Chp 28 Asthma and COPD medsurg

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 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 nurse is educating the patient on oxygen use for the home. The patient asks the nurse "Does this mean that I will not be able to go anywhere?" The most appropriate response by the nurse is: 1 Encourage the patient to continue normal activity and travel plans. 2 Explain the need to minimize activity in the home to conserve oxygen use. 3 Point out that most travel companies do not accommodate travelers with oxygen. 4 Point out that distance traveling may not be possible because oxygen tanks are so small.

1 Encourage the patient who uses home O2 to continue normal activity and to travel normally; this helps the patient maintain quality of life. Explaining the need to minimize activity in the home to conserve oxygen use, pointing out that distance traveling may not be possible because oxygen tanks are so small, and pointing out that most travel companies do not accommodate travelers with oxygen are incorrect because minimizing activity in the home most likely would decrease the patient's mobility and lead to other health conditions. If travel is by automobile, arrangements can be made for O2 to be available at the destination point. O2 supply companies often can assist in these arrangements. If a patient wishes to travel by bus, train, or airplane, the patient should inform the appropriate people when reservations are made that O2 will be needed for travel.

When teaching a patient about chronic obstructive pulmonary disease (COPD) rehabilitation, what strategy should the nurse teach the patient as essential to perform for energy conservation? 1 Exercise training 2 Complete inactivity 3 Reduced food intake 4 Reduced water intake

1 Exercise training leads to energy conservation, which is an important component in COPD rehabilitation. Complete inactivity may alleviate symptoms acutely but is not helpful in the long term, because the patient needs to learn effective ways to improve muscle function. It is also important to reduce dyspnea by exercise training. Reduced water and food intake is not advisable; instead, increased water and food intake is essential to maintain energy and to loosen the secretions.

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 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.

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 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 is caring for the patient with chronic obstructive pulmonary disease (COPD). The patient complains of difficult breathing. What action by the nurse is most appropriate? 1 Initiate oxygen administration at low flow rates 2 Begin administration of oxygen at maximum levels 3 Withhold oxygen to prevent depression of the hypoxic drive 4 Wait until arterial blood gases (ABGs) are obtained before starting oxygen

1 It is critical to start O2 at low flow rates until ABGs can be obtained. Beginning administration of oxygen at maximum levels, withholding oxygen to prevent depression of the hypoxic drive, and waiting until arterial blood gases are obtained before starting oxygen are incorrect because the key concern is not providing adequate oxygen to the patient but instead starting oxygen at a lower level to prevent hypoxia. Should the amount of oxygen delivered be too high, it is much easier to reverse high CO2 than to lower O2. Although there has been concern regarding the dangers of administering O2 to COPD patents and reducing their drive to breath, the "hypoxic drive" is complex and involves other factors and not all patients with COPD retain CO2. ABGs are used as a guide to determine what FIO2 level is sufficient and can be tolerated. Assess the patient's mental status and vital signs before starting O2 therapy and frequently thereafter.

The nurse provides education to a patient with asthma about how to take medication through a metered dose inhaler. Which action performed by the patient indicates effective learning? 1 Cleans the device with water 2 Inhales two puffs, two seconds apart 3 Does not shake the medication before taking it 4 Breathes in rapidly while taking the medication

1 Most of the medications used in the treatment of asthma are delivered through inhalers like metered dose inhalers. This helps to prevent systemic side effects and promote the onset of action. The patient should clean the plastic case of the metered dose inhaler with water. The patient should inhale two puffs per dose and shake the device before use. The patient should breathe slowly for at least 10 seconds after administration of a puff.

The nurse gathers data related to individual patients' forced expiratory volume in one-second values. The nurse suspects that which patient has intermittent asthma? Forced expiratory volume in 1 sec 1 Patient A 90 2 Patient B 80 3 Patient C 70 4 Patient D 50

1 Patient A with normal forced expiratory volume in one second between exacerbations is suspected to have intermittent asthma. Forced expiratory volume in one second above 80 is normal. If the forced expiratory volume in one second is more than or equal to 80, it indicates that patient B has mild asthma. If the forced expiratory volume in one second is less than 80, it indicates that patient C has moderate asthma. If the forced expiratory volume in one second is less than 60, it indicates that patient D has severe asthma.

