Show:
COPD
Asthma
Medications
Nursing Interventions
Delegation
100
Which of the following is a priority goal for the client with COPD? A. Maintaining functional ability B. Minimizing chest pain C. increasing C02 levels in the blood D. Treating infectious agents
What is Maintaining functional ability. Rationale: Priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the clients functional ability.
100
The client with Asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack? A. Occupational exposure to toxins B. Viral respiratory infections C. Exposure to cigarette smoke D. exercising in cold temperatures
What is Viral Respiratory infections. Rationale: The most common precipitator of asthma attacks is viral respiratory infections. Cleints with asthma should avoid people who have the flu or a cold and should get yearly flu vaccines.
100
Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant which of the following is a possible side effect of this drug? A. Constipation B. Bradycardia C. Diplopia D. Restlessness
What is Restlessness. Rationale: Increasing dyspnea in exertion indicates that the client may be experiencing complications of COPD, and therefore the physician should be notified.
100
A cyanotic client with an unknow diagnosis is admitted to the ER in relation to oxygen, the first nursing action would be to? A. wait until the clients lab work is done B. Not administer O2 unless ordered by physician C. Administer O2 at 2L flow per/min D. Administer O2 at 10L per/ min and check clients nail bed.
What is Administer O2 at 2L flow/min. Rationale: Administer O2 at 2L per/min no more, for if the client is emphysemic and recieves too much high level O2 he will develop CO2 necrosis and respiratory system will cease to function.
100
A patient with chronic obstructive pulmonary disease (COPD). Which intervention for airway management should you delegate to a nursing assistant (PCT)? 1. Assisting the patient to sit up on the side of the bed 2. Instructing the patient to cough effectively 3. Teaching the patient to use incentive spirometry 4. Auscultating breath sounds every 4 hours
What is 1 Rationale: Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. Teaching, instructing, and assessing patients all require additional education and skills and are more appropriate for a licensed nurse
200
When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate the client will do which of the following? A. Develop infections easily B. Maintain current status C. Require less supplemental O2 D. Show permanent improvement
What is Develop infections easily Rational: A client with COPD is at high risk for development of respiratory infections.
200
Which of the following health promotion activities should the nurse include in discharge teaching plan for a client with Asthma? A. Incorporate physical exercise as tolerated into the treatment plan B. Monitor peak flow numbers after meals and at bedtime C. Eliminate stressors in the work and home environment D. Use sedative to ensure uninterrupted sleep at night
What is Incorporate physical exercise as tolerated into the treatment plan. Rationale: Physical exercise is beneficial and should be incorporated as tolerated into hte client's schedule.
200
A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma? A. Corticosteroids promote bronchodilation B. Corticosteroids act as an expectorant C. Corticosteroids have an anti-inflammatory effect D. Corticosteroids prevent development of respiratory infections
What is Corticosteroids have an anti-inflammatory effect Rationale: Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion
200
A client has just returned to a nursing unit following bronchoscopy. A nurse would implement which of the following nursing interventions for this client? A. Encouraging additional fluids for the next 24 hours B. Ensuring the return of the gag reflex before offering foods or fluids C. Administering atropine intravenously D. Administering small doses of midazolam (Versed).
What is Ensuring the return of the gag reflux before offering foods or fluids. Rationale: After bronchoscopy, the nurse keeps the client on NPO status until the gag reflex returns because the preoperative sedation and the local anesthesia impair swallowing and the protective laryngeal reflexes for a number of hours
200
The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? 1.Observe how well the patient performs pursed-lip breathing 2. Plan a nursing care regiment that gradually increases activity intolerance 3. Assist the patient with basic activities of daily living 4. Consult with the physical therapy department about reconditioning exercises
What is 1 Rationale: Experienced LPNs/LVNs can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. Assisting patients with ADLs is more appropriately delegated to a nursing assistant. Planning and consulting require additional education and skills, appropriate to an RN
300
The nurse assesses the respiratory status of a client who is experiencing an exacerbation of COPD secondary to an upper respiratory tract infection. Which of the following findings would be expected? A. Normal breath sounds B. Prolonged inspiration C. Normal chest movement D. Coarse crackles and rhonchi
What is Coarse crackles and rhonchi. Rationale: Exacerbations of COPD are frequently caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions.
