Asthma and COPD
Theophylline (Theo-Dur) tablets are prescribed for a client with chronic airflow limitation, and the nurse instructs the client about the medication. Which statement by the client indicates a need for further teaching? "I will take the medication on an empty stomach." "I will take the medication with food." "I will continue to take the medication even if I am feeling better." "Periodic blood levels will need to be obtained."
"I will take the medication on an empty stomach." Theo-Dur is a bronchodilator. The medication should be administered with food such as milk and crackers to prevent GI irritation.
A nurse is suctioning fluids from a client via a tracheostomy tube. When suctioning, the nurse must limit the suctioning to a maximum of: 5 seconds 10 seconds 30 seconds 1 minute
10 seconds Hypoxemia can be caused by prolonged suctioning, which stimulates the pacemaker cells within the heart. A vasovagal response may occur causing bradycardia. The nurse must preoxygenate the client before suctioning and limit the suctioning pass to 10 seconds.
A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client? Increased oxygen saturation with exercise Hypocapnia A hyperinflated chest on x-ray film A widened diaphragm noted on chest x-ray film
A hyperinflated chest on x-ray film Clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration. Chest x-ray films reveal a hyperinflated chest and a flattened diaphragm is the disease is advanced.
A 7-year-old client is brought to the E.R. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following? Acute asthma Bronchial pneumonia Chronic obstructive pulmonary disease (COPD) Emphysema
Acute asthma Based on the client's history and symptoms, acute asthma is the most likely diagnosis. He's unlikely to have bronchial pneumonia without a productive cough and fever and he's too young to have developed COPD or emphysema.
Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next? Administer beta-adrenergic blockers Administer bronchodilators Obtain serum electrolyte levels Have the client lie flat in the bed
Administer bronchodilators Bronchodilators would help open the client's airway and improve his oxygenation status. Beta-adrenergic blockers aren't indicated in the management of asthma because they may cause bronchospasm. Obtaining laboratory values wouldn't be done on an emergency basis, and having the client lie flat in bed could worsen his ability to breathe.
Emergency treatment for a client with impending anaphylaxis secondary to hypersensitivity to a drug should include which of the following actions first? Administering oxygen Inserting an I.V. catheter Obtaining a complete blood count (CBC) Taking vital signs
Administering oxygen Giving oxygen would be the best first action in this case. Vital signs then should be checked and the physician immediately notified. If the client doesn't already have an I.V. catheter, one may be inserted now if anaphylactic shock is developing. Obtaining a CBC wouldn't help the emergency situation.
An elderly client with pneumonia may appear with which of the following symptoms first? Altered mental status and dehydration fever and chills Hemoptysis and dyspnea Pleuritic chest pain and cough
Altered mental status and dehydration Fever, chills, hemoptysis, dyspnea, cough, and pleuritic chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.
Dani was given dilaudid for pain. She's sleeping and her respiratory rate is 4 breaths/minute. If action isn't taken quickly, she might have which of the following reactions? Asthma attack Respiratory arrest Improve cardiac output Constipation
Respiratory arrest Narcotics can cause respiratory arrest if given in large quantities.
A patient is ordered at 1400 to take Theophylline. You're assessing the patient's morning lab results and note that the Theophylline level drawn this morning reads: 15 mcg/mL. You're next nursing action is to? A. Administer the dose at 1400 as ordered B. Notify the physician for further orders C. Hold the 1400 dose D. Collect another blood sample to confirm the level
The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is normal and the nurse should administer the dose at 1400 as ordered.
A client is scheduled for blood to be drawn from the radial artery for an ABG determination. Before the blood is drawn, an Allen's test is performed to determine the adequacy of the: Popliteal circulation Ulnar circulation Femoral circulation Carotid circulation
Ulnar circulation Before radial puncture for obtaining an ABG, you should perform an Allen's test to determine adequate ulnar circulation. Failure to determine the presence of adequate collateral circulation could result in severe ischemic injury o the hand if damage to the radial artery occurs with arterial puncture.
