INSTRUCTIONS Best practices in chronic obstructive pulmonary disease
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Best practices in chronic obstructive pulmonary disease
General Purpose: To familiarize the NP with evidence-based guidelines for COPD management. Learning Objectives: After reading the preceding article and taking the following test, you should be able to: 1. Discuss the causes, pathophysiology, and diagnosis of COPD. 2. Identify evidence-based guidelines for the treatment of COPD.
1. What is the main distinguishing characteristic of COPD?
a. airflow limitation
b. cor pulmonale
c. airway obstruction
d. progressive exercise intolerance
2. Two groups have issued COPD guidelines: ATS/ERS and the
3. Demographically, COPD is
a. largely underdiagnosed.
b. decreasing as a cause of death.
c. the sixth leading cause of death in the United States.
d. decreasing as a cause of healthcare resource utilization.
4. The pulmonary inflammation of COPD is an abnormal response primarily to
a. chemical gases.
b. cigarette smoke.
c. air pollutants.
d. biomass fuel smoke.
5. GOLD guidelines define COPD as the ratio of FEV1 to FVC of
a. greater than 50%.
b. greater than 70%.
c. less than 70%.
d. less than 85%.
6. Risk factors for COPD include all of the following except
a. low antioxidant diet.
b. alpha-1 antitrypsin deficiency.
c. passive exposure to cigarette smoke.
d. early onset of autoimmune disorders.
7. The diagnostic tool of choice for COPD is
b. MMRC Scale.
c. 6-minute walk test.
8. What is the primary purpose of the BODE Index?
a. screen for COPD
b. secondary diagnostic tool
c. measure pulmonary function
d. predict hospitalization and mortality for COPD
9. A COPD patient should receive the pneumococcal vaccination at diagnosis and
a. every 5 years.
b. every 10 years.
c. again in 5 years if the first dose was prior to 65 years old.
d. again in 10 years if the first dose was prior to 60 years old.
10. The cornerstone of maintenance therapy for moderate to severe COPD is
a. short-acting bronchodilators.
b. long-acting bronchodilators.
c. oral corticosteroid therapy.
d. inhaled corticosteroid therapy.
11. Research on patients with severe COPD showed which drug option was most effective at preventing exacerbations?
a. fluticasone 250 mcg
b. salmeterol 50 mcg alone
c. salmeterol 50 mcg/fluticasone 500 mcg
d. budesonide 60 mcg/formoterol 4.5 mcg
12. In order to detect the impact of symptoms on activity, the author recommends asking,
a. "What are you doing?"
b. "How are you doing?"
c. "How would you rate your health in general?"
d. "What is the worst your breathlessness gets on 4-point scale?"
13. What is the preferred way of determining the need for supplemental oxygen?
a. pulse oximetry
b. arterial blood gases
c. patient symptoms (such as dyspnea, anxiety)
d. patient signs (such as cyanosis, increased respiratory rate)
14. A physiological indication for starting oxygen therapy is reaching a PaO2 of
a. 80-90 mm Hg.
b. 70-80 mm Hg.
c. 60-70 mm Hg.
d. less than 55 mm Hg.
15. The goal of oxygen therapy in COPD is to maintain an SpO2 during exertion of greater than
16. Once oxygen is prescribed during an exacerbation, ABGs should be rechecked in
a. 1 day.
b. 3 to 7 days.
c. 10 to 30 days.
d. 30 to 90 days.
17. Comorbidities common with COPD include all except
b. abuse of hypnotics for sleep.
d. nocturnal desaturation.
18. Which statement about pulmonary rehabilitation is true?
a. It is the standard of care for chronic symptomatic lung disease.
b. It is overutilized and there is little evidence it affects outcomes.
c. It is not recommended for advanced stages (III and IV) of COPD.
d. It is a new strategy for COPD care but is not covered by Medicare.