Prep U--Ex. 4-Ch. 24 (Med Surg) Chronic Pulmonary Disease

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 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

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 In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)?

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 do not account for the majority.

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? Activity intolerance related to fatigue Anxiety related to actual threat to health status Risk for infection related to retained secretions Impaired gas exchange related to airflow obstruction

Impaired gas exchange related to airflow obstruction Explanation: A patent airway and an adequate breathing pattern are the top priority for any client, making Impaired gas exchange related to airflow obstruction the most important nursing diagnosis. Although Activity intolerance, Anxiety, and Risk for infection may also apply to this client, they aren't as important as Impaired gas exchange.

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?

Respiratory alkalosis Respiratory alkalosis (low PaCO2) is the most common finding in patients with an ongoing asthma exacerbation and is due to hyperventilation.

A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed?

With meals Nearly 90% of patients with cystic fibrosis have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals.

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. During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can't get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles don't replace wheezes during an acute asthma attack.

The classification of Stage IV of COPD is defined as mild COPD. at risk for COPD. moderate COPD. very severe 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 nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "I will shake the MDI container before I use it." "I can't use a spacer or holding chamber with the MDI." "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." "I will take a slow, deep breath in after pushing down on the MDI."

"I can't use a spacer or holding chamber with the MDI."

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?" All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: "Nicotine patches would be appropriate for you." "Have you tried to quit smoking before?" "I can refer you to the American Lung Association." "Many options are available for you."

"Have you tried to quit smoking before?" Explanation: All the options are appropriate statements; however, the nurse needs to assess the client's statement further. Assessment data include information about previous attempts to quit smoking.

The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction?

"I can't use a spacer or holding chamber with the MDI." The patient can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining patient statements are accurate and indicate the patient understands how to use the MDI correctly.

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?

"I do not need to rinse my mouth with this type of inhaler." Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation ... Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The patient should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

The clinic nurse is caring for a client who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The client asks the nurse what COPD means. What would be the nurse's best response? "It is an umbrella term for diseases like acute bronchitis." "It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." "It means your lungs can't expand and contract like they are supposed to which makes it hard for you to breathe." "It is a term that covers so many lung diseases I can't list them all."

"It means that the lungs have been damaged in such a way that there is limited airflow in and out of the lungs." Explanation: Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs.

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 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 pulm ... (more) 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.

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? a) "You and your physician should discuss the options that are available for treatment." b) "At this point, do you really want to go through something like that?" c) "You would have a difficult time recovering from the procedure." d) "You are not a candidate because you have heart failure."

"You and your physician should discuss the options that are available for treatment." Treatment options for patients 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 patients 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, 2010).

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent?

90% The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.

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 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 physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs?

Administer the salmeterol and then administer the triamcinolone. A client with asthma typically takes bronchodilators and uses corticosteroid inhalers to prevent acute episodes. Triamcinolone is a corticosteroid; Salmeterol is an adrenergic stimulant (bronchodilator). If the client is ordered a bronchodilator and another inhaled medication, the bronchodilator should be administered first to dilate the airways and to enhance the effectiveness of the second medication. The client may not choose the order in which these drugs are administered because they must be administered in a particular order. Monitoring the client's theophylline level isn't necessary before administering these drugs because neither drug contains theophylline.

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Ipratropium bromide Fluticasone propionate Ipratropium bromide and albuterol sulfate Albuterol

Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

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

Albuterol Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What drug would the nurse know to administer to the client? Ipratropium bromide Albuterol Formoterol Isoproterenol

Albuterol Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

Which is the strongest predisposing factor for asthma? Allergy Congenital malformations Male gender Air pollution

Allergy

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 An oxygen saturation of 99% A transverse chest diameter twice that of the anteroposterior diameter A respiratory rate of 12 breaths/minute

An inspiratory-expiratory (I:E) ratio of 2:1

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 Patients, especially older adults, with pre-existing cardiovascular disease may have adverse cardiovascular reactions with inhaled therapy. Albuterol does not increase the secretions of the GI tract or cause gastric irritation. It will not worsen a peptic ulcer.

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? Anxiety Imbalanced nutrition: More than body requirements Impaired swallowing Unilateral neglect

Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

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?

Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxiety is a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

Which of the following is the most common chronic disease of childhood? Autism Cerebral palsy Asthma Obesity

Asthma

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 Emphysema Pleurisy Pneumonia

Atelectasis In bronchiectasis, the retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (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 Emphysema Pleurisy Pneumonia

Atelectasis Retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (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 Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).

