Honan, Chapter 11: Nursing Management: Patients With Chronic Obstructive Pulmonary Disease and 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?

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

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

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

A nurse is reviewing the medical records of several clients who have been diagnosed with COPD. When reviewing pulmonary function test results, the client with which postbronchodilator FEV1/FVC result would be considered to have the most severe disease?

63%

The nurse is caring for a 24-year-old patient with an antitrypsin deficiency who states that she has never smoked in her life. An antitrypsin deficiency predisposes the patient to what?

Emphysema

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute and a pulse oximetry of 93% despite receiving nasal oxygen at 2 L/minute. What action should the nurse take?

Encourage the client to exhale slowly against pursed lips.

The classification of Stage III of COPD is defined as

severe COPD.

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

Take ordered medications as scheduled.

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

"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time."

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Albuterol

A hospital patient with a complex medical history that includes asthma has rung his call bell and states that he is having an asthma attack. The nurse has completed a rapid assessment of the patient and has identified the need for pharmacologic interventions. After consulting the patient's medication administration record, the nurse should administer a p.r.n. dose of:

Albuterol (Ventolin)

The nurse is caring for an asthmatic patient hospitalized with an acute asthma exacerbation. What drugs would the nurse anticipate being ordered for this patient to gain underlying control of persistent asthma?

Anti-inflammatory drugs

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse?

Apply supplemental oxygen as ordered.

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

Beta-adrenergics

Which statement is true about both lung transplant and bullectomy?

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

Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation?

Bronchitis

A patient's history, physical exam, and pulmonary function testing have culminated in a diagnosis of chronic obstructive bronchitis. The nurse who is providing care for this patient will understand that the effects of the disease are primarily attributable to:

Chronic mucus hypersecretion

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

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

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

Which exposure accounts for most cases of COPD?

Exposure to tobacco smoke

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

An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure?

Highest airflow during a forced expiration

Asthma is cause by which type of response?

IgE-mediated

Which measure may increase complications for a client with COPD?

Increased oxygen supply

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process?

Polycythemia

Which terms means an increase in the red blood cell concentration in the blood?

Polycythemia

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

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

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

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 Atelectasis

Why would a client with COPD report feeling fatigued? Select all that apply.

The client is using all expendable energy just to breathe. Lung function gradually decreases over time in clients with COPD.

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

Use diaphragmatic breathing.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange?

Using a Venturi mask to deliver oxygen as ordered

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side.

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

implementing measures to clear pulmonary secretions.

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include

the importance of blood tests to monitor serum concentrations.

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:

uses the sternocleidomastoid muscles.

The classification of Stage IV of COPD is defined as

very severe COPD.

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?"

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

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

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%