chp 20
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 Impaired swallowing Unilateral neglect Anxiety
Anxiety
The classification of Stage II of COPD is defined as mild COPD. moderate COPD. at risk for COPD. severe COPD. very severe COPD.
moderate COPD. Stage II is moderate COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage III is severe COPD. Stage IV is very severe COPD.
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? Pleurisy Atelectasis Emphysema Pneumonia
Atelectasis In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).
The classification of Stage IV of COPD is defined as at risk for COPD. very severe COPD. moderate COPD. mild COPD. severe COPD.
very severe COPD. 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.
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% 58 mm Hg; 88% 60 mm Hg; 90% 56 mm Hg; 86%
60 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.
Which of the following is accurate regarding status asthmaticus? Patients have a productive cough. A severe asthma episode that is refractory to initial therapy Usually does not progress to severe obstruction Usually occurs with warning
A severe asthma episode that is refractory to initial therapy 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 is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important risk factor for emphysema? Infectious agents Air pollution Allergens Cigarette smoking
Cigarette smoking The most important risk factor for COPD is cigarette smoking. Nutrition, exercise, and exposure to dust and pollen are not risk factors for COPD.
Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. Ascites Compromised gas exchange Decreased airflow Jugular vein distention Wheezes
Compromised gas exchange Decreased airflow Wheezes
A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? Cromolyn sodium Theophylline Albuterol Budesonide
Cromolyn sodium Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. The other medications listed are not mast cell stabilizers.
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? 1,800-calorie ADA Low-fat Full-liquid High-protein
High-protein
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 Provides nebulized tobramycin (TOBI) Administers vancomycin intravenously Gives oral pancreatic enzymes with meals
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.
Which exposure accounts for most cases of COPD? Ambient air pollution Exposure to tobacco smoke Occupational exposure Passive smoking
Exposure to tobacco smoke Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases. Occupational exposure, passive smoking, and ambient air pollution are risk factors, but they do not account for most cases.
The classification of Stage III of COPD is defined as moderate COPD. mild COPD. at risk for COPD. severe COPD. very severe COPD.
severe COPD. 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 client with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? "You are not a candidate because you have heart failure." "You would have a difficult time recovering from the procedure." "You and your physician should discuss the options that are available for treatment." "At this point, do you really want to go through something like that?"
"You and your physician should discuss the options that are available for treatment." Treatment options for clients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are limited, although lung volume reduction surgery is a palliative surgical option that is approved by Medicare in selected patients. This includes clients with homogenous disease or disease that is focused in one area and not widespread throughout the lungs. Lung volume reduction surgery involves the removal of a portion of the diseased lung parenchyma. This reduces hyperinflation and allows the functional tissue to expand, resulting in improved elastic recoil of the lung and improved chest wall and diaphragmatic mechanics. This type of surgery does not cure the disease nor improve life expectancy; however, it may decrease dyspnea, improve lung function and exercise tolerance, and improve the patient's overall quality of life (GOLD, 2015).
What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? Mast cells Neutrophils Lymphocytes Eosinophils
Mast cells Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.
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 Metabolic alkalosis Metabolic acidosis Respiratory alkalosis
Respiratory acidosis 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 patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Metabolic acidosis Respiratory alkalosis Metabolic alkalosis Respiratory acidosis
Respiratory acidosis 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.
Which statement describes emphysema? 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 destruction of the walls of overdistended alveoli 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 Emphysema is a category of chronic obstructive pulmonary disease (COPD). In emphysema, impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of alveoli; a chronic inflammatory response may induce disruption of the parenchymal tissues. Asthma has a clinical outcome of airflow obstruction. Bronchitis includes the presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.
Asthma is cause by which type of response? IgD-mediated IgM-mediated IgE-mediated IgA-mediated
IgE-mediated Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.
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 Oxygen through nasal cannula at 2 L/minute Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour
Oxygen through nasal cannula at 2 L/minute
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 Heart rate of 100 beats/minute Urine output of 40 ml/hour Respiratory rate of 22 breaths/minute
Respiratory rate of 22 breaths/minute 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 developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Take ordered medications as scheduled. Avoid contact with fur-bearing animals. Avoid goose down pillows. Change filters on heating and air conditioning units frequently.
Take ordered medications as scheduled. Although avoiding contact with fur-bearing animals, changing filters on heating and air conditioning units frequently, and avoiding goose down pillows are all appropriate measures for clients with asthma, taking ordered medications on time is the most important measure in preventing asthma attacks.
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." "Maintain bed rest." "Weigh yourself daily and report a gain of 2 lb in 1 day." "Eat a high-sodium diet."
"Weigh yourself daily and report a gain of 2 lb in 1 day." 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.
Which statement is true about both lung transplant and bullectomy? Both procedures improve the overall quality of life of a client with COPD. 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. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat clients with bullous emphysema.
