PrepU Ch.20: Chronic Pulm Disease

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? "Raise your arms over your head." "Sit in a chair whenever doing an activity." "Drink fluids upon arising from bed." "Delay self-care activities for 1 hour."

"Delay self-care activities for 1 hour." Explanation: 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.

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

-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 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 long-term support for medical management. -Provide medical support for the current exacerbation. -Treat the underlying cause of the event. -Teach the client to suspend activity. -Return the client to their original functioning abilities.

-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.

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply. Activate the MDI once. The device may increase delivery of the MDI medication. It is not necessary to hold your breath after using. Use normal inhalations with the device. Take a slow, deep inhalation from the device.

-Take a slow, deep inhalation from the device. -Activate the MDI once. -The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

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

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

Bullae Explanation: 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 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? Levalbuterol HFA Cromolyn sodium Ipratropium Albuterol

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 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? Teach the client to perform upper chest breaths. Increase the flow of oxygen. Encourage the client to exhale slowly against pursed lips. Encourage the client to take deep breaths.

Encourage the client to exhale slowly against pursed lips. Explanation: 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 against pursed lips. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the client control the rate and depth of respiration. It also promotes relaxation, enabling the client to gain control of dyspnea and reduce feelings of panic. Taking deep breaths and upper chest breathing are inefficient breathing techniques; the client with COPD should be encouraged to practice diaphragmatic breathing. Increasing oxygen flow is not necessary because the pulse oximetry is 93%.

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

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.

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? IV II III I

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 40% for a patient with COPD. What stage should the nurse document the patient is in? IV II III I

III 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%.

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

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.

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

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

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? It prolongs the inspiratory phase of respiration. It helps prevent early airway collapse. It decreases use of accessory breathing muscles. It increases inspiratory muscle strength.

It helps prevent early airway collapse. Explanation: 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.)

Which terms means an increase in the red blood cell concentration in the blood? Emphysema Polycythemia Asthma Bronchitis

Polycythemia Explanation: 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. Bronchitis is a disease of the airways defined as the presence of cough and sputum production for a certain period of time.

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 dry, hacking cough Tachycardia Dyspnea Sharp, stabbing chest pain

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

The patient should take the medication an hour before meals or 2 hours after a meal. Explanation: The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

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 Keeping the client in semi-Fowler's position Administering a sedative as ordered Encouraging the client to drink three glasses of fluid daily

Using a Venturi mask to deliver oxygen as ordered Explanation: The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: stay with the client until the therapist arrives. notify the primary physician immediately. give the nebulizer treatment herself. administer the treatment by metered-dose inhaler.

give the nebulizer treatment herself. Explanation: The client's needs are preeminent, so the nurse should administer the nebulizer treatment immediately. The nurse can deal with the respiratory therapist's lack of response after the client's condition is stabilized. There is no need to involve the physician in personnel issues. Staying with the client is important, but it isn't a substitute for administering the needed bronchodilator. The order is for a nebulizer treatment not a metered-dose inhaler, so the nurse can't change the route without a new order from the physician.

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. has a pulse oximetry reading of 93%. sits in tripod position. 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.