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AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000426689.73460.01
Feature Articles

CE Test 2.6 Hours: COPD Exacerbations

Contrada, Emily

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Continued Education
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* To take the test online, go to our secure Web site at

* To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

* Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to: Lippincott Williams and Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is February 28, 2015.

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* Send in together two or more tests from any nursing journal published by Lippincott, Williams and Wilkins (LWW), and deduct $0.95 from the price of each test.

* We also offer CE accounts for hospitals and other health care facilities online at Call 1-800-787-8985 for details.

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LWW, publisher of AJN, will award the number of contact hours indicated for each continuing nursing education activity. LWW is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center (ANCC).

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LWW is also an approved provider of continuing nursing education by the District of Columbia and Florida #FBN2454. Your certificate is valid in all states.

The ANCC's accreditation status of the LWW Department of Continuing Education refers to its continuing nursing educational activities only and does not imply Commission on Accreditation approval or endorsement of any commercial product.

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To outline current guidelines and evidence-based recommendations for identifying, assessing, and managing chronic obstructive pulmonary disease (COPD) exacerbations.

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After reading this article and taking this test, you will be able to

* explain the prevalence, outcomes, and preventive strategies related to COPD.

* outline the risk factors, pathophysiology, and clinical manifestations of COPD.

* plan the appropriate interventions for patients having a COPD exacerbation.

1. As a cause of death in the United States, how does chronic obstructive pulmonary disease (COPD) rank?

a. third

b. fourth

c. fifth

d. sixth

2. According to the third National Health and Nutrition Examination Survey, what percentage of the U.S. population showed evidence of impaired lung function?

a. 1% to 4%

b. 5% to 10%

c. 11% to 14%

d. 15% to 20%

3. For patients hospitalized with hypercarbic exacerbations of COPD, mortality after 2 years is approximately

a. 30%.

b. 40%.

c. 50%.

d. 60%.

4. Risk factors for COPD include

a. male gender.

b. obesity.

c. alcohol abuse.

d. α1-antitrypsin deficiency.

5. The parenchymal destruction of COPD causes lungs to

a. collapse during expiration.

b. fill with fluid.

c. consolidate.

d. become fibrotic.

6. Exacerbations of COPD are significantly more likely to occur during which season?

a. spring

b. summer

c. autumn

d. winter

7. Almost half of patients experiencing a COPD exacerbation report a major reduction in

a. appetite.

b. physical activity.

c. urinary elimination.

d. secretion mobilization.

8. Which of the following manifestations reflects pulmonary hyperinflation?

a. sinus bradycardia

b. increasing systolic blood pressure

c. resonant percussion over the heart

d. increased distance between the cricoid cartilage and suprasternal notch

9. Which of the following manifestations indicates a severe COPD exacerbation?

a. paradoxical chest wall movement

b. pursed-lip breathing

c. peripheral cyanosis

d. chest discomfort

10. In both outpatient and inpatient settings, the first intervention for a COPD exacerbation usually involves increasing the dose or frequency of the patient's

a. short-acting anticholinergic.

b. short-acting inhaled bronchodilator.

c. systemic glucocorticosteroid.

d. oral methylxanthine.

11. A common adverse effect of short-acting anticholinergic agents is

a. diarrhea.

b. hypokalemia.

c. tachycardia.

d. urinary retention.

12. Which of the following is a risk associated with administering oral prednisolone at high doses for longer than 14 days?

a. hypoglycemia

b. excessive sedation

c. muscle atrophy

d. hypertension

13. During COPD exacerbations with purulent sputum production, the most common bacterial causes include

a. Haemophilus influenzae.

b. Staphylococcus aureus.

c. Pseudomonas aeruginosa.

d. Mycoplasma pneumoniae.

14. During COPD exacerbations, the arterial oxygen saturation goal for patients without complications should be

a. 86% to 88%.

b. 88% to 92%.

c. 92% to 94%.

d. 94% to 98%.

15. Poor candidates for noninvasive ventilation are those who have

a. a pH between 7.25 and 7.35.

b. a partial pressure of carbon dioxide in arterial blood above 45 mmHg.

c. a high risk of vomiting or aspiration.

d. severe dyspnea with respiratory muscle fatigue.

16. One of the first signs of treatment success with noninvasive ventilation for COPD exacerbations is a reduction in

a. respiratory rate.

b. blood pressure.

c. secretions.

d. acidosis.

17. A significant risk associated with mechanical ventilation is

a. hypertension.

b. barotrauma.

c. bradycardia.

d. respiratory arrest.

18. The single most effective means of reducing COPD progression, regardless of disease status, is

a. oxygen therapy.

b. exercise training.

c. nutrition counseling.

d. smoking cessation.

© 2013 Lippincott Williams & Wilkins, Inc.