Chapter 11: PrepU - Nursing Management of patients with COPD

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 disorder within its classification. Which of the following is that disorder? Asthma Bronchiectasis Cystic fibrosis Emphysema

4

Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. 1- Tobacco smoke 2- Occupational dust 3- Air pollution 4- Infection 5- Second-hand smoke

all

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. 1- Inflamed airways obstruct airflow. 2- Mucus secretions block airways. 3- Overinflated alveoli impair gas exchange. 4- Dry airways obstruct airflow.

1,2,3

Which is the strongest predisposing factor for asthma? Congenital malformations Allergy Male gender Air pollution

2

The nurse is performing an admission assessment of a patient who has a history of asthma. The nurse should be aware that the most common signs of asthma are what? Shallow respirations Increased A-P diameter Bilateral wheezes Rhonchi in the lower bases

3

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) less than 30% predicted? 1- I 2- II 3- III 4- IV

4

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

4

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? 1- An inhaled beta2-adrenergic agonist 2- An inhaled corticosteroid 3- An I.V. beta2-adrenergic agonist 4- An oral corticosteroid

1

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? 1- I 2- II 3- III 4- IV

1

Which of the following occupy space in the thorax, but do not contribute to ventilation? 1- Bullae 2- Alveoli 3- Lung parenchyma 4- Mast cells

1

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? 1- Varicella 2- Influenza 3- Hepatitis B 4- Human papilloma virus (HPV)

2

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? Lung sounds Skin color Heart rate Respiratory rate

1

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? 1- Lung sounds 2- Skin color 3- Heart rate 4- Respiratory rate

1

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? 1- Theophylline 2- Levalbuteral 3- Terbutaline 4- Albuteral

1

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 Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/minute

1

Which of the following is the key underlying feature of asthma? 1- Inflammation 2- Shortness of breath 3- Productive cough 4- Chest tightness

1

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. 1- Inflamed airways that obstruct airflow 2- Mucus secretions that block airways 3- Overinflated alveoli that impair gas exchange 4- Dry airways that obstruct airflow Decreased numbers of goblet cells

1, 2,3

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. 1- Status asthmaticus 2- Respiratory failure 3- Pertussis 4- Atelectasis 5- Thoracentesis

1,2,4

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.) 1- To combat dehydration 2- To assist with the effectiveness of the corticosteroids 3- To loosen secretions 4- To facilitate expectoration 5- To relieve bronchospasm

1,3,4

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? 1- nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 2- salmeterol/fluticasone (Seretide) MDI daily at 0800 3- azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 4- prednisone 5 mg oral daily at 0800

2

A client 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? 1- Ipratropium bromide 2- Fluticasone propionate 3- Ipratropium bromide and albuterol sulfate 4- Albuterol

4

The classification of Stage IV of COPD is defined as 1- at risk for COPD. 2- mild COPD. 3- severe COPD. 4- very severe COPD. 5- moderate COPD.

4

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

1

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: 1- "Nicotine patches would be appropriate for you." 2- "Have you tried to quit smoking before?" 3- "I can refer you to the American Lung Association." 4- "Many options are available for you."

2

A nurse is administering supplemental oxygen to a client with COPD. The nurse assesses the oxygen saturation level to evaluate the client's status. Which reading would the nurse identify as being appropriate to reduce the risk of vital organ damage in this client? 82% 86% 89% 92%

4

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 1- Atelectasis 2- Emphysema 3- Pleurisy 4- Pneumonia

1

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? Streptococcus pneumonia and Haemophilus influenzae Streptococcus pneumonia and varicella Haemophilus influenzae and varicella Haemophilus influenzae and Gardasil

1

Which exposure accounts for most cases of COPD? Exposure to tobacco smoke Occupational exposure Passive smoking Ambient air pollution

1

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

1

A patient's history, physical exam, and pulmonary function testing have culminated in a diagnosis of chronic obstructive bronchitis. The nurse who is providing care for this patient will understand that the effects of the disease are primarily attributable to: Autoimmune of alveoli Chronic mucus hypersecretion A reduction in oxygen binding sites on erythrocytes Decreased respiratory drive

2

The admitting nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse the need to monitor the patient for what related signs and symptoms? Hypoxemia and clubbing of the fingers Dyspnea and hypoxemia Clubbing of the fingers and cyanosis Bronchospasm and clubbing of the fingers

2

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% FEV1 = 70% FEV1 = 50% FEV1 = 30%

1

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? I II III IV

2

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

3

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client 1- Has wheezes in the right lung lobes 2- Has a respiratory rate of 28 breaths/minute 3- Reports shortness of breath 4- Cannot perform activities of daily living

1

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? 1- Emphysema 2- Asthma 3- Polycythemia 4- Bronchitis

3

The classification of grade I COPD is defined as mild COPD. moderate COPD. severe COPD. very severe COPD.

