Ch 24 PrepU COPD
Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. a) Albuterol is a bronchodilator. b) Decadron is an antibiotic. c) Bactrim is a bronchodilator. d) Prednisone is a corticosteroid. e) Ciprofloxacin is an antibiotic.
A, D, E • Prednisone is a corticosteroid. • Albuterol is a bronchodilator. • Ciprofloxacin is an antibiotic. Explanation: Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) a) Wheezes b) Decreased airflow c) Compromised gas exchange d) Ascites e) Jugular vein distention
a, b, c Wheezes • Decreased airflow • Compromised gas exchange Explanation: 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 (GOLD, 2010).
A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? a) "You and your physician should discuss the options that are available for treatment." b) "At this point, do you really want to go through something like that?" c) "You would have a difficult time recovering from the procedure." d) "You are not a candidate because you have heart failure."
a. "You and your physician should discuss the options that are available for treatment." Explanation: 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 (GOLD, 2010).
Emphysema is described by which of the following statements? a) A disease of the airways characterized by destruction of the walls of overdistended alveoli b) A disease that results in a common clinical outcome of reversible airflow obstruction c) Chronic dilatation of a bronchus or bronchi d) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years
a. A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: 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 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) "Weigh yourself daily and report a gain of 2 lb in 1 day." d) "Limit yourself to smoking only 2 cigarettes per day."
c. "Weigh yourself daily and report a gain of 2 lb in 1 day." Explanation: 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.
The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent? a) 70% b) 50% c) 30% d) 90%
d. 90% Explanation: The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.
Emphysema is described by which of the following statements? a) A disease that results in a common clinical outcome of reversible airflow obstruction b) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years c) Chronic dilatation of a bronchus or bronchi d) A disease of the airways characterized by destruction of the walls of overdistended alveoli
d. A disease of the airways characterized by destruction of the walls of overdistended alveoli Explanation: 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 over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, 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 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.
A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be a) Foradil b) Isuprel c) Atrovent d) Albuterol
d. Albuterol Explanation: Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.
Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at curing COPD. b) Both are aimed at treating end-stage emphysema. c) Both are used to treat patients with bullous emphysema. d) Both are aimed at improving the overall quality of life of a patient with COPD.
d. Both are aimed at improving the overall quality of life of a patient with COPD. Explanation: The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient 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 patients with bullous emphysema.
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) Intravenous methylprednisolone (Solu-Medrol) 120 mg b) Vancomycin 1 gram intravenously over 1 hour c) Ipratropium bromide (Alupent) by metered-dose inhaler d) Oxygen through nasal cannula at 2 L/minute
d. Oxygen through nasal cannula at 2 L/minute Explanation: 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.