Prep U: COPD Management

A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse: A. Assesses fasting blood glucose levels B. Informs the client to limit fluid intake due to fluid retention C. Encourages the client to decrease caloric intake due to increased appetite D. Aspirates for blood return before injecting the medication

A. Assesses fasting blood glucose levels Adverse effects of methylprednisolone 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.

Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation? A. Bronchitis B. Pneumonia C. Common cold D. Asthma

A. Bronchitis A wide range of viral, bacterial, and mycoplasmal infections can produce acute episodes of bronchitis, a leading cause of exacerbations. Pneumonia, the common cold, and asthma are not leading causes of exacerbations.

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

A. Exhales hard and fast with a single blow

A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? A. Inhaled beclomethasone (Beconase) B. Oral prednisone (Deltasone) C. Subcutaneous omalizumab (Xolair) D. Oral sustained-release albuterol (Proventil)

A. Inhaled beclomethasone (Beconase) For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone. The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma.

The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client: A. Positions the inhaler 1 to 2 inches away from his open mouth B. Immediately repeats the second puff after the first puff C. Holds the breath for 5 seconds after administering the medication D. Carefully holds the inhaler upright without shaking it

A. Positions the inhaler 1 to 2 inches away from his open mouth To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 1 to 2 inches away from the client's open mouth. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be: A. Isuprel B. Albuterol C. Atrovent D. Foradil

B. Albuterol

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

B. An inhaled beta2-adrenergic agonist 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 patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? A. Budesonide B. Cromolyn sodium C. Theophylline D. Albuterol

B. Cromolyn sodium Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. The other medications listed are not mast cell stabilizers.

Which of the following exposures accounts for most of the risk factors for COPD? A. Passive smoking B. Exposure to tobacco smoke C. Occupational exposure D. Ambient air pollution

B. Exposure to tobacco smoke 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.

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: A. maintain the client on bed rest. B. instruct the client to drink at least 2 L of fluid daily. C. administer anxiolytics, as ordered, to control anxiety. D. administer pain medication as ordered.

B. instruct the client to drink at least 2 L of fluid daily. Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

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

B. uses the sternocleidomastoid muscles. 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.

A male patient newly diagnosed with COPD tells the nurse, "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? Which of the following is the nurse's best response? A. "As your COPD worsens, you will develop frequent respiratory infections." B. "You can also expect to experience a progressive weight gain." C. "Other symptoms you may develop are shortness of breath on exertion, and sputum production." D. "There are no other symptoms; however, your cough may get worse as the disease progresses."

C. "Other symptoms you may develop are shortness of breath on exertion, and sputum production."

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? A. IV B. III C. I D. II

C. I

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. A. Tiotropium (Spirit) B. Ipratropium HFA (Atrovent) C. Zafirlukast (Accollate) D. Zileuton (Zyflo) E. Montelukast (Singulair)

C. Zafirlukast (Accollate) D. Zileuton (Zyflo) E. Montelukast (Singular) Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.

A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? A. Administer the triamcinolone and then administer the salmeterol. B. Monitor the client's theophylline level before administering the medications. C. Allow the client to choose the order in which the drugs are administered. D. Administer the salmeterol and then administer the triamcinolone.

D. Administer the salmeterol and then administer the triamcinolone. A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone is a corticosteroid; Salmeterol 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.

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? A. An oxygen saturation of 99% B. A respiratory rate of 12 breaths/minute C. A transverse chest diameter twice that of the anteroposterior diameter D. An inspiratory-expiratory (I:E) ratio of 2:1

D. An inspiratory-expiratory (I:E) ratio of 2:1 The normal I:E ratio is 1:2, meaning that expiration takes twice as long as inspiration. A ratio of 2:1 is seen in clients with COPD because inspiration is longer than expiration. A client with COPD typically has a barrel chest in which the anteroposterior diameter is larger than the transverse chest diameter. A client with COPD usually has a respiratory rate greater than 12 breaths/minute and an oxygen saturation rate below 93%.

