COPD Test
A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply.
Wheezing • Dyspnea • Cough
Theophylline
monitor the clients serum levels for toxicity. Side effects will include tachycardia nausea and diarrhea
A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:
the airways are so swollen that no air can get through.
The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction? a) "I will take a slow, deep breath in after pushing down on the MDI." b) "I will shake the MDI container before I use it." c) "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." d) "I can't use a spacer or holding chamber with the MDI."
"I can't use a spacer or holding chamber with the MDI
A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? a) Cromolyn sodium b) Albuterol c) Budesonide d) Theophylline
Cromolyn sodium
Choice Multiple question - Select all answer choices that apply. 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. a) Right ventricular enlargement b) Left ventricular hypertrophy c) Elevated plasma brain natriuretic peptide (BNP) d) Enlarge of central pulmonary arteries e) Dyspnea and fatigue disproportionate to pulmonary function abnormalities
Dyspnea and fatigue disproportionate to pulmonary function abnormalities • Right ventricular enlargement • Elevated plasma brain natriuretic peptide (BNP) • Enlarge of central pulmonary arteries 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.
Instruct the client how to recognize and avoid triggering agents such as
Environmental factors such as changes in temperature (especially warm to cold) and humidity Air pollutants Strong odors (perfume) Seasonal allergens (grass tree and week pollens) and perennial allergens (mold feathers dust roaches animal dander foods treated with sulfites) Stress and emotional distress Medications (aspirin NSAIDS beta-blockers Cholinergics) Enzymes including those in laundry detergents chemicals (household cleaners) Sinusitis with postnasal drip Viral respiratory tract infection
Health promotion
If the client smokes promote smoking cessation Encourage influenza and pneumonia vaccinations for all clients who have asthma and especially for the older adults Instruct the client how to properly self-administer medications (nebulizers and inhalers) Instruct client to use hot water to eliminate dust mites in bed linens
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? a) Activity intolerance related to shortness of breath b) Impaired gas exchange related to airflow obstruction c) Anxiety related to difficulty breathing d) Risk for infection related to retained secretions
Impaired gas exchange related to airflow obstruction
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? a) Oral theophylline (Theo-Dur) b) Inhaled cromolyn sodium (Intal) c) Inhaled albuterol (Ventolin) d) Oxygen therapy
Inhaled albuterol (Ventolin)
Which of the following medications are contraindicated in acute asthma exacerbations? a) Atrovent b) Intal c) Proventil d) Xopenex
Intal
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? a) Skin color b) Lung sounds c) Heart rate d) Respiratory rate
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.
Histamine, a mediator that supports the inflammatory process in asthma, is secreted by a) Lymphocytes b) Mast cells c) Neutrophils d) Eosiniphils
Mast cells Explanation: 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.
Asthma diagnoses are based on symptoms and classified into one of the following four categories
Mild intermittent-symptoms occur less than twice a week Mild persistent-symptoms occur less than twice a week Moderate persistent-Daily symptoms occur in conjunction with exacerbations twice a week Severe persistent-symptoms occur continually along with frequent exacerbations that limit the clients physical activity and quality of life
A nurse is caring for an asthmatic client who requires a low concentration of oxygen. Which of the following delivery devices should the nurse use in order to administer oxygen to the client?
Nasal cannula
Obtain the clients history regarding current and previous asthma exacerbations
Onset and duration Precipitating factors (Stress, exercise, exposures to irritant) Changes in medication regimen Medications that relieve symptoms Other medications taken Self-care methods used to relieve symptoms
A male patient newly diagnosed with COPD tells the nurse, "I can't believe I have COPD, I only had a cough; are there other symptoms I should know about"? Which of the following is the nurse's best response?
Other symptoms you may develop are shortness of breath on exertion, and sputum production."
In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to what acid-base imbalance? a) Metabolic acidosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic alkalosis
Respiratory acidosis
A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD?
Respiratory failure
A patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position?