1

What are the primary causes for an acute exacerbation of COPD? Select all that apply. 1- Air pollution 2- Tracheobronchial infection 3- Change in season from spring to summer 4- Gastrointestinal viruses 5- Hypertension

1,2

Upon assessment, the nurse suspects that a client 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

1,2,3

Long-term oxygen therapy has been prescribed for a patient whose chronic obstructive pulmonary disease (COPD) has recently increased in severity. When teaching this patient about this treatment modality, what information should the nurse provide? "In time, you will learn to effectively adjust your flow rates depending on the dyspnea you are experiencing or that you anticipate." "It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time." "A good rule of thumb is to temporarily stop your oxygen whenever you feel like you could comfortably go without it." "Try to predict those situations where you'll need oxygen and apply your nasal prongs 30 minutes ahead of time."

2

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

2

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

1

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 Respiratory alkalosis Metabolic alkalosis Metabolic acidosis

1

The nurse is caring for a 24-year-old patient with an antitrypsin deficiency who states that she has never smoked in her life. An antitrypsin deficiency predisposes the patient to what? Pulmonary edema Emphysema Community-acquired pneumonia Empyema

2

Mrs. Fawcett is a 70-year-old woman who has a diagnosis of emphysema and who receives long-term oxygen therapy. She has presented to the emergency department because she states that she is experiencing an exacerbation of her chronic obstructive pulmonary disease (COPD), and she is in visible respiratory distress. How can the nurse best assess Mrs. Fawcett's dyspnea? Observe her activity tolerance and assess her skin tone. Measure her SpO2 by pulse oximetry and assess her respiratory rate. Auscultate her anterior and posterior lung fields. Ask her to rate her shortness of breath on a scale of 0 to 10.

4

A patient in an acute-care setting is being monitored closely after recently experiencing status asthmaticus. The nurse who is providing care for the patient has been assessing the patient's respiratory status frequently and has just completed auscultation of the patient's breath sounds. The nurse notes that the patient's breath sounds are significantly quieter than during the previous assessment. How should the nurse best interpret this assessment finding? 1- The patient's upper airways are responding to bronchodilators. 2- The patient's respiratory wheeze is resolving. 3- The patient's airflow may be severely limited. 4- The patient is in the early stages of a pulmonary infection.

3

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

3

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

3

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include 1- the importance of blood tests to monitor serum concentrations. 2- taking the medication at least 1 hour prior to meals. 3- monitoring liver function studies as prescribed. 4- development of hyperkalemia.

1

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? 1- An inspiratory-expiratory (I:E) ratio of 2:1 2- A transverse chest diameter twice that of the anteroposterior diameter 3- An oxygen saturation of 99% 4- A respiratory rate of 12 breaths/minute

1

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: instruct the client to drink at least 2 L of fluid daily. maintain the client on bed rest. administer anxiolytics, as ordered, to control anxiety. administer pain medication as ordered.

1

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 Decrease alveolar ventilation Increase oxygen distribution

1,2,4

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

2

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? 1- "I lubricate my lips and nose with K-Y jelly." 2- "I make sure my oxygen mask is on tightly so it won't fall off while I nap." 3- "I have a 'no smoking' sign posted at my front door to remind guests not to smoke." 4-"I clean my mask with water after every meal."

2

Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. 1- Compromised gas exchange 2- Decreased airflow 3- Wheezes 4- Jugular vein distention 5- Ascites

1,2,3

A public health nurse works with numerous patients who live with chronic obstructive pulmonary disease (COPD) in the community and has seen firsthand the effects of many of the risk factors underlying the disease. Which of the following public health initiatives addresses the most salient risk factor for COPD? Close follow-up of older adults who have a history of pneumonia Allergy screening for elementary school students A lung health awareness program at a large industrial complex An anti-smoking campaign in a junior high school

4

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 Emphysema Pleurisy Pneumonia

1

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? Chest pain during respiration Sputum and a productive cough Fever, chills, and diaphoresis Tachypnea and tachycardia

2

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs? 1- Administer the triamcinolone and then administer the salmeterol. 2- Administer the salmeterol and then administer the triamcinolone. 3- Allow the client to choose the order in which the drugs are administered. 4- Monitor the client's theophylline level before administering the medications.

2

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) and is now performing discharge teaching with this patient. What should the nurse include in the teaching about breathing techniques? Make inhalation longer than exhalation. Exhale through a wide open mouth. Use diaphragmatic breathing. Use chest breathing.

3

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

3

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. paradoxical chest wall movement with respirations. tracheal deviation to the unaffected side. muffled or distant heart sounds.

