Chapter 31: Nursing Management- Obstructive Pulmonary Diseases

After the nurse has completed diet teaching for a client with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following client statements indicate that the teaching has been effective? a. "I will drink lots of fluids with my meals." b. "I will have ice cream as a snack every day." c. "I will exercise for 15 minutes before meals." d. "I will decrease my intake of meat or poultry."

B

Which of the following actions should be included in the plan of care for a client with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea? a. Schedule a sweat chloride test. b. Arrange for a hospice nurse visit. c. Place the client on a low-sodium diet. d. Perform chest physiotherapy every 4 hours.

D

The nurse has completed client teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the client indicates good understanding of the teaching? a. The client attaches a spacer before using the MDI. b. The client coughs vigorously after using the inhaler. c. The client floats the MDI in water to see if it is empty. d. The client activates the inhaler at the onset of expiration.

A

The nurse is caring for a client with cystic fibrosis (CF) who has blood glucose levels that are consistently 11-14 mmol/L. Which of the following nursing actions should the nurse plan to implement? a. Discuss the role of diet in blood glucose control. b. Educate the client about administration of insulin. c. Give oral hypoglycemic medications before meals. d. Evaluate the client's home use of pancreatic enzymes.

B

The nurse is evaluating the effectiveness of therapy for a client who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective? a. No wheezes are audible. b. Oxygen saturation is >92%. c. Accessory muscle use has decreased. d. Respiratory rate is 16 breaths/minute.

B

The nurse is teaching a client about continuous home oxygen use and cautions the client to take extra care to not run out of oxygen. Which of the following seasons should the nurse instruct the client has the highest rate of oxygen evaporation? a. Spring b. Summer c. Fall d. Winter

B

The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client? a. Elevated temperature b. Clubbing of the fingers c. Jugular vein distension d. Complaints of chest pain

C

The nurse has received a change-of-shift report about the following clients with chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first? a. A client with a respiratory rate of 38 b. A client with loud expiratory wheezes c. A client with jugular vein distension and peripheral edema d. A client who has a cough productive of thick, green mucus

A

Which of the following findings in a client who has received omalizumab is considered an adverse effect? a. Pain at injection site b. Flushing and dizziness c. Respiratory rate 22 breaths/minute d. Peak flow reading 75% of normal

A

After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicate that more teaching is needed? a. The client inhales slowly through the nose. b. The client tenses the neck muscles while exhaling. c. The client practises by blowing through a straw. d. The client's ratio of inhalation to exhalation is 1:3.

B

Which of the following information should the nurse include in teaching a client with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy? a. Storage of oxygen tanks will require adequate space in the home. b. Travel opportunities will be limited because of the use of oxygen. c. Oxygen flow should be increased if the client has more dyspnea. d. Oxygen use can improve the client's prognosis and quality of life.

D

The nurse in the emergency department receives arterial blood gas results for four recently admitted clients with asthma. Which of the following clients require the most rapid action by the nurse? a. 20-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 32-year-old with ABG results: pH 7.50, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 40-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 64-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

A

The nurse is assessing a young adult client in the outpatient clinic who has a new diagnosis of emphysema and does not have a history of smoking. Which of the following information should the nurse anticipate teaching the client about? a. a1-antitrypsin testing b. Use of the nicotine patch c. Continuous pulse oximetry d. Effects of leukotriene modifiers

A

The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions? a. Keep the air entrainment ports clean and unobstructed. b. Give a high enough flow rate to keep the bag from collapsing. c. Use an appropriate adaptor to ensure adequate oxygen delivery. d. Drain moisture condensation from the oxygen tubing every hour.

A

The nurse is caring for a client with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the client asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse's response? a. One drug decreases inflammation, and the other is a bronchodilator. b. It is a combination of long-acting and slow-acting bronchodilators. c. The combination of two drugs works more quickly in an acute asthma attack. d. The two drugs work together to block the effects of histamine on the bronchioles.

A

Which of the following actions should the nurse anticipate taking first when a client who is experiencing an asthma attack develops bradycardia and a decrease in wheezing? a. Assist with endotracheal intubation. b. Document changes in respiratory status. c. Encourage the client to cough and deep breathe. d. Administer IV methylprednisolone.

A

Which of the following findings by the nurse for a client with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? a. Pulse oximetry reading of 91% b. Absence of wheezes or crackles c. Decreased use of accessory muscles d. Respiratory rate of 22 breaths/minute

A

A young adult client with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which of the following responses is best for the nurse to respond initially? a. "Are you aware of the normal lifespan for clients with CF?" b. "Do you need any information to help you with the decision?" c. "You will need to have genetic counselling before making a decision." d. "Many women with CF do not have difficulty in conceiving children."

B

The following medications are prescribed by the health care provider for a client having an acute asthma attack. Which medication should the nurse administer first? a. Salmeterol 50 mcg per dry-powder inhaler (DPI) b. Salbutamol 2.5 mg per nebulizer c. Triamcinolone 2 puffs per metered-dose inhaler (MDI) d. Methylprednisolone 60 mg IV

B

The nurse is admitting a client with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the client in to improve gas exchange? a. Resting in bed with the head elevated to 45-60 degrees b. Sitting up at the bedside in a chair and leaning slightly forward c. Resting in bed in a high Fowler's position with the knees flexed d. In the Trendelenburg position with several pillows behind the head

B

The nurse is caring for a client with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first? a. Tell the client to go to the hospital emergency department. b. Instruct the client to use the prescribed albuterol. c. Ask about recent exposure to any new allergens or asthma triggers. d. Question the client about use of the prescribed inhaled corticosteroids.

