Chapter 24: Management of Patients With Chronic Pulmonary Disease
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, 90%
Which of the following occupy space in the thorax, but do not contribute to ventilation?
Bullae Explanation: Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange.
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
A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?
Cromolyn sodium Explanation: Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Albuterol is a long-acting beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator
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 peptide (BNP) Enlargement of central pulmonary arteries Left ventricular hypertrophy
Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries
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
Exhale slowly
A nurse evaluates the results of a spirometry test to help confirm a diagnosis of obstructive lung disease. Which one of the following results indicates an initial early stage of COPD? (FEV1 refers to forced expired volume in 1 second.) FEV1 > 80% FEV1 = 70% FEV1 = 50% FEV1 = 30%
FEVI> 80%
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 quitting before?
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?
I
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 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 will shake the MDI container before I use it."
I can't use a spacer or holding chamber with the MDI
A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? "I lubricate my lips and nose with K-Y jelly." "I make sure my oxygen mask is on tightly so it won't fall off while I nap." "I have a 'no smoking' sign posted at my front door to remind guests not to smoke." "I clean my mask with water after every meal."
I make sure my oxygen mask is on tightly so it won't fall off while I nap
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
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in?
III
In which grade of COPD is the forced expiratory volume (FEV) less than 30%?
III
Which type of chest configuration is typical of a client with COPD?
III
Asthma is cause by which type of response?
IgE-mediated
Asthma is cause by which type of response? IgE-mediated IgA-mediated IgD-mediated IgM-mediated
IgE-mediated
A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?
Impaired gas exchange related to airflow obstruction
Which of the following is a characteristics of emphysema?
Increased total lung capacity
Which of the following is the key underlying feature of asthma?
Inflammation
A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?
Inhaled albuterol (Ventolin)
Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo) Ipratropium HFA (Atrovent) Tiotropium (Spiriva)
Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo)
A client being seen in the emergency department has labored respirations. Auscultation reveals inspiratory and expiratory wheezes. Oxygen saturation is 86%. The client was nonresponsive to an albuterol (Ventolin) inhaler and intravenous methylprednisolone (Solu-Medrol). The nurse administers the following prescribed treatment first:
Oxygen therapy through a non-rebreather mask
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? Cromolyn sodium Theo-Dur Serevent Proventil
Proventil
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 Haemophilus influenzae
mild COPD
The classification of Stage I of COPD is defined as
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 disease of the airways characterized by the destruction of the walls of overdistended alveoli
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 occurs with warning Usually does not progress to severe obstruction
a severe asthma episode that is refractory to initial therapy
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 Atrovent Albuterol Foradil Isuprel
albuterol
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. Albuterol is a bronchodilator. Dexamethasone is an antibiotic. Cotrimoxazole is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.
albuterol is a bronchodilator ciprofloxacin is an antibiotic prednisone is a corticosteroid
Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. Tobacco smoke Occupational dust Air pollution Infection Second-hand smoke
all of the above
Which is the strongest predisposing factor for asthma?
allergy
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. Alter smooth muscle tone Reduce airway obstruction Decrease alveolar ventilation Increase oxygen distribution
alter smooth muscle tone reduce airway obstruction increase oxygen distribution
A client with asthma is being treated with albuterol (Proventil). 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 Peptic ulcer disease Bronchospasm Angina
angina
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
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
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
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 cure COPD. Both procedures treat end-stage emphysema. Both procedures treat patients with bullous emphysema. Both procedures improve the overall quality of life of a client with COPD.
both procedures improve the overall quality of life of a client with COPD
Which of the following occupy space in the thorax, but do not contribute to ventilation? Bullae Alveoli Lung parenchyma Mast cells
bullae
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?
cystic fibrosis
Which of the following is a symptom diagnostic of emphysema? Dyspnea Copious sputum production Normal elastic recoil The occurrence of cor pulmonale
dyspnea
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 Bronchiectasis Cystic fibrosis Emphysema
emphysema
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 Exhale slowly Perform upper chest breaths Increase the flow of oxygen
exhale slowly
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
The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) Inflamed airways obstruct airflow. Mucus secretions block airways. Overinflated alveoli impair gas exchange. Dry airways obstruct airflow.
