Chapter 24
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 can't use a space or holding chamber with the MDI."
What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?
Mast cells
The classification of Stage II of COPD is defined as
Moderate COPD
The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply.
Dyspnea and fatigue disproportionate to pulmonary function abnormalities, Right ventricular enlargement, Elevated plasma brain natriuretic (BNP), enlargement of central pulmonary arteries
Which of the following is a common irritant that acts as a trigger of asthma?
Esophageal reflux
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
Respiratory acidosis
A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home?
Inhaled beclomethasone
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?
"I do not need to rinse my mouth with this type of inhaler."
Which statement describes emphysema?
A disease of the airways characterized by destruction of the walls of overdistended alveoli
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
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?
Collects sputum for culture and sensitivity
Which medication is contraindicated in acute asthma exacerbations?
Cromolyn sodium
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?
Emphysema
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
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
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
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 disease (COPD)? Choose all that apply.
Inflamed airways that obstruct airflow, Mucus secretions that block airways, Overinflated alveoli that 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.
Nicotine gum, Bupropion SR, Nortriptyline
Which of the following is not a primary symptom of COPD?
Weight gain
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
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."
Which of the following is accurate regarding status asthmaticus?
A severe asthma episode that is refractory to initial therapy
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 salmeterol and then administer the triamcinolone
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
Which is the strongest predisposing factor for asthma?
Allergy
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?
Apply supplemental oxygen as ordered
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?
Assesses fasting blood glucose levels
Which type of chest configuration is typical of a client with COPD?
Barrel chest
Which statement is true about both lung transplant and bullectomy?
Both procedures improve the overall quality of life of a client with COPD
A client with a history of respiratory problems tells the nurse that he would like to explore strategies to reduce his risk. He also mentions being currently unemployed and not wanting to pursue costly strategies. What would the nurse emphasize as the single most cost-effective intervention to reduce the risk of developing COPD or slow its progression?
Cessation of smoking
A nurse is teaching a client about asthma. What symptoms should be included with the teaching? select all that apply.
Chest tightness, Wheezing, Dyspnea, Productive cough
Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply.
Compromised gas exchange, Decreased airflow, Wheezes
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?
Cromolyn sodium
Which exposure accounts for most cases of COPD?
Exposure to tobacco smoke
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
Asthma is cause by which type of response?
IgE-mediated
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes
Implementing measures to clear pulmonary secretions
Which measure may increase complications for a client with COPD?
Increased oxygen supply
Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply.
Inflamed airways obstruct airflow, Mucus secretions block airways, Overinflated alveoli impair gas exchange
Which of the following is the key underlying feature of asthma?
Inflammation
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?
Providing sufficient oxygen to improve oxygenation
Which diagnostic test is most accurate in assessing acute airway obstruction?
Pulmonary function studies
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
The classification of Stage III of COPD is defined as
Severe COPD
A 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 productive cough
A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply.
Status asthmaticus, Respiratory failure, Atelectasis
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
The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?
The patient should take the medi0cation an hour before meals or 2 hours after a meal
A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:
Uses the sternocleidomastoid muscles
The classification of Stage IV of COPD is defined as
Very severe 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?
Performing chest physiotherapy as ordered
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 _____%.
60 mm Hg, 90%
A physician orders a beta2 adrenergic-agonist (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client?
Albuterol
A nurse is teaching a client about bronchodilators. What bronchodilator actions that relieve bronchospasm should the nurse include in the client teaching? Select all that apply.
Alter smooth muscle tone, Reduce airway obstruction, Increase oxygen distribution
In which statements regarding medications taken by a client diagnosed with COPD do the drug name and the drug category correctly match? Select all that apply.
Albuterol is a bronchodilator, Ciprofloxacin is an antibiotic, Prednisone is a corticosteroid
A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?
An inhaled beta2-adrenergic agonist
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:
Atelectasis
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 imbalance?
Respiratory acidosis
A nurse is assisting with a subclavian 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:
Diminished or absent breath sounds on the affected side
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
Respiratory acidosis
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?
Streptococcus pneumonia and Hemophilus influenzae
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?
Take ordered medications as scheduled
A client has 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?
Lung sounds
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
