COPD NCLEX CHRONIC EXAM QUESTIONS WITH COMPLETE ANSWERS and rationales

COPD NCLEX CHRONIC EXAM QUESTIONS WITH COMPLETE ANSWERS and rationales MULTICHOICES Question 1 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 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 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 Rationale: Concurrent use of an MAOI and a beta-agonist can lead to hypertensive crisis. Hypotension is not of concern with this combination of medications; the client is at risk for a hypertensive crisis. The beta-agonist could lead to tachycardia, but since no specific agent is listed the nurse should consider the potential interaction of the MAOI and the beta-agonist first. Bradycardia is not of concern with this combination of medication; it is more likely that the client will experience tach