CHAPTER 24 Management of Patients With Chronic Pulmonary Disease

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? 1. Anxiety 2. Impaired swallowing 3. Imbalanced nutrition: More than body requirements 4. Unilateral neglect

Anxiety Correct response: Anxiety Explanation: In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: 1. "Have you tried to quit smoking before?" 2. "Nicotine patches would be appropriate for you." 3. "Many options are available for you." 4. "I can refer you to the American Lung Association."

Correct response: "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.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? 1. "I can't use a spacer or holding chamber with the MDI." 2. "I will shake the MDI container before I use it." 3. "I will take a slow, deep breath in after pushing down on the MDI." 4. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use."

Correct response: "I can't use a spacer or holding chamber with the MDI." Explanation: 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.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? 1. "I will shake the MDI container before I use it." 2. "I will take a slow, deep breath in after pushing down on the MDI." 3. "I can't use a spacer or holding chamber with the MDI." 4. "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use."

Correct response: "I can't use a spacer or holding chamber with the MDI." Explanation: 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 with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? 1. "Weigh yourself daily and report a gain of 2 lb in 1 day." 2. "Limit yourself to smoking only 2 cigarettes per day." 3. "Maintain bed rest." 4. "Eat a high-sodium diet."

Correct response: "Weigh yourself daily and report a gain of 2 lb in 1 day." Explanation: The nurse should instruct the client to weigh himself 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.

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 ___%. 1. 56 mm Hg; 86% 2. 60 mm Hg; 90% 3. 58 mm Hg; 88% 4. 54 mm Hg; 84%

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

Which statement describes emphysema? 1. A disease of the airways characterized by destruction of the walls of overdistended alveoli 2. Chronic dilatation of a bronchus or bronchi 3. A disease that results in reversible airflow obstruction, a common clinical outcome 4. Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years

Correct response: A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of COPD. 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.

Which of the following is accurate regarding status asthmaticus? A1. severe asthma episode that is refractory to initial therapy 2. Patients have a productive cough. 3. Usually does not progress to severe obstruction 4. Usually occurs with warning

Correct response: A severe asthma episode that is refractory to initial therapy Explanation: Status asthmaticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.

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? 1. Albuterol 2. Ipratropium bromide 3. Ipratropium bromide and albuterol sulfate 4. Fluticasone propionate

Correct response: Albuterol Explanation: 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 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? 1. Albuterol 2. Ipratropium bromide and albuterol sulfate 3. Fluticasone propionate 4. Ipratropium bromide

Correct response: Albuterol Explanation: 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 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? 1. Fluticasone propionate 2. Ipratropium bromide and albuterol sulfate 3. Ipratropium bromide 4. Albuterol

Correct response: Albuterol Explanation: 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 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? I1. pratropium bromide and albuterol sulfate 2. Fluticasone propionate 3. Ipratropium bromide 4. Albuterol

Correct response: Albuterol Explanation: 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.

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. 1. Dexamethasone is an antibiotic. 2. Albuterol is a bronchodilator. 3. Prednisone is a corticosteroid. 4. Cotrimoxazole is a bronchodilator. 5. Ciprofloxacin is an antibiotic.

Correct response: Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid. Explanation: Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics. All of these drugs could be prescribed to a client with COPD.

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. 1. Prednisone is a corticosteroid. 2. Albuterol is a bronchodilator. 3. Cotrimoxazole is a bronchodilator. 4. Dexamethasone is an antibiotic. 5. Ciprofloxacin is an antibiotic.

Correct response: Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid. Explanation: Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics. All of these drugs could be prescribed to a client with COPD.

Which is the strongest predisposing factor for asthma? 1. Air pollution 2. Male gender 3. Allergy 4. Congenital malformations

Correct response: Allergy Explanation: Allergy is the strongest predisposing factor for asthma.

