Ch 22 Respiratory Function

16. A frail, older patient is in the emergency room in severe respiratory distress. The patient has had repeated hospitalizations for the same thing. After stabilizing the patient, which action by the nurse is most appropriate? a. Determine what the patient's end-of-life wishes are. b. Assess the family caregiver for compliance with treatment. c. Administer intravenous (IV) fluids at a rapid rate. d. Prepare to vaccinate the patient against pneumonia.

ANS: A Because of the lifesaving modalities needed to care for such a patient, the nurse and physician work together to determine what the patient's end-of-life wishes are. In the emergency department, patient stabilization comes first, but once this has been accomplished a discussion should occur with the patient and family about further treatment desires. The family caregiver may or may not be adherent, or the patient may assume all self-care. IV fluids should not be given at a rapid rate because of the risk of heart failure. The patient should receive an immunization against pneumonia per guidelines. DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

14. A patient has been taught about nutrition related to COPD. Which menu selection may indicate a need for further teaching? a. Bagel and cream cheese b. Broiled chicken breast c. Beans and peas d. Tofu stir-fry

ANS: A Carbohydrates should not make up more than 50% of the daily intake of calories because they break down into carbon dioxide, worsening breathing. The other selections show good understanding. Of course, the nurse needs to take into consideration the amount of carbohydrates in the entire day and not just one selection. DIF: Evaluating (Evaluation) REF: N/A OBJ: 22-3 TOP: Nursing Process: Evaluation MSC: Health Promotion

18. The nurse caring for patients using continuous positive airway pressure (CPAP) knows what about treatment effectiveness? a. Effectiveness depends on compliance. b. It's too expensive for many older adults. c. It is rarely effective for sleep apnea. d. Complicated settings make it hard to use.

ANS: A Effectiveness is determined by compliance for nearly any regime, and unfortunately compliance with CPAP is less than 50%. The other statements are incorrect. DIF: Remembering (Knowledge) REF: Page 451 OBJ: 22-7 TOP: Nursing Process: Assessment MSC: Physiologic Integrity MULTIPLE RESPONSE

4. The nurse is aware of the typical occurrence of comorbidities in the older adult. Motivated by this knowledge, the nurse assesses a patient with diagnosed respiratory dysfunction for possible: a. poor wound healing of the legs and feet. b. ineffective absorption of vitamins and minerals. c. abnormal urine protein levels. d. visual problems including retinal detachment.

ANS: A In addition, older patients are more likely to have comorbidities involving the cardiovascular and respiratory systems. Peripheral circulation is a possible cardiovascular problem that would result in poor wound healing. The other options are not related to having a respiratory dysfunction. DIF: Remembering (Knowledge) REF: Page 425 OBJ: 22-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

10. The nurse gives priority to assessing an older patient who presents with symptoms of acute respiratory distress for which other condition? a. Substernal chest pain b. A history of panic attacks c. Any known allergies d. Bruising on the chest

ANS: A The symptoms of asthma and respiratory distress mimic other conditions such as myocardial ischemia. The nurse assesses for this condition as the priority over the others. DIF: Applying (Application) REF: N/A OBJ: 22-2 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

3. The nurse is concerned about an older adult patient developing toxic levels of the prescribed theophylline when it is determined that the patient has a(n): a. one pack a day smoking habit. b. elevated serum potassium level. c. history of chronic bronchitis. d. chronic, nonproductive cough.

