MDC 3 EXAM 2 COMPREHENSIVE EXAM 2026
FULL SOLUTION QUESTIONS AND ANSWERS
GRADED A+
◉ COPD assessment. Answer: -Ask about age, gender, occupational
history, family history
-Most often seen in older men
-Some types of emphysema occurs in families, especially those who
are AATI deficient
-Smokers usually have a productive cough in the morning, non-
smokers do not
-Assess any cough, sputum color, amount produced, and time during
the day when it is worse
-Breathing may be worse when lying down (orthopnea)
-Unexpected weight loss is likely when COPD has progresses
◉ COPD physical assessment. Answer: -Loss of muscle mass in
extremities
-Neck muscles may be enlarged
-Pt often sits in a forward-bending posture with arms held forward,
position known as orthopneic or tripod position
-Changes in chest size and fatigue
,-Patients with respiratory muscle fatigue breaths with rapid, shallow
breath and may have an abnormal breathing pattern. Their
abdominal wall is sucked in during inspirations and they may use
accessory muscles in abdomen or neck
-Assess for clubbed fingers
-Prolonged respiratory acidosis can cause metabolic alkalosis
◉ COPD acute exacerbations. Answer: -Resp rate could be as high as
40-50 breaths per minute and requires immediate medical attention
-Has respiratory muscles become fatigued, respiratory movement is
jerky and appears uncoordinated.
-Check for retractions and asymmetric chest expansion.
-The patient with emphysema will have limited diaphragmatic
movement because diaphragm is flattened and below its usual
resting state
◉ COPD interventions. Answer: -Improve gas exchange
-Teach breathing management such as airway management,
breathing techniques, effective coughing, oxygen therapy, exercise
conditioning, suctioning, hydration, use of a vibratory positive
pressure device, adhering to drug therapy
-Consultation with dietitian
-Teach stress management techniques and ways to stay calm during
acute dyspneic episodes
,-Teach to avoid crowds to prevent getting sick. -Vaccinate for
pneumonia, influenza
-Assess ABG levels
◉ COPD plan of care. Answer: -Non-serg management focuses on
airway maintenance, monitoring, breathing techniques, positioning,
effective coughing, oxygen therapy exercise coordination, suctioning,
hydration, and use of vibration devices
-Teach pt how to be a partner in their plan of care
-Before any interventions, assess breathing rate, rhythm, depth, and
use of accessory muscles
-Oxygen flow rate between 2 and 4 L per minute with Target
percentage between 88 and 92
◉ COPD preventing weight loss. Answer: -Goal is to achieve a body
weight with 10% of ideal with a serum albumin/prealbumin within
the normal range
-Plan biggest meals during times when pt is well rested and most
hungry
*4-6 meals a day
-Used pursed lip breathing
-Use bronchodilator 30 minutes before meals
-Pick foods that are easy to chew and not gas forming
-Avoid dry foods and caffeinated drinks
, ◉ COPD pharmacological interventions. Answer: 1) Drugs used to
manage COPD are the same drugs as for asthma and include beta-
adrenergic agents, cholinergic antagonists, xanthines,
corticosteroids, and cromones
2) The focus is on long-term control therapy with longer-acting
drugs, such as arformoterol; indacaterol; tiotropium; aclidinium
bromide; olodaterol; and the combination drugs, such as
fluticasone/vilanterol, olodaterol/tiotropium, and
vilanterol/umeclidinium.
3) Another drug class for COPD is the mucolytics, which thin the
thick secretions, making them easier to cough up and expel.
Nebulizer treatments with normal saline or a mucolytic agent such
as acetylcysteine or dornase alfa and normal saline help thin
secretions. Guaifenesin is a systemic mucolytic that is taken orally. A
combination of guaifenesin and dextromethorphan also raises the
cough threshold.
4) Many inhalers for COPD drug therapy are dry powder inhalers
(DPIs). These often require having the patient "load in" each dose.
The steps for this process involve opening the inhaler's capsule
chamber, removing the dry powder capsule from a separate blister
pack, placing the capsule in the chamber, closing the inhaler until it
clicks and punctures the capsule, and then using the inhaler. Often
the patient with severe COPD is older, has muscle weakness, has
poor manual dexterity, and may have some problems with cognition.
