Med-Surg Chapter 28

The nurse is caring for a five-year-old child with low body weight and poor growth. The parent reports that the child is unable to digest fat- and protein-rich foods. The nurse suspects that the child has what condition?

A child with low body weight, poor growth, and malabsorption of fat and protein may have pancreatic insufficiency, which can lead to atrophy and cyst formation. This may result in pancreatic dysfunction, which would affect synthesis of enzymes such as lipase, amylase, and protease, which help digest fats and proteins. Ultimately, this affects the growth and weight of the child. Liver cirrhosis occurs due to mucus deposition in the liver. Chronic bronchiolitis occurs due to mucus accumulation in the small airway. Cystic fibrosis-related diabetes mellitus (CFRD) occurs due to destruction of islet cells in the pancreas.

The nurse is caring for the patient with chronic obstructive pulmonary disease who is undernourished and underweight. Which steps can the nurse take to improve the patient's nutritional status? Select all that apply.

A diet high in calories and protein, moderate in carbohydrates, and moderate to high in fat is recommended and can be divided into five or six small meals a day. High-protein, high-calorie nutritional supplements can be offered between meals. Nonprotein calories should be divided evenly between fat and carbohydrate, but avoid overfeeding the patient. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. Fluids should be taken between meals (rather than with them) to prevent excess stomach distention and to decrease pressure on the diaphragm.

A patient has had chronic obstructive pulmonary disease (COPD) for three months. Further assessment reveals that forced expiratory volume in one second (FEV1) is 65 percent. Which treatment option would be most appropriate for this patient?

A patient who has had chronic obstructive pulmonary disease for three months and who has an FEV1 of 65 percent would require treatment with long-acting bronchodilators such as albuterol or ipratropium. These drugs can be used as monotherapy, but combining them improves the effect and decreases the risk of side effects. Salmeterol monotherapy is less effective than combination therapy of albuterol and ipratropium because of its lower efficacy and higher risk for side effects. Budesonide is an inhaled corticosteroid, which should not be used as monotherapy in patients with COPD because of its side effects. Budesonide and formoterol combination is used for COPD in patients with FEV1 of less than 60 percent.

The nurse expects that what diagnosis will be made for a patient that has permanent, abnormal dilation of medium-sized bronchi, inflammation, and elastic and muscular structural destruction of the bronchial wall?

A patient who has permanent, abnormal dilation of medium-sized bronchi, inflammation, and elastic and muscular structural destruction of the bronchial wall has bronchiectasis. Cystic fibrosis (CF) is an autosomal recessive, multi-system disease, which alters transport of sodium and chloride ions in and out of epithelial cells. Cor pulmonale occurs due to an increase in vascular resistance or pulmonary hypertension. Pneumothorax is a condition where air accumulates in the plural space.

A patient with asthma is prescribed ipratropium bromide. The nurse recognizes that the patient may develop what side effect of the medication?

A patient who is taking ipratropium bromide may develop dry mouth due to inhibition of parasympathetic nervous system. Anxiety is a side effect in the patient who is taking an oral medication of a beta-adrenergic agonist. Insomnia is the common side effect of methylxanthine. Corticosteroids upon inhalation may produce local irritation, such as dry cough.

The nurse is caring for a patient who is being mechanically ventilated that has a PaCO2 of 60 mm Hg, a respiratory pH of 6.8, and a PaO2 of 60 mm Hg. Which intervention will benefit the patient?

A patient with PaCO2 of 60 mm Hg and respiratory pH of 6.8 has severe respiratory acidosis. Therefore such a patient must take sodium bicarbonate to treat extreme acidosis. Bronchodilation by a beta-agonist like albuterol is not possible in the patient with extreme acidosis. Bronchoscopy helps to relieve acute attacks by removing thick mucus plugs. Chest physiotherapy is generally not recommended for asthma because it is too stressful for breathless patients.

A patient with cystic fibrosis (CF) is hospitalized with exacerbation of symptoms, wheezing, purulent sputum, and a fasting blood glucose level of 194 mmol/L. The nurse anticipates that what medication will be prescribed?

A patient with a blood glucose level of 194 mmol/L, purulent sputum, and wheezing associated with destruction of islets of pancreas has cystic fibrosis-related hyperglycemia (CFRD). The patient with CFRD has characteristics of both type 1 and type 2 diabetes mellitus. The patient should be administered insulin. Ivacaftor is useful in the patient with a G551D mutation of CF. Dornase alfa degrades deoxyribonucleic acid (DNA) of neutrophils in the sputum of the patient with CF. Pancrelipase helps to manage pancreatic insufficiency.

A male patient experiences a cough, perfuse sweating, local hypoxia, and arteriolar vasoconstriction. The patient states, "I hope that this condition allows me to have biologic children." What is the best nursing response?

A patient with a cough, profuse sweating, local hypoxia, and arteriolar vasoconstriction has cystic fibrosis. Men with cystic fibrosis may fail to develop vas deferens in utero. Therefore the sperm remain in the testes and do not pass through the penile urethra. The nurse may suggest assisted reproductive technology to the patient. The nurse should not depend upon a case manager or the primary health care provider to teach the patient. Patients with CF have normal production of sperm in spite of having testosterone insufficiency.

What is the purpose of dornase alfa, which is often prescribed for a patient with cystic fibrosis (CF)?

A patient with a cough, purulent mucus, local hypoxia, and arteriolar vasoconstriction has cystic fibrosis (CF). Management of CF aims to relieve airway obstruction and to control infection. Dornase alfa helps to degrade deoxyribonucleic acid in the sputum, thereby increasing the airflow and reducing the number of acute pulmonary exacerbations. Beta-adrenergic agonists help to avoid bronchospasm. Pancrelipase acts as a supplement for lipase, amylase and protease to manage pancreatic insufficiency. Chest tube drainage helps to control episodes of pneumothorax.

The nurse provides information to a student nurse about antibiotic therapy for a patient with cystic fibrosis (CF) who experiences a productive cough, PaO2 of 50 mmHg, arteriolar vasoconstriction, and cor pulmonale. Which statement made by the student nurse indicates effective learning?

A patient with a cough, sputum, PaO2 of 50 mm Hg, arteriolar vasoconstriction, and cor pulmonale has CF-related infection. Most patients with CF are at a risk of lung infection. Hence a standard treatment of prolonged antibiotic therapy helps to treat exacerbations and includes chronic suppression therapy in conjunction with airway clearance. The patient must be supported with two intravenous antibiotics with different mechanisms of action. Two to four weeks of intravenous antibiotic therapy may benefit the patient with severe exacerbations. For mild disease exacerbations, oral (versus intravenous) antibiotics will be prescribed.

A patient with asthma is admitted in the emergency department with severe dyspnea and is unable to speak. The nurse finds that the patient looks drowsy and confused. Which other finding does the nurse expect?

A patient with a severe asthma exacerbation is dyspneic at rest and has difficulty speaking. The patient may be unusually drowsy and confused as the arterial blood gas levels deteriorate. Upon auscultation, the nurse would hear no wheezing sound in the patient with life-threatening asthma. Peak flow in the patient reduces to 25 percent of the personal best, due to limited airflow in airway. The patient with reduction in peak flow of air experiences bradycardia with respiratory arrest.

A patient has hyperventilation, dyspnea, nasal flaring, anxiety, and pursed-lip breathing. The nurse concludes that the patient has an ineffective breathing pattern due to alveolar hypoventilation. Which interventions should the nurse implement for this patient to promote safe and effective care? Select all that apply.

A patient with an ineffective breathing pattern has alveolar hypoventilation. The nurse must monitor the patient for respiratory muscle fatigue to determine the need for ventilation. The nurse should encourage the patient to breathe slowly and deeply and to cough, mobilizing pulmonary secretions for effective airway clearance. The nurse should elevate the head of the patient's bed and provide an overbed table to reduce respiratory efforts. Bronchodilators should be administered because they help increase the gas exchange. The nurse should provide factual information concerning diagnosis, treatment, and prognosis to a patient with anxiety-related breathlessness.

The nurse provides education to a caregiver of a patient with bloody sputum, dyspnea, fever, chills, and chest pain. Which statement made by the caregiver indicates effective learning?

A patient with bloody sputum, dyspnea, fever, chills, and chest pain has bronchiectasis. The focus of the care is to promote drainage and removal of mucus in the airway. The patient must hydrate by drinking three liters of water per day. This helps to liquefy the secretions and thereby make it easier to remove them. The patient should drink low-sodium fluids to avoid systemic fluid retention. The patient will be anorexic; it is difficult to administer high-calorie foods to this patient. Oral hygiene, such as cleaning the patient's mouth and mucus crusts, promotes oral health, prevents infection, and may help increase appetite. If bleeding is suspected, the patient must be placed in a side-lying position with the suspected bleeding side down.

Which nursing intervention will the nurse include in the teaching plan for a patient with difficulty in breathing due to low oxygen level in the blood?

A patient with chronic obstructive pulmonary disorder (COPD) has dyspnea and hypoxemia due to poor ventilation. For males, erectile dysfunction can occur with COPD, as with many chronic diseases. The nurse may suggest that the patient refrain from sexual activity after eating to prevent breathlessness during intercourse. The patient should use pursed lips to breathe slowly. It is better to plan sexual activity during the day, when the patient's breathing is best. The patient should choose a less stressful position during intercourse and avoid the missionary position.

The nurse identifies that which treatment strategy will likely be prescribed for a patient with cor pulmonale, arteriolar vasoconstriction, and a PaO2 of 50 mm Hg?

