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Obstructive Pulmonary Disease
Terms in this set (42)
During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to which of the following pathophysiologic changes?
B) Pulmonary edema
C) Narrowing of the airway
D) Overdistention of the alveoli
A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which of the following clinical manifestations might be present as an early symptom during an exacerbation of asthma?
Early symptoms during an asthma attack
An early symptom during an asthma attack is anxiety because he is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating.
The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. Which of the following is the primary reason for the nurse to carefully inspect the chest wall of this patient?
A) Allow time to calm the patient.
B) Observe for signs of diaphoresis.
C) Evaluate the use of intercostal muscles.
D) Monitor the patient for bilateral chest expansion.
Which of the following positions is most appropriate for the nurse to place a patient experiencing an asthma exacerbation?
C) High Fowler's
D) Reverse Trendelenburg
The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the patient's respiratory status is improving?
A) Wheezing becomes louder
B) Vesicular breath sounds decrease
C) The cough remains nonproductive
D) Aerosol bronchodilators stimulate coughing
Asthma after treatment in relation to wheezing
The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange.
The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. The nurse assesses for which of the following etiologic factor for this nursing diagnosis in patients with asthma?
A) Work of breathing
B) Fear of suffocation
C) Effects of medications
D) Anxiety and restlessness
Work of breathing and asthma
When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity.
The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate which of the following is likely to be the next step in treatment?
A) Intravenous fluids
B) Biofeedback therapy
C) Systemic corticosteroids
D) Pulmonary function testing
A patient with acute exacerbation of COPD needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use?
A) Oxygen tent
B) Venturi mask
C) Nasal cannula
D) Partial nonrebreather mask
The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.
While teaching a patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to do which of the following?
A) Use the flow meter each morning after taking medications to evaluate their effectiveness.
B) Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse.
C) Increase the doses of the long-term control medication if the peak flow numbers decrease.
D) Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.
The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, the nurse should provide which of the following instructions?
A) "Close lips tightly around the mouthpiece and breathe in deeply and quickly."
B) "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it."
C) "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs."
D) "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."
The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after noting which of the following?
A) Hypertension and pulmonary edema
B) Oropharyngeal candidiasis and hoarseness
C) Elevation of blood glucose and calcium levels
D) Adrenocortical dysfunction and hyperglycemia
The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state which of the following as the primary benefit?
A) "I will pay less for medication because it will last longer."
B) "More of the medication will get down into my lungs to help my breathing."
C) "Now I will not need to breathe in as deeply when taking the inhaler medications."
D) "This device will make it so much easier and faster to take my inhaled medications."
Which of the following test results identifies that a patient with an asthma attack is responding to treatment?
A) An increase in CO2 levels
B) A decreased exhaled nitric oxide
C) A decrease in white blood cell count
D) An increase in serum bicarbonate levels
Nitric oxide and asthma
Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma.
The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which of the following patient vital signs?
A) Pulse rate of 76
B) Respiratory rate of 18
C) Temperature of 98.4° F
D) Oxygen saturation 96%
The patient has an order for each of the following inhalers. Which of the following should the nurse offer to the patient at the onset of an asthma attack?
A) Albuterol (Proventil)
B) Salmeterol (Serevent)
C) Beclomethasone (Beclovent)
D) Ipratropium bromide (Atrovent)
The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring which of the following patient parameters?
A) Apical pulse
B) Bowel sounds
C) Intake and output
D) Deep tendon reflexes
When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for which of the following potential triggers (select all that apply)?
C) Emotional stress
D) Decreased humidity
E) Upper respiratory infections
A, B, C, E
The nurse is assisting a patient to learn self-administration of beclomethasone two puffs inhalation every 6 hours. The nurse explains that the best way to prevent oral infection while taking this medication is to do which of the following as part of the self-administration techniques?
A) Chew a hard candy before the first puff of medication.
B) Rinse the mouth with water before each puff of medication.
C) Ask for a breath mint following the second puff of medication.