Which of the following is true about both lung transplant and bullectomy?

Both are aimed at improving the overall quality of life of a patient with COPD. The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient 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 patients with bullous emphysema.

Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)? Occupational exposure Cigarette smoking Air pollution Genetic abnormalities

Cigarette smoking Pipe, cigar, and other types of tobacco smoking are also risk factors for COPD. Although risk factors, neither occupational exposure nor air pollution is the most important risk factor for development of COPD. Genetic abnormalities are also a risk factor, but again, not the most important one.

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 environmental risk factor for emphysema?

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.

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:

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.

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:

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.

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 Ascites Wheezes Decreased airflow Jugular vein distention

Compromised gas exchange Wheezes Decreased airflow

A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? Albuterol Cromolyn sodium Budesonide Theophylline

Cromolyn sodium

Which of the following is a symptom diagnostic of emphysema? Dyspnea Copious sputum production The occurrence of corpulmonale Normal elastic recoil

Dyspnea

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?

Dyspnea 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.

Which of the following is a symptom diagnostic of emphysema?

Dyspnea Dyspnea is characteristic of emphysema. A chronic cough is considered the primary symptom of chronic bronchitis. Refer to Table 11-1 in the text.

Which of the following is a common irritant that acts as a trigger of asthma?

Esophageal reflux Esophageal reflux, viral respiratory infections, cigarette smoke, and exercise are all irritants that can trigger asthma. Peanuts, aspirin sensitivity, and molds are antigens

Which of the following is not a primary symptom of COPD? Cough Sputum production Weight gain Dyspnea upon exertion

Weight gain

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 Inhales deeply and holds the breath Records in a diary the number achieved after one breath Sits in a straight-back chair and leans forward

Exhales hard and fast with a single blow Explanation: To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.

Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? Passive smoking Ambient air pollution Occupational exposure Exposure to tobacco smoke

Exposure to tobacco smoke

Which exposure accounts for most cases of COPD? Exposure to tobacco smoke Occupational exposure Passive smoking Ambient air pollution

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.

Which of the following exposures accounts for most of the risk factors for COPD?

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.

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% The FEV1 decreases as the severity of obstruction increases. Therefore, an FEV1 of more than 80% indicates an initial stage, and an FEV1 of 30% indicates a very severe stage.

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? Full-liquid High-protein 1,800-calorie ADA Low-fat

High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

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 Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

In which grade of COPD is the forced expiratory volume (FEV) less than 30%? I II III IV

IV Clients with grade III COPD demonstrate an FEV1 less than 30-50% predicted, with respiratory failure or clinical signs of right heart failure. Grade I is mild COPD, with an FEV1 ≥80% predicted. Clients with grade II COPD demonstrate an FEV1 of 50-80% predicted. Grade IV is characterized by FEV1 less 30% predicted.

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Although teaching the family how to perform postural drainage and instructing the patient on the signs of respiratory infection are important, they are not the nurse's primary focus. The presence of a large amount of mucus may decrease the patient's appetite and result in an inadequate dietary intake; therefore, the patient's nutritional status is assessed and strategies are implemented to ensure an adequate diet.

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?

Increase walking distance around a city block without shortness of breath. 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 vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? Influenza Human papilloma virus (HPV) Hepatitis B Varicella

Influenza

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? It increases inspiratory muscle strength. It helps prevent early airway collapse. It prolongs the inspiratory phase of respiration. It decreases use of accessory breathing muscles.

It helps prevent early airway collapse.

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

It helps prevent early airway collapse. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

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? Heart rate Lung sounds Skin color Respiratory rate

Lung sounds

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 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? a) Intravenous methylprednisolone (Solu-Medrol) 120 mg b) Vancomycin 1 gram intravenously over 1 hour c) Ipratropium bromide (Alupent) by metered-dose inhaler d) Oxygen through nasal cannula at 2 L/minute

Oxygen through nasal cannula at 2 L/minute All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care?

Performing chest physiotherapy as ordered Nursing care includes helping patients manage pulmonary symptoms and prevent complications. Specific measures include strategies that promote removal of pulmonary secretions, chest physiotherapy, and breathing exercises. In addition, the nurse emphasizes the importance of an adequate fluid and dietary intake to promote removal of secretions and to ensure an adequate nutritional status. The patient with CF also experiences increased salt content in sweat gland secretions; thus, it is important to ensure the patient consumes a diet that is adequate in sodium. As the disease progresses, the patient will develop increasing hypoxemia. In this situation, preferences for end-of-life care should be discussed, documented, and honored; however, there is no indication that the patient terminally ill.

