Nur 265 - Respiratory Test 1 UPDATED
ACTUAL Questions and CORRECT
Answers
Chronic Obstructive Pulmonary Disease - CORRECT ANSWER Characterized by airflow
obstruction resulting from chronic bronchitis and emphysema
• Cigarette smoking - causative factor in 90% of patients
• Environmental & genetic factors (alpha1-antirypsin deficiency)
• Second hand smoke, urban pollution, occupational exposure to toxins
COPD - Pathophysiology - CORRECT ANSWER • Chronic Bronchitis - excessive
accumulation of mucous secretions block the airway, bronchospasm and inflammation of the
bronchi and bronchioles
• Emphysema - There is destruction of the walls of the overdistended alveoli which results in
impaired gas exchange
COPD - Smoking - CORRECT ANSWER Interferes with cilliary cleansing mechanism of
respiratory tract; causing airflow to be obstructed. The aveoli become over distended and there is
diminished lung capacity. Also irritates mucous glands, increasing mucous secretions. This all
causes protease release which breaks down the elastin in the aveoli.
Arterial blood gases PaO2: Range and abnormal findings - CORRECT ANSWER 80 - 100
↑=excessive O2 admin
↓=COPD, asthma, chronic bronchitis, cancer of bronchi and lungs, CF, respiratory distress
syndrome, anemias, atelectasis, hypoxia
Arterial blood gases PaCO2: Range and abnormal findings - - CORRECT ANSWER 35 -
45
↑=COPD, asthma, pneumonia, anesthesia effects, opoids, respiratory acidosis
↓=hyperventiliation, respiratory alkalosis
,Arterial blood gases -pH: Range and abnormal findings - CORRECT ANSWER 7.35 -
7.45
↑=metabolic or respiratory alkalosis
↓=metabolic or respiratory acidosis
Arterial blood gases HCO3: Range and abnormal findings - - CORRECT ANSWER 21 -
28
↑=respiratory acidosis as compensation for a primary metabolic alkalosis
↓=respiratory alkalosis as compensation for a primary metabolic acidosis
COPD - Emphysema - CORRECT ANSWER Some alveoli are destroyed and others
become large and flabby which decreases area for effective gas exchange trapping air in the
lungs. The hyper inflated lung flattens the diaphragm and increases the work of breathing
• The patient adjusts by increasing respiratory rate. Carbon dioxide retention and respiratory
acidosis occur.
• In late stage emphysema, there is a low oxygen level because the oxygen has a hard time
moving from disease lung tissue into the bloodstream.
COPD - Symptoms - CORRECT ANSWER • Dyspnea (even at rest in late stages), cough,
orthopnea
• Patient can't forcibly exhale air from lungs
• Risk for respiratory: infections, insufficiency and failure
• FEV/FVC ratio <70% = COPD
• "Barrel Chest", air trapped in lungs (from Emphysema)
• Diminished breath sounds with expiration. Dry crackles and wheezes heard at base with forced
expiration
• Increased total lung capacity, functional residual capacity and residual volume due to trapped
air
• ABG's (In advanced cases) = high PCO2, low PO2
• Chest X-Ray: low flat diaphragm and hyperinflation
,COPD - Typical Clinical Picture - CORRECT ANSWER Increased RR, rapid, shallow
respirations, use of accessory muscles (abdomen and neck), limited diaphragmatic excursion
(diaphragm is flattened)
• If the PO2 is chronically decreased: clubbing of fingers, cyanosis, delayed capillary refill
• Patient with an 8 pack a year history usually has obstructive changes but no manifestations
• Patient with a 20 pack history or longer often has early stage COPD found as changes in
pulmonary function test
COPD - Treatment - CORRECT ANSWER • First intervention: improve gas exchange and
maintain patent airway
• Monitor COPD patient q2h even if he is there for other reasons
• Deterioration of condition may require intubation and mechanical ventilation
Oxygen Therapy - CORRECT ANSWER • ABGs are best means to determine need for
oxygen and its effectiveness
• Pulse Ox can be used to determine the oxygen needed
• Typical patient requires oxygen flow of 2-4 liters via nasal cannula or 40% Venturi mask
• Patients with low oxygen level and high CO2 level require 1-2 liters/min via nasal cannula
because low oxygen level is the patients's primary stimulus to breathe
COPD - Medulla Oblongata (MO) Respiratory Center (ANS) - CORRECT ANSWER Has
2 stimuli for respiration: the oxygen drive and carbon dioxide drive.