ANS: A Theophylline is a medication that is affected by smoking, which increases serum drug levels. The other factors do not affect the pharmacokinetics of this drug. DIF: Remembering REF: Page 425 OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

4. The nurse is evaluating the effectiveness of an older patient's self-management of asthma. What does the nurse assess as the priority? (Select all that apply.) a. How many times a week a rescue inhaler treatment is needed b. How well the patient is able to avoid the known triggers c. Whether the patient experience frequent respiratory infections d. Whether the patient requires rest periods during the day e. Whether the patient believes he or she has the support of family and friends

ANS: A, B The evaluation of self-management is based on the patient's success in following through with the plan. Determine the frequency of rescue inhaler use, success at avoiding triggers, and the patient's ability to monitor and address lifestyle changes. DIF: Evaluating (Evaluation) REF: N/A OBJ: 22-3 TOP: Nursing Process: Evaluation MSC: Health Promotion

2. When teaching older adult asthmatic patients, the nurse stresses the importance of which of the following? (Select all that apply.) a. Being alert for the early signs of breathing problems b. Fostering an effective relationship with your health care provider c. Identifying and avoid personal triggers d. Incorporating regular rest periods into your daily routine e. Increasing vitamin C consumption, especially during winter months

ANS: A, B, C The prognosis for an older adult with asthma is relatively good. Success is based on a partnership between the patient and the health care provider to properly use prescribed medications, avoid asthma triggers, identify early signs of exacerbation, and maintain a healthy lifestyle. Rest may or may not be an issue if the patient has mild asthma. Vitamin C may have immune system benefits. DIF: Understanding (Comprehension) REF: Page 428 OBJ: 22-3 TOP: Teaching-Learning MSC: Health Promotion

5. The nurse encouraging an older patient to start pulmonary rehabilitation shares the benefits of the program, including which of the following? (Select all that apply.) a. Socialization b. Decreased cardiac risks c. Nutrition counseling d. Weight management e. Sports participation

ANS: A, B, C, D There are many aspects to pulmonary rehabilitation, including socialization, decreased cardiac risks, nutrition counseling, and weight management Sports are not included, although exercise is. DIF: Remembering (Knowledge) REF: Page 435-6 OBJ: 22-6 TOP: Teaching-Learning MSC: Health Promotion

3. The nurse is coordinating care for a newly admitted older adult. The patient is diagnosed with hypertension, asthma, atrial fibrillation, mild osteoarthritis, and glaucoma. Before administering the patient's corticosteroid medication, the nurse is especially interested in which of the following? (Select all that apply.) a. The name of the patient's hypertension medication b. What the patient uses to manage arthritic pain c. Whether the patient feels the asthma is well controlled d. Whether the patient takes low-dose aspirin regularly e. Whether the patient has ever had glaucoma-related surgery

ANS: A, B, D Asthma may be exacerbated by the use of nonsteroidal antiinflammatory agents for arthritis, aspirin for circulation, nonselective beta-blockers for hypertension, or glaucoma eye drops that contain beta-blockers. Feeling that the asthma is under control and previous surgery are not directly related. DIF: Application (Applying) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

1. To minimize an older adult's risk for developing postsurgical atelectasis, the nurse does which of the following? (Select all that apply.) a. Regularly assesses and medicates for pain b. Teaches effective deep-breathing techniques c. Provides oxygen via nasal cannula d. Encourages the patient to drink all fluids on meal trays e. Assesses lung sounds frequently

ANS: A, B, D Promotion of deep breathing, effective pain management, adequate hydration, frequent position changes, and early mobility will decrease the risk of developing atelectasis. Providing oxygen and assessing lung sounds will not prevent atelectasis from occurring. DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Nursing Process: Implementation MSC: Physiologic Integrity

15. An older patient is hospitalized with influenza and is prescribed amantadine (Symmetrel). What assessment finding would indicate this drug is not appropriate for the patient? a. BUN 22 mg/dL b. Creatinine 3.2 mg/dL c. Sodium 132 mEq/L d. Potassium 4.2 mEq/L

ANS: B Amantadine can cause behavioral changes, delirium, hallucinations, agitation, and seizures, mostly in patients with impaired renal function. The creatinine is high, indicating renal disease. The other lab values are normal. DIF: Analyzing (Analysis) REF: N/A OBJ: 22-3 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. Because the older adult is not as likely to exhibit the typical signs of ineffective gas exchange, the nurse is particularly suspicious of: a. a nonproductive cough in an afebrile patient. b. irritability in a usually pleasant patient. c. pale nail beds in a patient of color. d. an elevated white blood cell (WBC) count in an 82-year-old patient.