When should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? 1 One hour before a meal 2 Immediately after meals 3 After providing juice to the patient 4 After administering nasal medications

1 Postural drainage is performed one hour before meals to avoid nausea and vomiting. The procedure can also be performed three hours after meals but not immediately after meals, to avoid nausea and vomiting. Even if only juice is provided to the patient before postural drainage, the patient may feel nausea. Nasal medications may be excreted during the drainage if postural drainage is performed after administering nasal medications.

The nurse is caring for a patient with suspected chronic obstructive pulmonary disease (COPD). What diagnostic test should the nurse monitor for confirmation of the presence of COPD? 1 Spirometry 2 Chest x-ray 3 Complete blood count 4 Computed tomography (CT)

1 Spirometry is the best diagnostic test to confirm the presence of COPD; it determines the obstruction of airways with the forced expiratory volume/forced vital capacity (FEV1/FVC) ratio. Chest x-rays, complete blood count, and CT are not used routinely to assess COPD; they are used to assess the presence of lung hyperinflation but not the severity of COPD.

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 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.

What instruction should the nurse give to a patient with asthma who has received a prescription for albuterol and ipratropium nebulization? 1 After the treatment, cough effectively. 2 During the treatment, breathe rapidly through the mouth. 3 For the treatment, it is recommended to be in the side-lying position. 4 Between treatments, it is sufficient to clean the mouth by gargling with

1 The nurse should instruct the patient to cough effectively after the treatment to prevent hypoventilation and local irritation in the throat. This also helps to disperse accumulated drug in the airway. The nurse should advise the patient to sit upright to ensure efficient breathing and adequate penetration of the aerosol. The patient on corticosteroid inhalation needs to clean the mouth by performing mouthwash to avoid local irritation in the throat. While the patient is on aerosolized medication, the nurse should instruct the patient to breathe slowly and deeply.

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 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.

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 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 finding indicates to the nurse that a patient's respiratory status is improving following an acute asthma exacerbation? 1 Audible wheezing 2 Pursed lip breathing 3 Use of intercostal muscles 4 Oxygen saturation 89% of room air

1 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. Pursed lip breathing does not correlate with asthma improvement. The use of intercostal muscles and an oxygen saturation of 89% are evidence of continued asthma exacerbation.

Which intervention by the student nurse indicates the need for further teaching while performing percussion of a patient with chronic obstructive pulmonary disorder (COPD)? 1 Using both hands at once during percussion 2 Placing a thin towel over the area of percussion 3 Positioning the hand in a cup-like position with thumbs closed 4 Creating an air pocket between the patient's chest and the hand

1 The student nurse is performing percussion to detect mucus movement. The nurse should place both hands in a cup-like position and should use them in an alternating rhythmic fashion. Placing a thin towel or cloth over the area of percussion will help to reduce the risk of infection. During percussion, the hands should be in cup-like positions with thumbs closed, because this helps to create an air pocket. The cup-like position of the hand on the patient's chest will create an air pocket. This facilitates the movement of thick mucus.

A patient with chronic obstructive pulmonary disease (COPD) is experiencing anxiety. What medication as ordered should the nurse administer to this patient? 1 Buspirone 2 Tiotropium 3 Indacaterol 4 Roflumilast

1 Buspirone is an anxiolytic psychotropic drug that helps to reduce anxiety in the patient during COPD treatment. Tiotropium and indacaterol are long-acting anticholinergic drugs, which help to treat COPD by reducing inflammation. Indacaterol inhalation is used to control wheezing, shortness of breath, coughing, and chest tightness caused by COPD. Roflumilast is an antiinflammatory agent, which helps to treat the exacerbations of COPD but does not treat anxiety.

The nurse understands that which description best characterizes chronic obstructive pulmonary disease (COPD)? 1 Progressive persistent expiratory airflow limitation 2 Airway obstruction due to increased mucus production 3 Difficulty clearing secretions due to dilated bronchioles 4 Variations in airflow over time with normal lung function in between

1 COPD is characterized by persistent airflow limitations which are progressive and not fully reversible. Cystic fibrosis is characterized by airway obstruction related to increased mucus production. Dilated bronchioles are characteristic of bronchiectasis leading to difficulty in clearing secretions. Asthma is characterized by variations in airflow over time.