• When blood O2 is below normal, through the oxygen drive, the MO stimulates the patient to
breathe
• When blood CO2 is above normal, through the carbon dioxide drive, the MO stimulates the
patient to breathe
• Patients with COPD who always have an increased CO2 level, the carbon dioxide drive stops
working and only the oxygen drive stimulates breathing. If this patient is given a high O2 flow
rate and the O2 level becomes too high, the oxygen drive will not stimulate breathing and the
patient may stop breathing.
• Once respirations stop, they may not start back
, COPD - Breathing Techniques - CORRECT ANSWER • Pursed Lip Breathing - close
mouth, breathe in through the nose and out through pursed lips slowly taking twice the amount
of time it took to breathe in. Use during physical activity
• Abdominal Breathing - the patient lies on his back with his knees bent. Breathe from the
abdomen while keeping the chest still with a book on the abdomen to create resistance
• Positioning - patient should be kept in semi Fowlers or Fowler's position to ease the work of
breathing
• Exercise conditioning - exercises the large muscle groups or restraints the respiratory muscles
as part of a pulmonary rehabilitation programs (breathes against a set resistance or
hyperventilates into a machine that controls O2/CO2 concentrations)
COPD - Nursing Care - CORRECT ANSWER • Energy conservation - pace activities with
rest periods in-between. Place frequently used objects nearby, adjust work heights, do not work
with arms raised and refrain from talking during activities
• Controlled coughing - hug pillow against stomach with head bent slightly downward. After the
third to fifth deep breath (in through nose, out through pursed lips) the patient produces 2 or 3
strong coughs through the same breath
• Suctioning - nasotrahceally by RT of the nurse or orally if the patient has difficulty
expectorating effectively
COPD - Diet - CORRECT ANSWER • 2-3 Liters of fluids PO to liquefy secretions, rest
before meals and may need assistance.
• May need 4-6 small meals, bronchodilator may be used 30 minutes before eating.
• Avoid caffeine (dehydrating), milk, chocolate and dry foods (stimulate coughing). Eat a high
calorie, high protein diet.
• Severe COPD patient may be thin with loss of muscle mass in the extremities and enlarged
neck muscles
• Positioning - For patients who can tolerate it, should sit in chair for one hour periods 2-3 times
a day
COPD - Postural Drainage - CORRECT ANSWER Moves secretions from smaller
bronchial airways to main bronchus and trachea. Then the patient coughs up secretions.
• The patient should inhale bronchodilators and mucolytic agents before postural drainage. Is
usually done before meals and at bedtime.
ACTUAL Questions and CORRECT
Answers
Chronic Obstructive Pulmonary Disease - CORRECT ANSWER Characterized by airflow
obstruction resulting from chronic bronchitis and emphysema
• Cigarette smoking - causative factor in 90% of patients
• Environmental & genetic factors (alpha1-antirypsin deficiency)
• Second hand smoke, urban pollution, occupational exposure to toxins
COPD - Pathophysiology - CORRECT ANSWER • Chronic Bronchitis - excessive
accumulation of mucous secretions block the airway, bronchospasm and inflammation of the
bronchi and bronchioles
• Emphysema - There is destruction of the walls of the overdistended alveoli which results in
impaired gas exchange
COPD - Smoking - CORRECT ANSWER Interferes with cilliary cleansing mechanism of
respiratory tract; causing airflow to be obstructed. The aveoli become over distended and there is
diminished lung capacity. Also irritates mucous glands, increasing mucous secretions. This all
causes protease release which breaks down the elastin in the aveoli.
Arterial blood gases PaO2: Range and abnormal findings - CORRECT ANSWER 80 - 100
↑=excessive O2 admin
↓=COPD, asthma, chronic bronchitis, cancer of bronchi and lungs, CF, respiratory distress
syndrome, anemias, atelectasis, hypoxia
Arterial blood gases PaCO2: Range and abnormal findings - - CORRECT ANSWER 35 -
45
↑=COPD, asthma, pneumonia, anesthesia effects, opoids, respiratory acidosis
↓=hyperventiliation, respiratory alkalosis
,Arterial blood gases -pH: Range and abnormal findings - CORRECT ANSWER 7.35 -
7.45
↑=metabolic or respiratory alkalosis
↓=metabolic or respiratory acidosis
Arterial blood gases HCO3: Range and abnormal findings - - CORRECT ANSWER 21 -
28
↑=respiratory acidosis as compensation for a primary metabolic alkalosis
↓=respiratory alkalosis as compensation for a primary metabolic acidosis
COPD - Emphysema - CORRECT ANSWER Some alveoli are destroyed and others
become large and flabby which decreases area for effective gas exchange trapping air in the
lungs. The hyper inflated lung flattens the diaphragm and increases the work of breathing
• The patient adjusts by increasing respiratory rate. Carbon dioxide retention and respiratory
acidosis occur.
