Chronic obstructive pulmonary disease (COPD), questions and answers

Chronic obstructive pulmonary disease (COPD), questions and answers When assessing the client with COPD, which health promotion information would be most important for the nurse to obtain? 1. Number of years the client has smoked. 2. Risk factors for complications. 3. Ability to administer inhaled medication. 4. Possibility for lifestyle changes. 1. This would be information needed to treat the cause but not the most important in health promotion. 2. The risk factors for complications would be important in planning care. 3. Assessing the ability to deliver medications would be important when teaching the client. ***4. The possibility of lifestyle changes is most important in health promotion. The most important is smoking cessation. The nurse needs to assess if the client has the willing- ness to consider cessation of smoking and carry out the plan. If the client refuses to stop, treatment will need to be altered. TEST-TAKING HINT: The test taker needs to read the question for words such as "health promotion." These words make all the other answer options wrong because they do not promote health. The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first? 1. Assist the client into a sitting position at 90 degrees. 2. Give oxygen at six (6) LPM via nasal cannula. 3. Monitor vital signs with the client sitting upright. 4. Notify the health-care provider about the client's status. ***1. The client should be assisted into a sitting position either on the side of the bed or in the bed. This position decreases the work of breathing. Some clients find it easier sitting on the side of the bed leaning over the bed table. The nurse needs to maintain the client's safety. 2. Oxygen will be applied as soon as possible,but the least amount possible. If levels of oxygen are too high, the client may stop breathing. 3. Vital signs need to be monitored, but this is not the first priority. If the equipment is not in the room, another member of the health-care team should bring it to the nurse. The nurse should stay with the client. 4. The health-care provider will need to be notified, but the client needs to be treated first. The nurse should get assistance if possible so that the nurse can treat this client quickly. TEST-TAKING HINT: When a question asks for the test taker to choose the intervention to implement first, the test taker should treat life-threatening events first. In this situation the client is in respiratory distress so the nurse must act quickly to prevent the progression to respiratory failure. "Notify the health-care provider" is usually not the first intervention. There are usually assessment data to obtain before calling. When assessing the client with the diagnosis of COPD, which data would require the nurse to take immediate action? 1. Large amounts of thick white sputum. 2. Oxygen flow meter set on eight (8) liters. 3. Use of accessory muscles during inspiration. 4. Presence of a barrel chest and dyspnea. 1. A large amount of thick sputum is a common symptom of COPD. There is no cause for immediate intervention. ***2. The nurse should decrease the oxygen rate. Hypoxemia is the stimulus for breathing in the client with COPD. If the hypoxemia improves and the oxygen level increases, the drive to breathe may be eliminated. Careful monitoring is important to prevent complications. 3. It is common for clients with COPD to use accessory muscles when inhaling. These clients tend to lean forward. 4. In clients with COPD, there is a characteristic barrel chest from chronic hyperinflation, and dyspnea is common. TEST-TAKING HINT: This question requires interpreting the data to determine which is abnormal or unexpected and thus is the one that needs intervention before the client is harmed. At first the test taker may be tempted to choose "4" because of the word "dyspnea" or "3" because of the use of accessory muscles, but these are common occurrences for that client or, in other words, normal for the client. If the data describes a normal scenario for that client, the test taker should look for the option that is different or describes an occurrence that is not expected or that is incorrect—in this case, the oxygen being given too rapidly. While the nurse is caring for the client diagnosed with COPD, which outcome would require a revision in the plan of care? 1. The client has no signs of respiratory distress. 2. The client shows an improved respiratory pattern. 3. The client demonstrates intolerance to activity. 4. The client participates in establishing goals. 1. The expected outcome of showing no signs of respiratory distress would indicate that the plan of care is effective and should be continued. 