21. Show A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF? A) Alveolar mucus plugging, infection, and eventual bronchiectasis B) Bronchial mucus plugging, inflammation, and eventual bronchiectasis C) Atelectasis, infection, and eventual COPD D) Bronchial mucus plugging, infection, and eventual COPD albuterol is a short acting inhalant and will relax muscles quickly Short-acting beta2-adrenergic agonists, such as albuterol (AccuNeb, Proventil, Ventolin), levalbuterol (Xopenex HFA), and pirbuterol (Maxair), are the inhalant 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 that stabilize mast cells, and are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists, such as theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus), are not indicated for immediate relief of symptoms. Recommended textbook solutions
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Combined sets Terms in this set (137)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?" 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 A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma? Cromolyn sodium 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 An increase in the red blood cell concentration in the blood is termed which of the following? Polycythemia Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. • Zafirlukast (Accolate) Nursing students are gathered for a study session about the pulmonary system. One student asks the others to name the primary causes for an acute exacerbation of COPD. Which of the following responses should be in the reply? Choose all that apply. • Air pollution The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. • Right ventricular enlargement
Asthma is cause by which type of response? IgE-mediated 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? Delay self-care activities for one hour Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. • Asymmetry of chest movement A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. • Atelectasis A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to Exhale slowly Which of the following is a characteristics of emphysema? Increased total lung capacity The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.) • Activate the MDI once. A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. • Thick mucus Which of the following occupy space in the thorax, but do not contribute to ventilation? Bullae 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: atelectasis. 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. 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? 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 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 The hormone brain natriuretic peptide (BNP) is produced by which of the following? Ventricles of the heart 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 quitting before? Which of the following is a clinical manifestation of a pneumothorax? Select all that apply. • Sudden chest pain A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer? An inhaled beta2-adrenergic agonist 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. • Mucus secretions that block airways Which of the following is accurate regarding status asthmaticus? A severe asthma episode that is refractory to initial therapy 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 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 An increase in the red blood cell concentration in the blood is termed which of the following? Polycythemia 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 Which of the following is a common irritant that acts as a trigger of asthma? Esophageal Reflux Disease Which of the following is the key underlying feature of asthma? Inflammation Emphysema is described by which of the following statements? A disease of the airways characterized by destruction of the walls of overdistended alveoli The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. • Dyspnea and fatigue disproportionate to pulmonary function abnormalities A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. • Status asthmaticus The hormone brain natriuretic peptide (BNP) is produced by which of the following? Ventricles of the heart 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: Oxygen therapy through a non-rebreather mask 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. • Increase oxygen distribution A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to Exhale slowly Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. • Tobacco smoke
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? Impaired gas exchange related to airflow obstruction 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) 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 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 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. • Alter smooth muscle tone mild COPD The classification of Stage I of COPD is defined as 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. 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 Which is the strongest predisposing factor for asthma? allergy Which symptoms are considered primary symptoms of COPD? Cough cough 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 Oxygen through nasal cannula at 2 L/minute 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. Alter smooth muscle tone alter smooth muscle tone 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 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? cystic fibrosis To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? Streptococcus pneumonia and Haemophilus influenzae The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) Inflamed airways obstruct airflow. inflamed airways obstruct air flow Which statement describes emphysema? A disease of the airways