A patient with cor pulmonale, arteriolar vasoconstriction, and partial oxygen of 50 mm Hg (hypoxemia) is in respiratory failure. The patient needs supplementation of oxygen for speedy recovery. The patient with a large pneumothorax requires chest tube drainage. The patient with chronic cystic fibrosis requires lung transplantation. The patient with hemoptysis requires bronchial artery embolization.

A patient with cystic fibrosis (CF) experiences oily, irregular bowel movements and has a fat-soluble vitamin deficiency. The nurse anticipates what prescription?

A patient with cystic fibrosis (CF) who has oily, irregular bowel movements indicates steatorrhea in the patient with pancreatic insufficiency. This occurs due to malabsorption of fats and fat-soluble vitamins such as A, D, K, and E. Hence the patient should take pancrelipase before each meal. Pancrelipase helps to manage pancreatic insufficiency, because it includes pancreatic enzyme replacement for lipase, protease, and amylase. Azithromycin and tobramycin help to reduce exacerbations of CF due to Pseudomonas. Antimicrobial administration helps to control severe exacerbations of CF

A patient with dyspnea and hypoxemia has received an initial nebulized short-acting β2-adrenergic agonist (SABA) with ipratropium treatment. The patient's forced expiratory volume in one second is 60 percent, and the peak flow is less than 25 percent of personal best. The nurse anticipates that which medication will be administered?

A patient with dyspnea and hypoxemia and who is on initial treatment with ipratropium has severe asthma. Such a patient has low forced expiratory volume in one second of 60 percent and peak flow less than 25 percent of personal best. Intravenous administration of magnesium sulfate helps to resolve the patient's condition faster. Administration of epinephrine is not indicated for the treatment of asthma exacerbations. However, a subcutaneous or intramuscular injection may be used for acute treatment of anaphylaxis. Administration of theophylline is no longer recommended for asthma exacerbations. Sodium bicarbonate administration is limited to the treatment of severe metabolic or respiratory acidosis.

A patient with a forced expiratory volume of 80 percent and a three-day history of breathlessness develops nausea, vomiting, headache, tachycardia, and dysrhythmias. The nurse suspects that which medication that the patient takes is the cause of the patient's symptoms?

A patient with forced expiratory volume of 80 percent and breathlessness for three days has mild asthma. The patient may develop nausea, vomiting, headache, tachycardia, and dysrhythmias upon theophylline use. Theophylline is a methylxanthine bronchodilator with narrow therapeutic use. Therefore its use is very limited. The patient's serum concentration levels should be monitored regularly to determine that the drug is within therapeutic window. Albuterol is a short-acting beta agonist that is safe in the patient with mild asthma. Mometasone is a corticosteroid that may cause local irritation like cough and hoarseness upon inhalation. Omalizumab is a monoclonal antibody that decreases circulating free IgE levels in the patient with allergic asthma.

Which intervention by the nurse would be most appropriate for safe and effective care for a patient with expiratory airflow obstruction, ineffective cough, decreased airway humidity, and abnormal breath sounds?

A patient with ineffective cough, decreased airway humidity, and abnormal breath sounds has ineffective airway clearance. Hence the nurse must instruct the patient to inhale deeply by bending slightly forward and perform three to four huffs against an open glottis to avoid airway collapse upon exhalation. The nurse should monitor for respiratory muscle fatigue to determine the need for respiratory ventilation. The nurse should set up and administer oxygen to a patient with impaired gas exchange. Auscultating breath sounds to assess the ventilation and the presence of adventitious sounds helps obtain the breathing patterns of a patient who is on treatment.

Which cells cause inflammation in a patient with an inflamed airway and productive cough who has Pseudomonas aeruginosa infection?

A patient with inflammation of the airway, productive cough, and Pseudomonas aeruginosa infection may have cystic fibrosis. The chronic inflammation may lead to infection. Neutrophils release inflammatory mediators like interleukins, oxidants, and proteases that contribute to the progression of the disease. Mast cells, lymphocytes, and macrophages are the inflammatory cells that mediate inflammation of the airways in patients with asthma and chronic pulmonary disease

Which condition may develop if a patient with localized hypoxia and arteriolar vasoconstriction who has blebs and large cysts in the lungs is left untreated?

A patient with localized hypoxia and arteriolar vasoconstriction has lung disorder with changes in the bronchial wall. Blebs and large cysts in the lungs are severe manifestations of lung destruction. If the patient is left untreated, the patient may develop pneumothorax. Atelectasis is a complication of asthma due to hyperinflation of the lungs and increased dead space. Hemoptysis is a lung complication that occurs due to erosion of enlarged pulmonary arteries. Chronic bronchitis may be the initial stage of lung disorders.

The registered nurse is teaching a student nurse about care management in a patient with oxygen saturation less than 90 percent, dyspnea, breathlessness, and forced expiratory volume in one second (FEV1) less than 60 percent. Which statement made by the student nurse indicates effective learning?

A patient with oxygen saturation less than 90%, dyspnea, and breathlessness has chronic obstructive pulmonary disease (COPD). The nurse should advise the patient to cease smoking and to avoid exposure to irritants to maintain healthy lungs. The nurse should counsel the patient to stop smoking because it is the only way to slow the progression of COPD. The patient should avoid gas-forming foods such as cabbage, beans, and cauliflower. The nurse should advise the patient to breathe slowly while performing effective Huff coughing. The patient with COPD has to eat more high-calorie food, divided into six small meals per day

What are complications associated with pancreatic insufficiency? Select all that apply

A patient with pancreatic insufficiency may have protein and fat malabsorption. Hence the patient may be thin with frequent, bulky, foul-smelling stools (steatorrhea) and a low body mass index (BMI). Osteopenia occurs in a patient with chromosome 7 mutation's effect on development of bone. Chronic elevation of liver enzymes leads to liver cirrhosis in the patient with cystic fibrosis. Distal intestinal obstruction syndrome results from intermittent obstruction in the terminal ileum.

The nurse recognizes that which intervention will be beneficial to the patient with pleuritic chest pain, dyspnea, wheezing, and mouth bleeding?

A patient with pleuritic chest pain, dyspnea, wheezing, and bleeding may have bronchiectasis with hemoptysis. Bronchiectasis is difficult to treat. The nurse should aim to treat acute flare-ups and should try to prevent a decline in lung function. Therefore the nurse should teach the patient about the benefits of pneumococcal and influenza vaccination. The nurse should allow the patient to consume dietary liquids after clearing the mouth of dried sputum crusts. This helps to increase the appetite of the patient. The nurse should raise the head of the bed and place the patient in a side-lying position when mouth bleeding occurs, to allow expectoration and to prevent aspiration. Hydrating the respiratory system with hypertonic saline improves expectoration of secretions and is likely to be beneficial.

The nurse is teaching energy conservation techniques to a patient with severe dyspnea and oxygen saturation of 50 mm Hg. Which action of the patient indicates effective learning?

A patient with severe dyspnea and oxygen saturation of 50 mm Hg has chronic obstructive pulmonary disease (COPD). The patient must follow measures to conserve energy during daily living. Assuming a tripod posture and placing the mirror on the table to use an electric razor conserves much more energy than standing in front of a mirror to shave. The patient should try to sit as much as possible when performing activities. The patient should use the upper thoracic and neck muscles to breathe rather than the diaphragm. This will help the patient overcome difficulty performing activities using the upper limbs, and thus reduces dyspnea. The patient must exhale while pulling, pushing, or lifting and inhale while at rest.

The nurse is caring for a patient with an oxygen saturation of 45 percent of personal best who stops breathing while sleeping and has a tendency to sleep during the day. Which intervention by the nurse will help the patient most while recovering?

A patient with sleep apnea has oxygen saturation of 45 percent, stops breathing while sleeping, and has a tendency to sleep during the day. The patient with severe breathlessness and hypoxemia may need immediate medical attention and regular follow-up. Therefore the patient should be encouraged to use typed messages such as texting and instant messages to communicate. The patient should avoid exercise or walking during the attack because severe dyspnea may lead to respiratory failure. The patient should have an adequate diet to prevent weight loss. Hence, the patient should avoid consuming more fluids at mealtime. Patients with severe sleep apnea and dyspnea cannot speak in sentences because of difficulty in breathing.

A patient experiencing severe wheezing arrives in the emergency department and is diagnosed with severe exacerbation of asthma. During the admission assessment, the nurse on the inpatient unit notes that the patient continues to struggle with breathing; however, there is an absence of wheezing. How should the nurse interpret the assessment findings?

A silent chest or absence of wheezing in a patient who had been having severe wheezing indicates an impending respiratory failure. The patient may need mechanical ventilation to support respiration. It is a sign of severe obstruction and it is a life-threatening condition. It is not a sign of improvement. Oxygen therapy may not help the patient, because there is an obstruction in the airway. Chest physiotherapy helps in removing secretions from the airway, but may not be helpful in patients who are at risk of respiratory failure.

The nurse is transporting an oxygen dependent patient to the radiology department. Which mask would be most effective during transportation?

A simple face mask covers the nose and mouth of the patient and is useful in administering oxygen for very short periods, such as during transportation. A patient who has undergone tracheostomy surgery will have less difficulty breathing with a tracheostomy collar. Oxygen-conserving cannulas help to administer oxygen for long-term therapy. Partial and non-rebreather masks are useful in administering high concentrations of oxygen for short-term periods, or about 24 hours.

A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. What condition or diagnosis does the nurse recognize?

