Honan-Chapter 11: Nursing Management: Patients With Chronic Obstructive Pulmonary Disease and Asthma

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

IV Explanation: COPD is classified into four grades depending on the severity measured by pulmonary function tests. However, pulmonary function is not the only way to assess or classify COPD; pulmonary function is evaluated in conjunction with symptoms, health status impairment, and the potential for exacerbations. Grade I (mild): FEV1/FVC <70% and FEV1 ≥80% predicted. Grade II (moderate): FEV1/FVC <70% and FEV1 50% to 80% predicted. Grade III (severe): FEV1/FVC <70% and FEV1 <30% to 50% predicted. Grade IV (very severe): FEV1/FVC <70% and FEV1 <30% predicted.

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.

Obstructive lung disease. Explanation: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is a FEV1/FVC ratio less than 70%.

Which diagnostic test is the most accurate in assessing acute airway obstruction? Arterial blood gases (ABGs) Pulmonary function studies Pulse oximetry Chest x-ray

Pulmonary function studies Explanation: Pulmonary function studies are the most accurate means of assessing acute airway obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics for an airway obstruction.

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%

92% Explanation: Adequate oxygenation of clients (keeping the oxygen saturation at or above 90%) is important to prevent vital organ damage while monitoring for any possible complications of oxygen supplementation. Thus, an oxygen saturation level of 92% would be best.

The school nurse is caring for a 10-year-old girl who is having an asthma attack on the school ground at recess. What is the preferred treatment to alleviate this patient's current airflow obstruction? Corticosteroids Anticholinergics Beta-adrenergics Peak flow monitoring device

Beta-adrenergics Explanation: Asthma exacerbations are best managed by early treatment and education of the patient. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication.

A client's spouse states that she is worried about her husband because he appears to be breathing "really hard." The nurse performs a respiratory assessment. What findings would indicate a need for further interventions? BP 122/82, HR 102, R 24, noted barrel chest, temperature 98.4 °F (36.9 °C) Client states, "It always seems like I just can't catch my breath." Pale, paper-thin skin, O2 at 2L/min via nasal cannula BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C)

BP 122/80, HR 116, R 24, pale and clammy skin, temp 101.3 °F (38.5 °C) Explanation: Bronchopulmonary infections must be controlled to diminish inflammatory edema and to permit recovery of normal ciliary action. Minor respiratory infections of no consequence to people with normal lungs can be life-threatening to people with COPD. The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior.

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

Bronchitis Explanation: 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.

Patients with advanced COPD experience progressive inactivity, exercise intolerance, and disability. The nurse must carefully monitor the exercise tolerance of patients taking: Antihistamines Short acting beta-adrenergics Anticholinergics Corticosteroids

Corticosteroids Explanation: Corticosteroids are associated with myopathy, especially in leg muscles.

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

Exposure to tobacco smoke Explanation: 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 they do not account for most cases.

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 Oral sustained-release albuterol Subcutaneous omalizumab Oral prednisone

Inhaled beclomethasone Explanation: For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone (Beconase). The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma.

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

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.

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: When a client presents in the emergency department with an exacerbation of COPD, the nurse should first administer oxygen therapy and perform a rapid assessment of whether the exacerbation is potentially life threatening.

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.

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

Sputum and a productive cough Explanation: 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.

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.) To combat dehydration To assist with the effectiveness of the corticosteroids To loosen secretions To facilitate expectoration To relieve bronchospasm

To combat dehydration To loosen secretions To facilitate expectoration Explanation: The nurse also assesses the patient's skin turgor for signs of dehydration. Fluid intake is essential to combat dehydration, to loosen secretions, and to facilitate expectoration.

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

With meals Explanation: Nearly 90% of clients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals.

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 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.

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

A severe asthma episode that is refractory to initial therapy Explanation: 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.

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

Acute inflammation of the patient's hyperresponsive airway Explanation: The underlying pathology in asthma is reversible and diffuse airway inflammation; the airways become hyperresponsive (respond to stimuli in an exaggerated manner). Excess mucus production may accompany the disease, but this is not central to the pathophysiology. Misinterpretation of signals by the brain and autoimmune destruction of the mucosa are not aspects of asthma.

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

An anti-smoking campaign in a junior high school Explanation: Lung infections, allergies, and occupational toxins are known risk factors for COPD. However, these are eclipsed by the harmful role of smoking in the development of the disease.

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? Albuterol Budesonide Cromolyn sodium Theophylline

Cromolyn sodium Explanation: Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Though also used in the treatment of asthma the following are NOT mast cell stabilizers: Albuterol is a beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator.