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) A. To combat dehydration B. To relieve bronchospasm C. To loosen secretions D. To facilitate expectoration E. To assist with the effectiveness of the corticosteroids

A. To combat dehydration C. To loosen secretions D. To facilitate expectoration

Although many signs and symptoms lead to a diagnosis of emphysema, one symptom stands as the primary presenting symptom. Which of the following is the primary presenting symptom? A. Chronic and persistent cough B. Tachypnea C. Dyspnea D. Wheezing

C. Dyspnea Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. Chronic cough and sputum production often precede the development of airflow limitation by many years. However, not all people with cough and sputum production develop COPD. The cough may be intermittent and unproductive in some patients.

As a cause of death in the United States, chronic obstructive pulmonary disease (COPD) ranks: A. Third B. Second C. Fourth D. Fifth

C. Fourth Currently, COPD and associated conditions (chronic lower respiratory diseases are the fourth leading cause of death in the United States, accounting for almost 125,000 American deaths per year.

A nurse evaluates the results of a spirometry test to help confirm a diagnosis of obstructive lung disease. Which one of the following results indicates an initial early stage of COPD? (FEV1 refers to forced expired volume in 1 second.)

FEV1 > 80%

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: A. Gives oral pancreatic enzymes with meals B. Administers vancomycin intravenously C. Provides nebulized tobramycin (TOBI) D. Collects sputum for culture and sensitivity

D. Collects sputum for culture and sensitivity 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.

Which of the following is a symptom diagnostic of emphysema? A. Copious sputum production B. Normal elastic recoil C. The occurrence of cor pulmonale D. Dyspnea

D. Dyspnea

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. A. Asymmetry of chest movement B. Oxygen desaturation C. Bilaterally equal breath sounds D. Sudden chest pain E. Unilateral retractions

A. Asymmetry of chest movement B. Oxygen desaturation D. Sudden chest pain E. Unilateral retractions

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by: A. Lymphocytes B. Eosinophils C. Mast cells D. Neutrophils

C. Mast cells

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in? A. IV B. II C. I D. III

D. III

Which diagnostic is the most accurate in assessing acute airway obstruction? A. Chest x-ray B. Pulmonary function studies C. Pulse oximetry D. Arterial blood gases (ABGs)

B. Pulmonary function studies Pulmonary function studies are the most accurate means of assessing acute airway obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics for an airway obstruction.

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis

B. Respiratory alkalosis Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.

An increase in the red blood cell concentration in the blood is termed which of the following? A. Bronchitis B. Emphysema C. Asthma D. Polycythemia

D. Polycythemia 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.

Asthma is cause by which type of response? A. IgE-mediated B. IgA-mediated C. IgM-mediated D. IgD-mediated

A. IgE-mediated 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.

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? A. Providing sufficient oxygen to improve oxygenation B. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise C. Avoiding the use of oxygen to decrease the hypoxic drive D. Increasing pH

A. Providing sufficient oxygen to improve oxygenation

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

D. Respiratory acidosis As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.

The classification of Stage IV of COPD is defined as A. moderate COPD. B. severe COPD. C. mild COPD. D. very severe COPD. E. at risk for COPD.

D. very severe COPD. 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 patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis

A. Respiratory acidosis 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.

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? A. The patient should take the medication with meals since it may cause nausea. B. The patient should take the medication separately without other medications. C. The patient should take the medication an hour before meals or 2 hours after a meal. D. The patient should take the medication with a small amount of liquid.

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

Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which one of the following tests? A. Arterial blood gases (ABGs) B. Pulmonary function studies C. Lumbar puncture D. Sweat chloride concentration

D. Sweat chloride concentration

Which of the following would not be considered a primary symptom of COPD? A. Dyspnea on exertion B. Sputum production C. Cough D. Weight gain

D. Weight gain

Which of the following measures may increase complications for a patient with COPD? A. Administration of antibiotics B. Administration of antitussive agents C. Increased oxygen supply D. Decreased oxygen supply

C. Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Patients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and increasing hypercapnia occurs. All the other measures are aimed at preventing complications.

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: A. paradoxical chest wall movement with respirations. B. muffled or distant heart sounds. C. tracheal deviation to the unaffected side. D. diminished or absent breath sounds on the affected side.

D. diminished or absent breath sounds on the affected side. 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 patient is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which of the following medications is contraindicated in the treatment of asthma exacerbations? A. Proventil (Albuterol) B. Xopenex (Levalbuterol HFA) C. Atrovent (Ipratropium) D. Intal (Cromolyn Sodium)

D. Intal (Cromolyn Sodium) Intal is contraindicated in patients with acute asthma exacerbation. Indications for Intal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Intal is also a preventive treatment prior to exposure to exercise or known allergen. Proventil (albuterol), Xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms.

