Question

A nurse is collecting data from a client who is experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

Answer 1

Correct Answers:

PaCO2 48 mm Hg.

Rationale :

🔵In COPD exacerbations, impaired gas exchange leads to retention of carbon dioxide (hypercapnia).

🔵A PaCO₂ of 48 mm Hg indicates elevated CO₂ levels, since the normal range is 35–45 mm Hg.

🔵This finding reflects ventilatory failure, a hallmark of COPD, due to narrowed airways and poor alveolar ventilation.

🔵Other classic findings include low PaO₂, dyspnea, and wheezing rather than high oxygen or structural chest changes.

🔵Monitoring arterial blood gases (ABGs) is essential to detect worsening respiratory acidosis in COPD.

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Answer 2

Correct Answers:

Increased risk for pneumonia

Rationale :

🟢Clients with COPD are prone to frequent respiratory infections, particularly pneumonia, due to impaired mucociliary clearance.

🟢The structural lung damage and excessive mucus production create an environment where pathogens thrive.

🟢Recurrent infections also accelerate lung function decline, worsening the progression of COPD.

🟢Vaccinations such as the influenza and pneumococcal vaccine are strongly recommended to reduce this risk.

🟢Teaching infection prevention is a critical part of COPD management education.

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Answer 3

Correct Answers:

Stimulates secretions.

Rationale :

🔴Expectorants such as guaifenesin work by stimulating respiratory tract secretions, thinning mucus and making it easier to expel.

🔴This helps relieve productive coughs by enhancing the clearance of airway mucus.

🔴Unlike antitussives, expectorants do not suppress the cough reflex but instead make the cough more effective.

🔴Adequate hydration enhances the effectiveness of expectorants by further thinning secretions.

🔴They are commonly used in respiratory conditions like bronchitis, COPD, and asthma with mucus production.

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Answer 4

Correct Answers:

Stimulates secretions.

Rationale :

🔴Expectorants such as guaifenesin work by stimulating respiratory tract secretions, thinning mucus and making it easier to expel.

🔴This helps relieve productive coughs by enhancing the clearance of airway mucus.

🔴Unlike antitussives, expectorants do not suppress the cough reflex but instead make the cough more effective.

🔴Adequate hydration enhances the effectiveness of expectorants by further thinning secretions.

🔴They are commonly used in respiratory conditions like bronchitis, COPD, and asthma with mucus production.

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Answer 5

Correct Answers:

Bronchospasm occurs when there is Inflammation, edema, and excess mucus.

Rationale :

🟡In asthma, bronchospasm results from a triad of inflammation, airway edema, and mucus hypersecretion.

🟡These changes narrow the bronchioles, making it difficult for air to move in and out of the lungs.

🟡Clients present with wheezing, chest tightness, dyspnea, and prolonged expirations during exacerbations.

🟡The underlying pathophysiology is linked to hyperresponsiveness of the airways to triggers like allergens, smoke, or exercise.

🟡Effective management includes bronchodilators, corticosteroids, and trigger avoidance.

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Answer 6

Correct Answers:

Permanent abnormal dilation of bronchi and bronchioles

Rationale :

🔷Bronchiectasis is defined as irreversible dilation of the bronchi and bronchioles caused by chronic infection and inflammation.

🔷This leads to retention of mucus, recurrent infections, and chronic productive cough.

🔷Structural damage results from the breakdown of airway walls, impairing clearance of secretions.

🔷Clients often present with foul-smelling sputum, hemoptysis, and recurrent pneumonias.

🔷Management focuses on airway clearance techniques, antibiotics, and bronchodilators.

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Answer 7

Correct Answers:

The child should blow hard and fast into the meter.
The child should repeat the test three times, waiting 30 seconds between each use.

Rationale :

“Blow hard and fast into the meter”

🟣A peak flow meter measures Peak Expiratory Flow Rate (PEFR), which reflects the maximum airflow the child can generate during a forced exhalation; this requires a single, forceful, and rapid “blast.”

🟣The child should inhale to total lung capacity, seal lips tightly around the mouthpiece, and then exhale as hard and as fast as possible in one quick effort to avoid underestimating PEFR.

🟣A slow or prolonged exhalation gives falsely low readings because PEFR captures the initial explosive flow, not the entire exhaled volume.

🟣Proper technique—upright posture (preferably standing), tight seal, and a crisp, explosive blow—improves accuracy and reproducibility of results.

🟣The meter should be reset to zero before each attempt, and the same technique should be used each time to allow reliable trend monitoring against the child’s personal best.

“Repeat three times, waiting 30 seconds between each use”

🟣Performing three separate efforts reduces random variability and ensures the data reflect the child’s true maximal performance rather than a one-off effort.

🟣A 30-second rest between blows prevents fatigue, dizziness, and submaximal effort, which can artificially lower readings.

🟣After three trials, the child should record the highest value (not the average); this is used to determine green/yellow/red zones and guide the asthma action plan.

🟣Repeating measurements at the same time each day under consistent conditions improves trend detection for early identification of bronchospasm.

🟣Consistent three-trial technique, brief rest, and best-of-three recording provide valid, actionable data for both routine monitoring and exacerbation management.

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Answer 8

Correct Answers:

Dyspnea
Barrel chest
Clubbing of the fingers

Rationale :

Dyspnea

💠The hallmark symptom of emphysema is progressive dyspnea, caused by destruction of alveolar walls and loss of elastic recoil, which trap air inside the lungs.

💠This results in impaired gas exchange and an increased work of breathing.

💠Clients often adapt with pursed-lip breathing to prolong exhalation and reduce air trapping.