Sitting upright, leaning forward slightly
Choice Multiple question - Select all answer choices that apply. Why would a patient with COPD report feeling fatigued? Select all that apply. a) The patient is using all expendable energy for activities of daily living (ADLs). b) There is a gradual decrease in muscle function over time in a patient with COPD. c) There is a gradual decrease in lung function over time in a patient with COPD. d) The patient is using all expendable energy just to breathe.
The patient is using all expendable energy just to breathe. • There is a gradual decrease in lung function over time in a patient with COPD. Explanation: The patient is using all expendable energy just to breathe. There is a gradual decrease in lung function, not muscle function, over time in a patient with COPD. In the patient with COPD, fatigue and feeling of exhaustion stem directly from the disease, not from activity level
Choice Multiple question - Select all answer choices that apply. 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. a) Airway remodeling b) Swelling of bronchial membranes c) Thick mucus d) Destruction of the alveolar wall
Thick mucus • Swelling of bronchial membranes • Airway remodeling Explanation: As asthma becomes more persistent, inflammation progresses and airway edema, mucus hypersecretion, and formation of mucus plugs can occur. Airway remodeling may occur in response to chronic inflammation, causing further airway narrowing. Destruction of the alveolar wall does not occur with asthma.
You are caring for a 65-year-old client who has been newly diagnosed with emphysema. The client is confused by the new terms and wants to know what ventilation means. Which of the following can instruct this client?
Ventilation is breathing air in and out of the lungs.
Nursing considerations for people with asthma
Watch the client for decrease immunity function Monitor for hyperglycemia Advise the client to report black tarry stools Observe the client for fluid retention and weight gain. This can be common Monitor the clients throat and mouth for aphthous lesions (canker sores) Omalizumab can cause anaphylaxis
Methylxanthines
such as theophylline require close monitoring of serum medication levels due to a narrow therapeutic range. Use only when other treatments are ineffective
A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: a) "Nicotine patches would be appropriate for you." b) "Many options are available for you." c) "I can refer you to the American Lung Association." d) "Have you tried to quit smoking before?"
"Have you tried to quit smoking before?
A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this client's airflow obstruction?
Administer an inhaled beta-adrenergic agonist
Client Education Salmeterol
Advise client to use to prevent an asthma attack and not at the onset of an attack
Client education Ipratropium
Advise the client to suck on hard candies to help relieve dry mouth, increase fluid intake and report headache, blurred vision, or palpitations, which may indicate toxicity of ipratropium. Monitor the clients heart rate
Disease Prevention
Advise the client to use protective equipment (mask) and ensure proper ventilation while working in environments that contain carcinogens or particles in the air Educate the client regarding infection prevention techniques
Asthma Laboratory test Sputum Cultures
Bacteria can indicate infection
Anti-inflammatory agents These are used to decrease airway inflammation and they include
Corticosteroids such as fluticasone and prednisone Leukotriene antagonists such as montelukast, mast cell stabilizers such as cromolyn sodium, and monoclonal antibodies such as omalizumab.
Asthma Assessment Objective data Physical Assessment findings
Coughing Wheezing Mucus production Use of accessory muscles Prolonged exhalation Poor oxygen saturation (low SaO2) Barrel chest or increased chest diameter
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 1 hour."