A male patient with chronic obstructive pulmonary disease (COPD) becomes dyspneic at rest. His baseline blood gas results are PaO2 70 mm Hg, PaCO2 52mm Hg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention? 1 Arterial pH 7.26 2 PaCO2 50 mm Hg 3 Patient in tripod position 4 Increased sputum expectoration

1 The patient's pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod position helps the patient's breathing, and the increase in sputum expectoration will improve the patient's ventilation.

The nurse is providing education about the risk factors of asthma. Which factors does the nurse explain are associated with asthma? Select all that apply. 1 Immune response 2 Sedentary lifestyle 3 History of pancreatitis 4 Genetic predisposition 5 Exposure to air pollutants

1,4,5 Risk factors for asthma include immune response, genetic predisposition, and exposure to air pollutants. Exercise, not a sedentary lifestyle, is also a risk factor. A history of gastroesophageal reflux disease is a risk factor, but a history of pancreatitis is not.

The patient has a prescription for albuterol 3 mg by nebulizer. Available is a solution containing 24mg/mL. How many mL should the nurse administer? 1 0.125 mL 2 0.15 mL 3 0.6 mL 4 0.75 mL

1. 0.125 ml 1 mL x 3 mg = 3 mg = 0.125 mL

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 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.

The nurse provides home care instructions to a patient who has emphysema. Which statement by the patient indicates correct understanding of the teaching? 1 "I'll get a dehumidifier to use at home." 2 "I'll report any change in the color of my sputum." 3 "When I feel short of breath, I'll increase my oxygen flow rate." 4 "The correct procedure for pursed-lip breathing is to inhale twice as long as I exhale."

2 A change in the color of the patient's sputum from clear to yellow or green may indicate an infection and therefore should be reported to the patient's healthcare provider. Patients with emphysema should have humidified air in the home to prevent drying of the respiratory tract. The rate of oxygen delivery should not be increased over that recommended by the primary healthcare provider because of the risk of decreased respiratory drive. The correct procedure for pursed-lip breathing is to exhale twice as long as the breather inhales.

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 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.

A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. What condition or diagnosis does the nurse recognize? 1 Acute bronchitis 2 An asthma attack 3 Pulmonary edema 4 Congestive heart failure

2 A sudden onset of coughing and wheezing are the initial and most obvious symptoms of an acute asthma attack. An asthma attack may begin mildly but progress to respiratory distress and arrest if it goes untreated. Acute bronchitis is irritation and inflammation of the mucous-membrane lining of the respiratory tract, usually caused by an infectious agent. Pulmonary edema is fluid accumulation in the lungs due to heart failure or lung injury. The fluid collection impairs gas exchange and may result in respiratory failure. Congestive heart failure, or heart failure, is a condition in which the heart cannot pump effectively. Fluid may accumulate in the lungs. Edema may develop in the lower extremities, and shortness of breath may also occur with increasing frequency and severity.

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? 1 Prescribe fruits and fruit juices to be offered between meals 2 Prescribe a high-calorie, high-protein diet with six small meals a day 3 Teach the patient to use frozen meals at home that can be microwaved 4 Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet

2 Because the patient with COPD needs to use greater energy to breathe, there often is decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, thus interfering with the work of breathing. For these reasons, the patient with COPD should eat six small meals per day, taking in a high-calorie, high-protein diet, with non-protein calories divided evenly between fat and carbohydrate. Prescribing fruits and fruit juices, teaching the patient to use frozen meals at home, and providing a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet will not increase the patient's caloric intake.

The nurse is caring for the patient with chronic obstructive pulmonary disease (COPD). The nurse will include in the patient plan of care: 1 Teach the patient to discontinue oxygen while eating 2 Advise the patient to rest at least 30 minutes before eating 3 Tell the patient to avoid taking bronchodilators before meals 4 Encourage the patient to perform mild exercises 60 minutes before eating

2 COPD patients should rest for at least 30 minutes before eating to decrease dyspnea and conserve energy. Encouraging the patient to perform mild exercises 60 minutes before eating, telling the patient to avoid taking bronchodilators before meals, and teaching the patient to discontinue oxygen while eating are incorrect because patients should be encouraged to rest before eating to conserve energy and decrease dyspnea, and the exercises before meals would do the exact opposite. It is okay for the patient to use a bronchodilator before meals if prescribed, because it will decrease dyspnea and conserve energy. If a patient has O2 therapy prescribed, use of supplemental O2 by nasal cannula while eating may be beneficial, because this will decrease dyspnea and conserve energy.