• In late stage emphysema, there is a low oxygen level because the oxygen has a hard time
moving from disease lung tissue into the bloodstream.
COPD - Symptoms - CORRECT ANSWER • Dyspnea (even at rest in late stages), cough,
orthopnea
• Patient can't forcibly exhale air from lungs
• Risk for respiratory: infections, insufficiency and failure
• FEV/FVC ratio <70% = COPD
• "Barrel Chest", air trapped in lungs (from Emphysema)
• Diminished breath sounds with expiration. Dry crackles and wheezes heard at base with forced
expiration
• Increased total lung capacity, functional residual capacity and residual volume due to trapped
air
• ABG's (In advanced cases) = high PCO2, low PO2
• Chest X-Ray: low flat diaphragm and hyperinflation
,COPD - Typical Clinical Picture - CORRECT ANSWER Increased RR, rapid, shallow
respirations, use of accessory muscles (abdomen and neck), limited diaphragmatic excursion
(diaphragm is flattened)
• If the PO2 is chronically decreased: clubbing of fingers, cyanosis, delayed capillary refill
• Patient with an 8 pack a year history usually has obstructive changes but no manifestations
• Patient with a 20 pack history or longer often has early stage COPD found as changes in
pulmonary function test
COPD - Treatment - CORRECT ANSWER • First intervention: improve gas exchange and
maintain patent airway
• Monitor COPD patient q2h even if he is there for other reasons
• Deterioration of condition may require intubation and mechanical ventilation
Oxygen Therapy - CORRECT ANSWER • ABGs are best means to determine need for
oxygen and its effectiveness
• Pulse Ox can be used to determine the oxygen needed
• Typical patient requires oxygen flow of 2-4 liters via nasal cannula or 40% Venturi mask
• Patients with low oxygen level and high CO2 level require 1-2 liters/min via nasal cannula
because low oxygen level is the patients's primary stimulus to breathe
COPD - Medulla Oblongata (MO) Respiratory Center (ANS) - CORRECT ANSWER Has
2 stimuli for respiration: the oxygen drive and carbon dioxide drive.
• When blood O2 is below normal, through the oxygen drive, the MO stimulates the patient to
breathe
• When blood CO2 is above normal, through the carbon dioxide drive, the MO stimulates the
patient to breathe
• Patients with COPD who always have an increased CO2 level, the carbon dioxide drive stops
working and only the oxygen drive stimulates breathing. If this patient is given a high O2 flow
rate and the O2 level becomes too high, the oxygen drive will not stimulate breathing and the
patient may stop breathing.
• Once respirations stop, they may not start back
, COPD - Breathing Techniques - CORRECT ANSWER • Pursed Lip Breathing - close
mouth, breathe in through the nose and out through pursed lips slowly taking twice the amount
of time it took to breathe in. Use during physical activity
• Abdominal Breathing - the patient lies on his back with his knees bent. Breathe from the
abdomen while keeping the chest still with a book on the abdomen to create resistance
• Positioning - patient should be kept in semi Fowlers or Fowler's position to ease the work of
breathing
• Exercise conditioning - exercises the large muscle groups or restraints the respiratory muscles
as part of a pulmonary rehabilitation programs (breathes against a set resistance or
hyperventilates into a machine that controls O2/CO2 concentrations)
COPD - Nursing Care - CORRECT ANSWER • Energy conservation - pace activities with
rest periods in-between. Place frequently used objects nearby, adjust work heights, do not work
with arms raised and refrain from talking during activities
• Controlled coughing - hug pillow against stomach with head bent slightly downward. After the
third to fifth deep breath (in through nose, out through pursed lips) the patient produces 2 or 3
strong coughs through the same breath
• Suctioning - nasotrahceally by RT of the nurse or orally if the patient has difficulty
expectorating effectively
COPD - Diet - CORRECT ANSWER • 2-3 Liters of fluids PO to liquefy secretions, rest
before meals and may need assistance.
• May need 4-6 small meals, bronchodilator may be used 30 minutes before eating.
• Avoid caffeine (dehydrating), milk, chocolate and dry foods (stimulate coughing). Eat a high
calorie, high protein diet.
• Severe COPD patient may be thin with loss of muscle mass in the extremities and enlarged
neck muscles
• Positioning - For patients who can tolerate it, should sit in chair for one hour periods 2-3 times
a day
COPD - Postural Drainage - CORRECT ANSWER Moves secretions from smaller
bronchial airways to main bronchus and trachea. Then the patient coughs up secretions.
• The patient should inhale bronchodilators and mucolytic agents before postural drainage. Is
usually done before meals and at bedtime.