Which of the following measures can reduce or prevent the incidence of atelectasis in a post-operative client? Chest physiotherapy Mechanical ventilation Reducing oxygen requirements Use of an incentive spirometer
Use of an incentive spirometer Using an incentive spirometer requires the client to take deep breaths and promotes lung expansion. Chest physiotherapy helps mobilize secretions but won't prevent atelectasis. Reducing oxygen requirements or placing someone on mechanical ventilation doesn't affect the development of atelectasis.
An oxygenated delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? Venturi mask Aerosol mask Face tent Tracheostomy collar
Venturi mask The venture mask delivers the most accurate oxygen concentration. The Venturi mask is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, the aerosol mask, and the tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.
The nurse reviews the ABG values of a client. The results indicate respiratory acidosis. Which of the following values would indicate that this acid-base imbalance exists? pH of 7.48 PCO2 of 32 mm Hg pH of 7.30 HCO3- of 20 mEq/L
pH of 7.30
A client has started a new drug for hypertension. Thirty minutes after he takes the drug, he develops chest tightness and becomes short of breath and tachypneic. He has a decreased level of consciousness. These signs indicate which of the following conditions? Asthma attack Pulmonary embolism respiratory failure Rheumatoid arthritis
respiratory failure The client was reacting to the drug with respiratory signs of impending anaphylaxis, which could lead to eventual respiratory failure. Although the signs are also related to an asthma attack or a pulmonary embolism, consider the new drug first. Rheumatoid arthritis doesn't manifest these signs.
A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed 1 L/min 2 L/min 6 L/min 10 L/min
2 L/min To obtain a sputum specimen, the client should rinse the mouth to prevent contamination, breathe deeply, and then cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.
A nurse is preparing to obtain an arterial blood gas specimen from a client and plans to perform the Allen's test on the client. Number in order of priority the steps for performing the Allen's test (#1 is first step). 1. Ask the client to open and close the hand repeatedly. 2. Apply pressure over the ulnar and radial arteries. 3. Assess the color of the extremity distal to the pressure point 4. Release pressure from the ulnar artery 5. Explain the procedure to the client. 5, 2, 3, 1, 4. 5, 3, 2, 1, 4. 5, 2, 1, 4, 3. 5, 2, 4, 1, 3.
5, 2, 1, 4, 3.
A client is in danger of respiratory arrest following the administration of a narcotic analgesic. An arterial blood gas value is obtained. The nurse would expect to PaCO2 to be which of the following values? 15 mm Hg 30 mm Hg 40 mm Hg 80 mm Hg
80 mm Hg A client about to go into respiratory arrest will have inefficient ventilation and will be retaining carbon dioxide. The value expected would be around 80 mm Hg. All other values are lower than expected.
Which of the following respiratory disorders is most common in the first 24 to 48 hours after surgery? Atelectasis Bronchitis Pneumonia Pneumothorax
Atelectasis Atelectasis develops when there's interference with the normal negative pressure that promotes lung expansion. Clients in the postoperative phase often splint their breathing because of pain and positioning, which causes hypoxia. It's uncommon for any of the other respiratory disorders to develop.
Which of the following treatment goals is best for the client with status asthmaticus? Avoiding intubation Determining the cause of the attack Improving exercise tolerance Reducing secretions
Avoiding intubation Inhaled beta-adrenergic agents, I.V. corticosteroids, and supplemental oxygen are used to reduce bronchospasm, improve oxygenation, and avoid intubation. Determining the trigger for the client's attack and improving exercise tolerance are later goals. Typically, secretions aren't a problem in status asthmaticus.
A client with acute asthma showing inspiratory and expiratory wheezes and a decreased expiratory volume should be treated with which of the following classes of medication right away? Beta-adrenergic blockers Bronchodilators Inhaled steroids Oral steroids
Bronchodilators Bronchodilators are the first line of treatment for asthma because bronchoconstriction is the cause of reduced airflow. Beta-adrenergic blockers aren't used to treat asthma and can cause bronchoconstriction. Inhaled or oral steroids may be given to reduce the inflammation but aren't used for emergency relief.
