1. A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurse’s best answer?
A) The most important risk factor for COPD is exposure to occupational toxins.
B) The most important risk factor for COPD is inadequate exercise.
C) The most important risk factor for COPD is exposure to dust and pollen.
D) The most important risk factor for COPD is cigarette smoking.
The most important risk factor for COPD is cigarette smoking. Lack of exercise and exposure to dust and pollen are not risk factors for COPD. Occupational risks are significant but are far exceeded by smoking.
2. A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD?
A) Lung cancer
B) Cystic fibrosis
C) Respiratory failure
Complications of COPD include respiratory failure, pneumothorax, atelectasis, pneumonia, and pulmonary hypertension (corpulmonale). Lung cancer, cystic fibrosis, and hemothorax are not common complications.
3. A nurse is caring for a young adult patient whose medical history includes an alpha1-antitrypsin deficiency. This deficiency predisposes the patient to what health problem?
A) Pulmonary edema
B) Lobular emphysema
C) Cystic fibrosis (CF)
A host risk factor for COPD is a deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patient’s risk of pulmonary edema, CF, or empyema.
4. The nurse is assessing a patient whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
A) Signs of oxygen toxicity
B) Chronic chest pain
C) A barrel chest
D) Long, thin fingers
In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The patient would not show signs of oxygen toxicity unless he or she received excess supplementary oxygen.
5. A patient with emphysema is experiencing shortness of breath. To relieve this patient’s symptoms, the nurse should assist her into what position?
A) Sitting upright, leaning forward slightly
B) Low Fowler’s, with the neck slightly hyperextended
The typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breathe. Low Fowler’s positioning would be less likely to aid oxygenation. Prone or Trendelenburg positioning would exacerbate shortness of breath.
6. A nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis?
A) Elevated sweat chloride concentration
B) Presence of protein in the urine
C) Positive phenylketonuria
D) Malignancy on lung biopsy
Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and malignancy are not diagnostic for CF.
7. A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this client’s airflow obstruction?
A) Administer corticosteroids by metered dose inhaler
B) Administer inhaled anticholinergics
C) Administer an inhaled beta-adrenergic agonist
D) Utilize a peak flow monitoring device
Asthma exacerbations are best managed by early treatment and education of the patient. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication. A peak flow device will not resolve short-term shortness of breath.
8. A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
A) Gradually increase levels of physical exertion.
B) Change filters on heaters and air conditioners frequently.
C) Take prescribed medications as scheduled.
D) Avoid goose-down pillows.
Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.
9. A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process?
A) Intermittent episodes of acute bronchospasm
B) Alveolar distention and impaired diffusion
C) Dilation of bronchi and bronchioles
D) Excessive gas exchange in the bronchioles
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. It is not characterized by acute bronchospasm, alveolar distention, or excessive gas exchange.
10. A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the child’s nutritional status, what intervention should most likely be included in the plan of care?
A) Pancreatic enzyme supplementation with meals
B) Provision of five to six small meals per day rather than three larger meals
C) Total parenteral nutrition (TPN)
D) Magnesium, thiamine, and iron supplementation
Nearly 90% of patients with CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals. Frequent, small meals or TPN are not normally indicated. Vitamin supplements are required, but specific replacement of magnesium, thiamine, and iron is not typical.
11. A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patient’s care?
A) Oral administration of diuretics
B) Intravenous fluids to reduce the viscosity of secretions
C) Postural chest drainage
D) Pulmonary function testing
Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Diuretics and IV fluids will not aid in the mobilization of secretions. Lung function testing may be indicated, but this assessment will not relieve the patient’s symptoms.
12. A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma?
A) Shallow respirations
B) Increased anterior-posterior (A-P) diameter
C) Bilateral wheezes
The three most common symptoms of asthma are cough, dyspnea, and wheezing. There may be generalized wheezing (the sound of airflow through narrowed airways), first on expiration and then, possibly, during inspiration as well. Respirations are not usually slow and the child’s A-P diameter does not normally change.
13. A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize?
A) Smoking up to one-half of a pack of cigarettes weekly is allowable.
B) Chronic inhalation of indoor toxins can cause lung damage.
C) Minor respiratory infections are considered to be self-limited and are not treated.
D) Activities of daily living (ADLs) should be clustered in the early morning hours.
Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all patients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. ADLs should be paced throughout the day to permit patients to perform these without excessive distress.
14. A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care?
A) Taking prophylactic antibiotics as ordered
B) Adhering to the treatment regimen in order to cure the disease
C) Avoiding airplanes, buses, and other crowded public places
D) Setting realistic short-term and long-range goals
A major area of teaching involves setting and accepting realistic short-term and long-range goals. Emphysema is not considered curable and antibiotics are not used on a preventative basis. The patient does not normally need to avoid public places.
