Pulmonary Conditions

A nurse is caring for a client who has sleep apnea and is prescribed modafinil (Provigil). The client asks, "How will this medication help me?" How should the nurse respond? a. "This medication will treat your sleep apnea." b. "This sedative will help you to sleep at night." c. "This medication will promote daytime wakefulness." d. "This analgesic will increase comfort while you sleep."

Answer C: "This medication will promote daytime wakefulness." Modafinil is helpful for clients who have narcolepsy (uncontrollable daytime sleep) related to sleep apnea. This medication promotes daytime wakefulness.

You're discussing nutrition with your patient who has cystic fibrosis. You explain that it is very important the patient regularly takes fat-soluble vitamins. This includes: A.Vitamin B B.Vitamin D C.Vitamin C D.Vitamin K E.Vitamin E F.Vitamin A

B,D,E,F - Vitamins that are fat-soluble are Vitamin D, E, K, A....remember the word DEKA!

You're educating the parents of an 8-month-old, who was recently diagnosed with cystic fibrosis, about the disease. You explain to the parents that the child has a gene mutation on the ____________. The gene that is specifically mutated is called? A.Endocrine glands; Hbg S gene B.Exocrine glands; CFTR gene C.Endocrine glands; Chromosome 21 D.Exocrine glands; HTT gene

B - Cystic fibrosis affects the EXOCRINE glans, specifically the Cystic Fibrosis Transmembrane Regulator gene (CFTR). This is a protein that controls the channels of sodium and chloride, hence the sodium and water transport in and out of the cell.

Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands his care plan? A. The client promises to do pursed-lip breathing at home. B. The client states actions to reduce pain. C. The client says that he will use oxygen via a nasal cannula at 5 L/ minute. D. The client agrees to call the physician if dyspnea on exertion increases.

D. The client agrees to call the physician if dyspnea on exertion increases. Rationale: Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/ minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia.

Which systems below are affected by cystic fibrosis? A.Reproductive B.Lymphatic C.Respiratory D.Gastrointestinal E.Neuro F. Integumentary

A,C,D,F Cystic fibrosis affects the respiratory system (this causes thick mucus to build up in the lungs and it can affect both the upper and lower respiratory system like the sinuses), gastrointestinal (pancreas, intestines, and liver are all affected due to thick mucus), and integumentary (skin's sweat glands will make extremely salty sweat).

When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about: A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Opioids C. Anticonvulsants D. Antidepressants

Answer B. Opioids Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids.

When assessing a client for obstructive sleep apnea (OSA), the nurse understands the MOST common symptom is: A. Headache B. Early awakening C. Nocturia D. Excessive daytime sleepiness

Answer D: Excessive daytime sleepiness Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following? a. Develop infections easily b. Maintain current status c. Require less supplemental oxygen d. Show permanent improvement

a. Develop infections easily Rationale: A client with COPD is at high risk for development of respiratory infections. COPD is a slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are

What should the nurse include when teaching health maintenance strategies to the client with COPD? Select all that apply. a. Yearly influenza immunizations b. Immunization against pneumonia c. Limitation of physical activity d. Oral fluid restrictions e. Adequate caloric intake

a. yearly influenza immunizations b. immunization against pneumonia e. Adequate caloric intake Rationale:Clients with COPD are highly susceptible to respiratory infections such as influenza, so they should be immunized yearly. Clients with COPD use a large amount of calories because of labored respiratory function; increased caloric intake is necessary to maintain a healthy weight. Clients with COPD should undergo a progressive rehabilitation program to increase their activity tolerance. Fluid restriction is not needed with COPD unless there is a fluid retention from another etiology.

You're providing care to an 18-year-old male who has cystic fibrosis. Select all the possible complications this patient can experience due to cystic fibrosis: A.Blood glucose 255mg/dL B.Hearing disturbances C.Hemoptysis D.Greasy, foul smelling stools E.Weight gain F.Meconium ileus G.Excessive mucus production H.Dyspnea I.Coughing J.Hyperoxemia K.Infertility

A,C,D,G,H,I,K - All these are complication of cystic fibrosis. Option B: hearing disturbances not common, Option E: weight LOSS rather than gain due to the inability to digest food due to lacking pancreatic enzymes, Option F: this only occurs in infants...remember meconium is the first "bowel movement" an infant experiences after birth...this patient here is 18-years-old, and Option J: high oxygen in the blood....no but rather low because of the thick mucus blocking air flow in the lungs, which will lead to hypoxia.

