PrepU Oxygenation Questions (In progress)

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. Albuterol is a bronchodilator. Dexamethasone is an antibiotic. Cotrimoxazole is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.

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

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 Has a respiratory rate of 28 breaths/minute Reports shortness of breath Cannot perform activities of daily living

Has wheezes in the right lung lobes Explanation: Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

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. Dry airways obstruct airflow.

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.

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

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

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? Skin color Heart rate Lung sounds Respiratory rate

Lung sounds Explanation: 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 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? Atrovent Flovent Combivent Proventil

Proventil Explanation: Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis

Respiratory acidosis Explanation: As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

The classification of Stage II of COPD is defined as at risk for COPD. moderate COPD. severe COPD. very severe COPD. mild COPD.

moderate COPD. Explanation: Stage II is moderate COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage III is severe COPD. Stage IV is very severe COPD.

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

"Have you tried to quit smoking before?" Explanation: 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.

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 Jugular vein distention Ascites

Compromised gas exchange Decreased airflow Wheezes 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).

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

Dyspnea Explanation: Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.

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 Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour

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.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." "I can't use a spacer or holding chamber with the MDI." "I will take a slow, deep breath in after pushing down on the MDI." "I will shake the MDI container before I use it."

"I can't use a spacer or holding chamber with the MDI." Explanation: The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly.

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? "I will make sure to take a slow, deep breath as I push on my inhaler." "After I breathe in, I will hold my breath for 10 seconds." "I do not need to rinse my mouth with this type of inhaler." "If I use the spacer, I know I am only supposed to push on the inhaler once."

"I do not need to rinse my mouth with this type of inhaler." Explanation: 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.

The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response? "It is an umbrella term for diseases like acute bronchitis." "It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." "It means your lungs can't expand and contract like they are supposed to which makes it hard for you to breathe." "It is a term that covers so many lung diseases I can't list them all."

"It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." Explanation: Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.

A client is being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? Completion of a 12-lead ECG Administration of corticosteroids and bronchodilators Administration of antibiotics Client education: avoidance of irritants like smoke and pollutants

Administration of antibiotics Explanation: Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia. Corticosteroids and bronchodilators are administered to asthmatic clients when they show symptoms of wheezing. An ECG is used to evaluate atrial arrhythmias.

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

Asks the client, "What are your allergies?" Explanation: 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.

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

Dyspnea Explanation: Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.

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? Full-liquid High-protein 1,800-calorie ADA Low-fat

High-protein Explanation: Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes teaching the family how to perform postural drainage. instructing the client on the signs of respiratory infection. implementing measures to clear pulmonary secretions. providing the client a low-calorie, high-fiber diet.

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.

The classification of Stage III of COPD is defined as at risk for COPD. mild COPD. severe COPD. very severe COPD. moderate COPD.

severe COPD. Explanation: Stage III is severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage IV is very 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: sits in tripod position. has a pulse oximetry reading of 93%. uses the sternocleidomastoid muscles. 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.

The classification of Stage IV of COPD is defined as at risk for COPD. mild COPD. severe COPD. very severe COPD. moderate COPD.

very severe COPD. Explanation: Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage III is severe COPD. Stage IV is very severe COPD.

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 can stop using this drug when I begin to feel better." "I should use this inhaler whenever I get short of breath." "I need to hold my breath as long as possible after I take a deep inhalation." "I need to call the physician right away if I feel my heart beating fast after using the drug."

"I need to hold my breath as long as possible after I take a deep inhalation." Explanation: 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 client diagnosed with asthma is preparing for discharge. The nurse is educating the client on the proper use of a peak flow meter. The nurse instructs the client to complete which action? Move the indicator to the top of the numbered scale. Sit down while completing a peak flow reading. Take and record peak flow readings three times daily. If coughing occurs during the procedure, repeat it.

If coughing occurs during the procedure, repeat it. Explanation: 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 the mouthpiece in the mouth and closing the lips around it; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the client coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.

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

diminished or absent breath sounds on the affected side. Explanation: 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 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? nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 salmeterol/fluticasone (Seretide) MDI daily at 0800 azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 prednisone 5 mg oral daily at 0800

salmeterol/fluticasone (Seretide) MDI daily at 0800 Explanation: When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.