Chapter 19- Respiration

For which health problems would the nurse identify the diagnosis Risk of Infection as being appropriate for an older patient? (Select all that apply.) A) Reduced vital capacity B) Reduced ciliary activity C) Increase in residual capacity D) Underinflation of lung bases E) Less efficient cough response

Ans: A, B, E Feedback: The diagnosis Risk of Infection is appropriate for the patient with reduced vital capacity, reduced ciliary activity, and less efficient cough response. The diagnosis Ineffective Breathing Pattern would be appropriate for the patient with increase in residual capacity. The diagnosis Impaired Gas Exchange would be appropriate for the patient with underinflation of lung bases.

An older patient with a terminal illness is extremely thin and is prescribed to use oxygen via a face mask at home. Which is the priority nursing consideration to ensure the patient's oxygenation needs are met? A) Ensure a tight seal around the face mask. B) Maintain the patency of the nasal passages. C) Observe the patient for signs of pneumonia. D) Educate the family about risks of oxygen use.

Ans: A Feedback: If the patient is emaciated, a face mask may leak. The proper administration is the first consideration and would supersede family education and potential pneumonia. Nasal passages need not necessarily remain patent with the use of a face mask.

An older patient has been treated for three incidents of respiratory infection within 6 months. The patient complains of shortness of breath when walking outside in the cold weather. What should the nurse recommend to this patient? A) Drink plenty of water B) Avoid going outdoors C) Call the physician for antibiotics D) Increase the use of bronchial medications

Ans: A Feedback: It is important that the elderly, especially with frequent respiratory infections, actively work at removing bronchial secretions to minimize the effects of respiratory complications. Drinking fluids is an important activity for this patient. It would be inappropriate to encourage the patient to increase medication dosages or stay indoors. Antibiotics may or may not be necessary.

The nurse educator is instructing new graduate nurses on the differences in presentation and course of pneumonia in older adults. What differences should the educator include in this teaching? A) Older adults often do not experience chest pain or exhibit a high fever B) Older adults often develop sepsis before symptoms of pneumonia are evident C) Older adults more often develop lung consolidation rather than production of secretions D) Pneumonia in older adults is most often linked to exposure to environmental toxins over the course of a lifetime

Ans: A Feedback: Older adults often fail to manifest a fever or chest pain with pneumonia. Older adults do not develop sepsis before other symptoms of pneumonia occur and do not develop lung consolidation rather than secretions. Pneumonia is not often linked to exposure to toxins over the lifetime.

The nurse is preparing discharge instructions for an older patient with chronic obstructive pulmonary disease. What should the nurse teach the patient about the use of inhaled bronchodilators? A) "Usually, one or two puffs should bring you relief for around four hours." B) "It's important to take these medications only when you experience serious symptoms." C) "These medications can make your shortness of breath worse if you take them too often." D) "If you develop any sort of heart disease or circulatory problems in the future, these inhalers will have to be discontinued."

Ans: A Feedback: One or two inhalations of bronchodilators normally bring relief for around 4 hours. The use of bronchodilators is not limited to periods of severe shortness of breath. The overuse of bronchodilators can cause cardiac arrhythmias but they are not necessarily contraindicated in all individuals with underlying heart or circulatory problems. Overuse is not known to exacerbate shortness of breath.

An older patient with asthma is prescribed an inhaler. What health problem will the nurse suspect impacts the patient's ability to comply with this prescribed treatment? A) Severe arthritis B) Type 2 diabetes C) Macular degeneration D) Ventricular tachycardia

Ans: A Feedback: The patient is required to manipulate the inhaler, coordinating the spray with inhaling, which can be affected by severe arthritis in the hands. Diabetes would not impact the patient's ability to comply with this treatment. Macular degeneration might impact the patient's ability to comply with this treatment but arthritis would be a greater influence. Ventricular tachycardia would not impact the patient's ability to comply with the prescribed treatment.

The nurse is teaching a patient with emphysema to progressively increase activity. At which point in time should the nurse instruct the client to stop activity? A) A decrease in respiratory rate and pulse B) An increase in respiratory rate and pulse C) An increase in respiratory rate and a decrease in pulse D) A decrease in respiratory rate and an increase in pulse

Ans: A Feedback: The patient should be instructed to discontinue activity when respiration rate and pulse decrease. The other instructions would not be correct to instruct the patient.

