Chapter 11: Nursing Management: Patients With Chronic Obstructive Pulmonary Disease and Asthma

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

"Have you tried to quit smoking before?"

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction?

"I can't use a spacer or holding chamber with the MDI." The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly.

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? -Albuterol -Levalbuterol HFA -Cromyolyn sodium -Ipratropium

-Cromyolyn sodium

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply. Nicotine gum Clonidine Bupropion SR Caffeine Acetaminophen

-Nicotine gum -Clonidine -Bupropion SR First-line therapy includes nicotine gum as well as the antidepressants bupropion SR and nortriptyline. Second-line pharmacotherapy includes the antihypertensive agent clonidine. However, the use of clonidine is limited by its side effects. Varenicline, a nicotinic acetylcholine receptor partial agonist, may also assist in smoking cessation.

Asthma is cause by which type of response?

IgE-mediated

A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: A dry, hacking cough Dyspnea Tachycardia Sharp, stabbing chest pain

Sharp, stabbing chest pain

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 Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

A patient in an acute-care setting is being monitored closely after recently experiencing status asthmaticus. The nurse who is providing care for the patient has been assessing the patient's respiratory status frequently and has just completed auscultation of the patient's breath sounds. The nurse notes that the patient's breath sounds are significantly quieter than during the previous assessment. How should the nurse best interpret this assessment finding?

The patient's airflow may be severely limited.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes

implementing measures to clear pulmonary secretions. Nursing management focuses on alleviating symptoms and helping clients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the client 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 client's appetite and result in inadequate dietary intake; therefore, the client's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

The classification of Stage II of COPD is defined as

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

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? -"Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." -"I will take a slow, deep breath in after pushing down on the MDI." -"I can't use a spacer or holding chamber with the MDI." -"I will shake the MDI container before I use it."

"I can't use a spacer or holding chamber with the MDI."

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary?

"I do not need to rinse my mouth with this type of inhaler." Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

Long-term oxygen therapy has been prescribed for a patient whose chronic obstructive pulmonary disease (COPD) has recently increased in severity. When teaching this patient about this treatment modality, what information should the nurse provide?

"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time." Patients requiring oxygen therapy need to be taught the importance of adhering to the oxygen prescription. Patients often think they can tell when they need oxygen by their symptoms. The presence or absence of dyspnea is unreliable in detecting the need for supplemental oxygen. Many hypoxemic patients do not feel dyspnea. Additionally, many patients who are dyspneic do not have significant hypoxemia or oxygen desaturation.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? -"I can't use a spacer or holding chamber with the MDI." -"I will take a slow, deep breath in after pushing down on the MDI." -"Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." -"I will shake the MDI container before I use it."

-"I can't use a spacer or holding chamber with the MDI."

Which of the following is the key underlying feature of asthma? -Productive cough -Shortness of breath -Chest tightness -Inflammation

-Inflammation

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? -Ipratropium bromide (Alupent) by metered-dose inhaler -Oxygen through nasal cannula at 2 L/minute -Vancomycin 1 gram intravenously over 1 hour -Intravenous methylprednisolone (Solu-Medrol) 120 mg

-Oxygen through nasal cannula at 2 L/minute

An increase in the red blood cell concentration in the blood is termed which of the following? Emphysema Bronchitis Asthma Polycythemia

-Polycythemia

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. -Strengthen the diaphragm -Prevent airway collapse -Control the rate and depth of respirations -Condition the inspiratory muscles -Release air trapped in the lungs

-Prevent airway collapse -Control the rate and depth of respirations -Release air trapped in the lungs The nurse is teaching the client the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases air trapped in the lungs, and helps the client control the rate and depth of respirations. This helps clients relax and get control of dyspnea and reduces the feelings of panic they may experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training, the client will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? I II III IV

A. I

A client 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?

Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

A client's plan of care specifies postural drainage. Which action should the nurse perform when providing this noninvasive therapy?

Assist the client into a position that will allow gravity to move secretions. In postural drainage, the client assumes a position that allows gravity to facilitate the draining of secretions from all areas of the lungs. Postural drainage is usually performed two to four times per day, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. Because the client usually sits in an upright position (i.e., high- or semi-Fowler position), secretions are likely to accumulate in the lower parts of the lungs. Several other positions are used in postural drainage so that the force of gravity helps move secretions from the smaller bronchial airways to the main bronchi and trachea. The client is encouraged to cough and remove secretions during postural drainage.

