CH 31 obstructive pulmonary diseases

A

A 30-year-old patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which topic would the nurse plan to teach the patient? A. alpha 1-Antitrypsin testing B. Leukotriene modifiers C. Use of the nicotine patch D. Continuous pulse oximetry

A

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction would the nurse include in the discharge teaching? A. O2 use can improve the patient's quality of life. B. Travel is not possible with the use of O2 devices. C. O2 flow should be increased if the patient has more dyspnea. D. Storage of O2 requires large metal tanks that last 4 to 6 hours.

b

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action would the nurse take? a. Teach the patient signs of hypoglycemia. b. Have the patient add dietary salt to meals. c. Suggest decreasing intake of dietary fat and calories. d. Teach the patient about pancreatic enzyme replacement.

D

A patient newly diagnosed with asthma is being discharged. Which topic would the nurse include in the discharge teaching? A. Complications associated with O2 therapy B. Use of long-acting -adrenergic medications C. Side effects of sustained-release theophylline D. Self-administration of inhaled corticosteroids

B

A patient seen in the asthma clinic has recorded daily peak flowrates that are 70% of the baseline. Which action will the nurse plan to take next? A. Teach the patient about the use of oral corticosteroids. B. Administer a bronchodilator and recheck the spirometry. C. Recommend increasing the dose of the leukotriene inhibitor. D. Instruct the patient to keep the scheduled follow-up appointment.

a

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment would the nurse complete first? A. Listen to the patient's breath sounds. B. Ask about inhaled corticosteroid use. c. Determine when the dyspnea started. d. Measure forced expiratory volume (FEV) flow rate.

a

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action would the nurse take first? A. Notify the health care provider. B. Document changes in respiratory status. C. Encourage the patient to cough and deep breathe. D. Administer IV methylprednisolone (Solu-Medrol).

C

A patient with chronic obstructive pulmonary disease (COPD) has been eating very little and has lost weight. Which intervention would be most important for the nurse to include in the plan of care? A. Encourage increased intake of whole grains. B. Increase the patient's menu order of fruits and fruit juices. C. Offer high-calorie protein snacks between meals and at bedtime. D. Assist the patient in choosing foods with high vegetable content.

C

A patient with cystic fibrosis has blood glucose levels that are consistently between 180 to 250 mg/dL. Which action will the nurse expect to implement? A. Discuss the role of diet in blood glucose control. B. Evaluate the patient's use of pancreatic enzymes. C. Teach the patient about administration of insulin. d. D. Give oral hypoglycemic medications before meals.

B

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which patient problem would the nurse identify? A. Fear of death B. Low self-esteem C. Anticipatory grieving D. Lack of knowledge

B

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering trying to become pregnant. Which initial response would the nurse provide? a. "Are you aware of the normal lifespan for patients with CF?" b. "Would like more information to help you with that decision?" c. "Y ou should have genetic counseling before making that choice." d. "Many women with CF do not have difficulty conceiving children."

D

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention would the nurse include in the plan of care? a. Schedule a sweat chloride test. b. Arrange for a hospice nurse visit. c. Place the patient on a low-sodium diet. d. Perform chest physiotherapy every 4 hours.

C

The nurse teaches a patient who has asthma about peak flowmeter use. Which action by the patient indicates that teaching was successful? A. The patient inhales rapidly through the peak flowmeter mouthpiece. B. The patient takes montelukast (Singulair) for peak flows in the red zone. C. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone. D. The patient calls the health care provider when the peak flow is in the green zone.

B

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action would the nurse take first? A. Tell the patient to go to the hospital emergency department. B. each the patient to use the prescribed albuterol (Ventolin HFA). C. Ask about recent exposure to any new allergens or asthma triggers. D. Question the patient about use of the prescribed inhaled corticosteroids.

A

The emergency department nurse is evaluating the outcomes for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? A. O2 saturation is >90%. B. No wheezes are audible. C. Respiratory rate is 16 breaths/min. D. Accessory muscle use has decreased.

B

The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which action would the nurse implement for a patient who has an impaired breathing pattern due to anxiety? A. Titrate O2 to keep saturation at least 90%. B. Teach the patient how to use the pursed-lip technique. C. Discuss a high-protein, high-calorie diet with the patient. D. Suggest the use of over-the-counter sedative medications.

B

The home health nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching? A. The patient lies in supine position when using the nebulizer. B. The patient removes the facial mask when the misting stops. C. The patient reports washing the nebulizer mouthpiece weekly. D. The patient inhales while holding the mask 4 inches away from the face.

D

The nurse completes an admission assessment on a patient with asthma. Which information indicates a need for discussion with the health care provider about a change in therapy? A. The patient uses an albuterol inhaler before aerobic exercise. B. The patient's only medications are albuterol and salmeterol inhalers. C. The patient's heart rate increases slightly after using the albuterol inhaler. D. The patient used albuterol more often when symptoms were worse in the spring.