A sudden onset of coughing and wheezing are the initial and most obvious symptoms of an acute asthma attack. An asthma attack may begin mildly but progress to respiratory distress and arrest if it goes untreated. Acute bronchitis is irritation and inflammation of the mucous-membrane lining of the respiratory tract, usually caused by an infectious agent. Pulmonary edema is fluid accumulation in the lungs due to heart failure or lung injury. The fluid collection impairs gas exchange and may result in respiratory failure. Congestive heart failure, or heart failure, is a condition in which the heart cannot pump effectively. Fluid may accumulate in the lungs. Edema may develop in the lower extremities, and shortness of breath may also occur with increasing frequency and severity.

What complication does the nurse expect in a child with chronic pulmonary disease who is diagnosed with α1-antitrypsin (AAT) deficiency?

AAT deficiency is an autosomal recessive disorder associated with mutations in the SERPINA1 gene, S and Z alleles. These mutations result in abnormalities of the lungs and liver. The mutation in the SERPINA1 gene does not affect the functions of the kidneys, intestine, or urinary tract.

A patient presents with acute exacerbation of asthma. The nurse expects which strategies will be included in the treatment plan? Select all that apply.

Acute exacerbation of asthma may be life-threatening and needs immediate intervention. Administering 100% oxygen helps to relieve hypoxia and improve tissue oxygenation. Nebulization with SABA helps to relax the airways and promote airflow. Corticosteroids are administered to blunt the hyperactive immune response. Sedatives should be avoided as they may depress the respiratory center and worsen dyspnea. Antibiotics are not administered unless there are symptoms of pneumonia.

A patient is prescribed albuterol with a metered dose inhaler (MDI). After taking the cap off and shaking the inhaler, the nurse should instruct the patient to perform the steps of taking the medication in what order?

After taking the cap off the medicine and shaking the inhaler, the patient breathes out all the air from the lungs and holds the inhaler as recommended. Then, the patient should start breathing in slowly through the mouth by pressing down the inhaler. With five seconds, the patient should start breathing slowly and deeply. The patient should hold the breath for 10 seconds or more as much as possible. This should be repeated three to four times for better relief. The patient has to wait about one minute between puffs to avoid local irritation caused by the drug

The patient has a prescription for each of the inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack?

Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol is a long-acting β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone is a corticosteroid inhaler and is not recommended for an acute asthma attack. Ipratropium bromide is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists (SABAs).

The patient has a prescription to use albuterol and beclomethasone inhalers, two puffs each. The nurse determines that the patient needs additional teaching on how to safely self-administer these medications after noting that the patient performs which action?

Albuterol, a β2-adrenergic agonist medication, should be used first to dilate the airways before administration of the corticosteroid beclomethasone. Administering the beclomethasone on a set schedule to prevent an asthma attack and rinsing the mouth following use of the inhalers are correct actions.

A patient is having an asthma attack, and is short of breath and appears frightened. The nurse understands that possible triggers for asthma exacerbations include which factors? Select all that apply.

Alcohol, GERD, animal dander, perfumes, and cold weather (not humid) are all possible triggers for acute asthma exacerbations.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? Select all that apply.

Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.

The nurse is assessing a patient who is having an acute asthma attack. Which nursing intervention is the priority for this patient?

An inhaled short-acting beta2-adrenergic agonist like albuterol is the treatment of choice for providing quick relief to a patient having an acute asthma attack. Humidification is more typically used for chronic obstructive pulmonary disease treatment. Oral corticosteroids are longer-acting and may be used in the long-term management of asthma. The nurse may place the patient in high-Fowler's position, but administering albuterol comes first.

The patient is receiving 3 L of oxygen (O2) via nasal cannula. Which action by the nurse is most appropriate? Select all that apply.

Assessing the bubble-through humidifier if humidity is used, assuring that the patient is wearing the nasal cannula correctly, and adjusting humidification according to patient comfort are correct because oxygen (O2) obtained from cylinders or wall systems is dry. Dry O2 has an irritating effect on mucous membranes and dries secretions. A common device used for humidification when the patient has a cannula or a mask is a bubble-through humidifier. It is important for the nurse to assess the bubble-through humidifier if humidity is used to make sure the humidification is on. This adds to the comfort of the patient. The nurse assesses the patient to make sure the nasal cannula is worn correctly for optimal effect. The cannula can become easily dislodged. Humidification is adjusted according to the patient's comfort level. When oxygen levels are 1 to 4 L, the use of humidification may not be the preference of all patients. Believing that humidification is never needed is incorrect because the use of humidification is a patient preference. The nurse should assess the patient's nose for dryness, not the eyes.

The nurse finds that a patient is experiencing breathlessness, chest tightness, and a cough after climbing stairs. What is the most likely reason for these symptoms?

Asthma that is induced or exacerbated during physical exertion is called exercise-induced asthma (EIA). Typically, EIA occurs after vigorous exercise, not during it. Airway obstruction may occur due to changes in the airway mucosa caused by hyperventilation during exercise, with either cooling or rewarming of air and capillary leakage in the airway wall. Edema of airway walls occurs during respiratory tract infections. A change in responsiveness of the airway occurs on exposure to irritants, as seen with occupational asthma. Patients who are genetically predisposed to develop an allergic (immunoglobulin E-mediated) response have an increased risk of allergic asthma, but it would not cause an exacerbation after climbing stairs.

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every six hours. What should the nurse explain as the best way to prevent oral infection while taking this medication?

Because beclomethasone is a corticosteroid, the patient should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection. The mouth should be rinsed after the second puff, not before each puff. Hard candy or breath mints will not prevent oral infection.

The nurse observes that a patient with cystic fibrosis (CF) has a body temperature of 102° F, shortness of breath, sore throat, and purulent mucous. The nurse expects what other assessment finding?

Because of the CF, the presence of bullae and blebs in the lungs can also be observed. The symptoms the patient is experiencing, specifically a body temperature of 102° F, shortness of breath, sore throat, and purulent mucus, are indicative of a chronic lung infection. The patient with advanced lung disease (versus a lung infection) has digital clubbing. A patient with bloody sputum and dyspnea, fever, chills, and chest pain is experiencing bronchiectasis. A patient with an accumulation of mucus in the liver experiences chronic elevation of liver enzymes, which leads to cirrhosis.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient?

Because the patient with COPD needs to use greater energy to breathe, there often is decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat six small meals per day, taking in a high-calorie, high-protein diet, with non-protein calories divided evenly between fat and carbohydrate. Prescribing fruits and fruit juices, teaching the patient to use frozen meals at home, and providing a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet will not increase the patient's caloric intake.

A patient experiences exacerbations of wheezing and breathlessness when exercising in the early morning. The nurse learns that patient has a three-year history of sinusitis. What is appropriate to be included on the patient's plan of care?

Both acute and chronic sinusitis make asthma worse, causing severe inflammation of the mucous membranes. Such patients should undergo removal of large nasal polyps to help control exacerbations of asthma. Beta-antagonists promote bronchoconstriction, leading to further airway obstruction and breathlessness in the patient. The nurse should advise the patient to avoid exercise when the air is cool and dry to prevent exacerbations. Intravenous corticosteroids are as effective as inhaled corticosteroids. However, the patient may experience exacerbations upon administration of corticosteroids intravenously. This intervention may increase fluid accumulation in the sinuses, further leading to pain.

The nurse anticipates that which treatment therapy will be prescribed for a patient with massive hemoptysis?

Bronchial artery embolization helps treat the patient with massive hemoptysis. Chest tube drainage helps the patient with pneumothorax. The patient with cor pulmonale or hypoxemia may require home oxygen therapy. Sclerosing of the pleural space benefits the patient with pneumothorax.

The nurse is preparing a patient for a procedure with the thoracoscope to reduce the exacerbations of chronic obstructive pulmonary disease (COPD). What procedure should the nurse be sure the patient understands?

Bullectomy is a surgical procedure to reduce the exacerbations of COPD. The patient with COPD may have large bullae, which are resected through a thoracoscope. Airway bypass is a bronchoscopic procedure that helps to treat COPD by creating extra anatomic openings between the diseased lung and bronchi; however, this procedure does not require a thoracoscope. Lung transplantation is effective treatment for the patients with advanced COPD; however, this procedure is not associated with the use of a thoracoscope. Lung volume reduction surgery is a surgical procedure to reduce the size of the lung by removing diseased tissue. It requires a bronchoscope, not a thoracoscope.

A patient with chronic obstructive pulmonary disease (COPD) is experiencing anxiety. What medication as ordered should the nurse administer to this patient?

Buspirone is an anxiolytic psychotropic drug that helps to reduce anxiety in the patient during COPD treatment. Tiotropium and indacaterol are long-acting anticholinergic drugs, which help to treat COPD by reducing inflammation. Indacaterol inhalation is used to control wheezing, shortness of breath, coughing, and chest tightness caused by COPD. Roflumilast is an antiinflammatory agent, which helps to treat the exacerbations of COPD but does not treat anxiety.

What is an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands?

CF is an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands. This defect primarily affects the lungs, pancreas and biliary tract, and sweat glands. Sweat glands excrete increased amounts of sodium and chloride. While sickle-cell disease, Tay-Sachs disease, and spinal muscular atrophy are all autosomal recessive, multisystem diseases; they are not characterized by altered function of the exocrine glands.

