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COPD NCLEX CHRONIC. QUESTIONS AND ANSWERS
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COPD NCLEX CHRONIC. QUESTIONS AND ANSWERS
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COPD NCLEX CHRONIC. QUESTIONS AND ANSWERSA 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 - Answers -b. 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." - Answers
-b. 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 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. - Answers -a. 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 - Answers -a. 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.
When developing a discharge plan to manage the care of a client with COPD, the nurse
should anticipate that the client will do which of the following?
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