15. A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation?
A) Sudden onset of pleuritic chest pain
B) Wheezes on auscultation
C) Increased anterior-posterior (A-P) diameter
D) Clubbing of the fingers
Characteristic symptoms of bronchiectasis include chronic cough and production of purulent sputum in copious amounts. Clubbing of the fingers also is common because of respiratory insufficiency. Sudden pleuritic chest pain is a common manifestation of a pulmonary embolism. Wheezes on auscultation are common in patients with asthma. An increased A-P diameter is noted in patients with COPD.
16. A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding?
A) Strong exercise tolerance
B) Exhalation volume is normal
C) Respiratory infection
D) Obstructive lung disease
Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is apparent when an FEV1/FVC ratio is less than 70%.
17. A nurse has been asked to give a workshop on COPD for a local community group. The nurse emphasizes the importance of smoking cessation because smoking has what pathophysiologic effect?
A) Increases the amount of mucus production
B) Destabilizes hemoglobin
C) Shrinks the alveoli in the lungs
D) Collapses the alveoli in the lungs
Smoking irritates the goblet cells and mucous glands, causing an increased accumulation of mucus, which, in turn, produces more irritation, infection, and damage to the lung.
18. A pediatric nurse practitioner is caring for a child who has just been diagnosed with asthma. The nurse has provided the parents with information that includes potential causative agents for an asthmatic reaction. What potential causative agent should the nurse describe?
B) Lack of sleep
C) Psychosocial stress
Common causative agents that may trigger an asthma attack are as follows: dust, dust mites, pets, soap, certain foods, molds, and pollens. Lack of sleep, stress, and bacteria are not common triggers for asthma attacks.
19. A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?
A) Lie supine to facilitate air entry
B) Avoid pursed lip breathing
C) Use diaphragmatic breathing
D) Use chest breathing
Inspiratory muscle training and breathing retraining may help improve breathing patterns in patients with COPD. Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration. Diaphragmatic breathing, not chest breathing, increases lung expansion. Supine positioning does not aid breathing.
20. A nurse is caring for a patient who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the patient for which of the following clinical manifestations?
A) Copious sputum production
B) Pain on inspiration
C) Pigeon chest
D) Dry cough
Clinical manifestations of bronchiectasis include hemoptysis, chronic cough, copious purulent sputum, and clubbing of the fingers. Because of the copious production of sputum, the cough is rarely dry. A pigeon chest is not associated with the disease and patients do not normally experience pain on inspiration.
21. A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF?
A) Alveolar mucus plugging, infection, and eventual bronchiectasis
B) Bronchial mucus plugging, inflammation, and eventual bronchiectasis
C) Atelectasis, infection, and eventual COPD
D) Bronchial mucus plugging, infection, and eventual COPD
The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.
22. An older adult patient has been diagnosed with COPD. What characteristic of the patient’s current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)?
A) The patient has not yet quit smoking.
B) The patient has severe arthritis in her hands.
C) The patient requires both corticosteroids and beta2-agonists.
D) The patient has cataracts.
Safe and effective MDI use requires the patient to be able to manipulate the device independently, which may be difficult if the patient has arthritis. Smoking does not preclude MDI use. A modest loss of vision does not preclude the use of an MDI and a patient can safely use more than one MDI.
23. A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following?
A) Social work assessment
B) Insurance coverage
C) Chloride levels
D) Available diagnostic tests
In addition to the patient’s history, the nurse reviews the results of available diagnostic tests. Social work assessment is not a priority for the majority of patients. Chloride levels are relevant to CF, not COPD. Insurance coverage is not normally the domain of the nurse.
24. An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what?
A) Kyphosis and clubbing of the fingers
B) Dyspnea and hypoxemia
C) Sepsis and pneumothorax
D) Bradypnea and pursed lip breathing
These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea.
25. A nurse is caring for a patient with COPD. The patient’s medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status? Select all that apply.
A) Negative sputum culture
B) Increased viscosity of lung secretions
C) Increased respiratory rate
D) Increased expiratory flow rate
E) Relief of dyspnea
Ans: D, E
The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the patient’s respiratory status. Bronchodilators would not have a direct result on the patient’s infectious process.
26. A nurse’s assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the patient is experiencing bronchospasm?
A) Fine or coarse crackles on auscultation
B) Wheezes or diminished breath sounds on auscultation
C) Reduced respiratory rate or lethargy
D) Slow, deliberate respirations
Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, inefficient breathing and agitation.
27. The case manager for a group of patients with COPD is providing health education. What is most important for the nurse to assess when providing instructions on self-management to these patients?
