COPD
The nurse in charge formulates a nursing diagnosis of Activity intolerance related to inadequate oxygenation and dyspnea for a client with chronic bronchitis. To minimize this problem, the nurse instructs the client to avoid conditions that increase oxygen demands. Such conditions include:
What is B?
Conditions that increase oxygen demands include obesity, smoking, exposure to temperature extremes, and stress. Patients with COPD can experience hypoxia during increased activity and may need oxygenation to avoid hypoxemia which puts them at risk for exacerbations of the condition.
The nurse in charge is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide?
What is A?
Pursed-lip breathing helps prevent early airway collapse. Learning this technique helps the client control respiration during periods of excitement, anxiety, exercise, and respiratory distress. The positive pressure created opposes the forces exerted on the airways from the flow of exhalation. As a result, pursed-lip breathing helps support breathing by the opening of the airways during exhalation and increasing excretion of volatile acids in the form of carbon dioxide preventing or relieving hypercapnia.
A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?
What is C?
Take the inhaler out of the mouth. If the client can, he should hold his breath as he slowly counts to 10. This lets the medicine reach deep into the lungs. The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.
A community health nurse is conducting an educational session with community members regarding TB. The nurse tells the group that one of the first symptoms associated with TB is:
What is B?
One of the first pulmonary symptoms includes a slight cough with the expectoration of mucoid sputum. A chronic cough, hemoptysis, weight loss, low-grade fever, and night sweats are some of the most common physical findings in pulmonary tuberculosis. Other options are late symptoms and signify cavitation and extensive lung involvement.
A 79-year-old client is admitted with pneumonia. Which nursing diagnosis should take priority?
What is D?
Pneumonia is an acute infection of the lung parenchyma. The inflammatory reaction may cause an outpouring of exudate into the alveolar spaces, leading to an ineffective airway clearance related to retained secretions. This diagnosis is related to excessive secretions and ineffective cough or nonproductive coughing. Inflammation and increased secretions in pneumonia make it difficult to maintain a patent airway.
An oxygenated 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?
What is A?
The venturi mask delivers the most accurate oxygen concentration. The Venturi mask is the best oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. An air-entrainment (also known as venturi) mask can provide a pre-set oxygen to the patient using jet mixing. As the percent of inspired oxygen increases using such a mask, the air-to-oxygen ratio decreases, causing the maximum concentration of oxygen provided by an air-entrainment mask to be around 40%.The face tent, the aerosol mask, and the tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high humidity.
A nurse is caring for a client with emphysema. The client is receiving oxygen. The nurse assesses the oxygen flow rate to ensure that it does not exceed:
What is B?
Correct Answer: B. 2 L/min
One to 3 L/min of oxygen by nasal cannula may be required to raise PaO2 to 60 to 80 mm Hg. However, oxygen is used cautiously and should not exceed 2 L/min. Because of the long-standing hypercapnia, the respiratory drive is triggered by low oxygen levels rather than increased carbon dioxide levels, as is the case in a normal respiratory system. Supplemental oxygen can successfully reach the alveoli in these lungs, which prevents this vasoconstriction and thereby increases perfusion and improves gas exchange, thus resulting in improvement of hypoxemia.
The nurse would anticipate which of the following ABG results in a client experiencing a prolonged, severe asthma attack?
A. Decreased PaCO2, increased PaO2, and decreased pH.
B. Increased PaCO2, decreased PaO2, and decreased pH.
C. Increased PaCO2, increased PaO2, and increased pH.
D. Decreased PaCO2, decreased PaO2, and increased pH
What is B?
As the severe asthma attack worsens, the client becomes fatigued and alveolar hypotension develops. This leads to carbon dioxide retention and hypoxemia. The client develops respiratory acidosis. Therefore, the PaCO2 level increases, the PaO2 level decreases, and the pH decreases, indicating acidosis.
A client who is HIV+ has had a PPD skin test. The nurse notes a 7-mm area of induration at the site of the skin test. The nurse interprets the results as:
What is A. Positive?
The client with HIV+ status is considered to have positive results on PPD skin test with an area greater than 5-mm of induration. The client with HIV is immunosuppressed, making a smaller area of induration positive for this type of client. If the PPD is reddened and raised 10mm or more, it’s considered positive according to the CDC. If the infection risk is very high, the PPD test need not be repeated. The positive PPD test is usually followed by TB symptom assessment, physical exam, and chest radiograph.
A client with pneumonia has a temperature of 102.6*F (39.2*C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care?
What is C, frequent linen changes?
Frequent linen changes are appropriate for this client because of diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Adjust and monitor environmental factors like room temperature and bed linens as indicated.
A nurse is caring for a client hospitalized with acute exacerbation of COPD. Which of the following would the nurse expect to note on assessment of this client?
What is C?
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-ray films reveal a hyperinflated chest and a flattened diaphragm as the disease is advanced. The inflammatory response and obstruction of the airways cause a decrease in the forced expiratory volume (FEV1) and tissue destruction leads to airflow limitation and impaired gas exchange. Hyperinflation of the lungs is often seen on imaging studies and occurs due to air trapping from airway collapse during exhalation.
A client with emphysema should receive only 1 to 3 L/minute of oxygen if needed, or he may lose his hypoxic drive. Which of the following statements is correct about hypoxic drive?
What is C?
