Pharmacology and the Nursing Process
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Bowel sounds are assessed using the diaphragm of the stethoscope for high-pitched and gurgling sounds [Gu, Lim, & Moser, 2010]. The frequency and character of the sounds are usually heard as clicks and gurgles that occur irregularly and range from 5 to 35 per minute. The terms normal [sounds heard about every 5 to 20 seconds], hypoactive [one or two sounds in 2 minutes], hyperactive [5 to 6 sounds heard in less than 30 seconds], or absent [no sounds in 3 to 5 minutes] are frequently used in documentation, but these assessments are highly subjective [Li, Wang, & Ma, 2012].
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A nurse is teaching a client about chronic obstructive pulmonary disease [COPD]. Which information should the nurse include? [Select all that apply.]
A.
COPD is a respiratory disorder that has components of chronic bronchitis and emphysema.
B.
After a flare-up, the lung tissue returns to normal.
C.
COPD is a curable
disease.
D.
COPD exacerbations cause shortness of breath and increased sputum production.
E.
Intermittent flare-ups of the symptoms are expected.
COPD is a respiratory disorder that has components of chronic bronchitis and emphysema.
COPD exacerbations cause shortness of breath and increased sputum production.
Intermittent flare-ups of the symptoms are expected.
Rationale: Chronic obstructive pulmonary disease [COPD] is an incurable disease. It is characterized by periods of exacerbation, or flare-ups. Lung tissue is permanently damaged with each exacerbation and does not return to normal. COPD does cause the symptoms of dyspnea and increased sputum production, and it is a disorder that includes both bronchitis and emphysema.
The nurse is assessing a client who has chronic bronchitis. Which symptom should the nurse expect to find? [Select all that
apply.]
A.
Distended neck veins
B.
Barrel chest
C.
Cough with sputum production
D.
Diminished breath sounds
E.
Wheezing
Distended neck veins
Cough with sputum production
Wheezing
Rationale: Clients with chronic bronchitis will exhibit distended neck veins, a cough with sputum production, and wheezing. The client with emphysema would present with diminished breath sounds and a barrel chest.
The nurse is assessing a client diagnosed with emphysema. Which clinical manifestation should the nurse expect to find? [Select all that apply.]
A.
Barrel chest
B.
Diminished breath sounds
C.
Use of accessory muscles when breathing
D.
Cough with copious amounts of sputum
E.
Hypercapnia noted within laboratory results
Barrel chest
Diminished breath sounds
Use of accessory muscles when breathing
Rationale: Clinical findings that support the diagnosis of emphysema include a barrel chest, use of accessory muscles when breathing, and diminished breath sounds. A cough with copious amounts of sputum and hypercapnia are indicative of chronic bronchitis.
The nurse is describing the effects of smoking. Which effect should be included? [Select all that apply.]
A.
Destruction of airways
B.
Inhibited function of
alveolar macrophages
C.
Atrophy of mucus-secreting glands
D.
Constriction of smooth muscle
E.
Enhanced ciliary movement
Destruction of airways
Inhibited function of alveolar macrophages
Constriction of smooth muscle
Rationale: Cigarette smoking has been known to cause inhibited function of alveolar macrophages, airway destruction, and constricted smooth muscle. Cigarette smoking causes impaired ciliary movement, not enhanced ciliary movement. Cigarette smoking causes mucus-secreting glands to hypertrophy, not atrophy.
Which condition should the nurse understand occurs in the pathophysiology of emphysema? [Select all that apply.]
A.
Fluid buildup in the lungs
B.
Loss of elastic recoil of the lungs
C.
Excessive mucus produced
D.
Enlargement of the alveoli
E.
Decrease in cilia function
Loss of elastic recoil of the lungs
Enlargement of the alveoli
Rationale: The pathophysiology of emphysema includes enlargement of the alveoli and loss of elastic recoil of the lungs. Decreased ciliary function, fluid buildup in the lungs, and excessive mucus production occur with chronic bronchitis, not emphysema.
The nurse is teaching coughing techniques to a client with chronic obstructive pulmonary disease. Which technique should the
nurse include?
A.
Inhale deeply through the mouth prior to huff coughing.
B.
Limit fluid intake to decrease pulmonary secretions.
C.
Cough twice, the first time to loosen mucus and the second time to expel secretions.
D.
Utilize oxygen therapy as needed.
Cough twice, the first time to loosen mucus and the second time to expel secretions.
Rationale: Coughing twice is the correct method that should be included in the teaching. Prolonged coughing tends to be ineffective and increases fatigue. While oxygen therapy may be an important component of care, it is to prevent and treat hypoxemia. When inhaling before huff coughing, inhale or sniff though the nose to avoid pushing secretions back down into the lungs. Fluid intake should not be limited and is not part of coughing techniques that should be included in the teaching.
The nurse is discussing dietary changes for a
client with chronic obstructive pulmonary disease. Which advice should the nurse include?
