Chapter 26: Coordinating Care for Patients with Lower Airway Disorders

2. The nurse develops the nursing diagnosis "Ineffective Airway Clearance related to intermittent, reversible airway obstruction secondary to bronchoconstriction and airway inflammation." For which disorder is this nursing diagnosis most relevant? 1. Asthma 2. Bronchiectasis 3. Chronic bronchitis 4. Emphysema

2. ANS: 1 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 7. Developing a comprehensive plan of nursing care for patients with upper airway disorders Chapter page reference: 496 Heading: Asthma/Pathophysiology Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Difficult Feedback 1 Asthma is a chronic lung disease characterized by an intermittent, reversible airway obstruction resulting from inflammation of the lung's airways and a tightening of the muscles that surround the airways. The condition affects the bronchial airways, not the alveoli. 2 Bronchiectasis is the chronic dilation of the bronchioles, often found in patients with cystic fibrosis. 3 Chronic bronchitis affects the small airways and is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. The chronic airflow limitation is caused by a mixture of small airways disease and destruction of the lung tissue. 4 Emphysema causes loss of lung elasticity leading to hyperinflation of the alveoli. The small airways collapse prematurely causing trapping of air in the alveoli and subsequent distention. Carbon dioxide cannot leave the alveoli, and oxygen cannot enter, resulting in an ineffective exchange of oxygen and carbon dioxide.

1. Friends of a patient hospitalized with asthma would like to bring the patient a gift. Which gift would the nurse recommend for this patient? 1. A basket of flowers 2. A stuffed animal 3. Fruit and candy 4. A book

1. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 496 Heading: Asthma/Pathophysiology Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Inflammation Difficulty: Moderate Feedback 1 A patient with asthma must not be exposed to items that can exacerbate the disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. 2 A patient with asthma must not be exposed to items that can exacerbate the disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. 3 A patient with asthma must not be exposed to items that can exacerbate the disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. 4 Objects void of irritants, such as a book, would be an appropriate gift.

10. Patients with asthma initially develop respiratory alkalosis. Which arterial blood gas value is consistent with this acid-base disorder? 1. pH 7.32 2. PaCO2 30 mm Hg 3. PaO2 78 mm Hg 4. SpO2 90%

10. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 3. Describing the diagnostic results used to confirm the diagnosis of lower airway disorders Chapter page reference: 499 Heading: Asthma/Nursing Interventions/Assessment Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: pH Regulation Difficulty: Moderate Feedback 1 The pH is elevated in respiratory alkalosis. 2 Initially respiratory alkalosis develops due to hyperventilation (decreased PaCO2). As respiratory difficulty increases, respiratory acidosis may develop (increased PaCO2). This PaCO2 is low, consistent with respiratory alkalosis. 3 This PaO2 indicates very mild hypoxemia, which is not unusual in patients with chronic obstructive pulmonary disease (COPD). 4 This SpO2 is within the normal range.

11. The nurse provides education to a patient who is prescribed an aerochamber for the treatment of asthma. Which patient statement indicates the need for additional teaching? 1. "I will place the mouthpiece over my nose and mouth." 2. "I should hear a whistling sound as I inhale the medication." 3. "I should wait a few seconds before I administer the second dose." 4. "I will hold my breath for 10 seconds after inhaling the medication."

11. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 4. Discussing the medical management of asthma. Chapter page reference: 500 - 502 Heading: Asthma/Nursing Interventions/Teaching/ Box 26.2 Patient Education: Use of Metered-Dose Inhaler and Aerochamber Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 This patient statement indicates a correct understanding of the information presented for proper use of an aerochamber. 2 When using the aerochamber, the patient is instructed to take a deep, slow breath in (a whistling sound indicates the patient is breathing in too quickly). This patient statement indicates the need for additional teaching. 3 This patient statement indicates a correct understanding of the information presented for proper use of an aerochamber. 4 This patient statement indicates a correct understanding of the information presented for proper use of an aerochamber.

