Management of Respiratory Diseases

A patient has frequent attacks of difficulty breathing and wheezing. The nurse is teaching the caregiver about the proper way of positioning the patient to decrease the sense of panic during an attack. Which statement of the caregiver indicates the need for further teaching? 1) "I should make the patient lay in a side-lying position." 2) "I should ask the patient to perform abdominal breathing." 3) "I should ask the patient to purse the lips while breathing." 4) "I should make sure that the patient's environment is calm."

1) "I should make the patient lay in a side-lying position." Unlike a sitting position, a side-lying position does not provide for maximum chest expansion. Abdominal breathing will reduce the respiratory rate as deep breathing increases, which reduces the asthma attack. Pursed-lip breathing will help keep the airways open, which reduces the effect of asthma. A calm environment also helps reduce asthma attack. Test-Taking Tip: The patient is breathless, so the nurse should focus on easing the breath of the patient. You need to identify the intervention which may exacerbate the patient's condition.

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? 1) "I will keep my rescue inhaler with me at all times" 2) "I do not need to get a flu shot because I'm under age 50" 3) "I will use my peak flow meter only when I feel like I'm getting sick" 4) "I will use my corticosteroid inhaler only when I feel short of breath"

1) "I will keep my rescue inhaler with me at all times" 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.

Which nursing instructions would be beneficial to the patient who has shortness of breath, wheezing, and chest tightness? Select all that apply. 1) "You should avoid contact with furred animals." 2) "You should wash bed covers in hot water and detergent." 3) "You should avoid wearing masks in cold climate conditions." 4) "You should take aspirin when you have shortness of breath." 5 ) "You should take propanol when you have excess wheezing." 6) "You should ensure that the household does not have any cockroaches."

1) "You should avoid contact with furred animals." 2) "You should wash bed covers in hot water and detergent." 6) "You should ensure that the household does not have any cockroaches." Shortness of breath, wheezing, and chest tightness indicate that the patient has asthma. Fur acts as an irritant and increases the allergic reactions associated with asthma. Dust mites also trigger asthma, so the patient should wash bed covers with hot water and detergent because this reduces allergens. Danders such as cockroach remains and droppings trigger asthma. Propanol is a nonselective β-blocker that inhibits bronchodilation and should be avoided by patients with asthma. Cold climate conditions are an irritant that triggers asthma, so the patient should wear a mask or scarf in a cold environment. Aspirin precipitates attacks of asthma; therefore the patient should avoid taking aspirin.

The nurse determines that a patient is not experiencing the beneficial effects of ipratropium after noting which finding in the patient? 1) Expiratory wheezing 2) Elevated blood pressure 3) Increased low back pain 4) Hypoactive bowel sounds

1) Expiratory wheezing 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.

The nurse monitoring the peak flow meter reading of a patient with asthma documents that "The patient has 80 percent of his or her personal best number." Which instruction should the nurse give to the patient in this situation? 1) "You should take your medicines as usual." 2) "You may require an increase in dose of medication." 3) "You should take short-acting β-adrenergic agonists immediately." 4) "You require immediate attention of the primary health care provider."

1) "You should take your medicines as usual." The peak flow meter reading of 80 percent of his or her personal best number indicates that the patient is in the green zone of peak flow zone system and that the patient's asthma is under control. Therefore the nurse instructs the patient to take medications as usual. The patient who has a peak flow meter reading of 50 percent to 80 percent of his or her own personal best number will be in the yellow zone of peak flow zone system. This patient may require an increase in dose of the medication. The patient who has a peak flow meter reading less than 50 percent of his or her own personal best number will be in the red zone of peak flow zone system. The patient should be given a dose of short-acting β-adrenergic agonists immediately, which will require the immediate attention of the primary health care provider.