A nurse is caring for a client after a bronchoscopy and biopsy. Which of the following signs if noted in the client should be reported immediately to the physician? Blood-streaked sputum Dry cough Hematuria Bronchospasm
Bronchospasm If a biopsy was performed during a bronchoscopy, blood-streaked sputum is expected for several hours. Frank blood indicates hemorrhage. A dry cough may be expected. The client should be assessed for signs of complications, which would include cyanosis, dyspnea, stridor, bronchospasm, hemoptysis, hypotension, tachycardia, and arrhythmias. Hematuria is unrelated to this procedure.
A 58-year-old client with a 40-year history of smoking one to two packs of cigarettes a day has a chronic cough producing thick sputum, peripheral edema, and cyanotic nail beds. Based on this information, he most likely has which of the following conditions? Adult respiratory distress syndrome (ARDS) Asthma Chronic obstructive bronchitis Emphysema
Chronic obstructive bronchitis Because of his extensive smoking history and symptoms, the client most likely has chronic obstructive bronchitis. Clients with ARDS have acute symptoms of and typically need large amounts of oxygen. Clients with asthma and emphysema tend not to have a chronic cough or peripheral edema.
The term "blue bloater" refers to which of the following conditions? Adult respiratory distress syndrome (ARDS) Asthma Chronic obstructive bronchitis Emphysema
Chronic obstructive bronchitis Clients with chronic obstructive bronchitis appear bloated; they have large barrel chests and peripheral edema, cyanotic nail beds and, at times, circumoral cyanosis. Clients with ARDS are acutely short of breath and frequently need intubation for mechanical ventilation and large amounts of oxygen. Clients with asthma don't exhibit characteristics of chronic disease, and clients with emphysema appear pink and cachectic (a state of ill health, malnutrition, and wasting).
The term "pink puffer" refers to the client with which of the following conditions? ARDS Asthma Chronic obstructive bronchitis Emphysema
Emphysema Because of the large amount of energy it takes to breathe, clients with emphysema are usually cachectic. They're pink and usually breathe through pursed lips, hence the term "puffer". Clients with ARDS are usually acutely short of breath. Clients with asthma don't have any particular characteristics, and clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
A 69-year-old client appears thin and cachectic. He's short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions? ARDS Asthma Chronic obstructive bronchitis Emphysema
Emphysema In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchial collapse, as well. In ARDS, the client's condition is more acute and typically requires mechanical ventilation. In asthma and bronchitis, wheezing is prevalent.
A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He's tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders? ARDS Asthma Chronic obstructive bronchitis Emphysema
Emphysema These are classic signs and symptoms of a client with emphysema. Clients with ARDS are acutely short of breath and require emergency care; those with asthma are also acutely short of breath during an attack and appear very frightened. Clients with chronic obstructive bronchitis are bloated and cyanotic in appearance.
A 19-year-old comes into the emergency department with acute asthma. His respiratory rate is 44 breaths/minute, and he appears to be in acute respiratory distress. Which of the following actions should be taken first? Take a full medication history Give a bronchodilator by nebulizer Apply a cardiac monitor to the client Provide emotional support to the client
Give a bronchodilator by nebulizer The client is having an acute asthma attack and needs to increase oxygen delivery to the lung and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. First, resolve the acute phase of the attack ad how to prevent attacks in the future. It may not be necessary to place the client on a cardiac monitor because he's only 19-years-old, unless he has a past medical history of cardiac problems.
A nurse is preparing to obtain a sputum specimen from a client. Which of the following nursing actions will facilitate obtaining the specimen? Limiting fluids Having the client take 3 deep breaths Asking the client to spit into the collection container Asking the client to obtain the specimen after eating
Having the client take 3 deep breaths To obtain a sputum specimen, the client should rinse the mouth to prevent contamination, breathe deeply, and then cough unto a sputum specimen container. The client should be encouraged to cough and not spit so as to obtain sputum. Sputum can be thinned by fluids or by a respiratory treatment such as inhalation of nebulized saline or water. The optimal time to obtain a specimen is on arising in the morning.
Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics? How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart How to increase his oxygen therapy How to treat respiratory infections without going to the physician How to recognize the signs of an impending respiratory infection
How to recognize the signs of an impending respiratory infection Respiratory infection in clients with a respiratory disorder can be fatal. It's important that the client understands how to recognize the signs and symptoms of an impending respiratory infection. It isn't appropriate for the wife to listen to his lung sounds, besides, you can't purchase stethoscopes from Wal-Mart. If the client has signs and symptoms of an infection, he should contact his physician at once.
