Asthma/COPD Quiz
The nurse is transporting an oxygen dependent patient to the radiology department. Which mask would be most effective during transportation? Simple face mask Tracheostomy collar Oxygen-conserving cannula Partial and non-rebreather masks
A A simple face mask covers the nose and mouth of the patient and is useful in administering oxygen for very short periods, such as during transportation. A patient who has undergone tracheostomy surgery will have less difficulty breathing with a tracheostomy collar. Oxygen-conserving cannulas help to administer oxygen for long-term therapy. Partial and non-rebreather masks are useful in administering high concentrations of oxygen for short-term periods, or about 24 hours.
A patient with chronic obstructive pulmonary disease (COPD) is suspected to have developed cor pulmonale. The nurse recognizes that which test result helps confirm the diagnosis? Large pulmonary vessels on chest x-ray Left-sided heart enlargement on echocardiogram Decreased B-type natriuretic peptide (BNP) levels Decreased pressure found in a right heart catheterization
A Cor pulmonale is a cardiac complication of COPD resulting from pulmonary hypertension. Due to pulmonary hypertension, the pulmonary vessel may appear enlarged in a chest x-ray. There may be increased pressure found in a right heart catheterization due to pulmonary hypertension. Cor pulmonale is usually associated with right-sided heart enlargement, because there is increased pressure in the blood vessels of lungs. The BNP levels are increased due to the stretching of the right ventricle.
The nurse caring for a patient with diabetes mellitus and chronic obstructive pulmonary disease (COPD) on oral prednisone will monitor which parameter regularly? Blood sugar Bowel sounds Blood pressure Hemoglobin A1c
A Corticosteroids such as prednisone can lead to elevated blood sugar, especially for patients with diabetes. For this reason, it is useful to monitor the patient's blood sugar. The patient's blood pressure and bowel sounds will not be affected. The hemoglobin A1c will demonstrate average blood sugars over the past three months, which would not evaluate blood sugar since beginning prednisone.
A nurse is using an airway clearance device to mobilize secretions in a patient with chronic obstructive pulmonary disease (COPD). The nurse instructs the patient, "You must sit in an upright position during the process." Which device does the nurse use during this procedure? Flutter Acapella SmartVest TheraPEP therapy system
A Flutter is an airway clearance device that helps to mobilize lung secretions by increasing oscillations. Patients breathe into the mouthpiece, which has a steel ball. The patient must be upright, and the angle at which the Flutter is held is critical. Acapella, a small hand-held device, combines the benefits of both positive expiratory pressure (PEP) therapy and airway vibrations to mobilize pulmonary secretions. Patients are free to stand, sit, or recline. SmartVest is a high-frequency chest wall oscillation device that helps to mobilize secretions. It can be used in a variety of positions. The TheraPEP therapy system also helps to mobilize secretions. This device has a mouthpiece connected to a cylindrical resistor so the patient does not need to stay in an upright position.
The nurse is caring for a patient with severe chronic obstructive pulmonary disease (COPD) who has frequent exacerbations. What treatment strategy does the nurse recognize would be most beneficial for this patient? Roflumilast Indacaterol Ipratropium Salmeterol and formoterol
A Roflumilast is an antiinflammatory drug that reduces cytokines and helps to limit the exacerbations of COPD. Indacaterol is used for treating moderate COPD. Ipratropium, a short-acting bronchodilator, treats some symptoms of COPD. However, short-acting bronchodilators are not effective medications to reduce exacerbations in patients with severe COPD. Long-acting bronchodilators such as salmeterol and formoterol are effective in moderate COPD only.
The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? Wheezing becomes louder. Cough remains nonproductive. Vesicular breath sounds decrease. Aerosol bronchodilators stimulate coughing.
A The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. After a severe asthma exacerbation, the cough may be productive and stringy. Vesicular breath sounds will increase with improved respiratory status. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.
