Lippincott: COPD, Asthma, Emphysema, RSV, Aspiration Pneumonia, TEF

B. Oxygen through nasal cannula at 2 L/minute Explanation: All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

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. administer antibiotics

A. 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 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. More than body requirements C. Impaired swallowing D Unilateral neglect

All of the above 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

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

A. 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 A. implementing measures to clear pulmonary secretions B. Teach the family how to perform postural drainage C. educate the patient on signs of respiratory infection

A. "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.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? A. "Weigh yourself and report a gain of 2 lb in 1 day." B. "Limit your smoking to 2 cigarettes a week." C. "When you go home, you need to eat foods high in sodium."

D. 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 nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? A. Dilated pupil reaction B. Increased urine production C. Increased heart rate of 100 D. Respiratory rate of 22 breaths/min

D. 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? A. Avoid contact with fur-bearing animals B. Change filters on heating and air conditioning units frequently C. Avoid using goose down pillows D. Take ordered medications as scheduled

Cough, Wheezing & Dyspnea Explanation: The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances, cough may be the only symptom.

A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. A. wheezing b. cough c. wheezing d. dyspnea

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.

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. productive cough and sputum B. wheezing C. chest tightness D. lung crackles

All of the above Explanation: Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. (Select all that apply) A. Alter smooth muscle tone B. Reduce airway obstruction C. Increase oxygen distribution

C. 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? A. metabolic acidosis B. respiratory alkalosis C. respiratory acidosis D. metabolic alkalosis

C. IV Explanation: Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 30% predicted.

In which grade of COPD is the forced expiratory volume (FEV) less than 30%? A. I B. II C. IV D. III

A, B & C 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 the drug name and the drug category correctly match? Select all that apply A. Prednisone is a corticosteroid. B. Albuterol is a bronchodilator. C. Ciprofloxacin is an antibiotic. D. Dexamethasone is an antibiotic E. citrimoxazole is a bronchodilator

B. 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.

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. A. Neutrophils B. Mast cells C. Eosinophils D. Lymphocytes

B. mild COPD. Explanation: Grade I is mild COPD. Grade II is moderate COPD. Grade III is severe COPD. Grade IV is very severe COPD.

The classification of grade I COPD is defined as A.moderate B. mild C. severe D. very severe

A. Atelectasis Explanation: Retention of secretions and subsequent obstruction ultimately cause the aveoli 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: A. Atelectasis B. Emphysema C. Asthma asthmaticus

A, C, D, 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, 2010).

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) A. Compromised gas exchange B. Wheezes Decreased airflow C. Decreased airflow D. Wheezes

D. 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.

Which exposure accounts for most cases of COPD? A. occupational exposure B. passive smoking C. ambient air pollution D. exposure to tobacco smoke

B. 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 accurate regarding status asthmaticus? A.occurs with warning B. Is refractory to initial therapy C. Wet cough D. Slow progressive chest tightness

Weight gain Explanation: COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Weight loss is common with COPD.

Which of the following is not a primary symptom of COPD? A. cough B. sputum production C. dyspnea on exertion D. weight gain

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

Which of the following is the key underlying feature of asthma? A. cough B. chest tightness C. Wheezing D. Inflammation

A, B & C Explanation: Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. A. Singulair (montekulast) B. Accolate (zafirlukast) C. Zyflo (Zileuton) D. Atrovent (pratropium bromide) E. Spiriva (Tiotropium)