Management of Chronic Obstructive Pulmonary Disease (COPD) Nursing

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1 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 1:

Which irritants are implicated in increased COPD risk?

A) Tobacco smoking

B) Household and occupational exposures

C) Outdoor air pollution

D) All of the above

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Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 2:

Which are risk factors for COPD?

A) Chronic bronchitis

B) Severe childhood respiratory infections

C) Poverty

D) All of the above

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Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 3:

Airway hyperreactivity with or without asthma is a predictor of COPD and respiratory mortality, as well as an indicator of excess lung function decline risk in mild COPD.

A) True

B) False

4 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 4:

Which of the following patients should undergo spirometry screening for COPD?

A) 21-year old patient with no health conditions who uses e-cigarettes

B) 55-year-old impoverished, underweight female reporting breathing difficulty who has been smoking for 20 pack-years

C) 10-year-old patient with no health conditions who reports with itchy eyes and itchy and runny nose

D) All of the above

5 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 5:

Which post-bronchodilator spirometry result indicates a COPD diagnosis?

A) Single FEV1/FVC result of 0.7

B) FEV1/FVC of 0.8 confirmed on 2 separate occasions

C) FEV1/FVC of 0.6 confirmed on 2 separate occasions

D) All of the above

6 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 6:

Which is a first-line pharmacotherapy option for smoking cessation?

A) Long-acting NRT combined with short-acting as-needed NRT

B) Varenicline plus sustained-release bupropion

C) Nortriptyline

D) All of the above

7 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 7:

You are working with a patient who is ready to quit smoking and currently smokes 2 pack of cigarettes per day, beginning within 15 minutes of waking up. The patient prefers NRT. Which is an appropriate smoking cessation regimen for this patient?

A) 7 mg nicotine patch once daily with 2 mg nicotine lozenge as-needed

B) 21 mg nicotine patch once daily with 4 mg nicotine gum as-needed

C) Clonidine patch 0.1 mg daily

D) All of the above

8 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 8:

Which is an NRT option for breakthrough cravings in smoking cessation?

A) Lozenge

B) Gum

C) Inhaler

D) All of the above

9 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 9:

Which is an appropriate response if a patient is not ready to quit smoking?

A) “We can re-visit again the next time I see you."

B) "Congratulations on your decision to quit smoking!"

C) "Remove tobacco products from your home, car, and work."

D) All of the above

10 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 10:

Which is recommended for all patients with COPD?

A) Smoking cessation and avoidance of irritants

B) As-needed SABA or SAMA for immediate relief of symptoms

C) Staying up-to-date on recommended vaccines

D) All of the above

11 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 11:

Which inhaler device requires a forceful inhalation?

A) Soft mist inhaler

B) Metered dose inhaler

C) Dry powder inhaler

D) All of the above

12 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 12:

Which helps to improve administration of metered dose inhalers and reduce the risk of oral candidiasis from inhaled corticosteroids?

A) Spacer

B) Inspiratory flow meter

C) Increasing the dose

D) All of the above

13 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 13:

A patient hospitalized 1 month ago for a COPD exacerbation would be in which Group?

A) GOLD Group A

B) GOLD Group B

C) GOLD Group E

D) GOLD Group F

14 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 14:

Which is an appropriate initial COPD treatment option for GOLD Group E patient?

A) Umeclidinium 62.5 mcg + vilanterol 25 mcg DPI, 1 inhalation once daily

B) Albuterol sulfate 108 mcg, 2 inhalations every 4 hours as maintenance therapy

C) Montelukast 10 mg, 1 tablet once daily

D) All of the above

15 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 15:

What other monitoring should be considered for GOLD Group E patient?

A) Blood eosinophils

B) Vitamin D level

C) mMRC and CAT

D) All of the above

16 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 16:

A patient with COPD taking umeclidinium 62.5 mcg + vilanterol 25 mcg DPI, 1 inhalation once daily, is treated in hospital for a COPD exacerbation and is found to have a blood eosinophil level of 400 cells/μL. Which therapy is appropriate?

