Gas exchange
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? -"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day." -"Limit yourself to smoking only 2 cigarettes per day." -"Eat a high-sodium diet." -"Maintain bed rest."
"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day."
When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which instruction? -Avoid exposure to people with known respiratory infections. -Maintain a high-protein diet. -Participate regularly in aerobic exercises. -Abstain from cigarette smoking.
Abstain from cigarette smoking.
A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which statement is true concerning oxygen administration to a client with COPD? -High oxygen concentrations will cause coughing and dyspnea. -Increased oxygen use will cause the client to become dependent on the oxygen. -High oxygen concentrations may inhibit the hypoxic stimulus to breathe. -Administration of oxygen is contraindicated in clients who are using bronchodilator
High oxygen concentrations may inhibit the hypoxic stimulus to breathe.
A client with an exacerbation of chronic obstructive pulmonary disease (COPD) is admitted to the hospital. Which nursing diagnosis requires the nurse to collaborate with other health team members to achieve the best outcome for the client? -Impaired skin integrity -Imbalanced nutrition: Less than body requirements -Impaired gas exchange -Activity intolerance
Impaired gas exchange
While making rounds, the nurse finds a client with chronic obstructive pulmonary disease sitting in a wheelchair, slumped over a lunch tray. After determining the client is unresponsive and calling for help, what should the nurse do next? -Open the client's airway. -Call the rapid response team. -Push the "code blue" (emergency response) button. -Call for a defibrillator.
Open the client's airway.
Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration? -The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing. -The cells in the alveoli are so damaged by the client's long history of respiratory problems that increased oxygen levels and reduced carbon dioxide levels likely will cause the cells to burst. -The client's long history of respiratory problems indicates that he would be unable to absorb oxygen given at a higher rate. -The oxygen will be lost at the client's nostrils if given at a higher level with a nasal cannula
The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing.
The nurse is assessing the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which finding is expected? -prolonged inspiration -normal breath sounds -normal chest movement -coarse crackles and rhonchi
coarse crackles and rhonchi
A home health nurse sees a client with end-stage chronic obstructive pulmonary disease (COPD). An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? -increased white blood cell count -decreased oxygen requirements -increased sputum production -decreased activity tolerance
decreased oxygen requirements
When developing a discharge plan with a client with chronic obstructive pulmonary disease (COPD), what information should the nurse include in the plan? People with COPD: -require less supplemental oxygen. -develop respiratory infections easily. -usually maintain their current status. -show permanent improvement.
develop respiratory infections easily.
An adult with a history of chronic obstructive pulmonary disease (COPD) and metastatic carcinoma of the lung has not responded to radiation therapy and is being admitted to the hospice program. The nurse should conduct a focused assessment for which symptom? -pleural friction rub -dyspnea -ascites -peripheral edema
dyspnea
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 -full-liquid -high-protein -low-fat
high-protein
When assessing a client with advanced chronic obstructive pulmonary disease (COPD) which are expected findings? -collapsed neck veins -increased anteroposterior chest diameter -increased chest excursions with respiration -underdeveloped neck muscles
increased anteroposterior chest diameter
The nurse is caring for a client with asthma. The nurse should conduct a focused assessment to detect: -morning headaches. -increased forced expiratory volume. -normal breath sounds. inspiratory and expiratory wheezing.
inspiratory and expiratory wheezing.
Which is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? -increasing carbon dioxide levels in the blood -treating infectious agents -maintaining functional ability -minimizing chest pain
maintaining functional ability
The nurse is offering further education to a client about the management of COPD. Which outcomes would indicate the teaching has been effective? Select all that apply. -The client maintains smoking cessation. -The client schedules follow-up physician appointments. -The client demonstrates pursed-lip breathing and coughing exercises. -The client continues to smoke four cigarettes a day. -The client exercises daily for 2 hours.
-The client demonstrates pursed-lip breathing and coughing exercises. -The client maintains smoking cessation. -The client schedules follow-up physician appointments.
