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COPD practice set PREPU
Terms in this set (40)
Which of the following would be a potential cause of respiratory acidosis?
Respiratory acidosis is always due to inadequate excretion of CO, with inadequate ventilation, resulting in elevated plasma CO concentration, which causes increased levels of carbonic acid. In addition to an elevated PaCO, hypoventilation usually causes a decrease in PaO
The nursing instructor is teaching a class of level I nursing students how to do a physical assessment on a patient with lung disease and chronic hyperinflation of the lungs. What would a nurse most likely assess in this type of patient?
a) Large, drooping eyes
b) Long, thin fingers
c) Dry, flaky skin
d) A barrel chest
A barrel chest
In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess dry, flaky skin; large, drooping eyes, or long, thin fingers.
The clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurse's best answer?
a) "The most important risk factor for COPD is exposure to dust and pollen."
b) "The most important risk factor for COPD is inadequate nutrition."
c) "The most important risk factor for COPD is regular exercise."
d) "The most important risk factor for COPD is cigarette smoking."
The most important risk factor for COPD is 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 client is being sent home with oxygen therapy. The nurse instructs that
a) The client should raise the flow of oxygen if shortness of breath increases.
b) The client will not be able to travel with oxygen.
c) Oxygen is addictive and its use must be decreased.
d) Smoking or a flame is dangerous near oxygen.
Smoking or a flame is dangerous near oxygen.
The nurse should cautions the client against smoking or using a flame near oxygen. Oxygen is not addictive. Clients can travel with portable oxygen systems. Teaching also includes the proper flow of oxygen.
Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive?
a) Hepatitis B
b) Human papilloma virus (HPV)
Clients with COPD are more susceptible to respiratory infections, so they should be encouraged to receive the influenza and pneumococcal vaccines. Clients with COPD aren't at high risk for varicella or hepatitis B. The HPV vaccine is to guard against cervical cancer and is recommended only for women ages 9 to 26.
You are a pediatric nurse practitioner caring for a child who has just been diagnosed with asthma. You provide the parents with information that includes potential causative agents for an asthmatic reaction. What would this information include as a potential causative agent for an asthma attack?
c) Hot shower
d) Watching television
Common causative agents that may trigger an asthma attack are as follows: dust, dust mites, pets, soap, certain foods, molds, and pollens. Watching television, hot showers, and rainstorms are not triggers for asthma attacks.
When developing a preventative plan of care for a patient at risk for developing chronic obstructive pulmonary disease (COPD), which of the following should be incorporated?
a) Smoking cessation
b) Weight reduction
c) Cancer prevention
d) Cholesterol management
The most important risk factor for the development of COPD is cigarette smoking. The effects of cigarette smoke are complex and lead to the development of COPD in approximately 15% to 20% of smokers. Tobacco smoke irritates the airways and, in susceptible individuals, results in mucus hypersecretion and airway inflammation.
A student nurse prepares to care for a patient with bronchiectasis. The student nurse should anticipate that what would be ordered for this patient?
c) Potassium supplements
Bronchodilators, which may be prescribed for patients who also have reactive airway disease, may also assist with secretion management. Antihypertensives, potassium supplements, and diuretics would not be routinely administered to patients with bronchiectasis.
A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?
a) Anxiety related to actual threat to health status
b) Impaired gas exchange related to airflow obstruction
c) Risk for infection related to retained secretions
d) Activity intolerance related to fatigue
Impaired gas exchange related to airflow obstruction
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.
For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway?
a) Teaching the client how to perform controlled coughing
b) Restricting fluid intake to 1,000 ml/day
c) Enforcing absolute bed rest
d) Administering ordered sedatives regularly and in large amounts
Teaching the client how to perform controlled coughing
Controlled coughing helps maintain a patent airway by helping to mobilize and remove secretions. A moderate fluid intake (usually 2 L or more daily) and moderate activity help liquefy and mobilize secretions. Bed rest and sedatives may limit the client's ability to maintain a patent airway, causing a high risk of infection from pooled secretions
A client being seen in the emergency department has labored respirations. Auscultation reveals inspiratory and expiratory wheezes. Oxygen saturation is 86%. The client was nonresponsive to an albuterol (Ventolin) inhaler and intravenous methylprednisolone (Solu-Medrol). The nurse administers the following prescribed treatment first:
a) Oxygen therapy through a non-rebreather mask
b) Normal saline 0.9% at 100 mL/hr intravenously
c) Intravenous magnesium sulfate
d) Oral fluid of at least 2500 mL/day
Oxygen therapy through a non-rebreather mask
The description is consistent with status asthmaticus. The client has not responded to treatment. Oxygen saturation is low. As oxygenation is the priority per Maslow's hierarchy of needs, oxygen therapy would be supplied first. Then, the nurse would initiate intravenous fluids and magnesium sulfate. Last, the nurse would encourage the client to drink fluids to prevent dehydration
Your patient is experiencing shortness of breath. To relieve the symptoms in this patient, you would place your patient in what position?
