Download Chapter 24: Answers to Questions in the Book

Student Review Questions, Chapter 24, Management of Patients With Chronic
Pulmonary Disease
1.
Which of the following is the most important risk factor for development of chronic
obstructive pulmonary disease (COPD)?
Occupational exposure
*Cigarette smoking
Air pollution
Genetic abnormalities
Pipe, cigar and other types of tobacco smoking are also risk factors for COPD. While a
risk factor, occupational exposure is not the most important risk factor for development
of COPD. Air pollution is a risk factor for development of COPD, but it is not the most
important risk factor.
2.
Which type of chest configuration is typical of the patient with COPD?
*Barrel chest
Pigeon chest
Flail chest
Funnel chest
Barrel chest results from fixation of the ribs in the inspiratory position. Pigeon chest
results from a displaced sternum. Flail chest results when the ribs are fractured. Funnel
chest occurs when there is a depression in the lower portion of the sternum and is
associated with Marfan's syndrome or rickets.
3.
In which stage of COPD is the forced expiratory volume (FEV1) less than 30%?
II
I
0
*III
Stage III patients demonstrate an FEV1 less than 30% with respiratory failure or clinical
signs of right heart failure. Stage II patients demonstrate an FEV1 of 30% to 80%. Stage
I is mild COPD with an FEV1 less than 70%. Stage 0 is characterized by normal
spirometry.
4.
Which of the following terms means an increase in the red blood cell concentration in the
blood?
Emphysema
Asthma
*Polycythemia
Bronchitis
Polycythemia is an increase in the red blood cell concentration in the blood. Emphysema
is a disease of the airways characterized by destruction of the walls of overdistended
alveoli. Asthma is a disease with multiple precipitating mechanisms resulting in a
common clinical outcome of reversible airflow obstruction.
5.
Which of the following is the strongest predisposing factor for asthma?
Congenital malformations
*Allergy
Male gender
Air pollution
Allergy is the strongest predisposing factor for asthma.
6.
Which of the following medications are contraindicated in acute asthma exacerbations?
Proventil
*Intal
Xopenex
Atrovent
Intal is contraindicated in patients with acute asthma exacerbation.
7.
As status asthmaticus worsens, the nurse would expect which acid-base imbalance?
Respiratory alkalosis
Metabolic alkalosis
*Respiratory acidosis
Metabolic acidosis
As status asthmaticus worsens the PaCO2 and an increased pH. As status asthmaticus
worsens, the PaCO2 increases and the pH decreases, reflecting respiratory acidosis.
8.
Which diagnostic is the most accurate in assessing acute airway obstruction?
Arterial blood gases (ABGs)
*Pulmonary function studies
Pulse oximetry
Chest x-ray
Pulmonary function studies are the most accurate means of assessing acute airway
obstruction. ABGs, pulse oximetry, and chest x-ray are not the most accurate diagnostics
for an airway obstruction.
9.
Cystic fibrosis (CF) is diagnosed by clinical signs and symptoms in addition to which one
of the following tests?
Pulmonary function studies
*Sweat chloride concentration
Arterial blood gases (ABGs)
Lumbar puncture
Diagnosis of CF is based on an elevated sweat chloride concentration, together with
clinical signs and symptoms consistent with the disease.
10.
Which of the following would not be considered a primary symptom of COPD?
Cough
Sputum production
Dyspnea on exertion
*Weight gain
COPD is characterized by three primary symptoms: cough, sputum production, and
dyspnea on exertion. Weight loss is common with COPD.
11.
Which of the following exposures accounts for the majority of cases with regard to risk
factors for COPD?
*Exposure to tobacco smoke
Occupational exposure
Passive smoking
Ambient air pollution
Exposure to tobacco smoke accounts for an estimated 80% to 90% of COPD cases.
Occupational exposure, passive smoking, and ambient air pollution are risk factors but do
not account for the majority.
12.
The classification of Stage I of COPD is defined as
at risk for COPD.
*mild COPD.
severe COPD.
very severe COPD.
Stage I is mild COPD. Stage 0 is at risk for COPD. Stage III is severe COPD. Stage IV
is very severe COPD.
13.
Which of the following is a second-line pharmacotherapy for smoking abstinence?
Nicotine gum
*Catapres
Zyban
Wellbutrin
Second-line pharmacotherapy includes the antihypertensive agent clonidine (Catapres).
However, its use is limited by its side effects. First-line therapy includes nicotine gum,
Zyban, and Wellbutrin.