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Which instruction should be included in teaching a patient with chronic obstructive pulmonary disease (COPD) how to self-administer ipratropium via a metered-dose inhaler (MDI)?

"Breathe out slowly before positioning the inhaler."

The nurse is conducting a health history interview with a patient diagnosed with chronic obstructive pulmonary disease (COPD). Which question is appropriate when assessing the patient's nutritional-metabolic pattern?

"Have you lost any weight recently?"

After the nurse has completed diet and nutrition teaching for a patient with chronic obstructive pulmonary disease (COPD), which patient statements indicate effective learning? Select all that apply.

"I should avoid beans and cabbage." "I can enjoy eating more cold foods and desserts." "I am glad I can have a peanut butter and jelly sandwich at lunch every day."

After the nurse has completed teaching a patient with severe chronic obstructive pulmonary disease (COPD) how to conserve energy and improve nutrition, which patient statement indicates the need for further teaching?

"I will perform deep-breathing and coughing exercises before meals."

Which patient statement indicates understanding of teaching about chronic obstructive pulmonary disease (COPD)?

"I'll report any change in the color of my sputum."

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

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." (Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status)

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

"Inflammation causes bronchoconstriction, hyperreactivity, and edema of the airways."

When a patient hospitalized with chronic obstructive pulmonary disease (COPD) asks the nurse whether oxygen use will be needed at home, which response by the nurse is best?

"You will qualify for supplemental oxygen therapy if your resting oxygen saturation drops to 88%."

The nurse collaborates with the health care team to arrange for home care for a patient with pulmonary tuberculosis (TB). Of the family members who live with the patient, which one is at the greatest risk for contracting the disease?

A 75-year-old parent who takes prednisone

The nurse is assessing a patient who is hospitalized with suspected tuberculosis (TB) and expects which initial manifestations? Select all that apply.

Dry cough that becomes productiveMalaiseLow-grade feverUnexplained weight loss (Rationale: Symptoms of pulmonary TB usually do not develop until 2 to 3 weeks after infection or reactivation. The primary manifestation is an initial dry cough that often becomes productive with mucoid or mucopurulent sputum. Active TB disease may initially present with constitutional symptoms (e.g., fatigue, malaise, anorexia, unexplained weight loss, low-grade fevers, night sweats). Dyspnea is a late symptom that may signify considerable pulmonary disease or a pleural effusion. Hemoptysis, which occurs in less than 10% of patients with TB, is also a late sign)

Which statement about influenza is true?

generalized myalgia occurs

When a patient is experiencing an acute asthma attack, how will the nurse position the patient?

high fowlers

the nurse determines appropriate transmission based precautions for several patients who are hospitalized with infections. a patient with which diagnosis requires droplet precautions? select all that apply

influenza A bacterial meningitis

Which classification of allergic rhinitis is consistent with symptoms that occur fewer than four days per week?

intermittent (Intermittent means that the symptoms are present fewer than four days per week or less than four weeks per year.)

The nurse assesses the severity of asthma symptoms reported by a patient. Based on the information in the chart, at which level would the nurse classify the patient's asthma?

mild persistent

A patient presents with a persistent runny nose, sneezing, and watery eyes. The patient also reports a recent onset of headache and nasal congestion. On further questioning, a nurse finds that the patient recently brought a cat home. What condition is the patient likely to have?

perennial rhinitis

A patient with asthma develops nausea, vomiting, headache, tachycardia, and dysrhythmias. The nurse would suspect which medication as the cause of the symptoms?

theophylline

When educating a patient about nonpharmacologic interventions to manage sinusitis, which instructions will the nurse include? Select all that apply.

use steam inhaler avoid exposure to smoke sleep with your head elevated

A patient is brought to the emergency department with chest tightness and acute dyspnea after an afternoon of gardening. As the nurse auscultates the patient's lungs, which finding would indicate a need for asthma testing?

wheezes

After initial treatment of a patient with an acute asthma exacerbation, which finding indicates improvement in the patient's respiratory function?

wheezing becomes louder

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

β 2 agonists

A patient is hospitalized with symptoms of tuberculosis (TB). The nurse recognizes that at least one of the sputum specimens for acid-fast bacilli (AFB) needs to be obtained at which time of the day?

6 am

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

Administering an albuterol bronchodilator

Which patient action when using albuterol and beclomethasone inhalers indicates a need for further teaching?