A.
Follow a low-salt diet.
B.
Restrict fluids.
C.
Increase dairy products.
D.
Follow a high-carbohydrate diet.
Follow a low-salt diet.
Rationale: A low-salt diet is recommended to prevent fluid retention, which can lead to dyspnea and edema. Fluids should not be restricted because they help liquefy secretions and prevent dehydration, and clients should be provided with careful recommendations for adequate fluid intake. High carbohydrates are not recommended, and dairy products should be avoided because they can thicken secretions.
A 6-year-old child is diagnosed with chronic obstructive pulmonary disease [COPD]. Which risk factor should the nurse expect to find in the child's history?
A.
Exposure to air pollution
B.
Secondhand cigarette smoke
C.
Inherited
genetic abnormality
D.
Repeated bouts of colds and flu
Inherited genetic abnormality
Rationale: Although secondhand cigarette smoke and exposure to air pollution is detrimental to children and can result in long-term lung effects, a deficiency of alpha-1 antitrypsin [AAt] is usually the cause of COPD in children in this age group and is an inherited genetic abnormality. Lung infections can lead to problems as the child ages.
The nurse is caring for a client with chronic obstructive pulmonary disease [COPD] who has shortness of breath, a respiratory rate of 28 breaths/min, and an O2 saturation of 92%. Which intervention is contraindicated in this client?
A.
Putting the client in supine recumbent position
B.
Administering bronchodilators
C.
Applying oxygen
D.
Performing percussion, vibration, and postural drainage
Putting the client in supine recumbent position
Rationale: Individuals who experience COPD with chronic hypercarbia become dependent on low levels of oxygen in the blood as a stimulus for breathing. In keeping with this theory, the alleviation of hypoxia by way of supplemental oxygen administration may lead to respiratory depression or even respiratory failure. Percussion with vibration and postural draining, and administration of bronchodilators all may help reduce the symptoms. Putting the client in supine recumbent position would be contraindicated.
The nurse is teaching a client with chronic obstructive pulmonary disease [COPD] about the benefits of an exercise regimen. Which information should the nurse include? [Select all that apply.]
A.
Dyspnea and fatigue may improve with exercise.
B.
Inhale and exhale rapidly to maintain oxygenation while exercising.
C.
Exercise can prevent the condition from
worsening.
D.
Regular exercise improves exercise tolerance and muscle strength.
E.
An exercise regimen can improve the ability to perform activities of daily living [ADLs].
Dyspnea and fatigue may improve with exercise.
Exercise can prevent the condition from worsening.
Regular exercise improves exercise tolerance and muscle strength.
An exercise regimen can improve the ability to perform activities of daily living [ADLs].
Rationale: Exercise can enhance the client's ability to perform activities of daily living [ADLs] and may prevent deterioration of the physical condition. Regular exercise can improve exercise tolerance, muscle strength, and quality of life in clients with COPD and reduce dyspnea and fatigue. There are several techniques that the client should be taught to enhance breathing during exercise [such as pursed-lip and abdominal breathing]. Rapid breathing will cause fatigue and changes in respiratory status.
The nurse is discussing tests to evaluate the extent of chronic obstructive pulmonary disease [COPD]. Which test should the nurse include? [Select all that apply.]
A.
Pulmonary function tests
B.
Ventilation-perfusion testing
C.
Lung biopsy
D.
Bronchoscopy
E.
Arterial blood gas analysis
Pulmonary function tests
Ventilation-perfusion testing
Arterial blood gas analysis
Rationale: Diagnostic testing used for this client will include pulmonary function tests, ventilation-perfusion testing, and arterial blood gas analysis. Bronchoscopy and lung biopsy are not indicated for COPD diagnosis and are utilized to diagnose conditions that require direct visualization and testing of lung tissue [such as lung cancer].
The nurse is planning a collaborative care conference for a client recently
diagnosed with chronic obstructive pulmonary disease. Which team member should the nurse invite? [Select all that apply.]
A.
Physical therapist
B.
Occupational therapist
C.
Respiratory therapist
D.
Nutritionist
E.
Billing specialist
Physical therapist
Occupational therapist
Respiratory therapist
Nutritionist
Rationale: When planning a care conference for a client with chronic obstructive pulmonary disease, a respiratory therapist, physical therapist, occupational therapist, and nutritionist should act as collaborative team members to plan this client's care. Billing specialists need not be involved in care conferences.
The nurse is teaching a client with chronic obstructive pulmonary disease [COPD] about the purpose of using a bronchodilator. Which explanation should the nurse include?
A.
Exhibits anti-inflammatory
properties
B.
Has long duration of affect
C.
Strengthens the bronchial muscle contraction
D.