Which of the following pathophysiological mechanisms that occurs in the lung parenchyma allows pneumonia to develop? Atelectasis Bronchiectasis Effusion Inflammation
Inflammation The most common feature of all types of pneumonia is an inflammatory pulmonary response to the offending organism or agent. Atelectasis and bronchiectasis indicate a collapse of a portion of the airway that doesn't occur with pneumonia. An effusion is an accumulation of excess pleural fluid in the pleural space, which may be a secondary response to pneumonia.
Emergency treatment of a client in status asthmaticus includes which of the following medications? Inhaled beta-adrenergic agents Inhaled corticosteroids I.V. beta-adrenergic agents Oral corticosteroids
Inhaled beta-adrenergic agents Inhaled beta-adrenergic agents help promote bronchodilation, which improves oxygenation. I.V. beta-adrenergic agents can be used but have to be monitored because of their greater systemic effects. They're typically used when the inhaled beta-adrenergic agents don't work. Corticosteroids are slow-acting, so their use won't reduce hypoxia in the acute phase.
Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? Circumoral cyanosis Increased forced expiratory volume Inspiratory and expiratory wheezing Normal breath sounds
Inspiratory and expiratory wheezing Inspiratory and expiratory wheezes are typical findings in asthma. Circumoral cyanosis may be present in extreme cases of respiratory distress. The nurse would expect the client to have a decreased forced expiratory volume because asthma is an obstructive pulmonary disease. Breath sounds will be "tight" sounding or markedly decreased; they won't be normal.
Which of the following types of asthma involves an acute asthma attack brought on by an upper respiratory infection? Emotional Extrinsic Intrinsic Mediated
Intrinsic Intrinsic asthma doesn't have an easily identifiable allergen and can be triggered by the common cold. Asthma caused be emotional reasons is considered to be in the extrinsic category. Extrinsic asthma is caused by dust, molds, and pets; easily identifiable allergens. Mediated asthma doesn't exist.
Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema? It enhances cardiovascular fitness It improves respiratory muscle strength It reduces the number of acute attacks It worsens respiratory function and is discouraged
It enhances cardiovascular fitness Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack. Most exercise has little effect on respiratory muscle strength, and these clients can't tolerate the type of exercise necessary to do this. Exercise won't reduce the number of acute attacks. In some instances, exercise may be contraindicated, and the client should check with his physician before starting any exercise program.
Which of the following additional assessment data should immediately be gathered to determine the status of a client with a respiratory rate of 4 breaths/minute? Arterial blood gas (ABG) and breath sounds Level of consciousness and a pulse oximetry value Breath sounds and reflexes Pulse oximetry value and heart sounds
Level of consciousness and a pulse oximetry value First, the nurse should attempt to rouse the client because this should increase the client's respiratory rate. If available, a spot pulse oximetry check should be done and breath sounds should be checked. The physician should be notified immediately if of the findings. He'll probably order ABG analysis to determine specific carbon dioxide and oxygen levels, which will indicate the effectiveness of ventilation. Reflexes and heart sounds will be part of the more extensive examination done after these initial actions are completed.
An unconscious client is admitted to an emergency room. Arterial blood gas measurements reveal a pH of 7.30, a low bicarbonate level, a normal carbon dioxide level, and a normal oxygen level. An elevated potassium level is also present. These results indicate the presence of: Metabolic acidosis Respiratory acidosis Combined respiratory and metabolic acidosis Over compensated respiratory acidosis
Metabolic acidosis In an acidotic condition, the pH would be low, indicating the acidosis. In addition, a low bicarbonate level along with the pH would indicate a metabolic state.
A nurse is caring for a client with an ileostomy understands that the client is most at risk for developing which acid-base disorder? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Metabolic acidosis Intestinal secretions are high in bicarbonate and may be lost through enteric drainage tubes or an ileostomy or with diarrhea. These conditions result in metabolic acidosis.
