Chapter 29 Obstructive Pulmonary Diseases
Which inhaler should the nurse be prepared to administer to the patient at the onset of an asthma attack? A. Albuterol B. Fluticasone/Salmeterol C. Fluticasone D. Salmeterol
A Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone/salmeterol, fluticasone, and salmeterol are not short-acting bronchodilators and will not relieve the patient's symptoms of an acute asthma exacerbation.
The patient has a prescription for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? A. Albuterol B. Salmeterol C. Beclomethasone D. Ipratropium bromide
A 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).
A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? A. Anxiety B. Cyanosis C. Bradycardia D. Hypercapnia
A An early manifestation during an asthma attack is anxiety, because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH because he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.
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? A. Chronic obstructive pulmonary disease (COPD) B. Tuberculosis C. Pneumonia D. Influenza
A 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.
The nurse provides teaching to a patient with asthma who has been advised to use nebulization. What should the nurse include in the instructions about nebulization? A. Sit in an upright position during the treatment. B. Hold the inspiration for 10 seconds. C. Breathe rapidly between forced breaths. D. Do not cough after the nebulization treatment.
A 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.
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? A. "I will keep my rescue inhaler with me at all times." B. "I do not need to get a flu shot because I'm under age 50." C. "I will use my peak flow meter only when I feel like I'm getting sick." D. "I will use my corticosteroid inhaler only when I feel short of breath."
A 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 should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? A. One hour before a meal B. Immediately after meals C. After providing juice to the patient D. After administering nasal medications
A Postural drainage is performed one hour before meals to avoid nausea and vomiting. The procedure can also be performed three hours after meals but not immediately after meals, to avoid nausea and vomiting. Even if only juice is provided to the patient before postural drainage, the patient may feel nausea. Nasal medications may be excreted during the drainage if postural drainage is performed after administering nasal medications.
Prolonged exposure to a high level of oxygen leads to pulmonary damage caused by: A. Oxygen toxicity B. Normoxia C. Anoxia D. Hypoxia
A Pulmonary O2 toxicity may result from prolonged exposure to a high level of O2 (PaO2). High concentrations of oxygen can result in a severe inflammatory response because of oxygen radicals and damage to alveolar-capillary membranes resulting in severe pulmonary edema, shunting of blood, and hypoxemia. These individuals develop acute respiratory distress syndrome (ARDS). Normoxia is not a condition of having too much oxygen, but a normal amount. Anoxia and hypoxia are conditions of having too little oxygen, not too much.
The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct? A. Sit in an upright position during the treatment. B. Take short, shallow breaths while inhaling the medication. C. Rinse the nebulizer equipment under running water once a week. D. During the treatment, breathe in and hold the breath for five seconds.
A 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.
The nurse recognizes that which treatment regimen would be helpful for a patient with a G551D mutation pancreatic enzyme deficiency who has decreased absorption of protein and fat absorption with poor growth and oily stools? A. Ivacaftor B. Tobramycin C. Dornase alfa D. Azithromycin
A The patient with a G551D mutation pancreatic enzyme deficiency who has decreased absorption of protein and fat absorption with poor growth and oily stools has pancreatic insufficiency. Ivacaftor is useful and effective in the patient with a G551D mutation. Tobramycin helps to treat the patient with cystic fibrosis affected by Pseudomonas. Dornase alfa helps to degrade deoxyribonucleic acid (DNA) of neutrophils in the patient with cystic fibrosis. Azithromycin also helps to treat the patient with cystic fibrosis affected by Pseudomonas.
What is the most common sign during an initial assessment that alerts the nurse that the patient has chronic obstructive pulmonary disease? A. Barrel chest B. Sunken chest C. Hyperventilation D. Circumoral cyanosis
A The patient with chronic obstructive pulmonary disease (COPD) develops a barrel chest over time because trapped air enlarges the lungs and thoracic cavity, thereby reducing chest flexibility. Sunken chest, also known as funnel chest or pectus excavatum, is not related to COPD. Hyperventilation is not characteristically seen with COPD. Instead, the patient usually displays persistent dyspnea on exertion, with or without a chronic cough. Circumoral cyanosis is a bluish discoloration of the skin surrounding the mouth. It is usually an indication of a severely diminished level of oxygen and respiratory distress. Circumoral cyanosis can result from a variety of respiratory diseases and may be a late sign of the COPD disease process.