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 Polycythemia is an increase in the red blood cell concentration in the blood. In COPD, the body attempts to improve oxygen-carrying capacity by producing increasing amounts of red blood cells.

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Combivent Atrovent Flovent Proventil

Proventil

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? Increasing pH Providing sufficient oxygen to improve oxygenation Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Avoiding the use of oxygen to decrease the hypoxic drive

Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Respiratory acidosis As status asthmaticus worsens, the PaCO increases and the pH decreases, reflecting respiratory acidosis.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Avoid contact with fur-bearing animals. Take ordered medications as scheduled. Avoid goose down pillows. Change filters on heating and air conditioning units frequently.

Take ordered medications as scheduled.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? -Avoid contact with fur-bearing animals. -Change filters on heating and air conditioning units frequently. -Take ordered medications as scheduled. -Avoid goose down pillows.

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.

Which of the following would not be considered a primary symptom of COPD?

Weight gain COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion. Weight loss is common with COPD.

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?

The patient should take the medication an hour before meals or 2 hours after a meal. The nurse should instruct the patient to take the leukotriene receptor antagonist at least 1 hour before meals or 2 hours after meals.

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 The client with COPD retains carbon dioxide, which inhibits stimulation of breathing by the medullary center in the brain. As a result, low oxygen levels in the blood stimulate respiration, and administering unspecified, unmonitored amounts of oxygen may depress ventilation. To promote adequate gas exchange, the nurse should use a Venturi mask to deliver a specified, controlled amount of oxygen consistently and accurately. Drinking three glasses of fluid daily wouldn't affect gas exchange or be sufficient to liquefy secretions, which are common in COPD. Clients with COPD and respiratory distress should be placed in high Fowler's position and shouldn't receive sedatives or other drugs that may further depress the respiratory center.

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: pleural effusion. pulmonary edema. oxygen toxicity. atelectasis.

atelectasis.

The nurse is caring for a patient with COPD. The patient is receiving oxygen therapy via nasal cannula. The nurse understands that the goal of oxygen therapy is to maintain the patient's SaO2 level at or above what percent? a) 70% b) 50% c) 30% d) 90%

d. 90% The goal of supplemental oxygen therapy is to increase the baseline resting partial arterial pressure of oxygen (PaO2) to at least 60 mm Hg at sea level and arterial oxygen saturation (SaO2) to at least 90%.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: -paradoxical chest wall movement with respirations. -muffled or distant heart sounds. -diminished or absent breath sounds on the affected side. -tracheal deviation to the unaffected side.

diminished or absent breath sounds on the affected side.

A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes: -providing the client a low-calorie, high-fiber diet. -teaching the family how to perform postural drainage. -implementing measures to clear pulmonary secretions. -instructing the client on the signs of respiratory infection.

implementing measures to clear pulmonary secretions.

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: instruct the client to drink at least 2 L of fluid daily. administer pain medication as ordered. maintain the client on bed rest. administer anxiolytics, as ordered, to control anxiety.

instruct the client to drink at least 2 L of fluid daily.

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?

salmeterol/fluticasone (Seretide) MDI daily at 0800 When providing information about medications, the nurse needs to include right drug, right dose, right route, right frequency, and right time. Salmeterol/fluticasone does not include how many puffs the client is to take.

The classification of Stage III of COPD is defined as: at risk for COPD. mild COPD. severe COPD. very severe COPD. moderate 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 nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he:

uses the sternocleidomastoid muscles. Use of accessory muscles indicates worsening breathing conditions. Assuming the tripod position, a 93% pulse oximetry reading, and a request for the nurse to raise the head of the bed don't indicate that the client's condition is worsening.

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.

• Albuterol is a bronchodilator. • Ciprofloxacin is an antibiotic. • Prednisone is a corticosteroid. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.

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) Decadron is an antibiotic. c) Bactrim is a bronchodilator. d) Prednisone is a corticosteroid. e) Ciprofloxacin is an antibiotic.

• Prednisone is a corticosteroid. • Albuterol is a bronchodilator. • Ciprofloxacin is an antibiotic. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone (Decadron) and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole (Bactrim) are antibiotics. These are all drugs that could be prescribed to a patient with COPD.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

• Wheezes • Compromised gas exchange • Decreased airflow Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD.

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? a) "Eat a high-sodium diet." b) "Maintain bed rest." c) "Weigh yourself daily and report a gain of 2 lb in 1 day." d) "Limit yourself to smoking only 2 cigarettes per day."