The nurse is caring for the patient with chronic obstructive pulmonary disease (COPD). The nurse will include in the patient plan of care:

COPD patients should rest for at least 30 minutes before eating to decrease dyspnea and conserve energy. Encouraging the patient to perform mild exercises 60 minutes before eating, telling the patient to avoid taking bronchodilators before meals, and teaching the patient to discontinue oxygen while eating are incorrect because patients should be encouraged to rest before eating to conserve energy and decrease dyspnea, and the exercises before meals would do the exact opposite. It is okay for the patient to use a bronchodilator before meals if prescribed, because it will decrease dyspnea and conserve energy. If a patient has O2 therapy prescribed, use of supplemental O2 by nasal cannula while eating may be beneficial, because this will decrease dyspnea and conserve energy.

A patient in the outpatient clinic has symptoms including chronic cough, sputum production, and dyspnea. On taking a detailed history of the patient, the nurse finds that this patient has a prolonged exposure to smoke. Which condition would the nurse most likely suspect the patient to have?

COPD symptoms include cough, sputum production, and dyspnea. In addition, this patient has a history of exposure to allergens such as smoke. Tuberculosis is a bacterial infection with a low-grade fever and weight loss. Dyspnea is a late symptom of tuberculosis. Pneumonia is an infection with a cough, dyspnea, fever, chills, and pleuritic chest pain. Influenza is a viral infection with sneezing, watery eyes and nose, and fever.

A patient with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy through a mask. Which nursing actions should the nurse perform to ensure proper care of the patient? Select all that apply.

Choosing the optimal oxygen device, assessing the need for adjustment in oxygen flow rate, and monitoring signs of adverse effects of oxygen therapy are all duties that the nurse should perform when evaluating the response of the patient to oxygen therapy. Taking a chest radiograph and assessing the need to change intravenous fluids are not relevant to this situation.

The nurse is caring for a patient with chronic obstructive pulmonary disease. About what medications will the nurse educate the patient that have the side effects of a feeling of early satiety and a bloating sensation? Select all that apply

Chronic cough, dyspnea, and chronic inflammation in lung parenchyma indicate that the patient has chronic obstructive pulmonary disease ( COPD). Theophylline is a methylxanthine drug that relaxes smooth muscles and helps to treat COPD effectively, but it causes gastrointestinal side effects. Corticosteroids help to control swelling in the lungs, although they can also cause abdominal distension, so the patient may experience bloating and feelings of satiety. Diuretics are helpful for treating cor pulmonale, a complication associated with COPD, but they are not associated with feelings of satiety or bloating. Roflumilast is an antiinflammatory medication that helps to reduce inflammation in the lungs but does not cause a bloating sensation or a feeling of satiety. Bronchodilators are not associated with feelings of satiety or bloating.

The nurse is educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes despite the diagnosis. What complication of smoking should the nurse discuss with the patient?

Chronic smokers develop COPD and are more prone to cardiac complications, because smoking directly affects the function of the lungs and heart. The patient with COPD may experience a loss of appetite due to dyspnea, which may lead to the development of cachexia. Osteoporosis is a complication of COPD that is associated with continuous systemic inflammation. Dyspnea and a loss of appetite are associated with COPD and may manifest as a metabolic syndrome. Cachexia, osteoporosis, and metabolic syndrome are not associated with smoking.

Which corticosteroid can be administered directly through inhalation?

Ciclesonide has reduced local side effects like oropharyngeal candidiasis, hoarseness, and dry cough because it activates the lungs and is administered directly through inhalation. Drugs such as fluticasone, budesonide, and mometasone cause local irritation as they are activated in the pharynx. Therefore these medications require a spacer for delivery into the lungs.

The nurse is assessing a patient who may have manifestations of chronic obstructive pulmonary disease (COPD). Which of these is a clinical manifestation of early COPD?

Clinical manifestations of COPD typically develop slowly. A chronic intermittent cough, which is often the first symptom to develop, later may be present every day as the disease progresses. Typically, dyspnea is progressive, usually occurs with exertion, and is present every day. Dyspnea at rest and chest breathing are manifestations of late COPD. The cough may be unproductive of mucus.

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?

Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

A patient experiencing an acute asthma exacerbation has received a bronchodilator and supplemental oxygen. Which treatment should the nurse anticipate if the patient's condition remains unchanged?

Corticosteroids are antiinflammatories that are effective in treating respiratory distress caused by bronchoconstriction. The patient would be given this medication as an IV push medication. Chest x-ray is not a treatment of an asthma exacerbation. IV antibiotics are not indicated in the absence of infection. Peak flow measurements can measure airflow, but will not improve the patient's condition.

The nurse caring for a patient with diabetes mellitus and chronic obstructive pulmonary disease (COPD) on oral prednisone will monitor which parameter regularly?

Corticosteroids such as prednisone can lead to elevated blood sugar, especially for patients with diabetes. For this reason, it is useful to monitor the patient's blood sugar. The patient's blood pressure and bowel sounds will not be affected. The hemoglobin A1c will demonstrate average blood sugars over the past three months, which would not evaluate blood sugar since beginning prednisone

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters?

Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.

A child with a nonproductive cough states, "I am having trouble breathing." What action should the nurse take to reduce the severity of breathlessness in the child?

Cough may be the only symptom in patients with cough-variant asthma. The nurse should instruct the child with asthma to sit upright or slightly bent forward, because these positions would help the child to use accessory muscles for respiration. The child should not lie in a supine position, which may increase bronchial tone and cause irritation with stimulation of cough receptors. The child must not walk for half an hour, because it may trigger the symptoms. The nurse should instruct the child to take deep breaths.

Which change occurs during cystic fibrosis?

Cystic fibrosis (CF) affects both the upper and lower respiratory tracts. It affects the small airway first and progresses to the larger airways, finally passing into the lungs, causing hyperinflation of the lungs due to obstruction of the bronchioles by thick mucus that traps the air. The mucous dehydrates and becomes thick due to decreased ciliary movement. One of the first signs is a strong salty taste to the skin. This is the result of higher levels of salt present in the sweat. Parents of children with cystic fibrosis have mentioned tasting this saltiness when kissing their children. A hallmark of CF in children is poor weight gain and growth. These children are unable to get enough nutrients from their food because of the lack of enzymes to help absorb fats and proteins

A patient who has a family history of α1-protease inhibitor deficiency reports fever of unknown cause, malaise, and cough associated with purulent sputum. Which test should the patient undergo regularly to assess the severity of the condition?

Deficiency of α1-antitrypsin (AAT) is an autosomal recessive disorder that affects the lungs or liver. AAT deficiency is a genetic risk factor for chronic obstructive pulmonary disease (COPD). The patient with a family history of α1-protease inhibitor deficiency should consult a pulmonologist about regular spirometry screening. This helps the patient get appropriate genetic counseling. Liver enzyme tests, renal hormone tests, and computer tomography may not provide complete relevant information to counsel the patient.

The nurse is educating a patient regarding breathing techniques. What technique should the nurse avoid in a patient with chronic obstructive pulmonary disease (COPD) who has marked hyperinflation?

Diaphragmatic breathing is a technique in which the patient breathes with the diaphragm but does not use accessory muscles. The use of the diaphragm increases the work of breathing, so the patient with COPD may have difficulty in breathing. Yoga involves slow, deep breathing. It is helpful for the patient with COPD to perform yoga. Huff coughing is an effective coughing technique that helps to clear sputum from the airways. Pursed-lip breathing is a prolonged exhalation breathing exercise in which the patient exhales for a prolonged time.

The nurse is assessing a patient with asthma who has been diagnosed with a severe and life-threatening exacerbation. What findings would the nurse find?

Early in exacerbation the CO2 level is decreased, but increases if exacerbation is prolonged or severe. With an asthma exacerbation, patients are unable to speak in sentences and only speak a few words at a time before taking a breath. The pH level on an ABG decreases as the episode is prolonged, but is increased early in the exacerbation. With a life-threatening asthma attack, PEFR is 40% of the patient's personal best.

The nurse is educating the patient on oxygen use for the home. The patient asks the nurse "Does this mean that I will not be able to go anywhere?" The most appropriate response by the nurse is:

Encourage the patient who uses home O2 to continue normal activity and to travel normally; this helps the patient maintain quality of life. Explaining the need to minimize activity in the home to conserve oxygen use, pointing out that distance traveling may not be possible because oxygen tanks are so small, and pointing out that most travel companies do not accommodate travelers with oxygen are incorrect because minimizing activity in the home most likely would decrease the patient's mobility and lead to other health conditions. If travel is by automobile, arrangements can be made for O2 to be available at the destination point. O2 supply companies often can assist in these arrangements. If a patient wishes to travel by bus, train, or airplane, the patient should inform the appropriate people when reservations are made that O2 will be needed for travel.

A patient with asthma experiences anaphylaxis. Which medication should the nurse prepare to administer?

Epinephrine helps to resolve anaphylactic reactions in the patient with asthma. Administer epinephrine either subcutaneously or intramuscularly to treat the patient. The nurse should monitor the blood pressure and electrocardiogram of the patient closely after administration of the drug. Timolol is a beta-blocker that may trigger the symptoms of asthma in the patient. Magnesium sulfate helps to treat the patient with severe or life threatening asthma. Sodium bicarbonate helps to treat severe metabolic or respiratory acidosis.

On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than four times a week. The patient's forced expiratory volume in the first second of expiration (FEV1) is less than 60%, and normal activity is very limited. Which treatment option should the nurse consider appropriate?