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client Exhales hard and fast with a single blow Inhales deeply and holds the breath Records in a diary the number achieved after one breath Sits in a straight-back chair and leans forward

Exhales hard and fast with a single blow Explanation: To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary

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 II III IV

I Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.

A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Teach the client to suspend activity.

Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Explanation: The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities.

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 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

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 pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: Sharp, stabbing chest pain Dyspnea A dry, hacking cough Tachycardia

Sharp, stabbing chest pain Explanation: The initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute and a pulse oximetry of 93% despite receiving nasal oxygen at 2 L/minute. What action should the nurse take? Encourage the client to take deep breaths. Encourage the client to exhale slowly against pursed lips. Teach the client to perform upper chest breaths. Increase the flow of oxygen.

Encourage the client to exhale slowly against pursed lips. Explanation: When a client with COPD exhibits shallow, rapid, and inefficient respirations, the nurse encourages the client to perform pursed-lip breathing, which includes exhaling slowly against pursed lips. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and helps the client control the rate and depth of respiration. It also promotes relaxation, enabling the client to gain control of dyspnea and reduce feelings of panic. Taking deep breaths and upper chest breathing are inefficient breathing techniques; the client with COPD should be encouraged to practice diaphragmatic breathing. Increasing oxygen flow is not necessary because the pulse oximetry is 93%.

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

Polycythemia Explanation: Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

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. Explanation: 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.

The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen A 62 year old with emphysema who has 300 mL of intravenous fluid remaining A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office

An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office Explanation: On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD.

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.

instruct the client to drink at least 2 L of fluid daily. Explanation: Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated.

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

"I make sure my oxygen mask is on tightly so it won't fall off while I nap." Explanation: The client requires additional teaching if he states that he fits his mask tightly. Applying the oxygen mask too tightly can cause skin breakdown, so the client should be cautioned against wearing it too tightly. Oxygen therapy is drying to the oral and nasal mucosa; therefore, the client should be encouraged to apply a water-soluble lubricant, such as K-Y jelly, to prevent drying. Smoking is contraindicated wherever oxygen is in use; posting of a "no smoking" sign warns people against smoking in the client's house. Cleaning the mask with water two or three times per day removes secretions and decreases the risk of infection.

A client with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? "You are not a candidate because you have heart failure." "You would have a difficult time recovering from the procedure." "At this point, do you really want to go through something like that?" "You and your physician should discuss the options that are available for treatment."

"You and your physician should discuss the options that are available for treatment." Explanation: Treatment options for clients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are limited, although lung volume reduction surgery is a palliative surgical option that is approved by Medicare in selected patients. This includes clients with homogenous disease or disease that is focused in one area and not widespread throughout the lungs. Lung volume reduction surgery involves the removal of a portion of the diseased lung parenchyma. This reduces hyperinflation and allows the functional tissue to expand, resulting in improved elastic recoil of the lung and improved chest wall and diaphragmatic mechanics. This type of surgery does not cure the disease nor improve life expectancy; however, it may decrease dyspnea, improve lung function and exercise tolerance, and improve the patient's overall quality of life (GOLD, 2015).

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%

63% Explanation: Obstructive lung disease is defined as a postbronchodilator FEV1/FVC ratio of less than 70%. The lower the FEV1, the more severe the disease process. Therefore, the client with the FEV1/FVC of 63% would be considered to have the most severe condition.

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? Apply supplemental oxygen as ordered. Assess vital signs every 2 hours, including O2 saturations and ABG results. Educate the client about the importance of pursed lip breathing. Refer the client to respiratory therapy if breathing becomes labored.

Apply supplemental oxygen as ordered. Explanation: When the client arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment. Oxygen will correct the hypoxemia. Careful observation of the liter flow or the percentage administered and its effect on the patient is important. These clients generally require low-flow oxygen rates of 1-2 L/min. Monitor and titrate to achieve desired PaO2. Periodic arterial blood gases and pulse oximetry help evaluate the adequacy of oxygenation.

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

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).

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 Increased sputum production Decreased activity tolerance Normothermia

Decreased oxygen requirements Explanation: 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.

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 Dry airways that obstruct airflow Decreased numbers of goblet cells

Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Explanation: Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.

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

Streptococcus pneumonia and Hemophilus influenzae Explanation: 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.

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.

The patient should take the medication an hour before meals or 2 hours after a meal. Explanation: The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. Thick mucus Swelling of bronchial membranes Destruction of the alveolar wall Airway remodeling

Thick mucus Swelling of bronchial membranes Airway remodeling Explanation: As asthma becomes more persistent, inflammation progresses and airway edema, mucus hypersecretion, and formation of mucus plugs can occur. Airway remodeling may occur in response to chronic inflammation, causing further airway narrowing. Destruction of the alveolar wall does not occur with asthma.