"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.

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse?

"You and your physician should discuss the options that are available for treatment." Treatment options for patients 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 patients 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.

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 mm Hg; 90% 54 mm Hg; 84% 56 mm Hg; 86% 58 mm Hg; 88%

60 mm Hg; 90%

Which statement describes emphysema? -A disease of the airways characterized by destruction of the walls of overdistended alveoli -Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years -A disease that results in reversible airflow obstruction, a common clinical outcome -Chronic dilatation of a bronchus or bronchi

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 Status epilepticus 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 being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? Completion of a 12-lead ECG Client education: avoidance of irritants like smoke and pollutants Administration of antibiotics Administration of corticosteroids and bronchodilators

Administration of antibiotics

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) Atrovent d) Albuterol

Albuterol Short-acting beta2-adrenergic agonists include albuterol, levalbuterol, and pirbuterol. They are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. They are used to relax smooth muscle.

In which statements regarding medications taken by a client diagnosed with COPD do 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. Theophylline, albuterol, and atropine are bronchodilators. Dexamethasone and prednisone are corticosteroids. Amoxicillin, ciprofloxacin, and cotrimoxazole are antibiotics. All of these drugs could be prescribed to a client with COPD.

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. Cotrimoxazole is a bronchodilator. Albuterol is a bronchodilator. Prednisone is a corticosteroid. Dexamethasone is an antibiotic. Ciprofloxacin is an antibiotic.

Albuterol is a bronchodilator. Prednisone is a corticosteroid. Ciprofloxacin is an antibiotic.

Which of the following is the strongest predisposing factor for asthma?

Allergy Allergy is the strongest predisposing factor for asthma.

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?

Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxietyis a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

A 55-year-old client is scheduled for spirometry testing for evaluation of chronic obstructive pulmonary disease (COPD). The nurse: Asks the client, "What are your allergies?" Explains to the client not to eat or drink before the spirometry test States that various blood tests must also be done Tells the client that arterial blood gas is performed after spirometry testing

Asks the client, "What are your allergies?" 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 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 Pneumonia Emphysema Pleurisy

Atelectasis

You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for what? Pain Atelectasis Impaired physical mobility Side effects of medication therapy

Atelectasis Explanation: For a client with obstructive pulmonary disease, atelectasis is one of the conditions for which nursing actions are identified to detect, manage, and minimize the unexpected outcomes.

Which statement is true about both lung transplant and bullectomy? Both procedures treat patients with bullous emphysema. Both procedures treat end-stage emphysema. Both procedures cure COPD. 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 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. 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.

Which of the following occupy space in the thorax, but do not contribute to ventilation?

Bullae Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

Which of the following is a second-line pharmacotherapy for smoking abstinence?

Catapres Second-line pharmacotherapy includes the antihypertensive agent clonidine (Catapres). However, its use is limited by its side effects. First-line therapy includes nicotine gum, Zyban, and Wellbutrin.

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?

Cromolyn sodium Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Albuterol is a long-acting beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator.

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 COPD may include diseases that cause airflow obstruction (e.g., emphysema, chronic bronchitis) or any combination of these disorders. Other diseases such as cystic fibrosis, bronchiectasis, and asthma that were previously classified as types of COPD are now classified as chronic pulmonary disorders. Asthma is now considered a distinct, separate disorder and is classified as an abnormal airway condition characterized primarily by reversible inflammation.

Which of the following exposures accounts for most of the risk factors for COPD?

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.

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client: Has wheezes in the right lung lobes Has a respiratory rate of 28 breaths/minute Reports shortness of breath Cannot perform activities of daily living

Has wheezes in the right lung lobes Explanation: Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

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 Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption. Full liquids, 1,800-calorie ADA, and low-fat diets aren't appropriate for a client with COPD.

Asthma is cause by which type of response? IgE-mediated IgA-mediated IgD-mediated IgM-mediated

IgE-mediated Explanation: 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 has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?

Inhaled albuterol (Ventolin) For intermittent asthma, the preferred treatment is with an inhaled short-acting beta2-agonist. The other treatments are for persistent asthma.

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? Lung sounds Skin color Heart rate 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.

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? Eosinophils Lymphocytes Mast cells Neutrophils

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.

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Proventil Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a cor ... (more) Proventil, a SABA, is given to asthmatic patients for quick relief of symptoms. Atrovent is an anticholinergic. Combivent is a combination SABA/anticholinergic, and Flovent is a corticosteroid.