Experiencing symptoms of asthma throughout the day and also experiencing nighttime awakenings more than four times a week is suggestive of poorly controlled asthma. This patient also has an FEV1 less than 60%; normal activity being very limited correlates with that. Treatment with oral corticosteroids should be considered. Advice for maintaining control of asthma symptoms and following up after a month can be given in case of well controlled asthma. Reevaluation in two to six weeks is suggested if the asthma is not well controlled or if the patient experiences symptoms more than two times a month

A patient with chronic obstructive pulmonary disease (COPD) needs to be taught about effective huff coughing in a stepwise manner. In which order should the nurse put the steps for teaching the patient?

For effective huff coughing, the patient should assume a sitting position with his head slightly flexed, shoulders relaxed, knees flexed, forearms supported by a pillow, and, if possible, feet on the floor. Then the patient should inhale slowly through the mouth while breathing deeply from the diaphragm; the patient should hold the breath for two to three seconds. The patient should forcefully exhale quickly, as if fogging up a mirror with his breath to create a "huff," which moves the secretions to larger airways.

A patient with asthma is prescribed formoterol. What should the nurse include in the medication education provided to the patient? Select all that apply

Formoterol is a long-acting β2-adrenergic agonist (LABA) and is effective in treating symptoms of asthma that persist at night. Formoterol is not helpful to treat wheezing that gets worse, because short-acting beta blockers may be more beneficial. Side effects include cold or flu-like symptoms. LABAs should never be used as monotherapy for asthma, and they should only be used if the patient is taking inhaled corticosteroids. Short-acting beta blockers help the patient to obtain quick relief from bronchospasm. The patient must take the drug every 12 hours. The nurse should instruct the patient not to overuse formoterol, because there are other options also available.

To teach effective huff coughing to a patient with chronic obstructive pulmonary disease (COPD), the nurse should instruct the patient to perform which action?

Huff coughing is completed through forceful exhalations to rid the lungs of mucus once it is felt in the bronchi. The patient using upright, abdominal splinting is not indicated, and the patient should not hold the breath before coughing.

The nurse would monitor which comorbidity in the patient treated for an asthma exacerbation with methylprednisolone?

Hyperglycemia or increased blood glucose level is an adverse effect of methylprednisolone, so the patient with diabetes mellitus should be monitored for elevations in blood sugar. Methylprednisolone will not affect elevated cholesterol, hypothyroidism, or Raynaud's phenomenon

A nurse is caring for a patient diagnosed with chronic obstructive pulmonary disease (COPD). The lab reports of the patient reveal a hemoglobin level of 20 g/dL. What could be the reason for the increased hemoglobin?

In COPD, there is chronic hypoxia. To compensate for it, the production of RBC increases, leading to polycythemia or increased hemoglobin levels. The patient cannot have a hemoglobin level of 20 g/dL by eating iron-rich food. Patients with COPD usually have compromised heart function. The patient does have COPD and polycythemia is a defense response of the body against hypoxemia.

The nurse is assessing the respiratory system of an 87-year-old patient admitted with emphysema. Which assessment findings does the nurse expect? Select all that apply.

In patients with emphysema, the nurse would hear decreased breath sounds, barrel chest, and wheezes. Crackles would indicate fluid not consistent with emphysema and increased tactile fremitus, and dullness would indicate a consolidation of fluid or tissue in the lungs.

A patient with late-stage chronic obstructive pulmonary disease (COPD) presented to the emergency room with increasing dyspnea. Lab results indicate a pH of 7.36, a PaCO2 of 47 mm Hg, and a HCO3 of 25 mEq/L. The patient asks the nurse what these lab results mean. What does the nurse know this lab data indicates?

In the patient with late-stage COPD, a low-normal pH, a high-normal or above normal PaCO2, and a high-normal HCO3 indicate compensated respiratory acidosis. This occurs when CO2 is chronically retained and the kidneys compensate to increase the pH to normal range. Severe hypoxemia and respiratory failure can both be related to COPD, however these lab results in the late stage of COPD indicate compensated respiratory acidosis. The pH is high-normal (normal range 7.35-7.45), the PaCO2 is above normal (normal range 35-45 mm Hg), the HCO3 is high normal (normal range 22-26 mEq/L); thus the lab values are not all within the normal range.

The nurse recalls that the steps that lead to airway remodeling occur in what order?

Inhaling animal dander triggers the inflammatory cascade in the patient. As the inflammatory process begins, the degranulation of mast cells takes place, leading to the release of inflammatory mediators. Then, inflammatory cells such as macrophages, eosinophils, and neutrophils infiltrate the airway to produce an inflammatory process. This results in neuropeptide release, with autonomic nervous system side effects that ultimately result in airway remodeling.

Which measure should a patient with chronic obstructive pulmonary disorder (COPD) take when performing physical activity?

It is essential to involve the patient with chronic obstructive pulmonary disease (COPD) in physical activity for 20 minutes three times a week. The patient should remember to think about steps and breathing, which will help decrease anxiety and also slow the pace. The patient must walk slowly with pursed lips to breathe. The patient should exhale while pushing and inhale while at rest. The patient should wait for 5 minutes to relax and regain a normal breathing rate before administration of a beta agonist after exercise.

A patient presents to the emergency department with acute exacerbation of asthma. What actions should the nurse perform to monitor the patient's respiratory and cardiovascular systems? Select all that apply.

It is essential to monitor respiratory and cardiovascular systems in case of acute exacerbation of asthma. Auscultating lung sounds, measuring blood pressure and respiratory rate, and monitoring ABGs and pulse oximetry are required to monitor these systems. Chest radiographs are seldom useful in the management of an acute asthma attack. Checking the temperature may not contribute to monitoring respiratory and cardiovascular systems.

The nurse is educating a patient who was recently diagnosed with asthma about the use of a peak flow meter. Which statement is the nurse's priority?

It is important that the patient identify his or her personal best readings to evaluate when the symptoms are evolving into a medical emergency. The peak flow meter does not reduce asthma attacks; it helps monitor symptoms of asthma. It should be used at least twice a day for the first two weeks to determine the patient's personal best, which will be used to monitor airway constriction. The peak flow meter is used after the use of an inhaler, not before, to measure the effectiveness of the medication.

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do?

It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the health care provider based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter, and should be assessed before and after medications to evaluate their effectiveness.

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change?

Narrowing of the airway by persistent but variable inflammation leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Laryngospasm, pulmonary edema, and overdistention of the alveoli do not produce wheezing.

Which test result identifies that a patient with asthma is responding to treatment?

Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the asthma patient.

The nurse is caring for the patient with cystic fibrosis (CF). Which is the most important factor for the nurse to consider?

Of the CF patients in the Cystic Fibrosis Patient Registry, more than 47% are 18 years of age or older. The median predicted survival was 16 years in 1970, but has increased to more than 38 years. With early diagnosis and improvements in therapy, the prognosis of patients with CF has improved significantly. Nurses who work in adult care settings increasingly manage patients with CF. The severity and progression of the disease varies and the first signs and symptoms typically occur in children. However, some patients are not diagnosed until they are adults; some live to over 80 years old.

A patient with allergic asthma has been prescribed omalizumab. The patient requests that the medication be administered at home for convenience. Which nursing action is appropriate in this case?

Omalizumab is a monoclonal antibody to IgE that decreases circulating free IgE levels. The drug prevents IgE from attaching to mast cells, preventing the release of chemical mediators that may exacerbate asthma. The medication can cause anaphylactic reaction and should be administered at a clinic that is well-equipped to handle emergencies. The nurse should not encourage self-administration of the medication at home, because the anaphylactic reaction can be life-threatening. The nurse may not be well equipped to handle emergencies at home, so the medication should not be administered during a home visit. A family member should not be asked to administer the medication for the same reason.

When teaching a patient with chronic obstructive pulmonary disease (COPD) about using pursed-lip breathing (PLB), what is the most important instruction?

PLB should be used before, during, and after activities that cause shortness of breath. The correct way of doing PLB is to exhale by relaxing the facial muscles without puffing the cheeks and to inhale slowly through the nose. Exhalation should be made three times longer than inhalation. During PLB, inhalation should be done slowly and deeply through the nose.

Pulmonary rehabilitation (PR) is an evidence-based intervention that includes many disciplines working together to individualize treatment of the symptomatic chronic obstructive pulmonary disease (COPD) patient. What is PR designed to do? Select all that apply.

PR is an evidence-based intervention that includes many disciplines working together to individualize treatment of the symptomatic COPD patient. PR is designed to reduce symptoms and improve quality of life. PR is an effective intervention to improve exercise capacity and decrease hospitalizations, anxiety, and depression. An energy-saving tip is to exhale when pushing, pulling, or exerting effort during an activity and inhale during rest. PR should no longer be viewed as a "last ditch" effort for patients with severe COPD.

The nurse is overseeing an exercise program for patients with mild chronic obstructive pulmonary disease (COPD). Part of the program involves walking. Vital signs are taken after walking. The nurse becomes concerned when a 60-year-old patient's pulse rate is what?

Parameters that may be monitored in the patient with mild COPD are resting pulse and pulse rate after walking. Pulse rate after walking should not exceed 75% to 80% of the maximum heart rate (maximum heart rate is age in years subtracted from 220). 220 - age (60) = 160 (maximum heart rate). 120 is 75% of the patient's maximum heart rate.

The nurse is evaluating an asthmatic patient's knowledge of self-care. Which statement by the patient indicates an adequate understanding of the instructions given?

