PrepU Chapter 24: Management of Patients With Chronic Pulmonary Disease

Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply.

- Albuterol is a bronchodilator. - Ciprofloxacin is an antibiotic. -Prednisone is a corticosteroid

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

- Compromised gas exchange -Decreased airflow -Wheezes

A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply.

- Cough -Wheezing -Dyspnea

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.

-Alter smooth muscle tone -Reduce airway obstruction -Increase oxygen distribution

Emphysema is described by which of the following statements?

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

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

Albuterol

Which of the following is the strongest predisposing factor for asthma?

Allergy

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

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

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

Which of the following is true about both lung transplant and bullectomy?

Both are aimed at improving the overall quality of life of a patient with COPD.

Which of the following is a second-line pharmacotherapy for smoking abstinence?

Catapres

A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about?

Cromolyn sodium

Which of the following is a common irritant that acts as a trigger of asthma?

Esophageal reflux

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

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?

II

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions

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?

Inhaled beclomethasone (Beconase)

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by

Mast cells

A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant?

Proventil

A patient 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?

Proventil

Which diagnostic is the most accurate in assessing acute airway obstruction?

Pulmonary function studies

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

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

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

Take ordered medications as scheduled.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb in 1 day."

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?

"I need to hold my breath as long as possible after I take a deep inhalation."

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse?

"You and your physician should discuss the options that are available for treatment."

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

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

- Montelukast (Singulair) - Zafirlukast (Accolate) -Zileuton (Zyflo)

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.)

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

A client is prescribed methylprednisolone (Solu-Medrol) 125 mg intravenously. The medication is available in a 125 mg single-dose vial containing 2 mL. The nurse will administer methylprednisolone over 2 minutes. How many mL will the nurse administer each 15 seconds? Write your answer to 2 decimal places. Starting with 0., enter the correct number ONLY.

0.25

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%

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema?

Cigarette smoking

Which of the following is a symptom diagnostic of emphysema?

Dyspnea

Which of the following exposures accounts for most of the risk factors for COPD?

Exposure to tobacco smoke

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)?

Exposure to tobacco smoke

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 stage of COPD is the forced expiratory volume (FEV) less than 30%?

III

A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?

Inhaled albuterol (Ventolin)

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 helps prevent early airway collapse.

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 assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care?

Performing chest physiotherapy as ordered

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

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 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

Which of the following would not be considered a primary symptom of COPD?

Weight gain

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?

With meals

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

albuterol (Proventil).

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 Stage I of COPD is defined as

mild COPD.

A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information?

salmeterol/fluticasone (Seretide) MDI daily at 0800

The classification of Stage III of COPD is defined as

severe COPD.

The classification of Stage IV of COPD is defined as

very severe COPD.