B

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement to determine the appropriate oxygen flow rate? a. Minimize oxygen use to avoid oxygen dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer oxygen according to the client's level of dyspnea. d. Avoid administration of oxygen at a rate of more than 2 L/minute.

B

The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old client with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the client? a. Walk until pulse rate exceeds 130. b. Walk for a total of 20 minutes daily. c. Exercise until shortness of breath occurs. d. Limit exercise to activities of daily living (ADLs).

B

The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include? a. "Stop exercising if you start to feel short of breath." b. "Use the bronchodilator before you start to exercise." c. "Breathe in and out through the mouth while you exercise." d. "Upper body exercise should be avoided to prevent dyspnea."

B

Which of the following diagnostic tests should the nurse plan to discuss with a client who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)? a. Eosinophil count b. Spirometry c. Immunoglobin E (IgE) levels d. Radioallergosorbent test (RAST)

B

The nurse is assessing a client in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take? a. Teach the client about the use of oral corticosteroids. b. Administer a bronchodilator and recheck the peak flow. c. Instruct the client to continue to use current medications. d. Evaluate whether the peak flow meter is being used correctly.

C

The nurse is caring for a client with a history of asthma. Which of the following assessments finding should the nurse communicate immediately to the health care provider? a. Pulse oximetry reading of 91% b. Respiratory rate of 26 breaths/minute c. Use of accessory muscles in breathing d. Peak expiratory flow rate of 240 mL/minute

C

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which of the following nursing actions is best? a. Change the oxygen flow rate to the highest prescribed rate. b. Reinforce the ongoing use of pursed lip breathing techniques. c. Educate the client to use the Flutter airway clearance device. d. Teach the client about consistent use of inhaled corticosteroids.

C

The nurse is conducting an admission history for a client with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy? a. The client has a history of pneumonia 2 years ago. b. The client has chronic inflammatory bowel disease. c. The client takes propranolol for hypertension. d. The client uses acetaminophen for headaches.

C

Which of the following actions by a client who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use? a. The client records an average of three peak flow readings every day. b. The client inhales rapidly through the peak flow meter mouthpiece. c. The client uses the albuterol metered-dose inhaler (MDI) for peak flows in the yellow zone. d. The client calls the health care provider when the peak flow is in the green zone.

C

Which of the following information should the nurse teach a client with COPD? a. To exercise immediately before a meal. b. To eat a high-calorie, low-protein diet. c. To have 5 or 6 small meals a day. d. Avoid foods that are cooked in a microwave.

C

Which of the following topics should the nurse include in medication teaching for a client with newly diagnosed persistent asthma? a. Use of long-acting b-adrenergic medications b. Adverse effects of sustained-release theophylline c. Self-administration of inhaled corticosteroids d. Complications associated with oxygen therapy

C

The nurse is caring for a client in the emergency department who is experiencing an acute asthma attack. After listening to the client's breath sounds, which of the following actions should the nurse take next? a. Start an intravenous with Ringer's Lactate. b. Ask about inhaled corticosteroid use. c. Determine when the dyspnea started. d. Obtain the forced expiratory volume (FEV) flow rate.

D

The nurse is caring for a client who is hospitalized with cystic fibrosis (CF) and is coughing up large quantities of thick green mucus. Which of the following treatments should the nurse include in the teaching plan? a. Antibiotic resistance b. Inhaled bronchodilators c. Oral corticosteroid therapy d. Aerosolized amoxicillin

D

The nurse is caring for a client with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the client. c. Suggest the use of over-the-counter sedative medications. d. Teach the client how to effectively use pursed lip breathing.

D

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem? a. Increase the client's intake of fruits and fruit juices. b. Have the client exercise for 10 minutes before meals. c. Assist the client in choosing foods with a lot of texture. d. Offer high calorie snacks between meals and at bedtime.

D

The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, which of the following nursing diagnoses is best? a. Hopelessness related to chronic stress (expectation of death) b. Ineffective coping related to insufficient sense of control c. Deficient knowledge related insufficient information (education about COPD) d. Social isolation related to insufficient personal resources (increased physical dependence)

D

The nurse is interviewing a client with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis? a. The client tells the nurse about a family history of bronchitis. b. The client's history indicates a 40 pack-year cigarette history. c. The client denies having any respiratory problems until the last 6 months. d. The client complains about a productive cough every winter for 3 months.

D

The nurse is preparing a client with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan? a. Avoid eating or drinking for several hours before the testing. b. Use rescue medications immediately before the tests are done. c. Take oral corticosteroids at least 2 hours before the examination. d. Withhold bronchodilators for 6-12 hours before the examination.

D

Which of the following information about a newly admitted client with chronic obstructive pulmonary disease (COPD) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline? a. The client has had a recent 10-pound weight gain. b. The client has a cough productive of green mucus. c. The client denies any shortness of breath at present. d. The client takes cimetidine 150 mg daily.

D

Which of the following information given by a client with asthma while the nurse is doing the admission assessment is most indicative of a need for a change in therapy? a. The client uses terbutaline before any aerobic exercise. b. The client says that the asthma symptoms are worse every spring. c. The client's heart rate increases after using the salbutamol inhaler. d. The client's only medications are formoterol and salmeterol.

D

Which of the following information should the nurse include when teaching the client with asthma about the prescribed medications? a. Utilize the inhaled corticosteroid when shortness of breath occurs. b. Inhale slowly and deeply when using the dry-powder inhaler (DPI). c. Hold your breath for 5 seconds after using the bronchodilator inhaler. d. Tremors are an expected adverse effect of rapidly acting bronchodilators.

D