A nurse understands that the excessive use of oral antacids containing bicarbonate can result in which acid-base disturbance? Respiratory alkalosis Respiratory acidosis Metabolic acidosis Metabolic alkalosis
Metabolic alkalosis Increases in base components occur as a result of oral or parenteral intake of bicarbonates, carbonates, acetates, citrates, or lactates. Excessive use of oral antacids containing bicarbonate can cause metabolic alkalosis.
A nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client, knowing that the client is at risk for which acid-base disorder? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Metabolic alkalosis Loss of gastric fluid via nasogastric suction or vomiting causes metabolic alkalosis as a result of the loss of hydrochloric acid.
A nurse is caring for a client who is on a mechanical ventilator. Blood gas results indicate a pH of 7.50 and a PCO2 of 30 mm Hg. The nurse has determined that the client is experiencing respiratory alkalosis. Which laboratory value would most likely be noted in this condition? Sodium level of 145 mEq/L Potassium level of 3.0 mEq/L Magnesium level of 2.0 mg/L Phosphorus level of 4.0 mg/dl
Potassium level of 3.0 mEq/L Clinical manifestations of respiratory alkalosis include headache, tachypnea, paresthesias, tetany, vertigo, convulsions, hypokalemia, and hypocalcemia. Options 1, 3, and 4 identify normal laboratory values. Option 2 identifies the presence of hypokalemia.
A nurse is caring for a client with renal failure. Blood gas results indicate a pH of 7.30; a PCO2 of 32 mm Hg, and a bicarbonate concentration of 20 mEq/L. The nurse has determined that the client is experiencing metabolic acidosis. Which of the following laboratory values would the nurse expect to note? Sodium level of 145 mEq/L Magnesium level of 2.0 mg/dL Potassium level of 5.2 mEq/L Phosphorus level of 4.0 mg/dL
Potassium level of 5.2 mEq/L Clinical manifestations of metabolic acidosis include hyperpnea with Kussmaul's respirations; headache; N/V, and diarrhea; fruity-smelling breath resulting from improper fat metabolism; CNS depression, including mental dullness, drowsiness, stupor, and coma; twitching, and coma. Hyperkalemia will occur.
A nurse instructs a client to use the pursed lip method of breathing. The client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed lip breathing is: Promote oxygen intake Strengthen the diaphragm Strengthen the intercostal muscles Promote carbon dioxide elimination
Promote carbon dioxide elimination Pursed lip breathing facilitates maximum expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation.
Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why? Reducing fluid volume reduces oxygen demand Reducing fluid volume improves clients' mobility Restricting fluid volume reduces sputum production Reducing fluid volume improves respiratory function
Reducing fluid volume reduces oxygen demand Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear airways. Reducing fluid volume won't improve respiratory function, but may improve oxygenation.
A nurse is caring for a client with diabetic ketoacidosis and documents that the client is experiencing Kussmaul's respirations. Based on this documentation, which of the following did the nurse observe? Respirations that are abnormally deep, regular, and increased in rate Respirations that are regular but abnormally slow Respirations that are labored and increased in depth and rate Respirations that cease for several seconds
Respirations that are abnormally deep, regular, and increased in rate Kussmaul's respirations are abnormally deep, regular, and increased in rate.
A client's ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
Respiratory acidosis
A nurse plans care for a client with chronic obstructive pulmonary disease, knowing that the client is most likely to experience what type of acid-base imbalance? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Respiratory acidosis Respiratory acidosis is most often due to hypoventilation. Chronic respiratory acidosis is most commonly caused by COPD. In end-stage disease, pathological changes lead to airway collapse, air trapping, and disturbance of ventilation-perfusion relationships.
A nurse reviews the ABG values and notes a pH of 7.50, a PCO2 of 30 mm Hg, and an HCO3 of 25 mEq/L. The nurse interprets these values as indicating: Respiratory acidosis uncompensated Respiratory alkalosis uncompensated Metabolic acidosis uncompensated
Respiratory alkalosis uncompensated In respiratory alkalosis, the pH will be higher than normal and the PCO2 will be low.