Asthma Assessment Subjective Data
Dyspnea Chest tightness Anxiety and/or stress
Albuterol
Watch the client for tremors and tachycardia
Client education for people with asthma
Encourage the client to drink plenty of fluids to promote hydration Encourage the client to take prednisone with food Advise client to use this medication to prevent asthma not for the onset of an attack Use good mouth care Do not stop the use of this type of medication suddenly
Pulmonary function test (PFTs) are the most accurate test for diagnosing asthma and its severity
Forced vital capacity (FVC) is the volume of air exhaled from full inhalation to full exhalation. Forced expiratory volume in the first second (FEV1) is the volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation Peak expiratory flow is the fastest airflow rate reached during exhalation A decrease in FEV1 by 15% to 20% below the expected value is common in clients who have asthma. An increase in these values by 12% following the administration of bronchodilators is diagnostic for asthma
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client a) Has wheezes in the right lung lobes b) Reports shortness of breath c) Cannot perform activities of daily living d) Has a respiratory rate of 28 breaths/minute
Has wheezes in the right lung lobes
Asthma Laboratory test ABG's
Hypoxemia (decreased PaO2 less than 80 mm Hg Hypocarbia (decreased PaCO2 less than 35 mm Hg early in attack) Hypercarbia (increased PaCO2 greater than 45 mm Hg-later in attack
A client suffering from chronic obstructive pulmonary disease complains that it is hard to cough up secretions and they are thick and sticky. The nurse should instruct the client to
Increase her fluid intake to thin secretions
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
Combination agents (bronchodilator and anti inflammatory)
Ipratropium and albuterol Fluticasone and almeterol IF prescribed separately for inhalation administration at the same time, administer the bronchodilator first in order to increase the absorption of the anti-inflammatory agent
A nurse is preparing a prescribed dosage of an inhalant medication for a client with asthma. Which of the following explains why inhalation is a good route for medication administration?
It allows the lungs to quickly absorb the medication.
Manifestations of asthma
Mucosal edema Bronchoconstriction Excessive mucus production
Ipratropium
Observe the client for dry mouth
Complications Respiratory failure
Persistent hypoxemia related to asthma can lead to respiratory failure Nursing action Monitor oxygenation levels and acid base balance Prepare for intubation and mechanical ventilation as indicated
Nursing care for clients with asthma
Position the client to maximize ventilation (high fowlers=90) Administer oxygen therapy as prescribed Monitor cardiac rate and rhythm for changes during an acute attack (can be irregular, tachycardic or with PVC's) Initiate and maintain IV access Maintain a calm and reassuring demeanor Provide rest periods for older adult clients who have dyspnea. Design room and walkways with opportunities for rest. Incorporate rest into ADL's Encourage prompt medical attention for infections and appropriate vaccinations Administer medication as prescribed
Nursing actions for Status asthmaticus
Prepare for emergency intubation As prescribed administer oxygen, bronchodilatorys, epinephrine, and initiate systemic steroid therapy
Encourage regular exercise as part of asthma therapy
Promotes ventilation and perfusion Maintains cardiac health Enhances skeletal muscle strength Clients may require pre-medication
A nursing student understands that emphysema is directly related to which of the following? a) Respiratory acidosis from airway obstruction b) Hypercapnia resulting from decreased carbon dioxide tension c) Hypoxemia secondary to impaired oxygen diffusion d) Diminished alveolar surface area
Respiratory acidosis from airway obstruction
Teamwork and collaboration for people with asthma
Respiratory services should be consulted for inhalers and breathing treatments for airway management Nutritional services can be contacted for weight loss or gain related to medications or diagnosis Rehabilitation care can be consulted if the client has prolonged weakness and needs assistance with increasing level of activity
Medications Bronchodilators (inhalers)
Short acting beta2 agonist such as albuterol, provide rapid relief of acute symptoms and prevent exercise induced asthma
Anticholinergic medications
Such as ipratropium block the paracympathetic nervous system. This allows for the sympathetic nervous system effects of increased bronchodilation and decreased pulmonary secretions. These medications are long acting and used to prevent bronchospasms
Choice Multiple question - Select all answer choices that apply. Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. a) Occupational dust b) Second-hand smoke c) Tobacco smoke d) Infection e) Air pollution
Tobacco smoke • Occupational dust • Air pollution • Infection • Second-hand smoke Explanation: Risk factors for chronic obstructive pulmonary disease are tobacco smoke, environmental tobacco smoke, occupational dust and chemicals, indoor and outdoor air pollution, and infection
Chest x-ray
is used to diagnose changes in the clients chest structure over time
Long-acting beta2 agonists
such as slameterol primarily are used for asthma attack prevention
Status asthmaticus
this is a life threatening episode of airway obstruction that is often unresponsive to common treatment. It involves extreme wheezing labored breathing use of accessory muscles distended neck veins and creates a risk for cardiac and/or respiratory arrest
Which of the following is a common irritant that acts as a trigger of asthma? a) Peanuts b) Molds c) Aspirin sensitivity d) Esophageal reflux
Esophageal reflux Explanation: Esophageal reflux, viral respiratory infections, cigarette smoke, and exercise are all irritants that can trigger asthma. Peanuts, aspirin sensitivity, and molds are antigens
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 nursing student just learned that the primary presenting symptom of emphysema is dyspnea. During the clinical rotation that same week, the student is assigned to a patient diagnosed with emphysema. In prioritizing the care for the shift, the student would choose which of the following interventions first? a) Refer to respiratory therapy if labored breathing persists. b) Educate regarding smoking cessation. c) Apply oxygen therapy as ordered. d) Monitor vital signs every 2 hours, including respiratory rate and characteristics.