12. The nurse develops the nursing diagnosis "Ineffective Airway Clearance related to increased mucus production secondary to chronic inflammation of small airways." For which disorder is this nursing diagnosis most relevant? 1. Asthma 2. Chronic bronchitis 3. Cystic fibrosis 4. Emphysema

12. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 7. Developing a comprehensive plan of nursing care for patients with upper airway disorders Chapter page reference: 503 Heading: COPD/Pathophysiology Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Difficult Feedback 1 Asthma is a chronic lung disease characterized by an intermittent, reversible airway obstruction resulting from inflammation of the lung's airways and a tightening of the muscles that surround the airways. The condition affects the bronchial airways, not the alveoli. 2 Chronic bronchitis affects the small airways and is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. The chronic airflow limitation is caused by a mixture of small airways disease and destruction of the lung tissue. 3 Cystic fibrosis is a genetic disease of the exocrine glands (glands that secrete hormones into ducts also called duct glands) such as the sweat, salivary, or pancreas glands. It is a multisystem disease that produces increased amounts of thick mucus in the respiratory, gastrointestinal (GI), and reproductive systems. 4 Emphysema causes loss of lung elasticity leading to hyperinflation of the alveoli. The small airways collapse prematurely causing trapping of air in the alveoli and subsequent distention. Carbon dioxide cannot leave the alveoli, and oxygen cannot enter, resulting in an ineffective exchange of oxygen and carbon dioxide.

13. The nurse develops the nursing diagnosis "Impaired Gas Exchange related to decreased lung elasticity and hyperinflation of the alveoli secondary to exposure to inhaled pollutants." For which disorder is the nursing diagnosis most relevant? 1. Asthma 2. Chronic bronchitis 3. Cystic fibrosis 4. Emphysema

13. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 7. Developing a comprehensive plan of nursing care for patients with upper airway disorders Chapter page reference: 503 Heading: COPD/Pathophysiology Integrated Processes: Nursing Process: Analysis Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Difficult Feedback 1 Asthma is a chronic lung disease characterized by an intermittent, reversible airway obstruction resulting from inflammation of the lung's airways and a tightening of the muscles that surround the airways. The condition affects the bronchial airways, not the alveoli. 2 Chronic bronchitis affects the small airways and is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years. The chronic airflow limitation is caused by a mixture of small airways disease and destruction of the lung tissue. 3 Cystic fibrosis is a genetic disease of the exocrine glands (glands that secrete hormones into ducts also called duct glands) such as the sweat, salivary, or pancreas glands. It is a multisystem disease that produces increased amounts of thick mucus in the respiratory, gastrointestinal (GI), and reproductive systems. 4 Emphysema causes loss of lung elasticity leading to hyperinflation of the alveoli. The small airways collapse prematurely causing trapping of air in the alveoli and subsequent distention. Carbon dioxide cannot leave the alveoli, and oxygen cannot enter, resulting in an ineffective exchange of oxygen and carbon dioxide.

14. Which clinical manifestation in the patient with chronic obstructive pulmonary disease (COPD) is more indicative of emphysema? 1. Cyanosis 2. Obese 3. Reddish complexion 4. Non-productive cough

14. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of chronic obstructive pulmonary disease. Chapter page reference: 503 - 504 Heading: COPD/Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Easy Feedback 1 Patients with chronic bronchitis are typically obese, have hypoxemia, and appear cyanotic, or as a "blue bloater," and have excessive mucus production with a productive cough. 2 Patients with chronic bronchitis have hypoxemia and appear cyanotic, or as a "blue bloater," and have excessive mucus production with a productive cough. 3 Patients with emphysema sometimes have a reddish complexion, appear to be puffing, and may be referred to as a "pink puffer." 4 The cough is usually productive in both chronic bronchitis and emphysema.

15. The nurse is providing care to a patient diagnosed with emphysema. Which clinical manifestation does the nurse correlate with this diagnosis? 1. Tachycardia 2. Cough 3. Barrel chest 4. Wheezing

15. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of chronic obstructive pulmonary disease Chapter page reference: 503 - 504 Heading: Chronic Obstructive Pulmonary Disease COPD/Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Although coughing, wheezing, and tachycardia may also be experienced by a patient diagnosed with chronic obstructive pulmonary disease (COPD), these are not specific to COPD caused by emphysema. 2 Although coughing, wheezing, and tachycardia may also be experienced by a patient diagnosed with COPD, these are not specific to COPD caused by emphysema. 3 Barrel chest occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded. 4 Although coughing, wheezing, and tachycardia may also be experienced by a patient diagnosed with COPD, these are not specific to COPD caused by emphysema.

