Chronic Obstructive Pulmonary Disorders
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%
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
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
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 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
Asthma is cause by which type of response? IgE-mediated IgA-mediated IgD-mediated IgM-mediated
IgE-mediated
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
Which is the strongest predisposing factor for asthma?
allergy
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
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 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 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%
Which type of chest configuration is typical of a client with COPD?
III
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 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 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
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
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
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
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
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
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 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 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
Which type of chest configuration is typical of a client with COPD?
barrel chest
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 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
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
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
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