ANS: B An early sign of respiratory problems is a change in mental status. Because the physiologic responses to hypoxemia and hypercapnia are blunted in older patients, compensatory changes in heart rate, respiratory rate, and blood pressure may be delayed and cerebral perfusion may suffer. Mental status changes may include subtle increases in forgetfulness and irritability. DIF: Applying (Application) REF: N/A OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

6. The nurse is preparing information for the caregivers of a patient with chronic respiratory issues. The nurse will make the greatest impact on their ability to provide quality care while maintaining the patient's emotional well-being by including: a. suggestions regarding proper nutrition and exercise for the caregiver. b. an explanation on how to preserve the patient's sense of autonomy. c. encouragement for the primary caregiver to set aside time for his or her own interests. d. recommendations of periodic self-reflection regarding the stressors the patient experiences.

ANS: B Many patients with respiratory illness feel a loss of control over their lives because of their symptoms. They may become demanding and controlling in dealing with their families and friends. Well-being is enhanced by having some control over one's life. The other options relate to the caregivers. DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Teaching-Learning MSC: Psychosocial Integrity

2. An older adult's pulmonary function studies indicate that his vital capacity is reduced and his residual volume is increased. The nurse recognizes that these test results are observed in the patient's: a. ineffective cough reflex. b. shallow breathing. c. slow respiratory rate. d. frequent respiratory infections.

ANS: B Normal aging results in the progressive loss of elastic recoil of the lung parenchyma and conducting airways as well as reduced elastic recoil of the lung and the opposing forces of the chest wall. The lung becomes less elastic as collagenic substances surrounding the alveoli and alveolar ducts stiffen and form cross-linkages that interfere with the elastic properties of the lungs. Any and all of these structural changes make it more difficult for the older person to ventilate. DIF: Remembering (Knowledge) REF: Page 422 OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Health Promotion

9. An 80-year-old patient is concerned about contracting pneumonia. The nurse educates her that the key to prevention is: a. early recognition of the symptoms. b. being vaccinated per government guidelines c. minimizing contact with the public during the winter months. d. supplementing one's daily diet with various vitamin C sources.

ANS: B The key to pneumonia prevention is being appropriately vaccinated. All individuals should be vaccinated at age 65 unless they have conditions that lead them to earlier vaccination. Revaccination is indicated in certain circumstances. Signs and symptoms are subtle in the aging population. Minimizing contact during winter months is an appropriate suggestion, just not the best one. Vitamin C may have immune system benefits. DIF: Remembering (Knowledge) REF: Page 446 OBJ: 22-3 TOP: Teaching-Learning MSC: Health Promotion

13. An older adult with chronic obstructive pulmonary disease (COPD) asks why he should quit smoking now. What response by the nurse is best? a. "It will keep your disease from getting worse." b. "There are many benefits to quitting even now." c. "It will decrease the risk of getting cancer too." d. "You're right; there really isn't a reason to quit."

ANS: B There are many benefits to smoking cessation including reduction in the number of respiratory infections, improvement in the function of the mucociliary clearance of the lungs, decreased coughing and dyspnea, increased appetite, and decreased sputum production. This is a more comprehensive answer than keeping the disease from worsening and lowering the chance of getting cancer. DIF: Understanding (Comprehension) REF: Page 432 OBJ: 22-4 TOP: Teaching-Learning MSC: Health Promotion

11. The nurse is caring for an older adult who has been prescribed inhaled corticosteroids for asthma. What does the nurse teach about this medication? a. Taken just before retiring for the night b. Reserved for acute attacks only c. Used in increasing doses as needed d. How to use and rinse the inhaler