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? A. Lung sounds B. Respiratory rate C. Skin color D. Heart rate

A. Lung sounds 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 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: A. atelectasis. B. pleural effusion. C. oxygen toxicity. D. pulmonary edema.

A. atelectasis. 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 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse: A. Explains to the client not to eat or drink before the spirometry test B. Asks the client, "What are your allergies?" C. States that various blood tests must also be done D. Tells the client that arterial blood gas is performed after spirometry testing

B. Asks the client, "What are your allergies?" Spirometry testing includes use of a bronchodilator and then further testing. The nurse needs to assess for allergies first. The client does not need to be NPO prior to spirometry testing. Venous blood work may be done for clients younger than 45 years old, to check for a deficiency in alpha 1-antitrypsin. Arterial blood gases, if ordered, are obtained prior to spirometry testing.

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

B. Has wheezes in the right lung lobes

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? A. Activity intolerance related to fatigue B. Ineffective coping related to anxiety C. Disturbed sleep pattern related to cough D. High risk for ineffective therapeutic regimen management related to lack of knowledge

B. Ineffective coping related to anxiety 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.

To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? A. Streptococcus pneumonia and varicella B. Streptococcus pneumonia and Haemophilus influenzae C. Haemophilus influenzae and Gardasil D. Haemophilus influenzae and varicella

B. Streptococcus pneumonia and Haemophilus influenzae Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for females ages 9 to 26 years.

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to: A. Take deep breaths B. Increase the flow of oxygen C. Exhale slowly D. Perform upper chest breaths

C. Exhale slowly When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.

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

A. "Have you tried to quit smoking before?" 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 patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? A. "I do not need to rinse my mouth with this type of inhaler." B. "After I breathe in, I will hold my breath for 10 seconds." C. "If I use the spacer, I know I am only supposed to push on the inhaler once." D. "I will make sure to take a slow, deep breath as I push on my inhaler."

A. "I do not need to rinse my mouth with this type of inhaler." 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 patient should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

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? A. Stage II B. Stage I C. Stage III D. Stage IV

A. Stage II 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 patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's condition. Which of the following are therapy goals? Select all that apply. A. Provide long-term support for medical management. B. Treat the underlying cause of the event. C. Provide medical support for the current exacerbation. D. Teach the patient to suspend activity. E. Return the patient to his original functioning abilities.

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

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. A. Status asthmaticus B. Respiratory failure C. Atelectasis D. Thoracentesis E. Pertussis

A. Status asthmaticus B. Respiratory failure C. Atelectasis

The wife of a patient who was admitted 3 days ago with an exacerbation of chronic obstructive pulmonary disease (COPD) states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. Which of the following findings would indicate a need for further interventions? (Select all that apply.) A. BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F B. Patient states, "It always seems like I just can't catch my breath." C. Pale, paper-thin skin, O2 at 2L/min via nasal cannula D. BP 122/82, HR 102, R 24, noted barrel chest

A. BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 degrees F Bronchopulmonary infections must be controlled to diminish inflammatory edema and to permit recovery of normal ciliary action. Minor respiratory infections of no consequence to people with normal lungs can be life-threatening to people with COPD. The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior.

Which of the following occupy space in the thorax, but do not contribute to ventilation? A. Bullae B. Alveoli C. Mast cells D. Lung parenchyma

A. Bullae Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

A patient diagnosed with asthma is preparing for discharge. The nurse is educating the patient on the proper use of a peak flow meter. The nurse will instruct the patient to complete which of the following? A. If coughing occurs during the procedure, repeat it. B. Move the indicator to the top of the numbered scale. C. Take and record peak flow readings three times daily. D. Sit down while completing a peak flow reading.

A. If coughing occurs during the procedure, repeat it. Steps for using the peak flow meter correctly include (1) Moving the indicator to the bottom of the numbered scale; (2) standing up; (3) taking a deep breath and filling the lungs completely; (4) placing mouthpiece in mouth and closing lips around mouthpiece; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the patient coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) A. Inflamed airways obstruct airflow. B. Overinflated alveoli impair gas exchange. C. Dry airways obstruct airflow. D. Mucus secretions block airways.