After assessing the peak flow meter readings of a patient with asthma, the nurse concludes that the patient should inhale quick relief medicine right away. What could be the peak flow number of the patient? 1) 40 percent of personal best number 2) 60 percent of personal best number 3) 75 percent of personal best number 4) 85 percent of personal best number

1) 40 percent of personal best number The patient with asthma whose peak flow meter reading is in the red zone or less than 50 percent of his or her personal best number is instructed to inhale a quick relief medicine immediately, which is a short-acting β-adrenergic agonist. Therefore the peak flow meter reading of the patient could be 40 percent of his or her personal best number. The patient who has a peak flow meter reading between 50 percent and 80 percent will require an increase in medication dosage, but not immediate treatment. Therefore the patient with a peak flow meter reading of 60 percent or 75 percent of his or her personal best number will not require immediate treatment. The patient with a peak flow meter reading of 85 percent of his or her personal best number is in the green zone of peak flow zone and does require any further change in the treatment strategy.

An adolescent who has a history of asthma experiences wheezing after vigorous exercise. What nursing instruction is helpful for this patient? 1) Advise the patient to avoid dry air 2) Encourage the patient to get exposure to cold air 3) Recommend the patient to continue vigorous exercise 4) Advise the patient to avoid swimming in indoor heated pools

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

Which inhaler should the nurse be prepared to administer to the patient at the onset of an asthma attack? 1) Albuterol 2) Fluticasone 3) Salmeterol 4) Fluticasone/Salmeterol

1) Albuterol 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 inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? 1) Albuterol 2) Salmeterol 3) Beclomethasone 4) Ipratropium bromide

1) Albuterol 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 patient is having an asthma attack, and is short of breath and appears frightened. The nurse understands that possible triggers for asthma exacerbations include which factors? Select all that apply. 1) Alcohol 2) Perfumes 3) Animal dander 4) Humid weather 5) Gastroesophageal reflux disease (GERD)

1) Alcohol 2) Perfumes 3) Animal dander 5) Gastroesophageal reflux disease (GERD) Alcohol, GERD, animal dander, perfumes, and cold weather (not humid) are all possible triggers for acute asthma exacerbations.

When teaching a patient with asthma about ways to reduce the severity of asthma and asthma attacks, which measures should be included? Select all that apply. 1) Avoid food irritants. 2) Avoid animals with fur. 3) Identify personal triggers. 4) Go out in the cold air for a walk. 5) Use nonsteroidal antiinflammatory drugs (NSAIDs).

1) Avoid food irritants. 2) Avoid animals with fur. 3) Identify personal triggers. Patients with asthma should be taught to avoid food irritants and animals with fur. Identifying personal triggers can help to avoid them. Going out in the cold air and the use of NSAIDs are not recommended, because they can precipitate an asthma attack.

The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? 1) Clear lung sounds 2) Heart rate 80 beats/minute 3) Capillary refill less than three seconds 4) Positive bowel sounds in all quadrants

1) Clear lung sounds 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.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? Select all that apply. 1) Exercise 2) Allergies 3) Emotional stress 4) Decreased humidity 5) Upper respiratory infections

1) Exercise 2) Allergies 3) Emotional stress 5) Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.

When teaching a patient about using a dry powder inhaler, what instructions should be included in this teaching? Select all that apply. 1) Increase the inspiration. 2) Slow down the inspiration. 3) Keep the device moisture-free. 4) Shake the inhaler well before use. 5) Avoid shaking the inhaler before use

1) Increase the inspiration. 3) Keep the device moisture-free. 5) Avoid shaking the inhaler before use With dry powder inhalers, there is no need to shake before use. Inspiration should be rapid, and the device should be kept moisture-free to protect the dry powder. Shaking the inhaler well before use and slow inspiration are actions performed when using metered-dose inhalers.

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do? 1) Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. 2) Use the flow meter each morning after taking medications to evaluate their effectiveness. 3) Increase the doses of the long-term control medication if the peak flow numbers decrease. 4) Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

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

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? 1) Less than 50% of the patient's personal best is achieved. 2) Peak flow measurements remain unchanged after exercise. 3) Wheezing is improved moderately with the use of a bronchodilator. 4) The short-acting bronchodilator is being used every three to four days.

1) Less than 50% of the patient's personal best is achieved. 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.