16. The nurse correlates which data from a patient's history to a diagnosis of bronchitis? 1. A history of rhinitis 2. A history of eczema 3. A family history of allergies 4. A history of progressive dyspnea

16. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of chronic obstructive pulmonary disease. Chapter page reference: 503 - 504 Heading: COPD/Clinical Manifestations Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 This is expected for the patient with asthma, not bronchitis. 2 This is expected for the patient with asthma, not bronchitis. 3 This is expected for the patient with asthma, not bronchitis. 4 Progressive dyspnea is expected for the patient who is diagnosed with bronchitis.

17. The nurse teaches a patient how to implement pursed-lip breathing. Which patient statement indicates a need for additional instruction? 1. "I will sit up with my shoulders relaxed." 2. "I will be sure to exhale twice as long as I inhale." 3. "I will inhale through my mouth while slowly counting." 4. "I will exhale through my mouth as if I was blowing out candles."

17. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 506 - 507 Heading: COPD/Nursing Interventions/Teaching Box 26.3 Pursed-Lip Breathing (PLB) Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Oxygenation Difficulty: Moderate Feedback 1 This patient statement indicates a correct understanding for the implementation of pursed-lip breathing. 2 This patient statement indicates a correct understanding for the implementation of pursed-lip breathing. 3 The patient inhales through the nose, not the mouth. This patient statement indicates the need for additional instruction. 4 This patient statement indicates a correct understanding for the implementation of pursed-lip breathing.

18. A patient diagnosed with chronic obstructive pulmonary disease (COPD) has a pulse oximetry reading of 93%, increased red blood and white blood cell count, temperature of 101°F, pulse 100 bpm, respirations 35 bpm, and a chest x-ray examination that showed a flattened diaphragm with infiltrates. Based on this data, which prescription does the nurse question for this patient? 1. Antibiotic therapy 2. Nonsteroidal anti-inflammatory agents 3. Oxygen by nasal cannula at 3 to 4 L/minute 4. Bronchodilators such as an adrenergic stimulating drugs or anticholinergic agents

18. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 4. Discussing the medical management of chronic obstructive pulmonary disease Chapter page reference: 507 Heading: Chronic Obstructive Pulmonary Disease (COPD)/Safety Alert Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Moderate Feedback 1 The order for antibiotic therapy is expected because the patient is febrile with an increase in white blood cells. 2 Nonsteroidal anti-inflammatory agents are commonly ordered to decrease the inflammation and swelling of lung tissues to maximize oxygen and carbon dioxide exchange and to improve symptoms and would be expected for this patient. 3 The nurse should be concerned about the order for oxygen to be provided at 3 to 4 L/minute. This amount of oxygen is too much for a patient with COPD because the patient's breaths are stimulated by a hypoxic drive and this disease process causes the body to retain carbon dioxide. Providing this much oxygen can result in an increase in carbon dioxide levels, leading to respiratory failure. Oxygen for this patient should be at a lower rate, such as 1 to 2 L/minute, with close assessments of the patient's breathing status.

19. The nurse correlates which diagnostic result as consistent with the diagnosis of cystic fibrosis? 1. Elevated serum chloride 2. Elevated sodium levels in sweat 3. Decreased urine chloride 4. Decreased urine specific gravity

19. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 3. Describing the diagnostic results used to confirm the diagnosis of lower airway disorders Chapter page reference: 509 Heading: Cystic Fibrosis/Diagnosis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Cystic fibrosis does not impact serum or urine chloride levels. Elevated levels of chloride in the sweat are found in patients with cystic fibrosis. 2 The sweat chloride test measures the concentration of chloride in the patient's sweat. A high level of chloride is an indication of cystic fibrosis. The normal value is less than 30 mEq/L. The test is positive for cystic fibrosis when the chloride level is greater than or equal to 60 mEq/L. 3 Cystic fibrosis does not impact serum or urine chloride levels. Elevated levels of chloride in the sweat are found in patients with cystic fibrosis. 4 Urine specific gravity is not directly impacted by cystic fibrosis. A decreased urine specific gravity is associated with fluid overload and decreased urine osmolarity.

