Patients With Chronic Obstructive Pulmonary Disease and Asthma

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?

The patient should take the medication an hour before meals or 2 hours after a meal.

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.

-Inflamed airways that obstruct airflow -Mucus secretions that block airways -Overinflated alveoli that impair gas exchange

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.

-Prevent airway collapse -Control the rate and depth of respirations -Release air trapped in the lungs

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

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

Impaired gas exchange related to airflow obstruction

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.

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

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

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (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

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?"

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."

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."

The nurse in the pulmonary clinic is teaching a 22-year-old female client who has been experiencing more frequent exacerbations of asthma how to use a peak flow meter.

-"The use of my peak flow meter can help treat an acute asthma attack." -"To measure peak flow, I first forcibly exhale, then I place the meter in my mouth."

A nurse is admitting a client with emphysema. What are presenting findings the nurse should assess? Select all that apply.

-Chronic cough -Dyspnea -Wheezing

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

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.

-Montelukast -Zafirlukast -Zileuton

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%

Which statement describes emphysema?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

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

The nurse at the beginning of the evening shift in the emergency department receives a report at 1900 on the following clients. Which client would the nurse assess first?

An 86-year-old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office

A public health nurse works with numerous patients who live with chronic obstructive pulmonary disease (COPD) in the community and has seen firsthand the effects of many of the risk factors underlying the disease. Which of the following public health initiatives addresses the most salient risk factor for COPD?

An anti-smoking campaign in a junior high school

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

Mrs. Fawcett is a 70-year-old woman who has a diagnosis of emphysema and who receives long-term oxygen therapy. She has presented to the emergency department because she states that she is experiencing an exacerbation of her chronic obstructive pulmonary disease (COPD), and she is in visible respiratory distress. How can the nurse best assess Mrs. Fawcett's dyspnea?

Ask her to rate her shortness of breath on a scale of 0 to 10.

A client's plan of care specifies postural drainage. Which action should the nurse perform when providing this noninvasive therapy?

Assist the client into a position that will allow gravity to move secretions.

Which statement is true about both lung transplant and bullectomy?

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

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 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?

Cromolyn sodium

The admitting nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse the need to monitor the patient for what related signs and symptoms?

Dyspnea and hypoxemia

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in?

I

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

I

Asthma is cause by which type of response?

IgE-mediated

Which of the following is the key underlying feature of asthma?

Inflammation

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?

Mast cells

The nurse is caring for a client who is experiencing mild shortness of breath during the immediate postoperative period, with oxygen saturation readings between 89% and 91%. Which method of oxygen delivery is most appropriate for the client's needs?

Nasal cannula

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan?

Performing chest physiotherapy as ordered

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

The home care nurse is assessing a client who requires home oxygen therapy. What criterion indicates that an oxygen concentrator will best meet the needs of the client in the home environment?

The client desires a portable oxygen delivery system that can deliver 2 L/min.

A patient in an acute-care setting is being monitored closely after recently experiencing status asthmaticus. The nurse who is providing care for the patient has been assessing the patient's respiratory status frequently and has just completed auscultation of the patient's breath sounds. The nurse notes that the patient's breath sounds are significantly quieter than during the previous assessment. How should the nurse best interpret this assessment finding?

The patient's airflow may be severely limited.

A client with a severe exacerbation of chronic obstructive pulmonary disease requires reliable and precise oxygen delivery. Which mask will the nurse expect the health care provider to prescribe?

Venturi mask

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?

With meals

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:

atelectasis.

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.

The classification of grade I COPD is defined as

mild COPD.

The classification of Stage II of COPD is defined as

moderate COPD.

The classification of Stage III of COPD is defined as

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:

uses the sternocleidomastoid muscles.

The classification of Stage IV of COPD is defined as

very severe COPD.

Asthma is a chronic illness and requires life-long management by patients and clinicians to achieve the goals of therapy. The signs and symptoms of this disease are primarily attributable to what pathophysiological process?

Acute inflammation of the patient's hyperresponsive airway

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

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

A client with a history of respiratory problems tells the nurse that he would like to explore strategies to reduce his risks. He also mentions being currently unemployed and not wanting to pursue costly strategies. What would the nurse emphasize as the single most cost-effective intervention to reduce the risk of developing COPD or slow its progression?

Cessation of smoking

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 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

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

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?

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?

Sputum and a productive cough

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for?

Atelectasis

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?

Oxygen through nasal cannula at 2 L/minute

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.

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?

High-protein