inflamed airways obstruct air flow mucus secretions block airways 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. Nicotine gum Clonidine Bupropion SR Varenicline
nicotine gum bupropion SR
A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: Respiratory alkalosis Metabolic alkalosis Respiratory acidosis Metabolic acidosis
respiratory alkalosis
A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: Sharp, stabbing chest pain Dyspnea A dry, hacking cough Tachycardia
sharp, stabbing chest pain
cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test? Pulmonary function studies Sweat chloride concentration Arterial blood gases Lumbar puncture
sweat chloride production
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. taking the medication at least 1 hour prior to meals. monitoring liver function studies as prescribed. development of hyperkalemia.
the importance of blood tests to monitor serum concentrations
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.
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. 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.
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.
• Atelectasis • Status asthmaticus • Respiratory failure Explanation: Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Pertussis and pneumothorax are not complications.
Emphysema is described by which of the following statements?
A disease of the airways characterized by destruction of the walls of overdistended alveoli
Which of the following is accurate regarding status asthmaticus?
A severe asthma episode that is refractory to initial therapy
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
Albuterol 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.
The physician orders a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? Alupent Brethine Foradil Isuprel
Brethine
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 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 will shake the MDI container before I use it."
Correct response: "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.
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 ___%. 54 mm Hg; 84% 56 mm Hg; 86% 58 mm Hg; 88% 60 mm Hg; 90%
Correct response: 60 mm Hg; 90% Explanation: The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%
You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what? Pain Atelectasis Impaired physical mobility Side effects of medication therapy
Correct response: Atelectasis Explanation: For a client with obstructive pulmonary disease, atelectasis is one of the conditions for which nursing actions are identified to detect, manage, and minimize the unexpected outcomes.
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
Correct response: Atelectasis Explanation: Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).
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 Jugular vein distention Ascites
Correct response: Compromised gas exchange Decreased airflow 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 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 Bronchiectasis Cystic fibrosis Emphysema
Correct response: Emphysema Explanation: 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.
An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure? Highest airflow during a forced inspiration Highest airflow during a forced expiration Highest airflow during a normal inspiration Highest airflow during a normal expiration
Correct response: Highest airflow during a forced expiration Explanation: A peak flow meter is a small hand-held device that measures the fastest flow the patient can generate after taking a deep breath in and blowing out as hard and fast as possible.
A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in? I II III IV
Correct response: III Explanation: All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.
The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? Using a long-acting steroid inhaler when an attack is coming Avoiding exercise and any strenuous activity Preparing a written action plan Staying in the house if it is too cold or too hot
Correct response: Preparing a written action plan Explanation: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations (Expert Panel Report 3, 2007).
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 Avoiding the use of oxygen to decrease the hypoxic drive Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Increasing pH
Correct response: Providing sufficient oxygen to improve oxygenation Explanation: The main objective in treating patients with hypoxemia and hypercapnia is to give 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? Respiratory rate of 22 breaths/minute Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/minute
Correct response: Respiratory rate of 22 breaths/minute Explanation: 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 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 Pertussis Atelectasis Thoracentesis
Correct response: Status asthmaticus Respiratory failure Atelectasis Explanation: Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.
Which of the following is not a primary symptom of COPD? Cough Sputum production Dyspnea upon exertion Weight gain
Correct response: Weight gain Explanation: COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Weight loss is common with COPD.
A client is being admitted to an acute health care facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The nurse is placing this information on the Medication Reconciliation Record. What medication information needs to be clarified with the health care provider? nicotine patch 21 mg transdermal daily at 0800 salmeterol/fluticasone MDI daily at 0800 azithromycin 600 mg oral daily for 10 days at 0800, on Day 4 prednisone 5 mg oral daily at 0800
Correct response: salmeterol/fluticasone MDI daily at 0800 Explanation: When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.
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 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.
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?
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 hormone brain natriuretic peptide (BNP) is produced by which of the following?
Ventricles of the heart
Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply.
• Tobacco smoke • Occupational dust • Air pollution • Infection • Second-hand smoke
Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.
• Zafirlukast (Accolate) • Montelukast (Singulair) • Zileuton (Zyflo) Explanation: Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.
A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?
An inhaled beta2-adrenergic agonist Explanation: 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 admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate?