Part of a rescue plan for asthma patients is to have access to a short-acting bronchodilator, such as albuterol, to use for rapid control of symptoms. Asthma patients should get a flu shot annually, and the self-monitoring of one's "Personal Best" with a peak flow meter should be done at least daily as part of an asthma action plan. Corticosteroids cannot abort an asthma attack.

When teaching a patient with asthma about ways to reduce the severity of asthma and asthma attacks, which measures should be included? Select all that apply.

Patients with asthma should be taught to avoid food irritants and animals with fur. Identifying personal triggers can help to avoid them. Going out in the cold air and the use of NSAIDs are not recommended, because they can precipitate an asthma attack.

Which intervention is beneficial to a patient with chronic obstructive pulmonary disease (COPD)?

Patients with chronic obstructive pulmonary disease (COPD) should limit fluid intake during mealtimes because too much liquid might make the patient feel too full to eat. COPD patients should eat cold foods rather than hot foots in order to feel less full. COPD patients should eat frequent meals and snacks because it helps the diaphragm move freely and makes gas exchange in the lungs easier. Performing physical activity before meals may increase breathlessness and may affect food intake.

A patient with an acute attack of asthma is in a state of panic. Which nursing measures help to relieve the panic? Select all that apply.

Pursed-lip breathing keeps the airways open, slows down the respiratory rate, and encourages deep breathing. "Talking down" is a technique that helps to calm the patient. A calm, quiet, and reassuring nurse helps to pacify the patient. Use of sedatives should not be encouraged, because they may cause respiratory depression. There is no technique called "walking down."

A patient with chronic obstructive pulmonary disease (COPD) experiences dyspnea and has a forced expiratory volume (FEV1) of 70% of predicted value. The nurse expects that what will be included on the patient's treatment plan?

Since the patient has FEV1 of 70% and is suffering from mild COPD, the patient may benefit from the use of short-acting bronchodilators. Budesonide, being a steroid, is not used for treating mild COPD. Use of theophylline in COPD is controversial and should be used only in patients who do not respond to other drugs. A combination of fluticasone and salmeterol is not required for treating mild COPD; this medication is prescribed to patients who have a FEV1 of less than 60%.

A patient experiences chronic sinusitis. The nurse recognizes that which treatment strategy may help relieve the patient's symptoms caused by impaired ciliary movement in the airway?

Sinusitis is a painful inflammation of the sinuses due to mucus plugging the nasal passages. A patient with sinusitis has impaired ciliary movement due to airway obstruction by the mucus. An airway clearance technique through postural drainage by percussion and vibration or frequent chest wall oscillation helps to relieve symptoms of sinusitis. Dornase alfa helps to degrade deoxyribonucleic acid of neutrophils in cystic fibrosis sputum. β2-adrenergic agonists help with bronchodilation. Huff's coughing method helps to relieve symptoms for the patient with other airway obstructive disorders.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β2-adrenergic agonists bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment?

Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β2-adrenergic agonists bronchodilator is insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.

An asthmatic patient was prescribed theophylline. A nurse understands that the patient is at risk for tachycardia and seizures. In regard to safety, the nurse expects that what will be included on the patient's treatment plan?

Tachycardia and seizures are known toxic effects of theophylline at higher blood levels. In addition, the drug has a narrow margin of safety. Therefore monitoring blood levels of theophylline helps to reduce such toxic effects. Caffeine increases the toxic effects of theophylline. Monitoring plasma levels of adrenaline may not help, because tachycardia is not associated with adrenaline in this case. Prophylactic use of diazepam may not prevent seizures that are caused by the use of theophylline.

The nurse determines that a patient is experiencing the most common adverse effect of albuterol after noting which sign?

Tachycardia is a common adverse effect of the use of inhaled β2-adrenergic agonists because of its stimulant effect. Headache, diarrhea, and oral candidiasis are not associated adverse effects of albuterol.

A patient is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) and requires supplemental oxygen. To deliver the precise amount of oxygen, the nurse should use which type of equipment?

The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. A non-rebreather and simple face mask are less precise in terms of the amount of oxygen delivered. The laryngeal mask airway is an invasive airway used for surgical procedures or emergency situations.

A patient needs to receive oxygen at a 28% concentration. The nurse will set up which oxygen delivery device?

The Venturi mask is a high-flow device that delivers fixed concentrations of oxygen (e.g., 24%, 28%), independent of the patient's respiratory pattern. Nasal cannulas, simple face masks, and non-rebreather masks are examples of low-flow devices that deliver less precise concentrations of oxygen.

The nurse is evaluating if a patient understands how to determine safely whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler?

The best method to determine when to replace an inhaler is by knowing the maximum puffs available per MDI and then replacing it after the number of days when those inhalations have been used (100 puffs/2 puffs each day = 50 days). It is no longer appropriate to see if a canister floats in water or not because this is not an accurate way to determine the remaining inhaler doses. Shaking the canister and checking the indicator on the side of the canister are not the most effective ways of determining whether an MDI is empty.

A four-year-old child with cystic fibrosis (CF) experiences a cough associated with viscous, purulent, and greenish sputum. The nurse expects that which organism will be found in the patient's sputum?

The child has a frequent cough with viscous, purulent, and greenish sputum, which indicates a bacterial infection. The most common bacteria that affect children are Staphylococcus aureus. Burkholderia cepacia is a less common and most serious type of organism that causes CF in children. Haemophilus influenza and Pseudomonas aeruginosa are the organisms that cause CF in adults.

Infection can be a major hazard of O2 administration. Heated nebulizers present the highest risk. Which is the most common organism found?

The constant use of humidity supports bacterial growth, with the most common organism being P. aeruginosa. Rickettsia prowazekii, Clostridium perfringens, and Bordatella pertussis are not the most common organisms found in this case.

When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections?

The damage to the lungs includes alveolar macrophage dysfunction that increases the incidence of infections and thus increases patient discomfort and cost to treat the infections. Other lung damage that contributes to infections includes cilia paralysis or destruction, increased mucus secretion, and bronchospasms that lead to sputum accumulation and increased cough. The patient may be aware already of respiratory mucosa damage with hoarseness and decreased sense of smell and taste, but these do not increase the incidence of pulmonary infection

The nurse is teaching a patient pursed-lip breathing (PLB). What instructions by the nurse are correct?

The exhalation period needs to be three times as long as the inhalation period. Patients need to inhale slowly and deeply through the nose first. PLB should be used before, during, and after any activity that causes shortness of breath. While exhaling, the facial muscles need to be relaxed without any puffing out of the cheeks.

To promote airway clearance in a patient with pneumonia and asthma, the nurse instructs the patient to perform which action?

The flutter device is used to increase mucus production to promote airway clearance and gas exchange; it should be used while the patient is in an upright position. Supplemental oxygen may not be indicated depending on the oxygen saturation level. Pursed-lip breathing and the incentive spirometer will not promote airway clearance.

The nurse reviews pursed-lip breathing with a 61-year-old patient with emphysema. Which statement made by the patient indicates correct understanding of this technique?

The focus of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. Exhalation should be two to three times longer than inhalation. Lying down is not indicated, lips should be pursed during the exhalation phase, and it is not necessary to puff out the cheeks at any time during this technique

The nurse concludes that interventions carried out to promote airway clearance in a patient admitted with asthma are successful on the basis of which finding?

The issue is airway clearance, which is evaluated most directly as successful if the patient can engage in effective and productive coughing. Oxygen saturation would indicate gas exchange, not airway clearance. Use of accessory muscles indicates respiratory distress. The absence of wheezing does not always coincide with improved airway clearance and may represent worsening bronchospasm.

The licensed practical nurse is caring for a chronic obstructive pulmonary disease (COPD) patient who has severe hypoxemia. The primary health care provider prescribed oxygen administration for this patient. Which intervention can the nurse perform for the patient?

The licensed practical nurse should adjust the oxygen flow rate depending on the desired oxygen level for patients with COPD who are receiving oxygen therapy. Teaching patients about home oxygen use is not appropriate because this is the responsibility of a registered nurse. If the oxygen level is raised more than the requirement, it will lead to hypoxia. The level of carbon dioxide can be easily decreased, but it is very difficult to reduce the level of oxygen in the body. Therefore, the licensed practical nurse should not provide the patient with a high amount or continuous supply of oxygen.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient?

The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Allowing time to calm the patient, observing for diaphoresis, and monitoring for bilateral chest expansion are correct, but they are not the primary reason for inspecting the chest wall of this patient.

What is a priority nursing assessment for a 38-year-old patient experiencing an acute asthma exacerbation?

The nurse physically inspects the chest wall to evaluate the use of intercostal muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Pupillary response is a neurologic, not respiratory, assessment. Pedal pulses are measured to assess circulatory function. CVA tenderness is indicative of kidney inflammation, not asthma.

What discharge instructions should the nurse include for the patient with asthma? Select all that apply.

The nurse should advise the patient to soak the nebulizer in soap and water as the hot water kills the germs on it. Educating the patient about drugs and devices before discharge from the hospital is the responsibility of the nurse. The nurse should warn the patient about the dangers of noncompliance with the medications to avoid triggering asthma attacks. The patient should wash the mouth after inhalation of corticosteroids. The patient must wash respiratory equipment with 1:1 water and white vinegar.

Which parameter should the nurse consider while assessing a patient with cystic fibrosis (CF)?

The nurse should assess for thick and abundant bronchial mucus due to improper airway clearance in a patient with cystic fibrosis. Recurring lung infections occur due to impaired gas exchange. A decrease in life expectancy is related to ineffective dietary intolerance and weakness. Altered pancreatic enzyme production occurs mainly due to ingestion of nutrients less than the body requires.