A nurse reviews the arterial blood gas results of a patient and notes the following: pH 7.45; PCO2 30 mm Hg; and bicarbonate concentration of 22 mEq/L. The nurse analyzes these results as indicating: Metabolic acidosis, compensated Metabolic alkalosis, uncompensated Respiratory alkalosis, compensated Respiratory acidosis, compensated
Respiratory alkalosis, compensated The normal pH is 7.35 to 7.45. In a respiratory condition, an opposite (see-saw) will be seen between the pH and the PCO2. In this situation, the pH is at the high end of the normal value and the PCO2 is low. In an alkalotic condition, the pH is up. Therefore, the values identified in the question indicate a respiratory alkalosis. Compensation occurs when the pH returns to a normal value. Because the pH is in the normal range at the high end, compensation has occurred.
It's highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons? All clients are recommended to have these vaccines These vaccines produce bronchodilation and improve oxygenation These vaccines help reduce the tachypnea these clients experience Respiratory infections can cause severe hypoxia and possibly death in these clients.
Respiratory infections can cause severe hypoxia and possibly death in these clients. It's highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. The vaccines have no effect on bronchodilation or respiratory care.
A nurse is suctioning fluids from a client through an endotracheal tube. During the suctioning procedure, the nurse notes on the monitor that the heart rate decreases. Which of the following is the most appropriate nursing intervention? Continue to suction Ensure that the suction is limited to 15 seconds Stop the procedure and reoxygenated the client Notify the physician immediately
Stop the procedure and reoxygenated the client During suctioning, the nurse should monitor the client closely for side effects, including hypoxemia, cardiac irregularities such as a decrease in HR resulting from vagal stimulation, mucosal trauma, hypotension, and paroxysmal coughing. If side effects develop, especially cardiac irregularities, this procedure is stopped and the client is reoxygenated.
You are providing care to a patient with COPD who is receiving medical treatment for exacerbation. The patient has a history of diabetes, hypertension, and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In addition, the patient has multiple areas of bruising on the arms and legs. Which medication ordered for this patient can cause hyperglycemia and bruising? A. Prednisone B. Atrovent C. Flagyl D. Levaquin
The answer is A. Prednisone is a corticosterioid and can cause hyperglycemia and brusing.
An alarm beeps notifying you that one of your patient's oxygen saturation is reading 89%. You arrive to the patient's room, and see the patient comfortably resting in bed watching television. The patient is already on 2 L of oxygen via nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing action would be: A. Continue to monitor the patient B. Increase the patient's oxygen level to 3 L C. Notify the doctor for further orders D. Turn off the alarm settings
The answer is A. This patient is not in any distress from the description provided...therefore, you would continue to monitor the patient. Patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels. Therefore, it is normal for patients who have COPD to have an oxygen saturation between 88-93%.....any higher would decrease the stimulation to breathe and they may stop breathing. Therefore, you would not increase the oxygen level to 3 L, notify the doctor, or turn off the alarm settings.
In regards to question 10, which action by the patient demonstrates they know how to properly use this medication? A. The patient rinses their mouth after using the Spiriva inhaler. B. The patient rinses their mouth after using the Pulmicort inhaler. C. The patient dispenses of the inhalers. D. The patient coughs 2 times after using the Pulmicort inhaler.
The answer is B. The patient should rinse the mouth after using any type of corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the medication from the mouth. If left in the mouth, the patient can develop thrush.
A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler. How should the patient take this medication? A. The patient should use the medications every 2 hours for acute episodes of shortness of breath. B. The patient should use the Spiriva first and then 5 minutes later the Pulmicort. C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later. D. The patient should use the medications at the same exact time, regardless of the order.
The answer is B. The patient should use the bronchodilator first which is the Spiriva to open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers in this order will allow the corticosteroid to work properly after the lung fields are opened due to bronchodilation.
A patient is newly diagnosed with COPD due to chronic bronchitis. You're providing education to the patient about this disease process. Which statement by the patient indicates they understood your teaching about this condition? A. "If I stop smoking, it will cure my condition." B. "Complications from this condition can lead to pulmonary hypertension and right-sided heart failure." C. "I'm at risk for low levels of red blood cells due to hypoxia and may require blood transfusions during acute illnesses." D. "My respiratory system is stimulated to breathe due to high carbon dioxide levels rather than low oxygen levels.
