PrepU Ch. 24 Management of COPD
A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be - Isuprel - Foradil - Atrovent - Albuterol
Albuterol
A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse: - Informs the client to limit fluid intake due to fluid retention - Assesses fasting blood glucose levels - Aspirates for blood return before injecting the medication - Encourages the client to decrease caloric intake due to increased appetite
Assesses fasting blood glucose levels
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 - Perform upper chest breaths - Exhale slowly - Increase the flow of oxygen - Take deep breaths
Exhale slowly
Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)? - Exposure to tobacco smoke - Passive smoking - Occupational exposure - Ambient air pollution
Exposure to tobacco smoke
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 - III - II - IV
II
In which stage of COPD is the forced expiratory volume (FEV) less than 30%? - II - III - 0 - I
III
Asthma is cause by which type of response? - IgD-mediated - IgE-mediated - IgM-mediated - IgA-mediated
IgE-mediated
A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following? - Instructing the patient on the signs of respiratory infection - Implementing measures to clear pulmonary secretions - Teaching the family how to perform postural drainage - Providing the patient with a low-calorie, high-fiber diet
Implementing measures to clear pulmonary secretions
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 - Vancomycin 1 gram intravenously over 1 hour - Ipratropium bromide (Alupent) by metered-dose inhaler
Oxygen through nasal cannula at 2 L/minute
Which of the following terms means an increase in the red blood cell concentration in the blood? - Emphysema - Bronchitis - Asthma - Polycythemia
Polycythemia
A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant? - Serevent - Proventil - Theo-Dur - Cromolyn sodium
Proventil
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? - Increasing pH - Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise - Avoiding the use of oxygen to decrease the hypoxic drive - Providing sufficient oxygen to improve oxygenation
Providing sufficient oxygen to improve oxygenation
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
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? - Metabolic acidosis - Respiratory acidosis - Respiratory alkalosis - Metabolic alkalosis
Respiratory acidosis
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 - Respiratory rate of 22 breaths/minute - Heart rate of 100 beats/minute - Urine output of 40 ml/hour
Respiratory rate of 22 breaths/minute
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. - Status asthmaticus - Thoracentesis - Respiratory failure - Atelectasis - Pertussis
Status asthmaticus Respiratory failure Atelectasis
Which of the following would not be considered a primary symptom of COPD? - Dyspnea on exertion - Weight gain - Sputum production - Cough
Weight gain
A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? - nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800 - salmeterol/fluticasone (Seretide) MDI daily at 0800 - prednisone 5 mg oral daily at 0800 - azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4
salmeterol/fluticasone (Seretide) MDI daily at 0800
The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction? - "I can't use a spacer or holding chamber with the MDI." - "I will shake the MDI container before I use it." - "I will take a slow, deep breath in after pushing down on the MDI." - "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use."
"I can't use a spacer or holding chamber with the MDI."
A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? - "After I breathe in, I will hold my breath for 10 seconds." - "I do not need to rinse my mouth with this type of inhaler." - "If I use the spacer, I know I am only supposed to push on the inhaler once." - "I will make sure to take a slow, deep breath as I push on my inhaler."
"I do not need to rinse my mouth with this type of inhaler."
A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? - "I need to call the physician right away if I feel my heart beating fast after using the drug." - "I can stop using this drug when I begin to feel better." - "I should use this inhaler whenever I get short of breath." - "I need to hold my breath as long as possible after I take a deep inhalation."
"I need to hold my breath as long as possible after I take a deep inhalation."
A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? - "At this point, do you really want to go through something like that?" - "You would have a difficult time recovering from the procedure." - "You are not a candidate because you have heart failure." - "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."
