Chapter 24: Management of Patients with Chronic Pulmonary Disease Prep U
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 Respiratory rate Heart rate
Lung sounds
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
Respiratory acidosis
A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: pleural effusion. atelectasis. pulmonary edema. oxygen toxicity.
atelectasis.
The classification of Stage III of COPD is defined as moderate COPD. at risk for COPD. mild COPD. severe COPD. very severe COPD.
severe COPD.
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: "Many options are available for you." "Nicotine patches would be appropriate for you." "I can refer you to the American Lung Association." "Have you tried to quit smoking before?"
"Have you tried to quit smoking before?"
Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation? Common cold Bronchitis Pneumonia Asthma
Bronchitis
The classification of Stage IV of COPD is defined as at risk for COPD. moderate COPD. mild COPD. severe COPD. very severe COPD.
very severe COPD.
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." "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." "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."
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." "Weigh yourself daily and report a gain of 2 lb in 1 day." "Maintain bed rest." "Eat a high-sodium diet."
"Weigh yourself daily and report a gain of 2 lb in 1 day."
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? Imbalanced nutrition: More than body requirements Anxiety Unilateral neglect Impaired swallowing
Anxiety
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? Pneumonia Atelectasis Pleurisy Emphysema
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. Decreased airflow Wheezes Compromised gas exchange Ascites Jugular vein distention
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? Albuterol Cromolyn sodium Ipratropium Levalbuterol HFA
Cromolyn sodium
A health care provider orders a beta-2 adrenergic agonist agent (bronchodilator) that is long-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? Salmeterol Foradil Isuprel Terbutaline
Salmeterol
A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. Pertussis Status asthmaticus Atelectasis Thoracentesis Respiratory failure
Status asthmaticus Respiratory failure Atelectasis
A client with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the client has been prescribed? After meals and at bedtime Before meals With meals Three times a day regardless of meal time
With meals
At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-Medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer: albuterol (Proventil). morphine. propranolol (Inderal). alprazolam (Xanax).
albuterol (Proventil).
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Urine output of 40 ml/hour Dilated and reactive pupils Respiratory rate of 22 breaths/minute Heart rate of 100 beats/minute
Respiratory rate of 22 breaths/minute
Which of the following is accurate regarding status asthmaticus? Usually occurs with warning Patients have a productive cough. Usually does not progress to severe obstruction A severe asthma episode that is refractory to initial therapy
A severe asthma episode that is refractory to initial therapy
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? Ipratropium bromide and albuterol sulfate Albuterol Ipratropium bromide Fluticasone propionate
Albuterol
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
Asthma is cause by which type of response? IgD-mediated IgM-mediated IgE-mediated IgA-mediated
IgE-mediated
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? Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Oxygen through nasal cannula at 2 L/minute Vancomycin 1 gram intravenously over 1 hour
Oxygen through nasal cannula at 2 L/minute
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 Increasing pH Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise
Providing sufficient oxygen to improve oxygenation
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
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis
Respiratory acidosis
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 a productive cough
The classification of grade I COPD is defined as mild COPD. moderate COPD. severe COPD. very severe COPD.
mild 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: uses the sternocleidomastoid muscles. sits in tripod position. has a pulse oximetry reading of 93%. wants the head of the bed raised to a 90-degree level.
uses the sternocleidomastoid muscles.
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "I will take a slow, deep breath in after pushing down on the MDI." "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 shake the MDI container before I use it."
"I can't use a spacer or holding chamber with the MDI."
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take? Aspirates for blood return before injecting the medication Encourages the client to decrease caloric intake due to increased appetite Assesses fasting blood glucose levels Informs the client to limit fluid intake due to fluid retention
Assesses fasting blood glucose levels
Which statement is true about both lung transplant and bullectomy? Both procedures treat patients with bullous emphysema. Both procedures treat end-stage emphysema. Both procedures cure COPD. 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.
A nurse is teaching a client about asthma. What symptoms should be included with the teaching? Select all that apply. Chest tightness Productive cough Crackles Wheezing Dyspnea
Chest tightness Wheezing Dyspnea Productive cough
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 Collects sputum for culture and sensitivity Gives oral pancreatic enzymes with meals Provides nebulized tobramycin (TOBI)
Collects sputum for culture and sensitivity
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 Records in a diary the number achieved after one breath Inhales deeply and holds the breath Sits in a straight-back chair and leans forward
Exhales hard and fast with a single blow
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
Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. Mucus secretions block airways. Overinflated alveoli impair gas exchange. Dry airways obstruct airflow. Inflamed airways obstruct airflow.
Inflamed airways obstruct airflow. Mucus secretions block airways. Overinflated alveoli impair gas exchange.
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. Overinflated alveoli that impair gas exchange Dry airways that obstruct airflow Mucus secretions that block airways Inflamed airways that obstruct airflow Decreased numbers of goblet cells
Inflamed airways that obstruct airflow Mucus secretions that block airways Overinflated alveoli that impair gas exchange
What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? Eosinophils Neutrophils Mast cells Lymphocytes
Mast cells
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Change filters on heating and air conditioning units frequently. Avoid contact with fur-bearing animals. Take ordered medications as scheduled. Avoid goose down pillows.
Take ordered medications as scheduled.
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 medication an hour before meals or 2 hours after a meal. The patient should take the medication separately without other medications. The patient should take the medication with meals since it may cause nausea. The patient should take the medication with a small amount of liquid.
The patient should take the medication an hour before meals or 2 hours after a meal.
Which of the following is not a primary symptom of COPD? Weight gain Sputum production Dyspnea upon exertion Cough
Weight gain
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. Cotrimoxazole is a bronchodilator. Albuterol is a bronchodilator. Ciprofloxacin is an antibiotic. Prednisone is a corticosteroid. Dexamethasone is an antibiotic.
• Albuterol is a bronchodilator.• Ciprofloxacin is an antibiotic.• Prednisone is a corticosteroid. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.
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. muffled or distant heart sounds. tracheal deviation to the unaffected side.
diminished or absent breath sounds on the affected side.
The classification of Stage II of COPD is defined as severe COPD. moderate COPD. mild COPD. very severe COPD. at risk for COPD.
moderate COPD.
