Chronic Obstructive Pulmonary Disease (15 Questions)

1.1 Mr. Lemoine, 82 years old, has a medical history of chronic obstructive pulmonary disease (COPD). He is admitted for a pulmonary infection and is receiving intravenous antibiotics and prednisone. His target oxygen saturation, as per medical orders, is 88–92%.

During your shift, you observe the following:
*With no oxygen, his SpO₂ is 88%.
*With 2 L/min, it increases to 91%.
*When increased to 3 L/min, his SpO₂ reaches 93%.

You reduce the O₂ back to 2L/min, and his saturation drops to 91%.

Question:
According to the prescription, what is the most appropriate nursing action? *
1.2 Later in your shift, you notice that Mr. Lemoine appears more tired and slightly confused. His respiratory rate is 24 breaths per minute, shallow but regular. You notify the physician, who orders an arterial blood gas (ABG) analysis.

You collect the sample and receive the following ABG results:
*pH: 7.30
*PaCO₂: 55 mm Hg
*HCO₃⁻: 24 mEq/L
*PaO₂: 68 mm Hg
*SpO₂: 90% on 2 L/min nasal cannula

Question:
Based on these results, how would you interpret Mr. Lemoine’s acid-base status? *
2.1 Mr. Ducet, 82 years old, has a history of chronic obstructive pulmonary disease (COPD). He was admitted to the hospital for increased shortness of breath and productive green sputum. He is currently being treated with IV prednisone and antibiotics for a suspected pulmonary infection.

During your shift, you assess Mr. Ducet. His oxygen saturation is 88% on room air. You follow the medical order to administer oxygen at 3 L/min via nasal cannula, with a target SpO₂ of ≥90%. After a few minutes, his saturation improves to 92%.

An hour later, you observe that Mr. Ducet is wandering around the unit and appears restless. His daughter approaches you and says, “This is very unusual. At home, when he has difficulty breathing, he stays seated quietly. Why is he walking around like this?”

Although his SpO₂ is technically within the prescribed range, you recognize that restlessness in elderly patients may signal a clinical change.

Question:
Aside from the pulmonary infection, what is the most likely cause of Mr. Ducet’s restlessness and unusual behavior? *
2.2 Later in the shift, Mr. Ducet, still on 3 L/min oxygen, appears more confused and restless. His oxygen saturation remains stable at 92%, and his respiratory rate is 24 breaths/min. He’s oriented only to person and place.

His daughter, clearly concerned, asks:
"He doesn’t act like this at home. Is he going to stay this way? Is this permanent?"

Question:
What is the most appropriate response to reassure Mr. Lemoine’s daughter? *
3. M. Jacques Gagnon, 72 years old, is admitted with a COPD exacerbation. He has a long history of smoking and severe emphysema. The nurse enters the room and finds M. Gagnon drowsy and difficult to rouse. His respiratory rate is 8 breaths/min. The nurse notes that the oxygen flow meter is set to 6 L/min via nasal cannula (previously set at 2 L/min by the nurse, but the patient’s family increased it because he looked short of breath).

Medical Orders:
*Titrate O2 to maintain SpO2 88-92%.
*Salbutamol/Ipratropium nebs q4h.

Question:
What physiological mechanism does the nurse suspect is causing the drowsiness? *
4. Mme. Ginette Tremblay, 68 years old, is attending pulmonary rehabilitation. She tells the nurse, "I get so out of breath just walking to the mailbox. I panic and can't get the air out."

Medical Orders:
*Pulmonary Rehab teaching protocol.

Question:
What breathing technique should the nurse teach to manage dyspnea and prevent air trapping? *
5. M. Pierre Roy, 65 years old, has severe COPD and a BMI of 18 (Underweight). He tells the nurse, "I'm too tired to eat. Chewing makes me out of breath, and my stomach feels full right away."

Medical Orders:
*High-calorie, high-protein diet.
*Consult Dietitian.

Question:
Which dietary instruction is most appropriate? *
6. Mme. Claire Bouchard, 70 years old, has end-stage COPD. During the physical assessment, the nurse notes significant pitting edema in both ankles and distended neck veins (JVD) when the patient is sitting at 45 degrees. The liver is palpable.

Medical Orders:
*Furosemide 40 mg PO daily.
*Fluid restriction 1.5 L/day.

Question:
What complication of COPD do these signs indicate? *
7. M. Robert Fortin, 62 years old, is prescribed Advair (Fluticasone/Salmeterol). He asks the nurse, "Why do I have to rinse my mouth after this one? I don't do that with my blue puffer."

Medical Orders:
*Advair Diskus 250/50 1 puff BID.
*Ventolin PRN.

Question:
What is the correct nursing explanation? *
8. M. Sylvain Cote, 58 years old, is being discharged in January. He tells the nurse, "I like to go for a walk every morning to keep my legs strong, even when it's freezing outside."

Medical Orders:
*Discharge home.
*Activity as tolerated.

Question:
What specific precaution should the nurse recommend regarding cold weather? *
9. Mme. Isabelle Lavoie, 66 years old, presents to the ED with increased dyspnea. The nurse observes her sitting on the side of the stretcher, leaning forward with her arms supported on the bedside table.

Medical Orders:
*Assessment and vitals.

Question:
How should the nurse document this position, and why is the patient doing it? *
10. M. Michel Desjardins, 74 years old, is prescribed home oxygen therapy. The nurse is conducting a home safety assessment. M. Desjardins says, "I maintain my wood stove in the living room to keep warm."

Medical Orders:
*Home Oxygen 2 L/min continuous.

Question:
What is the nurse’s priority safety instruction? *
11. Mme. Sophie Turcotte, 60 years old, calls the nurse. She is extremely short of breath (dyspnea +++), anxious, and her SpO2 is 84%.

Medical Orders:
*Oxygen PRN.
*Ventolin/Atrovent nebulizers PRN.
*Prednisone 50 mg PO daily.

Question:
What is the nurse’s first action? *
13. Mme. Denise Fortin, 67 years old, has severe COPD (Stage III). She was admitted this morning for an acute exacerbation. She is currently on 2 L/min of oxygen via nasal cannula.

At 15:00, the nurse reassesses her. Mme. Fortin is visibly short of breath, sitting in a tripod position, and speaking in short phrases. Her respiratory rate is 30 breaths/min, and her colour appears pale. The pulse oximeter reads SpO₂ 85% on 2 L/min. She remains alert and oriented.

Medical Orders:
*Bed rest.
*Ventolin MDI 2 puffs q4h PRN.
*Oxygen PRN: Titrate between 1–4 L/min via nasal cannula to maintain SpO₂ between 88–92%. Do not exceed 4 L/min.
*Notify MD if SpO₂ < 88% despite maximal O₂ per parameters.

Question:
Based on the assessment and the medical orders, what is the nurse’s priority action? *