Clients with emphysema breathe when their oxygen levels drop to a certain level; this is known as the hypoxic drive. In the meantime, his carbon dioxide levels continue to climb, and the client will pass out, leading to a respiratory arrest. The hypoxic drive theory then goes on to say that if the healthcare provider gives these patients too much oxygen they blunt their hypoxic drive. As their chemoreceptors are already tolerant of high levels of carbon dioxide, and therefore they have also lost that drive, their respirations will begin to slow causing a further rise in carbon dioxide levels, and a consequent acidosis.
A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?
What is C?
Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. At a physiologic level, steroids reduce airway inflammation and mucus production and potentiate beta-agonist activity in smooth muscles and reduce beta-agonists tachyphylaxis in patients with severe asthma. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.
A nurse is caring for a client diagnosed with TB. Which assessment, if made by the nurse, would not be consistent with the usual clinical presentation of TB and may indicate the development of a concurrent problem?
What is D. a high grade fever?
The client with TB usually experiences cough (non-productive or productive), fatigue, anorexia, weight loss, dyspnea, hemoptysis, chest discomfort or pain, chills and sweats (which may occur at night), and a low-grade fever. Clients with TB typically have low-grade fevers, not higher than 102*F. A chronic cough, hemoptysis, weight loss, low-grade fever, and night sweats are some of the most common physical findings in pulmonary tuberculosis.
The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following?
What is D, decreased oxygenation of the blood?
A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. It is evident that the cyanosis of pneumonia patients is due to the incomplete saturation of venous blood with oxygen in the lungs, and that the various shades of blue observed in the distal parts are caused by an admixture of reduced hemoglobin and oxyhemoglobin in the superficial capillaries.
A male client admitted to an acute care facility with pneumonia is receiving supplemental oxygen, 2 L/minute via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these history findings, the nurse closely monitors the oxygen flow and the client’s respiratory status. Which complication may arise if the client receives a high oxygen concentration?
What is A?
Hypoxia is the main breathing stimulus for a client with COPD. Excessive oxygen administration may lead to apnea by removing that stimulus. During apnea, there is no movement of the muscles of inhalation, and the volume of the lungs initially remains unchanged. Depending on how blocked the airways are, there may or may not be a flow of gas between the lungs and the environment.
Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?
What is A?
Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack. People with long-term lung conditions can help improve their symptoms through regular exercise. It can be tempting to avoid exercise because one may think it will make them breathless, but if the client does less activity he becomes less fit, and daily activities will become even harder.
The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.
What is A and D?
Inhaled respiratory medications are often taken by using a device called a metered-dose inhaler, or MDI. The MDI is a pressurized canister of medicine in a plastic holder with a mouthpiece. When sprayed, it gives a reliable, consistent dose of medication.
The nurse should include which of the following instructions when developing a teaching plan for clients receiving INH and rifampin for treatment for TB?
What is D?
INH and rifampin are hepatotoxic drugs. Clients should be warned to limit intake of alcohol during drug therapy. Liver function tests should be monitored routinely as rifampin, isoniazid, pyrazinamide, and ethambutol all may exert hepatotoxic effects. CBC also requires regular monitoring for patients taking rifampin, as it can cause thrombocytopenia and neutropenia.
A client with pneumonia has a temperature ranging between 101° and 102°F and periods of diaphoresis. Based on this information, which of the following nursing interventions would be a priority?
What is D?
A fluid intake of at least 3 L/day should be provided to replace any fluid loss occurring as a result of the fever and diaphoresis; this is a high-priority intervention. Force fluids to at least 3000 mL/day or as individually appropriate. Meets basic fluid needs, reducing risk of dehydration and to mobilize secretions, and promote expectoration.
At 11 p.m., a male 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:
What is D?
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.
It’s highly recommended that clients with asthma, chronic bronchitis, and emphysema have Pneumovax and flu vaccinations for which of the following reasons?
What is D?
It’s highly recommended that clients with respiratory disorders be given vaccines to protect against respiratory infection. Infections can cause these clients to need intubation and mechanical ventilation, and it may be difficult to wean these clients from the ventilator. Another pneumococcal vaccine, PPSV23, is indicated in the United States for all adults 65 years of age and older, as well as younger patients with conditions that increase the risk for developing pneumococcal pneumonia or invasive pneumococcal disease. Conditions that would indicate PPSV23 in patients younger than 65 years of age are as follows: chronic heart disease excluding hypertension, chronic lung disease including asthma, diabetes mellitus, cerebrospinal fluid leak, cochlear implant, alcohol use disorder, chronic liver disease, cigarette smoking, hemoglobinopathy (including sickle cell disease), etc.
The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack?
What is B?
The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Asthma is a condition of acute, fully reversible airway inflammation, often following exposure to an environmental trigger. The pathological process begins with the inhalation of an irritant (e.g., cold air) or an allergen (e.g., pollen), which then, due to bronchial hypersensitivity, leads to airway inflammation and an increase in mucus production. This leads to a significant increase in airway resistance, which is most pronounced on expiration.
The nurse is teaching a client who has been diagnosed with TB how to avoid spreading the disease to family members. Which statement(s) by the client indicate(s) that he has understood the nurse’s instructions? Select all that apply.
What is B, C, D, and E?
Review pathology of disease (active and inactive phases; dissemination of infection through bronchi to adjacent tissues or via bloodstream and/or lymphatic system) and potential spread of infection via airborne droplet during coughing, sneezing, spitting, talking, laughing, singing.
Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply.
What is A, C, and E?
A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client’s ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the patient with pneumonia.