Med_Surg_Chapter_24

Med-Surg Ch 24: Management of Patients with Chronic Pulmonary Disease Question A client is being treated in the ED for respiratory distress coupled with pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? • Administration of antibiotics Question A child is having an asthma attack and the parent can’t remember which inhaler to use for quick relief. The nurse accesses the child’s medication information and tells the parent to use which inhalant? • Proventil Question A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? • Anxiety Question Which statement describes emphysema? • A disease of the airways characterized by destruction of the walls of overdistended alveoli Question A client is prescribed metaproterenol 20 mg four times each day. How many mg of metaproterenol does the client take each day? Enter the correct number ONLY. • 80 Question A client experiencing an asthmatic attack is prescribed methylprednisolone (Solu–Medrol) intravenously. The nurse: • Assesses fasting blood glucose levels Question A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? • Lung sounds Question A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to • Exhale slowly Question A client is at risk for emphysema. When reviewing information about the condition with the client, which would the nurse emphasize as the most important environmental risk factor for emphysema? • Cigarette smoking Question A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information? • salmeterol/fluticasone (Seretide) MDI daily at 0800 Question A client is being admitted to the medical–surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? • Cromolyn sodium Question A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? • Oxygen through nasal cannula at 2 L/minute Question A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? • Anxiety Question A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes • implementing measures to clear pulmonary secretions. Question A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction? • "Weigh yourself daily and report a gain of 2 lb in 1 day." Question A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is: • "Have you tried to quit smoking before?" Question A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? • "Delay self–care activities for 1 hour." Question A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met? • Decreased oxygen requirements Question A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder? • Emphysema Question A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? • Respiratory rate of 22 breaths/minute Question A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? • High-protein Question A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client • Has wheezes in the right lung lobes Question A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care? • "I do not need to rinse my mouth with this type of inhaler." Question A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include: • diminished or absent breath sounds on the affected side. Question A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: • the airways are so swollen that no air can get through. Question A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? • Take ordered medications as scheduled. Question A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply. • Status asthmaticus • Respiratory failure • Atelectasis Question A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply. • Inflamed airways that obstruct airflow • Mucus secretions that block airways • Overinflated alveoli that impair gas exchange Question A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply. • Cough • Wheezing • Dyspnea Question A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? • Sputum and a productive cough Question A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? • Respiratory acidosis Question A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? • Proventil Question A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be • Albuterol Question A physician orders triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs? • Administer the salmeterol and then administer the triamcinolone. Question A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first: • Collects sputum for culture and sensitivity Question After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options. • Alter smooth muscle tone • Reduce airway obstruction • Increase oxygen distribution Question As status asthmaticus worsens, the nurse would expect which acid-base imbalance? • Respiratory acidosis Question Asthma is cause by which type of response? • IgE-mediated Question Histamine, a mediator that supports the inflammatory process in asthma, is secreted by • Mast cells Question In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid–base imbalances? • Respiratory acidosis Question In which grade of COPD is the forced expiratory volume in 1 second (FEV1) greater than 80% predicted? • I Question In which statements regarding medications taken by a client diagnosed with COPD do the the drug name and the drug category correctly match? Select all that apply. • Albuterol is a bronchodilator. • Ciprofloxacin is an antibiotic. • Prednisone is a corticosteroid. Question The classification of Stage II of COPD is defined as • moderate COPD. Question The classification of Stage III of COPD is defined as • severe COPD. Question The classification of Stage IV of COPD is defined as • very severe COPD. Question The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client • Exhales hard and fast with a single blow Question The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client’s care plan? • Performing chest physiotherapy as ordered Question The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? • Providing sufficient oxygen to improve oxygenation Question The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? • Respiratory alkalosis Question The nurse is reviewing pressurized metered-dose inhaler (pMDI) instructions with a client. Which statement by the client indicates the need for further instruction? • “I can’t use a spacer or holding chamber with the MDI.” Question The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? • Atelectasis Question The nursing student recalls that the underlying pathophysiology of chronic obstructive pulmonary disease (COPD) includes the following components: (Select all that apply.) • Inflamed airways obstruct airflow. • Mucus secretions block airways. • Overinflated alveoli impair gas exchange. Question To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations? • Streptococcus pneumonia and Haemophilus influenzae Question Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse’s concern? (Select all that apply.) • Compromised gas exchange • Decreased airflow • Wheezes Question When developing a preventative plan of care for a patient at risk for developing chronic obstructive pulmonary disease (COPD), which of the following should be incorporated? • Smoking cessation Question Which exposure accounts for most cases of COPD? • Exposure to tobacco smoke Question Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? • Exposure to tobacco smoke Question Which of the following is the key underlying feature of asthma? • Inflammation Question Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply. • Montelukast (Singulair) • Zafirlukast (Accolate) • Zileuton (Zyflo) Question Which is the most important risk factor for development of COPD? • Cigarette smoking Question The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? • Atelectasis Question Which of the following is a symptom diagnostic of emphysema? • Dyspnea Question Which of the following is not a primary symptom of COPD? • Weight gain Question Which of the following occupy space in the thorax, but do not contribute to ventilation? • Bullae Question Which statement describes emphysema? • A disease of the airways characterized by destruction of the walls of overdistended alveoli Question Which statement is true about both lung transplant and bullectomy? • Both procedures improve the overall quality of life of a client with COPD. Question Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? • Influenza