COPD

Manifestations

100

A nurse is assessing a client who is in the early stages of COPD. Which of the following findings should the nurse expect? 

1. Chronic productive cough

2. barrel-shaped chest

3. shortness of breath with activity

4. cyanosis

5. accessory muscle breathing

6. fatigue

1, 3, 6

200

During the assessment of a client with COPD, the nurse observes a respiratory pattern characterized by prolonged expiratory phase and wheezing. What is the physiological explanation for this finding?

1. Alveolar collapse during inspiration

2. Narrowing of the airways due to inflammation and mucus production

3. Increased elasticity of the lungs causing air trapping

4. Overproduction of surfactant in the alveoli

Correct Answer: b. Narrowing of the airways due to inflammation and mucus production
Rationale: In COPD, airway inflammation and mucus production lead to wheezing and prolonged expiration due to difficulty expelling trapped air.

300

Which of the following are late manifestions:

1. Barrel chest

2. Cyanosis

3. Use of accessory muscle during breathing

4. Dyspnea with activity

5. Digital clubbing

Correct Answers: 1, 2, 3, 5

Teaching Interventions

100

A nurse is teaching a client with chronic obstructive pulmonary disease (COPD) how to use an incentive spirometer. Which of the following statements indicates that the client understands the teaching?
Select the best answer.

1. "I should exhale as forcefully as I can into the mouthpiece."
2. "I should inhale slowly and deeply through the mouthpiece and hold my breath for 3 to 5 seconds."
3. "I should breathe in and out quickly through the device to exercise my lungs."
4. "I should use the device only when I feel short of breath."

Correct Answer: 2
Rationale: The client should inhale slowly and deeply, hold their breath for 3-5 seconds, and then exhale slowly. This action promotes lung expansion and prevents atelectasis.

200

A nurse is preparing a COPD client for discharge. Which statement by the client indicates the need for further teaching?
Select the best answer.

1. "I will use pursed-lip breathing when I feel short of breath."
2. "I should wash my hands often and avoid crowds to prevent infection."
3. "I can stop using my long-acting inhaler (LABA) when I feel better."
4. "I need to keep my head elevated when sleeping to help me breathe."

Correct Answer: 3
Rationale: Long-acting bronchodilators (LABAs) should be taken daily as prescribed, even if the client feels better. Stopping the medication can increase the risk of exacerbations.

300

The nurse is observing a client with COPD using a flutter device (Aerobika). Which action by the client indicates a need for further teaching?
Select the best answer.

1. The client sits upright while using the device.
2. The client exhales forcefully through the device.
3. The client tilts the device slightly while exhaling.
4. The client performs a huff cough after several breaths.

Correct Answer: 2
Rationale: The client should exhale slowly, not forcefully, through the flutter device to create vibrations in the airways that loosen mucus. Exhaling forcefully can be ineffective and tiring.

Discharge Planning

100

A nurse is reviewing a COPD action plan with a client. The client is currently in the "Yellow Zone" based on symptoms of increased shortness of breath and mucus production. What is the most appropriate action for the nurse to recommend?
Select the best answer.

1. Call 911 immediately.
2. Increase the use of a short-acting bronchodilator as prescribed.
3. Stop taking all long-term medications.
4. Go to the emergency department immediately.

Correct Answer: 2
Rationale: In the "Yellow Zone" of a COPD action plan, clients are advised to increase the use of short-acting bronchodilators (SABA) and monitor their response. If symptoms worsen or do not improve, they should seek medical attention.

200

The nurse is providing discharge instructions to a client with COPD. Which statement by the client requires further teaching?
Select the best answer.

1. "I will avoid being around people who are sick to reduce my risk of infection."
2. "I should stop smoking to help slow the progression of my COPD."
3. "If I feel short of breath, I will use my long-acting bronchodilator for quick relief."
4. "I will ensure I stay up to date on my flu and pneumonia vaccines."

Correct Answer: 3
Rationale: Long-acting bronchodilators (LABAs) are used for long-term control, not for quick relief of shortness of breath. A short-acting bronchodilator (SABA) should be used during flare-ups or sudden shortness of breath.

300

A nurse is teaching a client with COPD about infection prevention. Which statement by the client indicates an understanding of the teaching?
Select all that apply.

1. "I should wash my hands frequently with soap and water."
2. "I should avoid crowded places, especially during cold and flu season."
3. "I will make sure to get the flu and pneumonia vaccines as recommended."
4. "I only need to wear a mask if I feel sick."
5. "I should avoid touching my face, especially my eyes, nose, and mouth."

Correct Answers: 1, 2, 3, 5
Rationale: To prevent respiratory infections, clients with COPD should practice frequent handwashing, avoid crowds, get vaccinated, and avoid touching their face to prevent germ entry. Wearing a mask should be done in high-risk areas, not just when the client feels sick.