Chapter 11 COPD Exam 2 Med Surg ...

COPD NCLEX Chronic.ScienceMedicinePulmonology Milohmylove Save Chapter 11 COPD Exam 2 Med Surg ...25 terms Monk3gam3Preview Pneumonia NCLEX practice questio...34 terms Daniel_Griffiths2 Preview COPD 19 terms pveatchPreview COPD Teacher Iren 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

• 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."

• 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

• 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

• 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 tachycardia.

A 7-year-old client is brought to the E.R. He's tachypneic and afebrile and has a respiratory rate of 36 breaths/minute and a nonproductive cough. He recently had a cold. From his history, the client may have which of the following?a.Acute asthma b.Bronchial pneumonia c.Chronic obstructive pulmonary disease (COPD) d.Emphysema a acute asthma Rationale: Based on the client's history and symptoms, acute asthma is the most likely diagnosis. He's unlikely to have bronchial pneumonia without a productive cough and fever and he's too young to have developed COPD or emphysema.A 34-year-old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, what action should the nurse take to initiate care of the client?a.Initiate oxygen therapy and reassess the client in 10 minutes.b.Draw blood for an ABG analysis and send the client for a chest x-ray.c.Encourage the client to relax and breathe slowly through the mouth d.Administer ordered bronchodilators

• Administer ordered bronchodilators

Rationale: In an acute asthma attack, diminished or absent breath sounds can be an ominous sign of indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, intravenous corticosteroids, and possibly intravenous theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing an ABG and obtaining a chest x-ray. It would be futile to encourage the client to relax and breathe slowly without providing necessary pharmacologic intervention.

The nurse is planning to teach a client with COPD how to cough effectively. Which of the following instructions should be included?a.Take three deep abdominal breath, bend forward, and cough while saying the word "who" on exhalation.b.Lie flat on back, splint the thorax, take two deep breaths and cough.c.Take several rapid, shallow breaths and then cough forcefully.d.Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.

• Take three deep abdominal breaths, bend forward, and cough while saying the word "who"

Rationale: The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process 3 or 4 times, the client should take a deep abdominal breath, bend forward and cough while saying the word "WHO" . This intervention is called "huff" cough.Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.A school-age child with CF asks the nurse what sports she can be involved in as she becomes older. Which of the following activities would be most appropriate for the nurse to suggest?a.swimming b.track c.baseball d.javelin throwing

• Swimming

Rationale: Swimming would be the most appropriate suggestion because it coordinates breathing and movement of all muscle groups and can be done on an individual basis or as a team sport. Because track events, baseball and javelin throwing usually are performed outdoors, the child would be breathing in large amounts of dust and dirt, which would be irritating to her mucous membranes and pulmonary system. The strenuous activity and increased energy expenditure associated with track events, in conjunction with the dust and possible heat, would play a role in placing the child at risk for an URTI and compromising her respiratory function.