While reviewing the laboratory reports of a patient with a chronic cough, dyspnea, and lung inflammation, the nurse finds that the patient has a forced expiratory volume of 55%. Which treatment strategy would be most effective for this patient? 1 Roflumilast 2 Salmeterol and formoterol 3 Lung volume reduction surgery 4 50% oxygen at 8 L/minute concentration

2 Chronic cough, dyspnea, and lung inflammation indicate that the patient has chronic obstructive pulmonary disease (COPD). The patient with COPD has a forced expiratory volume of 55%, indicating that the patient has moderate COPD. Long acting β-adrenergic agonists such as salmeterol and formoterol will be effective for the patient. Roflumilast is an antiinflammatory agent that acts as a phosphodiesterase inhibitor and helps to reduce COPD. Lung volume reduction surgery is a surgical treatment, which is useful in treating patients with severe COPD. However, it is not preferable for patients with moderate COPD. Fifty percent oxygen at an 8 L/minute concentration is required for a patient who is on long-term oxygen therapy.

A child with a nonproductive cough states, "I am having trouble breathing." What action should the nurse take to reduce the severity of breathlessness in the child? 1 Assist the child to lie in supine position 2 Instruct the child to bend forward slightly 3 Suggest that the child walk for 30 minutes 4 Instruct the child to take short, quick breaths

2 Cough may be the only symptom in patients with cough-variant asthma. The nurse should instruct the child with asthma to sit upright or slightly bent forward, because these positions would help the child to use accessory muscles for respiration. The child should not lie in a supine position, which may increase bronchial tone and cause irritation with stimulation of cough receptors. The child must not walk for half an hour, because it may trigger the symptoms. The nurse should instruct the child to take deep breaths.

The nurse is caring for a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? 1 Oxygen saturation of 92% 2 Presence of edema in the ankles 3 Yellowish discoloration of the skin 4 Partial pressure of arterial oxygen (PaO2) is 60 mm Hg

2 Cough, sputum production, and dyspnea indicate that the patient has chronic obstructive pulmonary disease (COPD). Cor pulmonale is the impairment or failure of the right side of the chest, which is characterized by the presence of edema in the ankles. The patient with cor pulmonale will have chronic hypoxia, so the oxygen saturation is less than 88%. The patient with chronic obstructive pulmonary disease (COPD) will have the bluish discoloration of skin associated with polycythemia. A yellowish discoloration is associated with jaundice. The PaO2 of the patient with COPD is less than 60 mm Hg due to severe hypoxemia. A PaO2 of 60 mm Hg is a normal finding.

A patient with asthma experiences anaphylaxis. Which medication should the nurse prepare to administer? 1 Timolol 2 Epinephrine 3 Magnesium sulfate 4 Sodium bicarbonate

2 Epinephrine helps to resolve anaphylactic reactions in the patient with asthma. Administer epinephrine either subcutaneously or intramuscularly to treat the patient. The nurse should monitor the blood pressure and electrocardiogram of the patient closely after administration of the drug. Timolol is a beta-blocker that may trigger the symptoms of asthma in the patient. Magnesium sulfate helps to treat the patient with severe or life threatening asthma. Sodium bicarbonate helps to treat severe metabolic or respiratory acidosis.

A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use? 1 Oxygen tent 2 Venturi mask 3 Nasal cannula 4 Oxygen-conserving cannula

2 The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. An oxygen tent is not required for a patient with COPD. A nasal cannula delivers a less-precise amount of oxygen. An oxygen-conserving cannula is not appropriate for this patient.

Which assessment finding does the nurse expect when caring for a patient with asthma? 1 pH of 5.11 2 PaCO2 of 30 mm Hg 3 Blood pressure of 110/60 mm Hg 4 Respiratory rate of 25 breaths/minute

2 The patient with acute asthma may reveal signs of hypoxemia and hyperventilation due to air flow limitation, indicated by a low level of partial pressure of carbon dioxide in blood (PaCO2), such as 30 mmHg. This condition leads to a rise in pH leading to respiratory alkalosis; however, a pH of 5.11 is low. The respiratory rate of the asthmatic patient increases to more than 30 breaths/minute due to the use of accessory muscles. The patient with anxiety due to breathlessness has an increase in pulse and blood pressure.