D) Rinse the mouth with water following the second puff of medication.
The nurse is scheduled to give a dose of salmeterol by metered dose inhaler (MDI). The nurse would administer the right drug by selecting the inhaler with which of the following trade names?
The trade or brand name for salmeterol
an adrenergic bronchodilator, is Serevent
The nurse is evaluating whether a patient understands how to safely determine whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler?
A) Place it in water to see if it floats.
B) Keep track of the number of inhalations used.
C) Shake the canister while holding it next to the ear.
D) Check the indicator line on the side of the canister.
The nurse is scheduled to give a dose of ipratropium bromide by metered dose inhaler. The nurse would administer the right drug by selecting the inhaler with which of the following trade names?
The trade or brand name for ipratropium bromide,
an anticholinergic medication, is Atrovent
The patient has an order for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/ml. How many milliliters should the nurse use to prepare the patient's dose?
When planning patient teaching about COPD, the nurse understands that the symptoms are caused by which of the following?
A) An overproduction of the antiprotease a1-antitrypsin
B) Hyperinflation of alveoli and destruction of alveolar walls
C) Hypertrophy and hyperplasia of goblet cells in the bronchi
D) Collapse and hypoventilation of the terminal respiratory unit
In COPD, there are structural changes that include
hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.
The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which of the following findings?
A) Absence of dyspnea
B) Improved mental status
C) Effective and productive coughing
D) PaO2 within normal range for the patient
When caring for a patient with COPD, the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which of the following would be an appropriate intervention to add to the plan of care for this patient?
A) Order fruits and fruit juices to be offered between meals.
B) Order a high-calorie, high-protein diet with six small meals a day.
C) Teach the patient to use frozen meals at home that can be microwaved.
D) Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.
The nurse reviews pursed lip breathing with a patient newly diagnosed with COPD. The nurse reinforces that this technique will assist respiration by which of the following mechanisms?
A) Loosening secretions so that they may be coughed up more easily
B) Promoting maximal inhalation for better oxygenation of the lungs
C) Preventing bronchial collapse and air trapping in the lungs during exhalation
D) Increasing the respiratory rate and giving the patient control of respiratory patterns
The focus of pursed lip breathing is to
slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.
The focus of pursed lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.
Nursing assessment findings of jugular vein distention and pedal edema would be indicative of which of the following complications of emphysema?
A) Acute respiratory failure
B) Secondary respiratory infection
C) Pulmonary edema caused by left-sided heart failure
D) Fluid volume excess resulting from cor pulmonale
Cor pulmonale is
a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.
A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. Which of the following would be the most appropriate response by the nurse?
A) "Long-term home oxygen therapy should be used to prevent respiratory failure."
B) "Oxygen will not be needed until or unless you are in the terminal stages of this disease."
C) "Long-term home oxygen therapy should be used to prevent heart problems related to COPD."
D) "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."
Before discharge, the nurse discusses activity levels with a 61-year-old patient with COPD and pneumonia. Which of the following exercise goals is most appropriate once the patient is fully recovered from this episode of illness?
A) Slightly increase activity over the current level.
B) Swim for 10 min/day, gradually increasing to 30 min/day.
C) Limit exercise to activities of daily living to conserve energy.
D) Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.
The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which of the following assessment findings?
A) Decreased respiratory rate
B) Increased respiratory rate
C) Increased peak flow readings
D) Decreased sputum production
The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler. Which of the following instructions given by the nurse is most appropriate to help the patient learn proper inhalation technique?
A) "Avoid shaking the inhaler before use."
B) "Breathe out slowly before positioning the inhaler."
C) "After taking a puff, hold the breath for 30 seconds before exhaling."
D) "Using a spacer should be avoided for this type of medication."
Which of the following statements made by a patient with COPD indicates a need for further teaching regarding the use of an ipratropium inhaler?
A) "I should rinse my mouth following the two puffs to get rid of the bad taste."
B) "I should wait at least 1 to 2 minutes between each puff of the inhaler."
C) "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse."
D) "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."
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