20. The nurse monitors for which gastrointestinal clinical manifestations in the patient diagnosed with cystic fibrosis? 1. Diarrhea 2. Hematemesis 3. Melena 4. Steatorrhea

20. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of Chapter page reference: 509 Heading: Cystic Fibrosis/Nursing Interventions/Assessment and Analysis Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Assessment Difficulty: Moderate Feedback 1 Gastrointestinal clinical manifestations of cystic fibrosis include constipation, not diarrhea. 2 Gastrointestinal clinical manifestations of cystic fibrosis include greasy, fatty stools, not hematemesis (blood in vomitus). 3 Gastrointestinal clinical manifestations of cystic fibrosis include greasy, fatty stools, not melena (blood in the stool). 4 Gastrointestinal clinical manifestations of cystic fibrosis include steatorrhea (frequent greasy, bulky, fatty stools) or difficult bowel movements.

21. Which statement by the patient regarding the treatment for cystic fibrosis indicates the need for further teaching? 1. "Taking CFTR modulators will cure my cystic fibrosis." 2. "There are medications that will decrease the viscosity of the secretions." 3. "I may need to take vitamins to support my nutritional needs." 4. "I may also have to take pancreatic enzymes for nutritional purposes."

21. ANS: 1 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 510 Heading: Cystic Fibrosis/Nursing Interventions/Actions & Teaching Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 This statement indicates the need for further teaching because cystic fibrosis transmembrane conductance regulator (CFTR) modulators are medications targeting specific defects caused by mutations in the CFTR gene. These treatments do not correct errors in the CFTR gene but attempt to correct the malfunctioning protein made by the CFTR gene. It is not a cure. 2 This statement indicates teaching effectiveness because the patient with cystic fibrosis may take mucolytics to thin the mucus. 3 This statement indicates teaching effectiveness because fat-soluble vitamins (A, D, E, and K) are given as supplements because the long-term antibiotic therapy used to treat cystic fibrosis eradicates the normal flora of the gastrointestinal tract. 4 This statement indicates teaching effectiveness because pancreatic replacement enzymes are given to help with digestion and absorption of food.

22. Although all of these patients do not currently smoke cigarettes, the nurse recognizes that which patient is at greatest risk factor for the development of lung cancer? 1. 60-year-old black male with a history of smoking in his teens 2. 64-year-old white female who went to an elementary school that had asbestos 3. 68-year-old black male with a 40 pack-year history of smoking 4. 72-year-old white male with a 10 pack-year history of smoking

22. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 1. Describing the epidemiology of lower airway disorders Chapter page reference: 510 Heading: Lung Cancer/Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integration: Physiological Adaptation Cognitive Level: Application (Application) Concept: Assessment Difficulty: Difficult Feedback 1 Risk factors for lung cancer include age older than 65, male gender, black race, exposure to occupational pollutants/asbestos, and cigarette smoking history. The risk of developing lung cancer increases as the number of cigarettes smoked and the length of time spent smoking increase. This patient has two risk factors—race and smoking history. 2 Risk factors for lung cancer include age older than 65, male gender, black race, exposure to occupational pollutants/asbestos, and cigarette smoking history. The risk of developing lung cancer increases as the number of cigarettes smoked and the length of time spent smoking increase. This patient has one risk factor—exposure to asbestos. 3 Risk factors for lung cancer include age older than 65, male gender, black race, exposure to occupational pollutants/asbestos, and cigarette smoking history. The risk of developing lung cancer increases as the number of cigarettes smoked and the length of time spent smoking increase. This patient has four risk factors—age, race, gender, and significant smoking history. 4 Risk factors for lung cancer include age older than 65, male gender, black race, exposure to occupational pollutants/asbestos, and cigarette smoking history. The risk of developing lung cancer increases as the number of cigarettes smoked and the length of time spent smoking increase. This patient has three risk factors—age, gender, and smoking history (but less significant than the patient with a 40 pack-year history).