A patient's partner informs the nurse that the patient wakes up with a startle and gasps for breath several times at night. The nurse understands the patient is experiencing sleep apnea. What are the common risk factors in this patient for sleep apnea? Select all that apply. A. A Body mass index (BMI) 30 kg/m2 B. Age 44 years C. Habit of smoking D. Neck circumference 18 inches E. Occasional consumption of alcohol

Answer: A,C,D. The common risk factors for sleep apnea include BMI greater than 28 kg/m2, smoking habit, and neck circumference greater than 17 inches. Sleep apnea is often observed in patients older than 65 years. Occasional consumption of alcohol is not a risk factor by itself.

A patient with obstructive sleep apnea tells the nurse, "I just hate using this continuous positive airway pressure (CPAP) thing, but I know I need it. Is there anything I can do so that I don't need to use it?" Which of these would be an appropriate suggestion from the nurse? A Taking a nap during the day. B Referral to a weight loss program. C Trying a mild sedative at bedtime. D Drinking a glass of wine just before bedtime.

Answer: B Referral to a weight loss program. Because excessive weight worsens obstructive sleep apnea (OSA), referral to a weight loss program may be indicated. Weight loss and bariatric surgery reduce OSA. Daytime napping does not help this condition. Instruct the patient to avoid taking sedatives or consuming alcoholic beverages for three to four hours before sleep. Sleep medications often make OSA worse.

A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as prescribed. Which statement is true concerning oxygen administration to a client with COPD? A.High oxygen concentrations will cause coughing and dyspnea. B.High oxygen concentrations may inhibit the hypoxic stimulus to breathe. C.Increased oxygen use will cause the client to become dependent on the oxygen D.Administration of oxygen is contraindicated in clients who are using bronchodilators.

B Clients who have a long history of COPD may retain carbon dioxide (CO2). Gradually, the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying if it's not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.

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 70; HCO3 34 mEq/L. What should the nurse do first? A.Apply a 100% nonrebreather mask B.Assess the vital signs C.Reposition the client D.Prepare for intubation

B Clients with COPD have CO2 retention, and the respiratory drive is simulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. After assessing the vital signs, the nurse should assist the client as needed to assume the most comfortable position for breathing. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.

What type of test is typically the first used to diagnose a patient with cystic fibrosis? A.Abnormal urine test B.MRI scan for clogged lungs C.Salty sweat test D.Muscle coordination test

C -Cystic fibrosis is not know to affect the muscular system -Symptoms of cystic fibrosis include abnormal ion concentrations in the respiratory, digestive tracts, and sweat glands -CT scans, not MRI scans, are typically used to examine patients with cystic fibrosis. Regardless, this would not normally be the first test used to diagnose cystic fibrosis. -One of the first tests that indicate a patient has cystic fibrosis is that they have abnormally high salt concentrations in their sweat.

A nurse is assessing a client with chronic emphysema. Which finding requires immediate intervention? A.Using pursed-lip breathing and prolong expiration B. Circumoral cyanosis C. Crackles auscultated posteriorly halfway up the left lung D. Appearance of a "barrel chest"

C Crackles auscultated in the lung field indicate excessive fluid, a problem that requires immediate intervention. Pursed-lip breathing and a prolonged expiratory phase, circumoral cyanosis, and increased anterior-posterior diameter of the chest (resulting in "barreled chest") are not unusual findings for clients with emphysema.

Which information should the nurse include in a teaching plan for the client newly diagnosed with chronic obstructive pulmonary disease (COPD)? Select all that apply. A.Pulmonary rehabilitation programs offer very little benefit. B.Pneumococcal vaccination is contraindicated for clients with lung disease. C.High humidity increases the effort of breathing. D.A bronchodilator with metered-dose inhaler should be readily available. E.Smoking cessation is important to slow or stop disease progression

C, D, E High humidity has been shown to increase the work of breathing. Carrying a metered dose inhaler can facilitate early intervention if bronchospasm and shortness of breath should occur. Smoking cessation is difficult to achieve but very important in preventing COPD progression. Pulmonary rehabilitation programs are a great source of support for health promotion and maintenance for clients with COPD. Both the pneumococcal an influenza vaccine can help protect against respiratory infections.