Improves airflow and reduces air trapping
Improves airflow and reduces air trapping
Rationale: Bronchodilators improve airflow and reduce air trapping in clients with COPD, resulting in alleviating dyspnea and improving exercise tolerance. Most bronchodilators have short duration of effect, they do not have anti-inflammatory properties, and they act by relaxing bronchial smooth muscle, not strengthening contracting action.
The nurse is leading a support group for clients and families with chronic obstructive pulmonary disease [COPD]. Which item should be discussed as a method to prevent COPD exacerbations? [Select all that apply.]
A.
Use of cough suppressants
B.
Yearly flu vaccine
C.
Restricting smoking in home environment
D.
Pneumococcal
vaccine
E.
Use of cool mist humidifiers
Yearly flu vaccine
Restricting smoking in home environment
Pneumococcal vaccine
Use of cool mist humidifiers
Rationale: Immunization against pneumococcal pneumonia and a yearly influenza vaccine are recommended to reduce the risk of respiratory infections. Cool mist humidifiers may help lubricate the airways and loosen mucus. Smoking is detrimental to the client, and the environment should remain smoke free. Cough suppressants have been shown to be ineffective for this condition.
A client with end-stage chronic obstructive pulmonary disease [COPD] asks the nurse about lung surgery. Which is the best response by the nurse?
A.
"No surgery is possible when you have COPD."
B.
"Because you cannot tolerate high levels of oxygen, surgery is impossible."
C.
"Lung reduction surgery is experimental but may be an
option."
D.
"Lung transplants are only done for children."
"Lung reduction surgery is experimental but may be an option."
Rationale: Lung transplants are done for adults with COPD, and the procedure has shown promising survival rates. Lung reduction surgery is an experimental option. The procedure reduces the overall volume of the lung, reshapes it, and improves elastic recoil. As a result, pulmonary function and exercise tolerance improve, and dyspnea is reduced. Oxygenation is closely monitored in a COPD client during surgery, but surgery is possible.
The nurse is completing a health history of a client who has an exacerbation of chronic obstructive pulmonary disease. Which should the nurse obtain?
A.
Percussion tone
B.
Breath sounds
C.
Peripheral pulses
D.
Current medications
Current medications
Rationale: The nurse should inquire about the client's current medications during the health history. If the client is unable to provide the information, a family member can provide this to the nurse. Breath sounds, percussion tone, and peripheral pulses are physical assessment items that the nurse must obtain during the assessment, and they do not require a family member's involvement.
The nurse is teaching a client with chronic obstructive pulmonary
disease [COPD] about types of irritants that should be avoided. Which irritant should the nurse include? [Select all that apply.]
A.
Warm, humid air
B.
Dust
C.
Air pollution
D.
Smoke
E.
Pets
Dust
Air pollution
Smoke
Pets
Rationale: The nurse should teach a client with COPD to avoid indoor pollutants, smoke, dust, and air pollution. The client should also avoid very cold, dry air, not warm, humid air. Allergies to pets can cause respiratory distress as well.
The nurse reviews the arterial blood gas [ABG] results of a client with end-stage chronic obstructive pulmonary disease [COPD]. Which finding should the nurse expect?
A.
Low CO2 with hypoxia
B.
Normal CO2 with hypoxia
C.
Hypercapnia with hypoxia
D.
Hypercapnia with normal oxygenation
Hypercapnia with hypoxia
Rationale:
Hypercapnia, or elevated
CO2
levels, and hypoxia, or decreased oxygen levels, are expected findings of an end-stage COPD client due to ineffective gas exchange.
The nurse gave discharge instructions to a client who has chronic obstructive pulmonary disease [COPD]. Which action by the client indicates that the teaching was effective?
A.
Eats a least two large meals per day
B.
Maintains oxygen saturation of at least
95%
C.
Maintains adequate fluid intake by taking at least 5 quarts of fluid daily
D.
Wears an identification band and carries a list of medications
Wears an identification band and carries a list of medications
Rationale: Wearing an identification band and carrying a current list of medications is very important in case of emergency. The client with COPD should eat small, frequent meals, because the effort of eating can lead to fatigue. Oxygen saturation in a COPD client should be around 90%. Higher saturations can affect the drive to breathe. Adequate fluid intake is important, but it should be between 0.5 to 2.5 quarts per day.
The client with chronic obstructive pulmonary disease has severe hypercapnia, hypoxemia, lethargy, and cyanotic nail beds. Which treatment should the nurse expect to be ordered?
A.
High flow oxygen administration
B.
Respiratory
treatment with bronchodilators
C.
Percussion and postural drainage
D.
Endotracheal intubation
Endotracheal intubation
Rationale: This client is in respiratory failure and is decompensating. Intubation will aid in increasing oxygenation [which will treat the lethargy and cyanosis] and decrease the
CO2
level [aid in decreasing lethargy]. High flow oxygen will only treat hypoxemia; bronchodilators may open airways but are not
indicated for respiratory failure. Percussion and postural drainage will help mobilize secretions but will not treat the critical gas exchange problem quickly enough.
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