Which should the nurse include when providing information related to health promotion and disease prevention to a patient with cystic fibrosis (CF)? Select all that apply.

The nurse should encourage the patient to consume more fluids and caloric supplements to enhance nutritional support in the patient. The nurse should advise the patient to learn about vascular access devices, which may be used for medication administration. Aerobic exercise is effective to clear the patient's airway. The patient must consume more dietary salt to replenish chloride stores in the body. The patient needs support systems; recommending the limitation of relationships is not appropriate.

What instruction should the nurse give to a patient with asthma who has received a prescription for albuterol and ipratropium nebulization?

The nurse should instruct the patient to cough effectively after the treatment to prevent hypoventilation and local irritation in the throat. This also helps to disperse accumulated drug in the airway. The nurse should advise the patient to sit upright to ensure efficient breathing and adequate penetration of the aerosol. The patient on corticosteroid inhalation needs to clean the mouth by performing mouthwash to avoid local irritation in the throat. While the patient is on aerosolized medication, the nurse should instruct the patient to breathe slowly and deeply.

A nurse is caring for a patient who is having an acute asthma attack. Which interventions should the nurse question? Select all that apply.

The nurse should question prednisone 10 mg, PO because this is an urgent situation that requires intravenous, intramuscular, and inhaled medications, rather than oral ones. There is not enough documentation to indicate that this patient requires administration of blood products, and blood products are not used to treat oxygen saturation. Peak flow readings, arterial blood gases, and continuous oxygen would be considered the standard of care for this patient.

A patient who has been diagnosed with tuberculosis states, "I am not taking my medication, because I cannot afford it." Which ethical practices does the nurse demonstrate by implementing a social service consult to assist the patient in obtaining the medication needed for treatment? Select all that apply.

The nurse who includes other members of the health care team, such as social services, to assist in obtaining the necessary resources or support for the patient to complete a course of treatment is demonstrating patient and community advocacy. The social worker can facilitate the resources for the patient to obtain the medication but cannot ensure the patient's adherence to the treatment plan. Contacting a social worker does not provide a legal process for medication compliance. Provision of direct observed therapy involves providing the antituberculosis drugs directly to the patient and watching as he or she swallows the medications.

Which complication does the nurse monitor in the patient who is using an oxygen-conserving cannula?

The oxygen-conserving cannula is applied as a moustache or pendant type, over the ears. The patient may experience necrosis over the tops of the ears due to constant contact. The oxygen-conserving cannula has pipes placed directly over the naris, so the loss of oxygen into atmosphere is very little. A patient who is using a tracheostomy collar will have tissue damage at the tracheostomy tube. While using non-rebreather masks, a decrease in the fraction of inspired oxygen, or FIO2, may occur.

Which strategy should the nurse teach a patient with emphysema to manage anxiety related to impaired gas exchange?

The patient can decrease anxiety related to impaired gas exchange by performing pursed-lip breathing. The nurse cannot advise an increase in medication dosages without a health care provider's prescription. The patient should be encouraged to perform ADLs. Stress will not impact anxiety related to emphysema.

In which position is it most appropriate for the nurse to place a patient experiencing an asthma exacerbation?

The patient experiencing an asthma attack should be placed in high-Fowler's position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The supine, lithotomy, and reverse Trendelenburg positions will not facilitate ventilation.

What does the nurse interpret from finding that a patient, after being treated for chronic cough and dyspnea associated with inflammation in lung parenchyma, loses muscle mass?

The patient has chronic cough and dyspnea associated with inflammation in lung parenchyma, indicating that the patient has chronic obstructive pulmonary disease (COPD). The patient experiences loss of muscle mass after treatment. This indicates that the patient is on high doses of corticosteroids, which may cause muscle loss due to protein catabolism. Diuretics are provided to reduce cardiac complications and may cause fluid imbalance. Theophylline is an antiinflammatory agent that helps to treat COPD effectively. Theophylline may cause side effects like bloating but is not associated with loss of muscle mass. Bronchodilators help to treat COPD by reducing the hyperinflation of lungs but are not associated with protein catabolism or muscle loss.

The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct?

The patient is placed in an upright position that allows for most efficient breathing to ensure adequate penetration and deposition of the aerosolized medication. The patient must breathe slowly and deeply through the mouth and hold inspirations for two or three seconds. Deep diaphragmatic breathing helps ensure deposition of the medication. Instruct the patient to breathe normally in between these large forced breaths to prevent alveolar hypoventilation and dizziness. After the treatment instruct the patient to cough effectively. An effective home-cleaning method is to wash the nebulizer equipment daily in soap and water, rinse it with water, and soak it for 20 to 30 minutes in a 1:1 white vinegar-water solution, followed by a water rinse and air drying.

An adolescent who has a history of asthma experiences wheezing after vigorous exercise. What nursing instruction is helpful for this patient?

The patient is suffering from exercise-induced asthma. The nurse should encourage the patient to avoid exposure to dry air, because it precipitates exercise-induced asthma. Exposure to cold air also precipitates asthma. The patient should be discouraged from performing vigorous exercise, because it can precipitate asthma. Swimming in indoor heated pools should be encouraged over swimming outdoors, because outdoor swimming can trigger asthma attacks.

The health care provider has prescribed salmeterol for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide?

The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs. The inhaler should not be placed several inches in front of the mouth.

The health care provider has prescribed an inhaled corticosteroid for the patient with asthma. The nurse should provide which instructions to the patient regarding the use of a dry powder inhaler (DPI)?

The patient should hold the breath for as long as possible to increase the amount of medication absorbed by the lungs. The DPI should not be shaken and should be stored in a cool area, and the patient's mouth should be closed tightly around the mouthpiece of the inhaler.

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler?

The patient should not just keep taking extra puffs of the inhaler to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status. Rinsing the mouth after the puffs will eliminate a bad taste. Waiting one to two minutes between each puff will facilitate the effectiveness of the administration. Ipratropium is not used in an emergency for COPD

What is the best method to prevent oral infection while the patient is taking fluticasone?

The patient should rinse the mouth with water after the second puff of medication to reduce the risk of fungal overgrowth and oral infection. An oral antibiotic solution is not indicated and would not treat a fungal infection. Brushing the teeth is not necessary before medication administration and the mouth should be rinsed after, not before, medication administration.

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is recovered fully from this episode of illness?

The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 minutes/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).

The nurse is teaching a student nurse about breath sounds in a patient with asthma. Which statement made by the student nurse indicates the need for further teaching?

The patient with a minor attack may wheeze loudly during expiration, but the patient experiencing a severe asthma attack does not wheeze; he or she may have no audible sound on auscultation due to decreased airflow into the lungs. The patient must be able to move enough air through the airway to wheeze. Wheezing usually begins with exhalation and may be present during both inspiration and expiration as asthma progresses.

A patient in the emergency ward is dyspneic and speaks unclear words. Assessment findings include a respiratory rate of 45 breaths/minute, a pulse of 130 beats/minute, oxygen saturation of 90%, and neck vein distention. Which treatment does the nurse expect will help alleviate the patient's symptoms?

The patient with a severe attack of asthma has an elevated respiratory rate, decreased oxygen saturation and elevated pulse, and the inability to speak, which indicate a severe airway obstruction. The patient may also have neck vein distension. Hence the nurse should anticipate correction of hypoxemia and improve ventilation in the patient with supplementary oxygenation by nasal prongs. This helps to keep oxygen saturation above 90 percent. Administration of ipratropium does not provide additional benefits to the patient. Three puffs of albuterol every 30 minutes help to resolve the symptoms in the patients with mild asthma. Obtaining the peak flow rate and continuous monitoring of the patient is critical during asthma attack, but will not alleviate the patient's symptoms

Which assessment finding does the nurse expect when caring for a patient with asthma?

The patient with acute asthma may reveal signs of hypoxemia and hyperventilation due to air flow limitation, indicated by a low level of partial pressure of carbon dioxide in blood (PaCO2), such as 30 mmHg. This condition leads to a rise in pH leading to respiratory alkalosis; however, a pH of 5.11 is low. The respiratory rate of the asthmatic patient increases to more than 30 breaths/minute due to the use of accessory muscles. The patient with anxiety due to breathlessness has an increase in pulse and blood pressure.

Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Select all that apply.

The patient with chronic obstructive pulmonary disorder (COPD) may develop complications such as pneumonia, cor pulmonale, and exacerbations of COPD, which require acute interventions. After the crisis is resolved, the patient has to undergo assessment for the degree and severity of the underlying respiratory problem. This information helps the nurse plan a better care plan. Atelectasis and mucoid impact are complications of asthma.

Which laboratory abnormality observed by the nurse confirms the diagnosis of a patient with low body mass index, wheezing, coughing, frequent pneumonia, bleeding, and sweating?

The patient with low body mass index, wheezing, coughing, frequent pneumonia, bleeding, and sweating may have cystic fibrosis ( CF) and impaired movement of sodium and chloride ions in and out of the epithelial cells. The high concentrations of sodium and chloride in the sweat of the patient with CF results from decreased chloride reabsorption in the sweat duct. Abnormal levels of unabsorbed dietary fat lead to steatorrhea. Chronically elevated liver enzymes lead to liver cirrhosis. Elevated inflammatory cytokines may result in osteopenia and osteoporosis.

What would be the appropriate nursing intervention for the patient whose laboratory report shows oxygen saturation of 45 mm Hg and carbon dioxide saturation of 60 mm Hg?