A nurse has taught the technique of pursed-lip breathing to a patient. During a return demonstration, what patient action requires correction? 1) Puffing of cheeks while exhaling air 2) Slow and deep inhalation through the nose 3) Slow exhalation through pursed lips, as if whistling 4) Exhalation time three times as long as inhalation time

1) Puffing of cheeks while exhaling air In pursed-lip breathing, the patient should avoid puffing of the cheeks while exhaling the air. Puffing of the cheeks makes the technique less effective. Slow and deep inhalation, slow exhalation through pursed lips as if whistling, and exhalation time thrice as long as inhalation time are correct techniques of pursed-lip breathing.

The nurse determines that the patient is not experiencing adverse effects of albuterol after noting which patient vital sign? 1) Pulse rate of 72 beats/minute 2) Temperature of 98.4° F 3) Oxygen saturation 96% 4) Respiratory rate of 18 breaths/minute

1) Pulse rate of 72 beats/minute Albuterol is a β2-adrenergic agonist that sometimes can cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as an adverse effect. Temperature, oxygen saturation, and respiratory rate do not reflect effects of albuterol.

The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct? 1) Sit in an upright position during the treatment 2) Take short, shallow breaths while inhaling the medication 3) Rinse the nebulizer equipment under running water once a week 4) During the treatment, breathe in and hold the breath for five seconds

1) Sit in an upright position during the treatment 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.

A patient who has a family history of α1-protease inhibitor deficiency reports fever of unknown cause, malaise, and cough associated with purulent sputum. Which test should the patient undergo regularly to assess the severity of the condition? 1) Spirometry 2) Liver enzyme tests 3) Renal hormone tests 4) Computerized tomography

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

A nurse observes a patient using a dry powder inhaler device. The nurse should correct which patient actions? Select all that apply. 1) The patient breathes into the inhaler. 2) The patient performs deep and quick breathing. 3) The patient shakes the medicine before using it. 4) The patient holds the breath for more than 10 seconds. 5) The patient inhales more than 1 puff with each inspiration.

1) The patient breathes into the inhaler. 3) The patient shakes the medicine before using it. 5) The patient inhales more than 1 puff with each inspiration. When using a dry powder inhaler, the patient should not breathe into the inhaler, because this affects the dosing. Inhaling more than one puff with each inspiration may cause waste of the medication. The patient should not shake the medicine before using it because it can alter the dosing. Deep and quick breathing is the proper technique, because it ensures that the medicine moves deep into the lungs. The patient should be encouraged to hold the breath beyond 10 seconds to help in penetration of the dry powder.

A smoker with forced expiratory volume in one second (FEV1) of 50 percent and arterial blood oxygen saturation less than 85 percent is referred for pulmonary rehabilitation (PR). Which interventions does the nurse anticipate will be part of the PR? Select all that apply. 1) Using the internet to deliver daily motivational messages 2) Planning the rehabilitation program for three consecutive weeks 3) Providing pulmonary care if the patient is unable to quit smoking 4) Considering pulmonary care as the last possible attempt to help the patient 5) Teaching exercises that focus on the muscles used for ambulation along with upper limb exercises

1) Using the internet to deliver daily motivational messages 5) Teaching exercises that focus on the muscles used for ambulation along with upper limb exercises PR is an evidence-based intervention that helps individualize treatment for each patient. It helps improve the quality of life of patients with severe chronic obstructive pulmonary disease (COPD) by intervening to improve exercise capacity and decrease hospitalization. PR uses an internet program to deliver daily motivational messages that are linked with individualized walking goals. It also helps the patient provide feedback related to pedometer use. PR provides exercise training to improve the patient's physical fitness. Exercise is also helpful in assessing unexpected changes in arterial blood gases. The PR plan lasts for six weeks, and many insurance plans pay for it; the longer the program, the more effective the results. Some rehabilitation programs refuse to take patients who are not committed to quitting smoking. PR should not be considered the last possible attempt to help a patient with severe pulmonary disorder.