23. The nurse is caring for a patient in a community clinic who wishes to quit smoking. The patient asks the nurse, "If I quit smoking, will my risk of lung cancer be the same as a nonsmoker?" Which is the best response by the nurse? 1. "No one knows for sure what the risk is for someone who quits smoking." 2. "Your risk of lung cancer will be equal to that of a nonsmoker." 3. "Your risk of lung cancer will decline if you quit, but it will remain higher than a nonsmoker's." 4. "Your risk of lung cancer will never drop because the damage has already been done."

23. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 1. Describing the epidemiology of lower airway disorders Chapter page reference: 510 Heading: Lung Cancer/ Epidemiology Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Application [Applying] Concept: Cellular Regulation Difficulty: Moderate Feedback 1 The risk for someone who quits is known to be dramatically less than for someone who continues to smoke. 2 Although the patient's risk for lung cancer will diminish sharply on quitting smoking, it will not drop to the level of someone who never smoked. 3 The risk for someone who quits is known to be dramatically less than for someone who continues to smoke. 4 Although damage has been done, the patient's risk will drop dramatically on quitting smoking.

24. The nurse is caring for an older adult patient who is very thin and emaciated. The patient reports new onset of shortness of breath. A chest x-ray examination reveals a spot on the lungs that the physician believes is an inoperable lung cancer. Because of the patient's poor nutritional status, chemotherapy is not an option. The healthcare provider also believes that the location of the cancer would make radiation therapy unsuccessful. In advocating for this patient, what approach does the nurse collaborate with the healthcare team to offer the patient? 1. Provide palliative care to keep the patient comfortable without diagnostic testing 2. Perform any procedure necessary to diagnose the patient properly 3. Promote the use of blood tests to diagnose the suspected cancer 4. Determine the patient's and family's wishes regarding diagnostic testing

24. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 5. Developing a comprehensive plan of nursing care for patients with lower airway disorders Chapter page reference: 511 Heading: Lung Cancer/Nonsurgical Management Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Basic Care and Comfort Cognitive Level: Application [Applying] Concept: Cellular Regulation Difficulty: Difficult Feedback 1 An older adult emaciated patient may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the patient and family that should direct the plan of care and choices of diagnostic testing. 2 An older adult emaciated patient may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the patient and family that should direct the plan of care and choices of diagnostic testing. 3 An older adult emaciated patient may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the patient and family that should direct the plan of care and choices of diagnostic testing. 4 An older adult emaciated patient may have few options for treatment of cancer, if confirmed. The best course of treatment may be palliative care, but it is the choice of the patient and family that should direct the plan of care and choices of diagnostic testing.

26. In reviewing teaching about use of the peak flow meter in a patient with asthma, which statements by the patient indicate understanding of correct use? Select all that apply. 1. "I will lie flat in the bed." 2. "I take a deep breath before placing the mouthpiece in my mouth." 3. "I breathe out slowly and continuously." 4. "I should repeat three times and the numbers should be close." 5. "I blow out in one fast, hard blast."

26. ANS: 2, 4, 5 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 500 - 502 Heading: Asthma/ Nursing Interventions/Teaching/ Box 26.2 - Patient Education: Use of Metered-Dose Inhaler and Aerochamber Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Reduction or Risk Potential Cognitive Level: Application [Applying] Concept: Assessment Difficulty: Moderate Feedback 1 This is incorrect. The patient needs to be standing up straight when using the peak flow meter. 2 This is correct. The patient takes a deep breath, then puts the mouthpiece of the peak flow meter into the mouth, and then tightly closes the lips around the mouthpiece. 3 This is incorrect. The patient blows out as hard and as quickly as possible in one breath, until nearly all of the air is out of the lungs. 4 This is correct. The patient should repeat the entire routine three times. 5 This is correct. The patient blows out as hard and as quickly as possible in one breath, until nearly all of the air is out of the lungs.