A) Continue current therapy

B) Add prednisone 40 mg, 1 tablet once daily for 6 months

C) Switch to vilanterol 25 mcg + umeclidinium 62.5 mcg + fluticasone 100 mcg DPI, 1 inhalation once daily

D) All of the above

17 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 17:

Inhaled corticosteroids alone for COPD (without asthma) improve FEV1 and mortality.

A) True

B) False

18 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 18:

Inhaled corticosteroids alone for COPD (without asthma) improve FEV1 and mortality.

A) True

B) False

19 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 19:

Clinical trials demonstrate that LABAs have a greater effect on reducing COPD exacerbation and hospitalization rates than LAMAs.

A) True

B) False

20 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 20:

A patient taking fluticasone 110 mcg 2 inhalations twice daily for asthma is newly-diagnosed with COPD and prefers a single maintenance inhaler for cost and adherence reasons. The patient had 1 recent mild COPD exacerbation treated outpatient, with a current mMRC score of 1 and CAT score of 3. Which is appropriate for this patient?

A) Switch inhaler devices

B) Review inhaler use (dose, technique, adherence, accessibility, adverse effects)

C) Escalate therapy without further review

D) All of the above

21 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 21:

The patient (from Question 20) is found to be using the fluticasone inhaler correctly and has a consistent refill history, indicating 100% medication adherence. Which is appropriate treatment for this patient?

A) Continue current therapy

B) Switch fluticasone to tiotropium 2.5 mcg SMI, 2 inhalations once daily

C) Switch to budesonide 160 mcg + formoterol 4.5 mcg HFA MDI, 2 inhalations twice daily

D) All of the above

22 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 22:

A 40-year-old patient with COPD recently received Tdap vaccine. What other vaccines are appropriate to consider for the patient at this time?

A) Pneumococcal vaccine

B) Annual influenza vaccine

C) SARS-CoV-2 vaccine

D) All of the above

23 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 23:

Withdrawing inhaled corticosteroids is associated with the greatest FEV1 loss and increase in patients with blood eosinophils ≥ 300 cells/μL at baseline.

A) True

B) False

24 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 24:

Roflumilast may be considered for patients with COPD, chronic bronchitis, and FEV1 < 50% in addition to having which of the following criteria?

A) On a current regimen of LABA+LAMA+ICS

B) On a current regimen of LABA+LAMA with blood eosinophils < 100 cells/μL

C) On a current regimen of LABA+LAMA requiring therapy escalation but unable to take ICS

D) All of the above

25 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 25:

Azithromycin for up to one year may be considered for patients with COPD who are nonsmokers and have which of the following criteria?

A) On a current regimen of LABA+LAMA+ICS

B) On a current regimen of LABA+LAMA with blood eosinophils < 100 cells/μL

C) On a current regimen of LABA+LAMA requiring therapy escalation but unable to take ICS

D) All of the above

26 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 26:

Which is appropriate for a patient using a dry powder inhaler but unable to inhale forcefully?

A) Check patient's inspiratory capacity objectively

B) Switch to MDI or SMI

C) Switch to nebulizer

D) All of the above

27 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 27:

Physical activity is not associated with mortality in COPD.

A) True

B) False

28 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 28:

Weight loss and malnutrition is associated with poor COPD prognosis.

A) True

B) False

29 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 29:

Which is true about pulmonary rehabilitation?

A) Improves dyspnea, health status, exercise capacity, anxiety, and depression.

B) Does not promote long-term adherence to health-enhancing behaviors.

C) Indicated for patients with COPD Group A only.

D) All of the above

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Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 30:

In patients with severe resting chronic hypoxemia, long-term oxygen therapy can improve survival.

A) True

B) False

31 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 31:

Which are some of the key palliative care treatment targets in COPD?

A) Weight loss, 6-minute walking distance, inspiratory flow

B) Reversibility of lung function decline, weight-lifting, immunoglobulin therapy

C) Dyspnea, nutritional support, pain, anxiety, and depression

D) All of the above

32 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 32:

Early advance care planning can _______________

A) Ignore patient and family wishes when providing care.

