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Chapter 20 Management of Patients With Chronic Pulmonary Disease
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Chapter 20 Management of Patients With Chronic Pulmonary Disease
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Chapter 20 Management of Patients With Chronic Pulmonary Disease1. A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive
pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize
the risk of contracting this disease. What would be the nurse's best answer?
A) The most important risk factor for COPD is exposure to occupational toxins.î
B) The most important risk factor for COPD is inadequate exercise.î
C) The most important risk factor for COPD is exposure to dust and pollen.î
D) The most important risk factor for COPD is cigarette smoking.î
Ans: D
Feedback:
The most important risk factor for COPD is cigarette smoking. Lack of exercise and exposure to
dust and pollen are not risk factors for COPD. Occupational risks are significant but are far
exceeded by smoking.
2. A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary
disease (COPD). What should the nurse identify as a complication of COPD?
A) Lung cancer
B) Cystic fibrosis
C) Respiratory failure
D) Hemothorax
Ans: C
Feedback:
Complications of COPD include respiratory failure, pneumothorax, atelectasis, pneumonia,
and pulmonary hypertension (corpulmonale). Lung cancer, cystic fibrosis, and hemothorax are
not common complications.
3. A nurse is caring for a young adult patient whose medical history includes an alpha1-
antitrypsin deficiency. This deficiency predisposes the patient to what health problem? A)
Pulmonary edema
B) Lobular emphysema C) Cystic fibrosis (CF) D) Empyema
Ans: B
Feedback:
, A host risk factor for COPD is a deficiency of alpha1-antitrypsin, an enzyme inhibitor that
protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid
development of lobular emphysema even in the absence of smoking. This deficiency does not
influence the patient's risk of pulmonary edema, CF, or
empyema.
4. The nurse is assessing a patient whose respiratory disease in characterized by chronic
hyperinflation of the lungs. What would the nurse most likely assess in this patient? A) Signs
of oxygen toxicity
B) Chronic chest pain
C) A barrel chest
D) Long, thin fingers
Ans: C
Feedback:
In COPD patients with a primary emphysematous component, chronic hyperinflation leads to
the barrel chest thorax configuration. The nurse most likely would not assess chest pain or
long, thin fingers; these are not characteristic of emphysema. The patient would not show
signs of oxygen toxicity unless he or she received excess supplementary oxygen.
5. A patient with emphysema is experiencing shortness of breath. To relieve this patient's
symptoms, the nurse should assist her into what position?
A) Sitting upright, leaning forward slightly
B) Low Fowler's, with the neck slightly hyperextended
C) Prone
D) Trendelenburg
Ans: A
Feedback:
The typical posture of a person with COPD is to lean forward and use the accessory
, muscles of respiration to breathe. Low Fowler's positioning would be less likely to aid
oxygenation. Prone or Trendelenburg positioning would exacerbate shortness of breath.
6. A nurse is evaluating the diagnostic study data of a patient with suspected cystic
fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic
fibrosis?
A) Elevated sweat chloride concentration
B) Presence of protein in the urine
C) Positive phenylketonuria
D) Malignancy on lung biopsy
Ans: A
Feedback:
Gene mutations affect transport of chloride ions, leading to CF, which is characterized
by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as
well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria,
and malignancy are not diagnostic for CF.
7. A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is
the preferred intervention to alleviate this client's airflow obstruction?
A) Administer corticosteroids by metered dose inhaler
B) Administer inhaled anticholinergics
C) Administer an inhaled beta-adrenergic agonist
D) Utilize a peak flow monitoring device
Ans: C
Feedback:
Asthma exacerbations are best managed by early treatment and education of the patient.
Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow
obstruction. Systemic corticosteroids may be necessary to decrease airway
inflammation in patients who fail to respond to inhaled beta-adrenergic medication. A
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