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 Pneumonia Pleurisy Emphysema

Atelectasis

Which statement is true about both lung transplant and bullectomy?

Both procedures improve the overall quality of life of a client with COPD. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client 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 clients with bullous emphysema.

Which of the following occupy space in the thorax, but do not contribute to ventilation?

Bullae 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.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? a) Avoiding the use of oxygen to decrease the hypoxic drive b) Increasing pH c) Providing sufficient oxygen to improve oxygenation d) Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise

C) Providing sufficient oxygen to improve oxygenation. Explanation: The main objective in treating patients with hypoxmia and hypercapnia is to give sufficient oxygen to improve oxygenation.

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 25% for a patient with COPD. What stage should the nurse document the patient is in?

IV 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%.

Asthma is cause by which type of response?

IgE-mediated Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.

A nurse is preparing a discharge teaching plan for a client diagnosed with asthma and prescribed a leukotriene modifier. Which medication would the nurse most likely include when teaching the client about this group of medications? montelukast cromolyn sodium nedocromil albuterol

Montelukast Leukotriene modifiers (inhibitors), or antileukotrienes, are a class of medications that include montelukast, zafirlukast, and zileuton. Cromolyn and nedocromil are mast cell stabilizers. Albuterol is a short-acting bronchodilator.

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. Which method of oxygen delivery is most appropriate for the client's needs?

Nasal Cannula

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. Which method of oxygen delivery is most appropriate for the client's needs?

Nasal cannula A nasal cannula is used when the client requires a low to medium concentration of oxygen for which precise accuracy is not essential. The Venturi mask is used primarily for clients with COPD because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The client's respiratory status does not require a partial- or non-rebreathing mask.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

Which diagnostic test is most accurate in assessing acute airway obstruction?

Pulmonary function studies 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. Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.

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

The importance of blood tests to monitor serum concentrations.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) and is now performing discharge teaching with this patient. What should the nurse include in the teaching about breathing techniques?

Use diaphragmatic breathing. Inspiratory muscle training and breathing retraining may help improve breathing patterns. Pursed-lip breathing helps slow expiration, prevent collapse of small airways, and control the rate and depth of respiration. It also promotes relaxation, which allows patients to gain control of dyspnea and reduce feelings of panic. Diaphragmatic breathing, not chest breathing, increases lung expansion, although its benefits have been shown to be limited.

Which of the following is not a primary symptom of COPD? Weight gain Dyspnea upon exertion Cough Sputum production

Weight gain

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. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.

The classification of Stage III of COPD is defined as

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

The classification of Stage IV of COPD is defined as

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

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs? -Administer the triamcinolone and then administer the salmeterol. -Allow the client to choose the order in which the drugs are administered. -Monitor the client's theophylline level before administering the medications. -Administer the salmeterol and then administer the triamcinolone.

-Administer the salmeterol and then administer the triamcinolone.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client -Records in a diary the number achieved after one breath -Sits in a straight-back chair and leans forward -Exhales hard and fast with a single blow -Inhales deeply and holds the breath

-Exhales hard and fast with a single blow

An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure? -Highest airflow during a forced expiration. -Highest airflow during a forced inspiration -Highest airflow during a normal expiration -Highest airflow during a normal inspiration

-Highest airflow during a forced expiration

A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. -Provide long-term support for medical management. -Teach the client to suspend activity. -Provide medical support for the current exacerbation. -Return the client to their original functioning abilities. -Treat the underlying cause of the event.

-Provide long-term support for medical management. -Provide medical support for the current exacerbation. -Return the client to their original functioning abilities. -Treat the underlying cause of the event.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. -Respiratory failure -Status asthmaticus -Atelectasis -Thoracentesis -Pertussis

-Respiratory Failure -Status asthmaticus -Atelectasis

The home care nurse is assessing a client who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the client in the home environment? -The client desires a portable oxygen delivery system that can deliver 2 L/min. -The client requires a high-flow system for use with a tracheostomy collar. -The client desires a low-maintenance oxygen delivery system that delivers oxygen flow rates up to 6 L/min. -The client's respiratory status requires a system that provides an FiO2 of 65%.

