Med Surg Exam 1 Chapter 29

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. Text Reference - p. 606

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. Text Reference - p. 607

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. Text Reference - p. 604

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. Text Reference - p. 604

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. Text Reference - p. 596

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit?

A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or the increase the speed of using the inhaler. Text Reference - p. 573

While teaching a 45-year-old patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to notify the health care provider immediately if which situation occurs?

Achieving less than 50% of the patient's personal best on the peak flow meter indicates a medical emergency related to poor gas exchange and air flow. The patient should notify the health care provider immediately. Wheezing should be improved with a bronchodilator. Short acting bronchodilators used every one to two days indicate the need for additional asthma treatment. Peak flow measurements should not decrease following exercise if asthma is well-controlled. Text Reference - p. 566

The nurse measures the pulse of a patient admitted with bronchitis and asthma and finds it to be 120 beats/minute. To which medication might the nurse attribute this finding?

Albuterol, used to treat asthma, increases the sympathetic nervous system response, and may increase the heart rate. Allopurinol, acetaminophen, and montelukast do not elevate the heart rate. Text Reference - p. 570

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 beclamethosone 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. Text Reference - p. 571

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. Text Reference - p. 631

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. Text Reference - p. 624

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. Text Reference - p. 569

A patient with acute breathlessness is unable to speak and has a peak flow of 30 percent of personal best. The nurse finds that the patient is not responding to the usual therapy. Which intervention can help resolve the patient's condition?

Deliver oxygen and helium (heliox) along with albuterol to the patient who is not responding to the usual beta agonist (albuterol) treatment. This helps with bronchodilation in the patient due to the combined effect of low-density helium and albuterol. Oxygen helps to improve peak flow rate in the patient. Chest physiotherapy may suffocate the patient with breathlessness. Use of bronchial thermoplasty is rare in acute attacks. It proves beneficial in the patient as an alternative therapy. Theophylline is no longer found to be beneficial for the patient with an asthma exacerbation. Text Reference - p. 569

A patient presents with a productive cough and a body temperature of 102o F. The patient's white blood cell (WBC) count is 15,000/mm3. The nurse expects that what diagnostic test will be prescribed?

Fever, productive cough and white blood cells of 15,000/mm3 indicate infection in the patient. Evidence of the sputum culture test helps to rule out bacterial infection from other upper respiratory tract problems. Niox Mino test helps to measure airway inflammation related to asthma and an allergy skin test is helpful for assessment of sensitivity for specific allergen. A lung function test helps to evaluate the lung capacity in the patient with respiratory problems. Text Reference - p. 567

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease?

In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antiproteaste α1-antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells. Text Reference - p. 582

The nurse determines that a patient is not experiencing the beneficial effects of ipratropium after noting which finding in the patient?

Ipratropium, a bronchodilator, decreases wheezing; if wheezing persists, the medication has not been effective. Ipratropium will have no effect on bowel sounds, blood pressure, or pain of any kind. Text Reference - p. 570

Nebulization

Nebulization involves administering drug solution as mists produced by small machines called nebulizers. An upright position allows for efficient breathing that ensures adequate penetration and deposition of the aerosolized medication. The patient should hold the inspiration for two to three seconds to ensure penetration of the medication. The patient should practice deep breathing in between the forced breathing to prevent alveolar hypoventilation. The patient should be encouraged to cough effectively after the nebulization to mobilize the secretions. Text Reference - p. 575

Asthma

Symptoms of asthma include cough, chest tightness, and wheezing. Crackles are heard when fluid has accumulated in the lungs, which is not consistent with asthma. Pink frothy sputum is seen with pulmonary edema. Text Reference - p. 591

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic 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 β-adrenergic 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. Text Reference - p. 569

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 nonrebreather 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.

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

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. Text Reference - p. 621

The nurse provides education to a patient who is prescribed a metered-dose inhaler. Which actions taken by the patient indicate the need for further teaching? Select all that apply.

The metered-dose inhaler (MDI) has to be shaken before use, and the patient should only inhale one puff per inspiration. The patient using an MDI should wait between each puff. The MDI should be activated during inspiration. The patient should to hold the breath for 10 seconds after each puff. Text Reference - p. 574

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. Text Reference - p. 564

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. Text Reference - p. 590

A 45-year-old patient is experiencing an asthma exacerbation. To facilitate airflow, the nurse should place the patient in which position?

The patient experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. Prone, supine, and Trendelenburg's positions do not facilitate airflow or decrease chest expansion, and may cause respiratory distress. Text Reference - p. 578

Which laboratory finding helped the nurse reach the conclusion that a patient with a chronic cough and dyspnea has hypercapnia?

The patient has a chronic cough and dyspnea, indicating that he or she has chronic obstructive pulmonary disease (COPD). The normal range of PaCO2 is 35 to 45 mm Hg. The PaCO2 of the patient is 55 mm Hg, which indicates hypercapnia. Normal hemoglobin levels are 13.5 to 17.5 g/dL. The patient has a hemoglobin concentration of 12 g/dL, which is a normal finding and does not indicate that the patient has any complication. The normal range for red blood cell count is 4.7 to 6.1 million cells/microliter. A patient with COPD may develop polycythemia but this patient has a normal red blood cell count of 4.9 million cells/µL. A PaO2 level of above 70 mm Hg indicates that the patient does not have hypoxemia. The partial pressure of arterial oxygen is 75 mm Hg, which is a normal finding. Text Reference - p. 585

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. Text Reference - p. 574

A patient who is receiving therapy for bronchial hyperresponsiveness has developed oropharyngeal candidiasis, hoarseness and dry cough. The nurse suspects that which medication is the cause of the patient's symptoms?

The patient may develop oropharyngeal candidiasis, hoarseness and dry cough due to local side effects caused by inhalation of corticosteroids, such as fluticasone. Zafirlukast is a leukotriene modifier that helps with bronchodilation and inflammation. Albuterol is a bronchodilator and helps with mucociliary clearance. Omalizumab is a monoclonal antibody that decreases circulating free IgE levels. Text Reference - p. 571

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. Text Reference - p. 575

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. Text Reference - p. 565