A nurse documents and reports the presence steatorrhea in a patient with cystic fibrosis (CF). What does this finding indicate about the patient? a. Is being adequately maintained on the present dose of pancreatic enzyme b. Is not adequately digesting food, leaving loose, fatty, sticky and foul smelling stool c. Has diarrhea related to excess mucus in the bowel d. Has inadequate hydration

Correct Answers: B Rationale: Foul, bulky stools are the result of inadequately digested food if oral pancreatic enzymes are inadequate.

The pediatric nurse describes the effects of cystic fibrosis on the body systems to the parents of a child recently diagnosed with the disease. Which statements does the nurse include to the parents? (Select all that apply.) A. Altered protein and vitamin metabolism causes a type of dementia in older children. B. Increased mucus obstructs the airways, and stasis of fluid causes infections. C. Pancreatic ducts are often blocked by mucus, leading to poor nutrition. D. Reproduction is affected, as ovarian ducts and the vas deferens are occluded. E. Thick mucus affects several body systems, preventing some organs from working.

Correct Answers: B, C, D, E Rationale: Cystic fibrosis is an inherited autosomal recessive disorder that causes the production of thick mucus that blocks exocrine glands and affects several body systems, including the respiratory, gastrointestinal, and reproductive systems. It does not lead to a type of dementia.

A patient completed a sweat test yesterday. The results are back and are 45 mmol/L. As the nurse you know this means: A. The patient tested positive for cystic fibrosis. B. The patient tested negative for cystic fibrosis. C. The patient needs further testing because results are not conclusive.

Correct Answers: C Rationale: A sweat test is gold standard in testing for cystic fibrosis. The result interpretations are the following: 39 mmol/L or less in patients 6 months or older are NEGATIVE for cystic fibrosis 40 to 59 mmol/L needs further testing, not conclusive 60 or more mmol/L POSITIVE for cystic fibrosis.

Cystic fibrosis is an autosomal recessive genetic disorder. Which option below best describes what most likely happens for a child to develop this condition? A. One parent, who is a carrier of the mutated gene, has to pass it to the child B. One of the parents has to have cystic fibrosis in order to pass it to their offspring C. Both of the parents must have cystic fibrosis in order for the child to develop it D. Both parents, who are carriers of the mutated gene, each pass one mutated gene to the child

Correct Answers: D Rationale: CF is an autosomal recessive genetic disorder. This means that both of the parents are carriers of the disease (they won't have signs and symptoms of CF). They each have one healthy gene and one mutated gene. For CF to occur in their offspring, the parents will have to each pass ONE of the mutated genes to the child. In this case, it will be the CFTR gene....so the child receives one mutated gene from each parent and this leads to the child to develop CF.

Which diet would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? A.Low-fat, low-cholesterol diet B.Bland, soft diet C.Low-sodium diet D.High-calorie, high-protein diet

D The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland soft foods.

The nurse assesses 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 of the following findings would be expected? A. Normal breath sounds. B. Prolonged inspiration. C. Normal chest movement. D. Coarse crackles and rhonchi.

D. Coarse crackles and rhonchi. Rationale Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.

The nurse who is explaining the pathophysiology of COPD to a client includes the fact that alveolar destruction results in which manifestations? Select all that apply. a. Decrease surface area for gas exchange b. Increased dead space air c. Development of pulmonary emboli d. Chronic dilation of bronchioles e. Airway collapse related to loss of elasticity

a.decrease surface area for gas exchange e. Airway collapse related to loss of elasticity Rationale: The loss of elasticity in the airway of a client with COPD can be airway attributed to repeated infections and inflammation, which leads to airway collapse. Airway collapse can cause alveolar destruction because of either over or under inflation of alveolar sacs. The impaired gas exchange occurring with COPD is caused by the loss of alveolar surface area available for gas exchange. Destruction of alveoli is not related to increased dead space air, pulmonary emboli, or chronic dilation of bronchioles.