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? 1) Venturi mask 2) Simple face mask 3) Non-rebreather mask 4) Laryngeal mask airway

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

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? 1) Wheezing becomes louder. 2) Cough remains nonproductive. 3) Vesicular breath sounds decrease. 4) Aerosol bronchodilators stimulate coughing

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

Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)? 1) β 2 agonists 2) Anticholinergics 3) Massage and postural drainage techniques 4) Oxygen supplementation through a nasal mask

1) β 2 agonists β2 agonists may cause restlessness and insomnia in patients with COPD. Anticholinergics are not associated with insomnia. Massage and postural drainage techniques will not lead to insomnia and restlessness. Oxygen supplementation through a nasal mask will not cause restlessness and insomnia.

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? 1) "I should advise the patient to eat more cabbage, beans, and cauliflower." 2) "I should advise the patient to avoid smoking and occupational exposure to irritants." 3) "I should advise the patient to breathe rapidly while performing effective Huff coughing." 4) "I should advise the patient to avoid high-calorie foods like butter, cheese, and margarine."

2) "I should advise the patient to avoid smoking and occupational exposure to irritants." 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? 1) "I will pay less for medication because it will last longer." 2) "More of the medication will get down into my lungs to help my breathing." 3) "Now I will not need to breathe in as deeply when taking the inhaler medications." 4) "This device will make it so much easier and faster to take my inhaled medications."

2) "More of the medication will get down into my lungs to help my breathing." 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.

What would be the appropriate nursing intervention for the patient whose laboratory report shows oxygen saturation of 45 mm Hg and carbon dioxide saturation of 60 mm Hg? 1) Advise the patient to move to a higher-altitude location. 2) Advise the patient to plan sexual activity during the early afternoon. 3)Advise the patient to walk for 30 minutes daily, breathing through the nose. 4) Administer β-adrenergic agonists, as prescribed, immediately after exercise.

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

A patient presents to the emergency department with acute exacerbation of asthma. What actions should the nurse perform to monitor the patient's respiratory and cardiovascular systems? Select all that apply. 1) Take a chest radiograph 2) Auscultate the lung sounds 3) Check the patient's temperature 4) Measure blood pressure and respiratory rate 5) Monitor arterial blood gases (ABGs) and pulse oximetry

2) Auscultate the lung sounds 4) Measure blood pressure and respiratory rate 5) Monitor arterial blood gases (ABGs) and pulse oximetry It is essential to monitor respiratory and cardiovascular systems in case of acute exacerbation of asthma. Auscultating lung sounds, measuring blood pressure and respiratory rate, and monitoring ABGs and pulse oximetry are required to monitor these systems. Chest radiographs are seldom useful in the management of an acute asthma attack. Checking the temperature may not contribute to monitoring respiratory and cardiovascular systems.

A patient with an acute attack of asthma is in a state of panic. Which nursing measures help to relieve the panic? Select all that apply. 1) Use sedation 2) Be calm, quiet, and reassuring 3) Encourage pursed-lip breathing 4) Utilize a "walking down" technique 5) Utilize the "talking down" technique

2) Be calm, quiet, and reassuring 3) Encourage pursed-lip breathing 5) Utilize the "talking down" technique Pursed-lip breathing keeps the airways open, slows down the respiratory rate, and encourages deep breathing. "Talking down" is a technique that helps to calm the patient. A calm, quiet, and reassuring nurse helps to pacify the patient. Use of sedatives should not be encouraged, because they may cause respiratory depression. There is no technique called "walking down."

What is the most appropriate time to obtain peak flow readings with the best peak flow number? 1) Five minutes after meals 2) Between noon and 2 PM 3) Early in the morning on an empty stomach 4) Two hours after inhaling a short-acting B2-agonist

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

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? 1) Follow up after a month 2) Consider oral corticosteroids 3) Reevaluate in two to six weeks 4) Advise maintaining control of asthma symptoms

2) Consider oral corticosteroids 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.

