Question 1

WRONG

As a cause of death in the United States, COPD ranks:

Second.

B Third.

Fourth.

D Fifth.
Question 1 Explanation:
COPD is the fourth leading cause of death in the United States.

Question 2

CORRECT

Two diseases common to the etiology of COPD are:

A Asthma and atelectasis.

Chronic bronchitis and emphysema.

C Pneumonia and pleurisy.

D Tuberculosis and pleural effusion.

Question 2 Explanation:
Chronic bronchitis and emphysema belong to the old classification of COPD.Option A:
Asthma may be one of the chronic pulmonary diseases but atelectasis is not. Option C:
Pneumonia and pleurisy are not classified under the COPD. Option D: Tuberculosis and
pleural effusion are not chronic pulmonary diseases

Question 3

CORRECT

The underlying pathophysiology of COPD is:

A Inflamed airways that obstruct airflow.

B Mucus secretion that blocks airways.

C Alveolar wall destruction.

Characterized by variations in all of the above.

Question 3 Explanation:
Inflammation, hypersecretion of mucus, and alveolar wall destruction are included in the
pathophysiology of COPD.Option A: Inflammation occurs through the proximal and
peripheral airways, lung parenchyma, and pulmonary vasculature. Option B:
Hypersecretion occurs due to the increase in the number of goblet cells. Option C:
Alveolar wall destruction leads to loss of alveolar attachments and a decrease in elastic
recoil.

Question 4

WRONG

The abnormal inflammatory response in the lungs occurs primarily in the:

Airways.
B Parenchyma.

C Pulmonary vasculature.
Areas identified in all of the above.

Question 4 Explanation:
The airways, parenchyma, and pulmonary vasculature undergo inflammation in
COPD.Option A: The airways are inflamed in COPD. Option B: The lung parenchyma
undergoes an inflammatory response in COPD. Option C: The pulmonary vasculature is
affected by inflammation in COPD.

Question 5

CORRECT

The most important environmental risk factor in emphysema is:

A Air pollution.

B Allergens.

C Infectious agents.
Cigarette smoking.

Question 5 Explanation:
Cigarette smoking is the foremost factor in the development of emphysema.Option A:
Air pollution is a risk factor in the development of emphysema but it is not the primary
factor. Option B: Allergens may contribute to the development of emphysema but it is
not the main factor. Option C: Infectious agents are part of the risk factors for
emphysema but it is not the main factor.
1. True or False: COPD is reversible and tends to happens gradually.

 True
 False
The answer is FALSE. COPD IRREVERSIBLE and tends to happens gradually.

2. A patient is presenting with chronic obstructive pulmonary disease. The patient

has a chronic productive cough with dyspnea on excretion. Arterial blood gases
show a low oxygen level and high carbon dioxide level in the blood. On
assessment, the patient has cyanosis in the lips and edema in the abdomen and
legs. Based on your nursing knowledge and the patient's symptoms, you suspect
the patient suffers from what type of COPD?

 A. Emphysema
 B. Pneumonia

 C. Chronic bronchitis
 D. Pneumothorax
The answer is C. The key words to let you know the patient is experiencing chronic
bronchitis are: cyanosis and edema in the abdomen and legs. Remember chronic
bronchitis is sometimes referred to as "blue bloaters".

3. A patient with emphysema may present with all of the following symptoms
EXCEPT?

 A. Barrel chest
 B. Hyperinflation of the lungs
 C. Hypoventilation

 D. Hypercapnia
The answer is C. Patients with emphysema present with HYPERventilation. The body
will try to compensate for the low oxygen blood levels and will cause the patient to
hyperventilate. Remember emphysema patients are sometimes called "pink puffers".
They will have a barrel chest (due to the use of accessory muscles for breathing),
hyperinflation of the lungs (due to damage of the alveoli sacs and creation of air sacs),
and hypercapnia (high carbon dioxide levels).
4. The term" blue bloaters" is used to describe patients with?

 A. Pulmonary hypertension

 B. Left-sided heart failure

 C. Chronic Bronchitis
 D. Emphysema
The answer is C. "Blue bloaters" is used to describe patients with chronic bronchitis,
and the term "pink puffers" is used to describe patients with emphysema.

5. A patient is newly diagnosed with COPD due to chronic bronchitis. You're

providing education to the patient about this disease process. Which statement
by the patient indicates they understood your teaching about this condition?

 A. "If I stop smoking, it will cure my condition."

 B. "Complications from this condition can lead to pulmonary hypertension
and right-sided heart failure."
 C. "I'm at risk for low levels of red blood cells due to hypoxia and may require

blood transfusions during acute illnesses."

 D. "My respiratory system is stimulated to breathe due to high carbon dioxide
levels rather than low oxygen levels.
The answer is B. This is the only correct statement. Option A is wrong because smoking
cessation will NOT cure the condition but it may slow down the progress of it. Option C
is wrong because the patient may develop HIGH LEVELS of red blood cells due to the
body trying to compensate for hypoxia. Option D is wrong because patients with COPD
are stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon
dioxide levels.

