COPD PATHOPHYSIOLOGY AND MANAGEMENT
EXAMINATION (2025/2026)CHRONIC OBSTRUCTIVE
PULMONARY DISEASE – NCLEX-STYLE FINAL EXAMINATION
Advanced Clinical Reasoning, Pathophysiology, Pharmacology
and Nursing Management
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department.
The nurse caring for the child should monitor for which sign, knowing that it indicates a
worsening of the condition?
a.
Warm, dry skin
b.
Decreased wheezing
c.
Pulse rate of 90 beats/minute
d.
Respirations of 18 breaths/minute
b. decreased wheezing
Rationale: Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a
child with asthma may be interpreted incorrectly as a positive sign when it may actually signal
an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With
treatment, increased wheezing actually may signal that the child's condition is improving.
Warm, dry skin indicates an improvement in the child's condition because the child is normally
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,diaphoretic during exacerbation. The normal pulse rate in a 10 year old is 70-110 beats/min and
normal respiratory rate is 16-20 breaths/minute.
The patient asks the nurse why the physician ordered beclomethasone (Beclovent) for his COPD.
Which statement by the nurse is most appropriate?
a.
"Beclovent prevents airway dilation."
b.
"Beclovent decreases inflammation, and makes it easier to breathe."
c.
"Beclovent suppresses the immune response."
d.
"Beclovent decreases responsiveness to medications that dilate the airway."
b. Beclovent decreases inflammation and makes it easier to breathe
Rationale: Beclovent is an inhaled corticosteroid that is thought to decrease inflammation and
dilate the airway. Preventing airway dilation is undesirable for this patient, and the exact
opposite action of Beclovent. The exact mechanism of action is unknown. Becolvent, like any
other corticosteroid, does suppress the immune response, but this is not the rationale for
administration of the medication. Inhaled corticosteroids are thought to increase
responsiveness of bronchial smooth muscle to beta-agonist drugs.
The nurse teaches a client with COPD to assess for s/sx of right-sided heart failure. Which of the
following s/sx would be included in the teaching plan?
a.
Clubbing of nail beds
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, b.
Hypertension
c.
Peripheral edema
d.
Increased appetite
c. 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. Clubbing of
nail beds is associated with conditions of chronic hypoxia. Hypertension is associated with left-
sided heart failure. Clients with heart failure have decreased appetites.
A client with asthma has started to take a beta-adrenergic agent. The client also takes a
monoamine oxidase inhibitor (MAOI). For what complication should the nurse asses the client?
a.
Hypotension
b.
Hypertension
c.
Tachycardia
d.
Bradycardia
b. hypertension
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EXAMINATION (2025/2026)CHRONIC OBSTRUCTIVE
PULMONARY DISEASE – NCLEX-STYLE FINAL EXAMINATION
Advanced Clinical Reasoning, Pathophysiology, Pharmacology
and Nursing Management
A 10-year-old child with asthma is treated for acute exacerbation in the emergency department.
The nurse caring for the child should monitor for which sign, knowing that it indicates a
worsening of the condition?
a.
Warm, dry skin
b.
Decreased wheezing
c.
Pulse rate of 90 beats/minute
d.
Respirations of 18 breaths/minute
b. decreased wheezing
Rationale: Asthma is a chronic inflammatory disease of the airways. Decreased wheezing in a
child with asthma may be interpreted incorrectly as a positive sign when it may actually signal
an inability to move air. A "silent chest" is an ominous sign during an asthma episode. With
treatment, increased wheezing actually may signal that the child's condition is improving.
Warm, dry skin indicates an improvement in the child's condition because the child is normally
1|Page
,diaphoretic during exacerbation. The normal pulse rate in a 10 year old is 70-110 beats/min and
normal respiratory rate is 16-20 breaths/minute.
The patient asks the nurse why the physician ordered beclomethasone (Beclovent) for his COPD.
Which statement by the nurse is most appropriate?
a.
"Beclovent prevents airway dilation."
b.
"Beclovent decreases inflammation, and makes it easier to breathe."
c.
"Beclovent suppresses the immune response."
d.
"Beclovent decreases responsiveness to medications that dilate the airway."
b. Beclovent decreases inflammation and makes it easier to breathe
Rationale: Beclovent is an inhaled corticosteroid that is thought to decrease inflammation and
dilate the airway. Preventing airway dilation is undesirable for this patient, and the exact
opposite action of Beclovent. The exact mechanism of action is unknown. Becolvent, like any
other corticosteroid, does suppress the immune response, but this is not the rationale for
administration of the medication. Inhaled corticosteroids are thought to increase
responsiveness of bronchial smooth muscle to beta-agonist drugs.
The nurse teaches a client with COPD to assess for s/sx of right-sided heart failure. Which of the
following s/sx would be included in the teaching plan?
a.
Clubbing of nail beds
2|Page
, b.
Hypertension
c.
Peripheral edema
d.
Increased appetite
c. 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. Clubbing of
nail beds is associated with conditions of chronic hypoxia. Hypertension is associated with left-
sided heart failure. Clients with heart failure have decreased appetites.
A client with asthma has started to take a beta-adrenergic agent. The client also takes a
monoamine oxidase inhibitor (MAOI). For what complication should the nurse asses the client?
a.
Hypotension
b.
Hypertension
c.
Tachycardia
d.
Bradycardia
b. hypertension
3|Page