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? Providing sufficient oxygen to improve oxygenation Avoiding the use of oxygen to decrease the hypoxic drive Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Increasing pH

Providing sufficient oxygen to improve oxygenation Explanation: The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Metabolic acidosis Respiratory acidosis Metabolic alkalosis Respiratory alkalosis

Respiratory acidosis

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 alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

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 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 a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

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?

Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

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?

Stage II All grades of COPD are associated with an FEV1/FVC ratio of less than 70%. Grade I (mild) is associated with an FEV1 of greater than or equal to 80%. Grade II (moderate) is associated with an FEV1 of 50%-80%. Grade III is associated with an FEV1 of <30%-50%. Grade IV is associated with an FEV1 of <30%.

In which stage of COPD is the forced expiratory volume (FEV) less than 30%?

Stage III Stage III patients demonstrate an FEV less than 30% with respiratory failure or clinical signs of right heart failure. Stage II patients demonstrate an FEV of 30% to 80%. Stage I is mild COPD with an FEV less than 70%. Stage 0 is characterized by normal spirometry.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.) a) Wheezes b) Decreased airflow c) Compromised gas exchange d) Ascites e) Jugular vein distention

Wheezes • Decreased airflow • Compromised gas exchange Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2010).

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 (Depo-medrol) 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:

albuterol (Proventil). The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client's greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It's given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished. Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client's breathing. Propranolol is contraindicated in a client who's wheezing because it's a beta2 adrenergic antagonist. Morphine is a respiratory center depressant and is contraindicated in this situation.

Which of the following is true about both lung transplant and bullectomy? a) Both are aimed at curing COPD. b) Both are aimed at treating end-stage emphysema. c) Both are used to treat patients with bullous emphysema. d) Both are aimed at improving the overall quality of life of a patient with COPD.

d. Both are aimed at improving the overall quality of life of a patient with COPD. The treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a patient 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 patients with bullous emphysema.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: -diminished or absent breath sounds on the affected side. -paradoxical chest wall movement with respirations. -tracheal deviation to the unaffected side. -muffled or distant heart sounds.

diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed apneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side. In the case of a pneumothorax, auscultating for breath sounds will reveal absent or diminished breath sounds on the affected side. Paradoxical chest wall movements occur in flail chest conditions. Tracheal deviation occurs in a tension pneumothorax. Muffled or distant heart sounds occur in cardiac tamponade.

The classification of Stage I of COPD is defined as: mild COPD. moderate COPD. severe COPD. very severe COPD.

mild COPD. Stage I is mild COPD. Stage 0 is at risk for COPD. Stage III is severe COPD. Stage IV is very severe COPD.

The classification of Stage II of COPD is defined as: at risk for COPD. moderate COPD. severe COPD. very severe COPD. mild 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.

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. Reduce airway obstruction Decrease alveolar ventilation Alter smooth muscle tone Increase oxygen distribution

• Reduce airway obstruction • Alter smooth muscle tone • Increase oxygen distribution Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

• Wheezes • Decreased airflow • Compromised gas exchange Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with 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% 56 mm Hg; 86% 58 mm Hg; 88% 60 mm Hg; 90%

60 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.

Emphysema is described by which of the following statements? a) A disease of the airways characterized by destruction of the walls of overdistended alveoli b) A disease that results in a common clinical outcome of reversible airflow obstruction c) Chronic dilatation of a bronchus or bronchi d) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of two consecutive years

A disease of the airways characterized by destruction of the walls of overdistended alveoli Emphysema is a category of COPD. 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.

Emphysema is described by which of the following statements?

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 over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, 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 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

Emphysema is described by which of the following statements? a) A disease that results in a common clinical outcome of reversible airflow obstruction b) Presence of cough and sputum production for at least a combined total of 2 to 3 months in each of 2 consecutive years c) Chronic dilatation of a bronchus or bronchi d) A disease of the airways characterized by destruction of the walls of overdistended alveoli

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 over-distended alveoli. Emphysema is a pathologic term that describes an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli. Also, 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 2 consecutive years. Bronchiectasis is a condition of chronic dilatation of a bronchus or bronchi.

A patient is being treated in the ED for respiratory distress, coupled with pneumonia. The patient has no past medical history. However, the patient works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which of the following orders based on immediate needs for the patient?