27. The nurse is providing care to a patient diagnosed with chronic obstructive pulmonary disease (COPD). Which factors in the patient's history support the current diagnosis? Select all that apply. 1. Working in an industrial environment 2. Working in an office setting with air conditioning 3. History of asthma 4. Current cigarette smoking 5. Playing golf several times a week

27. ANS: 1, 3, 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 1. Describing the epidemiology of lower airway disorders Chapter page reference: 500 Heading: Chronic Obstructive Pulmonary Disease (COPD)/Epidemiology Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Oxygenation Difficulty: Easy Feedback 1 This is correct. Risk factors associated with the development of chronic obstructive pulmonary disease (COPD) include working in an industrial environment, a history of asthma, and cigarette smoking. 2 This is incorrect. Working in an office setting with air conditioning and playing golf several times a week are not risk factors for the development of COPD. 3 This is correct. Risk factors associated with the development of COPD include working in an industrial environment, a history of asthma, and cigarette smoking. 4 This is correct. Risk factors associated with the development of COPD include working in an industrial environment, a history of asthma, and cigarette smoking. 5 This is incorrect. Working in an office setting with air conditioning and playing golf several times a week are not risk factors for the development of COPD.

28. The community health nurse is preparing an educational program for local residents. Which information does the nurse include about chronic obstructive pulmonary disease (COPD)? Select all that apply. 1. Cigarette smoking is the leading cause of COPD. 2. Approximately 80% to 90% of deaths from COPD are related to smoking. 3. There is an increased incidence of COPD in individuals who abuse alcohol. 4. Less than 5% of all COPD cases are caused by deficiency in alpha-1 antitrypsin. 5. COPD is completely reversible if the individual stops smoking.

28. ANS: 1, 2, 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 1. Describing the epidemiology of upper airway disorders Chapter page reference: 500 Heading: COPD/Epidemiology Integrated Processes: Teaching and Learning Client Need: Physiological Adaptation: Reduction of Risk Potential Cognitive Level: Comprehension [Understanding] Concept: Nursing Roles Difficulty: Moderate Feedback 1 This is correct. Cigarette smoking is the leading cause of COPD, and approximately 80% to 90% of deaths from COPD are related to smoking. 2 This is correct. Cigarette smoking is the leading cause of COPD, and approximately 80% to 90% of deaths from COPD are related to smoking. 3 This is incorrect. There is no association between incidence of COPD and alcohol use/abuse. 4 This is correct. Fewer than 5% of all COPD cases are caused by a deficiency of an enzyme called alpha-1 antitrypsin (AAT). AAT is produced in the liver and is present in the lungs. When present, it has lung protectant properties. 5 This is incorrect. COPD causes irreversible changes in the lungs. Smoking cessation can slow the progression of the disease but not totally reverse all lung damage.

29. Which systems should the nurse anticipate will be affected when planning care for a patient diagnosed with cystic fibrosis? Select all that apply. 1. Respiratory 2. Neurological 3. Reproductive 4. Cardiovascular 5. Gastrointestinal

29. ANS: 1, 3, 5 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of cystic fibrosis Chapter page reference: 507 - 508 Heading: Cystic Fibrosis/Pathophysiology Integrated Processes: Nursing Process: Planning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Comprehension [Understanding] Concept: Inflammation Difficulty: Easy Feedback 1 This is correct. Cystic fibrosis is a multisystem disease that produces increased amounts of thick mucus in the respiratory, gastrointestinal (GI), and reproductive systems. The disease is characterized by thick, viscous mucus that clogs the lungs and obstructs the pancreas. Other organs that are affected include the liver, salivary glands, and testes. 2 This is incorrect. The neurological system is not directly affected by cystic fibrosis. 3 This is correct. Cystic fibrosis is a multisystem disease that produces increased amounts of thick mucus in the respiratory, GI, and reproductive systems. The disease is characterized by thick, viscous mucus that clogs the lungs and obstructs the pancreas. Other organs that are affected include the liver, salivary glands, and testes. 4 This is incorrect. The cardiovascular system is not directly affected by cystic fibrosis. 5 This is correct. Cystic fibrosis is a multisystem disease that produces increased amounts of thick mucus in the respiratory, GI, and reproductive systems. The disease is characterized by thick, viscous mucus that clogs the lungs and obstructs the pancreas. Other organs that are affected include the liver, salivary glands, and testes.

3. Which statements by a patient with asthma indicates effective teaching? 1. "We'll use the fireplace to keep the house warm in the winter." 2. "We will replace the carpet in our bedroom with tile." 3. "We'll make sure that we dust our plants frequently." 4. "We're glad we can keep our dog."

3. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 497 - 498 Heading: Asthma/Treatment Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analysis [Analyzing] Concept: Inflammation Difficulty: Moderate Feedback 1 Smoke from fireplaces should be eliminated. 2 Control of dust in the bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the bedroom with tile flooring will reduce dust. 3 Plants are often an allergen that can induce symptoms of asthma; therefore, this is not appropriate. 4 When possible, pets and plants should not be kept in the home.

30. Which statements about lung cancer indicate that teaching was effective? Select all that apply. 1. "A reclining position allows full lung expansion." 2. "Controlled breathing reduces shortness of breath." 3. "I will pace myself when doing things with my family." 4. "I will eat three large meals a day to ensure I get enough calories." 5. "Pain medication administered around the clock will improve my comfort."

30. ANS: 2, 3, 5 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with lower airway disorders Chapter page reference: 513 Heading: Lung Cancer/Nursing Interventions/Teaching Integrated Processes: Teaching and Learning Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Oxygenation Difficulty: Moderate Feedback 1 This is incorrect. This patient statement indicates a need for additional education. An upright position (e.g., semi-Fowler's) allows for full lung expansion. 2 This is correct. This patient statement indicates a correct understanding of the information presented. 3 This is correct. This patient statement indicates a correct understanding of the information presented. 4 This is incorrect. This patient statement indicates a need for additional education. Small, frequent meals decrease the work of breathing with less impact on the diaphragm. 5 This is correct. This patient statement indicates a correct understanding of the information presented.

4. The nurse monitors for which therapeutic effect when administering leukotriene receptor antagonists to patients diagnosed with asthma? 1. Cause bronchodilation of the airways 2. Decrease viscosity of secretions 3. Decrease work of breathing by relaxing muscles around bronchi 4. Inhibit the inflammatory process

4. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 4. Discussing the medical management of asthma. Chapter page reference: 498 Heading: Asthma/Medications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Application [Applying] Concept: Medication Difficulty: Moderate Feedback 1 Leukotriene receptor antagonists interfere with the inflammatory response, not bronchodilation (bronchodilators have this action). 2 Leukotriene receptor antagonists interfere with the inflammatory response. Mucolytics decrease the viscosity of secretions. 3 Anticholinergics relax the muscles around the larger airways or bronchi to ease the work of breathing. 4 Leukotriene receptor antagonists are another class of drugs that may be used to enhance asthma control if the usual medications are not effective. They are not steroids; they inhibit the leukotriene-mediated inflammatory process.

5. In administering bronchodilator therapy to a patient with asthma, the nurse correlates the effectiveness of this classification of medication to which mechanism of action? 1. Bronchodilators widen the airways because they act on the parasympathetic nervous system. 2. Bronchodilators widen the airways because they stimulate the sympathetic nervous system. 3. Bronchodilators decrease inflammation of the airways. 4. Bronchodilators decrease the production of mucus that narrows the airways.

5. ANS: 2 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 4. Discussing the medical management of asthma Chapter page reference: 498 Heading: Asthma/Medications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Comprehension [Understanding] Concept: Medication Difficulty: Moderate Feedback 1 Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system. 2 During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs. 3 Corticosteroids and leukotrienes decrease the inflammatory response associated with airway. 4 Anti-inflammatories, typically in the form of inhaled corticosteroids, reduce mucus production.

6. In providing care to a patient admitted with an acute asthma exacerbation, the nurse prepares which "rescue" medication for administration first? 1. Inhaled anti-inflammatories 2. Mucolytics 3. Long-acting beta2-adrenergic agonists 4. Short-acting beta2-adrenergic agonists

6. ANS: 4 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 4. Discussing the medical management of asthma. Chapter page reference: 498 Heading: Asthma/Medications Integrated Processes: Nursing Process: Implementation Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Application [Applying] Concept: Medication Difficulty: Difficult Feedback 1 Long-term control medications are used daily regardless of the symptoms a patient is experiencing to achieve and maintain control of the asthma. The most effective long-term control medications for asthma are inhaled anti-inflammatories. 2 Mucolytics decrease viscosity of secretions but are not considered "rescue" medications. 3 Anticholinergics are another group of bronchodilators. Different from beta2-adrenergic agonists, which relax the bronchioles or small airways, anticholinergics relax the muscles around the larger airways or bronchi. 4 "Rescue" drugs are those medications used once an asthma attack has started; these are usually short-acting bronchodilators. Short-acting beta2-adrenergic agonists are the gold standard because they are most effective. Short-acting beta2-adrenergic agonists should be used for acute exacerbations of asthma only.