Monitor vital signs every 2 hours, including respiratory rate and characteristics. Explanation: Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. All the other interventions are correct yet require an assessment prior to their implementation
A client tells the nurse he is experiencing dyspnea. Which action by the nurse is most appropriate?
Placing the client in high Fowler's position
As status asthmaticus worsens, the nurse would expect which acid-base imbalance? a) Metabolic acidosis b) Respiratory acidosis c) Respiratory alkalosis d) Metabolic alkalosis
Respiratory acidosis
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.
Respiratory failure • Atelectasis • Status asthmaticus
A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? a) "If I use the spacer, I know I am only supposed to push on the inhaler once." b) "I do not need to rinse my mouth with this type of inhaler." c) "I will make sure to take a slow, deep breath as I push on my inhaler." d) "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."
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 nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma?
Bilateral wheezes
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 a) Foradil b) Isuprel c) Albuterol d) Atrovent
Albuterol
Choice Multiple question - Select all answer choices that apply. Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply. a) Albuterol is a bronchodilator. b) Prednisone is a corticosteroid. c) Decadron is an antibiotic. d) Ciprofloxacin is an antibiotic. e) Bactrim is a bronchodilator.
Albuterol is a bronchodilator. • Prednisone is a corticosteroid. • Ciprofloxacin is an antibiotic.
Which of the following is the strongest predisposing factor for asthma?` a) Allergy b) Air pollution c) Male gender d) Congenital malformations
Allergy Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk of asthma. Common allergens can be seasonal (grass, tree, and weed pollens) or perennial (mold, dust, roaches, animal dander).
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first? a) An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen b) A 62 year old with emphysema who has 300 mL of intravenous fluid remaining c) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office d) A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26
An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office Explanation: On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD.
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?
Angina
A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse a) States that various blood tests must also be done b) Tells the client that arterial blood gas is performed after spirometry testing c) Asks the client, "What are your allergies?" d) Explains to the client not to eat or drink before the spirometry test
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
The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the MOST important nursing intervention. a) Assess vital signs every 2 hours including O2 saturations and ABG results. b) Apply oxygen as ordered via nasal cannula. c) Educate the importance of pursed lip breathing. d) Refer to respiratory therapy if breathing becomes labored.
Assess vital signs every 2 hours including O2 saturations and ABG results. Explanation: The acuity of the onset and severity of respiratory failure depend on baseline pulmonary function, pulse oximetry or arterial blood gas values, comorbid conditions, and the severity of other complications of COPD.
A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu-Medrol) intravenously. The nurse:
Assesses fasting blood glucose levels
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 a) Pneumonia b) Emphysema c) Pleurisy d) Atelectasis
Atelectasis Explanation: Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).
When a client's ventilation is impaired, the body retains which substance?