2. An improved respiratory pattern indicates that the plan should be continued because the client is improving. ***3. The expected outcome should be that the client is showing an improved activity tolerance; because the client is not meeting the expected outcome, the plan of care needs revision. The nurse needs to collaborate with the health-care team and with the client to establish interventions that will assist in improving the client's outcome. 4. The client needs to participate in planning the course of care. The client is meeting the expected outcome. TEST-TAKING HINT: This question is similar to an "except" question. The test taker should look at each answer option for a positive outcome. Nurses want their clients to improve so the expected outcomes should be an improvement of some problem. The test taker should decide which outcome is not desired. The nurse is caring for the client diagnosed with end-stage COPD. Which data would warrant immediate intervention by the nurse? 1. The client's pulse oximeter reading is 92%. 2. The client's arterial blood gas level is 74. 3. The client has SOB when walking to the bathroom. 4. The client's sputum is rusty colored. 1. The client with end-stage COPD would have decreased peripheral oxygen levels; therefore, this would not warrant immediate intervention. 2. The client's ABGs would normally have a low oxygen level; therefore, this would not warrant immediate intervention. 3. The client would have shortness of breath (SOB) when ambulating to the bathroom. ***4. Rusty-colored sputum may indicate blood in the sputum and would require further assessment by the nurse. TEST-TAKING HINT: The test taker could rule out options "1" and "2" as correct answers because both describe the same data of de- creased oxygen, which is characteristic of COPD. What statement made by the client diagnosed with chronic bronchitis indicates to the nurse that more teaching is needed? 1. "I should contact my health-care provider if my sputum changes color or amount." 2. "I will take my bronchodilator regularly to prevent having bronchospasms." 3. "This metered dose inhaler gives a precise amount of medication with each dose." 4. "I need to return to the HCP to have my blood drawn with my annual physical." 1. When sputum changes in color, amount, or both, this indicates infection and the client should report this information to the health- care provider. 2. Bronchodilators should be taken routinely to prevent bronchospasms. 3. Clients use the metered dose inhalers because they deliver a precise amount of medication with correct use. ***4. Clients need to have blood levels drawn every six (6) months when taking bronchodilators. TEST-TAKING HINT: When evaluating whether the client has learned the information pre- sented, the test taker is observing for incorrect information. The test taker should pay close attention to numbers such as "every 12 months." Is that adequate for the stable client? Which nursing diagnoses would be appropriate for the nurse to include in the plan of care for the client diagnosed with COPD? Select all that apply. 1. Impaired gas exchange. 2. Inability to tolerate temperature extremes. 3. Activity intolerance. 4. Inability to cope with changes in roles. 5. Alteration in nutrition. ***1. The client diagnosed with COPD has diffi- culty exchanging oxygen with carbon diox- ide, which is manifested by physical signs such as fingernail clubbing and metabolic acidosis as seen on arterial blood gases. ***2. Clients need to avoid extremes in tempera- tures. Warm temperatures cause an in- crease in the metabolism and increase the need for oxygen. Cold temperatures cause bronchospasms. ***3. When a client has difficulty breathing the client can become fatigued so that the client can stop breathing. Activities should be timed so rest periods are available to prevent fatigue. ***4. Many clients have difficulty adapting to the role changes brought about because of the disease process. Many cannot maintain the activities involved in meeting responsibilities at home and at work. Clients should be assessed for these issues. ***5. Clients often lose weight because so much effort is expended to breathe. TEST-TAKING HINT: This is an example of an alternate question. There may be more than one (1) answer. The test taker should consider all options independently and understand that the question is not a trick. Which outcome would be appropriate for the client problem "ineffective gas exchange" for the client recently diagnosed with COPD? 1. The client demonstrates the correct way to purse-lip breathe. 2. The client lists three (3) signs/symptoms to report to the HCP. 3. The client will drink at least 2500 mL of water daily. 4. The client will be able to ambulate 100 feet with dyspnea. ***1. Pursed-lip breathing helps keep the alveoli open to allow for better oxygen and carbon dioxide exchange. 2. This would be an appropriate outcome for a knowledge-deficit problem. 3. This outcome does not ensure the client has an effective airway; increasing fluid does not ensure an effective airway. 