Administering the beclomethasone before the albuterol

When a patient is experiencing an asthma attack, which prescribed inhaler will the nurse have the patient use first?

Albuterol

Which inhaler would the nurse be prepared to administer to the patient at the onset of an asthma attack?

Albuterol

When caring for a patient diagnosed with cor pulmonale, which finding will the nurse expect?

Ankle edema

While obtaining a health history for a patient with suspected tuberculosis (TB), the nurse expects which early signs or symptoms of the disease? Select all that apply.

Anorexia Fatigue Night sweats

Which factors are possible triggers for asthma exacerbations? Select all that apply.

Aspirin Perfumes Animal dander Gastroesophageal reflux disease (GERD)

Which action will the nurse take to evaluate whether an asthmatic patient's prescribed ipratropium has been effective?

Auscultate lungs for wheezing.

The nurse is caring for a patient with a diagnosis of active tuberculosis (TB) and anticipates that which item will be included in the patient's treatment plan?

Avoid alcohol because it increases the hepatotoxicity associated with isoniazid (INH).

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

Avoid food irritants. Avoid animals with fur. Identify personal triggers.

Which findings will the nurse expect when assessing a clinic patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.

Barrel chest on inspection Wheezes on auscultation

Which parameter is most important to monitor for the patient who has been started on prednisone for an asthma exacerbation?

Breath sounds (Rationale: Because the patient is receiving an oral corticosteroid because of asthma exacerbation, the highest priority is to monitor for improvement in respiratory function. Corticosteroids may increase appetite and oral intake will be monitored, but the higher priority is assessment of respiratory status.)

The nurse assesses a patient with wheezing and dyspnea and determines that these symptoms are related to which pathophysiologic feature asthma?

Bronchoconstriction

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

Cor pulmonale (Rationale: Cor pulmonale is a right-sided heart failure caused by resistance to right-ventricular outflow resulting from lung disease; clinical manifestations include jugular venous distention and pedal edema.)

Which manifestations would the nurse identify with asthma? Select all that apply.

Cough Wheezing Chest tightness

Which factor on this patient's health history is a known trigger for asthma attacks?

Gastroesophageal reflux

Administration of the seasonal influenza vaccine would be contraindicated for the older adult with which condition?

Hypersensitivity to eggs

Which interprofessional treatment will the nurse anticipate being prescribed first for a patient who is seen in the emergency department for an asthma attack and has not improved after administration of albuterol?

IV methylprednisolone (Rationale: Systemic corticosteroids like IV methylprednisolone speed the resolution of asthma exacerbations and are indicated if the initial response to the short-acting β 2-adrenergic agonist bronchodilator is insufficient.)

Which factor causes the clinical manifestations of chronic obstructive pulmonary disease (COPD)?

Inability to effectively expire air

When the nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) exacerbation who requires oxygen administration, which assessment finding is of most concern?

Increased lethargy

To prevent respiratory complications of chronic obstructive pulmonary disease, which vaccines will the nurse plan to administer? Select all that apply.

Influenza Pneumococcal

A healthy 70-year-old patient asks the nurse, "Which types of vaccinations are recommended for people my age?" Which vaccinations should the nurse suggest? Select all that apply.

Influenza Pneumonia

A patient with a 10-year history of regular (three beers per week) alcohol consumption began taking rifampin to treat tuberculosis (TB). During a follow-up visit one week after starting the medication, the patient tells the nurse, "In the last week, my urine turned orange, and I am very worried about it." How does the nurse respond?

Inform the patient that it is one of the side effects of the medication. (Rationale: A nurse should be aware of some of the common side effects of antitubercular drugs like rifampin, one of which is orange discoloration of body fluids such as urine, sweat, tears, and sputum. It may also cause hepatitis.)

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

Instruct the child to bend forward slightly.

A patient's initial purified protein derivative (PPD) skin test result is positive. A repeat skin test is also positive. No signs or symptoms of tuberculosis or allergies are evident. Which medication therapy does the nurse anticipate will be prescribed?

Isoniazid (INH) (Rationale: The standard treatment regimen for latent tuberculosis infection (LTBI) is nine months of daily isoniazid. It is an effective and inexpensive drug that the patient can take orally.)

A patient who has tuberculosis (TB) is being treated with combination drug therapy. The nurse explains that combination drug therapy is essential for which reason?

