CH. 20 Management of Patients with Chronic Pulmonary Disease

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

A. "Have you tried to quit smoking before?"

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 ___%. A. 60 mm Hg; 90% B. 58 mm Hg; 88% C. 54 mm Hg; 84% D. 56 mm Hg; 86%

A. 60 mm Hg; 90%

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

A. Compromised gas exchange B. Wheezes D. Decreased airflow

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

A. Providing sufficient oxygen to improve oxygenation

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

A. Respiratory rate of 22 breaths/minute

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

A. the airways are so swollen that no air can get through.

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? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis

B. Respiratory acidosis

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? A. Change filters on heating and air conditioning units frequently. B. Take ordered medications as scheduled. C. Avoid contact with fur-bearing animals. D. Avoid goose down pillows.

B. Take ordered medications as scheduled.

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: A. notify the primary physician immediately. B. give the nebulizer treatment herself. C. stay with the client until the therapist arrives. D. administer the treatment by metered-dose inhaler.

B. give the nebulizer treatment herself.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes A. teaching the family how to perform postural drainage. B. implementing measures to clear pulmonary secretions. C. providing the client a low-calorie, high-fiber diet. D. instructing the client on the signs of respiratory infection.

B. implementing measures to clear pulmonary secretions.

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

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

A nurse is evaluating the diagnostic study data of a client with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? A. Decreased tidal volume B. Positive phenylketonuria C. Elevated sweat chloride concentration D. Presence of protein in the urine

C. Elevated sweat chloride concentration

Asthma is cause by which type of response? A. IgM-mediated B. IgA-mediated C. IgE-mediated D. IgD-mediated

C. IgE-mediated

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? A. Vancomycin 1 gram intravenously over 1 hour B. Intravenous methylprednisolone (Solu-Medrol) 120 mg C. Oxygen through nasal cannula at 2 L/minute D. Ipratropium bromide (Alupent) by metered-dose inhaler

C. Oxygen through nasal cannula at 2 L/minute

The classification of Stage II of COPD is defined as A. very severe COPD. B. mild COPD. C. moderate COPD. D. severe COPD. E. at risk for COPD.

C. moderate COPD.

The classification of Stage IV of COPD is defined as A. mild COPD. B. at risk for COPD. C. very severe COPD. D. moderate COPD. E. severe COPD.

C. very severe COPD.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? A. "Eat a high-sodium diet." B. "Maintain bed rest." C. "Limit yourself to smoking only 2 cigarettes per day." D. "Weigh yourself daily and report a gain of 2 lb in 1 day."

D. "Weigh yourself daily and report a gain of 2 lb in 1 day."

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

D. A severe asthma episode that is refractory to initial therapy

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? A. Emphysema B. Pneumonia C. Pleurisy D. Atelectasis

D. Atelectasis

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 type of disorder within its classification. Which of the following is part of that disorder? A. Cystic fibrosis B. Bronchiectasis C. Asthma D. Emphysema

D. Emphysema

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? A. Heart rate B. Respiratory rate C. Skin color D. Lung sounds

D. Lung sounds

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

D. Mast cells

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A. Respiratory alkalosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

D. Respiratory acidosis