The nurse teaches a 61-year-old patient with emphysema and pneumonia to obtain which vaccines? Select all that apply. 1) Tetanus 2) Influenza 3) Hepatitis B 4) Pneumococcal 5) Bacille Calmette-Guerin (BCG)

2) Influenza 4) Pneumococcal The pneumococcal and influenza vaccines are important for patients with a history of heart or lung disease and those recovering from a severe illness, age 65 or over, or living in a long-term care facility. Tetanus, BCG, and hepatitis B vaccines are not recommended for patients to protect the lungs from additional damage, although they may be required for other reasons.

The nurse is evaluating if a patient understands how to determine safely whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler? 1) Place it in water to see if it floats. 2) Keep track of the number of inhalations used. 3) Shake the canister while holding it next to the ear. 4) Check the indicator line on the side of the canister.

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

Which intervention is beneficial to a patient with chronic obstructive pulmonary disease (COPD)? 1) Avoiding cold foods 2) Limiting fluids during mealtimes 3) Avoiding frequent meals and snacks 4) Performing physical activity before meals

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

A patient has hyperventilation, dyspnea, nasal flaring, anxiety, and pursed-lip breathing. The nurse concludes that the patient has an ineffective breathing pattern due to alveolar hypoventilation. Which interventions should the nurse implement for this patient to promote safe and effective care? Select all that apply. 1) Avoid giving bronchodilators. 2) Monitor for respiratory muscle fatigue. 3) Encourage slow, deep breathing and coughing. 4) Elevate the head of the bed and provide an overbed table for the patient. 5) Provide factual information concerning diagnosis, treatment, and prognosis.

2) Monitor for respiratory muscle fatigue. 3) Encourage slow, deep breathing and coughing. 4) Elevate the head of the bed and provide an overbed table for the patient. A patient with an ineffective breathing pattern has alveolar hypoventilation. The nurse must monitor the patient for respiratory muscle fatigue to determine the need for ventilation. The nurse should encourage the patient to breathe slowly and deeply and to cough, mobilizing pulmonary secretions for effective airway clearance. The nurse should elevate the head of the patient's bed and provide an overbed table to reduce respiratory efforts. Bronchodilators should be administered because they help increase the gas exchange. The nurse should provide factual information concerning diagnosis, treatment, and prognosis to a patient with anxiety-related breathlessness.

Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Select all that apply. 1) Atelectasis 2) Pneumonia 3) Cor pulmonale 4) Mucoid impact 5) Exacerbations

2) Pneumonia 3) Cor pulmonale 5) Exacerbations The patient with chronic obstructive pulmonary disorder (COPD) may develop complications such as pneumonia, cor pulmonale, and exacerbations of COPD, which require acute interventions. After the crisis is resolved, the patient has to undergo assessment for the degree and severity of the underlying respiratory problem. This information helps the nurse plan a better care plan. Atelectasis and mucoid impact are complications of asthma.

The nurse administering beclomethasone to a patient can help reduce side effects by instructing the patient to perform which action? 1) Use this medication only as needed 2) Rinse mouth thoroughly after each use 3) Use the inhaler at the onset of an asthma attack 4) Avoid use of a spacer to increase the amount of medication absorption

2) Rinse mouth thoroughly after each use 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 patient has a prescription for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. Calculate how many mL the nurse should use to prepare the patient's dose. Fill in the blank using one decimal place. __ mL

2.5 mL

The patient is receiving 3 L of oxygen (O2) via nasal cannula. Which action by the nurse is most appropriate? Select all that apply. 1) Assesses eyes for dryness 2) Realizes that humidification is never needed 3) Adjusts humidification according to patient comfort 4) Assesses the bubble-through humidifier if humidity is used 5) Assures that the patient is wearing the nasal cannula correctly

3) Adjusts humidification according to patient comfort 4) Assesses the bubble-through humidifier if humidity is used 5) Assures that the patient is wearing the nasal cannula correctly Assessing the bubble-through humidifier if humidity is used, assuring that the patient is wearing the nasal cannula correctly, and adjusting humidification according to patient comfort are correct because oxygen (O2) obtained from cylinders or wall systems is dry. Dry O2 has an irritating effect on mucous membranes and dries secretions. A common device used for humidification when the patient has a cannula or a mask is a bubble-through humidifier. It is important for the nurse to assess the bubble-through humidifier if humidity is used to make sure the humidification is on. This adds to the comfort of the patient. The nurse assesses the patient to make sure the nasal cannula is worn correctly for optimal effect. The cannula can become easily dislodged. Humidification is adjusted according to the patient's comfort level. When oxygen levels are 1 to 4 L, the use of humidification may not be the preference of all patients. Believing that humidification is never needed is incorrect because the use of humidification is a patient preference. The nurse should assess the patient's nose for dryness, not the eyes.

