1.
Why is monitoring respiratory status a nursing priority when a client with COPD is receiving oxygen?
Correct Answer
C. Decreased arterial oxygen is the stimulus for breathing in a client with COPD.
Explanation
Monitoring respiratory status is a nursing priority when a client with COPD is receiving oxygen because decreased arterial oxygen is the stimulus for breathing in a client with COPD. This means that if the client's arterial oxygen levels are not monitored and maintained within a safe range, their breathing may become compromised, leading to respiratory distress or even respiratory failure. Therefore, it is important for nurses to closely monitor the client's respiratory status to ensure that they are receiving adequate oxygen and to intervene promptly if any signs of respiratory distress occur.
2.
Which laboratory results are consistent with long-term COPD? Mark all that apply.
Correct Answer(s)
A. Erythrocytosis
B. Hypoxemia
C. Hypercapnia
Explanation
Long-term COPD is characterized by the progressive damage to the lungs, leading to impaired gas exchange. Erythrocytosis, an increase in red blood cell count, is consistent with COPD as the body compensates for chronic hypoxemia by producing more red blood cells to carry oxygen. Hypoxemia, a low level of oxygen in the blood, is a common finding in COPD due to impaired lung function. Hypercapnia, an elevated level of carbon dioxide in the blood, occurs in COPD as the lungs are unable to effectively remove carbon dioxide. Leukopenia, a decrease in white blood cell count, is not typically associated with long-term COPD.
3.
A client with COPD complains of headaches and a “racing” heart; he is also restless and somewhat confused. Which problem would the nurse suspect?
Correct Answer
A. Respiratory acidosis
Explanation
The client with COPD is experiencing symptoms of respiratory acidosis. This occurs when there is an excess of carbon dioxide in the blood, leading to an increase in acidity. The headaches and racing heart are likely due to the body compensating for the increased carbon dioxide levels by increasing the heart rate. The restlessness and confusion may be a result of the acidosis affecting the central nervous system.
4.
A client with a history of COPD complains of increased shortness of breath and has wheezing noted upon auscultation. The client is administered a nebulizer treatment of Albuterol and Atrovent. Which evaluation would indicate a therapeutic response to this treatment?
Correct Answer
C. Decrease in shortness of breath
Explanation
A decrease in shortness of breath would indicate a therapeutic response to the nebulizer treatment of Albuterol and Atrovent in a client with a history of COPD. This is because these medications are bronchodilators that help to relax and open up the airways, reducing the feeling of breathlessness. If the client's shortness of breath decreases after the treatment, it suggests that the medications are effectively improving their breathing.
5.
A client has been prescribed theophylline (Theo-24) for COPD. Discharge instructions should include the interaction of which of the following:
Correct Answer
A. Nicotine transdermal patches
Explanation
Discharge instructions for a client prescribed theophylline (Theo-24) for COPD should include the interaction of nicotine transdermal patches. Theophylline is metabolized by the same enzyme system in the liver as nicotine, which can lead to increased theophylline levels in the body when used together. This can result in toxic effects of theophylline, such as nausea, vomiting, tremors, and seizures. Therefore, it is important to educate the client about this interaction and advise them to avoid using nicotine patches while taking theophylline.
6.
A client with a diagnosis of chronic obstructive pulmonary disease (COPD) is being discharged from the hospital. Which of the following is appropriate patient teaching before discharge?
Correct Answer
D. “Use your inhalers every day as directed even if symptoms are not present.”
Explanation
Using inhalers every day as directed, even if symptoms are not present, is appropriate patient teaching for a client with COPD before discharge. This is because inhalers help to manage and control the symptoms of COPD by opening up the airways and reducing inflammation. Consistent use of inhalers can prevent exacerbations and improve overall lung function. It is important for the client to understand the importance of using inhalers as prescribed, even when they do not feel any symptoms, to effectively manage their condition and prevent further complications.
7.
An elderly postoperative client has a history of chronic obstructive pulmonary disease. Based on this history, the nurse is especially concerned with monitoring the client for which problem?