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? A. Work of breathing B. Fear of suffocation C. Effects of medications D. Anxiety and restlessness
A 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.
A 61-year-old patient with asthma is admitted to the hospital. The nurse understands that symptoms of asthma include which of the following? Select all that apply. A. Wheezing B. Chest tightness C. Crackles D. Cough E. Pink frothy sputum
A, B, D 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.
A patient requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration. Which device is the most appropriate for this patient? A. Face mask B. Nasal cannula C. Partial and non-rebreather masks D. Tracheostomy collar
B A nasal cannula is the most commonly used device for a patient requiring low concentrations of oxygen of 24% at 1 L/min. It is safe and simple and allows freedom of movement. It can be used for a long time. Simple face masks can be used only for a short duration, especially during transportation. Partial and non-rebreather masks are useful for short-term therapy with high concentrations of oxygen. A tracheostomy collar is used to deliver high humidity and oxygen.
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. Cystic fibrosis B. Bronchiectasis C. Cor pulmonale D. Pneumothorax
B 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.
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. "I should advise the patient to eat more cabbage, beans, and cauliflower." B. "I should advise the patient to avoid smoking and occupational exposure to irritants." C. "I should advise the patient to breathe rapidly while performing effective Huff coughing." D. "I should advise the patient to avoid high-calorie foods like butter, cheese, and margarine."
B 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.
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. "I will pay less for medication because it will last longer." B. "More of the medication will get down into my lungs to help my breathing." C. "Now I will not need to breathe in as deeply when taking the inhaler medications." D. "This device will make it so much easier and faster to take my inhaled medications."
B 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.
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. Acute bronchitis B. An asthma attack C. Pulmonary edema D. Congestive heart failure
B 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.
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? A. Wheezing is improved moderately with the use of a bronchodilator. B. Less than 50% of the patient's personal best is achieved. C. The short-acting bronchodilator is being used every three to four days. D. Peak flow measurements remain unchanged after exercise.
B 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.
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? A. Prescribe fruits and fruit juices to be offered between meals B. Prescribe a high-calorie, high-protein diet with six small meals a day C. Teach the patient to use frozen meals at home that can be microwaved D. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet
B 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.
The nurse is caring for a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? A. Oxygen saturation of 92% B. Presence of edema in the ankles C. Yellowish discoloration of the skin D. Partial pressure of arterial oxygen (PaO2) is 60 mm Hg
B Cough, sputum production, and dyspnea indicate that the patient has chronic obstructive pulmonary disease (COPD). Cor pulmonale is the impairment or failure of the right side of the chest, which is characterized by the presence of edema in the ankles. The patient with cor pulmonale will have chronic hypoxia, so the oxygen saturation is less than 88%. The patient with chronic obstructive pulmonary disease (COPD) will have the bluish discoloration of skin associated with polycythemia. A yellowish discoloration is associated with jaundice. The PaO2 of the patient with COPD is less than 60 mm Hg due to severe hypoxemia. A PaO2 of 60 mm Hg is a normal finding.
When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? A. An overproduction of the antiprotease a1 antitrypsin B. Hyperinflation of alveoli and destruction of alveolar walls C. Hypertrophy and hyperplasia of goblet cells in the bronchi D. Collapse and hypoventilation of the terminal respiratory unit
B 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.
The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? A. Heart rate 80 beats per minute B. Clear lung sounds C. Capillary refill less than three seconds D. Positive bowel sounds in all quadrants
B Ipratropium is an inhaled anticholinergic used for asthma management. Clear lung sounds would indicate full passage of air and well-controlled symptom management. Heart rate, capillary refill, and bowel sounds are not associated with the benefits of ipratropium administration for bronchoconstriction and inflammation.