A patient presents with acute exacerbation of asthma. The nurse expects which strategies will be included in the treatment plan? Select all that apply. 1) Administration of sedatives 2) Administration of antibiotics 3) Administration of 100% oxygen 4) Intravenous administration of corticosteroids 5) Nebulization with short-acting β2-adrenergic agonists (SABAs)

3) Administration of 100% oxygen 4) Intravenous administration of corticosteroids 5) Nebulization with short-acting β2-adrenergic agonists (SABAs) Acute exacerbation of asthma may be life-threatening and needs immediate intervention. Administering 100% oxygen helps to relieve hypoxia and improve tissue oxygenation. Nebulization with SABA helps to relax the airways and promote airflow. Corticosteroids are administered to blunt the hyperactive immune response. Sedatives should be avoided as they may depress the respiratory center and worsen dyspnea. Antibiotics are not administered unless there are symptoms of pneumonia.

Which nursing intervention will the nurse include in the teaching plan for a patient with difficulty in breathing due to low oxygen level in the blood? 1) Suggest that the patient breathe slowly with an open mouth. 2) Advise the patient to refrain from sexual activity after eating. 3) Ask the patient to plan sexual activity during the late afternoon. 4) Suggest that the patient choose the missionary position during intercourse.

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

The nurse identifies the nursing diagnosis of "ineffective airway clearance" for a 58-year-old patient with asthma. The nurse should assess for which common etiologic factor for this nursing diagnosis? 1) Anxiety 2) Hypoxia 3) Bronchospasm 4) Adventitious breath sounds

3) Bronchospasm Asthma is the result of airway narrowing and inflammation, evidenced by bronchospasm. Anxiety, hypoxia, and adventitious breath sounds may occur as a result of bronchospasm; they are not causes of asthma exacerbation.

The nurse would monitor which comorbidity in the patient treated for an asthma exacerbation with methylprednisolone? 1) Hyperlipidemia 2) Hypothyroidism 3) Diabetes mellitus 4) Raynaud's phenomenon

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

The nurse is caring for a patient with an oxygen saturation of 45 percent of personal best who stops breathing while sleeping and has a tendency to sleep during the day. Which intervention by the nurse will help the patient most while recovering? 1) Advise the patient to walk for 30 minutes. 2) Encourage the patient to drink more fluids at mealtime. 3) Encourage the patient to use typed messages to communicate. 4) Ask the patient to speak continuously in sentences by taking deep breaths.

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

In which position is it most appropriate for the nurse to place a patient experiencing an asthma exacerbation? 1) Supine 2) Lithotomy 3) High-Fowler's 4) Reverse Trendelenburg

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

Which intervention by the nurse would be most appropriate for safe and effective care for a patient with expiratory airflow obstruction, ineffective cough, decreased airway humidity, and abnormal breath sounds? 1) Monitor for respiratory muscle fatigue. 2) Set up oxygen equipment and administer oxygen through a heated, humidified system. 3) Instruct the patient to inhale deeply, bend forward slightly, and perform three or four huffs. 4) Auscultate breath sounds to assess the areas of decreased ventilation and the presence of adventitious sounds.

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

Which delivery device is used for long-term oxygen therapy? 1) Nasal cannula 2) Simple face mask 3) Oxygen-conserving cannula 4) Partial and non-rebreather masks

3) Oxygen-conserving cannula An oxygen-conserving cannula is generally indicated for long-term therapy at home or during hospitalization. A nasal cannula is used for patients requiring low oxygen concentrations. A simple face mask is used only for short periods because longer use is typically not tolerated. Partial and non-rebreather masks are useful for short-term therapy in patients needing higher O2 concentrations.