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? 1. An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office 2. An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen 3. A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 4. A 62 year old with emphysema who has 300 mL of intravenous fluid remaining

Correct response: An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office Explanation: 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 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? 1. Anxiety 2. Unilateral neglect 3. Impaired swallowing 4. Imbalanced nutrition: More than body requirements

Correct response: Anxiety Explanation: In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take? 1. Aspirates for blood return before injecting the medication 2. Assesses fasting blood glucose levels 3. Informs the client to limit fluid intake due to fluid retention 4. Encourages the client to decrease caloric intake due to increased appetite

Correct response: Assesses fasting blood glucose levels Explanation: Adverse effects of methylprednisolone (Solu-Medrol) include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.

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 1. Emphysema 2. Pneumonia 3. Pleurisy 4. Atelectasis

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

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 1. Pneumonia 2. Emphysema 3. Pleurisy 4. Atelectasis

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

Which is the most important risk factor for development of COPD? 1. Occupational exposure 2. Cigarette smoking 3. Genetic abnormalities 4. Air pollution

Correct response: 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 and genetic abnormalities are risk factors for development of COPD, but neither is the most important.

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? 1. Collects sputum for culture and sensitivity 2. Gives oral pancreatic enzymes with meals 3. Administers vancomycin intravenously 4. Provides nebulized tobramycin (TOBI)

Correct response: Collects sputum for culture and sensitivity Explanation: 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.

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? 1. Provides nebulized tobramycin (TOBI) 2. Collects sputum for culture and sensitivity 3. Administers vancomycin intravenously 4. Gives oral pancreatic enzymes with meals

Correct response: Collects sputum for culture and sensitivity Explanation: 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 client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. 1. Ascites 2. Wheezes 3. Jugular vein distention 4. Compromised gas exchange 5. Decreased airflow

Correct response: Compromised gas exchange Decreased airflow Wheezes Explanation: Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2015).

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. 1. Decreased airflow 2. Jugular vein distention 3. Compromised gas exchange 4. Ascites 5. Wheezes

Correct response: Compromised gas exchange Decreased airflow Wheezes Explanation: Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2015).

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client 1. Inhales deeply and holds the breath 2. Exhales hard and fast with a single blow 3. Sits in a straight-back chair and leans forward 4. Records in a diary the number achieved after one breath

Correct response: Exhales hard and fast with a single blow Explanation: To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? 1. Exposure to tobacco smoke 2. Passive smoking 3. Ambient air pollution 4. Occupational exposure

Correct response: 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 do not account for the majority.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? 1. Occupational exposure 2. Exposure to tobacco smoke 3. Ambient air pollution 4. Passive smoking

Correct response: 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 do not account for the majority.

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client 1. Reports shortness of breath 2. Cannot perform activities of daily living 3. Has wheezes in the right lung lobes 4. Has a respiratory rate of 28 breaths/minute

Correct response: Has wheezes in the right lung lobes Explanation: Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? 1. Low-fat 2. 1,800-calorie ADA 3. Full-liquid 4. High-protein

Correct response: High-protein Explanation: 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. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? 1. Low-fat 2. Full-liquid 3. High-protein 4. 1,800-calorie ADA

Correct response: High-protein Explanation: 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. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

Asthma is cause by which type of response? 1. IgA-mediated 2. IgE-mediated 3. IgM-mediated 4. IgD-mediated

Correct response: IgE-mediated Explanation: 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.

Asthma is cause by which type of response? 1. IgM-mediated 2. IgE-mediated 3. IgD-mediated 4. IgA-mediated

Correct response: IgE-mediated Explanation: 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.

Which measure may increase complications for a client with COPD? 1. Decreased oxygen supply 2. Increased oxygen supply 3. Administration of antibiotics 4. Administration of antitussive agents

Correct response: Increased oxygen supply Explanation: 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 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? 1. High risk for ineffective therapeutic regimen management related to lack of knowledge 2. Ineffective coping related to anxiety 3. Activity intolerance related to fatigue 4. Disturbed sleep pattern related to cough

Correct response: Ineffective coping related to anxiety Explanation: Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior. Constant shortness of breath and fatigue may make the patient irritable and apprehensive to the point of panic. Although the other choices are correct, the most important psychosocial nursing diagnosis for a patient with COPD is ineffective coping related to a high level of anxiety.