Which intervention by the student nurse indicates the need for further teaching while performing percussion of a patient with chronic obstructive pulmonary disorder (COPD)? Using both hands at once during percussion Placing a thin towel over the area of percussion Positioning the hand in a cup-like position with thumbs closed Creating an air pocket between the patient's chest and the hand
A The student nurse is performing percussion to detect mucus movement. The nurse should place both hands in a cup-like position and should use them in an alternating rhythmic fashion. Placing a thin towel or cloth over the area of percussion will help to reduce the risk of infection. During percussion, the hands should be in cup-like positions with thumbs closed, because this helps to create an air pocket. The cup-like position of the hand on the patient's chest will create an air pocket. This facilitates the movement of thick mucus.
A patient is having an asthma attack, and is short of breath and appears frightened. The nurse understands that possible triggers for asthma exacerbations include which factors? Select all that apply. Alcohol Perfumes Animal dander Humid weather Gastroesophageal reflux disease (GERD)
A, B, C, E Alcohol, GERD, animal dander, perfumes, and cold weather (not humid) are all possible triggers for acute asthma exacerbations.
When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? Select all that apply. Exercise Allergies Emotional stress Decreased humidity Upper respiratory infections
A, B, C, E Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.
The nurse is discharging a patient with chronic obstructive lung disease (COPD) who will be attending an outpatient pulmonary rehabilitation (PR) program. The nurse knows that components of this type of program generally include: Select all that apply. Education Exercise training Smoking reduction Nutrition counseling On-site breathing treatments Attendance by at least one family member or significant other
A, B, D Nutrition counseling definitely is needed in a PR program to teach the patient healthy nutrition. Education is also necessary, as well as exercise training. Smoking cessation, not reduction, is needed. On-site breathing treatments are not offered. A family member or significant other is not a required component of these programs
A patient with chronic obstructive pulmonary disease (COPD) is advised to use oxygen therapy at home. A nurse provides discharge instructions about how to prevent respiratory infection. What should be included in the teaching? Select all that apply. Use mouthwash several times a day. Wash the nasal cannula twice a week. Retain secretions that are coughed out. Change the nasal cannula every two weeks. Clean the oxygen concentrator cabinet every week.
A, B, D The strategies to reduce infection while using oxygen therapy at home include changing the cannula every two weeks, washing the cannula twice a week with liquid soap, and using a mouthwash several times a day. The nasal cannula may become contaminated with repeated use and should be changed every week. It should also be cleaned twice a week to remove the particulate material and moisture. Frequent use of mouthwash helps to keep the oral cavity clean and prevent infection. Removing the secretions that are coughed out reduces the risk of infection. The oxygen concentrator cabinet should be cleaned every day, not weekly.
Which nursing instructions would be beneficial to the patient who has shortness of breath, wheezing, and chest tightness? Select all that apply. "You should avoid contact with furred animals." "You should wash bed covers in hot water and detergent." "You should avoid wearing masks in cold climate conditions." "You should take aspirin when you have shortness of breath." "You should take propanol when you have excess wheezing." "You should ensure that the household does not have any cockroaches."
A, B, F Shortness of breath, wheezing, and chest tightness indicate that the patient has asthma. Fur acts as an irritant and increases the allergic reactions associated with asthma. Dust mites also trigger asthma, so the patient should wash bed covers with hot water and detergent because this reduces allergens. Danders such as cockroach remains and droppings trigger asthma. Propanol is a nonselective β-blocker that inhibits bronchodilation and should be avoided by patients with asthma. Cold climate conditions are an irritant that triggers asthma, so the patient should wear a mask or scarf in a cold environment. Aspirin precipitates attacks of asthma; therefore the patient should avoid taking aspirin
The patient has a prescription to use albuterol and beclomethasone inhalers, two puffs each. The nurse determines that the patient needs additional teaching on how to safely self-administer these medications after noting that the patient performs which action? Rinses the mouth following use of the inhalers Administers the beclomethasone before the albuterol Administers the albuterol before the beclomethasone Administers the beclomethasone on a set schedule to prevent an asthma attack
B Albuterol, a β 2-adrenergic agonist medication, should be used first to dilate the airways before administration of the corticosteroid beclomethasone. Administering the beclomethasone on a set schedule to prevent an asthma attack and rinsing the mouth following use of the inhalers are correct actions.