B) Reduce anxiety for patients and their families.

C) Interfere with invasive mechanical ventilation decisions.

D) All of the above

33 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 33:

Key lifestyle recommendations for patients with COPD include:

A) Healthy diet

B) Physical activity

C) Good sleep habits

D) All of the above

34 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 34:

What is a COPD Action Plan?

A) A guide to help patients manage their COPD.

B) A tool to set aside for use only during emergencies.

C) A checklist of items to purchase for COPD treatment.

D) All of the above

35 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 35:

What can be recommended for patients with COPD to reduce exposure to irritants?

A) Mask-wearing

B) Efficient ventilation at home and at work

C) Non-polluting cooking stoves

D) All of the above

36 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 36:

A patient arrives to clinic with a mild COPD exacerbation and improves after treatment with a SABA. The patient is currently on tiotropium 2.5 mcg SMI, 2 inhalations once daily for COPD maintenance therapy. Which is appropriate?

A) Prednisone 40 mg daily for 5 days

B) First check tiotropium use before escalating therapy

C) Doxycycline 100 mg, 1 tablet every 12 hours

D) All of the above

37 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 37:

The patient (from Question 36) is able to demonstrate correct use of tiotropium inhaler, and prescription history reveals 100% adherence. Comorbidities are noncontributory (stable vital signs and physical assessment). The patient reports increased time spent gardening. Blood eosinophils are 100 cells/μL, mMRC score is 2 and CAT score is 10. Which is appropriate?

A) Self-management education (minimize irritant exposure/wear a mask, breathing exercises, COPD Action Plan, etc.) and pulmonary rehabilitation referral

B) Review the need for any vaccines and vitamin D supplementation

C) Escalate therapy by switching inhaler to tiotropium + olodaterol SMI, 2 inhalations once daily

D) All of the above

38 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 38:

Antibiotics are indicated for COPD exacerbations with ____________ .

A) 1 of 3 cardinal symptoms present

B) Patient requiring supplemental oxygen

C) At least 2 of 3 cardinal symptoms, one being increased sputum purulence

D) All of the above

39 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 39:

Which is true regarding transitions of care for COPD exacerbation hospitalizations?

A) Early follow up after discharge has been associated with reduced readmissions.

B) Good clinical practice only covers telemonitoring prior to discharge.

C) Readmissions are not associated with increased risk of mortality.

D) All of the above

40 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 40:

Examples of comorbidity management strategies for patients with COPD include:

A) Continuous positive airway pressure treatment for obstructive sleep apnea.

B) Selective β1-blockers for heart failure.

C) Prioritizing asthma guideline therapy for patients with concomitant asthma.

D) All of the above

41 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 41:

Factors which may predict severe COVID-19 in patients with COPD include:

A) Normal weight

B) Recent hospitalization for COPD exacerbation

C) Smoking cessation

D) All of the above

42 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 42:

For patients with COPD diagnosed with COVID-19:

A) Standard of care for COVID-19 should be provided.

B) Nebulizers and spirometry should be avoided if possible.

C) Elective bronchoscopy should be delayed until patients have a negative COVID-19 test.

D) All of the above

43 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 43:

For all patients with COPD taking a LABA and requiring therapy escalation, an ICS should be added first before adding a LAMA.

A) True

B) False

44 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 44:

Which is true regarding the risk of pneumonia with ICS treatment in COPD?

A) Patients with lower eosinophils are not at risk for pneumonia

B) Current smokers are not at increased risk for pneumonia vs non-smokers

C) Patients with severe COPD are at increased risk for pneumonia

D) All of the above

45 / 45

Management of Chronic Obstructive Pulmonary Disease (COPD)

Question 45:

Which is true regarding less common therapies for COPD?

A) Theophylline may be considered with caution for patients unable to use bronchodilators.

B) Opioids are used for patients with mild COPD.

C) Mucolytics are contraindicated in COPD.

D) All of the above

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