Hinkle Ch 20: Management of Patients with Chronic Pulmonary Disease

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

- "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.

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 will make sure to take a slow, deep breath as I push on my inhaler." - "After I breathe in, I will hold my breath for 10 seconds." - "I do not need to rinse my mouth with this type of inhaler." - "If I use the spacer, I know I am only supposed to push on the inhaler once."

- "I do not need to rinse my mouth with this type of inhaler." Explanation: 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.

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? - 50% - 70% - 90% - 30%

- 90% Explanation: The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.

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

- A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of 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.

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 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 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? - Anxiety - Imbalanced nutrition: More than body requirements - Impaired swallowing - Unilateral neglect

- 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.

Which statement is true about both lung transplant and bullectomy? - Both procedures cure COPD. - Both procedures treat end-stage emphysema. - Both procedures treat patients with bullous emphysema. - Both procedures improve the overall quality of life of a client with COPD.

- Both procedures improve the overall quality of life of a client with COPD. Explanation: 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.

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? - Collects sputum for culture and sensitivity - Administers vancomycin intravenously - Provides nebulized tobramycin (TOBI) - Gives oral pancreatic enzymes with meals

- 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. - Compromised gas exchange - Decreased airflow - Wheezes - Jugular vein distention - Ascites

- 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).

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? - Albuterol - Budesonide - Cromolyn sodium - Theophylline

- Cromolyn sodium Explanation: Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Though also used in the treatment of asthma the following are NOT mast cell stabilizers: Albuterol is a beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator.

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 - Cromolyn sodium - Levalbuterol HFA - Ipratropium

- Cromolyn sodium Explanation: Cromolyn sodium is contraindicated in clients with acute asthma exacerbation. Indications for cromolyn sodium are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Cromolyn sodium is also a preventive treatment before exposure to exercise or a known allergen. Albuterol, levalbuterol HFA, and ipratropium can be used to relieve acute symptoms.

A nurse is evaluating the diagnostic study data of a client with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? - Elevated sweat chloride concentration - Presence of protein in the urine - Positive phenylketonuria - Decreased tidal volume

- Elevated sweat chloride concentration Explanation: Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and decreased tidal volume are not diagnostic for CF.

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 type of disorder within its classification. Which of the following is part of that disorder? - Asthma - Bronchiectasis - Cystic fibrosis - Emphysema

- Emphysema Explanation: COPD may include diseases that cause airflow obstruction (e.g., emphysema, chronic bronchitis) or any combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of COPD are now classified as chronic pulmonary disorders. Asthma is now considered a distinct, separate disorder and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

Which exposure accounts for most cases of COPD? - Exposure to tobacco smoke - Occupational exposure - Passive smoking - Ambient air pollution

- Exposure to tobacco smoke Explanation: Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors, but they do not account for most cases.

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

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

Which measure may increase complications for a client with COPD? - Administration of antibiotics - Increased oxygen supply - Administration of antitussive agents - Decreased oxygen supply

- 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? - Disturbed sleep pattern related to cough - Ineffective coping related to anxiety - High risk for ineffective therapeutic regimen management related to lack of knowledge - Activity intolerance related to fatigue

- 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.

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

- Inflamed airways obstruct airflow. - Mucus secretions block airways. - Overinflated alveoli impair gas exchange. Explanation: Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.

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 Explanation: 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.

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 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. - Teach the client to suspend activity.

- 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.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? - Respiratory alkalosis - Metabolic alkalosis - Respiratory acidosis - Metabolic acidosis

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

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? - Chest pain during respiration - Sputum and a productive cough - Fever, chills, and diaphoresis - Tachypnea and tachycardia

- Sputum and a productive cough Explanation: 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.

Why would a client with COPD report feeling fatigued? Select all that apply. - The client is using all expendable energy just to breathe. - Muscle function gradually decreases over time in clients with COPD. - The client is using all expendable energy for activities of daily living (ADLs). - Lung function gradually decreases over time in clients with COPD.