Administration of antibiotics Antibiotics are administered to treat respiratory tract infections. Chronic bronchitis is inflammation of the bronchi caused by irritants or infection. Hence, smoking cessation and avoiding pollutants are necessary to slow the accelerated decline of the lung tissue. However, the immediate priority in this case is to cure the infection, pneumonia. Corticosteroids and bronchodilators are administered to asthmatic patients when they show symptoms of wheezing. An ECG is used to evaluate atrial arrhythmias

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 Anxiety Unilateral neglect

Anxiety In a client with a respiratory disorder, anxiety worsens such problems as dyspnea and bronchospasm. Therefore, Anxietyis a likely nursing diagnosis. This client may have inadequate nutrition, making Imbalanced nutrition: More than body requirements an unlikely nursing diagnosis. Impaired swallowing may occur in a client with an acute respiratory disorder, such as upper airway obstruction, but not in one with a chronic respiratory disorder. Unilateral neglect may be an appropriate nursing diagnosis when neurologic illness or trauma causes a lack of awareness of a body part; however, this diagnosis doesn't occur in a chronic respiratory disorder.

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 Administers vancomycin intravenously Provides nebulized tobramycin (TOBI) Gives oral pancreatic enzymes with meals

Collects sputum for culture and sensitivity Explanation: 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.

Upon assessment, the nurse suspects that a client 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

Compromised gas exchange Decreased airflow Wheezes Explanation: Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection. Bronchospasm can sometimes be detected on auscultation with a stethoscope when wheezing or diminished breath sounds are heard. Increased mucus production, along with decreased mucociliary action, contributes to further reduction in the caliber of the bronchi and results in decreased airflow and decreased gas exchange. This is further aggravated by the loss of lung elasticity that occurs with COPD (GOLD, 2015).

An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure? Highest airflow during a forced inspiration Highest airflow during a forced expiration Highest airflow during a normal inspiration Highest airflow during a normal expiration

Highest airflow during a forced expiration Explanation: A peak flow meter is a small hand-held device that measures the fastest flow the patient can generate after taking a deep breath in and blowing out as hard and fast as possible.

In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? I II III IV

I Explanation: COPD is classified into four grades depending on the severity measured by pulmonary function tests. However, pulmonary function is not the only way to assess or classify COPD; pulmonary function is evaluated in conjunction with symptoms, health status impairment, and the potential for exacerbations. Grade I (mild): FEV1/FVC <70% and FEV1 ≥80% predicted. Grade II (moderate): FEV1/FVC <70% and FEV1 50% to 80% predicted. Grade III (severe): FEV1/FVC <70% and FEV1 <30% to 50% predicted. Grade IV (very severe): FEV1/FVC <70% and FEV1 <30% predicted.

Asthma is cause by which type of response? IgM-mediated IgE-mediated IgA-mediated IgD-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 nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?

It helps prevent early airway collapse. Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. To increase inspiratory muscle strength and endurance, the client may need to learn inspiratory resistive breathing. To decrease accessory muscle use and thus reduce the work of breathing, the client may need to learn diaphragmatic (abdominal) breathing. In pursed-lip breathing, the client mimics a normal inspiratory-expiratory (I:E) ratio of 1:2. (A client with emphysema may have an I:E ratio as high as 1:4.)

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 All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy. All options listed are treatments that may be used for a client with an exacerbation of COPD. The first line of treatment is oxygen therapy.

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?

Proventil Short-acting beta2-adrenergic agonists (albuterol [AccuNeb, Proventil, Ventolin], levalbuterol [Xopenex HFA], and pirbuterol [Maxair]) are the medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. 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. These medications are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists are not indicated for immediate relief of symptoms. These include theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus).

Which of the following diagnostic test is the most accurate in assessing acute airway obstruction?

Pulmonary function studies Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC). Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. ABGs, and pulse oximetry are not the most accurate diagnostics for an airway obstruction.

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 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? Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis

Respiratory acidosis Explanation: 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.

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 Respiratory alkalosis Metabolic alkalosis Metabolic acidosis

Respiratory acidosis Explanation: 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 nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Respiratory rate of 22 breaths/minute Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/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 administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

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 administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Urine output of 40 ml/hour Dilated and reactive pupils Respiratory rate of 22 breaths/minute Heart rate of 100 beats/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 discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. Status asthmaticus Respiratory failure Pertussis Atelectasis Thoracentesis

Status asthmaticus Respiratory failure Atelectasis Explanation: Complications of asthma may include status asthmaticus, respiratory failure, and atelectasis. Pertussis is not an asthma complication. Thoracentesis is a diagnostic procedure, not a complication.

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

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) 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: pleural effusion. pulmonary edema. atelectasis. oxygen toxicity.

atelectasis. In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.