Ch 24 Mgmnt of Pts with Chronic Pulmonary Disease PrepU

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. Thoracentesis Atelectasis Respiratory failure Status asthmaticus Pertussis

2, 3, 4 Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Pertussis and pneumothorax are not complications.

In which statements regarding medications taken by a client diagnosed with COPD do the the drug name and the drug category correctly match? Select all that apply. Cotrimoxazole is a bronchodilator. Prednisone is a corticosteroid. Dexamethasone is an antibiotic. Ciprofloxacin is an antibiotic. Albuterol is a bronchodilator.

2, 4, 5 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.

Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test? Sweat chloride concentration Arterial blood gases Pulmonary function studies Lumbar puncture

A. Diagnosis of CF is based on an elevated sweat chloride concentration, together with clinical signs and symptoms consistent with the disease.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? Exposure to tobacco smoke Occupational exposure Passive smoking Ambient air pollution

A. 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 do not account for the majority.

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 Unilateral neglect Impaired swallowing

A. 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.

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

A. In a client with emphysema, albuterol is used as a bronchodilator. A respiratory rate of 22 breaths/minute indicates that the drug has achieved its therapeutic effect because fewer respirations are required to achieve oxygenation. Albuterol has no effect on pupil reaction or urine output. It may cause a change in the heart rate, but this is an adverse, not therapeutic, effect.

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 Pneumonia Emphysema Pleurisy

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

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as Atelectasis Emphysema Pleurisy Pneumonia

A. Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).

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

A. The nurse should instruct the client to weigh himself daily and report a gain of 2 lb in 1 day. COPD causes pulmonary hypertension, leading to right-sided heart failure or cor pulmonale. The resultant venous congestion causes dependent edema. A weight gain may further stress the respiratory system and worsen the client's condition. The nurse should also instruct the client to eat a low-sodium diet to avoid fluid retention and engage in moderate exercise to avoid muscle atrophy. The client shouldn't smoke at all.

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. 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 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? Proventil Cromolyn sodium Theo-Dur Serevent

A. Short-acting beta2-adrenergic agonists (albuterol [AccuNeb, Proventil, Ventolin], levalbuterol [Xopenex HFA], and pirbuterol [Maxair]) are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. These medications are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists are not indicated for immediate relief of symptoms. These include theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus).

The classification of Stage III of COPD is defined as severe COPD. mild COPD. at risk for COPD. moderate COPD. very severe COPD.

A. 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? Heart rate Lung sounds Skin color Respiratory rate

B. 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 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? Asthma Emphysema Bronchiectasis Cystic fibrosis

B. COPD may include diseases that cause airflow obstruction (eg, emphysema, chronic bronchitis) or any combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of COPD are now classified as chronic pulmonary disorders. Asthma is now considered a distinct, separate disorder and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

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? Levalbuterol HFA Cromolyn sodium Ipratropium Albuterol

B. 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.

A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? Maintain activity level of walking to the mailbox. Increase walking distance around a city block without shortness of breath. Relieve shortness of breath to a level as close as possible to tolerable. Continue with current level of mobility at home.

B. If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable.

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. atelectasis. oxygen toxicity. pulmonary edema.

B. 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.

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

B. 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.

The classification of Stage II of COPD is defined as mild COPD. moderate COPD. severe COPD. at risk for COPD. very severe COPD.

B. Stage II is moderate COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage III is severe COPD. Stage IV is very severe COPD.

A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: has a pulse oximetry reading of 93%. uses the sternocleidomastoid muscles. sits in tripod position. wants the head of the bed raised to a 90-degree level.

B. Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.

Which statement describes emphysema? A disease that results in reversible airflow obstruction, a common clinical outcome Chronic dilatation of a bronchus or bronchi A disease of the airways characterized by destruction of the walls of overdistended alveoli Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years

C. Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of alveoli; a chronic inflammatory response may induce disruption of the parenchymal tissues. 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.

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 alkalosis Respiratory acidosis Metabolic acidosis

C. 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.

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? Discussing palliative care and end-of-life issues with the client Providing the client a low-sodium diet Performing chest physiotherapy as ordered Restricting oral intake to 1,000 mL/day

C. Nursing care includes helping clients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the client is terminally ill.

Which is the most important risk factor for development of COPD? Occupational exposure Air pollution Cigarette smoking Genetic abnormalities

C. Risk factors for COPD include environmental exposures and host factors. The most important environmental risk factor for COPD worldwide is cigarette smoking. A dose-response relationship exists between the intensity of smoking (pack-year history) and the decline in pulmonary function. Other environmental risk factors include smoking pipes, cigars, and other types of tobacco. Passive smoking (i.e., second-hand smoke) also contributes to respiratory symptoms and COPD. Air pollution and genetic abnormalities are risk factors for development of COPD, but neither is the most important.