-The client desires a portable oxygen delivery system that can deliver 2 L/min.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: - pleural effusion. -oxygen toxicity. -pulmonary edema -atelectasis

-atelectasis

The classification of Stage II of COPD is defined as at risk for COPD. -severe COPD. -moderate COPD. -mild COPD. -very severe COPD.

-mild COPD.

The nurse recognizing a female patient's susceptibility to infection due to her history of chronic obstructive pulmonary disease (COPD). When teaching this patient to reduce her risk of infection in the community, what measure should the nurse emphasize to the patient?

Washing her hands frequently and thoroughly Patients with COPD should be encouraged to avoid sick individuals and to receive an annual flu vaccination. However, the most important infection-control measure is vigilant handwashing. Temperature transitions do not lead to infections. Allergens can exacerbate COPD, but they do not play a major role in the development of infection.

A nurse is developing a care plan for a client with chronic obstructive pulmonary disease (COPD) admitted to the hospital for the second time this year with pneumonia. Which nursing diagnoses would be appropriate for this client? Select all that apply. -Deficient knowledge regarding self-care related to preventable complications -Impaired gas exchange related to ventilation-perfusion inequality -Ineffective health management related to fatigue -Ineffective airway clearance related to inhalation of toxins -Activity intolerance related to oxygen supply and demand

-Deficient knowledge regarding self-care related to preventable complications -Impaired gas exchange related to ventilation-perfusion inequality

A client 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 is the best response by the nurse?

C. "Other symptoms you may develop are shortness of breath upon exertion and sputum production."

A 58-year-old smoker is undergoing lung function testing because of his recent history of progressive dyspnea and a productive cough. Which of the following assessment findings during spirometry would be consistent with a diagnosis of chronic obstructive pulmonary disease (COPD)? 1- The patient's vital capacity is ≤75% of expected norms for his age and gender. 2- The patient's SaO2 does not increase with the application of supplementary oxygen. 3- The patient's ability to forcibly exhale is significantly diminished. 4- The patient exhibits adventitious lung sounds during inhalation.

The patient's ability to forcibly exhale is significantly diminished.

A client with a severe exacerbation of chronic obstructive pulmonary disease requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe?

Venturi mask The Venturi mask is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. It is used primarily for clients with COPD because it can accurately provide appropriate levels of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The Venturi mask uses the Bernoulli principle of air entrainment (trapping the air like a vacuum), which provides a high airflow with controlled oxygen enrichment. For each liter of oxygen that passes through a jet orifice, a fixed proportion of room air is entrained. Varying the size of the jet orifice and adjusting the flow of oxygen can deliver a precise volume of oxygen. The other methods of oxygen delivery listed, the nonrebreathing mask, tracheostomy collar, and face tent, do not use the Bernoulli principle and thus lack the precision of a Venturi mask.

A client with asthma is being treated with albuterol. Which of the findings from the client's history would indicate to the nurse the need to administer this drug with caution? -Angina -Peptic ulcer disease -Bronchospasm -Raynaud's disease

-Angina

A client with asthma is being treated with albuterol. Which of the findings from the client's history would indicate to the nurse the need to administer this drug with caution? -Bronchospasm -Peptic ulcer disease -Angina -Raynaud's disease

-Angina

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? -Assess vital signs every 2 hours, including O2 saturations and ABG results. -Educate the client about the importance of pursed lip breathing. -Refer the client to respiratory therapy if breathing becomes labored. -Apply supplemental oxygen as ordered.

-Apply supplemental oxygen as ordered.

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? -Decreased oxygen requirements -Hyperthermia -Decreased activity tolerance -Increased sputum production

-Decreased oxygen requirements

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. -Overinflated alveoli impair gas exchange. -Mucus secretions block airways. -Inflamed airways obstruct airflow. -Dry airways obstruct airflow.

-Overinflated alveoli impair gas exchange. -Mucus secretions block airways. -Inflamed airways obstruct airflow. -Dry airways obstruct airflow

In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply. -Albuterol is a bronchodilator. -Dexamethasone is an antibiotic. -Cotrimoxazole is a bronchodilator. -Ciprofloxacin is an antibiotic. -Prednisone is a corticosteroid.