7. The nurse finds a patient admitted with asthma and pneumonia restless, anxious, complaining of increasing difficulty breathing, and stridor. Because of suspected status asthmaticus, an arterial blood gas is ordered. Which result requires an immediate intervention? 1. pH 7.30 2. PaCO2 48 mm Hg 3. PaO2 50 mm Hg 4. SpO2 88%

7. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 3. Describing the diagnostic results used to confirm the diagnosis of lower airway disorders Chapter page reference: 498 Heading: Asthma/Complications Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Difficult Feedback 1 Status asthmaticus is an acute exacerbation of asthma that is unresponsive to repeated doses or treatment with the typical rescue medications. Although the acidotic pH is concerning, the severe hypoxemia is the priority at this time. 2 Status asthmaticus is an acute exacerbation of asthma that is unresponsive to repeated doses or treatment with the typical rescue medications. Although the mildly acidotic PaCO2 is concerning, the severe hypoxemia is the priority at this time. 3 Status asthmaticus is an acute exacerbation of asthma that is unresponsive to repeated doses or treatment with the typical rescue medications. Although all of the arterial blood gas (ABG) results are concerning, the severe hypoxemia indicated by the low PaO2 is the priority at this time. 4 Status asthmaticus is an acute exacerbation of asthma that is unresponsive to repeated doses or treatment with the typical rescue medications. The significantly low PaO2 is a higher priority than the SpO2 at this time.

8. The nurse is providing care to a patient admitted after experiencing an acute asthma attack. Which assessment findings indicate the need for an immediate intervention? 1. Retractions and fatigue 2. Tachycardia and tachypnea 3. Inaudible breath sounds 4. Diffuse wheezing and the use of accessory muscles when inhaling

8. ANS: 3 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of asthma. Chapter page reference: 498 Heading: Asthma/Complications/Safety Alert Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Difficult Feedback 1 Retractions and fatigue are also a progression of symptoms that occur with an asthma attack and represent a more severe episode, but they are not the worst or most serious set of symptoms listed, because air is still moving and exchanging. 2 During an asthma attack, tachycardia, tachypnea, and prolonged expirations are common. They are early symptoms of the disease process and can be addressed without urgency. 3 Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that little or no air movement into and out of the lungs is taking place. Therefore, this set of symptoms represents the most urgent need, which is immediate intervention by the nurse to open up the lungs with drug management to prevent total respiratory failure. 4 Diffuse wheezing and the use of accessory muscles when inhaling indicate a progression of the severity of the symptoms, but airflow is still occurring; therefore, they do not require the most urgent action.

9. The nurse is caring for a patient newly diagnosed with asthma. Which assessment data indicate the need for an immediate intervention? 1. Diminished breath sounds 2. Decreased respiratory rate 3. Increased crackles 4. Increased respiratory rate

9. ANS: 1 Chapter number and title: 26, Coordinating Care for Patients with Lower Airway Disorders Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological processes of asthma. Chapter page reference: 498 Heading: Asthma/Complications/Safety Alert Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity: Physiological Adaptation Cognitive Level: Analysis [Analyzing] Concept: Oxygenation Difficulty: Moderate Feedback 1 Absent or diminished breath sounds signify a decrease in the movement of air as a result of increased obstruction or respiratory exhaustion. • If a patient's wheezing decreases and he has little or no breath sounds, this indicates the patient is not able to move air throughout the system. This is a medical emergency. It indicates respiratory failure. The patient may require mechanical ventilation. Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly, not slightly, diminished breath sounds may indicate exhaustion and impending respiratory failure. 2 Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. 3 Increased crackles are usually associated with heart failure and are not an indication of exhaustion. 4 An increased respiratory rate indicates respiratory compromise, but not exhaustion.