Pathophysiology
Nursing Interventions
Assessment
Diagnostic
Miscellaneous
100
A nurse is caring for a client, hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which of the following would the nurse expect to note on assessment of this client? a. Hypocapnia b. A hyper-inflated chest noted on the chest x-ray c. Increased oxygen saturation with exercise d. A widened diaphragm noted on the chest x-ray
What is b. hyper-inflated chest noted on the chest x-ray. Rationale: clinical manifestations of COPD include hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise and the use of accessory muscles of respiration. Chest x-rays reveal a hyper inflated chest and a flattened diaphragm if the disease is advanced
100
An oxygen delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed? a. Face tent b. Venturi mask c. Aerosol mask d. Tracheostomy collar
What is B. Venturi Mask Rationale: The Venturi mask deliver the most accurate oxygen concentration. It is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, aerosol mask and tracheostomy collar are also high flow oxygen delivery systems but most often are used to administer high humidity.
100
A nurse is assessing a client with chronic airflow limitation and notes that the client has a "barrel chest." The nurse interprets that this client has which of the following forms of chronic airflow limitation? a. emphysema b. bronchial asthma c. chronic obstructive bronchitis d. bronchial asthma and bronchitis
What is a. emphysema Rationale: The client with emphysema has hyperinflation of the alveoli and flattening of the diaphragm. These lead to increased anteroposterior diameter, referred to as "barrel chest." The client also has dyspnea with prolonged expiration and has hyperresonant lungs to percussion.
100
The confirmation of a diagnosis of COPD is done through what type of testing? a. Chest x-ray b. Sputum cultures c. Pulmonary function tests d. Bronchoscopy
What is c. Pulmonary function tests are done to confirm a diagnosis of COPD. Although chest x-rays, sputum cultures and bronchoscopies may be done on patients with an altered respiratory status, these are not diagnostic.
100
A plan of care for the patient with COPD could include a. exercise such as walking. b. chronic oral corticosteroid therapy. c. high flow rate of O2 administration. d. breathing exercises that involve inhaling longer than exhaling.
What is a. exercise such as walking. Rationale: Walking is appropriate for the patient with COPD because it is low intensity. Patient's with COPD want to avoid high flow rates of oxygen administration (no more than 2 L/min). Inhaling longer than exhaling would increase the air entrapment within the alveoli. Chronic oral corticosteroid is not an appropriate medication therapy.
200
A nurse instructs a client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is to: a. Promote oxygen intake. b. Strengthen the diaphragm. c. Strengthen the intercostal muscles. d. Promote carbon dioxide elimination.
What is d. promote carbon dioxide elimination. Rationale: Pursed-lip breathing facilitates maximal expiration for clients with obstructive lung disease. This type of breathing allows better expiration by increasing airway pressure that keeps air passages open during exhalation Options a, b, and c are not the purposes of this type of breathing.
200
A nurse is instructing a hospitalized client with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods, which of the following positions will the nurse instruct the client to assume? a. Sitting up in bed b. Side-lying in bed c. Sitting in a recliner chair D. Sitting on the side of the bed and leaning on an over-bed table
What is D. Sitting on the side of the bed and leaning on an over-bed table. Rationale: Positions that will assist the client with emphysema with breathing include sitting up and leaning on an over bed table, sitting up and resting the elbows on the knees and standing and leaning against the wall.
200
Which of the following assessment data is most important for the nurse to report to the primary care provider? a. Oxygen saturation of 90% on room air b. Pulse 110 beats/min after lunch c. Clubbing of fingers and cyanotic lips d. Blood pressure 149/88 mm Hg
What is c. Clubbing of fingers and cyanotic lips Rationale: Clubbed fingers and circumoral cyanosis are late signs of serious hypoxemia.
200
What does "FEV1" stand for in the pulmonary function test results? a. Forced Expiratory Volume in One Second b. Forced Expiratory Volume in One Minute c. Forced Expiratory Volume in One Week d. Forced Expiratory Volume in One Hour
What is a. Forced Expiratory Volume in One Second. Rationale: The Forced Expiratory Volume tells us the percentage of the total amount of air is expelled from the lungs during the first second of a forced exhalation.
200
What is one of the most important things that a nurse can teach a patient with COPD a. move to a hot, dry climate. b. perform chest physiotherapy. c. obtain adequate rest in the supine position. d. know the early signs/symptoms of COPD exacerbation
What is d. know the early signs/symptoms of COPD exacerbation. Rationale: Knowing the early signs/symptoms of COPD exacerbation can prevent them from occurring.
300
COPD is the combination of emphysema and _____. a. tuberculosis b. strep throat c. chronic bronchitis d. acute respiratory failure
What is c. chronic bronchitis. Rationale: In COPD, the bronchioles become inflammed, enlarged and eventually are unable to expel the air and collapse. The other options are not chronic conditions associated with COPD
300
A nurse is caring for a client with emphysema who is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed: a. 1 L/min b. 2 L/min c. 6 L/min d. 10 L/min
What is B. 2 L/min Rationale: Oxygen is used cautiously and should not exceed 2 L/min. because of the long-standing hypercapnia that occurs in emphysema, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system.