The patient with oxygen saturation of 45 mm Hg and carbon dioxide saturation of 60 mm Hg has severe hypoxemia and hypercapnic respiratory failure. The patient should be advised to plan sexual activity during the daytime, when the patient's breathing is normal. The ideal time would be in late morning or early afternoon before meals. If the patient moved to a high altitude, he or she might suffocate due to low partial pressure of oxygen levels. The patient should walk for 10 to 20 minutes three times per week, breathing through the nose with one step and through a pursed mouth for the next three steps. The patient should be administered a β2-adrenergic agonist five minutes after exercise to provide time for the patient to recover and return to a normal baseline.

What is the most appropriate time to obtain peak flow readings with the best peak flow number?

The peak flow readings should be taken between noon and 2 PM because the peak flow is highest during this period. The patient may feel nauseous if the peak flow readings are taken five minutes after meals. The peak flow readings are not at a high level early in the morning. The peak flow readings should be taken 20 minutes after administering short-acting β2-agonist because it is more effective; the medication would not be very effective two hours after inhaling a short-acting β2-agonist

When performing pilocarpine iontophoresis in a patient with steatorrhea, the nurse should perform the steps of the procedure in what order?

The pilocarpine iontophoresis is a sweat chloride test. The nurse should provide education to the patient before the procedure. This will allow the patient an opportunity to seek clarification as well as gaining knowledge about what to expect during the procedure. For the procedure, first pilocarpine is placed on the patient to stimulate sweat by a small electric current. The patient may feel tingling and warmth during the treatment; therefore the nurse should make the patient comfortable by communicating while performing the procedure. The sweat is collected on a gauge within five minutes, and the sweat is analyzed for chloride levels. The chloride level in the patient with steatorrhea will be above 60 mmol/L. The test is performed simultaneously for the other hand to confirm the diagnosis.

The nurse teaches a 61-year-old patient with emphysema and pneumonia to obtain which vaccines? Select all that apply.

The pneumococcal and influenza vaccines are important for patients with a history of heart or lung disease and those recovering from a severe illness, age 65 or over, or living in a long-term care facility. Tetanus, BCG, and hepatitis B vaccines are not recommended for patients to protect the lungs from additional damage, although they may be required for other reasons.

Which complications, along with edema in the ankles, does the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.

The presence of edema in the ankles indicates that the patient has the cardiac complication cor pulmonale, or failure in the right side of the heart. Cor pulmonale is associated with peripheral edema, especially in the ankles, so the patient will have weight gain. The patient with cor pulmonale will have tissue damage, resulting in hepatomegaly. The patient with cor pulmonale will have improper blood flow from the right atrium to the right ventricle, resulting in jugular vein distension. The patient with COPD will not have a decrease in white blood cells. The patient with COPD will have increased red blood cells due to hypoxemia, but will not have polycythemia.

Which finding helps to diagnose cystic fibrosis in a newborn?

The presence of meconium ileus helps to diagnose 20 percent of cases of cystic fibrosis (CF) in newborns. Gallstones and liver cirrhosis occur in some patients with CF. Liver cirrhosis occurs over time due to an accumulation of mucus in the liver of patients with cystic fibrosis. Terminal ileus does not indicate the presence of CF in the newborn.

The nurse is explaining the pathophysiology of asthma to a patient. Which is the most appropriate explanation?

The primary pathophysiologic process in asthma is persistent but variable inflammation of the airways. The airflow is limited because the inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways. Exposure to allergens or irritants initiates the inflammatory cascade. An immune response does not trigger asthma. Inflammation causes edema, not pressure, of the airways. Acid-base imbalances do not trigger asthma.

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving?

The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. After a severe asthma exacerbation, the cough may be productive and stringy. Vesicular breath sounds will increase with improved respiratory status. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.

The nurse administering beclomethasone to a patient can help reduce side effects by instructing the patient to perform which action?

The side effects of the glucocorticoid include oral candida, which can be prevented through rinsing the mouth with water or mouthwash after each use. This medication should be used on a schedule, not as needed, a spacer is encouraged, and it will not be helpful at the onset of an asthma attack because it is not an abortive medication; it is a preventative medication.

When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included?

The significant clinical manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain. Although drinking at least 3 L of low sodium fluid will help liquefy secretions to make them easier to expectorate, the health care provider does not need to be notified if the patient cannot do this

A patient with chronic obstructive pulmonary disease (COPD) is advised to use oxygen therapy at home. A nurse provides discharge instructions about how to prevent respiratory infection. What should be included in the teaching? Select all that apply.

The strategies to reduce infection while using oxygen therapy at home include changing the cannula every two weeks, washing the cannula twice a week with liquid soap, and using a mouthwash several times a day. The nasal cannula may become contaminated with repeated use and should be changed every week. It should also be cleaned twice a week to remove the particulate material and moisture. Frequent use of mouthwash helps to keep the oral cavity clean and prevent infection. Removing the secretions that are coughed out reduces the risk of infection. The oxygen concentrator cabinet should be cleaned every day, not weekly.

The nurse is caring for a child who is suspected of having cystic fibrosis (CF). The nurse knows that the gold standard of diagnosing this condition is:

The sweat chloride test is the most definitive test in children, but may not be conclusive in adults. Patients with CF secrete four times the normal amounts of sodium and chloride in their sweat. Genetic tests may be used if the sweat test is inconclusive. A lung biopsy is not used to diagnose this condition. Pancreatic insufficiency is related to CF but does not specifically diagnose the disease.

The patient with COPD has a prescription for ibuprofen 600 mg. The nurse questions the prescription, knowing that ibuprofen interacts with which concurrent medication?

The use of ibuprofen should be questioned with the concurrent use of hydrocortisone, a 28 corticosteroid. The use of these medications together increases the risk of gastrointestinal bleeding. Ibuprofen and sertraline, azithromycin, or ipratropium will not cause adverse effects

After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness and dry cough. What action should the nurse take to reduce the symptoms?

Upon inhalation into the pharynx, mometasone may cause local irritation such as oropharyngeal candidiasis, hoarseness, and dry cough. Hence the patient should rinse the mouth either with water or with mouthwash after inhalation. The patient may not be benefit by pausing between the puffs. Asking the patient to use a spacer or holding device for inhalation of corticosteroids can be helpful in getting more medication into the lungs. However, it does not reduce the symptoms of candidiasis. The next dose is given to the patient only upon further advice from the practitioner.

A patient develops vascular congestion, edema, and breathlessness within 30 minutes of the consumption of food containing tartrazine. The nurse identifies that which treatment may exacerbate the patient's condition?

Vascular congestion, edema, and breathlessness within 30 minutes indicate the early-phase response in asthma. Consumption of food containing tartrazine can trigger the inflammatory process. The patient with such a condition should avoid intravenous administration of corticosteroids, because they contain sulfite-containing preservatives, which further aggravate the condition. Administration of anticholinergics is safe in initial stages of asthma. Assisted ventilation and inhalation of oxygen by mask helps to treat life-threatening attacks of asthma.

The nurse is performing chest physiotherapy on a patient with chronic obstructive pulmonary disease. What appropriate techniques should be used when performing the procedure on this patient? Select all that apply.

Vibration, percussion, and postural drainage are chest physiotherapy techniques that help to remove excessive secretions in the lungs. Huff coughing and pursed-lip breathing are breathing techniques, which also help in the movement of chest secretions. Huff coughing and pursed-lip breathing are performed before chest physiotherapy but are not considered to be chest physiotherapy.

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis?

When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.

An asthmatic patient is in acute respiratory distress. The nurse auscultates the lungs and notes cessation of inspiratory wheezing. How does the nurse interpret this finding?

When the patient in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway. A pneumothorax would be evidenced by absent breath sounds. Absence of wheezing does not correlate with improved airflow if the patient is also in current respiratory distress. A mucus plug would result in crackles in the lungs.

A nurse observes a patient using a dry powder inhaler device. The nurse should correct which patient actions? Select all that apply.

When using a dry powder inhaler, the patient should not breathe into the inhaler, because this affects the dosing. Inhaling more than one puff with each inspiration may cause waste of the medication. The patient should not shake the medicine before using it because it can alter the dosing. Deep and quick breathing is the proper technique, because it ensures that the medicine moves deep into the lungs. The patient should be encouraged to hold the breath beyond 10 seconds to help in penetration of the dry powder.

A nurse observes a patient with asthma using a metered-dose inhaler. The nurse should correct which patient actions? Select all that apply

While using a metered dose inhaler, the breath should be held for at least 10 seconds for better absorption of the drug. The metered dose inhaler should be pressed with adequate strength to deliver the required dose. Inspiring slowly, shaking the device before using it, and coordinating use of the inhaler with inspiration are the right techniques for using a metered dose inhaler.

The nurse provides information to a group of nursing students about women with cystic fibrosis (CF) regarding conception and pregnancy. Which statement made by a student nurse related to female patients with CF indicates understanding of the education?

Women with CF may have menstrual irregularities and secondary amenorrhea during exacerbations. The female CF patient has the ability to breastfeed. The woman with cystic fibrosis has a thick cervical mucus membrane and is capable of becoming pregnant. There is no need for assisted reproductive techniques for the woman to conceive.

Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)?

β2 agonists may cause restlessness and insomnia in patients with COPD. Anticholinergics are not associated with insomnia. Massage and postural drainage techniques will not lead to insomnia and restlessness. Oxygen supplementation through a nasal mask will not cause restlessness and insomnia.