During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse determines that these symptoms are related to which pathophysiologic feature of the disease? A. Mucous production B. Bronchoconstriction C. Alveolar collapse D. Laryngeal stridor
B Narrowing (constriction) of the airway leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Mucous production may occur but is not responsible for wheezing. Alveolar collapse and laryngeal stridor are not related to asthma.
A patient with asthma has a body temperature of 102o F and produces purulent sputum. The nurse anticipates that which drug will be prescribed? A. A sedative B. An antibiotic C. A mucolytic D. Epinephrine
B The patient with body temperature of 102o F and purulent sputum may have bacterial infection. Hence, the treatment with antibiotics would benefit the patient. Sedatives may result in respiratory depression and death. Mucolytics are not recommended, because they are not beneficial to the patient suffering from asthma. Epinephrine helps to treat acute anaphylaxis.
When teaching a patient about chronic obstructive pulmonary disease (COPD) rehabilitation, what strategy should the nurse teach the patient as essential to perform for energy conservation? A. Complete inactivity B. Exercise training C. Reduced water intake D. Reduced food intake
B VExercise training leads to energy conservation, which is an important component in COPD rehabilitation. Complete inactivity may alleviate symptoms acutely but is not helpful in the long term, because the patient needs to learn effective ways to improve muscle function. It is also important to reduce dyspnea by exercise training. Reduced water and food intake is not advisable; instead, increased water and food intake is essential to maintain energy and to loosen the secretions.
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? A. The patient has developed a pneumothorax B. There is worsening airway inflammation and bronchoconstriction C. Airflow has now improved through the bronchioles D. A mucus plug has developed within a main stem bronchus
B 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 patient is hospitalized with an acute exacerbation of cystic fibrosis (CF). The nurse recognizes that which organisms may be present in the patient's sputum? Select all that apply. A. Burkholderia cepacia B. Staphylococcus aureus C. Haemophilus influenzae D. Pseudomonas aeruginosa E. Streptococcus pneumoniae
B, C, E Staphylococcus aureus, Haemophilus influenza, and Pseudomonas aeruginosa cause exacerbations of both cystic fibrosis and bronchiectasis. Burkholderia cepacia is rare but causes serious exacerbations of cystic fibrosis. Streptococcus pneumoniae causes more frequent exacerbations and rapid decline in lung function in bronchiectasis.
Which finding helped the nurse reach the conclusion that a patient with chronic obstructive pulmonary disease (COPD) requires oxygen therapy? A. Hemoglobin levels of 13.6 g/dL B. Saturation of hemoglobin (SaO2) 90% at rest C. Partial pressure of oxygen (PaO2) 52 mm Hg D. Red blood cell count 5 million cells/microliter
C A patient with a PaO2 less than 55 mm Hg requires oxygen therapy. A PaO2 level of 52 mm Hg indicates that the patient requires oxygen therapy. The normal level of hemoglobin is 13.5 to 17.5 grams per dL. The hemoglobin level of 13.6 gm/dL is a normal hemoglobin level and does not require oxygen therapy. A patient with a saturation of hemoglobin less than 88% requires oxygen therapy. A normal red blood cell count is 4.7 to 6.1 million cells/microliter.
Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? A. Acute respiratory failure B. Secondary respiratory infection C. Fluid volume excess resulting from cor pulmonale D. Pulmonary edema caused by left-sided heart failure
C 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.
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: A. Explain the need to minimize activity in the home to conserve oxygen use B. Point out that distance traveling may not be possible because oxygen tanks are so small C. Encourage the patient to continue normal activity and travel plans D. Point out that most travel companies do not accommodate travelers with oxygen
C 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 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? A. The patient consumes iron-rich food. B. The production of red blood cells increases in response to hypoxia. C. The heart is functioning well in response to COPD treatments. D. The patient no longer has COPD.
C 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.
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? A. Laryngospasm B. Pulmonary edema C. Narrowing of the airway D. Overdistention of the alveoli
C 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.
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? A. Intravenous (IV) fluids B. Biofeedback therapy C. Systemic corticosteroids D. Pulmonary function testing
C 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.