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 ___%. - 54 mm Hg; 84% - 56 mm Hg; 86% - 60 mm Hg; 90% - 58 mm Hg; 88%
60 mm Hg; 90%
Emphysema is described by which of the following statements? - Chronic dilatation of a bronchus or bronchi - A disease that results in a common clinical outcome of reversible airflow obstruction - Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years - A disease of the airways characterized by destruction of the walls of overdistended alveoli
A disease of the airways characterized by destruction of the walls of overdistended alveoli
Which of the following is accurate regarding status asthmaticus? - A severe asthma episode that is refractory to initial therapy - Usually does not progress to severe obstruction - Patients have a productive cough. - Usually occurs with warning
A severe asthma episode that is refractory to initial therapy
Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. - Albuterol is a bronchodilator. - Decadron is an antibiotic. - Ciprofloxacin is an antibiotic. - Prednisone is a corticosteroid. - Bactrim is a bronchodilator.
Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.
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? - A 62 year old with emphysema who has 300 mL of intravenous fluid remaining - An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office - A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26 - An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen
An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: - Inflammation of the bronchioles with a normal distention of the air spaces - An abnormal distention of the air spaces with destruction of the alveolar walls - Decreased sputum production with dilation of bronchioles - Increased oxygen diffusion with inflammation of the bronchioles
An abnormal distention of the air spaces with destruction of the alveolar walls
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? - Emphysema - Pleurisy - Pneumonia - Atelectasis
Atelectasis
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? - Pneumonia - Atelectasis - Pleurisy - Emphysema
Atelectasis
Which of the following is true about both lung transplant and bullectomy? - Both are aimed at curing COPD. - Both are aimed at treating end-stage emphysema. - Both are used to treat patients with bullous emphysema. - Both are aimed at improving the overall quality of life of a patient with COPD.
Both are aimed at improving the overall quality of life of a patient 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? - Bronchiectasis - Asthma - Emphysema - Cystic fibrosis
Emphysema
Which of the following measures may increase complications for a patient with COPD? - Decreased oxygen supply - Administration of antibiotics - Increased oxygen supply - Administration of antitussive agents
Increased oxygen supply
Histamine, a mediator that supports the inflammatory process in asthma, is secreted by - Eosiniphils - Mast cells - Lymphocytes - Neutrophils
Mast cells
The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) - Dry airways obstruct airflow. - Mucus secretions block airways. - Inflamed airways obstruct airflow. - Overinflated alveoli impair gas exchange.
Mucus secretions block airways. Inflamed airways obstruct airflow. Overinflated alveoli impair gas exchange.
The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care? - Providing the patient with a low sodium diet - Discussing palliative care and end-of-life issues with the patient - Restricting oral intake to 1,000 mL/day - Performing chest physiotherapy as ordered
Performing chest physiotherapy as ordered
A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? - Atrovent - Combivent - Proventil - Flovent
Proventil
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? - Metabolic alkalosis - Respiratory acidosis - Respiratory alkalosis - Metabolic acidosis
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? - Fever, chills, and diaphoresis - Sputum and a productive cough - Chest pain during respiration - Tachypnea and tachycardia
Sputum and a productive cough
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? - Tachypnea and tachycardia - Sputum and a productive cough - Chest pain during respiration - Fever, chills, and diaphoresis
Sputum and a productive cough
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? - Take ordered medications as scheduled. - Change filters on heating and air conditioning units frequently. - Avoid goose down pillows. - Avoid contact with fur-bearing animals.
Take ordered medications as scheduled.
For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? - Teaching the client how to perform controlled coughing - Administering ordered sedatives regularly and in large amounts - Restricting fluid intake to 1,000 ml/day - Enforcing absolute bed rest
Teaching the client how to perform controlled coughing
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. - muffled or distant heart sounds. - tracheal deviation to the unaffected side. - paradoxical chest wall movement with respirations.
diminished or absent breath sounds on the affected side.
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: - stay with the client until the therapist arrives. - notify the primary physician immediately. - administer the treatment by metered-dose inhaler. - give the nebulizer treatment herself.
give the nebulizer treatment herself.