A. Inflamed airways obstruct airflow. B. Overinflated alveoli impair gas exchange. D. Mucus secretions block airways. 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 client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. A. Swelling of bronchial membranes B. Airway remodeling C. Destruction of the alveolar wall D. Thick mucus

A. Swelling of bronchial membranes B. Airway remodeling D. Thick mucus

A patient is receiving theophylline (Theo-Dur) for long-term control and prevention of asthma symptoms. Patient teaching related to this medication will include which of the following? A. The importance of blood tests to monitor serum concentrations B. Taking the medication at least 1 hour prior to meals C. Monitoring liver function studies as prescribed D. Development of hyperkalemia

A. The importance of blood tests to monitor serum concentrations The nurse should inform patients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The patient is at risk of developing hypokalemia.

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? A. Theophylline B. Albuterol C. Terbutaline D. Levalbuteral

A. Theophylline Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists.

Why would a patient with COPD report feeling fatigued? Select all that apply. A. There is a gradual decrease in lung function over time in a patient with COPD. B. The patient is using all expendable energy just to breathe. C. The patient is using all expendable energy for activities of daily living (ADLs). D. There is a gradual decrease in muscle function over time in a patient with COPD.

A. There is a gradual decrease in lung function over time in a patient with COPD. B. The patient is using all expendable energy just to breathe.

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

A. 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: A. atelectasis. B. oxygen toxicity. C. pleural effusion. D. pulmonary edema.

A. atelectasis. 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 chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? A. "Drink fluids upon arising from bed." B. "Raise your arms over your head." C. "Delay self-care activities for 1 hour." D. "Sit in a chair whenever doing an activity."

C. "Delay self-care activities for 1 hour." Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.

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

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

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: A. Diminished alveolar surface area. B. Hypercapnia resulting from decreased carbon dioxide elimination. C. Respiratory acidosis. D. Hypoxemia secondary to impaired oxygen diffusion.

C. Respiratory acidosis. Decreased carbon dioxide elimination results in increased carbon dioxide tension (hypercapnia), which leads to respiratory acidosis and chronic respiratory failure.

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: A. Dyspnea B. Tachycardia C. Sharp, stabbing chest pain D. A dry, hacking cough

C. Sharp, stabbing chest pain 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.

A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? A. "I clean my mask with water after every meal." B. "I lubricate my lips and nose with K-Y jelly." C. "I have a 'no smoking' sign posted at my front door to remind guests not to smoke." D. "I make sure my oxygen mask is on tightly so it won't fall off while I nap."

D. "I make sure my oxygen mask is on tightly so it won't fall off while I nap." The client requires additional teaching if he states that he fits his mask tightly. Applying the oxygen mask too tightly can cause skin breakdown, so the client should be cautioned against wearing it too tightly. Oxygen therapy is drying to the oral and nasal mucosa; therefore, the client should be encouraged to apply a water-soluble lubricant, such as K-Y jelly, to prevent drying. Smoking is contraindicated wherever oxygen is in use; posting of a "no smoking" sign warns people against smoking in the client's house. Cleaning the mask with water two or three times per day removes secretions and decreases the risk of infection.

A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? A. "I need to call the physician right away if I feel my heart beating fast after using the drug." B. "I should use this inhaler whenever I get short of breath." C. "I can stop using this drug when I begin to feel better." D. "I need to hold my breath as long as possible after I take a deep inhalation."

D. "I need to hold my breath as long as possible after I take a deep inhalation." The client demonstrates effective teaching if he states that he'll hold his breath for as long as possible after inhaling the drug. Holding the breath increases the absorption of the drug into the alveoli. Metaproterenol needs to be used over an extended period for maximum effect. The client shouldn't use the inhaler whenever he feels out of breath because dependency can develop if the drug is used excessively. The client should adhere to the prescribed dosage. Tachycardia is an expected adverse reaction to metaproterenol. The client should be taught how to monitor his heart rate and contact the physician only if the heart rate exceeds 130 beats/minute.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A. It increases inspiratory muscle strength. B. It decreases use of accessory breathing muscles. C. It prolongs the inspiratory phase of respiration. D. It helps prevent early airway collapse.

D. It helps prevent early airway collapse. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)