- The client is using all expendable energy just to breathe. - Lung function gradually decreases over time in clients with COPD. Explanation: The client is using all expendable energy just to breathe. Lung function, not muscle function, gradually decreases over time in clients with COPD. In a client with COPD, fatigue and a feeling of exhaustion stem directly from the disease, not from activity level.

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

- With meals Explanation: Nearly 90% of clients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals.

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: - alprazolam (Xanax). - propranolol (Inderal). - morphine. - albuterol (Proventil).

- albuterol (Proventil). Explanation: The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client's breathing. Propranolol is contraindicated in a client who's wheezing because it's a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

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. - pulmonary edema. - atelectasis. - oxygen toxicity.

- atelectasis. Explanation: In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

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

- 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 III of COPD is defined as - at risk for COPD. - mild COPD. - severe COPD. - very severe COPD. - moderate COPD.

- 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 nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: - sits in tripod position. - has a pulse oximetry reading of 93%. - uses the sternocleidomastoid muscles. - wants the head of the bed raised to a 90-degree level.

- uses the sternocleidomastoid muscles. Explanation: Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.

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 - Emphysema - Pleurisy - Pneumonia

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

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 - Avoiding the use of oxygen to decrease the hypoxic drive - Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise - Increasing pH

- 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.

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

- 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.

Which is the strongest predisposing factor for asthma? - Congenital malformations - Allergy - Male gender - Air pollution

- Allergy Explanation: Allergy is the strongest predisposing factor for asthma.

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 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." - "I will shake the MDI container before I use it."

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

- 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.

A nurse is admitting a client with emphysema. What are presenting findings the nurse should assess? Select all that apply. - Fever - Chronic cough - Dyspnea - Wheezing - Tachypnea

- Chronic cough - Dyspnea - Wheezing Explanation: The clinical manifestations for emphysema is grouped with COPD and includes wheezing, sputum production, and dyspnea. Fever and tachypnea are not common findings.

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. - Administer the salmeterol and then administer the triamcinolone. - 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. Explanation: 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.

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. 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.

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? - An inhaled beta2-adrenergic agonist - An inhaled corticosteroid - An I.V. beta2-adrenergic agonist - An oral corticosteroid

- An inhaled beta2-adrenergic agonist Explanation: An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in? - I - II - III - IV

- II Explanation: 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%.

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? - I - II - III - IV

- IV Explanation: 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%.

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

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

- 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.

A nurse is teaching a client about asthma. Which symptom should be included with the teaching? Select all that apply. - Chest tightness - Wheezing - Dyspnea - Crackles - Cough

- Chest tightness - Wheezing - Dyspnea - Cough Explanation: The common symptoms of asthma are cough, chest tightness, dyspnea, and wheezing. In some instances, cough may be the only symptom. Crackles are not generally seen with asthma; they are associated with excess fluid in the lungs as with pneumonia.

Asthma is cause by which type of response? - IgE-mediated - IgA-mediated - IgD-mediated - IgM-mediated

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

- 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.

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

- 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? - Lung sounds - Skin color - Heart rate - Respiratory rate

- 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 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 - Increased sputum production - Decreased activity tolerance - Hyperthermia

- Decreased oxygen requirements Explanation: A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements.

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

- 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.

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

- 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 nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? - Respiratory rate of 22 breaths/minute - Dilated and reactive pupils - Urine output of 40 ml/hour - Heart rate of 100 beats/minute

- Respiratory rate of 22 breaths/minute Explanation: In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

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: - Sharp, stabbing chest pain - Dyspnea - A dry, hacking cough - Tachycardia

- Sharp, stabbing chest pain Explanation: The initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client - Exhales hard and fast with a single blow - Inhales deeply and holds the breath - 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 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.

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 - Respiratory alkalosis - Metabolic alkalosis - Metabolic acidosis

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

- 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? - Full-liquid - High-protein - 1,800-calorie ADA - Low-fat

- 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.