Chapter 24: Management of Patients With Chronic Pulmonary Disease

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 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? a) Anxiety b) Impaired swallowing c) Unilateral neglect d) Imbalanced nutrition: More than body requirements

A

Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply.

1. Air pollution 2. Tracheobronchial infection

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.

1. Albuterol is a bronchodilator. 2. Ciprofloxacin is an antibiotic. 3. Prednisone is a corticosteroid.

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.

1. Alter smooth muscle tone 2. Reduce airway obstruction 3. Increase oxygen distribution

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

1. Compromised gas exchange 2. Decreased airflow 3. Wheezes

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 ___%.

60 mm Hg; 90%

A client being seen in the emergency department has labored respirations. Auscultation reveals inspiratory and expiratory wheezes. Oxygen saturation is 86%. The client was nonresponsive to an albuterol (Ventolin) inhaler and intravenous methylprednisolone (Solu-Medrol). The nurse administers the following prescribed treatment first: A. Oxygen therapy through a non-rebreather mask B. Intravenous magnesium sulfate C. Normal saline 0.9% at 100 mL/hr intravenously D. Oral fluid of at least 2500 mL/day

A

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? a) Lung sounds b) Skin color c) Heart rate d) Respiratory rate

A

A client is being admitted to an acute healthcare facility with an exacerbation of 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? a) salmeterol/fluticasone (Seretide) MDI daily at 0800 b) azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 c) prednisone 5 mg oral daily at 0800 d) nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800

A

Which of the following would NOT be considered a primary symptom of COPD?

Weight gain

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? a) An inspiratory-expiratory (I:E) ratio of 2:1 b) A transverse chest diameter twice that of the anteroposterior diameter c) A respiratory rate of 12 breaths/minute d) An oxygen saturation of 99%

A

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) "Delay self-care activities for 1 hour." b) "Sit in a chair whenever doing an activity." c) "Drink fluids upon arising from bed." d) "Raise your arms over your head."

A

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? a) Sputum and a productive cough b) Tachypnea and tachycardia c) Fever, chills, and diaphoresis d) Chest pain during respiration

A

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) Sharp, stabbing chest pain b) Dyspnea c) Tachycardia d) A dry, hacking cough

A

Emphysema is described by which of the following statements? a) A disease of the airways characterized by destruction of the walls of overdistended alveoli b) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years c) Chronic dilatation of a bronchus or bronchi d) A disease that results in a common clinical outcome of reversible airflow obstruction

A

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

A

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: a) Respiratory acidosis. b) Diminished alveolar surface area. c) Hypercapnia resulting from decreased carbon dioxide elimination. d) Hypoxemia secondary to impaired oxygen diffusion.

A

A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed? a) Three times a day regardless of meal time b) Before meals c) With meals d) After meals and at bedtime

C

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. a) Oxygen desaturation b) Unilateral retractions c) Sudden chest pain d) Asymmetry of chest movement e) Bilaterally equal breath sounds

ABCD

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) Treat the underlying cause of the event. c) Provide long-term support for medical management. d) Teach the patient to suspend activity. e) Provide medical support for the current exacerbation.

ABCE

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) a) Mucus secretions block airways. b) Dry airways obstruct airflow. c) Inflamed airways obstruct airflow. d) Overinflated alveoli impair gas exchange.

ACD

The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the highest priority action?

Assess vital signs every 2 hours including O2 saturations and ABG results.