Correct Answer
C. Decreased gas exchange
Explanation
The nurse is especially concerned with monitoring the client for decreased gas exchange because of the client's history of chronic obstructive pulmonary disease. This condition causes obstruction in the airways, leading to difficulty in breathing and impaired oxygenation. Monitoring for decreased gas exchange is important to ensure that the client is receiving adequate oxygen and to detect any worsening of respiratory function.
8.
A client has COPD and a barrel chest. Which finding would the nurse expect when assessing the chest?
Correct Answer
C. Decreased respiratory excursion
Explanation
In a client with COPD and a barrel chest, the nurse would expect to find decreased respiratory excursion when assessing the chest. This is because COPD causes airway obstruction and reduced lung elasticity, leading to difficulty in fully expanding and contracting the lungs during breathing. As a result, the movement of the chest during respiration is restricted, resulting in decreased respiratory excursion.
9.
Which statement made by a client with COPD after being taught about the use of pursed-lip breathing indicates the need for additional instruction?
Correct Answer
A. “I will make sure to puff my cheeks out when I breathe out through my mouth.”
Explanation
The correct answer is "I will make sure to puff my cheeks out when I breathe out through my mouth." This statement indicates the need for additional instruction because puffing the cheeks out during pursed-lip breathing is not recommended. Pursed-lip breathing involves inhaling through the nose and exhaling slowly through pursed lips, as if blowing out a candle. Puffing the cheeks out can actually increase air trapping and make breathing more difficult for someone with COPD.
10.
Which would be an expected effect of resistive breathing training in a client with COPD?
Correct Answer
D. Increased respiratory muscle strength
Explanation
Resistive breathing training involves exercises that make the respiratory muscles work harder. In a client with COPD, these exercises can help strengthen the weakened respiratory muscles, which may have been affected by the disease. By increasing respiratory muscle strength, the client may experience improved breathing efficiency and a reduced feeling of breathlessness. This can contribute to better overall respiratory function and potentially enhance the client's ability to perform daily activities with less effort.
11.
A client with pneumonia is receiving supplemental oxygen, 2 L/min via nasal cannula. The client’s history includes chronic obstructive pulmonary disease (COPD) and coronary artery disease. Because of these 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?
Correct Answer
A. Apnea
Explanation
A client with chronic obstructive pulmonary disease (COPD) and coronary artery disease is at risk for retaining carbon dioxide due to impaired lung function. Giving the client a high oxygen concentration can suppress their respiratory drive and cause apnea, leading to a lack of oxygenation. This is a potential complication that the nurse should closely monitor for in this client.
12.
An elderly client is on an anticholinergic metered-dose inhaler (MDI) for chronic obstructive pulmonary disease. The nurse would suggest a spacer to
Correct Answer
C. Improve aerosol delivery in clients who are not able to coordinate the MDI
Explanation
A spacer is a device that is attached to the MDI to improve aerosol delivery. It helps to ensure that the medication is properly delivered to the lungs by slowing down the speed of the medication and reducing the amount of medication that is deposited in the mouth and throat. This is particularly beneficial for clients who have difficulty coordinating their inhalation with the activation of the MDI. By using a spacer, the client is able to receive a more effective dose of the medication, leading to improved outcomes in managing their COPD.
13.
The nurse enters the room of a client diagnosed with COPD. The client’s skin is pink, and respirations are 8 per minute. The client’s oxygen is running at 6 liters per minute. What should be the nurse’s first action?
Correct Answer
C. Lower the oxygen rate.
Explanation
The client's skin being pink and having a respiratory rate of 8 per minute indicate that the client may be experiencing carbon dioxide retention, which can be dangerous for someone with COPD. The high oxygen rate of 6 liters per minute may be contributing to this. Lowering the oxygen rate would help prevent further carbon dioxide retention and ensure the client's safety. Therefore, the nurse's first action should be to lower the oxygen rate.
14.
A client with chronic obstructive pulmonary disease (COPD) and a history of coronary artery disease is receiving aminophylline, 25mg/hour. Which one of the following findings by the nurse would require immediate intervention?