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 β2-agonist

2 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.

The nurse is explaining the pathophysiology of asthma to a patient. Which is the most appropriate explanation? 1 "An acid-base imbalance causes bronchoconstriction and edema of the airways." 2 "Inflammation causes bronchoconstriction, hyperreactivity, and edema of the airways." 3 "Inflammation causes bronchodilation, hyperreactivity, and pressure of the airways." 4 "An immune response causes bronchodilation, hyperreactivity, and edema of the airways."

2 The primary pathophysiologic process in asthma is persistent but variable inflammation of the airways. The airflow is limited because the inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways. Exposure to allergens or irritants initiates the inflammatory cascade. An immune response does not trigger asthma. Inflammation causes edema, not pressure, of the airways. Acid-base imbalances do not trigger asthma.

After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness and dry cough. What action should the nurse take to reduce the symptoms? 1 Recommend that the patient pauses between the puffs 2 Instruct the patient to rinse the mouth with water after inhalation 3 Assist the patient in obtaining a spacer or holding device for inhalation 4 Wait until the cough subsides before administering the patient's next dose

2 Upon inhalation into the pharynx, mometasone may cause local irritation such as oropharyngeal candidiasis, hoarseness, and dry cough. Hence the patient should rinse the mouth either with water or with mouthwash after inhalation. The patient may not be benefit by pausing between the puffs. Asking the patient to use a spacer or holding device for inhalation of corticosteroids can be helpful in getting more medication into the lungs. However, it does not reduce the symptoms of candidiasis. The next dose is given to the patient only upon further advice from the practitioner.

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.

2,4,5 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 chronic obstructive pulmonary disease (COPD) needs to be taught about effective huff coughing in a stepwise manner. In which order should the nurse put the steps for teaching the patient? 1. Forcefully exhale quickly. 2. Assume a sitting position. 3. Inhale slowly through your mouth. 4. Hold your breath for 2 to 3 seconds.

2. Assume a sitting position. 3. Inhale slowly through your mouth. 4. Hold your breath for 2 to 3 seconds. 1. Forcefully exhale quickly For effective huff coughing, the patient should assume a sitting position with his head slightly flexed, shoulders relaxed, knees flexed, forearms supported by a pillow, and, if possible, feet on the floor. Then the patient should inhale slowly through the mouth while breathing deeply from the diaphragm; the patient should hold the breath for two to three seconds. The patient should forcefully exhale quickly, as if fogging up a mirror with his breath to create a "huff," which moves the secretions to larger airways.

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 5 mg ÷ 2 mg/mL = 2.5 mL

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 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.

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change? 1 Laryngospasm 2 Pulmonary edema 3 Narrowing of the airway 4 Overdistention of the alveoli

3 Narrowing of the airway by persistent but variable inflammation leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Laryngospasm, pulmonary edema, and overdistention of the alveoli do not produce wheezing.

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 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 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.

When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections? 1 Smoking causes a hoarse voice 2 Cough will become nonproductive 3 Decreased alveolar macrophage function 4 Sense of smell is decreased with smoking

3 The damage to the lungs includes alveolar macrophage dysfunction that increases the incidence of infections and thus increases patient discomfort and cost to treat the infections. Other lung damage that contributes to infections includes cilia paralysis or destruction, increased mucus secretion, and bronchospasms that lead to sputum accumulation and increased cough. The patient may be aware already of respiratory mucosa damage with hoarseness and decreased sense of smell and taste, but these do not increase the incidence of pulmonary infection.

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 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.

What does the nurse interpret from finding that a patient, after being treated for chronic cough and dyspnea associated with inflammation in lung parenchyma, loses muscle mass? 1 The patient is on diuretic therapy. 2 The patient is on theophylline therapy. 3 The patient is on corticosteroid therapy. 4 The patient is on bronchodilator therapy.