Carbon dioxide (CO2)
Although many signs and symptoms lead to a diagnosis of emphysema, one symptom stands as the primary presenting symptom. Which of the following is the primary presenting symptom? a) Chronic and persistent cough b) Dyspnea c) Wheezing d) Tachypnea
Dyspnea Explanation: Dyspnea may be severe and often interferes with the patient's activities. It is usually progressive, worse with exercise, and persistent. As COPD progresses, dyspnea may occur at rest. Chronic cough and sputum production often precede the development of airflow limitation by many years. However, not all people with cough and sputum production develop COPD. The cough may be intermittent and unproductive in some patients.
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
A patient diagnosed with asthma is preparing for discharge. The nurse is educating the patient on the proper use of a peak flow meter. The nurse will instruct the patient to complete which of the following? a) Sit down while completing a peak flow reading. b) Move the indicator to the top of the numbered scale. c) If coughing occurs during the procedure, repeat it. d) Take and record peak flow readings three times daily.
If coughing occurs during the procedure, repeat it. Explanation: Steps for using the peak flow meter correctly include (1) Moving the indicator to the bottom of the numbered scale; (2) standing up; (3) taking a deep breath and filling the lungs completely; (4) placing mouthpiece in mouth and closing lips around mouthpiece; (5) blowing out hard and fast with a single blow; and (6) recording the number achieved on the indicator. If the patient coughs or a mistake is made in the process, repeat the procedure. Peak flow readings should be taken during an asthma attack.
A nurse is assisting a client with mild chronic obstructive pulmonary disease (COPD) to set a goal related to the condition. Which of the following is an appropriate goal for this client? a) Maintain activity level of walking to the mailbox. b) Increase walking distance around a city block without shortness of breath. c) Continue with current level of mobility at home. d) Relieve shortness of breath to a level as close as possible to tolerable.
Increase walking distance around a city block without shortness of breath. Explanation: If the client has mild COPD, goals are to increase exercise and prevent further loss of pulmonary function. The client who increases his walking distance without shortness of breath meets these criteria. If the client has severe COPD, goals are then to preserve current pulmonary function and relieve symptoms as much as possible. Examples of these goals are the other options, in which the activity level is at current and symptoms are relieved to tolerable or close to tolerable
Which of the following measures may increase complications for a patient with COPD?
Increased oxygen supply
A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has what pathophysiologic effect?
Increases the amount of mucus production
The nurse is prioritizing the client's nursing diagnoses. Which nursing diagnosis has the highest priority? a) Self-care Deficit: Bathing related to joint inflammation b) Ineffective Airway Clearance related to retention of secretions c) Constipation related to decreased fluid intake and decreased mobility d) Disturbed Sleep Pattern related to abdominal incisional pain
Ineffective Airway Clearance related to retention of secretions
A nursing student understands the importance of the psychosocial aspects of disease processes. When working with a patient with COPD, the student would rank which of the following nursing diagnoses as the MOST important when analyzing the psychosocial effects? a) Disturbed sleep pattern related to cough b) Ineffective coping related to anxiety c) High risk for ineffective therapeutic regimen management related to lack of knowledge d) Activity intolerance related to fatigue
Ineffective coping related to anxiety Explanation: Any factor that interferes with normal breathing quite naturally induces anxiety, depression, and changes in behavior. Constant shortness of breath and fatigue may make the patient irritable and apprehensive to the point of panic. Although the other choices are correct, the most important psychosocial nursing diagnosis for a patient with COPD is ineffective coping related to a high level of anxiety.
he 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
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 • Overinflated alveoli that impair gas exchange • Mucus secretions that block airways
Which of the following is the key underlying feature of asthma?