-Albuterol is a bronchodilator. -Ciprofloxacin is an antibiotic. -Prednisone is a corticosteroid.

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs?

Administer the salmeterol and then administer the triamcinolone. A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone (Azmacort) is a corticosteroid; Salmeterol (Serevent) is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as

Atelectasis Retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: oxygen toxicity. pulmonary edema. atelectasis. pleural effusion. SUBMIT ANSWER

Atelectaxis

Which measure may increase complications for a client with COPD?

Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications.

A client 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? -Ipratropium bromide -Fluticasone propionate -Ipratropium bromide and albuterol sulfate -Albuterol

-Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

Which statement describes emphysema?

A disease of the airways characterized by destruction of the walls of overdistended alveoli 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 overdistended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of alveoli; 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 two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

Upon assessment, the nurse suspects that a client 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

The school nurse is caring for a 10-year-old girl who is having an asthma attack on the school ground at recess. What is the preferred treatment to alleviate this patient's current airflow obstruction? -Peak flow monitoring device -Anticholinergics -Corticosteroids -Beta-adrenergics

Beta-adrenergics

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse? -Gives oral pancreatic enzymes with meals -Provides nebulized tobramycin (TOBI) -Collects sputum for culture and sensitivity -Administers vancomycin intravenously

Collects sputum for culture and sensitivity

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

Respiratory acidosis In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.

Long-term oxygen therapy has been prescribed for a patient whose chronic obstructive pulmonary disease (COPD) has recently increased in severity. When teaching this patient about this treatment modality, what information should the nurse provide? -"A good rule of thumb is to temporarily stop your oxygen whenever you feel like you could comfortably go without it." -"Try to predict those situations where you'll need oxygen and apply your nasal prongs 30 minutes ahead of time." -"In time, you will learn to effectively adjust your flow rates depending on the dyspnea you are experiencing or that you anticipate." -"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time."

"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time." Patients requiring oxygen therapy need to be taught the importance of adhering to the oxygen prescription. Patients often think they can tell when they need oxygen by their symptoms. The presence or absence of dyspnea is unreliable in detecting the need for supplemental oxygen. Many hypoxemic patients do not feel dyspnea. Additionally, many patients who are dyspneic do not have significant hypoxemia or oxygen desaturation.

A client 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 is the best response by the nurse?

"Other symptoms you may develop are shortness of breath upon exertion and sputum production." COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Clients 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 reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? -"I will take a slow, deep breath in after pushing down on the MDI." -"I will shake the MDI container before I use it." -"I can't use a spacer or holding chamber with the MDI." -"Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use."

-"I can't use a spacer or holding chamber with the MDI." The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly.

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

A client with a severe exacerbation of chronic obstructive pulmonary disease requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe? -Tracheostomy collar -Nonrebreathing mask -Venturi mask -Face tent

Venturi Mask The Venturi mask is the most reliable and accurate method for delivering precise concentrations of oxygen through noninvasive means. It is used primarily for clients with COPD because it can accurately provide appropriate levels of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive. The Venturi mask uses the Bernoulli principle of air entrainment (trapping the air like a vacuum), which provides a high airflow with controlled oxygen enrichment. For each liter of oxygen that passes through a jet orifice, a fixed proportion of room air is entrained. Varying the size of the jet orifice and adjusting the flow of oxygen can deliver a precise volume of oxygen. The other methods of oxygen delivery listed, the nonrebreathing mask, tracheostomy collar, and face tent, do not use the Bernoulli principle and thus lack the precision of a Venturi mask.

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 Left ventricular hypertrophy Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries

• Right ventricular enlargement• Enlarge of central pulmonary arteries• Elevated plasma brain natriuretic peptide (BNP)• Dyspnea and fatigue disproportionate to pulmonary function abnormalities Explanation:The diagnosis of pulmonary hypertension associated with COPD is suspected in patients complaining of dyspnea and fatigue that appear to be disproportionate to pulmonary function abnormalities. Enlargement of the central pulmonary arteries on the chest X-ray, echocardiogram suggestive of right ventricular enlargement, and elevated plasma BNP may be present