Which diagnostic findings indicate that a patient has asthma? Select all that apply. 1) Decrease in serum IgE 2) Increase in oxygen saturation 3) Positive skin test for allergens 4) Serum and sputum eosinophilia 5) Chest x-ray indicating hyperinflation

3) Positive skin test for allergens 4) Serum and sputum eosinophilia 5) Chest x-ray indicating hyperinflation Asthma is usually triggered due to allergens; therefore, the patient will have a positive skin test for allergens. Eosinophils are a type of white blood cells that help defend the body from inflammation. The patient with asthma will have acute inflammation, which results in an increase of eosinophils in serum and sputum. The patient with asthma has shortness of breath, which results in hyperinflation of the lungs. Therefore the chest x-ray shows hyperinflation. IgE antibodies bind to allergens that cause inflammation. Therefore the patient with asthma will have high serum IgE levels. Patients with asthma have breathlessness, which reduces oxygen concentration in the lungs. Therefore the patient will have a decrease of oxygen saturation.

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? 1) Hold the inspiration for 10 seconds 2) Breathe rapidly between forced breaths 3) Sit in an upright position during the treatment 4) Do not cough after the nebulization treatment

3) Sit in an upright position during the treatment 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.

To promote airway clearance in a patient with pneumonia and asthma, the nurse instructs the patient to perform which action? 1) Perform pursed-lip breathing 2) Wear supplemental oxygen at all times 3) Sit upright while using the flutter device 4) Use the incentive spirometer 10 times per hour

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

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β2-adrenergic agonists bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? 1) Biofeedback therapy 2) Intravenous (IV) fluids 3) Systemic corticosteroids 4) Pulmonary function testing

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

The nurse determines that a patient is experiencing the most common adverse effect of albuterol after noting which sign? 1) Diarrhea 2) Headache 3) Tachycardia 4) Oral candidiasis

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

A patient has had chronic obstructive pulmonary disease (COPD) for three months. Further assessment reveals that forced expiratory volume in one second (FEV1) is 65 percent. Which treatment option would be most appropriate for this patient? 1) Treatment with salmeterol 2) Treatment with budesonide 3) Treatment with albuterol and ipratropium combination 4) Treatment with budesonide and formoterol combination

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

The nurse determines that the patient has understood medication instructions about the use of a metered dose inhaler (MDI) when the patient performs which action? 1) Inhales rapidly when activating the inhaler 2) Holds the MDI sideways to increase ease of use 3) Waits one minute between each puff from the MDI 4) Breathes through the nose with activation of the MDI

3) Waits one minute between each puff from the MDI The patient should wait at least one minute in between puffs to increase medication dispersion throughout the lungs. The patient should inhale slowly, hold the MDI upright, and breathe through the mouth.

The health care provider has prescribed an inhaled corticosteroid for the patient with asthma. The nurse should provide which instructions to the patient regarding the use of a dry powder inhaler (DPI)? 1) "Shake the canister vigorously before use." 2) "Keep your inhaler in a warm, humid room to prevent crystallization." 3) "Keep your mouth open slightly to increase dispersion of the medication." 4) "Hold your breath for at least 10 seconds to increase medication absorption by your lungs."

4) "Hold your breath for at least 10 seconds to increase medication absorption by your lungs." The patient should hold the breath for as long as possible to increase the amount of medication absorbed by the lungs. The DPI should not be shaken and should be stored in a cool area, and the patient's mouth should be closed tightly around the mouthpiece of the inhaler.

A patient is learning to use a metered-dose inhaler (MDI). Which statement by the patient indicates the need for additional teaching? 1) "I will shake the canister before use." 2) "I will hold my breath for as long as I can after inhalation." 3) "I should wait at least one minute between puffs of medication." 4) "I should avoid using a spacer with this inhaler because it is ineffective."