1

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse? 1- Collects sputum for culture and sensitivity 2- Administers vancomycin intravenously 3- Provides nebulized tobramycin (TOBI) 4- Gives oral pancreatic enzymes with meals

1

Asthma is a chronic illness and requires life-long management by patients and clinicians to achieve the goals of therapy. The signs and symptoms of this disease are primarily attributable to what pathophysiological process? Acute inflammation of the patient's hyperresponsive airway Hypersecretion of mucus by goblet cells in the upper airway Misinterpretation of chemoreceptor signals by the pons and medulla Autoimmune destruction of the mucosa in the patient's upper airway

1

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? 1- Providing sufficient oxygen to improve oxygenation 2- Avoiding the use of oxygen to decrease the hypoxic drive 3- Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise 4- Increasing pH

1

A client with COPD is being referred to a pulmonary rehabilitation program. When explaining this program to the client, which information would the nurse most likely include as a reason for it? Select all that apply. symptom reduction improved quality of life reduction in disease progression greater participation in activities lessened need for medication therapy

1, 2, 4

The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.) 1- Take a slow, deep inhalation from the device. 2- Use normal inhalations with the device. 3- Activate the MDI once. 4- The device may increase delivery of the MDI medication. 5- It is not necessary to hold your breath after using.

1,3,4

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.

1,4,5

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 1- Take deep breaths 2- Exhale slowly 3- Perform upper chest breaths 4- Increase the flow of oxygen

2

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

2

An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure? 1- Highest airflow during a forced inspiration 2- Highest airflow during a forced expiration 3- Highest airflow during a normal inspiration 4- Highest airflow during a normal expiration

2

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."

2

A nurse is caring for a client with COPD. While reviewing breathing exercises, the nurse instructs the client to breathe in slowly through the nose, taking in a normal breath. Then the nurse asks the client to pucker his lips as if preparing to whistle. Finally, the client is told to exhale slowly and gently through the puckered lips. The nurse teaches the client this breathing exercise to accomplish which goals? Select all that apply. Strengthen the diaphragm Prevent airway collapse Control the rate and depth of respirations Condition the inspiratory muscles Release air trapped in the lungs

2,3,5

A 58-year-old smoker is undergoing lung function testing because of his recent history of progressive dyspnea and a productive cough. Which of the following assessment findings during spirometry would be consistent with a diagnosis of chronic obstructive pulmonary disease (COPD)? 1- The patient's vital capacity is ≤75% of expected norms for his age and gender. 2- The patient's SaO2 does not increase with the application of supplementary oxygen. 3- The patient's ability to forcibly exhale is significantly diminished. 4- The patient exhibits adventitious lung sounds during inhalation.

3

A cient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed? 1- After meals and at bedtime 2- Before meals 3- With meals 4- Three times a day regardless of meal time

3

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.

3

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: 1- pleural effusion. 2- pulmonary edema. 3- atelectasis. 4- oxygen toxicity.

3

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary? 1- "I will make sure to take a slow, deep breath as I push on my inhaler." 2- "After I breathe in, I will hold my breath for 10 seconds." 3- "I do not need to rinse my mouth with this type of inhaler." 4- "If I use the spacer, I know I am only supposed to push on the inhaler once."

3

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? Restricting oral intake to 1,000 mL/day Providing the client a low-sodium diet Performing chest physiotherapy as ordered Discussing palliative care and end-of-life issues with the client

3

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? 1- The patient should take the medication with meals since it may cause nausea. 2- The patient should take the medication separately without other medications. 3- The patient should take the medication an hour before meals or 2 hours after a meal. 4- The patient should take the medication with a small amount of liquid.

3

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? Air pollution Allergens Infectious agents Cigarette smoking

4

A nurse is reviewing the medical records of several clients who have been diagnosed with COPD. When reviewing pulmonary function test results, the client with which postbronchodilator FEV1/FVC result would be considered to have the most severe disease? 70% 68% 65% 63%

4

A resident of a long-term care facility has lived with chronic obstructive pulmonary disease (COPD) for many years but has experienced a gradual increase in dyspnea despite the use of long-term oxygen therapy. In recent weeks, dyspnea has interfered with the resident's ability to eat, and the nurse recognizes the potential nursing diagnosis of altered nutrition: less than body requirements. How can the nurse best foster this resident's nutritional status? Arrange for a high-protein diet to promote gas exchange. Provide meals early in the morning and late at night. Liaise with the resident's health care provider to organize total parenteral nutrition (TPN). Order small, frequent meals and nutritional supplements for the resident.

4

The patient is having pulmonary function studies performed. The patient has a spirometry test and has a FEV1/FVC ratio of 60%. This finding suggests: Strong exercise tolerance. Exhalation volume is normal. Healthy lung volumes. Obstructive lung disease.

4

Which statement is true about both lung transplant and bullectomy? Both procedures cure COPD. Both procedures treat end-stage emphysema. Both procedures treat patients with bullous emphysema. Both procedures improve the overall quality of life of a client with COPD.

4