Olivia McRitchie
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NCLEX Nursing (Medical-Surgical) Quiz on Exemplar 15.3: COPD, created by Olivia McRitchie on 30/09/2018.

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Olivia McRitchie
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Exemplar 15.3: COPD

Question 1 of 10

1

You have a 50-year-old male that has just been told he has stage 1 COPD w/chronic bronchitis. He is unsure what exactly that means, and he asks you to explain it to him. Which of the following is NOT an accurate response?

Select one of the following:

  • "COPD is typically either chronic bronchitis or emphysema."

  • "COPD is lung damage that results from repeated exposure to things that irritate your respiratory system. "

  • "Chronic bronchitis is the result of chronic inflammation in the lungs. There is excessive mucus production, and changes in certain lung cells make it really hard to get rid of that mucus."

  • "In emphysema, the chronic lung inflammation cause destruction of the little air sacs in your lungs, called 'alveoli'. This makes it very hard for oxygen to enter your body,"

  • "Damage to large and small airways will also lead to an increased mucous production."

  • "Unfortunately, COPD is not a reversible disease. Its symptoms can be managed though."

  • "Cigarette smoking is the greatest risk factor for COPD, but moderate to severe asthma, exposure to occupational irritants and air pollution, and alpha-antitrypsin deficiency are also potential causes of COPD."

Explanation

Question 2 of 10

1

You have 60 y/o female patient presenting w/COPD. She brings up a large amount of thick sputum every time she coughs, but brings up even more first thing in the morning. She has a blue tinge in her gums, lips, fingers, and toes. She has +4 pitting edema in both of her calves, ankles, and feet, and her jugular veins are distended. Upon auscultation, you could hear inspiratory & expiratory ronchi.

Which symptoms are dominant in this patient's COPD case?

Select one of the following:

  • Chronic bronchitis

  • Emphysema.

  • Neither

Explanation

Question 3 of 10

1

You have a 70 y/o female patient presenting w/COPD. She coughs a minimal amount, but when she does cough, she brings up very little sputum. She has dyspnea and tachypenia at rest that gets worse with even a minimal amount activity; therefore, she is not a very active individual. Despite her lack of activity, however, she is very thin.

Her anteroposterior chest diameter is 1:1. She uses accessory muscles & purse-lipped breathing, and will generally sit forward with her hands on her knees. Upon auscultation, you hear diminished breath sounds & wheezes. When you percuss, you hear a loud, low-pitched sound.

Which symptoms are dominant with this patient's COPD?

Select one of the following:

  • Emphysema

  • Chronic bronchitis

  • Neither

Explanation

Question 4 of 10

1

You have an elderly man that you are concerned might have COPD. You suggest that he undergoes testing for it, but he is apprehensive because he's unsure what that might entail. Drag and drop the correct test name for each description.
: "We will draw some blood to see how much oxygen and how much carbon dioxide you have in your blood.

: "We will perform tests to test your total lung capacity, the amount of air in your lungs after you exhale, the amount you can exhale in one second, and the total amount you can exhale overall. These tests will establish a COPD diagnosis and how far the disease has progressed."

: "We will perform a test to see how much of your lungs are taking in oxygen and how much of that oxygen is getting into the capillaries."
: "We will take some of your blood and test how much of each type of blood cell there is. An increase in the amount of red blood cells, or an overall increase in all blood cells, could indicate COPD."

: "We will measure how much carbon dioxide you exhale so we can see how much oxygen is being exchanged for carbon dioxide in the lungs."

Drag and drop to complete the text.

    Arterial blood gases
    Pulmonary function testing
    Ventilation-perfusion scanning
    CBC w/WBC differential
    Exhaled carbon dioxide

Explanation

Question 5 of 10

1

Select the medications that may be appropriate for the treatment of COPD (7 of these are right)

Select one or more of the following:

  • Albuterol sulfate

  • Salmeterol

  • Ipratropium bromide

  • Tiotropium bromide

  • Theophylline

  • Prednisone

  • Atorvastatin

  • Metoprolol

  • Amlodipine

  • Diazepam

Explanation

Question 6 of 10

1

Administering oxygen without intubation or mechanical ventilation to clients with chronic hypercapnia can increase PaCO2.