The nurse is assessing a patient who may have manifestations of chronic obstructive pulmonary disease (COPD). Which of these is a clinical manifestation of early COPD? Dyspnea at rest A chronic, intermittent cough The presence of chest breathing Production of copious amounts of sputum
B Clinical manifestations of COPD typically develop slowly. A chronic intermittent cough, which is often the first symptom to develop, later may be present every day as the disease progresses. Typically, dyspnea is progressive, usually occurs with exertion, and is present every day. Dyspnea at rest and chest breathing are manifestations of late COPD. The cough may be unproductive of mucus.
Which intervention is beneficial to a patient with chronic obstructive pulmonary disease (COPD)? Avoiding cold foods Limiting fluids during mealtimes Avoiding frequent meals and snacks Performing physical activity before meals
B Patients with chronic obstructive pulmonary disease (COPD) should limit fluid intake during mealtimes because too much liquid might make the patient feel too full to eat. COPD patients should eat cold foods rather than hot foots in order to feel less full. COPD patients should eat frequent meals and snacks because it helps the diaphragm move freely and makes gas exchange in the lungs easier. Performing physical activity before meals may increase breathlessness and may affect food intake.
The nurse is evaluating if a patient understands how to determine safely whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler? Place it in water to see if it floats. Keep track of the number of inhalations used. Shake the canister while holding it next to the ear. Check the indicator line on the side of the canister.
B The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing it after the number of days when those inhalations have been used (100 puffs/2 puffs each day = 50 days). It is no longer appropriate to see if a canister floats in water or not because this is not an accurate way to determine the remaining inhaler doses. Shaking the canister and checking the indicator on the side of the canister are not the most effective ways of determining whether an MDI is empty.
A patient with chronic obstructive pulmonary disease (COPD) reports waking up frequently from sleep. The patient smokes cigarettes before going back to sleep. What instructions should the nurse give to the patient to promote sleep? Select all that apply. Do not use oxygen therapy at night. Do not smoke between periods of sleep. Use saline nasal sprays before sleep if experiencing postnasal drip. Ask the health care provider about using β 2-agonists to relieve insomnia. Ask the health care provider about using diazepam (Valium) to induce sleep.
B, C Cigarette smoking aggravates sleep disturbance so the nurse should discourage this habit. The postnasal drip associated with COPD causes disturbed sleep and can be managed by using saline nasal sprays before going to sleep and upon awakening. Use of diazepam should be discouraged, because it may suppress respiration. Use of β 2-agonists will aggravate insomnia. If the patient is prescribed oxygen therapy, it should be continued as it helps to relieve insomnia
Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Select all that apply. Atelectasis Pneumonia Cor pulmonale Mucoid impact Exacerbations
B, C, E The patient with chronic obstructive pulmonary disorder (COPD) may develop complications such as pneumonia, cor pulmonale, and exacerbations of COPD, which require acute interventions. After the crisis is resolved, the patient has to undergo assessment for the degree and severity of the underlying respiratory problem. This information helps the nurse plan a better care plan. Atelectasis and mucoid impact are complications of asthma.
The nurse is caring for the patient with chronic obstructive pulmonary disease who is undernourished and underweight. Which steps can the nurse take to improve the patient's nutritional status? Select all that apply. Restrict fluid intake to 1 L/day Avoid overfeeding the patient Have the patient drink fluid with meals Provide five to six small meals per day Provide a diet high in protein and calories
B, D, E A diet high in calories and protein, moderate in carbohydrates, and moderate to high in fat is recommended and can be divided into five or six small meals a day. High-protein, high-calorie nutritional supplements can be offered between meals. Nonprotein calories should be divided evenly between fat and carbohydrate, but avoid overfeeding the patient. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. Fluids should be taken between meals (rather than with them) to prevent excess stomach distention and to decrease pressure on the diaphragm.
Which complications, along with edema in the ankles, does the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. Leukopenia Weight gain Polycythemia Hepatomegaly Jugular vein distension
B, D, E The presence of edema in the ankles indicates that the patient has the cardiac complication cor pulmonale, or failure in the right side of the heart. Cor pulmonale is associated with peripheral edema, especially in the ankles, so the patient will have weight gain. The patient with cor pulmonale will have tissue damage, resulting in hepatomegaly. The patient with cor pulmonale will have improper blood flow from the right atrium to the right ventricle, resulting in jugular vein distension. The patient with COPD will not have a decrease in white blood cells. The patient with COPD will have increased red blood cells due to hypoxemia, but will not have polycythemia.