300
A nurse enters the patient's room to do the morning assessment. Upon percussion the nurse would hear what type of sound? a. hyperresonance b. Dull c. Flat d. Hollow
What is a. hyperresonance. Rationale: Upon percussion hyperresonance is heard due to the trapped air.
300
What is a normal FEV1 reading? a. greater than 50% b. less than 80% c. greater than 80% d. less than 30%
What is c. greater than 80%. Rationale: COPD is seen once the FEV1 reading drops below 80%. The other options are diagnostic of COPD and would accompany symptoms of respiratory distress.
300
What is the most significant lifestyle change for a patient with COPD. a. Exercise b. Diet c. Smoking cessation d. Stress reduction
What is c. Smoking cessation. Rationale: Cigarette smoking causes the inflammation that worsen the prognosis. Although the other options are encouraged, smoking cessation is the priority.
400
In patients with COPD, a common assessment finding is the barrel chest, what causes this finding? a. Air that has been trapped in the alveoli b. Periods of apnea c. Air that has been trapped in the bronchioles d. Overuse of supplemental oxygen
What is a. Air that has been trapped in the alveoli. Rationale: The entrapment of air in the alveoli, due to the collapse of the bronchioles, causes the "barrel chest" appearance in patients with COPD. The other options do not cause "barrel chest."
400
What type of meal regimen is appropriate for patients affected by COPD? a. high calorie, low protein diet. b. high calorie, high protein diet. c. low calorie, high protein diet. d. high calorie, high carbohydrate diet.
What is b. high calorie, high protein diet. Rationale: This allows the patient to maintain adequate nutrition without over-exerting the body. All others are inappropriate for a patient with COPD.
400
What is an early indication of an exacerbation in a patient with COPD? Choose all that apply a. Change of Consciousness b. Numbness in left arm c. Use of accessory muscles d. Rapid and shallow respirations
What is c and d. Rationale: The use of accessory muscles and short rapid breathing indicates respiratory distress in patients with COPD. A change in the level of consciousness could occur late in the exacerbation. Numbness in the left arm is a sign of a mycardial infarction not an exacerbation of COPD
400
What does the chest x-ray of a person with COPD look like? Select all that apply. a. a flattened diaphragm b. cardiomegaly from front to back c. an expanded diaphragm d. abnormal air collections within the lung
What is a, b and d. Rationale: Because of the expansion of the lungs due to the entrapment of air, the diaphragm is flattened and the heart is forced to expand in the unnatural direction of front to back and abnormal air collections within the lung.
400
After a patient is diagnosed with COPD, the nurse should monitor; Select all that apply a. Respiratory rate, symmetry and effort. b. Reflexes c. Breath sounds d. Heart rhythm and vital signs e. Nutrition and weight loss
What is a, c, d and e. Rationale: Although monitoring reflexes is important, it is not vital to monitor in a patient with COPD.
500
Put the pathology of COPD in the correct order. 1. damage to lung tissue 2. increased collagen and scar tissue formation 3. enlarged goblet cells 4. repeated cycles of energy and repair of peripheral airways 5. inhalation of noxious particles 6. inflammatory mediators are released 7. excess mucous production
What is 5. inhalation of noxious particles 6. inflammatory mediators are released 1. damage to lung tissue 3. enlarged goblet cells 7. excess mucous production 4. repeated cycles of energy and repair of peripheral airways 2. increased collagen and scar tissue formation
500
A client is concerned that he will never be able to leave his house once he is on oxygen therapy. What should the nurse tell him?
What is the nurse should inform the client that there are portable oxygen delivery systems available. Rationale: Providing patients with a feeling of independence will decrease their anxiety and increase their willingness to comply.
500
The person with COPD frequently experiences Select all that apply. a. Cough b. Sputum production c. Weight gain d. Dyspnea e. Neuropathy
What is a, b and d. Rationale: Clinical manifestations of COPD are cough, sputum production and dyspnea. The person with advanced COPD frequently experiences weight loss. Neuropathy is not appropriate.
500
An appropriate nursing diagnosis for a patient with COPD would be Select all that apply a. Impaired gas exchange b. Activity intolerance c. Ineffective breathing pattern d. Ineffective airway clearance
What is a, b, c and d Rationale: all are correct :)
500
What types of medications are used to treat the symptoms of COPD? Select all that apply a. bronchodilators b. corticosteroids c. mucolytics d. beta-blockers e. antibiotics
What is a, b, c, e are all used at some point to treat the symptoms of COPD such relaxing the smooth muscle of the bronchioles, thinning mucous secretions and treating bacterial infections. Beta-blockers are not appropriate in treating COPD.
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