a) Sitting upright leaning forward slightly
b) Low Fowler's
Sitting upright leaning forward slightly
Shortness of breath has been cited as . Typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breath. Therefore, options B, C, and D are incorrect.
A client has intermittent asthma attacks. Which of the following therapies does the nurse teach the client to use at home when experiencing an asthma attack?
a) Oxygen therapy
b) Inhaled cromolyn sodium (Intal)
c) Oral theophylline (Theo-Dur)
d) Inhaled albuterol (Ventolin)
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 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:
a) the swelling has decreased.
b) the airways are so swollen that no air can get through.
c) the attack is over.
d) crackles have replaced wheezes.
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.
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?
a) Change filters on heating and air conditioning units frequently.
b) Avoid contact with fur-bearing animals.
c) Take ordered medications as scheduled.
d) 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.
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:
a) albuterol (Proventil).
b) propranolol (Inderal).
d) alprazolam (Xanax).
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.
A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?
a) "Limit yourself to smoking only 2 cigarettes per day."
b) "Weigh yourself daily and report a gain of 2 lb in 1 day."
c) "Maintain bed rest."
d) "Eat a high-sodium diet."
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 physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be
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
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
Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).
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.
a) Increase oxygen distribution
b) Reduce airway obstruction
c) Alter smooth muscle tone
d) Decrease alveolar ventilation
• Increase oxygen distribution
• Reduce airway obstruction
• Alter smooth muscle tone
Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation.
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?
a) Respiratory acidosis
b) Metabolic acidosis
c) Metabolic alkalosis
d) Respiratory alkalosis
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 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) Vancomycin 1 gram intravenously over 1 hour
b) Oxygen through nasal cannula at 2 L/minute
c) Intravenous methylprednisolone (Solu-Medrol) 120 mg
d) Ipratropium bromide (Alupent) by metered-dose inhaler
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.
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:
a) paradoxical chest wall movement with respirations.
b) tracheal deviation to the unaffected side.
c) diminished or absent breath sounds on the affected side.
d) 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 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?
b) Unilateral neglect
c) Impaired swallowing
d) Imbalanced nutrition: More than body requirements
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 nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?
a) Urine output of 40 ml/hour
b) Heart rate of 100 beats/minute
c) Respiratory rate of 22 breaths/minute
d) Dilated and reactive pupils
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 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?
d) 1,800-calorie ADA
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
The admitting nurse is assessing a client with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what?
a) Dyspnea and hypoxemia
b) Bronchospasm and clubbing of the fingers
c) Clubbing of the fingers and cyanosis
d) Hypoxemia and clubbing of the fingers
Dyspnea and hypoxemia
These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Clubbing of the fingers is not a sign of COPD. Cyanosis is a sign of hypoxemia.
You are developing the teaching portion of a care plan for a patient with COPD. What would be an important component for you to emphasize?
a) ADLs should be completed in the waking hours
b) Chronic inhalation of indoor toxins causes lung damage
c) Minor respiratory infections are not treated
d) Smoking one-half of a pack weekly is allowable
Chronic inhalation of indoor toxins causes lung damage
Other environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all patients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. Activities of daily living (ADLs) should be paced throughout day to permit patients to perform these without excessive distress.
The nurse is caring for a client with COPD. It is time to do discharge teaching with this client. The nurse teaches the client about breathing exercises. What should the nurse include in the teaching?
a) Use diaphragmatic breathing
b) Exhale through an open mouth
c) Make inhalation longer than exhalation
d) Use chest breathing
Use diaphragmatic breathing
Inspiratory muscle training and breathing retraining may help improve breathing patterns. Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration. It also promotes relaxation, which allows patients to gain control of dyspnea and reduce feelings of panic. Diaphragmatic breathing, not chest breathing, increases lung expansion
When caring for a client with COPD, the nurse knows it is important to monitor what?
a) Cognitive changes
c) Increasing hyperpnea
d) Support systems
The nurse monitors for cognitive changes (personality and behavioral changes, memory impairment), increasing dyspnea, tachypnea, and tachycardia, which may indicate increasing hypoxemia and impending respiratory failure.