A patient with chronic obstructive pulmonary disease (COPD) has severe dyspnea. The nurse is educating the patient about necessary interventions to conserve energy and avoid further complications. Which statement made by the patient indicates the need for further teaching? "I should eat three low-calorie, high fat meals a day." "I should rest for half an hour before eating." "I should perform deep breathing and effective coughing before meals." "I should take supplemental oxygen through a nasal cannula while eating."
C A patient with dyspnea or COPD may have difficulty while eating or performing simple tasks. Performing effective coughing or deep breathing exercises is a strenuous activity for a patient with dyspnea and would cause the patient to have difficulty eating. Patients diagnosed with COPD should try consuming several high calorie small meals a day to conserve energy and increase caloric intake to maintain a healthy weight. The patient will be able to conserve energy to chew and swallow if he or she rests for half an hour before meals. The patient who is on supplemental oxygen should take oxygen through a nasal cannula while eating, because it helps to prevent an episode of dyspnea during meals.
The nurse is collecting data on four patients with a history of mild asthma. Which patient is most likely to experience wheezing, congestion and angioedema? Hypertension, takes lisinopril Glaucoma, takes timolol Dysmenorrhea, takes ibuprofen GERD, takes epinephrine
C Patient C, who has dysmenorrhea and takes ibuprofen, is more likely to have wheezing within two hours of drug administration. In addition, the patient usually presents with profound rhinorrhea, congestion, tearing, and angioedema. Patient A, who has hypertension and takes lisinopril, may have a cough, which exacerbates asthma. Patient B who has glaucoma and who is taking timolol, may experience bronchospasm. Patient D, who has gastroesophageal reflux disease and is taking epinephrine, has a low incidence of asthma.
The nurse determines that a 61-year-old patient with chronic bronchitis has a nursing diagnosis of "impaired gas exchange" after noting an oxygen saturation of 88%. What is an appropriate intervention to add to the care plan? Obtain an arterial blood gas (ABG) Administer 6 L oxygen via nasal cannula Sit the patient upright in a chair leaning slightly forward Place the patient in the prone position to increase postural drainage
C The patient with chronic bronchitis can engage in better gas exchange in an upright position leaning slightly forward. Once the patient's oxygen increases, the nurse may obtain an ABG if requested by the health care provider. Placing the patient in a prone position would further impair gas exchange. Six liters of oxygen is too much oxygen for a patient with chronic bronchitis.
The nurse is caring for a patient with chronic obstructive pulmonary disease. About what medications will the nurse educate the patient that have the side effects of a feeling of early satiety and a bloating sensation? Select all that apply. Diuretics Roflumilast Theophylline Corticosteroids Bronchodilators
C, D Chronic cough, dyspnea, and chronic inflammation in lung parenchyma indicate that the patient has chronic obstructive pulmonary disease ( COPD). Theophylline is a methylxanthine drug that relaxes smooth muscles and helps to treat COPD effectively, but it causes gastrointestinal side effects. Corticosteroids help to control swelling in the lungs, although they can also cause abdominal distension, so the patient may experience bloating and feelings of satiety. Diuretics are helpful for treating cor pulmonale, a complication associated with COPD, but they are not associated with feelings of satiety or bloating. Roflumilast is an antiinflammatory medication that helps to reduce inflammation in the lungs but does not cause a bloating sensation or a feeling of satiety. Bronchodilators are not associated with feelings of satiety or bloating.
A patient presents with acute exacerbation of asthma. The nurse expects which strategies will be included in the treatment plan? Select all that apply. Administration of sedatives Administration of antibiotics Administration of 100% oxygen Intravenous administration of corticosteroids Nebulization with short-acting β2-adrenergic agonists (SABAs)
C, D, E Acute exacerbation of asthma may be life-threatening and needs immediate intervention. Administering 100% oxygen helps to relieve hypoxia and improve tissue oxygenation. Nebulization with SABA helps to relax the airways and promote airflow. Corticosteroids are administered to blunt the hyperactive immune response. Sedatives should be avoided as they may depress the respiratory center and worsen dyspnea. Antibiotics are not administered unless there are symptoms of pneumonia.