An older patient who smokes half a pack of cigarettes daily and is diagnosed with COPD expresses regret about starting smoking over 50 years ago at a time when it was considered both fashionable and harmless. What can the nurse respond to this patient? A) "Even though you have smoked for a long time, there are still benefits to quitting smoking." B) "If you continue to smoke, any medical treatment for your COPD is likely to be ineffective." C) "Unfortunately the damage is now done and quitting smoking will likely have little effect on your future health." D) "Even though it won't affect the course of your COPD, quitting smoking would probably make you feel better about yourself."

Ans: A Feedback: There are health benefits to quitting smoking at any stage and doing so would likely aid in the treatment of the patient's COPD. Continuing to smoke, while detrimental, would not necessarily render all medical treatments for COPD ineffective. Quitting smoking could stop the progression of the patient's disease.

An older patient with chronic bronchitis is having difficulty managing periods of dyspnea and anxiety. What can the nurse do to help the patient at this time? (Select all that apply.) A) Instruct on the disease process. B) Discuss reducing environmental irritants. C) Explain how to use transportable oxygen. D) Encourage to avoid temperature extremes. E) Recommend spending most time out of the home.

Ans: A, B, C, D Feedback: Respiratory problems can be frightening and cause anxiety. Patients need a complete understanding of the disease to help reduce anxiety. Reducing environmental irritants could reduce the patient's symptoms. Explaining how to use transportable oxygen will increase the patient's independence. Encouraging the patient to avoid temperature extremes could help reduce the patient's symptoms. Recommending that the patient spend most time out of the home could exacerbate the patient's symptoms.

What should the nurse instruct an older patient with a history of chronic bronchitis to help reduce the manifestations of the disease? (Select all that apply.) A) Maintain high fluid intake B) Maintain a healthy body weight C) Encourage to consciously expectorate secretions D) Teach the importance of avoiding respiratory infections E) Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) regularly

Ans: A, C, D Feedback: Older adults living with bronchitis may need encouragement to expectorate secretions and maintain adequate fluid intake. It is also important for these patients to avoid respiratory infections. NSAIDs are not used in the treatment of bronchitis and a healthy body weight is unlikely to directly affect the course of the health problem.

While making a home visit, the nurse determines that the quality of a patient's indoor air environment needs to be improved. What should the nurse instruct the patient? (Select all that apply.) A) Damp dust furniture B) Keep windows closed C) Avoid smoking inside the home D) Vacuum the floor coverings regularly E) Install air filters in heating and air conditioning units

Ans: A, C, D, E Feedback: Interventions to improve the quality of indoor air include damp dusting furniture, avoiding smoking inside the home, vacuuming the floor coverings regularly, and installing air filters in heating and air conditioning units. Opening windows would improve the quality of air in the home.

Which clinical guideline should the nurse follow when providing oxygen therapy to older adults? A) Oxygen therapy should be utilized with older adults only as a last resort B) Oxygen therapy should be used with caution to prevent CO2 retention and narcosis C) Inhaled or nebulized medications are contraindicated with ongoing oxygen therapy D) Oxygen therapy can safely be used with patients experiencing or at risk for developing lung disease

Ans: B Feedback: Oxygen therapy should be used with prudence to prevent the effects of carbon dioxide narcosis. It is not a treatment of last resort but neither should it be used with all patients at risk for lung disease or who have lung disease. It is possible, and indeed common, to use both oxygen and medications in the treatment of respiratory illnesses.

Which should the nurse recommend to an older patient with chronic obstructive pulmonary disease (COPD) and no specific dietary restrictions or limitations? A) Dairy products B) Spicy foods and garlic C) Green leafy vegetables D) Low-carbohydrate and high-protein foods

Ans: B Feedback: Spicy foods and garlic are noted to open airway passages, whereas dairy products promote mucus production and should be avoided. Vegetables and low-carbohydrate, high-protein foods are not known to affect the airways.

The nurse is visiting an older patient who has smoked for 50 years and has emphysema that severely affects the patient's quality of life. The patient has had multiple hospital admissions this past year. What is the nurse's priority when caring for this patient? A) Discussing the use of inhalers B) Assessing ability to perform activities of daily living C) Reviewing deep-breathing exercises D) Assessing the air quality in the home

Ans: B Feedback: The patient is demonstrating diminished capacity and should be assessed for continuing ability to provide self-care in the home. This concern would be a priority over using inhalers, assessing air quality, or reviewing deep-breathing exercises.