Inflammation
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? a) Subcutaneous omalizumab (Xolair) b) Oral sustained-release albuterol (Proventil) c) Oral prednisone (Deltasone) d) Inhaled beclomethasone (Beconase)
Inhaled beclomethasone (Beconase)
A patient is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which of the following medications is contraindicated in the treatment of asthma exacerbations? a) Intal (Cromolyn Sodium) b) Atrovent (Ipratropium) c) Proventil (Albuterol) d) Xopenex (Levalbuterol HFA)
Intal (Cromolyn Sodium) Explanation: Intal is contraindicated in patients with acute asthma exacerbation. Indications for Intal are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Intal is also a preventive treatment prior to exposure to exercise or known allergen. Proventil (albuterol), Xopenex (levalbuterol HFA), and Atrovent (ipratropium) can be used to relieve acute symptoms
A nurse is caring for a young adult patient whose medical history includes an alpha1-antitrypsin deficiency. This deficiency predisposes the patient to what health problem? a) Cystic fibrosis (CF) b) Pulmonary edema c) Empyema d) Lobular emphysema
Lobular emphysema Explanation: A host risk factor for COPD is a deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patient's risk of pulmonary edema, CF, or empyema.
Choice Multiple question - Select all answer choices that apply. The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a patient diagnosed with COPD. The nurse correctly includes which of the following medications? Select all that apply. a) Zyban b) Catapres c) Nicotine gum d) Chantix e) Wellbutrin
Nicotine gum • Zyban • Wellbutrin Explanation: First-line therapy includes nicotine gum, Zyban, and Wellbutrin. Second-line pharmacotherapy includes the antihypertensive agent clonidine (Catapres). However, the use of clonidine is limited by its side effects. Varenicline (Chantix), a nicotinic acetylcholine receptor partial agonist, may also assist in smoking cessation.
A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding?
Obstructive lung disease
Asthma Assessment Risk factors
Older adult clients have decreased pulmonary reserves due to physiologic lung changes that occur with the aging process Older clients are more susceptible to infections The sensitivity of beta-adrenergic receptors decreases with age. As the beta receptors age and lose sensitivity, they are less able to respond to agonist, which relax smooth muscle and can result in bronchospasm Family history of asthma Smoking Secondhand smoke exposure Environmental allergies Exposure to chemical irritants or dust Gastroesophageal reflux disease (GERD)
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 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
The nurse is caring for a patient with COPD. In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amounts of red blood cells. Which of the following is the term for this process?
Polycythemia
The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client a) Immediately repeats the second puff after the first puff b) Positions the inhaler 1 to 2 inches away from his open mouth c) Carefully holds the inhaler upright without shaking it d) Holds the breath for 5 seconds after administering the medication
Positions the inhaler 1 to 2 inches away from his open mouth Explanation: To administer a metered-dose inhaler, the client holds the inhaler upright and shakes the inhaler. The inhaler is positioned 1 to 2 inches away from the client's open mouth. After administering the medication, the client holds the breath for as long as possible, at least 10 seconds. The client may administer the next puff in 15 to 30 seconds
Which diagnostic is the most accurate in assessing acute airway obstruction? a) Pulmonary function studies b) Chest x-ray c) Arterial blood gases (ABGs) d) Pulse oximetry
Pulmonary function studies Explanation: Pulmonary function studies are the most accurate means of assessing acute airway obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics for an airway obstruction.
A nurse is caring for a male patient with COPD. While reviewing breathing exercises, the nurse instructs the patient to breathe in slowly through the nose, taking in a normal breath. Then, the nurse asks the patient to pucker his lips as if preparing to whistle. Finally, the patient is told to exhale slowly and gently through the puckered lips. The nurse teaches the patient this breathing exercise to accomplish which of the following? Select all that apply.
Release trapped air in the lungs • Prevent collapse of the airways • Control the rate and depth of respirations
A 4-year-old child is being treated for status asthmaticus. His arterial blood gas analysis reveals a pH of 7.28, PaCO2 of 55 mm Hg, and HCO3− of 26 mEq/L. What condition do these findings indicate?
Respiratory acidosis
A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care?
Setting realistic short-term and long-range goals
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 influenza
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.) a) The device may increase delivery of the MDI medication. b) Take a slow, deep inhalation from the device. c) Activate the MDI once. d) Use normal inhalations with the device. e) It is not necessary to hold your breath after using.
Take a slow, deep inhalation from the device. • Activate the MDI once. • The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.
For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway?
