Chapter 28

Which nursing action for a patient with COPD could the nurse delegate to the UAP? a. obtain oxygen saturation using pulse oximetry b. monitor for increase oxygen need with exercise c. teach the patient about the safe use of oxygen at home d. adjust oxygen to keep saturation in prescribed parameters

a. obtain oxygen saturation using pulse oximetry

A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute

320 (PEFR less than 80% of personal best)

A patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first? a. notify the healthcare provider b. document the changes in respiratory status c. encourage the patient to cough and deep breath d. administer IV methylprednisone (Solu-Medrol)

A notify the healthcare provider

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first? a. listen to breath sounds b. ask about inhaled corticosteroid use c. determine when the dyspnea started d. obtain the forced expiratory volume (FEV) flow rate

a. listen to breath sounds

The clinic nurse makes a follow up phone call to a patient with asthma. The patient reports a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse take first? a. tell the patient to go to the emergency department b. instruct 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 the use of prescribed inhaled corticosteroids

b. instruct the patient to used the prescribed albuterol (Ventolin HFA)

A patient is receiving 35% oxygen via Venturi mask. To ensure the correct amount of oxygen delivery, which action by the nurse is the MOST important? a. teach the patient to keep the mask on at all times b. keep the air entrainment ports clean and unobstructed c. give a high enough flow rate to keep the bag from collapsing d. drain moisture condensation from the oxygen tubing every hour

b. keep the air entrainment ports clean and unobstructed

The nurse is admitting a patient diagnosed with an acute exacerbation of COPD. What is the best way for the nurse to determine the appropriate oxygen flow rate? a. minimize oxygen use to avoid oxygen dependency b.maintain the pulse oximetry level at 90% or greater c. administer oxygen according to the patient's level of dyspnea d. avoid administration of oxygen at a rate of more than 2L/minute

b. maintain the pulse oximetry level at 90% or greater

The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessmest finding is the BEST indicator that the therapy has been effective? a. no wheezes are audible b. oxygen saturation is >90% c. accessory muscle use has decreased d. respiratory rate is 16 breaths/minute

b. oxygen saturation is >90%

Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be the MOST useful in evaluating the effectiveness of treatment? a. even, unlabored respirations b. pulse oximetry reading of 92% c. Respiratory rate of 18 breaths/minute d. absence of wheezes, ronchi, or crackles

b. pulse oximetry reading of 92%

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? a. schedule the procedure 1 hour after the patient eats b. maintain the patient in the lateral position for 20 minutes c. perform percussion before assisting the patient to the drainage position d. give the ordered albuterol (Ventolin HFA) before the patient receives therapy

d. give the ordered albuterol (Ventolin HFA) before the patient receives therapy

A patient hospitalized with COPD is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching? a. storage of oxygen tanks will require adequate space in the home b. travel opportunities will be limited because of the use of oxygen c. oxygen flow should be increase if the patient has more dyspnea d. oxygen can improve the patient's prognosis and quality of life

d. oxygen can improve the patient's prognosis and quality of life

A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should 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

d. perform chest physiotherapy every 4 hours

The home health nurse is visiting a patient with COPD. Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern r/t anxiety? a. titrate oxygen to keep saturation at 90% or greater b. discuss a high protein, high calorie diet with the patient c. suggest the use of OTC sedative medications d. teach the patient how to effectively use pursed lip breathing

d. teach the patient how to effectively used pursed lip breathing

The nurse teaches a patient about how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates a good understanding of the teaching? a. the patient attaches a spacer before using the inhaler b. the patient coughs vigorously after using the inhaler c. the patient activates the inhaler at the onset of expiration d. the patient removes the facial mask when misting has ceased

d. the patient removes the facial mask when misting has ceased

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

d. the patient uses an albuterol (VEntolin HFA) inhaler for peak flows in the yellow zone

The nurse completes an admission assessment on a patient with asthma. Which information given by the patient is the most indicative of a need for change in therapy? a. the patient uses albuterol (Proventil) before any aerobic exercise b. the patient says that the asthma symptoms are worse every morning c. the patient's heart rate increases after using the albuterol (Proventil) inhaler d. the patient's only medications are albuterol (Ventolin HFA) & salmeterol (Serevent)

d. the patient's only medications are albuterol (Ventolin HFA) & salmeterol (Serevent)