Correct Answer
C. Restlessness and palpitations
Explanation
Restlessness and palpitations in a client with COPD and a history of coronary artery disease who is receiving aminophylline could indicate a potential adverse reaction to the medication. Aminophylline is a bronchodilator that can cause stimulation of the central nervous system and cardiovascular system. Restlessness and palpitations may be signs of increased sympathetic activity, which can lead to tachycardia and potentially worsen coronary artery disease. Immediate intervention is necessary to assess the client's condition, provide appropriate treatment, and prevent further complications.
15.
In restrictive disease (e.g. pulmonary fibrosis), ____. In obstructive disease (e.g.asthma or COPD), ____.
Correct Answer
D. TLC is decreased; RV is increased.
Explanation
In restrictive lung diseases such as pulmonary fibrosis, the lungs become stiff and lose their ability to expand fully. This leads to a decrease in total lung capacity (TLC), as the lungs cannot hold as much air. On the other hand, the residual volume (RV), which is the amount of air left in the lungs after a forced exhalation, increases in restrictive diseases because the lungs have difficulty emptying completely. This is why the correct answer is "TLC is decreased; RV is increased."
16.
In patients with chronic obstructive pulmonary disease (COPD), the equal pressure point can be found closer to the alveolus at any lung volume.
Correct Answer
A. Yes
Explanation
In patients with chronic obstructive pulmonary disease (COPD), the equal pressure point can be found closer to the alveolus at any lung volume. This means that the pressure within the airways is equal to the pressure within the alveoli, indicating that there is a decreased pressure gradient for airflow. This can contribute to the airflow limitation seen in COPD patients.
17.
Slowly adapting pulmonary stretch fibers are useful in patients with COPD or airway obstruction because they:
Correct Answer
B. Allow for a longer expiratory pHase.
Explanation
Slowly adapting pulmonary stretch fibers are sensory receptors located in the airways that respond to changes in lung volume. These fibers are particularly important in patients with COPD or airway obstruction because they help regulate the duration of the expiratory phase. By allowing for a longer expiratory phase, these fibers help to prevent air trapping and hyperinflation of the lungs, which are common in these conditions. This allows for more effective emptying of the lungs and helps improve respiratory function.
18.
A patient presents with acute exacerbation of chronic bronchitis associated with COPD. If there is evidence of bacterial infection (e.g., purulent sputum), which of the following antibiotics would NOT be recommended for treatment?
Correct Answer
C. Levofloxacin (Levaquin)
Explanation
Levofloxacin (Levaquin) would not be recommended for treatment in a patient with acute exacerbation of chronic bronchitis associated with COPD if there is evidence of bacterial infection. This is because Levofloxacin is a broad-spectrum antibiotic that primarily targets Gram-negative bacteria, whereas chronic bronchitis exacerbations are commonly caused by Gram-positive bacteria such as Streptococcus pneumoniae or Haemophilus influenzae. Therefore, other antibiotics such as Clindamycin, TMP-SMX, or Doxycycline would be more appropriate for treating bacterial infections associated with chronic bronchitis and COPD.
19.
What is the most common cause of the chronic obstructive pulmonary disease (COPD)?
Correct Answer
C. Cigarette smoking
Explanation
Cigarette smoking is the most common cause of chronic obstructive pulmonary disease (COPD). Smoking damages the airways and lung tissue, causing inflammation and narrowing of the air passages. Over time, this leads to the development of COPD, which includes conditions such as chronic bronchitis and emphysema. Smoking also accelerates the natural aging process of the lungs and reduces their ability to function properly. Quitting smoking is essential in preventing and managing COPD.
20.
A COPD patient presents with asterixis. Severe hypercarbia is suspected. What other symptoms might the patient have?
Correct Answer
B. Conjunctival suffusion
Explanation
If a COPD patient presents with asterixis, which is a flapping tremor of the hands, it suggests severe hypercarbia, or high levels of carbon dioxide in the blood. Conjunctival suffusion, which is redness and swelling of the conjunctiva, the clear membrane that covers the white part of the eye, is a possible symptom of severe hypercarbia. Retinitis pigmentosa, temporal arteritis, retinal detachment, and strabismus are not typically associated with hypercarbia in COPD patients.