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Metabolic alkalosis Respiratory alkalosis Respiratory acidosis Metabolic acidosis

C. 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.

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

C. Nursing management focuses on alleviating symptoms and helping clients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the client on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the client's appetite and result in inadequate dietary intake; therefore, the client's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "I will shake the MDI container before I use it." "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."

C. 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.

Which measure may increase complications for a client with COPD? Administration of antibiotics Administration of antitussive agents Decreased oxygen supply Increased oxygen supply

D. Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications.

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: muffled or distant heart sounds. paradoxical chest wall movement with respirations. tracheal deviation to the unaffected side. diminished or absent breath sounds on the affected side.

D. 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 nursing student understands that emphysema is directly related to which of the following? Diminished alveolar surface area Hypercapnia resulting from decreased carbon dioxide tension Hypoxemia secondary to impaired oxygen diffusion Respiratory acidosis from airway obstruction

D. In the later stages of emphysema, carbon dioxide elimination is impaired, resulting in increased carbon dioxide tension in arterial blood (hypercapnia) leading to respiratory acidosis.

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

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

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

D. 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 patient 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." "At this point, do you really want to go through something like that?" "You would have a difficult time recovering from the procedure." "You and your physician should discuss the options that are available for treatment."

D. Treatment options for patients 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 patients 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.

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

D. 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 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? Combivent Atrovent Flovent Proventil

D. Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

The classification of Stage IV of COPD is defined as severe COPD. mild COPD. at risk for COPD. moderate COPD. very severe COPD.

E. 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.

The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) Overinflated alveoli impair gas exchange. Mucus secretions block airways. Inflamed airways obstruct airflow. Dry airways obstruct airflow.

1, 2, 3 Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Respiratory acidosis Metabolic alkalosis Respiratory alkalosis Metabolic acidosis

A. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. Wheezing Cough Crackles Dyspnea

The three most common symptoms of asthma are cough, dyspnea, and wheezing. In some instances, cough may be the only symptom.

The classification of grade I COPD is defined as mild COPD. moderate COPD. severe COPD. very severe COPD.

A. Grade I is mild COPD. Grade II is moderate COPD. Grade III is severe COPD. Grade IV is very severe COPD.

Which of the following is a symptom diagnostic of emphysema? Normal elastic recoil Dyspnea Copious sputum production The occurrence of cor pulmonale

B. Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.

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? Haemophilus influenzae and Gardasil Haemophilus influenzae and varicella Streptococcus pneumonia and Haemophilus influenzae Streptococcus pneumonia and varicella

C. 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.

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? "If I use the spacer, I know I am only supposed to push on the inhaler once." "I do not need to rinse my mouth with this type of inhaler." "After I breathe in, I will hold my breath for 10 seconds." "I will make sure to take a slow, deep breath as I push on my inhaler."

B. Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The patient should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

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

B. 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.

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 Take deep breaths Increase the flow of oxygen Perform upper chest breaths Exhale slowly

D. 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. Deep breaths or upper chest breathing is an inefficient breathing technique and should be changed to diaphragmatic breathing for the client with COPD. Some clients with COPD cannot tolerate much oxygen without developing hypercapnia.

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. Mucus secretions that block airways Decreased numbers of goblet cells Overinflated alveoli that impair gas exchange Inflamed airways that obstruct airflow Dry airways that obstruct airflow

1, 3, 4 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.

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? High-protein Full-liquid Low-fat 1,800-calorie ADA

A. 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.

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: Collects sputum for culture and sensitivity Administers vancomycin intravenously Provides nebulized tobramycin (TOBI) Gives oral pancreatic enzymes with meals

A. 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 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 Vancomycin 1 gram intravenously over 1 hour Ipratropium bromide (Alupent) by metered-dose inhaler Intravenous methylprednisolone (Solu-Medrol) 120 mg

A. All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply. Gastrointestinal viruses Hypertension Air pollution Fractured hip Tracheobronchial infection

C, E Common causes of an acute exacerbation include tracheobronchial infection and air pollution. However, the cause of approximately one third of severe exacerbations cannot be identified. Fractured hips, hypertension, and GI viruses are not causes of exacerbation of COPD.

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

C. Allergy is the strongest predisposing factor for asthma.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Wheezes Jugular vein distention Decreased airflow Compromised gas exchange Ascites

1, 3, 4 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.

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 ___%. 58 mm Hg; 88% 60 mm Hg; 90% 54 mm Hg; 84% 56 mm Hg; 86%

B. The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

!Which drug is second-line pharmacotherapy for smoking abstinence? Nortriptyline Nicotine gum Clonidine Buproprion SR

C. Second-line pharmacotherapy includes the antihypertensive agent clonidine. However, its use is limited by its side effects. First-line therapy includes nicotine gum, nortriptyline, and buproprion SR.