Which information will the nurse include in the asthma teaching plan for a patient being discharged? 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 5 seconds after using the bronchodilator inhaler d. tremors are an expected side effect f rapidly acting bronchodilators

d. tremors are an expected side effect of rapidly acting bronchodilators

The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe COPD. Which instructions would be most appropriate for the nurse to include in the plan of care? a. stop exercising when short of breath b. walk until pulse rate exceeds 130 beats/minute c. limit exercise to ADLs d. walk 15-20 minutes at least 3x/week

d. walk 15-20 minutes at least 3x/week

The nurse in the emergency department receives ABG results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 22 year old with pH 7.28, PaCO2 50mmHg, PaO2 58 mmHg b. 34 year old with pH 7.48, PaCO2 30 mmHg, PaO2 65 mmHg c. 45 year old with pH 7.34, PaCO2 33 mmHg, PaO2 80 mmHg d. 65 year old with pH 7.31, PaCO2 58 mmHg, PaO2 64 mmHg

a. 22 year old with pH 7.28, PaCO2 50mmHg, PaO2 58 mmHg

The nurse reviews the MAR for a patient having an acute asthma attack. Which medications should the nurse administer first? a. Albuterol (Ventolin) 2.5 mg per nebulizer b. Methylprednisone (Solu-Medrol) 60 mg IV c. Salmeterol (Severent) 50mcg per dry powder inhaler (DPI) d. Triamcinolone (Azmacort) 2 puffs per metered dose inhaler (MDI)

a. Albuterol (Ventolin HFA) 2.5 mg per nebulizer

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. Scattered crackles and wheezes heard bilaterally c. Complaint of sharp chest pain with deep breathing d. Respiratory rate 28 breaths/minute while ambulating

a. Cough productive of bloody, purulent mucus

A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of COPD. The nurse should plan to teach the patient about a. a1-antitrypsin testing b. use of the nicotine patch c. continuous pulse oximetry d. leukotriene modifiers

a. a1-antitrypsin testing

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be the most appropriate? a. have the patient add dietary salt to meals b. teach the patient about s/s of hypoglycemia c. suggest decreasing intake of dietary fat and calories d. instruct the patient about pancreatic enzyme replacements

a. have the patient add dietary salt to meals

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. peripheral edema b. elevated temperature c. clubbing of the fingers d. complaints of chest pain

a. peripheral edema

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is not sure about getting married and having children someday. Which initial response by the nurse is the best? a. "Are you aware of the normal lifespan for patients with CF?" b. "Do you need any information to help you decide?" c. "Many women with CF do not have difficulty conceiving children." d. "You will need to have genetic counseling before you decide"

b. "Do you need any information to help you decide?"

A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? a. use of long acting b-andrenergic medications b. side effects of sustained release theophylline c. self administration of inhaled corticosteroids d. complications associated with oxygen therapy

c. self administration of inhaled corticosteroids

The nurse provides dietary teaching for a patient with COPD who has a low 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 everyday." c. "I will exercise for 15 minutes before meals." d. "I will decrease my intake of meat and poultry."

b. "I can have ice cream as a snack everyday."

Which instruction should the nurse include in an exercise teaching plan for a patient with COPD? a. "stop exercising if you start to feel SOB" b. "use the bronchodilator before you start to exercise" c. "breathe in and out through the mouth while you exercise" d. "upper body exercise should be avoided to prevent dyspnea"

b. "use the bronchodilator before you start to exercise"

A patient with CF has blood glucose levels that are consistently between 180-250 mg/dL. Which nursing action will the nurse plan to implement? a. discuss the role of diet in blood glucose control b. teach the patient about administration of insulin c. give oral hypoglycemic medications before meals d. evaluate the patient's home use of pancreatic enzymes

b. teach the patient about administration of insulin

The nurse receives a change of shift report on the following patients with COPD. Which patient should the nurse assess first? a. a patient with loud expiratory wheezes b. a patient with a resp rate of 38/minute c. a patient who has a productive cough of thick, green mucus d. a patient with jugular vein distension and peripheral edema

b. a patient with a resp rate of 38/minute

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. peak flow reading 75% of normal d. resp rate of 22 breaths/minute