After completing an assessment of an older patient, which finding should the nurse attribute to a pathological process rather than age-related respiratory changes? A) Posture is slightly kyphotic B) Slight wheeze on exhalation C) Uses accessory muscles on expiration D) Mucous membranes drier than younger clients'

Ans: B Feedback: While some use of accessory muscles, kyphosis, and drying of mucous membranes occur as part of the aging process, a wheeze would not be considered a normal, age-related change and could indicate a pathological process.

The nurse assesses a change in the respiratory status of an older patient. Which findings should be reported to the health care provider immediately? (Select all that apply.) A) Infrequent cough B) Neck vein distention C) Elevated blood pressure D) Change in mental status E) Clear drainage from the nose

Ans: B, C, D Feedback: Manifestations of respiratory complications include elevated blood pressure, which could indicate chronic hypoxia, neck vein distention, and a change in mental status. Infrequent cough and clear drainage from the nose are not symptoms that would indicate respiratory complications.

During a home visit, the nurse notes that an older patient has increased joint pain and shortness of breath since moving in with her daughter 6 months ago. What could be contributing to this patient's complaints? A) Age-related changes B) Increase in pulmonary disease C) Family assistance limiting her mobility D) Increase in arthritic changes to the joints

Ans: C Feedback: Immobility is a major threat to pulmonary and joint health. Well-meaning families can sometimes limit activity rather than promote it, which can contribute to her complaints. An increase in joint pain and shortness of breath are not considered age-related changes. There is not enough information to determine that the patient has pulmonary disease or arthritic changes in the joints.

A patient with dementia has difficulty swallowing, and frequently coughs when eating. Recently, the patient has developed a nonproductive cough with a temperature of 99°F. The nurse is concerned that this patient is at risk for developing which health problem? A) Lung cancer B) Chronic bronchitis C) Aspiration and lung abscess D) Chronic obstructive lung disease

Ans: C Feedback: Aspiration of foreign material can cause a lung abscess, which is a risk in older people with decreased pharyngeal reflexes. Difficulty swallowing and coughing are not typical manifestations of chronic bronchitis, lung cancer, or chronic obstructive lung disease.

Most of the older patients on a geriatric care area have some degree of pulmonary disease and ineffective respirations. Which intervention should the nurse include on these patients' care plans? A) Enroll in yoga classes. B) Keep the nasal passages patent. C) Perform daily deep-breathing exercises. D) Avoid exposure to people with infections.

Ans: C Feedback: Deep-breathing exercises can help improve some age-related changes in lung capacity and are an activity that even nonambulatory patients can do. It is unknown if yoga classes would be appropriate for these patients. Keeping the nasal passages patent and avoiding exposure to those with infections would not immediately help the patients' ineffective respirations.

During an assessment the nurse notes that an older patient has a gray discoloration of the skin. Which health problem does the nurse suspect the patient is experiencing? A) Emphysema B) Lung abscess C) Chronic bronchitis D) Peripheral vascular disease

Ans: C Feedback: In the presence of chronic bronchitis, the patient can have a blue or gray discoloration of the skin caused by a lack of oxygen binding to the hemoglobin. Ruddy, pink complexions often occur with emphysema and are associated with hypoxia from a high carbon dioxide level in the blood. Specific skin color changes are not associated with lung abscess or peripheral vascular disease.

The nurse is facilitating a health promotion class at a senior center. Which statement made by a participant should be corrected by the nurse? A) "My wife and I both get our flu shots each fall." B) "I'm vigilant about staying away from anyone who has a cold or flu." C) "I use a puffer regularly to prevent any problems with my breathing in the future." D) "I've found that doing deep breathing exercises helps relax me and expand my lungs."

Ans: C Feedback: Older persons should be advised against treating respiratory problems themselves. Many over-the-counter cold and cough remedies can have serious effects in older adults and can interact with other medications being taken. These drugs also can mask symptoms of serious problems, thereby delaying diagnosis and treatment. Older adults should know that a cold lasting more than 1 week may not be a cold at all, but something more serious that requires medical attention. Getting influenza and pneumonia vaccinations as well as performing deep breathing exercises are valid health promotion activities. Avoiding others with a cold or the flu is a good disease prevention strategy and should be reinforced by the nurse.