During assessment, a nurse auscultates for a client's breath sounds. Auscultation provides which type of data? -subjective -secondary source -medical -objective
objective
A physician orders supplemental oxygen for a client with a respiratory problem. Which oxygen delivery device should the nurse use to provide the highest possible oxygen concentration? -venturi mask -nasal cannula -simple mask -nonrebreather mask
nonrebreather mask
The nurse is caring for a client who has experienced severe multiple trauma. The client's arterial blood gases reveal low arterial oxygen levels that are not responsive to high concentrations of oxygen. This finding is an indicator of the development of which of the following conditions? -Hypovolemic shock. -Asthma. -Hospital-acquired pneumonia. -Acute respiratory distress syndrome (ARDS).
Acute respiratory distress syndrome (ARDS).
Which statement indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands the care plan? The client: -will avoid direct contact with family and friends. -agrees to call the health care provider (HCP) if dyspnea on exertion increases. -can state actions to reduce pain. -will use oxygen via a nasal cannula at 5 L/min.
agrees to call the health care provider (HCP) if dyspnea on exertion increases.
A client experiencing a severe asthma attack has the following arterial blood gas results: pH 7.33; Pco2 48 mm Hg (6.4 kPa); Po2 58 mm Hg (7.7 kPa); HCO3 26 mEq/L (26 mmol/L). Which prescription should the nurse implement first? -albuterol nebulizer -sputum culture -chest X-ray -ipratropium inhaler
albuterol nebulizer
Which client would be most appropriate for the nurse to assign to an unlicensed assistive personnel (UAP) for morning care? -a middle-aged client who had a laryngectomy 2 days earlier -a young client receiving chemotherapy for Hodgkin's disease -an elderly client experiencing chest pain due to suspected pulmonary embolus -an elderly client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy for mild dyspnea
an elderly client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy for mild dyspnea
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? -a respiratory rate of 12 breaths/minute -a transverse chest diameter twice that of the anteroposterior diameter -an oxygen saturation of 94% -an inspiratory-expiratory (I:E) ratio of 1:3
an inspiratory-expiratory (I:E) ratio of 1:3 *he normal I:E ratio is 1:2, meaning that expiration takes twice as long as inspiration. A ratio of 1:3 may be seen in clients with COPD because inspiration is shorter than expiration. A client with COPD typically has a barrel chest in which the anteroposterior diameter is larger than the transverse chest diameter. A client with COPD usually has a respiratory rate greater than 12 breaths/minute and an oxygen saturation rate below 93%.
A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should -maintain the client on bed rest. -instruct the client to drink 2 L of fluid daily. -administer anxiolytics, as ordered, to control anxiety. -administer pain medication as ordered.
instruct the client to drink 2 L of fluid daily.
A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse's next action is based on the principle that: -it may be necessary to raise the head of this client's bed. -a quiet environment should be provided. -this client may need intubation. -encouraging the client to void before the medication takes effect will promote safety.
it may be necessary to raise the head of this client's bed.
A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) who is being discharged after treatment for an acute exacerbation. Which statement by the client indicates proper understanding of the discharge instructions? -"I should try to eat several small meals during the day." -"I should plan to do most of my exercises after I eat." -"I should do my most difficult activities when I first get up in the morning." -"I should take my bronchodilator at bedtime to prevent insomnia."
"I should try to eat several small meals during the day."
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? -hypertension -increased appetite -clubbing of nail beds -peripheral edema
peripheral edema
For a client with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? -using a Venturi mask to deliver oxygen as ordered -keeping the client in low-Fowler's position -encouraging the client to drink 3 glasses of fluid daily -administering a sedative as ordered
using a Venturi mask to deliver oxygen as ordered
The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). The results are as follows: pH 7.35; Pco2 62 (8.25 kPa); Po2 70 (9.31 kPa); HCO3 34 mEq/L (34 mmol/L). What should the nurse do first? -Assess the vital signs. -Prepare for intubation. -Reposition the client. -Apply a 100% nonrebreather mask.
Assess the vital signs.