4. This would be an outcome for the client prob- lem of activity intolerance. TEST-TAKING HINT: The test taker needs to identify the outcome for the client problem cited—namely, "ineffective gas exchange." The only answer option dealing with the air- way is "1," pursed-lip breathing. The primary nurse observes the unlicensed nursing assistant removing the nasal cannula from the client diagnosed with COPD while ambulating the client to the bath- room. Which action should the primary nurse take? 1. Praise the NA because this prevents the client from tripping on the oxygen tubing. 2. Place the oxygen back on the client while sitting in the bathroom and say nothing. 3. Explain to the NA in front of the client that the oxygen must be left in place at all times. 4. Discuss the NA's action with the charge nurse so that appropriate action can be taken. 1. The client diagnosed with COPD needs oxygen at all times, especially when exerting energy such as when ambulating to the bath- room. ***2. The client needs the oxygen, and the nurse should not correct the NA in front of the client; it is embarrassing for the NA, and the client loses confidence in the staff. 3. The nurse should not verbally correct an NA in front of the client; the nurse should correct the behavior and then talk to the NA in private. 4. The primary nurse should confront the NA and take care of the situation. Continued unsafe client care would warrant notifying the charge nurse. TEST-TAKING HINT: The test taker must know management concepts and the nurse should first address the behavior with the person directly then follow the chain of command. Remember, the nurse should treat a subordi- nate the way they would want to be treated and not embarrass the NA in front of the client. When assessing the client recently diagnosed with COPD, which sign and symptom should the nurse expect? 1. Clubbing of the client's fingers. 2. Infrequent respiratory infections. 3. Chronic sputum production. 4. Nonproductive hacking cough. 1. Clubbing fingers is the result of chronic hypox- emia, which would be expected with chronic COPD but not with recently diagnosed COPD. 2. These clients have frequent respiratory infections. ***3. Sputum production, along with cough and dyspnea on exertion, are the early signs/ symptoms of COPD. 4. These clients have a productive cough, not a nonproductive cough. TEST-TAKING HINT: The test taker must be observant of adjectives such as "recently diag- nosed," which helps to rule out incorrect answers such as "1." Option "2" has the word "infrequent." The test taker must notice these words. What statement made by the client would indicate that the nurse's discharge teaching was effective for the client diagnosed with COPD? 1. "I need to get an influenza vaccine each year, even when there is a shortage." 2. "I need to get a vaccine for pneumonia each year with my flu shot." 3. "If I reduce my cigarette smoking to six (6) a day, I won't have difficulty breathing." 4. "I need to restrict my drinking liquids to keep from having so much phlegm." ***1. Clients diagnosed with COPD should receive the influenza vaccine each year. If there is a shortage, these clients have top priority. 2. The pneumococcal vaccine should be given every five (5) to seven (7) years. It is important to prevent respiratory illnesses when possible with these clients. 3. Reducing the number of cigarettes smoked does not stop the progression of COPD, and the client will continue to experience signs and symptoms such as shortness of breath or dysp- nea on exertion. 4. Clients diagnosed with COPD should increase their fluid intake unless contraindicated for another health condition. The increased fluid assists the client in expectorating the thick sputum. TEST-TAKING HINT: Nurses are expected to serve as community resources. The nurse should be knowledgeable about health promo- tion activities such as immunizations. One (1) option describes a desired goal, but the other three (3) do not. Which referral would be appropriate for a client diagnosed with COPD? 1. The Asthma Foundation of America. 2. The American Cancer Society. 3. The American Lung Association. 4. The American Heart Association. 1. The asthma foundation would not be appro- priate for a client diagnosed with chronic lung disease. 2. The American Cancer Society is helpful for a client with lung cancer but not for a client with COPD. ***3. The American Lung Association has infor- mation that is helpful for a client with COPD. 4. Many clients with COPD end up with heart problems, but the American Heart Association does not have information for clients with COPD. TEST-TAKING HINT: The test taker should be familiar with organizations, but if the test taker had no idea what the answer was, the only option containing a word referring to respiration—"lung"—is option "3."