An inspiratory-expiratory (I:E) ratio of 2:1 Explanation: The normal I:E ratio is 1:2, meaning that expiration takes twice as long as inspiration. A ratio of 2:1 is seen in clients with COPD because inspiration is shorter than expiration. A client with COPD typically has a barrel chest in which the anteroposterior diameter is larger than the transverse chest diameter. A client with COPD usually has a respiratory rate greater than 12 breaths/minute and an oxygen saturation rate below 93%.
A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse
Asks the client, "What are your allergies?" Explanation: Spirometry testing includes use of a bronchodilator and then further testing. The nurse needs to assess for allergies first. The client does not need to be NPO prior to spirometry testing. Venous blood work may be done for clients younger than 45 years old, to check for a deficiency in alpha 1-antitrypsin. Arterial blood gases, if ordered, are obtained prior to spirometry testing.
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 will make sure to take a slow, deep breath as I push on my inhaler." "After I breathe in, I will hold my breath for 10 seconds." "I do not need to rinse my mouth with this type of inhaler." "If I use the spacer, I know I am only supposed to push on the inhaler once."
Correct response: "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.
The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response? "It is an umbrella term for diseases like acute bronchitis." "It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." "It means your lungs can't expand and contract like they are supposed to which makes it hard for you to breathe." "It is a term that covers so many lung diseases I can't list them all."
Correct response: "It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." Explanation: Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? "Limit yourself to smoking only 2 cigarettes per day." "Eat a high-sodium diet." "Weigh yourself daily and report a gain of 2 lb in 1 day." "Maintain bed rest."
Correct response: "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.
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. Albuterol is a bronchodilator. Dexamethasone is an antibiotic. Cotrimoxazole is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid.
Correct response: Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid. Explanation: 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.
A nurse is teaching a client about bronchodilators. What bronchodilator actions that relieve bronchospams should the nurse include in the client teaching? Select all that apply. Alter smooth muscle tone Reduce airway obstruction Decrease alveolar ventilation Increase oxygen distribution Reduce inflammation
Correct response: Alter smooth muscle tone Reduce airway obstruction Increase oxygen distribution Explanation: Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation. Inflammation would be reduced by corticosteriods.
In which grade of COPD is the forced expiratory volume (FEV) less than 30%? I II III IV
Correct response: IV Explanation: Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 30% predicted.
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. Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Dry airways that obstruct airflow Decreased numbers of goblet cells
Correct response: Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange Explanation: 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 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 Oral sustained-release albuterol Subcutaneous omalizumab Oral prednisone
Correct response: Inhaled beclomethasone Explanation: For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone (Beconase). The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma.
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? Lung sounds Skin color Heart rate Respiratory rate
Correct response: 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.
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 Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour
Correct response: Oxygen through nasal cannula at 2 L/minute Explanation: When a client presents in the emergency department with an exacerbation of COPD, the nurse should first administer oxygen therapy and perform a rapid assessment of whether the exacerbation is potentially life threatening.
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? Restricting oral intake to 1,000 mL/day Providing the client a low-sodium diet Performing chest physiotherapy as ordered Discussing palliative care and end-of-life issues with the client
Correct response: Performing chest physiotherapy as ordered 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.
A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Teach the client to suspend activity.
Correct response: Provide medical support for the current exacerbation. Treat the underlying cause of the event. Return the client to their original functioning abilities. Provide long-term support for medical management. Explanation: The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities.
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
Correct response: Respiratory acidosis 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.
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 acidosis Respiratory alkalosis Metabolic alkalosis Metabolic acidosis
Correct response: 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.
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: diminished or absent breath sounds on the affected side. paradoxical chest wall movement with respirations. tracheal deviation to the unaffected side. muffled or distant heart sounds.
Correct response: diminished or absent breath sounds on the affected side. Explanation: 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.
The classification of Stage III of COPD is defined as at risk for COPD. mild COPD. severe COPD. very severe COPD. moderate COPD.
Correct response: severe COPD. Explanation: 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 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.
Correct response: 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.
The classification of Stage IV of COPD is defined as at risk for COPD. mild COPD. severe COPD. very severe COPD. moderate COPD.
Correct response: very severe COPD. Explanation: 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.
A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?
Delay self-care activities for one hour Explanation: Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.
