Chapter 20: med surg management of chronic pulmonary diseases

A client with asthma is being treated with albuterol. Which of the findings from the client's history would indicate to the nurse the need to administer this drug with caution? Raynaud's disease Angina Bronchospasm Peptic ulcer disease

Angina Explanation: Patients, especially older adults, with pre-existing cardiovascular disease may have adverse cardiovascular reactions with inhaled therapy. Albuterol (Proventil) does not increase the secretions of the GI tract or cause gastric irritation. It will not worsen a peptic ulcer.

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient?

Respiratory alkalosis Explanation: Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation. pg 642

A commonly prescribed methylxanthine used as a bronchodilator is which of the following? Terbutaline Levalbuterol Theophylline Albuterol

Theophylline Explanation: Theophylline is an example of a methylxanthine. All the others are examples of inhaled short-acting beta2 agonists. pg 639

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? An oral corticosteroid An inhaled beta2-adrenergic agonist An I.V. beta2-adrenergic agonist An inhaled corticosteroid

a) An inhaled beta2-adrenergic agonist An inhaled beta2-adrenergic agonist helps promote bronchodilation, which improves oxygenation. Although an I.V. beta2-adrenergic agonist can be used, the client needs be monitored because of the drug's greater systemic effects. The I.V. form is typically used when the inhaled beta2-adrenergic agonist doesn't work. A corticosteroid is slow acting, so its use won't reduce hypoxia in the acute phase.

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: oxygen toxicity. pleural effusion. pulmonary edema. atelectasis.

atelectasis.

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

Mast cells

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. Dry airways obstruct airflow. Mucus secretions block airways. Inflamed airways obstruct airflow. Overinflated alveoli impair gas exchange.

Mucus secretions block airways. Inflamed airways obstruct airflow. Overinflated alveoli impair gas exchange.

The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply. Acetaminophen Caffeine Bupropion SR Nicotine gum Clonidine

Nicotine gum Clonidine Bupropion SR

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? I II III IV

I

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

"Have you tried to quit smoking before?"

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

Respiratory acidosis Explanation: As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? Assess vital signs every 2 hours, including O2 saturations and ABG results. Apply supplemental oxygen as ordered. Refer the client to respiratory therapy if breathing becomes labored. Educate the client about the importance of pursed lip breathing.

Apply supplemental oxygen as ordered.

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

A severe asthma episode that is refractory to initial therapy Explanation: 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.

A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take? Informs the client to limit fluid intake due to fluid retention Aspirates for blood return before injecting the medication Assesses fasting blood glucose levels Encourages the client to decrease caloric intake due to increased appetite

Assesses fasting blood glucose levels Explanation: Adverse effects of methylprednisolone (Solu-Medrol) include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in? II III IV I

I

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in? II III I IV

II

Which diagnostic test is most accurate in assessing acute airway obstruction? Arterial blood gases (ABGs) Pulse oximetry Spirometry Pulmonary function studies

Pulmonary function studies Explanation: Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs and pulse oximetry are not the most accurate diagnostics for an airway obstruction. Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).

During a health seminar for the prevention of COPD, a nurse advises participants that the number-one risk factor for COPD is: History of severe respiratory infections. Tobacco smoke. Occupational chemicals. Outdoor pollution.

Tobacco smoke.

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

uses the sternocleidomastoid muscles. Explanation: 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.

patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? Sputum and a productive cough Chest pain during respiration Fever, chills, and diaphoresis Tachypnea and tachycardia

Sputum and a productive cough Explanation: Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary? "After I breathe in, I will hold my breath for 10 seconds." "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." "I will make sure to take a slow, deep breath as I push on my inhaler."

"I do not need to rinse my mouth with this type of inhaler." Explanation: 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 client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation

A young adult with cystic fibrosis is admitted to the hospital for an acute airway exacerbation. Aggressive treatment is indicated. What is the first action by the nurse? Administers vancomycin intravenously Gives oral pancreatic enzymes with meals Provides nebulized tobramycin (TOBI) Collects sputum for culture and sensitivity

-Collects sputum for culture and sensitivity 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.

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

60 mm Hg; 90%

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? 70% 30% 90% 50%

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%.

A physician orders triamcinolone and salmeterol for a client with a history of asthma. What action should the nurse take when administering these drugs? Administer the triamcinolone and then administer the salmeterol. Allow the client to choose the order in which the drugs are administered. Monitor the client's theophylline level before administering the medications. Administer the salmeterol and then administer the triamcinolone.

Administer the salmeterol and then administer the triamcinolone. A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone (Azmacort) is a corticosteroid; Salmeterol (Serevent) is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.

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 Pleurisy Emphysema Atelectasis Pneumonia

Atelectasis

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? Albuterol Cromolyn sodium Levalbuterol HFA Ipratropium

Cromolyn sodium Explanation: 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.

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

Decreased airflow Compromised gas exchange Wheezes 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, 2015).

