Ch20 COPD

A patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position? Trendelenburg Low Fowler's, with the neck slightly hyperextended Sitting upright, leaning forward slightly Prone

Ans: Sitting upright, leaning forward slightlyFeedback:The typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breathe.

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? Intravenous methylprednisolone (Solu-Medrol) 120 mg Vancomycin 1 gram intravenously over 1 hour Oxygen through nasal cannula at 2 L/minute Ipratropium bromide (Alupent) by metered-dose inhaler

Oxygen through nasal cannula at 2 L/minute

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

Providing sufficient oxygen to improve oxygenationThe main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

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 Chest pain during respiration Tachypnea and tachycardia Fever, chills, and diaphoresis

Sputum and a productive cough

A nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do? begin using insulin decrease exercising taking anti-inflammatory drugs stop smoking cigarettes

stop smoking cigarettes

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." "I can refer you to the American Lung Association." "Have you tried to quit smoking before?" "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.

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." "I will shake the MDI container before I use it." "I will take a slow, deep breath in after pushing down on the MDI." "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." 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.

The nurse is caring for a patient that is experiencing increasing shortness of breath. The patient is pale and slight circumoral cyanosis is developing. Which laboratory test best measures the adequacy of tissue oxygenation? Hemoglobin level Red blood cell count Arterial blood gases Pulmonary function test

2. Arterial blood gasesArterial blood levels include levels of oxygen in the body and determines the adequacy of alveolar gas exchange. Red blood cell count provides information on the quantity of red blood cells in the system. Pulmonary function tests measures lung volume and capacity. Although hemoglobin is the red pigment in the red blood cells that carries oxygen, it is not the best measurement of tissue oxygenation.

It will be most important for the nurse to check pulse oximetry for which of these patients? A patient with pneumonia who has just been admitted to the unit. A patient who is morbidly obese and is refusing to get out of bed. A patient with emphysema and a respiratory rate of 16. A patient who has just received morphine sulfate for postoperative pain.

A patient with pneumonia who has just been admitted to the unit.

A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the priority intervention to alleviate this client's airflow obstruction? Administer an inhaled beta-adrenergic agonist Administer inhaled anticholinergics Administer corticosteroids by metered dose inhaler Utilize a peak flow monitoring device

Administer an inhaled beta-adrenergic agonist

Which of the following is true of sarcoidosis? Affects young, middle-aged adults. Effects of the disease is limited to the lung tissue. More common in people of European descent. Results in hyperinflation of the lungs.

Affects young, middle-aged adults.

The nurse is assessing a patient whose respiratory disease is characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient? Long, thin fingers Chronic chest pain A barrel chest Signs of oxygen toxicity

Ans: A barrel chest Feedback:In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The patient would not show signs of oxygen toxicity unless he or she received excess supplementary oxygen.

A nurse is teaching a patient with asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching? Dyspnea and increased respiratory secretions Fatigue and decreased level of consciousness Cough and oral thrush Nausea and vomiting

Cough and oral thrush

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one type of disorder within its classification. Which of the following is part of that disorder? Asthma Bronchiectasis Emphysema Cystic fibrosis

Emphysema

All of the following medications are ordered for a mechanically ventilated patient with acute respiratory distress syndrome (ARDS) and acute renal failure. Which medication should the nurse discuss with the health care provider before administration? IV methylprednisolone (Solu-Medrol) 40 mg IV ranitidine (Zantac) 50 mg IV gentamicin (Garamycin) 60 mg sucralfate (Carafate) 1 g per nasogatric tube

IV gentamicin (Garamycin) 60 mg

Asthma is cause by which type of response? IgA-mediated IgM-mediated IgE-mediated IgD-mediated

IgE-mediatedP655 Explanation: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.

Salmeterol (Serevent) has been added to your patients treatment regimen for asthma. Which of the following would be highest priority teaching for the patient? It is important to take the medication every day in order to prevent an asthma attack. The drug causes nervousness Avoid taking beverages with caffeine. Nausea and vomiting may be adverse effects

It is important to take the medication every day in order to prevent an asthma attack.

