Chapter 24: Management of Patients With Chronic Pulmonary Disease

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

moderate COPD. 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.

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

severe COPD. 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 client newly diagnosed with COPD tells the nurse, "I can't believe I have COPD; I only had a cough. Are there other symptoms I should know about"? Which is the best response by the nurse? "You can also expect to experience a progressive weight gain." "Other symptoms you may develop are shortness of breath upon exertion and sputum production." "As your COPD worsens, you will frequently develop respiratory infections." "There are no other symptoms; however, your cough may get worse as the disease progresses."

"Other symptoms you may develop are shortness of breath upon exertion and sputum production." COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Clients with COPD are at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk of acute and chronic respiratory failure. Weight loss is common with COPD.

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 ___%. 58 mm Hg; 88% 60 mm Hg; 90% 56 mm Hg; 86% 54 mm Hg; 84%

60 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

During a teaching session, a parent asks the nurse which inhaler to use for quick relief if the child has an asthma attack. What teaching should the nurse review with the parent? Theophylline is a tablet, so it will take a while to work. Albuterol is a short-acting inhalant and will relax muscles quickly. Salmeterol is a long-acting inhalant and will not provide relief for an asthma attack. Cromolyn sodium is an inhalant used for asthma.

Albuterol is a short-acting inhalant and will relax muscles quickly. Short-acting beta2-adrenergic agonists, such as albuterol (AccuNeb, Proventil, Ventolin), levalbuterol (Xopenex HFA), and pirbuterol (Maxair), are the inhalant medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents that stabilize mast cells, and are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists, such as theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus), are not indicated for immediate relief of symptoms.

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 Pleurisy Pneumonia Emphysema

Atelectasis Retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

In which grade of COPD is the forced expiratory volume (FEV) less than 30%? I II III IV

IV Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 30% predicted.

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

Increased oxygen supply 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.

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

Respiratory rate of 22 breaths/minute 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 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 Fever, chills, and diaphoresis Tachypnea and tachycardia Chest pain during respiration

Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

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

"Have you tried to quit smoking before?" 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.

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? "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." "I will make sure to take a slow, deep breath as I push on my 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." 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 client 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 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 an umbrella term for diseases like acute bronchitis." "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." Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.

Which of the following is accurate regarding status asthmaticus? Usually does not progress to severe obstruction A severe asthma episode that is refractory to initial therapy Usually occurs with warning Patients have a productive cough.

A severe asthma episode that is refractory to initial therapy Status asthmaticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.

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? Fluticasone propionate Ipratropium bromide and albuterol sulfate Ipratropium bromide Albuterol

Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

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

Allergy Allergy is the strongest predisposing factor for asthma.

You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what? Pain Impaired physical mobility Atelectasis Side effects of medication therapy

Atelectasis For a client with obstructive pulmonary disease, atelectasis is one of the conditions for which nursing actions are identified to detect, manage, and minimize the unexpected outcomes.

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

Bronchitis A wide range of viral, bacterial, and mycoplasmal infections can produce acute episodes of bronchitis, a leading cause of exacerbations. Pneumonia, the common cold, and asthma are not leading causes of exacerbations.

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? Decreased oxygen requirements Decreased activity tolerance Normothermia Increased sputum production

Decreased oxygen requirements A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? Exposure to tobacco smoke Passive smoking Ambient air pollution Occupational exposure

Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors but do not account for the majority.

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? Highest airflow during a normal expiration Highest airflow during a normal inspiration Highest airflow during a forced inspiration Highest airflow during a forced expiration

Highest airflow during a forced expiration A peak flow meter is a small hand-held device that measures the fastest flow the patient can generate after taking a deep breath in and blowing out as hard and fast as possible.

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

Mast cells 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.

An increase in the red blood cell concentration in the blood is termed which of the following? Bronchitis Polycythemia Asthma Emphysema

Polycythemia 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.

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

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

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

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

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

Respiratory acidosis 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.

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: Respiratory acidosis. Hypoxemia secondary to impaired oxygen diffusion. Hypercapnia resulting from decreased carbon dioxide elimination. Diminished alveolar surface area.

Respiratory acidosis. Decreased carbon dioxide elimination results in increased carbon dioxide tension (hypercapnia), which leads to respiratory acidosis and chronic respiratory failure.

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. Thoracentesis Status asthmaticus Pertussis Atelectasis Respiratory failure

Status asthmaticus Respiratory failure Atelectasis Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: the airways are so swollen that no air can get through. crackles have replaced wheezes. the swelling has decreased. the attack is over.

the airways are so swollen that no air can get through. During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can't get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles don't replace wheezes during an acute asthma attack.

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

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

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

-Compromised gas exchange -Decreased airflow -Wheezes 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).

Which statement describes emphysema? A disease that results in reversible airflow obstruction, a common clinical outcome Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years A disease of the airways characterized by destruction of the walls of overdistended alveoli Chronic dilatation of a bronchus or bronchi

A disease of the airways characterized by destruction of the walls of overdistended alveoli Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of alveoli; a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

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

Both procedures improve the overall quality of life of a client with COPD. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat clients with bullous emphysema.

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? Discussing palliative care and end-of-life issues with the client Providing the client a low-sodium diet Performing chest physiotherapy as ordered Restricting oral intake to 1,000 mL/day

Performing chest physiotherapy as ordered Nursing care includes helping clients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

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 Hemophilus influenzae Hemophilus influenzae and varicella Hemophilus influenzae and Gardasil Streptococcus pneumonia and varicella

Streptococcus pneumonia and Hemophilus influenzae Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for females ages 9 to 26 years.

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: pleural effusion. pulmonary edema. atelectasis. oxygen toxicity.

atelectasis. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

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. diminished or absent breath sounds on the affected side. muffled or distant heart sounds.

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

implementing measures to clear pulmonary secretions. 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.