Med Surg Exam The Patient with Exacerbation of COPD

The Patient with Exacerbation of COPD 1. In obtaining a history for a patient with chronic obstructive pulmonary disease, which risk factors are related to potentially causing or triggering the disease process? Select all that apply a. Cigarette smoking b. Occupational and air pollution c. Genetic tendencies d. Occupation e. Food or drug allergies 2. A nurse evaluates the following arterial blood gas and vital sign results for a patient with chronic obstructive pulmonary disease (COPD): · ABGs: pH = 7.32 PaCO2 = 62 mm HgPaO2 = 46 mm HgHCO3- = 28 mEq/L (28 mmol/L) · Heart rate = 110 beats/min, Respiratory rate = 12 breaths/min, Blood pressure = 145/65 mm Hg, Oxygen saturation = 76%. What action would the nurse take first? a. Administer a short-acting beta2 agonist inhaler. b. Document the findings as normal for a patient with COPD. c. Teach the patient diaphragmatic breathing techniques. d. Initiate oxygenation therapy to increase saturation to 92%. 3. A nurse cares for a patient who tests positive for alpha1-antitrypsin (AAT) deficiency. The patient asks, “What does this mean?” How would the nurse respond? a. “Your children will be at high risk for the development of chronic obstructive pulmonary disease.” b. “I will contact a genetic counselor to discuss your condition.” c. “Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke.” d. “This is a recessive gene and would have no impact on your health.” 4. A nurse is teaching a patient how to perform pursed-lip breathing. Which instructions would the nurse include in this teaching? a. “Open your mouth and breathe deeply.” b. “Use your abdominal muscles to squeeze air out of your lungs. c. “Breath out slowly without puffing your cheeks.” d. “Focus on inhaling and holding your breath as long as you can.” e. “Exhale at least twice the amount of time it took to breathe in.” 5. A nurse cares for a patient with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process would the nurse correlate with this patient’s history and clinical manifestations? a. Increased pulmonary pressure creating a higher workload on the right side of the heart b. Increased pulmonary pressure creating a higher workload on the right side of the heart c. Increased number and size of mucous glands producing large amounts of thick mucus d. Left ventricular hypertrophy creating a decrease in cardiac output 6. A home health nurse evaluates a patient who has chronic obstructive pulmonary disease. Which assessments would the nurse include in this patient’s evaluation? a. Examination of mucous membranes and nail beds b. Measurement of rate, depth, and rhythm of respirations c. Auscultation of bowel sounds for abnormal sounds d. Check peripheral veins for distention while at rest e. Determine the patient’s need and use of oxygen 7. After teaching a patient who is prescribed a long-acting beta2 agonist medication, a nurse assesses the patient’s understanding. Which statement indicates that the patient comprehends the teaching? a. “I will carry this medication with me at all times in case I need it.” b. “I will take this medication when I start to experience an asthma attack.” c. “I will take this medication every morning to help prevent an acute attack.” d. “I will be weaned off this medication when I no longer need it.” 8. A nurse assesses a patient who is prescribed fluticasone (Flovent) and notes oral lesions. What action would the nurse take? a. Encourage oral rinsing after fluticasone administration. b. Obtain an oral specimen for culture and sensitivity. c. Start the patient on a broad-spectrum antibiotic. d. Document the finding as a known side effect. e. The drug reduces local immunity and increases the risk for local infection 9. Which statement is true about the relationship of smoking cessation to the pathophysiology of chronic obstructive pulmonary disease (COPD)? a. Smoking cessation completely reverse the damage to the lungs b. Smoking cessation slows the rate of disease progression c. Smoking cessation is an important therapy for asthma but no for COPD d. Smoking cessation reverses the effects on the airways but not the lungs