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? A. Smoking causes a hoarse voice B. Cough will become nonproductive C. Decreased alveolar macrophage function D. Sense of smell is decreased with smoking
C 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 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? A. Allow time to calm the patient B. Observe for signs of diaphoresis C. Evaluate the use of intercostal muscles D. Monitor the patient for bilateral chest expansion
C 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.
A 45-year-old patient is experiencing an asthma exacerbation. To facilitate airflow, the nurse should place the patient in which position? A. Prone B. Supine C. High-Fowler's D. Trendelenburg's
C 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.
When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion? A. Fat-soluble vitamins and dietary salt should be avoided. B. Insulin may be needed with a diabetic diet if diabetes mellitus develops. C. Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. D. Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.
C The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed, because they are malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but there is no longer a diabetic diet and this is not priority information at this time. DIOS develops in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution (MiraLax) to thin bowel contents.
The nurse determines that a 61-year-old patient with chronic bronchitis has a nursing diagnosis of "impaired gas exchange," after noting an oxygen saturation of 88%. What is an appropriate intervention to add to the care plan? A. Obtain an arterial blood gas (ABG) B. Place the patient in the prone position to increase postural drainage C. Sit the patient upright in a chair leaning slightly forward D. Administer 6 L oxygen via nasal cannula
C The patient with chronic bronchitis can engage in better gas exchange in an upright position leaning slightly forward. Once the patient's oxygen increases, the nurse may obtain an ABG, if requested by the health care provider. Placing the patient in a prone position would further impair gas exchange. Six liters of oxygen is too much oxygen for a patient with chronic bronchitis.
The nurse administering beclomethasone to a patient can help reduce side effects by instructing the patient to perform which action? A. Use this medication only as needed B. Avoid use of a spacer to increase the amount of medication absorption C. Rinse mouth thoroughly after each use D. Use the inhaler at the onset of an asthma attack
C 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.
The nurse is caring for the patient with chronic obstructive pulmonary disease (COPD). The nurse will include in the patient plan of care: A. Encourage the patient to perform mild exercises 60 minutes before eating B. Tell the patient to avoid taking bronchodilators before meals C. Teach the patient to discontinue oxygen while eating D. Advise the patient to rest at least 30 minutes before eating
D 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.
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? A. Cachexia B. Osteoporosis C. Metabolic syndrome D. Cardiovascular disease
D 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.
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? A. Advise maintaining control of asthma symptoms. B. Follow up after a month. C. Reevaluate in two to six weeks. D. Consider oral corticosteroids.
D 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 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? A. Niox Mino test B. Allergy skin test C. Lung function test D. Sputum culture test
D 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.
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: A. 90 beats/minute B. 100 beats/minute C. 110 beats/minute D. 120 beats/minute
D 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.
A patient with emphysema is receiving oxygen at 1 L/min by way of nasal cannula. The nurse understands that this prescription is appropriate because: The patient does not require more than 1 L of oxygen High concentrations of oxygen may rupture the alveoli Oxygen is the natural stimulus for breathing and not required High concentrations of oxygen eliminate the respiratory drive
D Patients with emphysema become accustomed to a high level of carbon dioxide and low level of oxygen. This situation reverses the natural breathing stimulus. A low oxygen level then becomes the stimulus for breathing, and too much oxygen will eliminate the stimulus to breathe. There is not enough information to determine that the patient does not need more than 1 L of oxygen. A high concentrations of oxygen does not rupture alveoli. In healthy individuals, increased carbon dioxide, not oxygen, is the stimulus for breathing.
Infection can be a major hazard of O2 administration. Heated nebulizers present the highest risk. The most common organism found is: A. Rickettsia prowazekii B. Clostridium perfringens C. Bordatella pertussis D. Pseudomonas aeruginosa
D 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.
The patient has a prescription to receive methylprednisolone sodium succinate 150 mg intravenous (IV) push stat. Available is a solution containing 60 mg/mL. How many mL of methylprednisolone should the nurse administer? A. 1.25 mL B. 1.75 mL C. 2 mL D. 2.5 mL
D VUsing ratio and proportion, multiply 60 by x and multiply 150 × 1 to yield 60x = 150. Divide 150 by 60 to yield 2.5 mL.