Which of the following is a common irritant that acts as a trigger of asthma?
Esophageal Reflux Disease
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
Exhale slowly Explanation: 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 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
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 Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour
Oxygen through nasal cannula at 2 L/minute
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 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.
An increase in the red blood cell concentration in the blood is termed which of the following?
Polycythemia
An increase in the red blood cell concentration in the blood is termed which of the following?
Polycythemia Explanation: Polycythemia is an increase in the red blood cell concentration in the blood. Emphysema is a disease of the airways characterized by destruction of the walls of overdistended alveoli. Asthma is a disease with multiple precipitating mechanisms resulting in a common clinical outcome of reversible airflow obstruction.
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 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.
A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate? An inspiratory-expiratory (I:E) ratio of 2:1 A transverse chest diameter twice that of the anteroposterior diameter An oxygen saturation of 99% A respiratory rate of 12 breaths/minute
an inspiratory-expiratory (I:E) ration of 2:!
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. Explanation: 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 symptoms are considered primary symptoms of COPD? Cough Sputum production Dyspnea upon exertion Weight gain
cough
Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) Compromised gas exchange Decreased airflow Wheezes Jugular vein distention Ascites
decreased airflow compromised gas exchange wheezes
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:
diminished or absent breath sounds on the affected side
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
exposure to tobacco smoke
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? Restricting oral intake to 1,000 mL/day Providing the client a low-sodium diet Performing chest physiotherapy as ordered Discussing palliative care and end-of-life issues with the client
performing chest physiotherapy as ordered
The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client Positions the inhaler 1 to 2 inches away from his open mouth Carefully holds the inhaler upright without shaking it Holds the breath for 5 seconds after administering the medication Immediately repeats the second puff after the first puff
positions the inhaler 1-2 inches away from open mouth
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? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis
respiratory alkalosis
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? Chest pain during respiration Sputum and a productive cough Fever, chills, and diaphoresis Tachypnea and tachycardia
sputum and productive cough
A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. Thick mucus Swelling of bronchial membranes Destruction of the alveolar wall Airway remodeling
thick mucus airway remodeling swelling of bronchial membranes
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
The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.)
• Activate the MDI once. • The device may increase delivery of the MDI medication. • Take a slow, deep inhalation from the device.
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.
• Air pollution • Tracheobronchial infection Explanation: 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.
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.
• Alter smooth muscle tone • Reduce airway obstruction • Increase oxygen distribution
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.
• Asymmetry of chest movement • Sudden chest pain • Oxygen desaturation • Unilateral retractions Explanation: Signs and symptoms of pneumothorax include sudden chest pain that is sharp and abrupt, a significant and sudden increase in shortness of breath, asymmetry of chest movement, unilateral retractions, bilateral differences in breath sounds, and/or oxygen desaturation. The patient with a pneumothorax would not have bilaterally equal breath sounds.
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 peptide (BNP) • Enlarge of central pulmonary arteries
After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.
• Increase oxygen distribution • Alter smooth muscle tone • Reduce airway obstruction
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 • Overinflated alveoli that impair gas exchange • Inflamed airways that obstruct airflow
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.
• Right ventricular enlargement • Enlarge of central pulmonary arteries • Elevated plasma brain natriuretic peptide (BNP) • Dyspnea and fatigue disproportionate to pulmonary function abnormalities Explanation: The diagnosis of pulmonary hypertension associated with COPD is suspected in patients complaining of dyspnea and fatigue that appear to be disproportionate to pulmonary function abnormalities. Enlargement of the central pulmonary arteries on the chest X-ray, echocardiogram suggestive of right ventricular enlargement, and elevated plasma BNP may be present
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.
• Status asthmaticus • Atelectasis • Respiratory failure
Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.
• Sudden chest pain • Oxygen desaturation • Unilateral retractions • Asymmetry of chest movement Explanation: Signs and symptoms of pneumothorax include sudden chest pain that is sharp and abrupt, a significant and sudden increase in shortness of breath, asymmetry of chest movement, unilateral retractions, bilateral differences in breath sounds, and/or oxygen desaturation. The patient with a pneumothorax would not have bilaterally equal breath sounds.
A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply.
• Thick mucus • Swelling of bronchial membranes • Airway remodeling