6. An alarm beeps notifying you that one of your patient's oxygen saturation is
reading 89%. You arrive to the patient's room, and see the patient comfortably
resting in bed watching television. The patient is already on 2 L of oxygen via
nasal cannula. The patient is admitted for COPD exacerbation. Your next nursing
action would be:

 A. Continue to monitor the patient

  B. Increase the patient's oxygen level to 3 L
 C. Notify the doctor for further orders
 D. Turn off the alarm settings
The answer is A. This patient is not in any distress from the description
provided...therefore, you would continue to monitor the patient. Patients with COPD are
stimulated to breathe due to LOW OXYGEN LEVELS rather than high carbon dioxide
levels. Therefore, it is normal for patients who have COPD to have an oxygen saturation
between 88-93%.....any higher would decrease the stimulation to breathe and they may
stop breathing. Therefore, you would not increase the oxygen level to 3 L, notify the
doctor, or turn off the alarm settings.

7. You are providing teaching to a patient with chronic COPD on how to perform
diaphragmatic breathing. This technique helps do the following:

 A. Increase the breathing rate to prevent hypoxemia

 B. Decrease the use of the abdominal muscles

 C. Encourages the use of accessory muscles to help with breathing

 D. Strengthen the diaphragm
The answer is D. Diaphragmatic breathing helps strengthen the diaphragm because it
has become flatten due to the hyperinflation of the lungs. Due to the flattening of the
diaphragm, the body is unable to breathe with ease and must use the accessory
muscles to compensate. Therefore, diaphragmatic breathing helps DECREASE the
breathing rate to prevent hypoxemia, INCREASES the use of the abdominal muscles
RATHER than accessory muscles and strengthens the diaphragm.

8. A patient with severe COPD is having an episode of extreme shortness of

breath and requests their inhaler. Which type of inhaler ordered by the physician
would provide the FASTEST relief for the patient based on this particular
situation?

 A. Spiriva
 B. Salmeterol
 C. Symbicort

 D. Albuterol
The answer is D. The patient would best benefit from a SHORT-ACTING bronchodilator
to help with the shortness of breath. The only short-acting bronchodilator listed is
Albuterol. Spiriva is a long-acting bronchodilator. Symbicort is a combination of long-
acting bronchodilator and corticosteroid. Salmeterol is a long-acting bronchodilator.

9. Which of the following statements are incorrect about discharge teaching that
you would provide to a patient with COPD? Select-all-that-apply:

 A. "It is best to eat three large meals a day that are relatively low in

calories."
 B. "Avoid going outside during extremely hot or cold days."

 C. "It is important to receive the Pneumovax vaccine annually."

 D. "Smoking cessation can help improve your symptoms."
The answers are A and C. The patient needs to eat high calorie and protein rich meals
that are small but frequent. The Pneumovax is definitely recommended for patients with
COPD but is given every 5 years (not annually).

10. A patient is ordered by the physician to take Pulmicort and Spiriva via inhaler.
How should the patient take this medication?

 A. The patient should use the medications every 2 hours for acute episodes of
shortness of breath.
 B. The patient should use the Spiriva first and then 5 minutes later the

Pulmicort.
 C. The patient should use the Pulmicort first and then the Spiriva 5 minutes later.
 D. The patient should use the medications at the same exact time, regardless of
the order.
The answer is B. The patient should use the bronchodilator first which is the Spiriva to
open the airways and THEN the Pulmicort which is a corticosteroid. Using the inhalers
in this order will allow the corticosteroid to work properly after the lung fields are opened
due to bronchodilation.

11. In regards to question 10, which action by the patient demonstrates they know
how to properly use this medication?
  A. The patient rinses their mouth after using the Spiriva inhaler.
 B. The patient rinses their mouth after using the Pulmicort inhaler.

 C. The patient dispenses of the inhalers.

 D. The patient coughs 2 times after using the Pulmicort inhaler.
The answer is B. The patient should rinse the mouth after using any type of
corticosteroid inhalers (here Pulmicort is the corticosteroid not Sprivia) to remove the
medication from the mouth. If left in the mouth, the patient can develop thrush.

12. A patient with COPD is reporting depression and thoughts of suicide. The
patient states, "I just feel like ending it all." You assess the patient’s health
history and note that the patient was recently started on which medication that
could cause this side effect:

 A. Atrovent

 B. Prednisone
 C. Roflumilast
 D. Theophylline
The answer is C. Roflumilast is a phosphodiestrace-4 inhibitor that is used in the
treatment of patients with severe COPD due to chronic bronchitis. This medication can
caused increased suicidal thoughts, and the patient should be monitored for this while
taking Roflumilast.

13. A patient is ordered at 1400 to take Theophylline. You're assessing the

patient’s morning lab results and note that the Theophylline level drawn this
morning reads: 15 mcg/mL. You're next nursing action is to?

 A. Administer the dose at 1400 as ordered

 B. Notify the physician for further orders

 C. Hold the 1400 dose
 D. Collect another blood sample to confirm the level
The answer is A. A normal Theophylline level is 10-20 mcg/mL...therefore the level is
normal and the nurse should administer the dose at 1400 as ordered.
14. You are providing care to a patient with COPD who is receiving medical
treatment for exacerbation. The patient has a history of diabetes, hypertension,
and hyperlipidemia. The patient is experiencing extreme hyperglycemia. In
addition, the patient has multiple areas of bruising on the arms and legs. Which
medication ordered for this patient can cause hyperglycemia and bruising?

 A. Prednisone

 B. Atrovent
 C. Flagyl
 D. Levaquin
The answer is A. Prednisone is a corticosterioid and can cause hyperglycemia and
brusing.