Select one of the following:

  • True
  • False

Explanation

Question 7 of 10

1

You have a 71-year-old COPD patient taking ipratropium bromide, albuteral sulfate, and guaifenesin for his COPD. He is an active smoker, but he's trying to quit. He is reporting medications don't work as well as he'd like, so he's asking you for other ways he can help his COPD. Select appropriate responses you can give to this patient. (5 of these are right).

Select one or more of the following:

  • "If I get a providers orders, I can utilize percussion, vibration, and postural drainage."

  • "Smoking cessation can improve your lung function. You can quit by using nicotine patches or gum, or I can ask your doctor to prescribe you Wellbutrin."

  • "You should go outside as often as you possibly can. "

  • "Aerobic exercise has been shown to be largely unhelpful in increasing exercise tolerance. Swimming, however, has shown to be very helpful in increasing exercise tolerance."

  • "Start doing breathing exercises. Use purse-lipped and abdominal breathing whenever you aren't doing something else."

  • "Increased hydration has not been shown to be helpful when it comes to liquifying mucus secretions. Rather, you should invest in a humidifier."

  • "Cutting back on your intake of dairy products and salt may be helpful in reducing mucus production and keeping your mucus more liquified."

  • "Hot herbal teas made with peppermint may act as expectorants."

Explanation

Question 8 of 10

1

You have a 65 year old patient that has COPD with chronic bronchitis as the dominant symptom set. His SpO2 is down to 89% and he is becoming more tachypenic. His breathing also appears to be more labored. He is already on supplemental O2, running at 3 L./min via nasal cannula. His skin is not cyanotic, and his LOC is remaining stable. He is not bringing up as much sputum as he usually does.. Select the best intervention for this patient right now.

Select one of the following:

  • Assess respiratory rate and pattern, cough and secretions, and breath sounds once every 2 hours.

  • Weigh daily, monitor I&O, and assess mucus membranes & skin turgor.

  • Encourage a fluid intake of 2,000-2,500 mL/day

  • Assist with coughing and deep breathing once every 2 hours, with the patient sitting upright the entire process.

  • Place patient in Fowler, high Fowler, or tripod positioning.

  • Administer the patient's guaifenesin.

  • Monitor arterial blood gases.

Explanation

Question 9 of 10

1

You have a 80 year old newly admitted patient that has severe COPD with emphysema as the dominating symptom set. She is very activity intolerant, requiring assistance for every activity except turning herself in bed. Eating is downright exhausting for her, so she routinely only finishes about 25% of her meals. Because of her inability to finish meals, she appears cachectic.

Select appropriate interventions for this patient.

Select one or more of the following:

  • Work with her physical therapy and respiratory therapy to make up an appropriate exercise plan.

  • Couple activities such as toileting and showering.

  • Consult with a dietitian to make up an appropriate meal plan that will fill her nutritional needs.

  • Provide 3 square meals a day.

  • Place her in a seated or high-Fowlers position for meals.

  • Discourage the family from bringing food from home.

  • Keep snacks at the patient's bedside.

  • Provide mouth care before meals.

  • Immediately consult with the physician about enteral or parenteral feedings.

Explanation

Question 10 of 10

1

You have a 70 year old patient with moderate COPD, with chronic bronchitis as the dominating symptom set. She claims she has tried everything to quit smoking, but simply can't get the hang of it. You see that she has only one child, a son, that is married, and he appears to be her primary caregiver. He appears distressed by his mother's re-admittance to the hospital, while his wife looks annoyed.

Select the worst intervention for this situation.

Select one of the following:

  • Assess the son and daughter-in-law's interactions with the mother whenever you enter the room.

  • Ask the son and his wife what they know about COPD

  • Inquire about the patient's home situation

  • Refer the son and daughter-in-law to a home health care agency,

  • Ask the mother, the son, and the daughter-in-law separately how they feel about the situation,

  • Give the patient smoking cessation pamphlets.

Explanation

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