The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective Respiratory rate is 16 breaths/minute. No wheezes are audible. Accessory muscle use has decreased O2 saturation is >90%.

O2 saturation is >90%. Explanation: ANS: B The goal for treatment of an asthma attack is to keep the O2 saturation above 90%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Urine output of 40 ml/hour Heart rate of 100 beats/minute Dilated and reactive pupils Respiratory rate of 22 breaths/minute

Respiratory rate of 22 breaths/minute P658 Explanation:In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma? Rescue inhalers Antitussives Antibiotics Steroids

Steroids

The nurse is planning care for a client with a diagnsosis of COPD with a high anxiety level that causes shortness of breath. Which action should the nurse take given the client's reaction to anxiety? Discourage visitors who may cause anxiety to increase. Teach proper use of inhalers to control anxiety. Teach purse-lip breathing to use when feeling anxious. Administer prescribed anti-anxiety medications as needed.

Teach purse-lip breathing to use when feeling anxious. Explanation: Pursed-lip breathing can be effective when the client is experiencing shortness of breath. Anti-anxiety medications may be effective, but they also have potential respiratory side effects.

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? The patient takes propranolol (Inderal) for hypertension The patient has a history of pneumonia 6 months ago. The patient has chronic inflammatory bowel disease. The patient uses acetaminophen (Tylenol) for headaches.

The patient takes propranolol (Inderal) for hypertension Explanation: ANS: C b-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.

A nurse is providing discharge teaching for a client with COPD. What should the nurse teach the client about breathing exercises? Use chest breathing Use diaphragmatic breathing Lie supine to facilitate air entry Avoid pursed-lip breathing unless absolutely necessary

Use diaphragmatic breathing

In evaluating an asthmatic patient's knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient says, "I get a flu shot every year and see my HCP if I have an upper respiratory tract infection." "I use my corticosteroid inhaler when I feel short of breath." "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath." "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies."

a. "I use my corticosteroid inhaler when I feel short of breath." Rationale: A rescue plan for patients with asthma includes taking two to four puffs of a short-acting bronchodilator every 20 minutes three times to obtain rapid control of symptoms. Corticosteroids cannot abort an acute asthma attack.

When teaching a patient with asthma about the use of a peak flow meter, the nurse instructs the patient to use the flow meter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible. carry the flow meter with him at all times in case an asthma attack occurs. follow his written asthma action plan (such as increasing quick relief drugs) if the peak expiratory flow rate (PEFR) is in the yellow zone. use the flow meter to check the status of the patient's asthma every time the patient takes quick-relief medication.

follow his written asthma action plan (such as increasing quick relief drugs) if the peak expiratory flow rate (PEFR) is in the yellow zone.

The home care nurse is analyzing the client's understanding of caring for home oxygen equipment to treat chronic obstructive pulmonary disease. What statement by the client indicates additional teaching is needed? "I use mouthwash several times per day to deal with my dry mouth." "If I have a cold, I always replace my cannula as soon as I feel better." "The company sends me new cannulas every couple of weeks." "I wash the nasal cannula once a month with warm water and dish soap."

"I wash the nasal cannula once a month with warm water and dish soap." Explanation: The highest risk for infection is the cannula because there is the potential for bacterial growth due to the humitidy. Washing the cannula with mild liquid soap and rinsing thoroughly at least once per week is recommended.

A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing? Avoid goose-down pillows. Change filters on heaters and air conditioners frequently. Gradually increase levels of physical exertion. Take prescribed medications as scheduled.

Ans: Take prescribed medications as scheduled.Feedback:Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.