b. flushing and dizziness

A patient with COPD has ronchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. change the oxygen flow rate to the highest prescribed rate b. teach the patient to use the flutter airway clearance device c. reinforce the ongoing use of pursed lip breathing techniques d. teach the patient about consistent use of inhaled corticosteroids

b. teach the patient to use the flutter airway clearance device

The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed? a. the patient inhales slowly through the nose b. the patient puffs up the cheeks while exhaling c. the patient practices by blowing through a straw d. the patient's ration of inhalation to exhalation is 1:3

b. the patient puffs up the cheeks while exhaling

a patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next? a. increase the dose of the leukotriene inhibitor b. teach the patient about the use of oral corticosteroids c. administer a bronchodilator and recheck the peak flow d. instruct the patient to keep the next scheduled follow-up appointment

c. administer a bronchodilator and recheck the peak flow

A patient with COPD has poor gas exchange. Which action by the nurse would be most appropriate? a. have the patient rest in bed with the head elevated to 15-20 degrees b. ask the patient to rest in bed in a high-fowler's position with the knees flexed c. encourage the patient to sit up at the bedside in a chair and lean slightly forward d. place the patient in the Tredelenburg position with several pillows behind the head

c. encourage the patient to sit up at the bedside in a chair and lean slightly forward

A patient with COPD has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. encourage the intake of whole grains b. increase the patient's intake of fruits/fruit juices c. offer high calorie snacks between meals and at bedtime d. assist the patient in choosing foods with high vegetables and mineral content

c. offer high calorie snacks between meals and at bedtime

The nurse interviews a patient with a new diagnosis of COPD. Which information is the MOST helpful in confirming a diagnosis of chronic bronchitis? a. the patient tells the nurse about a family history of bronchitis b. the patient's history indicates a 30 pack-year cigarette history c. the patient complains about a productive cough every winter for 3 months d. the patient denies having any respiratory problems until the last 12 months

c. the patient complains about a productive cough every winter for 3 months

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate the nurse that teaching about the med administration has been successful? a. the patient shakes the device before use b. the patient attaches a spacer to the Diskus c. the patient rapidly inhales the medication d. the patient performs huff coughing after inhalation

c. the patient rapidly inhales the medication

The nurse is caring for a patient with COPD. Which information obtained from the patient would prompt the nursing to consult with the healthcare provider before administering the prescribed theophylline? a. the patient reports a recent 15 pound wight gain b. the patient denies and SOB at present c. the patient takes cimetidine (Tagamet) 150 mg daily d. the patient complains about coughing up green mucus

c. the patient takes cimetidine (Tagamet) 150 mg daily

The nurse takes an admission history on a patient with possible asthma who has new onset wheezing and SOB. Which information may indicate a need for a change in therapy? a. the patient has a chronic inflammatory bowel disease b. the patient has a history of pneumonia 6 months ago c. the patient takes propanolol (Inderal) for hypertension d. the patient uses acetaminophen (Tylenol) for headaches

c. the patient takes propanolol (Inderal) for hypertension

The nurse assessed a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? a. pulse oximetry reading of 91% b. respiratory rate of 26 breaths/minute c. use of accessory muscles in breathing d. peak expiratory flow rate of 240 L/minute

c. use of accessory muscles in breathing

A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure? a. give the rescue medication immediately before testing b. administer oral corticosteroids 2 hours before the procedure c. withhold bronchodilators for 6-12 hours before the examination d. ensure that the patient has been NPO for several hours before the test

c. withhold bronchodilators for 6-12 hours before the examination

A 55 year old patient with increasing dyspnea is being evaluated for a possible diagnosis of COPD. When teaching the patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask? a. "Are you claustrophobic?" b. "Are you allergic to shellfish?" c. "Do you have any metal implants or prostheses?" d. "Have you taken any bronchodilators in the past 6 hours?"

d. "Have you taken any bronchodilators in the past 6 hours?"

A patient with severe COPD tells the nurse "I wish i were dead! I'm just a burden on everybody." Based on this information, which nursing diagnosis is most appropriate? a. complicated grieving related to expectation of death b. ineffective coping related to unknown outcome of illness c. deficient knowledge related to lack of education about COPD d. chronic low self-esteem related to increased physical dependence

d. chronic low self esteem related to physical dependence