A) Knowledge of alternative treatment modalities
B) Family awareness of functional ability and activities of daily living (ADLs)
C) Knowledge of the pathophysiology of the disease process
D) Knowledge about self-care and their therapeutic regimen
When providing instructions about self-management, it is important for the nurse to assess the knowledge of patients and family members about self-care and the therapeutic regimen. This supersedes knowledge of alternative treatments or the pathophysiology of the disease, neither of which is absolutely necessary for patients to know. The patient’s own knowledge is more important than that of the family.
28. A nurse is developing a teaching plan for a patient with COPD. What should the nurse include as the most important area of teaching?
A) Avoiding extremes of heat and cold
B) Setting and accepting realistic short- and long-range goals
C) Adopting a lifestyle of moderate activity
D) Avoiding emotional disturbances and stressful situations
A major area of teaching involves setting and accepting realistic short-term and long-range goals. The other options should also be included in the teaching plan, but they are not areas that are as high a priority as setting and accepting realistic goals.
29. A nurse is assessing a patient who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes? Select all that apply.
A) Pulmonary hypertension
B) Airway obstruction
C) Pulmonary infections
D) Genetic disorders
Ans: B, C, D
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD. Bronchiectasis may be caused by a variety of conditions, including airway obstruction, diffuse airway injury, pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections, or genetic disorders such as cystic fibrosis. Bronchiectasis is not caused by pulmonary hypertension or atelectasis.
30. A nurse is planning the care of a client with bronchiectasis. What goal of care should the nurse prioritize?
A) The patient will successfully mobilize pulmonary secretions.
B) The patient will maintain an oxygen saturation level of ³98%.
C) The patient’s pulmonary blood pressure will decrease to within reference ranges.
D) The patient will resume prediagnosis level of function within 72 hours.
Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Pulmonary pressures are not a central focus in the care of the patient with bronchiectasis. Rapid resumption of prediagnosis function and oxygen saturation above 98% are unrealistic goals.
31. An interdisciplinary team is planning the care of a patient with bronchiectasis. What aspects of care should the nurse anticipate? Select all that apply.
A) Occupational therapy
B) Antimicrobial therapy
C) Positive pressure isolation
D) Chest physiotherapy
E) Smoking cessation
Ans: B, D, E
Chest physiotherapy, antibiotics, and smoking cessation are cornerstones of the care of patients with bronchiectasis. Occupational therapy and isolation are not normally indicated.
32. A patient’s severe asthma has necessitated the use of a long-acting beta2-agonist (LABA). Which of the patient’s statements suggests a need for further education?
A) I know that these drugs can sometimes make my heart beat faster.
B) I’ve heard that this drug is particularly good at preventing asthma attacks during exercise.
C) I’ll make sure to use this each time I feel an asthma attack coming on.
D) I’ve heard that this drug sometimes gets less effective over time.
LABAs are not used for management of acute asthma symptoms. Tachycardia is a potential adverse effect and decreased protection against exercise-induced bronchospasm may occur with regular use.
33. A nurse is providing health education to the family of a patient with bronchiectasis. What should the nurse teach the patient’s family members?
A) The correct technique for chest palpation and auscultation
B) Techniques for assessing the patient’s fluid balance
C) The technique for providing deep nasotracheal suctioning
D) The correct technique for providing postural drainage
A focus of the care of bronchiectasis is helping patients clear pulmonary secretions; consequently, patients and families are taught to perform postural drainage. Chest palpation and auscultation and assessment of fluid balance are not prioritized over postural drainage. Nasotracheal suctioning is not normally necessary.
34. A nurse is working with a child who is undergoing a diagnostic workup for suspected asthma. What are the signs and symptoms that are consistent with a diagnosis of asthma? Select all that apply.
A) Chest tightness
Ans: A, D, E
Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Crackles and bradypnea are not typical symptoms of asthma.
35. A nurse is caring for a patient who has been hospitalized with an acute asthma exacerbation. What drugs should the nurse expect to be ordered for this patient to gain underlying control of persistent asthma?
A) Rescue inhalers
B) Anti-inflammatory drugs
Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of anti-inflammatory medications. Rescue inhalers, antibiotics, and antitussives do not aid in the first-line control of persistent asthma.
36. A nurse is teaching a patient with asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching?
A) Dyspnea and increased respiratory secretions
B) Nausea and vomiting
C) Cough and oral thrush
D) Fatigue and decreased level of consciousness
Azmacort has possible adverse effects of cough, dysphonia, oral thrush (candidiasis), and headache. In high doses, systemic effects may occur (e.g., adrenal suppression, osteoporosis, skin thinning, and easy bruising). The other listed adverse effects are not associated with this drug.
37. A nurse is explaining to a patient with asthma what her new prescription for prednisone is used for. What would be the most accurate explanation that the nurse could give?