Teaching the client how to perform controlled coughing
A patient is receiving theophylline (Theo-Dur) for long-term control and prevention of asthma symptoms. Patient teaching related to this medication will include which of the following?
The importance of blood tests to monitor serum concentrations
A commonly prescribed methylxanthine used as a bronchodilator is which of the following? a) Albuteral b) Terbutaline c) Theophylline d) Levalbuteral
Theophylline
A patient with chronic obstructive pulmonary disease has been prescribed an inhaled bronchodilator. Which of the following techniques should the nurse implement in order to ensure safe and complete delivery of the prescribed medication?
Use a spacer or extender with the metered-dose inhaler.
A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?
Use diaphragmatic breathing
Which of the following would not be considered a primary symptom of COPD? a) Cough b) Sputum production c) Weight gain d) Dyspnea on exertion
Weight gain
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 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: a) albuterol. b) morphine. c) propranolol. d) alprazolam.
albuterol.
When assessing a client with asthma, which findings would most likely indicate the presence of a respiratory infection?
cough productive of yellow sputum
he nurse understands that a client with acute respiratory distress related to asthma may experience
dyspnea, wheezing, and polycythemia
A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.6° F (37° C). To help correct respiratory alkalosis, the nurse should:
instruct the client to breathe into a paper bag.
An 11-year-old is admitted for treatment of an asthma attack. Which finding indicates immediate intervention is needed?
intercostal retractions
Which set of arterial blood gas (ABG) results requires further investigation? a) pH 7.44, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L b) pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L c) pH 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L d) pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L
pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L
The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right-sided heart failure. Which sign or symptom should be included in the teaching plan?
peripheral edema
A client has just been diagnosed as being in status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: a) respiratory acidosis b) metabolic alkalosis c) metabolic acidosis d) respiratory alkalosis
respiratory alkalosis Explanation: During status asthmaticus, there is a reduced PaCO2 and initial respiratory alkalosis, with a decreased PaCO2 and an increased pH. As status asthmaticus worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.
A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? a) salmeterol/fluticasone (Seretide) MDI daily at 0800 b) prednisone 5 mg oral daily at 0800 c) azithromycin (Zithromax) 600 mg oral daily for 10 days at 0800, on day 4 d) nicotine patch (Nicoderm) 21 mg 1 patch daily at 0800
salmeterol/fluticasone (Seretide) MDI daily at 0800
A nurse is caring for a client who has end-stage chronic obstructive pulmonary disease receiving IV push morphine for pain management. During rounds, the nurse discusses with the physician the need to begin the client on a continuous morphine infusion. The nurse bases this request on
servicing as a client advocate is an important role.
A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
take prescribed medications as scheduled.
Choice Multiple question - Select all answer choices that apply. 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. a) Fractured hip b) Gastrointestinal viruses c) Tracheobronchial infection d) Air pollution e) Hypertension
• 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
Choice Multiple question - Select all answer choices that apply. Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. a) Ipratropium HFA (Atrovent) b) Zafirlukast (Accolate) c) Zileuton (Zyflo) d) Tiotropium (Spiriva) e) Montelukast (Singulair)
• Montelukast (Singulair) • Zafirlukast (Accolate) • Zileuton (Zyflo) Explanation: Singulair, Accolate, and Zyflo are leukotriene modifiers. Atrovent is a short-acting anticholinergic. Spiriva is a long-acting anticholinergic.
Choice Multiple question - Select all answer choices that apply. A patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's condition. Which of the following are therapy goals? Select all that apply. a) Treat the underlying cause of the event. b) Provide long-term support for medical management. c) Provide medical support for the current exacerbation. d) Teach the patient to suspend activity. e) Return the patient to his original functioning abilities.
• Provide medical support for the current exacerbation. • Treat the underlying cause of the event. • Return the patient to his original functioning abilities. • Provide long-term support for medical management. Explanation: The goal is to have a stable patient with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the patient can live a reasonably normal life. With adequate management, patients should not have to give up their usual activities.