300
Which of the following diagnostic studies is most helpful in determining the presence of asthma? A. Spirometry B. Large number of eosinophils in the blood C. Pulmonary function tests (PFTs) D. Incentive spirometer
What is Pulmonary Function Test (PFTs) Rationale: Pulmonary function tests are the most reliable way to diagnose asthma and differentiate it from other illnesses like COPD.
300
A client is receiving isoetharine hydrochloride (Bronkosol) via a nebulizer. The nurse monitors the client for which side effect of this medication? A.Constipation B. Diarrhea C. Bradycardia D. Tachycardia
What is Tachycardia. Rationale: Side effects that can occur from a beta 2 agonist include tremors, nausea, nervousness, palpitations, tachycardia, peripheral vasodilation, and dryness of the mouth or throat.
300
Auscultation of a client’s lungs reveals crackles in the left posterior base. The nursing intervention is to: A. Repeat auscultation after asking the client to deep breathe and cough. B. Instruct the client to limit fluid intake to less than 2000 ml/day. C. Inspect the client’s ankles and sacrum for the presence of edema D. Place the client on bedrest in a semi-Fowlers position.
What is Repeat auscultation after asking the client to deep breath and cough. Rationale: Although crackles often indicate fluid in the alveoli, they may also be related to hypoventilation and will clear after a deep breath or a cough.
300
True or False: An AP can teach a client who has asthma how to use their Albuterol inhaler before being discharged?
What is False. Rationale: An AP cannot teach a client how to use medication.
400
The nurse teaches a client with COPD to assess for s/s of right-sided heart failure. Which of the following s/s would be included in the teaching plan? A.Clubbing of nail beds B. Hypertension C. Peripheral edema D. Increased appetite
What is Peripheral edema. Rationale: Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume.
400
Which of the following assessment findings would help confirm a diagnosis of asthma in a client suspected of having the disorder? A. Circumoral cyanosis B. Increased forced expiratory volume C. Inspiratory and expiratory wheezing D. Normal breath sounds
What is Inspiratory and expiratory wheezing. Rationale: These are typical findings in patients who have asthma.
400
A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of metaproterenol?A. Irregular heartbeat B. Constipation C. Pedal edema D. Decreased heart rate
What is Irregualr heartbeat. Rationale: Irregular heart rates should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on the beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders.
400
The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included? A. Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation B. Lie flat on back, splint the thorax, take two deep breaths and cough C. Take several rapid, shallow breaths and then cough forcefully D. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing
What is Take a deep abdominal breath, bend forward, and cough 3 to 4 times on exhalation. Rationale: The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process 3 or 4 times, the client should take a deep abdominal breath, bend forward and cough 3 or 4 times upon exhalation (“huff” cough).
400
True or False: An RN must delegate tasks so that they can complete higher-level tasks that only RNs can perform.
What is True. Rationale: This allows more efficient use of all members of the health care team.
500
A client with COPD has developed secondary polycythemia. Which nursing diagnosis would be included in the plan care because of the polycythemia? A. Fluid volume deficit related to blood loss B. Impaired tissue perfusion related to thrombosis C. Activity intolerance related to dyspnea D. Risk for infection related to suppressed immune response
What is Impaired tissue perfusion related to thrombosis. Rationale: Chronic hypoxia associated with COPD may stimulate excessive RBC production (polycythemia). This results in increased blood viscosity and the risk of thrombosis.
500
Which of the following types of asthma involve an acute asthma attack brought on by an upper respiratory infection? A. Emotional B. Extrinsic C. Intrinsic D. Mediated
What is Intrinsic Rationale: Doesn't have an easily idenifiable allergen and can be triggered by the common cold.
500
A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate? A. This is an anticipated side-effect of your medication. It should go away in a couple of weeks.” B. “You are using your inhaler too much and it has irritated your mouth.” C. “You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.” D. “Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem.”
What is You have developed a fungal infection from your medication. It will need to be treated with an antibiotic. Rationale: Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the Corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.
500
A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? A. Altered nutrition: Less than body requirements related to fatigue. B. Activity intolerance related to dyspnea. C. Weight loss related to COPD. D. Ineffective breathing pattern related to alveolar hypoventilation.
What is Altered nutrition: Less than body requirements related to fatigue. Rationale: The client’s problem is altered nutrition—specifically, less than required. The cause, as stated by the client, is the fatigue associated with the disease process.
500
Which of the following is an incorrect task for an LVN: A) Monitor findings B) reinforce client teaching C) discharge a patient D) Administer enteral feedings E) Perform tracheostomy care
What is Discharge a patient Rationale: Only an RN can discharge a patient