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.

Use diaphragmatic breathing. Explanation: Inspiratory muscle training and breathing retraining may help improve breathing patterns. Pursed-lip breathing helps slow expiration, prevent collapse of small airways, and control the rate and depth of respiration. It also promotes relaxation, which allows patients to gain control of dyspnea and reduce feelings of panic. Diaphragmatic breathing, not chest breathing, increases lung expansion, although its benefits have been shown to be limited.

For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? Encouraging the client to drink three glasses of fluid daily Keeping the client in semi-Fowler's position Using a Venturi mask to deliver oxygen as ordered Administering a sedative as ordered

Using a Venturi mask to deliver oxygen as ordered Explanation: The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

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.

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 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

symptom reduction improved quality of life greater participation in activities Explanation: Pulmonary rehabilitation for clients with COPD is well established and widely accepted as a means to alleviate symptoms and optimize functional status. It is now considered part of the recommended treatment for symptomatic COPD. The primary goals of rehabilitation are to reduce symptoms, improve quality of life, and increase participation in everyday activities. It does not affect disease progression or the need for medication therapy.

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.

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."

"It's important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time." Explanation: Patients requiring oxygen therapy need to be taught the importance of adhering to the oxygen prescription. Patients often think they can tell when they need oxygen by their symptoms. The presence or absence of dyspnea is unreliable in detecting the need for supplemental oxygen. Many hypoxemic patients do not feel dyspnea. Additionally, many patients who are dyspneic do not have significant hypoxemia or oxygen desaturation. in other words... DONT TOUCH ANYTHING

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? "There are no other symptoms; however, your cough may get worse as the disease progresses." "As your COPD worsens, you will frequently develop respiratory infections." "Other symptoms you may develop are shortness of breath upon exertion and sputum production." "You can also expect to experience a progressive weight gain."

"Other symptoms you may develop are shortness of breath upon exertion and sputum production." Explanation: 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.

Which statement describes emphysema? A disease of the airways characterized by destruction of the walls of overdistended alveoli 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 Chronic dilatation of a bronchus or bronchi

A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: Emphysema is a category of COPD. 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.

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

Administer the salmeterol and then administer the triamcinolone. Explanation: A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone (Azmacort) is a corticosteroid; Salmeterol (Serevent) is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.

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? Ipratropium bromide Fluticasone propionate Ipratropium bromide and albuterol sulfate Albuterol

Albuterol Explanation: 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.

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client? Ipratropium bromide Albuterol Formoterol Isoproterenol

Albuterol Explanation: Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

A hospital patient with a complex medical history that includes asthma has rung his call bell and states that he is having an asthma attack. The nurse has completed a rapid assessment of the patient and has identified the need for pharmacologic interventions. After consulting the patient's medication administration record, the nurse should administer a p.r.n. dose of: Hydromorphone (Dilaudid) Albuterol (Ventolin) Ipratropium (Atrovent)

Albuterol (Ventolin) Explanation: Short-acting beta-adrenergics (SABAs), such as Ventolin, are used as needed for quick relief. Opioids, anticholinergics, and corticosteroids are not used for this purpose.

In which statements regarding medications taken by a client diagnosed with COPD do 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.

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

Allergy Explanation: Allergy is the strongest predisposing factor for asthma.

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 Imbalanced nutrition: More than body requirements Impaired swallowing Unilateral neglect

Anxiety Explanation: In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

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 Emphysema Pleurisy Pneumonia

Atelectasis Explanation: In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

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.

Both procedures improve the overall quality of life of a client with COPD. Explanation: 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.

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? Collects sputum for culture and sensitivity Administers vancomycin intravenously Provides nebulized tobramycin (TOBI) Gives oral pancreatic enzymes with meals

Collects sputum for culture and sensitivity Explanation: Aggressive therapy for cystic fibrosis involves airway clearance and antibiotics, such as vancomycin and tobramycin, which will be prescribed based on sputum cultures. Sputum must be obtained prior to antibiotic therapy so results will not be skewed. Administering oral pancreatic enzymes with meals will be a lesser priority.

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? Albuterol Cromolyn sodium Levalbuterol HFA Ipratropium

Cromolyn sodium Explanation: Cromolyn sodium is contraindicated in clients with acute asthma exacerbation. Indications for cromolyn sodium are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Cromolyn sodium is also a preventive treatment before exposure to exercise or a known allergen. Albuterol, levalbuterol HFA, and ipratropium can be used to relieve acute symptoms.