It discourages the development of resistant strains of the TB organism.

The school nurse will include which teaching to high school students to prevent the transmission of influenza? Select all that apply.

Obtain an influenza vaccination.Stay at home when symptomatic.Cover the nose and mouth when coughing.

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

Pneumonia Cor pulmonale Exacerbations

Which diagnostic findings will the nurse expect when caring for a patient who is experiencing worsening of asthma symptoms? Select all that apply.

Positive skin test for allergens Serum and sputum eosinophilia Chest x-ray indicating hyperinflation Rationale: Asthma is frequently triggered due to allergens; therefore patients frequently will have positive skin testing for allergens. Eosinophils increase with allergic reactions; since asthma is an inflammatory process, an increase in serum and sputum eosinophil count is expected. Air trapping with asthma leads to lung hyperinflation, which may be noted on the chest x-ray. Since allergic reactions are medicated by IgE, patients with asthma frequently have elevated IgE levels, leading to more hyper-responsive airways. Oxygen saturation will decrease because of airway inflammation and bronchospasm during an asthma attack.

How does the nurse correlate an asthma exacerbation with sinusitis?

Postnasal drip in sinusitis can exacerbate asthma.

Which description best characterizes chronic obstructive pulmonary disease (COPD)?

Progressive persistent expiratory airflow limitation

Which patient care goals are appropriate for a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.

Relief of symptoms Improved quality of life Prevention of disease progression Ability to perform activities of daily living (ADLs)

Which instruction will the nurse give to a patient who has a prescription for beclomethasone?

Rinse mouth thoroughly after each use.

A patient with inability to breathe through his nose who is assessed to find swelling of the nasal mucosa blocking the opening of the ostia may be experiencing which condition?

Sinusitis

Which intervention may improve gas exchange for a patient with chronic obstructive pulmonary disease (COPD) whose oxygen saturation is 88%?

Sit the patient upright in a chair leaning slightly forward.

Which intervention should be included in the plan of care for a patient who has lost 30 lb and has a nursing diagnosis of impaired nutritional status?

Suggest a high-calorie, high-protein diet with six small meals a day.

A patient with dyspnea and who is unable to speak clearly has a respiratory rate of 45 breaths/min, a pulse of 130 beats/min, oxygen saturation of 90%, and neck vein distention. Which treatment would the nurse expect to incorporate into the plan of care?

Supplementary oxygen through nasal cannulaThe patient with severe dyspnea is unable to speak and needs oxygen. Hence, select an option that will help relieve the patient's symptoms.

The nurse anticipates a diagnosis of sinusitis for a patient who reports a headache, nasal congestion, and fever for the past three days as indicated by which assessment findings? Select all that apply.

Swollen turbinates Edematous mucosa tenderness over the sinuses

what action should the nurse take when administering and reading the tuberculosis (TB) skin test

draw a diagram of the forearm and hand and label the injection site in the chart

The nurse recognizes that airborne infection isolation for a patient with pulmonary tuberculosis (TB) can be discontinued when which criterion is met?

Three consecutive acid-fast bacillus (AFB) smears are negative.

Which patient action may aggravate the acute sinusitis symptoms?

Use of phenylephrine for five days

The nurse is preparing a community education session related to the increased incidence of tuberculosis (TB) among the city's residents. The nurse identifies that which populations are most at risk for the disease? Select all that apply.

Workers at a nearby prison Adults who are homeless Middle-aged adults who live in the inner-city neighborhood Immigrants from an underdeveloped country who live in temporary housing in the city

a patient is admitted to a health care facility with a respiratory infection suspected to be caused by tuberculosis. which infection precaution?

airborne precautions

A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates incorporating which medication into the plan of care?

antibiotic

Which treatment plan medications would the nurse be prepared to administer to a patient hospitalized with allergic rhinitis? Select all that apply.

antihistamines, mast cell stabilizers, oral corticosteroids

Which clinical manifestation would alert the nurse to an early manifestation of an exacerbation of asthma in a patient brought to the emergency department following an automobile accident?

anxiety

A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. Which condition would the nurse associate with these manifestations?

asthma attack

Which of these is a clinical manifestation of early chronic obstructive pulmonary disease (COPD)?

chronic intermittent cough

The nurse provides education to a patient with asthma about how to take medication through a metered dose inhaler. Which action performed by the patient indicates effective learning?

cleans the device with water