A) To ensure long-term prevention of asthma exacerbations
B) To cure any systemic infection underlying asthma attacks
C) To prevent recurrent pulmonary infections
D) To gain prompt control of inadequately controlled, persistent asthma
Prednisone is used for a short-term (310 days) burst to gain prompt control of inadequately controlled, persistent asthma. It is not used to treat infection or to prevent exacerbations in the long term.
38. An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients?
A) Encouraging patients to carry a corticosteroid rescue inhaler at all times
B) Educating patients about recognizing and avoiding asthma triggers
C) Teaching patients to utilize alternative therapies in asthma management
D) Ensuring that patients keep their immunizations up to date
Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.
39. An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value?
A) Highest airflow during a forced inspiration
B) Highest airflow during a forced expiration
C) Airflow during a normal inspiration
D) Airflow during a normal expiration
Peak flow meters measure the highest airflow during a forced expiration.
40. A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
A) Teach the patient strategies for promoting diaphragmatic breathing.
B) Administer supplementary oxygen by simple face mask.
C) Teach the patient to perform airway suctioning.
D) Assist the patient in developing an appropriate exercise program.
The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in patients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.
1. The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful?
The patient shakes the device before use.
The patient rapidly inhales the medication.
The patient attaches a spacer to the Diskus.
The patient performs huff coughing after inhalation.
The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.
2. The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching?
The patient attaches a spacer before using the inhaler.
The patient coughs vigorously after using the inhaler.
The patient removes the facial mask when misting stops.
The patient activates the inhaler at the onset of expiration.
A nebulizer is used to administer aerosolized medication. A mist is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. The other options refer to inhaler use. Coughing vigorously after inhaling and activating the inhaler at the onset of expiration are both incorrect techniques when using an inhaler.
3. A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?
Give the rescue medication immediately before testing.
Administer oral corticosteroids 2 hours before the procedure.
Withhold bronchodilators for 6 to 12 hours before the examination.
Ensure that the patient has been NPO for several hours before the test.
Bronchodilators are held before spirometry so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should be held before spirometry. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
4. Which information will the nurse include in the asthma teaching plan for a patient being discharged?
Use the inhaled corticosteroid when shortness of breath occurs.
Inhale slowly and deeply when using the dry powder inhaler (DPI).
Hold your breath for 5 seconds after using the bronchodilator inhaler.
Tremors are an expected side effect of rapidly acting bronchodilators.
Tremors are a common side effect of short-acting b2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
5. The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective?
No wheezes are audible.
O2 saturation is >90%.
Accessory muscle use has decreased.
Respiratory rate is 16 breaths/minute.
The goal for treatment of an asthma attack is to keep the O2 saturation above 90%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.
6. A patient seen in the asthma clinic has recorded daily peak flow rates that are 75% of the baseline. Which action will the nurse plan to take next?
Increase the dose of the leukotriene inhibitor.
Teach the patient about the use of oral corticosteroids.
Administer a bronchodilator and recheck the peak flow.
Instruct the patient to keep the scheduled follow-up appointment.
The patient’s peak flow reading indicates that the condition is worsening (yellow zone). The patient should take the bronchodilator and recheck the peak flow. Depending on whether the patient returns to the green zone, indicating well-controlled symptoms, the patient may be prescribed oral corticosteroids or a change in dosing of other medications. Keeping the next appointment is appropriate, but the patient also needs to be taught how to control symptoms now and use the bronchodilator.
7. The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?
The patient inhales rapidly through the peak flow meter mouthpiece.
The patient takes montelukast (Singulair) for peak flows in the red zone.
The patient calls the health care provider when the peak flow is in the green zone.
The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.
Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting b2-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy.
8. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). The nurse should plan to teach the patient about
use of the nicotine patch.
continuous pulse oximetry.
When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in a1-antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be ordered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with COPD.
9. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?
The patient reports a recent 15-lb weight gain.
The patient denies shortness of breath at present.
The patient takes cimetidine (Tagamet HB) daily.
The patient complains of coughing up green mucus.
Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.
10. The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety?
Titrate O2 to keep saturation at least 90%.
Teach the patient how to use pursed-lip breathing.
Discuss a high-protein, high-calorie diet with the patient.
Suggest the use of over-the-counter sedative medications.
Pursed-lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires O2 therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.
11. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care?
Encourage increased intake of whole grains.
Increase the patient’s intake of fruits and fruit juices.
Offer high-calorie protein snacks between meals and at bedtime.
Assist the patient in choosing foods with high vegetable content.
Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture such as whole grains may take more energy to eat and get absorbed and lead to decreased intake. Although fruits, juices, and minerals are not contraindicated, foods high in protein are a better choice.
12. The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis?
The patient tells the nurse about a family history of bronchitis.
The patient indicates a 30 pack-year cigarette smoking history.
The patient reports a productive cough for 3 months every winter.<