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? Decreased activity tolerance Hyperthermia Increased sputum production Decreased oxygen requirements

Decreased oxygen requirements Explanation: A client who is free from infection will most likely have decreased oxygen requirements. A client with infection will display increased sputum production, fever, shortness of breath, decreased activity tolerance, and increased oxygen requirements.

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? Elevated sweat chloride concentration Decreased tidal volume Presence of protein in the urine Positive phenylketonuria

Elevated sweat chloride concentration Explanation: Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and decreased tidal volume are not diagnostic for CF.

A client with asthma is prescribed an inhaled corticosteroid. For which reason will the nurse recommend that a small volume nebulizer (SVN) be used to provide the medication to the client? Medication requires rapid inhalation Client has rheumatoid arthritis Client needs to exhale through the device Client needs to hold breath after inhalation

Explanation: A small volume nebulizer (SVN) is used to administer corticosteroids in addition to other medications. It requires slow tidal breathing with occasional deep breaths and administers the medication through a tight fitting facemask which is ideal for clients unable to use a mouthpiece. This delivery system is less dependent on the client's coordination and cooperation. A client with rheumatoid arthritis has swelling of the hands and would have difficulty using another delivery system for the medication. The SVN does not require rapid inhalation. Exhalation is not done through the device. The client does not need to hold the breath after inhalation. pg 115

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client Has wheezes in the right lung lobes Cannot perform activities of daily living Reports shortness of breath Has a respiratory rate of 28 breaths/minute

Has wheezes in the right lung lobes Explanation: Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

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

High-protein Explanation: 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 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? Increase walking distance around a city block without shortness of breath. Maintain activity level of walking to the mailbox. Relieve shortness of breath to a level as close as possible to tolerable. Continue with current level of mobility at home.

Increase walking distance around a city block without shortness of breath. Explanation: 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

Which of the following is the key underlying feature of asthma? Inflammation Shortness of breath Chest tightness Productive cough

Inflammation

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

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.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.

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

RR of 22breaths/min 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.

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

Respiratory acidosis - Increasing PaC02 indicates impending respiratory failure.Explanation: 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.

implementing measures to clear pulmonary secretions. Explanation: 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 classification of Stage III of COPD is defined as moderate COPD. very severe COPD. at risk for COPD. mild COPD. severe COPD.

severe COPD

A client 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? Albuterol Ipratropium bromide Fluticasone propionate Ipratropium bromide and albuterol sulfate

Albuterol -Albuterol is your short acting! It's the medication you want is you are experiencing an asthma attack. Explanation: Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

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? Impaired swallowing Unilateral neglect Anxiety Imbalanced nutrition: More than body requirements

Anxiety Explanation: 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 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? Respiratory rate Skin color Heart rate Lung sounds

Lung sounds Explanation: 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.

The client is prescribed albuterol 2 puffs as a metered-dose inhaler. Which action by the client demonstrates understanding of administration for this medication? Carefully holds the inhaler upright without shaking it Immediately repeats the second puff after the first puff Positions the inhaler 2 finger widths away from the lips Holds the breath for 5 seconds after administering the medication

Positions the inhaler 2 finger widths away from the lips Explanation: To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 2 finger widths away from lips. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds.

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 Avoiding the use of oxygen to decrease the hypoxic drive Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Providing sufficient oxygen to improve oxygenation

Providing sufficient oxygen to improve oxygenation

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is: Respiratory acidosis. Hypoxemia secondary to impaired oxygen diffusion. Diminished alveolar surface area. Hypercapnia resulting from decreased carbon dioxide elimination.

Respiratory acidosis.

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

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.

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include the importance of blood tests to monitor serum concentrations. monitoring liver function studies as prescribed. development of hyperkalemia. taking the medication at least 1 hour prior to meals.

the importance of blood tests to monitor serum concentrations. The nurse should inform clients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The client is at risk of developing hypokalemia.

A physician orders metaproterenol by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication? "I need to hold my breath as long as possible after I take a deep inhalation." "I can stop using this drug when I begin to feel better." "I need to call the physician right away if I feel my heart beating fast after using the drug." "I should use this inhaler whenever I get short of breath."

"I need to hold my breath as long as possible after I take a deep inhalation."

Which statement describes emphysema? 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 Chronic dilatation of a bronchus or bronchi A disease that results in reversible airflow obstruction, a common clinical outcome

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.

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

Exhales hard and fast with a single blow Explanation: 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.

The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." "I will shake the MDI container before I use it." "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."

I can't use a spacer or holding chamber with the MDI." Explanation: 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.

Asthma is cause by which type of response? IgA-mediated IgM-mediated IgD-mediated IgE-mediated

IgE-mediated

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

Increased oxygen supply Explanation: 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.

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 Performing chest physiotherapy as ordered Providing the client a low-sodium diet Restricting oral intake to 1,000 mL/day

Performing chest physiotherapy as ordered - This helps mobilize the secretions so they can be able to expel it out. Explanation: 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.

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? Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Respiratory acidosis Explanation: 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