C

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care? A. Walk until pulse rate exceeds 130 beats/min. B. Stop exercising when you feel short of breath. C. Walk 15 to 20 minutes a day at least 3 times/wk. D. Limit exercise to activities of daily living (ADLs).

a

The nurse in the emergency department receives arterial blood gas results for 4 recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse? A. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg B. pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg C. pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg D. pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

C

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is specific in confirming a diagnosis of chronic bronchitis? A. The patient relates a family history of bronchitis. B. The patient has a 30 pack-year cigarette smoking history. C. The patient reports a productive cough for 3 months of every winter. D. The patient has respiratory problems that began during the past 12 months.

B

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How would the nurse determine the appropriate O2 flowrate? A. Minimize O2 use to avoid O2 dependency. B. Maintain the pulse oximetry level at 90% or greater. C. Administer O2 according to the patient's level of dyspnea. D. Avoid administration of O2 at a rate of more than 2 L/min.

B

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective? a. "I will drink lots of fluids with my meals." b. "I can have ice cream as a snack every day." c. "I will exercise for 15 minutes before meals." d. "I will decrease my intake of beef and poultry."

B

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient would the nurse assess first? A. A patient with loud expiratory wheezes B. A patient with a respiratory rate of 38 breaths/min C. A patient who has a cough productive of thick, green mucus D. A patient with jugular venous distention and peripheral edema

B

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication would the nurse administer first? A. Methylprednisolone (Solu-Medrol) 60 mg IV B. Albuterol (Ventolin HFA) 2.5 mg per nebulizer C. Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI) D. Ipratropium (Atrovent) 2 puffs per metered-dose inhaler (MDI)

C

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy? A. The patient has chronic inflammatory bowel disease. B. The patient has a history of pneumonia 6 months ago. C. The patient takes propranolol (Inderal) for hypertension. D. The patient uses acetaminophen (Tylenol) for headaches.

B

The nurse teaches a patient who has chronic bronchitis about a new prescription for combined fluticasone and salmeterol (Advair Diskus) in a dry powder inhaler. Which patient action indicates to the nurse that teaching about medication administration has been successful? A.The patient shakes the device before use. B. The patient rapidly inhales the medication. C. The patient attaches a spacer to the device. D. The patient performs huff coughing after inhalation.

C

When preparing a clinic patient who has chronic obstructive pulmonary disease (COPD) for pulmonary spirometry, which question would the nurse ask? a. "Are you claustrophobic?" b.Are you allergic to shellfish?" c. "Have you taken any bronchodilators today?" d. "Do you have any metal implants or prostheses?"

A

Which action by the nurse would support ventilation for a patient with chronic obstructive pulmonary disease (COPD).? A. Encourage the patient to sit upright and lean forward. B. Have the patient rest with the head elevated 15 degrees. C. Place the patient in the Trendelenburg position with pillows behind the head. D. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed.

C

Which action would the nurse take to prepare a patient for spirometry? A. Give the rescue medication immediately before testing. B. Administer oral corticosteroids 2 hours before the procedure. C. Withhold bronchodilators for 6 to 12 hours before the examination. D. Ensure that the patient has been NPO for several hours before the test.

C

Which assessment finding for a patient with a history of asthma indicates that the nurse would take immediate action? A. Pulse oximetry reading of 91% B. Respiratory rate of 26 breaths/min C. Use of accessory muscles in breathing D. Peak expiratory flow rate of 240 L/min

B

Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? A. Pain at injection site B. Flushing and dizziness C. Respiratory rate 24 breaths/min D. Peak flow reading 75% of normal

B

Which assessment finding is most useful in evaluating the effectiveness of treatment to improve gas exchange? A. Even, unlabored respirations B. Pulse oximetry reading of 92% C. Absence of wheezes or crackles D. Respiratory rate of 18 breaths/min

A

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? A. Cough productive of bloody, purulent mucus B. Report of sharp chest pain with deep breathing C. Scattered crackles and wheezes heard bilaterally D. Respiratory rate 28 breaths/min while ambulating

C

Which finding would the nurse expect when assessing a patient with cor pulmonale? a. Chest pain B. Finger clubbing C. Peripheral edema D. Elevated temperature

D

Which information will the nurse include in the teaching plan for a patient newly diagnosed with asthma? A. Use the inhaled corticosteroid when shortness of breath occurs. B. Inhale slowly and deeply when using the dry powder inhaler (DPI). C. Hold your breath for 2 seconds after using the bronchodilator inhaler. D. Tremors are an expected side effect of rapidly acting bronchodilators.

C

Which instruction would the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)? a. "Avoidupperbodyexercisestopreventdyspnea." b. "Stop exercising if you start to feel short of breath." c. "Use the bronchodilator before you start to exercise." d. "Breathe in and out through the mouth while exercising."

A

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced assistive personnel (AP)? A. Measure O2 saturation using pulse oximetry. B. Monitor for increased O2 need with exercise. c. Teach the patient about safe use of O2 at home. D. Adjust O2 to keep saturation in prescribed parameters.