Question 1

The nurse is caring for a client with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care?

Accepted Answer

Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the client requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

Question 2

Which of the following information should the nurse include in teaching a client with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy?

Accepted Answer

Research supports the use of home oxygen to improve quality of life and prognosis. Since increased dyspnea may be a symptom of an acute process such as pneumonia, the client should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual client circumstances. Travel is possible by using portable oxygen concentrators.

Question 3

Which of the following information about a newly admitted client with chronic obstructive pulmonary disease (COPD) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline?

Accepted Answer

Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other client information would not impact whether the theophylline should be administered or not.

Question 4

The nurse is preparing a client with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?

Accepted Answer

Bronchodilators are held before pulmonary function testing so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the client to be NPO. Oral corticosteroids also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

Question 5

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement to determine the appropriate oxygen flow rate?

Accepted Answer

The best way to determine the appropriate oxygen flow rate is by monitoring the client's oxygenation either by arterial blood gases (ABGs) or pulse oximetry; an oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For clients with an exacerbation of COPD, an oxygen flow rate of 2 L/minute may not be adequate. Because oxygen use improves survival rate in clients with COPD, there is not a concern about oxygen dependency. The client's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

Question 6

The nurse is assessing a young adult client in the outpatient clinic who has a new diagnosis of emphysema and does not have a history of smoking. Which of the following information should the nurse anticipate teaching the client about?

Accepted Answer

When emphysema occurs in young clients, especially without a smoking history, a congenital deficiency in ?1-antitrypsin should be suspected. Because the client does not smoke, a nicotine patch would not be ordered. There is no indication that the client requires continuous pulse oximetry. Leukotriene modifiers would be used in clients with asthma, not with emphysema.

Question 7

The nurse is interviewing a client with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?

Accepted Answer

A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

Question 8

The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client?

Accepted Answer

Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the client with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.

Question 9

Which of the following information should the nurse include when teaching the client with asthma about the prescribed medications?

Accepted Answer

Tremors are a common adverse effect of short-acting ?2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The client should hold the breath for 10 seconds after using inhalers.

Question 10

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem?

Accepted Answer

Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Clients with COPD should rest before meals. Foods that have a lot of texture may take more energy to eat and lead to decreased intake. Although fruits and juices are not contraindicated, foods high in protein are a better choice.

Question 11

The nurse has completed client teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the client indicates good understanding of the teaching?

Accepted Answer

Spacers can improve the delivery of medication to the lower airways. The other client actions indicate a need for further teaching.

Question 12

The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions?

Accepted Answer

The air entrainment ports regulate the oxygen percentage delivered to the client, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or nonrebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a client receiving mechanical ventilation.

Question 13

Which of the following information should the nurse teach a client with COPD?

Accepted Answer

Eating five to six small meals per day helps avoid feelings of bloating and early satiety. The use of frozen foods and a microwave oven may help conserve a client's energy in food preparation. Exercises should be avoided for at least 1 hour before and after eating. A high-calorie, high-protein diet is recommended.

Question 14

The nurse is evaluating the effectiveness of therapy for a client who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective?

Accepted Answer

The goal for treatment of an asthma attack is to keep the oxygen saturation >92%. The other client data may occur when the client is too fatigued to continue with the increased work of breathing required in an asthma attack.

Question 15

Which of the following findings by the nurse for a client with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?

Accepted Answer

For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.

Question 16

After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicate that more teaching is needed?

Accepted Answer

The client should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the client indicate a good understanding of pursed lip breathing.

Question 17

The nurse is assessing a client in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take?

Accepted Answer

The client's peak flow readings indicate good asthma control (values over 80%), and no changes are needed. The other actions would be used for clients in the yellow or red zones for peak flow.

Question 18

The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old client with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the client?

Accepted Answer

The goal for exercise programs for clients with COPD is to increase exercise time gradually to a total of 20 minutes daily. Shortness of breath is normal with exercise and not an indication that the client should stop. Limiting exercise to ADLs will not improve the client's exercise tolerance. A 70-year-old client should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

Question 19

Which of the following actions by a client who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?

Accepted Answer

Readings in the yellow zone indicate a decrease in peak flow; the client should use short-acting ?2-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The client
should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings.

Question 20

The nurse is caring for a client with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the client asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse'sresponse?

Accepted Answer

Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. Neither medication is an antihistamine. The two-drug combination of salmeterol and fluticasone is not used during an acute attack because the medications do not work rapidly.

Quiz 31: Nursing Management Obstructive Pulmonary Diseases