characterized by destruction of the walls of overdistended alveoli a disease of the airways characterized by the destruction of the walls of overdistended alveoli
The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? Restricting oral intake to 1,000 mL/day performing chest physiotherapy as ordered
The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? "Because I am prescribed a corticosteroid-containing MDI, I will rinse my mouth with water after use." I can't use a spacer or holding chamber with the MDI 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 Which type of chest configuration is typical of a client with COPD? barrel chest Which type of chest configuration is typical of a client with COPD? III Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? Exposure to tobacco smoke exposure to tobacco smoke Which of the following is accurate regarding status asthmaticus? A severe asthma episode that is refractory to initial therapy Patients have a productive cough. a severe asthma episode that is refractory to initial therapy 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. Albuterol is a bronchodilator. albuterol is a bronchodilator Which statement is true about both lung transplant and bullectomy? Both procedures cure COPD. both procedures improve the overall quality of life of a client 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.) Compromised gas exchange decreased airflow 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 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, 90% 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 inspiratory-expiratory (I:E) ration of 2:! cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which test? Pulmonary function studies sweat chloride production A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to Take deep breaths exhale slowly 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 Atrovent albuterol 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? Raynaud's
disease angina Which of the following occupy space in the thorax, but do not contribute to ventilation? Bullae bullae Which of the following are risk factors for the development of chronic obstructive pulmonary disease (COPD)? Select all that apply. Tobacco smoke all of the above The nurse is reviewing first-line pharmacotherapy for smoking abstinence with a client diagnosed with COPD. The nurse correctly includes which medications? Select all that apply. Nicotine gum nicotine gum A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include the importance of blood tests to monitor serum concentrations. the importance of blood tests to monitor serum concentrations 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 productive cough The physician orders a beta-2 adrenergic agonist agent (bronchodilator) that is short-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? Alupent Brethine Foradil Isuprel Brethine A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 85% for a patient with COPD. What stage should the nurse document the patient is in? I A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in? III A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use? "I lubricate my lips and nose with K-Y jelly." I make sure my oxygen mask is on tightly so it won't fall off while I nap A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply. Thick mucus thick mucus A client has been classified as status asthmaticus. The nurse understands that this client will likely initially exhibit symptoms of: Respiratory alkalosis respiratory alkalosis 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 emphysema Asthma is cause by which type of response? IgE-mediated IgE-mediated Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. Montelukast (Singulair) Montelukast (Singulair) The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply. Dyspnea and fatigue
disproportionate to pulmonary function abnormalities Dyspnea and fatigue disproportionate to pulmonary function abnormalities Right ventricular enlargement Elevated plasma brain natriuretic peptide (BNP) Enlargement of central pulmonary arteries 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? Metabolic acidosis respiratory alkalosis 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% FEVI> 80% 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: atelectasis In which grade of COPD is the forced expiratory volume (FEV) less than 30%? III The client is prescribed albuterol (Ventolin) 2 puffs as a metered-dose inhaler. The nurse evaluates client learning as satisfactory when the client Positions the inhaler 1 to 2
inches away from his open mouth positions the inhaler 1-2 inches away from open mouth A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? Albuterol Cromolyn sodium Which of the following is a symptom diagnostic of emphysema? Dyspnea dyspnea A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: Sharp, stabbing chest pain sharp, stabbing chest pain 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? II A nurse is caring for a client admitted with an exacerbation of asthma. The nurse knows the client's condition is worsening when he: sits in tripod position. uses the sternocleidomastoid muscles 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: Correct response: 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 administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Correct response: 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 caring for a client admitted with an exacerbation of asthma.