The answer is B. This is the only correct statement. Option A is wrong because smoking cessation will NOT cure the condition but it may slow down the progress of it. Option C is wrong because the patient may develop HIGH LEVELS of red blood cells due to the body trying to compensate for hypoxia. Option D is wrong because patients with COPD are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide levels.
The term" blue bloaters" is used to describe patients with? A. Pulmonary hypertension B. Left-sided heart failure C. Chronic Bronchitis D. Emphysema
The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis, and the term "pink puffers" is used to describe patients with emphysema.
A patient with emphysema may present with all of the following symptoms EXCEPT? A. Barrel chest B. Hyperinflation of the lungs C. Hypoventilation D. Hypercapnia
The answer is C. Patients with emphysema present with HYPERventilation. The body will try to compensate for the low oxygen blood levels and will cause the patient to hyperventilate. Remember emphysema patients are sometimes called "pink puffers". They will have a barrel chest (due to the use of accessory muscles for breathing), hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs), and hypercapnia (high carbon dioxide levels).
A patient with COPD is reporting depression and thoughts of suicide. The patient states, "I just feel like ending it all." You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect: A. Atrovent B. Prednisone C. Roflumilast D. Theophylline
The answer is C. Roflumilast is a phosphodiestrace-4 inhibitor that is used in the treatment of patients with severe COPD due to chronic bronchitis. This medication can caused increased suicidal thoughts, and the patient should be monitored for this while taking Roflumilast.
A patient is presenting with chronic obstructive pulmonary disease. The patient has a chronic productive cough with dyspnea on excretion. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Based on your nursing knowledge and the patient's symptoms, you suspect the patient suffers from what type of COPD? A. Emphysema B. Pneumonia C. Chronic bronchitis D. Pneumothorax
The answer is C. The key words to let you know the patient is experiencing chronic bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic bronchitis is sometimes referred to as "blue bloaters".
You are providing teaching to a patient with chronic COPD on how to perform diaphragmatic breathing. This technique helps do the following: A. Increase the breathing rate to prevent hypoxemia B. Decrease the use of the abdominal muscles C. Encourages the use of accessory muscles to help with breathing D. Strengthen the diaphragm
The answer is D. Diaphragmatic breathing helps strengthen the diaphragm because it has become flatten due to the hyperinflation of the lungs. Due to the flattening of the diaphragm, the body is unable to breathe with ease and must use the accessory muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles RATHER than accessory muscles and strengthens the diaphragm.
A patient with severe COPD is having an episode of extreme shortness of breath and requests their inhaler. Which type of inhaler ordered by the physician would provide the FASTEST relief for the patient based on this particular situation? A. Spiriva B. Salmeterol C. Symbicort D. Albuterol
The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator to help with the shortness of breath. The only short-acting bronchodilator listed is Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.
True or False: COPD is reversible and tends to happens gradually. True False
The answer is FALSE. COPD IRREVERSIBLE and tends to happens gradually.
Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply: A. "It is best to eat three large meals a day that are relatively low in calories." B. "Avoid going outside during extremely hot or cold days." C. "It is important to receive the Pneumovax vaccine annually." D. "Smoking cessation can help improve your symptoms."
The answers are A and C. The patient needs to eat high calorie and protein rich meals that are small but frequent. The Pneumovax is definitely recommended for patients with COPD but is given every 5 years (not annually).
A client with emphysema should receive only 1 to 3 L/minute of oxygen, if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive? The client doesn't notice he needs to breathe The client breathes only when his oxygen levels climb above a certain point The client breathes only when his oxygen levels dip below a certain point The client breathes only when his carbon dioxide level dips below a certain point
The client breathes only when his oxygen levels dip below a certain point Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as the hypoxic drive. They don't take a breath when their levels of carbon dioxide are higher than normal, as do those with healthy respiratory physiology. If too much oxygen is given, the client has little stimulus to take another breath. In the meantime, his carbon dioxide levels continue to climb, and the client will pass out, leading to a respiratory arrest.
