COPD and Asthma

describe theophylline in COPD

Use of theophylline in COPD is controversial and should be used only in patients who do not respond to other drugs

a pt with COPD has an increased BNP level. What does this indicate?

Cor Pulmonale

describe formoterol

Long-acting bronchodilators effective in moderate COPD only

describe salmeterol

Long-acting bronchodilators effective in moderate COPD only

A patient is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) and requires supplemental oxygen. To deliver the precise amount of oxygen, the nurse should use which type of equipment?

Venturi mask - delivers precise concentrations of oxygen and should be selected whenever this is a priority concern

describe ipratropium

a long-acting bronchodilator, treats some symptoms of COPD

The nurse checks for which abnormal physical assessment findings consistent with cor pulmonale? Select all that apply. a. Jugular vein distention b. Pedal edema c. Crackles d. Wheezing e. Hepatomegaly

a, b, e (not crackles, bc they are associated with left sided HF)

A patient with chronic obstructive pulmonary disease (COPD) is experiencing anxiety. What medication as ordered should the nurse administer to this patient? a. Buspirone b. Tiotropium c. Indacaterol d. Roflumilast

a. Buspirone - an anxiolytic psychotropic drug that helps to reduce anxiety in the patient during COPD treatment.

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has increased B-type natriuretic peptide (BNP) levels. What treatment option does the nurse anticipate administering to this patient? a. Diuretics b. Albuterol c. Roflumilast d. Long-acting beta agonists

a. diuretics - help reduce symptoms of cor pulmonale (indicated by increased BNP)

describe budesonide

an inhaled corticosteroid, which should not be used as monotherapy in patients with COPD because of its side effects. Budesonide and formoterol combination is used for COPD in patients with FEV1 of less than 60 percent

Before administering ipratropium bromide, the nurse must confirm that the patient does not have which comorbidity? a. Chronic obstructive pulmonary disease (COPD) b. Glaucoma c. Hypertension d. Depression

b - ipratropium is an anticholinergic that increases intraoccular pressure

A patient has hyperventilation, dyspnea, nasal flaring, anxiety, and pursed-lip breathing. The nurse concludes that the patient has an ineffective breathing pattern due to alveolar hypoventilation. Which interventions should the nurse implement for this patient to promote safe and effective care? Select all that apply. a. Avoid giving bronchodilators. b. Monitor for respiratory muscle fatigue. c. Encourage slow, deep breathing and coughing. d. Elevate the head of the bed and provide an overbed table for the patient. e. Provide factual information concerning diagnosis, treatment, and prognosis

b, c, d

The nurse is caring for a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? a. O2 saturation of 92% b. Presence of edema in the ankles c. Yellowish discoloration of the skin d. Partial pressure of arterial oxygen (PaO2) is 60 mm Hg

b.

Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)? a. β2 agonists b. Anticholinergics c. Massage and postural drainage techniques d. Oxygen supplementation through a nasal mask

b.

While reviewing the laboratory reports of a patient with a chronic cough, dyspnea, and lung inflammation, the nurse finds that the patient has a forced expiratory volume of 55%. Which treatment strategy would be most effective for this patient? a. Roflumilast b. Salmeterol and formoterol c. Lung volume reduction surgery d. 50% oxygen at 8 L/minute concentration

b. - forced expiratory volume of 55% indicates moderate COPD. Long acting β-adrenergic agonists such as salmeterol and formoterol will be effective for the patient. Roflumilast is an antiinflammatory agent that acts as a phosphodiesterase inhibitor and helps to reduce COPD

The nurse is assessing a patient who may have manifestations of chronic obstructive pulmonary disease (COPD). Which of these is a clinical manifestation of early COPD? a. Dyspnea at rest b. chronic, intermittent cough c. The presence of chest breathing d. Production of copious amounts of sputum

b. - the rest are later manifestations

The patient has a prescription to use albuterol and beclomethasone inhalers, two puffs each. The nurse determines that the patient needs additional teaching on how to safely self-administer these medications after noting that the patient performs which action? a. Administers the albuterol before the beclomethasone b. Administers the beclomethasone before the albuterol c. Administers the beclomethason on a set schedule to prevent an asthma attack d. Rinses the mouth following use of the inhalers

b. - use B2- agonist first to dilate the airways before admin of corticosteroid

The nurse is caring for a patient with chronic obstructive pulmonary disease. About what medications will the nurse educate the patient that have the side effects of a feeling of early satiety and a bloating sensation? Select all that apply. a. Diuretics b. Roflumilast c. Theophylline d. Corticosteroids e. Bronchodilators

c, d - Theophylline is a methylxanthine drug that relaxes smooth muscles and helps to treat COPD effectively, but it causes gastrointestinal side effects. Corticosteroids help to control swelling in the lungs, although they can also cause abdominal distension, so the patient may experience bloating and feelings of satiety

The nurse determines that a 61-year-old patient with chronic bronchitis has a nursing diagnosis of "impaired gas exchange," after noting an oxygen saturation of 88%. What is an appropriate intervention to add to the care plan? a. Obtain an arterial blood gas (ABG) b. Place the patient in the prone position to increase postural drainage c. Sit the patient upright in a chair leaning slightly forward d. Administer 6 L oxygen via nasal cannula

c.