The nurse plays an important role in monitoring and managing potential complications in the patient who has recently undergone a coronary artery bypass graft (CABG). The nurse should be alert to which of the following respiratory complications? a) Urinary tract infection (UTI) b) Hyperkalemia c) Atelectasis d) Elevated blood glucose level

Atelectasis Explanation: Respiratory complications that may occur include atelectasis. An incentive spirometer and the use of deep breathing exercises are necessary to prevent atelectasis and pneumonia. Elevated blood sugar levels, hyperkalemia, UTI, and are complications that can occur but are unrelated to the respiratory system. (less)

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? a) Ipratropium bromide (Alupent) by metered-dose inhaler b) Oxygen through nasal cannula at 2 L/minute c) Vancomycin 1 gram intravenously over 1 hour d) Intravenous methylprednisolone (Solu-Medrol) 120 mg

B

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

B

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

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. a) Tiotropium (Spiriva) b) Zafirlukast (Accolate) c) Montelukast (Singulair) d) Ipratropium HFA (Atrovent) e) Zileuton (Zyflo)

BCE

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

Bullae

A client with 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) administer anxiolytics, as ordered, to control anxiety. b) maintain the client on bed rest. c) instruct the client to drink at least 2 L of fluid daily. d) administer pain medication as ordered.

C

A client with COPD is recovering from a MI. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: A. Pleural Effusion B. Pulmonary Edema C. Atelactasis D. Oxygen Toxicity

C

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with COPD Which diet is appropriate for this client? a) 1,800-calorie ADA b) Low-fat c) High-protein d) Full-liquid

C

A nurse is assisting a client with mild 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) 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. d) Continue with current level of mobility at home.

C

The classification of Stage III of COPD is defined as a) moderate COPD. b) at risk for COPD. c) very severe COPD. d) mild COPD. e) severe COPD.

E

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

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?

Performing chest physiotherapy as ordered

An increase in the red blood cell concentration in the blood is termed which of the following?

Polycythemia

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

RR 22

In 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

A nursing student understands that emphysema is directly related to which of the following?

Respiratory acidosis from airway obstruction

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:

albuterol (Proventil).

The classification of Stage I of COPD is defined as

mild COPD.

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)?

tobacco

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) Providing the patient with a low-calorie, high-fiber diet b) Implementing measures to clear pulmonary secretions c) Teaching the family how to perform postural drainage d) Instructing the patient on the signs of respiratory infection

B

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

B

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 a small amount of liquid. b) The patient should take the medication an hour before meals or 2 hours after a meal. c) The patient should take the medication with meals since it may cause nausea. d) The patient should take the medication separately without other medications.

B

Which of the following is a symptom diagnostic of emphysema? a) Normal elastic recoil b) Dyspnea c) The occurrence of cor pulmonale d) Copious sputum production

B

A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? a) Activity intolerance related to fatigue b) Disturbed sleep pattern related to cough c) High risk for ineffective therapeutic regimen management related to lack of knowledge d) Ineffective coping related to anxiety

D

Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which one of the following tests? a) Arterial blood gases (ABGs) b) Pulmonary function studies c) Lumbar puncture d) Sweat chloride concentration

D

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

D

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) 70% c) 90% d) 50%

D

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? a) Emphysema b) Pleurisy c) Pneumonia d) Atelectasis

D

Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at curing COPD. b) Both are aimed at treating end-stage emphysema. c) Both are used to treat patients with bullous emphysema. d) Both are aimed at improving the overall quality of life of a patient with COPD.

D

A client is recovering from coronary artery bypass graft (CABG) surgery. Which nursing diagnosis takes highest priority at this time? a) Disabled family coping related to knowledge deficit and a temporary change in family dynamics b) Anxiety related to an actual threat to health status, invasive procedures, and pain c) Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction d) Hypothermia related to exposure to cold temperatures and a long cardiopulmonary bypass time

Decreased cardiac output related to depressed myocardial function, fluid volume deficit, or impaired electrical conduction Explanation: For a client recovering from CABG surgery, Decreased cardiac output is the most important nursing diagnosis; anesthetics or a long cardiopulmonary bypass time may depress myocardial function, leading to decreased cardiac output. Other possible causes of decreased cardiac output in this client include fluid volume deficit and impaired electrical conduction. Anxiety, Disabled family coping, and Hypothermia may be relevant but take lower priority at this time; maintaining cardiac output is essential to sustaining the client's life.