The nursing instructor is teaching a class on how to prevent an outbreak of influenza. The instructor will require additional teaching when the student says: If I change my diet and eat lots of fruits and vegetables, I will not get influenza. I will always wear a mask when I come in contact with a patient with influenza. I will make sure that proper isolation precautions are observed when dealing with a patient with influenza. I always wash my hands before and after eating.

If I change my diet and eat lots of fruits and vegetables, I will not get influenza.

A patient's severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the patient's statements suggests a need for further education? "I know that these drugs can sometimes make my heart beat faster." "I'll make sure to use this each time I feel an asthma attack coming on." "I've heard that this drug is particularly good at preventing asthma attacks during exercise." "I've heard that this drug sometimes gets less effective over time." SUBMIT ANSWER

Ill make sure to use this each time I feel an asthma attack coming on. LABAs are not used for management of acute asthma symptoms. Tachycardia is a potential adverse effect and decreased protection against exercise-induced bronchospasm may occur with regular use.

A patient placed on multiple categories of medications for COPD asks, "Which of my medications will help get the mucus up that is stuck in the back of my throat". The nurse tell him that _________ will help thin secretions. Hycotuss guaifensen Ipratropium Acetominophen

guaifensen

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

moderate COPD.

Cystic fibrosis is also called: irritating cough disease bronchietctasis sticky mucous disease mucovicidosis

mucovicidosis

Which of the following is a complication of influenza? pneumonia weakness headache cough

pneumonia

The home care nurse is evaluating the environment prior to starting a client with chronic obstructive pulmonary disease on home oxygen theray. What factors should be of most concern? 1. Another client in the home receiving oxygen. 2. A family member who smokes lives in the home. 3. Presence of blankets that cause static. 4. Remodeling in process with cans of paint around. 5. Bathroom is too small to accommodate additional large equipment. All of the items Items 2, 3, and 4 Items 2 and 3 Items 1 and 5

Items 2, 3, and 4 Explanation: Safety factors to consider with home oxygen include family members or visiotrs who smoke in the house, the presence of any fabrics that may cause static, and also the presence of any flammable liquids such as paint, paint thinners, etc.

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? Metabolic alkalosis Respiratory alkalosis Metabolic acidosis Respiratory acidosis

Respiratory acidosis Explanation: Increased carbon dioxide tension in arterial blood leads to respiratory acidosis and chronic respiratory failure. In acute illness, worsening hypercapnia can lead to acute respiratory failure. The other acid-base imbalances would not correlate with COPD.

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? Neutrophils Eosinophils Mast cells Lymphocytes

Mast cells Explanation: Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.

The nurse has completed the assessment for a client in the clinic with a diagnsosis of chronic asthma. What would be the priority goal the nurse should discuss with the client? Maintaining a regular exercise routine. Recognizing triggers that cause asthma attacks. Complying with medication instructions. Understanding physical limitations caused by this disease.

Recognizing triggers that cause asthma attacks. Explanation: The priority goal is asthma control as evidenced by minimal symptoms both during the day and at night. While medication compliance is important, recognizing triggers that cause symptoms is the priority to control symptoms.

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

Respiratory acidosis Explanation: 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.

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? Haemophilus influenzae and varicella Haemophilus influenzae and Gardasil Streptococcus pneumoniae and varicella Streptococcus pneumoniae and Haemophilus influenzae

Streptococcus pneumoniae and Haemophilus influenzae Explanation: Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Another bacterium that poses a particular risk is Moraxella catarrhalis. Clients with COPD aren't at high risk for varicella (chicken pox and shingles) or human papillomavirus virus (HPV). The HPV vaccine is to protect against cancer and is usually recommended for individuals ages 9 to 26 years.

A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation? Assist the patient in developing an appropriate exercise program. Teach the patient strategies for promoting diaphragmatic breathing. Teach the patient to perform airway suctioning. Administer supplementary oxygen by simple face mask.

Teach the patient strategies for promoting diaphragmatic breathing.

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

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.

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. Jugular vein distention Compromised gas exchange Wheezes Ascites Decreased airflow

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, 2015).