The nurse knows the client's condition is worsening when he: Correct response: 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. Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. Correct response: The classification of Stage III of COPD is defined as Correct response: 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. 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 Correct response: Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis). A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? Correct response: 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. Which of the following is not a primary symptom of COPD? Correct response: COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea upon exertion. Weight loss is common with COPD. A client with chronic obstructive pulmonary disease (COPD) and cor
pulmonale is being prepared for discharge. The nurse should provide which instruction? Correct response: 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. In which grade of COPD is the
forced expiratory volume (FEV) less than 30%? Correct response: 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 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? Correct
response: When a client presents in the emergency department with an exacerbation of COPD, the nurse should first administer oxygen therapy and perform a rapid assessment of whether the exacerbation is potentially life threatening. 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? Correct response: 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. 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. Correct response: 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. A client presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands that goals of
therapy should be achieved to improve the client's condition. Which statements reflect therapy goals? Select all that apply. Correct response: The goal is to have a stable client with COPD leading the most productive life possible. COPD cannot necessarily be cured, but it can be managed so that the client can live a reasonably normal life. With adequate management, clients should not have to give up their usual activities. 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 ___%. Correct response: The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90% A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 40% for a patient with COPD. What stage should the nurse document the patient is in? Correct response: 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%. A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Correct response: 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 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? Correct response: 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 client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home? Correct response: For mild persistent asthma, the preferred treatment is an inhaled corticosteroid, such as beclomethasone (Beconase). The other medications are for long-term control, prevention, or both in moderate to severe persistent asthma. 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? Correct response: Chronic obstructive pulmonary disease (COPD) is an umbrella term for chronic lung diseases that have limited airflow in and out of the lungs. A nurse is discussing asthma complications with a client and family. What complications should the nurse
include in the teaching? Select all that apply. Correct response: 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 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? Correct response: COPD may include diseases that cause airflow obstruction (eg, 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. 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. Correct response: 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. A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary? Correct response: 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 client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation. A client is being admitted to an acute health care facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The nurse is placing this information on the Medication Reconciliation Record. What medication information needs to be clarified with the health care provider? Correct response: 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. 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? Correct response: 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. The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? Correct response: Nursing care includes helping clients 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. Clients with CF also experience increased salt content in sweat gland secretions; thus it is important to ensure the client consumes a diet that contains adequate amounts of sodium. As the disease progresses, the client 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 client is terminally ill. The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? Correct response: The client can use a spacer or a holding chamber to facilitate the ease of medication administration. The remaining client statements are accurate and indicate the client understands how to use the MDI correctly. 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? Correct response: The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation. Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. Correct response: The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? Correct response: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations (Expert Panel Report 3, 2007). The classification of Stage IV of COPD is defined as Correct response: 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. A nurse is teaching a client about
bronchodilators. What bronchodilator actions that relieve bronchospams should the nurse include in the client teaching? Select all that apply. Correct response: Bronchodilators relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation. Inflammation would be reduced by corticosteriods. 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: Correct response: 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 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 Correct response: Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis). You are caring for a client with obstructive pulmonary disease. Your nursing care includes diagnoses, outcomes, and interventions for
what? Correct response: 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. The classification of Stage III of COPD is defined as Correct response: 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. Students also viewedPrepU exam #2 Chp. 2477 terms ashleysoccer316 302 Hinkle Chapter 24: Management of Patients with…73 terms katetoba Chapter 24: Management of Patients With Chronic Pu…40 terms Jeremie_Bryant Chapter 24: Management of Patients with Chronic Pu…48 terms aurora_katie Sets found in the same folderChapter 26: Management of Patients with…148 terms beardogfish34 302 Hinkle Chapter 24: Management of Patients with…73 terms katetoba Ch 24 Chronic Pulmonary Disease81 terms ma2bsn Ch 24 Mgmnt of Pts with Chronic Pulmonary Disease…54 terms Michaela_Catino Other sets by this creatorChapter 24: COPD PrepU, Ch 24 Chronic Pulmonary Di…86 terms JASCARsmithPLUS Ch 11 Medsurg63 terms JASCARsmithPLUS MED SURG PREP U 31, Ch. 31 Assessment and Manageme…168 terms JASCARsmithPLUS Ch. 31 Assessment and Management of Patients with…123 terms
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What are the 4 major risk factors of COPD?Risk factors for COPD include:. Exposure to tobacco smoke. The most significant risk factor for COPD is long-term cigarette smoking. ... . People with asthma. ... . Occupational exposure to dusts and chemicals. ... . Exposure to fumes from burning fuel. ... . Genetics.. What are the causes that cause a COPD flare ups?The two most common causes of a COPD flare-up, or attack, are respiratory tract infections, such as acute bronchitis or pneumonia, and air pollution. Having other health problems, such as heart failure or an abnormal heartbeat (arrhythmia) may also trigger a flare-up. In some cases, the cause is not known.
What are 2 priority problems for the patient with a COPD exacerbation?Complications. There are two major life-threatening complications of COPD: respiratory insufficiency and failure. Respiratory failure.
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