NCLEX RN Practice Question # 859

NCLEX Examination.

Practice Question # 859.

COPD: Clinical Manifestations

COPD is characterized by three primary symptoms: cough, sputum production, and dyspnea on exertion (NIH, 2001). These symptoms often worsen over time. Chronic cough and sputum production often precede the development of airflow limitation by many years. However, not all individuals with cough and sputum production will develop COPD.

Dyspnea may be severe and often interferes with the patient’s activities. Weight loss is common because dyspnea interferes with eating, and the work of breathing is energy-depleting. Often the patient cannot participate in even mild exercise because of dyspnea; as COPD progresses, dyspnea occurs even at rest. As the work of breathing increases over time, the accessory muscles are recruited in an effort to breathe. The patient with COPD is at risk for respiratory insufficiency and respiratory infections, which in turn increase the risk for acute and chronic respiratory failure. In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the “barrel chest” thorax configuration.

This results from fixation of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity. Retraction of the supraclavicular fossae occurs on inspiration, causing the shoulders to heave upward. In advanced emphysema, the abdominal muscles also contract on inspiration.