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. 1. Inflamed airways that obstruct airflow 2. Mucus secretions that block airways 3. Overinflated alveoli that impair gas exchange 4. Decreased numbers of goblet cells 5. Dry airways that obstruct airflow

Correct response: Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Explanation: 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.

Which of the following is the key underlying feature of asthma? 1. Shortness of breath 2. Productive cough 3. Inflammation 4. Chest tightness

Correct response: Inflammation Explanation: Inflammation is the key underlying feature and leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheeze, and dyspnea.

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? 1. Heart rate 2. Skin color 3. Lung sounds 4. Respiratory rate

Correct response: Lung sounds Explanation: A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

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? 1. Skin color 2. Lung sounds 3. Heart rate 4. Respiratory rate

Correct response: Lung sounds Explanation: A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? 1 .Neutrophils 2. Lymphocytes 3. Eosinophils 4. Mast cells

Correct response: Mast cells Explanation: Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.

Which terms means an increase in the red blood cell concentration in the blood? 1. Emphysema 2. Bronchitis 3. Asthma 4. Polycythemia

Correct response: Polycythemia Explanation: Polycythemia is an increase in the red blood cell concentration in the blood. Emphysema is a disease of the airways characterized by destruction of the walls of overdistended alveoli. Asthma is a disease with multiple precipitating mechanisms resulting in a common clinical outcome of reversible airflow obstruction. Bronchitis is a disease of the airways defined as the presence of cough and sputum production for a certain period of time.

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. 1. Treat the underlying cause of the event. 2. Return the client to their original functioning abilities. 3. Teach the client to suspend activity. 4. Provide long-term support for medical management. 5. Provide medical support for the current exacerbation.

Correct response: Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Explanation: The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities.

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? 1. Increasing pH 2. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise 3. Avoiding the use of oxygen to decrease the hypoxic drive 4. Providing sufficient oxygen to improve oxygenation

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

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? 1. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise 2. Increasing pH 3. Providing sufficient oxygen to improve oxygenation 4. Avoiding the use of oxygen to decrease the hypoxic drive

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

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? 1. Metabolic alkalosis 2. Respiratory acidosis 3. Respiratory alkalosis 4. Metabolic acidosis

Correct response: Respiratory acidosis Explanation: As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? 1. Respiratory acidosis 2. Metabolic alkalosis 3. Metabolic acidosis 4. Respiratory alkalosis

Correct response: Respiratory acidosis Explanation: 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.

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? 1. Metabolic acidosis 2. Respiratory acidosis 3. Metabolic alkalosis 4. Respiratory alkalosis

Correct response: Respiratory acidosis Explanation: 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

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? 1. Respiratory alkalosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Metabolic acidosis

Correct response: Respiratory acidosis Explanation: 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 patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? 1. Respiratory alkalosis 2. Respiratory acidosis 3. Metabolic acidosis 4. Metabolic alkalosis

Correct response: Respiratory acidosis Explanation: 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.

A health care provider orders a beta-2 adrenergic agonist agent (bronchodilator) that is long-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? 1. Salmeterol 2. Foradil 3. Terbutaline 4. Isuprel

Correct response: Salmeterol Explanation: Salmeterol is a long-acting inhalant. Terbutaline (Brethine) is a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered by inhaler and oral form. Metaproterenol sulfate (Alupent) is a short-acting beta-2 adrenergic agonist agent, but it may be administered by an inhaler, by a nebulizer, or orally. Formoterol (Foradil) is a long-acting beta-2 adrenergic agonist agent given by inhalant and nebulizer. Isoprenaline (Isuprel) is a beta-2 adrenergic agonist agent, but it may be administered by various routes.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. 1. Respiratory failure 2. Thoracentesis 3. Pertussis 4. Status asthmaticus 5. Atelectasis

Correct response: Status asthmaticus Respiratory failure Atelectasis Explanation: Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. 1. Status asthmaticus 2. Respiratory failure 3. Thoracentesis 4. Atelectasis 5. Pertussis

Correct response: Status asthmaticus Respiratory failure Atelectasis Explanation: Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. 1. Thoracentesis 2. Status asthmaticus 3. Respiratory failure 4. Pertussis 5. Atelectasis

Correct response: Status asthmaticus Respiratory failure Atelectasis Explanation: Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply. 1. The device may increase delivery of the MDI medication. 2. Take a slow, deep inhalation from the device. 3. Activate the MDI once. 4. Use normal inhalations with the device. 5. It is not necessary to hold your breath after using.