Which intervention by the nurse would be most appropriate for safe and effective care for a patient with expiratory airflow obstruction, ineffective cough, decreased airway humidity, and abnormal breath sounds? a. Monitor for respiratory muscle fatigue. b. Set up oxygen equipment and administer oxygen through a heated, humidified system. c. Instruct the patient to inhale deeply, bend forward slightly, and perform three or four huffs. d. Auscultate breath sounds to assess the areas of decreased ventilation and the presence of adventitious sounds

c. - A patient with ineffective cough, decreased airway humidity, and abnormal breath sounds has ineffective airway clearance. Hence, the nurse must instruct the patient to inhale deeply by bending slightly forward and perform three to four huffs against an open glottis to avoid airway collapse upon exhalation

A patient with chronic obstructive pulmonary disease (COPD) has severe dyspnea. The nurse is educating the patient about necessary interventions to conserve energy and avoid further complications. Which statement made by the patient indicates the need for further teaching? a. "I should avoid walking during the day." b. "I should rest for half an hour before eating." c. "I should perform deep breathing and effective coughing before meals." d. "I should take supplemental oxygen through a nasal cannula while eating

c. - Performing effective coughing or deep breathing exercises is a strenuous activity for a patient with dyspnea and would cause the patient to have difficulty eating

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium after noting which assessment finding? a. Decreased respiratory rate b. Increased respiratory rate c. Increased peak flow readings d. Decreased sputum production

c. - ipratropium is an anticholinergic that should result in increase peak flow rate

Which delivery device is used for long-term oxygen therapy? a. Nasal cannula b. Simple face mask c. Oxygen-conserving cannula d. Partial and non-rebreather mask

c. - used for LT therapy (nasal cannulas are just for low flow and are not as useful for a LT COPD pt)

Which delivery device is used for long-term oxygen therapy? a. Nasal cannula b. Simple face mask c. Oxygen-conserving cannula d. Partial and non-rebreather masks

c. Oxygen-conserving cannula - An oxygen-conserving cannula is generally indicated for long-term therapy at home or during hospitalization

The nurse concludes that nursing interventions to promote airway clearance in a patient admitted with chronic obstructive pulmonary disease (COPD) are successful based on which finding? a. Absence of dyspnea b. Improved mental status c. Effective and productive coughing d. PaO2 within normal range for the patient

c. effective coughing - Airway clearance is evaluated most directly as successful if the patient can engage in effective and productive coughing

The nurse is caring for a patient with severe chronic obstructive pulmonary disease (COPD) who has frequent exacerbations. What treatment strategy does the nurse recognize would be most beneficial for this patient? a. salmeterol and formoterol b. indacaterol c. roflumilast d. ipratropium

c. roflumilast - is an antiinflammatory that reduces cytokines and limits the exacerbations of COPD

what are vibration, percussion, and postural drainage?

chest physiotherapy techniques that help remove excessive secretions in the lungs

The patient with COPD has a prescription for ibuprofen 600 mg. The nurse questions the prescription, knowing that ibuprofen interacts with which concurrent medication? a. Ipratropium b. Sertraline c. Azithromycin d. Hydrocortisone

d - use of NSAID's with corticosteroids increases risk of GI bleed

Which measure should a patient with chronic obstructive pulmonary disorder (COPD) take when performing physical activity? a. Walk briskly or bicycle with pursed lips. b. Exhale while at rest and inhale while pushing. c. Administer beta agonists immediately after exercise. d. Remember to think about steps and breathing while walking

d.

A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? a. "Long-term home oxygen therapy should be used to prevent respiratory failure." b. "Oxygen will not be needed until or unless you are in the terminal stages of this disease." c. "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." d. "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

d. - Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease?

hyperinflation of alveoli and destruction of alveolar walls

describe indacaterol

is used for treating moderate COPD

describe class and action of theophylline

methylxanthine drug relaxes smooth muscles and helps to treat COPD

A patient requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration. Which device is the most appropriate for this patient?

nasal cannula

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). What does the nurse recognize are the predominant inflammatory cells in this disorder?

neutrophils, lymphocytes, and macrophages

_____________cannula is most appropriate for a patient who is on long-term oxygen therapy at a high concentration

oxygen-conserving cannula

Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved ________________ status

respiratory

The nurse is assessing the respiratory system of an 87-year-old patient admitted with emphysema. Which assessment findings does the nurse expect? (looks, sounds, etc)

the nurse would hear decreased breath sounds, barrel chest, and wheezes

when should beta-agonists be administered in relation to exercise?

wait 5 min after or after breathing is back to normal

when do you admin a beta agonist in relation to exercise

wait for 5 minutes to relax and regain a normal breathing rate before administration of a beta agonist after exercise.