4) "I should avoid using a spacer with this inhaler because it is ineffective." A spacer should be avoided with dry powder inhalers; they are helpful to use with MDIs. Metered dose inhalers require shaking of the canister, the breath should be held to increase absorption of the medication into the lungs, and the patient should wait one to two minutes between puffs.

The nurse is teaching a patient pursed-lip breathing (PLB). What instructions by the nurse are correct? 1) "Inhale slowly and deeply through your mouth." 2) "During exhalation, relax your facial muscles and puff out your cheeks." 3) "Only use this action after any activity that causes you to be short of breath." 4) "Make breathing out (exhalation) three times longer than breathing in (inhalation)."

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

The patient with asthma asks the nurse, "How will I know when my inhaler is empty?" What is the best response by the nurse? 1) "The canister will float in water" 2) "There will be no sound when shaking the canister" 3) "Your wheezing will not improve despite inhaler use" 4) "You need to keep track of how many puffs you have used and how many puffs are available"

4) "You need to keep track of how many puffs you have used and how many puffs are available" Show the patient how to determine how many puffs are available in the canister. Then teach the patient to document each time a puff is used. It is important to teach the patient this simple way to check the inhaler. The canister may or may not produce a sound when shaking. Floating the canister in water used to be recommended, but is no longer recommended because water can enter the chamber. It is not reasonable to wait for the patient's wheezing to worsen before getting a new inhaler.

The nurse is educating a patient who was recently diagnosed with asthma about the use of a peak flow meter. Which statement is the nurse's priority? 1) "The peak flow meter should be used weekly." 2) "The peak flow meter reduces asthma attacks." 3) "The peak flow meter should be used before the use of an inhaler." 4) "You should find your personal best peak flow reading for comparison."

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

The licensed practical nurse is caring for a chronic obstructive pulmonary disease (COPD) patient who has severe hypoxemia. The primary health care provider prescribed oxygen administration for this patient. Which intervention can the nurse perform for the patient? 1) Teach about home oxygen use. 2) Provide a high amount of oxygen. 3) Provide a continuous supply of oxygen. 4) Adjust the oxygen flow rate depending on the desired oxygen level.

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

The nurse concludes that interventions carried out to promote airway clearance in a patient admitted with asthma are successful on the basis of which finding? 1) Absence of wheezing 2) Oxygen saturation 96% 3) Use of accessory muscles 4) Clearance of mucous from the bronchi

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

A patient with allergic asthma has been prescribed omalizumab. The patient requests that the medication be administered at home for convenience. Which nursing action is appropriate in this case? 1) Administer the injection to the patient on a home visit. 2) Ask a family member to administer the medication at home. 3) Load the injection and provide it to the patient for self-administration. 4) Explain to the patient that the medication should be administered strictly at the clinic.

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

An asthmatic patient was prescribed theophylline. A nurse understands that the patient is at risk for tachycardia and seizures. In regard to safety, the nurse expects that what will be included on the patient's treatment plan? 1) Encourage the use of caffeine 2) Use diazepam to prevent seizures 3) Monitor serum blood levels of adrenaline 4) Monitor serum blood levels of theophylline

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

Which measure should a patient with chronic obstructive pulmonary disorder (COPD) take when performing physical activity? 1) Walk briskly or bicycle with pursed lips. 2) Exhale while at rest and inhale while pushing. 3) Administer beta agonists immediately after exercise. 4) Remember to think about steps and breathing while walking.

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

The nurse is teaching energy conservation techniques to a patient with severe dyspnea and oxygen saturation of 50 mm Hg. Which action of the patient indicates effective learning? 1) Standing up while performing activities 2) Using diaphragm muscles to breathe deeply 3) Inhaling a lot of air while exerting effort and exhaling at rest 4) Using a tripod posture and placing the mirror on the table while using an electric razor

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

An asthmatic patient has been prescribed 4 puffs of salmeterol daily. The canister of the meter dose inhaler has 200 puffs. The nurse instructs the patient that the canister will be empty and will need to be replaced in how many days? Record your answer using a whole number. __ days

50 days