Correct response: Take a slow, deep inhalation from the device. Activate the MDI once. The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply. 1. The device may increase delivery of the MDI medication. 2. Take a slow, deep inhalation from the device. 3. Use normal inhalations with the device. 4. Activate the MDI once. 5. It is not necessary to hold your breath after using.

Correct response: Take a slow, deep inhalation from the device. Activate the MDI once. The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? 1. Avoid contact with fur-bearing animals. 2. Avoid goose down pillows. 3. Change filters on heating and air conditioning units frequently. 4. Take ordered medications as scheduled.

Correct response: Take ordered medications as scheduled. Explanation: 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 nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? 1. Take ordered medications as scheduled. 2. Avoid contact with fur-bearing animals. 3. Change filters on heating and air conditioning units frequently. 4. Avoid goose down pillows.

Correct response: Take ordered medications as scheduled. Explanation: 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 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: 1. tracheal deviation to the unaffected side. 2. diminished or absent breath sounds on the affected side. 3. muffled or distant heart sounds. 4. paradoxical chest wall movement with respirations.

Correct response: diminished or absent breath sounds on the affected side. Explanation: 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.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes 1. implementing measures to clear pulmonary secretions. 2. instructing the client on the signs of respiratory infection. 3. providing the client a low-calorie, high-fiber diet. 4. teaching the family how to perform postural drainage.

Correct response: implementing measures to clear pulmonary secretions. Explanation: 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.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes 1. instructing the client on the signs of respiratory infection. 2. implementing measures to clear pulmonary secretions. 3. providing the client a low-calorie, high-fiber diet. 4. teaching the family how to perform postural drainage.

Correct response: implementing measures to clear pulmonary secretions. Explanation: 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 1. moderate COPD. 2. at risk for COPD. 3. mild COPD. 4. very severe COPD. 5. severe COPD.

Correct response: moderate COPD. Explanation: 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 classification of Stage II of COPD is defined as 1. severe COPD. 2. at risk for COPD. 3. very severe COPD. 4. mild COPD. 5. moderate COPD.

Correct response: moderate COPD. Explanation: 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 classification of Stage II of COPD is defined as 1. very severe COPD. 2. mild COPD. 3. severe COPD. 4. moderate COPD. 5. at risk for COPD.

Correct response: moderate COPD. Explanation: 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 classification of Stage III of COPD is defined as 1. mild COPD. 2. very severe COPD. 3. severe COPD. 4. at risk for COPD. 5. moderate COPD.

Correct response: severe COPD. Explanation: 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.

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include 1. taking the medication at least 1 hour prior to meals. 2. monitoring liver function studies as prescribed. 3. the importance of blood tests to monitor serum concentrations. 4. development of hyperkalemia.

Correct response: the importance of blood tests to monitor serum concentrations. Explanation: 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.

The classification of Stage IV of COPD is defined as 1. mild COPD. 2. at risk for COPD. 3. moderate COPD. 4. severe COPD. 5. very severe COPD.

Correct response: very severe COPD. Explanation: 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.

The classification of Stage IV of COPD is defined as 1. mild COPD. 2. at risk for COPD. 3. very severe COPD. 4. severe COPD. 5. moderate COPD.

Correct response: very severe COPD. Explanation: 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.

The classification of Stage IV of COPD is defined as 1. severe COPD. 2. moderate COPD. 3. at risk for COPD. 4. mild COPD. 5. very severe COPD.

Correct response: very severe COPD. Explanation: 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.

The classification of Stage IV of COPD is defined as 1. very severe COPD. 2. severe COPD. 3. mild COPD. 4. moderate COPD. 5. at risk for COPD.

Correct response: very severe COPD. Explanation: 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.