💠Dyspnea eventually progresses from exertional to resting shortness of breath, significantly impacting quality of life.

Barrel chest

💠A barrel-shaped chest occurs due to chronic hyperinflation of the lungs and an increased anterior–posterior (A-P) diameter.

💠Air trapping keeps the chest in an expanded state, flattening the diaphragm and reducing its efficiency.

💠This structural change makes breathing more laborious and limits ventilatory capacity.

💠On physical assessment, hyperresonance on percussion and decreased breath sounds are often noted along with barrel chest.

Clubbing of the fingers

💠Digital clubbing is associated with long-term hypoxemia seen in advanced emphysema.

💠It is characterized by widening and rounding of the fingertips and loss of the normal nail angle.

💠The mechanism involves chronic oxygen deprivation, stimulating vascular and connective tissue changes at the nail beds.

💠Clubbing is an important physical sign pointing to chronic respiratory insufficiency and poor oxygenation.

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Answer 9

Correct Answers:

Wheezing
Chest tightness
Dyspnea
Sputum production
Chronic cough

Rationale :

Wheezing

🔷Airflow obstruction and airway narrowing in COPD cause wheezing, especially on expiration.

🔷Wheezing reflects turbulent airflow due to mucus plugging and bronchospasm.

🔷It is a common sign during exacerbations and helps guide the need for bronchodilator therapy.

Chest tightness

🔷Clients often describe a sensation of chest tightness related to airway inflammation and hyperinflation.

🔷This symptom worsens with exertion, as increased effort is needed to overcome resistance in narrowed airways.

🔷It can be mistaken for cardiac pain, making accurate respiratory assessment essential.

Dyspnea

🔷Dyspnea is the hallmark of COPD, caused by impaired gas exchange, loss of elastic recoil, and air trapping.

🔷Patients often report progressive shortness of breath that limits activity.

🔷Dyspnea is the most disabling symptom, contributing to reduced exercise tolerance and poor quality of life.

Sputum production

🔷Chronic hypersecretion of mucus is a classic manifestation, especially in chronic bronchitis.

🔷The excess sputum increases the risk of respiratory infections like pneumonia.

🔷Daily sputum production lasting for at least 3 months over 2 consecutive years is diagnostic for chronic bronchitis.

Chronic cough

🔷A persistent cough is often the earliest sign of COPD, caused by airway irritation and mucus buildup.

🔷The cough may be productive, especially in the morning when secretions accumulate overnight.

🔷It is one of the main criteria used to identify chronic bronchitis, a major type of COPD.

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Answer 10

Correct Answers:

Enlargement and destruction of alveoli

Rationale :

♦In emphysema, the alveoli become enlarged and destroyed, reducing the surface area for gas exchange.

♦This structural change leads to air trapping and hyperinflation of the lungs.

♦The loss of elastic recoil impairs effective expiration, contributing to dyspnea.

♦Clients often present with a “pink puffer” appearance due to labored breathing with near-normal oxygenation early on.

♦Over time, this damage is irreversible and progressive, requiring supportive management.

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Custom PN Respiratory Fall 2025

No.

1 :
A nurse is collecting data from a client who is experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

2 :
A nurse is providing an educational session to colleagues on the unit regarding COPD. Which of the following options would the nurse provide regarding associated risks of COPD?

3 :
A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

4 :
A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

5 :
A nurse is caring for a client with asthma. Which of the following happens physiologically when bronchospasm occurs?

6 :
Which statement best describes bronchiectasis?

7 :
A nurse is reinforcing teaching with the parent of a school-age child who has asthma about the use of a peak flow meter. Which of the following information should the nurse include in the teaching? (Select all that apply.)

8 :
A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

9 :
Which of the following are the most common manifestations of COPD? (Select all that apply.)

10 :
Which structural change occurs in the lungs of a client with emphysema?

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Custom PN Respiratory Fall 2025

No.

1 : A nurse is collecting data from a client who is experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

2 : A nurse is providing an educational session to colleagues on the unit regarding COPD. Which of the following options would the nurse provide regarding associated risks of COPD?

3 : A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

4 : A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

5 : A nurse is caring for a client with asthma. Which of the following happens physiologically when bronchospasm occurs?

6 : Which statement best describes bronchiectasis?

7 : A nurse is reinforcing teaching with the parent of a school-age child who has asthma about the use of a peak flow meter. Which of the following information should the nurse include in the teaching? (Select all that apply.)

8 : A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

9 : Which of the following are the most common manifestations of COPD? (Select all that apply.)

10 : Which structural change occurs in the lungs of a client with emphysema?

1 :
A nurse is collecting data from a client who is experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD). Which of the following findings should the nurse expect?

2 :
A nurse is providing an educational session to colleagues on the unit regarding COPD. Which of the following options would the nurse provide regarding associated risks of COPD?

3 :
A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

4 :
A nurse is reinforcing teaching with a client who is going to take an expectorant to manage a cough. The nurse should explain that this type of medication treats coughs by which of the following mechanisms?

5 :
A nurse is caring for a client with asthma. Which of the following happens physiologically when bronchospasm occurs?

6 :
Which statement best describes bronchiectasis?

7 :
A nurse is reinforcing teaching with the parent of a school-age child who has asthma about the use of a peak flow meter. Which of the following information should the nurse include in the teaching? (Select all that apply.)

8 :
A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect? (Select all that apply.)

9 :
Which of the following are the most common manifestations of COPD? (Select all that apply.)

10 :
Which structural change occurs in the lungs of a client with emphysema?