All of these issues can be barriers to proper use of a DPI inhaler for
COPD management.
FULL SOLUTION QUESTIONS AND ANSWERS
GRADED A+
◉ COPD assessment. Answer: -Ask about age, gender, occupational
history, family history
-Most often seen in older men
-Some types of emphysema occurs in families, especially those who
are AATI deficient
-Smokers usually have a productive cough in the morning, non-
smokers do not
-Assess any cough, sputum color, amount produced, and time during
the day when it is worse
-Breathing may be worse when lying down (orthopnea)
-Unexpected weight loss is likely when COPD has progresses
◉ COPD physical assessment. Answer: -Loss of muscle mass in
extremities
-Neck muscles may be enlarged
-Pt often sits in a forward-bending posture with arms held forward,
position known as orthopneic or tripod position
-Changes in chest size and fatigue
,-Patients with respiratory muscle fatigue breaths with rapid, shallow
breath and may have an abnormal breathing pattern. Their
abdominal wall is sucked in during inspirations and they may use
accessory muscles in abdomen or neck
-Assess for clubbed fingers
-Prolonged respiratory acidosis can cause metabolic alkalosis
◉ COPD acute exacerbations. Answer: -Resp rate could be as high as
40-50 breaths per minute and requires immediate medical attention
-Has respiratory muscles become fatigued, respiratory movement is
jerky and appears uncoordinated.
-Check for retractions and asymmetric chest expansion.
-The patient with emphysema will have limited diaphragmatic
movement because diaphragm is flattened and below its usual
resting state
◉ COPD interventions. Answer: -Improve gas exchange
-Teach breathing management such as airway management,
breathing techniques, effective coughing, oxygen therapy, exercise
conditioning, suctioning, hydration, use of a vibratory positive
pressure device, adhering to drug therapy
-Consultation with dietitian
-Teach stress management techniques and ways to stay calm during
acute dyspneic episodes
,-Teach to avoid crowds to prevent getting sick. -Vaccinate for
pneumonia, influenza
-Assess ABG levels
◉ COPD plan of care. Answer: -Non-serg management focuses on
airway maintenance, monitoring, breathing techniques, positioning,
effective coughing, oxygen therapy exercise coordination, suctioning,
hydration, and use of vibration devices
-Teach pt how to be a partner in their plan of care
-Before any interventions, assess breathing rate, rhythm, depth, and
use of accessory muscles
-Oxygen flow rate between 2 and 4 L per minute with Target
percentage between 88 and 92
◉ COPD preventing weight loss. Answer: -Goal is to achieve a body
weight with 10% of ideal with a serum albumin/prealbumin within
the normal range
-Plan biggest meals during times when pt is well rested and most
hungry
*4-6 meals a day
-Used pursed lip breathing
-Use bronchodilator 30 minutes before meals
-Pick foods that are easy to chew and not gas forming
-Avoid dry foods and caffeinated drinks
, ◉ COPD pharmacological interventions. Answer: 1) Drugs used to
manage COPD are the same drugs as for asthma and include beta-
adrenergic agents, cholinergic antagonists, xanthines,
corticosteroids, and cromones
2) The focus is on long-term control therapy with longer-acting
drugs, such as arformoterol; indacaterol; tiotropium; aclidinium
bromide; olodaterol; and the combination drugs, such as
fluticasone/vilanterol, olodaterol/tiotropium, and
vilanterol/umeclidinium.
3) Another drug class for COPD is the mucolytics, which thin the
thick secretions, making them easier to cough up and expel.
Nebulizer treatments with normal saline or a mucolytic agent such
as acetylcysteine or dornase alfa and normal saline help thin
secretions. Guaifenesin is a systemic mucolytic that is taken orally. A
combination of guaifenesin and dextromethorphan also raises the
cough threshold.
4) Many inhalers for COPD drug therapy are dry powder inhalers
(DPIs). These often require having the patient "load in" each dose.
The steps for this process involve opening the inhaler's capsule
chamber, removing the dry powder capsule from a separate blister
pack, placing the capsule in the chamber, closing the inhaler until it
clicks and punctures the capsule, and then using the inhaler. Often
the patient with severe COPD is older, has muscle weakness, has
poor manual dexterity, and may have some problems with cognition.
All of these issues can be barriers to proper use of a DPI inhaler for
COPD management.