ANS: C Corticosteroids are an effective long-term control medication that can be used in increasing doses as needed for asthma and related disorders. It is given by the inhalation method, so the nurse teaches the patient how to use and maintain the inhaler. The other teaching tips are incorrect. DIF: Applying (Application) REF: N/A OBJ: 22-3 TOP: Teaching-Learning MSC: Physiologic Integrity

17. A patient has a pulmonary embolism and asks the nurse to explain the purpose of the heparin infusion. What response by the nurse is best? a. "It helps dissolve the clot in your lungs." b. "It keeps you from getting septic." c. "It prevents the clot from getting bigger." d. "It prevents clots from forming in your heart."

ANS: C Heparin keeps the clot from getting bigger and hopefully prevents further clots from forming. It does not dissolve the clot. It does not specifically target the heart. It does not prevent sepsis. DIF: Understanding (Comprehension) REF: Page 450 OBJ: 22-3 TOP: Teaching-Learning MSC: Physiologic Integrity

1. The nurse best maximizes an older adult's potential to avoid developing a postsurgical respiratory infection by: a. walking the patient to the bathroom instead of using the bedside commode. b. encouraging compliance with prescribed antibiotic therapy. c. evaluating the patient's ability to effectively cough and deep breathe. d. offering fluids every hour while the patient is awake.

ANS: C Older adults have a decrease in the number and effectiveness of cilia in the tracheobronchial tree, which results in increasing difficulty clearing secretions. The other activities also help avoid atelectasis and infection, but evaluating the patient's ability to cough and deep breathe can indicate that other treatment measures may be needed postoperatively. DIF: Remembering (Knowledge) REF: Page 423 OBJ: 22-1 TOP: Nursing Process: Assessment MSC: Physiologic Integrity

8. An older adult patient who has tuberculosis is being treated with the drugs isoniazid 300 mg daily, rifampin 600 mg daily, and pyrazinamide 1500 mg daily. The nurse stresses the importance that the patient: a. wear tinted glasses when out in the sun. b. minimize contact with children younger than 3 years old. c. avoid alcohol while on the drug therapy. d. eat and drink dairy sparingly.

ANS: C Patients should not drink alcohol while taking isoniazid. The other recommendations are incorrect. DIF: Understanding (Comprehension) REF: Page 442 OBJ: 22-5 TOP: Teaching-Learning MSC: Physiologic Integrity

12. An older patient with severe peripheral arterial disease wishes to quit smoking. The nurse provide education to this patient on which of the following? a. "Cold turkey" method b. Gradual reduction c. Nicotine patches d. Bupropion hydrochloride (Zyban)

ANS: D Older patients should be offered assistance to quit smoking. The cold turkey and gradual reduction methods may not work if the patient is a long-term smoker. The patient with peripheral arterial disease should not use nicotine in any form as it causes vasoconstriction. Zyban is an appropriate choice. DIF: Applying (Application) REF: N/A OBJ: 22-4 TOP: Teaching-Learning MSC: Health Promotion

7. An older patient admitted to the hospital with symptoms strongly suggestive of tuberculosis (TB) has a negative Mantoux test. The nurse correctly anticipates that: a. the purified protein derivative (PPD) test will be administered. b. a chest x-ray will be ordered to detect possible infiltration. c. therapy consisting of a combination of bactericidal drugs will be initiated. d. the skin test will be repeated to achieve a booster effect.

ANS: D Tuberculin skin testing in older patients is an unreliable indicator of TB because they are more likely to have false-negative results because of reduced immune system activity. If skin testing is used, it is recommended that the standard 5 tuberculin unit (TU) Mantoux test be given and then repeated to create a booster effect. The PPD is not recommended. The skin test is followed up with a chest x-ray. Drug therapy should not begin until the patient has a diagnosis. DIF: Remembering (Knowledge) REF: Page 440 OBJ: 22-5 TOP: Nursing Process: Assessment MSC: Physiologic Integrity