The patient is receiving 3 L of oxygen (O 2) via nasal cannula. Which action by the nurse is most appropriate? Select all that apply. Assesses eyes for dryness Realizes that humidification is never needed Adjusts humidification according to patient comfort Assesses the bubble-through humidifier if humidity is used Assures that the patient is wearing the nasal cannula correctly
C, D, E Assessing the bubble-through humidifier if humidity is used, assuring that the patient is wearing the nasal cannula correctly, and adjusting humidification according to patient comfort are correct because oxygen (O 2) obtained from cylinders or wall systems is dry. Dry O 2 has an irritating effect on mucous membranes and dries secretions. A common device used for humidification when the patient has a cannula or a mask is a bubble-through humidifier. It is important for the nurse to assess the bubble-through humidifier if humidity is used to make sure the humidification is on. This adds to the comfort of the patient. The nurse assesses the patient to make sure the nasal cannula is worn correctly for optimal effect. The cannula can become easily dislodged. Humidification is adjusted according to the patient's comfort level. When oxygen levels are 1 to 4 L, the use of humidification may not be the preference of all patients. Believing that humidification is never needed is incorrect because the use of humidification is a patient preference. The nurse should assess the patient's nose for dryness, not the eyes.
A patient is learning to use a metered-dose inhaler (MDI). Which statement by the patient indicates the need for additional teaching? "I will shake the canister before use." "I will hold my breath for as long as I can after inhalation." "I should wait at least one minute between puffs of medication." "I should avoid using a spacer with this inhaler because it is ineffective."
D A spacer should be avoided with dry powder inhalers; they are helpful to use with MDIs. Metered dose inhalers require shaking of the canister, the breath should be held to increase absorption of the medication into the lungs, and the patient should wait one to two minutes between puffs.
The nurse is educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes despite the diagnosis. What complication of smoking should the nurse discuss with the patient? Cachexia Osteoporosis Metabolic syndrome Cardiovascular disease
D Chronic smokers develop COPD and are more prone to cardiac complications, because smoking directly affects the function of the lungs and heart. The patient with COPD may experience a loss of appetite due to dyspnea, which may lead to the development of cachexia. Osteoporosis is a complication of COPD that is associated with continuous systemic inflammation. Dyspnea and a loss of appetite are associated with COPD and may manifest as a metabolic syndrome. Cachexia, osteoporosis, and metabolic syndrome are not associated with smoking.
The nurse concludes that interventions carried out to promote airway clearance in a patient admitted with asthma are successful on the basis of which finding? Absence of wheezing Oxygen saturation 96% Use of accessory muscles Clearance of mucous from the bronchi
D The issue is airway clearance, which is evaluated most directly as successful if the patient can engage in effective and productive coughing. Oxygen saturation would indicate gas exchange, not airway clearance. Use of accessory muscles indicates respiratory distress. The absence of wheezing does not always coincide with improved airway clearance and may represent worsening bronchospasm.
Before discharge, the nurse discusses activity levels with a patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is recovered fully from this episode of illness? Slight increase in activity over the current level Limitation of exercise to activities of daily living to conserve energy Swimming for 10 minutes/day, gradually increasing to 30 minutes/day Walking for 20 minutes/day, keeping the pulse rate less than 130 beats/minute
D The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 minutes/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).
An asthmatic patient is in acute respiratory distress. The nurse auscultates the lungs and notes cessation of inspiratory wheezing. How does the nurse interpret this finding? The patient has developed a pneumothorax. Airflow has now improved through the bronchioles. A mucus plug has developed within a main stem bronchus. There is worsening airway inflammation and bronchoconstriction.
D When the patient in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway. A pneumothorax would be evidenced by absent breath sounds. Absence of wheezing does not correlate with improved airflow if the patient is also in current respiratory distress. A mucus plug would result in crackles in the lungs.