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

IgE-mediated 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.

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

Emphysema Explanation: A host risk factor for chronic obstructive pulmonary disease (COPD) is a deficiency of alpha1 antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking.

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.

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

Highest airflow during a forced expiration Explanation: 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.

The nurse has been asked to give a workshop on chronic obstructive pulmonary disease (COPD) for a local community group. When talking about what can be done for patients with COPD, the nurse encourages a COPD patient not to smoke because smoking has what effect? Increases the amount of mucus production Deoxygenates the hemoglobin Shrinks the alveoli in the lungs Collapses the alveoli in the lungs

Increases the amount of mucus production Explanation: Smoking irritates the goblet cells and mucus glands, causing an increased accumulation of mucus, which in turn produces more irritation, infection, and damage to the lung. It does not directly deoxygenate hemoglobin or shrink and collapse the alveoli, although these effects may result from the pathologies caused by smoking.

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.

Order small, frequent meals and nutritional supplements for the resident. Explanation: Small, frequent meals and nutritional supplements can promote nutrition in individuals whose COPD impairs their nutritional intake. A high-protein diet is not of particular benefit, and TPN would not be a first-line intervention. Dyspnea does not necessarily abate in the early morning and late at night.

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

Prevent airway collapse Control the rate and depth of respirations Release air trapped in the lungs Explanation: The nurse is teaching the client the technique of pursed-lip breathing. It helps slow expiration, prevents collapse of the airways, releases air trapped in the lungs, and helps the client control the rate and depth of respirations. This helps clients relax and get control of dyspnea and reduces the feelings of panic they may experience. Diaphragmatic breathing strengthens the diaphragm during breathing. In inspiratory muscle training, the client will be instructed to inhale against a set resistance for a prescribed amount of time every day in order to condition the inspiratory muscles.

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

Which diagnostic test is most accurate in assessing acute airway obstruction? Arterial blood gases (ABGs) Pulmonary function studies Pulse oximetry Spirometry

Pulmonary function studies Explanation: Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs and pulse oximetry are not the most accurate diagnostics for an airway obstruction. Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).

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

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.

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

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.

A health care provider orders a beta-2 adrenergic agonist agent (bronchodilator) that is long-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? Terbutaline Salmeterol Foradil Isuprel

Salmeterol Explanation: Salmeterol is a long-acting inhalant. Terbutaline (Brethine) is a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered by inhaler and oral form. Metaproterenol sulfate (Alupent) is a short-acting beta-2 adrenergic agonist agent, but it may be administered by an inhaler, by a nebulizer, or orally. Formoterol (Foradil) is a long-acting beta-2 adrenergic agonist agent given by inhalant and nebulizer. Isoprenaline (Isuprel) is a beta-2 adrenergic agonist agent, but it may be administered by various routes.

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)? The patient's vital capacity is ≤75% of expected norms for his age and gender. The patient's SaO2 does not increase with the application of supplementary oxygen. The patient's ability to forcibly exhale is significantly diminished. The patient exhibits adventitious lung sounds during inhalation.

The patient's ability to forcibly exhale is significantly diminished. Explanation: Spirometry is used to evaluate airflow obstruction. With obstruction, the patient has difficulty exhaling or cannot forcibly exhale air from the lungs, reducing the forced expired volume in 1 second (FEV1). Spirometry is not used to assess for adventitious lung sounds or changes in SpO2 with supplementary oxygen, although these are relevant assessment parameters for individuals suspected of having COPD. Vital capacity is a component of spirometry, but the diagnosis of COPD is not based on vital capacity in isolation.

A client with chronic obstructive pulmonary disease tells a nurse that he feels short of breath. The client's respiratory rate is 36 breaths/minute and the nurse auscultates diffuse wheezes. His arterial oxygen saturation is 84%. The nurse calls the assigned respiratory therapist to administer an ordered nebulizer treatment. The therapist says, "I have several more nebulizer treatments to do on the unit where I am now. As soon as I'm finished, I'll come and assess the client." The nurse's most appropriate action is to: notify the primary physician immediately. stay with the client until the therapist arrives. administer the treatment by metered-dose inhaler. give the nebulizer treatment herself.

give the nebulizer treatment herself. Explanation: The client's needs are preeminent, so the nurse should administer the nebulizer treatment immediately. The nurse can deal with the respiratory therapist's lack of response after the client's condition is stabilized. There is no need to involve the physician in personnel issues. Staying with the client is important, but it isn't a substitute for administering the needed bronchodilator. The order is for a nebulizer treatment not a metered-dose inhaler, so the nurse can't change the route without a new order from the physician.