Nursing management of the client with COPD involves a great deal of teaching. Which self-care activity would it be important for you to teach a client with COPD to do to avoid bronchospasm?
a) Avoid going outdoors if the pollen count is high
b) Assess the client for familiarity with potential side effects of prescribed medications
c) Encourage the patient to be immunized against influenza and S. pneumoniae
d) Monitor signs and symptoms of respiratory infection
Avoid going outdoors if the pollen count is high
It is important to caution the patient to avoid going outdoors if the pollen count is high or if there is significant air pollution, because of the risk of bronchospasm. Encouraging the patient to get immunizations is an action to prevent infection. Monitoring the patient for signs and symptoms of respiratory infection is an action the nurse does, not something the nurse teaches the client to do. Assessing the client is not teaching a self-care technique.
The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.)
a) Mucus secretions block airways.
b) Dry airways obstruct airflow.
c) Overinflated alveoli impair gas exchange.
d) Inflamed airways obstruct airflow.
• Mucus secretions block airways.
• Overinflated alveoli impair gas exchange.
• Inflamed airways obstruct airflow.
Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.
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:
a) oxygen toxicity.
c) pleural effusion.
d) pulmonary edema.
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.
A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.
a) Inflamed airways that obstruct airflow
b) Decreased numbers of goblet cells
c) Mucus secretions that block airways
d) Overinflated alveoli that impair gas exchange
e) Dry airways that obstruct airflow
• Inflamed airways that obstruct airflow
• Mucus secretions that block airways
• Overinflated alveoli that impair gas exchange
Because of chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the proximal airways, changes include increased numbers of goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing.
The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client
a) Sits in a straight-back chair and leans forward
b) Inhales deeply and holds the breath
c) Records in a diary the number achieved after one breath
d) Exhales hard and fast with a single blow
Exhales hard and fast with a single blow
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
A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?
a) Skin color
b) Heart rate
c) Respiratory rate
d) Lung sounds
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.
A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client
a) Has wheezes in the right lung lobes
b) Reports shortness of breath
c) Cannot perform activities of daily living
d) Has a respiratory rate of 28 breaths/minute
Has wheezes in the right lung lobes
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 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:
a) maintain the client on bed rest.
b) instruct the client to drink at least 2 L of fluid daily.
c) administer anxiolytics, as ordered, to control anxiety.
d) administer pain medication as ordered.
instruct the client to drink at least 2 L of fluid daily.
Mobilizing secretions is crucial to maintaining a patent airway and maximizing gas exchange in the client with COPD. Measures that help mobilize secretions include drinking 2 L of fluid daily, practicing controlled pursed-lip breathing, and engaging in moderate activity. Anxiolytics rarely are recommended for the client with COPD because they may cause sedation and subsequent infection from inadequate mobilization of secretions. Because COPD rarely causes pain, pain medication isn't indicated
The nurse at the beginning of the evening shift receives a report at 1900 on the following patients. Which patient would the nurse assess first?
a) A 74 year old with chronic bronchitis who has BP 128/58, HR 104, and R 26
b) A 62 year old with emphysema who has 300 mL of intravenous fluid remaining
c) An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
d) An 85 year old with COPD with wheezing and an O2 saturation of 89% on 2 L of oxygen
An 86 year old with COPD who arrived on the floor 30 minutes ago and is a direct admit from the doctor's office
On the patient's arrival at the emergency department, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. Pulse oximetry is helpful in assessing response to therapy but does not assess PaCO2 levels. The fluids will not run out during the very beginning of the shift. The vital signs listed are normal findings for patients with COPD
A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?
a) "Drink fluids upon arising from bed."
b) "Raise your arms over your head."
c) "Sit in a chair whenever doing an activity."
d) "Delay self-care activities for 1 hour."
"Delay self-care activities for 1 hour."
Some clients with COPD have shortness of breath and fatigue in the morning on arising as a result of bronchial secretions. Planning self-care activities around this time may be better tolerated by the client, such as delaying activities until the client is less short of breath or fatigued. The client raising the arms over the head may increase dyspnea and fatigue. Sitting in a chair when bathing or dressing will aid in dyspnea and fatigue but does not address the situation upon arising. Drinking fluids will assist in liquifying secretions which, thus, will aid in breathing, but again does not address the situation in the morning.
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