The nurse is preparing to implement a new postural drainage order for an older patient with copious secretions caused by community-acquired pneumonia. What action will the nurse take when implementing this order? A) Teach the patient to expect some dyspnea and distress during postural drainage B) Ask the physician to reconsider the order for postural drainage due to the patient's age C) Perform postural drainage allowing adequate periods of rest between position changes D) Suggest the physician to consider the use of bronchodilators rather than postural drainage

Ans: C Feedback: Postural drainage is not contraindicated for older adults. It does necessitate a gentle approach with adequate periods of rest. Bronchodilators would not provide an alternative to postural drainage but rather would likely be used in conjunction. Dyspnea and distress should not accompany properly performed postural drainage.

The nurse is caring for an older patient with right-sided paralysis who is confined to a wheelchair. Which health promotion intervention should the nurse include in this patient's care plan? A) Monitor intake and output B) Measure vital signs every 8 hours C) Perform range-of-motion exercises to the right arm D) Encourage deep-breathing exercises three times per day

Ans: D Feedback: The nurse needs to identify interventions to promote respiratory activity with this patient. Encouraging deep-breathing exercises three times a day would promote this patient's respiratory health. Range-of-motion exercises will not promote this patient's respiratory health. Monitoring intake and output and measuring vital signs will not promote this patient's respiratory health.

The nurse is visiting a patient who has been widowed and continues to live in the same home. The nurse notes the home is stuffy and the patient is experiencing a significant amount of wheezing. What should the nurse include when instructing this patient? A) Maintaining an exercise schedule B) Performing deep-breathing exercises C) Increasing the temperature in the house D) Maintaining the air quality in the house

Ans: D Feedback: The patient is having difficulty taking care of the house. The nurse would want to review those things that the patient can do to minimize breathing problems, such as dusting. The nurse should suggest ways to improve the air quality in the home such as opening a window a small amount to increase ventilation. An exercise schedule or deep-breathing exercises may or may not be appropriate for the patient at this time. Increasing the temperature in the home might make the house stuffier.

An older patient develops rapid, shallow respirations, with retraction of the respiratory muscles. What will the nurse do first to improve this patient's ineffective breathing pattern? A) Administer oxygen B) Prevent a respiratory infection C) Keep the nasal passages patent D) Raise the bed at least 30°

Ans: D Feedback: Although any of these interventions may be appropriate at one point or another, raising the bed is the most immediate, effective intervention. The nurse will need to receive an order from the physician for oxygen. Preventing infection and keeping nasal passages patent are not going to help the patient who is experiencing respiratory distress.

A patient who is prescribed deep breathing and coughing every hour has a nonproductive cough and is easily fatigued. What can the nurse do to increase the patient's secretions? A) Have the patient blow the nose. B) Encourage the patient to rest for 30 minutes. C) Provide the patient with aerosol medication. D) Give the patient a piece of hard candy to eat.

Ans: D Feedback: Hard candy and other sweets increase secretions, thereby helping make the cough productive. Blowing the nose, resting, or using aerosol medication will not help increase secretions.

Which older patient would the nurse suspect is displaying the effects associated with overusing bronchodilating nebulizers? A) A patient with acute delirium B) A patient with complaints of chest pain C) A patient with shortness of breath on exertion D) A patient with a new onset of a cardiac arrhythmia

Ans: D Feedback: Overuse of sympathomimetic bronchodilating nebulizers creates a risk of cardiac arrhythmias leading to sudden death. Chest pain, delirium, and shortness of breath are not noted to be markers of their overuse.

An older patient with a history of environmental exposure to chemicals complains of shortness of breath. Which symptom most likely indicates the patient has chronic obstructive pulmonary disease (COPD)? A) Red, frothy sputum B) Greenish, thick sputum C) Purulent and foul-smelling sputum D) Sticky, translucent, grayish white sputum

Ans: D Feedback: Tenacious, translucent, and grayish white sputum is associated with COPD. Purulent and foul-smelling sputum is associated with a lung abscess. Greenish, thick sputum is associated with a lung infection. Red, frothy sputum is associated with pulmonary edema or left-sided heart failure.

The nurse is preparing to perform postural drainage with an older patient. Which action would the nurse perform first? A) Rest period B) Oral hygiene C) Position for postural drainage D) Administer aerosol medications

Ans: D Feedback: The nurse would first provide the patient with any prescribed aerosol medications. Then the patient would be positioned for postural drainage followed by oral hygiene and then rest.