e) Control the rate and depth of respirations
a) Release trapped air in the lungs, c) Prevent collapse of the airways, e) Control the rate and depth of respirations Explanation: The nurse is teaching the patient the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases trapped air in the lungs, and helps the patient control the rate and depth of respirations. This helps patients relax and get control of dyspnea and reduces the feelings of panic they experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training the patient will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.
A patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's condition. Which of the following are therapy goals? Select all that apply. a) Return the patient to his original functioning abilities. b) Teach the patient to suspend activity. c) Provide medical support for the current exacerbation. d) Treat the underlying cause of the event. e) Return the patient to his original functioning abilities.
a) Return the patient to his original functioning abilities., a) Return the patient to his original functioning abilities., c) Provide medical support for the current exacerbation., d) Treat the underlying cause of the event. Explanation: The goal is to have a stable patient with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the patient can live a reasonably normal life. With adequate management, patients should not have to give up their usual activities.
A patient is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which of the following medications is contraindicated in the treatment of asthma exacerbations? a) Atrovent (Ipratropium) b) Intal (Cromolyn Sodium) c) Xopenex (Levalbuterol HFA) d) Proventil (Albuterol)
b) Intal (Cromolyn Sodium) Explanation: Intal is contraindicated in patients with acute asthma exacerbation. Indications for Intal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Intal is also a preventive treatment prior to exposure to exercise or known allergen. Proventil (albuterol), Xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms.
Emphysema is described by which of the following statements? a) A disease that results in a common clinical outcome of reversible airflow obstruction b) Chronic dilatation of a bronchus or bronchi c) A disease of the airways characterized by destruction of the walls of overdistended alveoli d) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years
c) A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.
A patient is being treated in the ED for respiratory distress, coupled with pneumonia. The patient has no past medical history. However, the patient works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which of the following orders based on immediate needs for the patient? a) Completion of a 12-lead ECG b) Administration of corticosteroids and bronchodilators c) Administration of antibiotics d) Patient education: avoidance of irritants like smoke and pollutants
c) Administration of antibiotics Explanation: Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia. Corticosteroids and bronchodilators are administered to asthmatic patients when they show symptoms of wheezing. An ECG is used to evaluate atrial arrhythmias.
Which type of chest configuration is typical of the patient with COPD? a) Pigeon chest b) Flail chest c) Barrel chest d) Funnel chest
c) Barrel chest Explanation: In patients with COPD who have a primary emphysematous component, chronic hyperinflation leads to the "barrel chest" thorax configuration. This configuration results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity. Pigeon chest results from a displaced sternum. Flail chest results when the ribs are fractured. Funnel chest occurs when there is a depression in the lower portion of the sternum; it is associated with Marfan's syndrome or rickets.
A patient diagnosed with asthma is preparing for discharge. The nurse is educating the patient on the proper use of a peak flow meter. The nurse will instruct the patient to complete which of the following? a) Take and record peak flow readings three times daily. b) Move the indicator to the top of the numbered scale. c) If coughing occurs during the procedure, repeat it. d) Sit down while completing a peak flow reading.
c) If coughing occurs during the procedure, repeat it. Explanation: Steps for using the peak flow meter correctly include (1) Moving the indicator to the bottom of the numbered scale; (2) standing up; (3) taking a deep breath and filling the lungs completely; (4) placing mouthpiece in mouth and closing lips around mouthpiece; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the patient coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.
A male patient newly diagnosed with COPD tells the nurse, "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? Which of the following is the nurse's best response? a) "You can also expect to experience a progressive weight gain." b) "As your COPD worsens, you will develop frequent respiratory infections." c) "There are no other symptoms; however, your cough may get worse as the disease progresses." d) "Other symptoms you may develop are shortness of breath on exertion, and sputum production."
d) "Other symptoms you may develop are shortness of breath on exertion, and sputum production." Explanation: COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Patients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. Weight loss is common with COPD.
The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent? a) 30% b) 50% c) 70% d) 90%
d) 90% Explanation: The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.
Which of the following is the strongest predisposing factor for asthma? a) Air pollution b) Congenital malformations c) Male gender d) Allergy
d) Allergy Explanation: Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk of asthma. Common allergens can be seasonal (grass, tree, and weed pollens) or perennial (mold, dust, roaches, animal dander).
In which grade of COPD is the forced expiratory volume (FEV) less than 30%? a) III b) I c) II d) IV
d) IV Explanation: 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 with COPD, and the potential for exacerbations. Grade I: (mild), FEV1/FVC < 70% and FEV1 ≥ 80% predicted. Grade II (moderate): FEV1/FVC1 < 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 COPD. In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amounts of red blood cells. Which of the following is the term for this process? a) Emphysema b) Bronchitis c) Asthma d) Polycythemia
d) Polycythemia Explanation: Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.
As status asthmaticus worsens, the nurse would expect the patient to develop which of the following acid-base imbalances? a) Metabolic alkalosis b) Metabolic acidosis c) Respiratory alkalosis d) Respiratory acidosis
d) Respiratory acidosis Explanation: There is reduced PaO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, PaCO2 increases and the pH decreases, reflecting respiratory acidosis.