3 The patient has chronic cough and dyspnea associated with inflammation in lung parenchyma, indicating that the patient has chronic obstructive pulmonary disease (COPD). The patient experiences loss of muscle mass after treatment. This indicates that the patient is on high doses of corticosteroids, which may cause muscle loss due to protein catabolism. Diuretics are provided to reduce cardiac complications and may cause fluid imbalance. Theophylline is an antiinflammatory agent that helps to treat COPD effectively. Theophylline may cause side effects like bloating but is not associated with loss of muscle mass. Bronchodilators help to treat COPD by reducing the hyperinflation of lungs but are not associated with protein catabolism or muscle loss.

A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates that which drug will be prescribed? 1 A sedative 2 A mucolytic 3 An antibiotic 4 Epinephrine

3 The patient with body temperature of 102° F and purulent sputum may have bacterial infection. Hence the treatment with antibiotics would benefit the patient. Sedatives may result in respiratory depression and death. Mucolytics are not recommended, because they are not beneficial to the patient suffering from asthma. Epinephrine helps to treat acute anaphylaxis.

The purpose of this exercise is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping. 1 Huff coughing 2 Diaphragmatic breathing 3 Pursed-lip breathing (PLB) 4 Chest physiotherapy (CPT)

3 The purpose of this exercise is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping. 1 Huff coughing 2 Diaphragmatic breathing 3 Pursed-lip breathing (PLB) 4 Chest physiotherapy (CPT)

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). What does the nurse recognize are the predominant inflammatory cells in this disorder? Select all that apply. 1 Mast cells 2 Eosinophils 3 Neutrophils 4 Lymphocytes 5 Macrophages

3,4,5 COPD is the chronic inflammation of the lung parenchyma. The predominant inflammatory cells of the parenchyma are neutrophils, lymphocytes, and macrophages. Neutrophils, lymphocytes, and macrophages attract inflammatory mediators like leukotrienes and macrophages. Mast cells and eosinophils are inflammatory cells associated with asthma.

A patient who is a chronic smoker is diagnosed with chronic obstructive pulmonary disease (COPD). What causes the loss of elastic recoil in the patient's lungs and the destruction of alveoli? 1 Secretion of leukotrienes and cytokines 2 Secretion of neutrophils and lymphocytes 3 Inhalation of noxious particles into the lungs 4 Imbalance of protease and antiprotease ratio

4 An imbalance in the ratio of protease and antiprotease will result in the destruction of alveoli and the loss of elastic recoil in the lungs. Inflammatory cells such as neutrophils and lymphocytes attract inflammatory mediators, leukotrienes and cytokines to increase inflammation. However, the secretion of leukotrienes and cytokines is not associated with the loss of elastic recoil and the destruction of alveoli. Neutrophils and lymphocytes are the inflammatory cells that trigger the process of inflammation, resulting in tissue damage but are not associated with loss of elastic recoil and destruction of alveoli. Inhalation of noxious particles will trigger the process of inflammation but does not destroy alveoli.

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every six hours. What should the nurse explain as the best way to prevent oral infection while taking this medication? 1 Chew a hard candy before the first puff of medication. 2 Rinse the mouth with water before each puff of medication. 3 Ask for a breath mint following the second puff of medication. 4 Rinse the mouth with water following the second puff of medication.

4 Because beclomethasone is a corticosteroid, the patient should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection. The mouth should be rinsed after the second puff, not before each puff. Hard candy or breath mints will not prevent oral infection.

A patient in the outpatient clinic has symptoms including chronic cough, sputum production, and dyspnea. On taking a detailed history of the patient, the nurse finds that this patient has a prolonged exposure to smoke. Which condition would the nurse most likely suspect the patient to have? 1 Influenza 2 Pneumonia 3 Tuberculosis 4 Chronic obstructive pulmonary disease (COPD)

4 COPD symptoms include cough, sputum production, and dyspnea. In addition, this patient has a history of exposure to allergens such as smoke. Tuberculosis is a bacterial infection with a low-grade fever and weight loss. Dyspnea is a late symptom of tuberculosis. Pneumonia is an infection with a cough, dyspnea, fever, chills, and pleuritic chest pain. Influenza is a viral infection with sneezing, watery eyes and nose, and fever.

The nurse is educating a patient regarding breathing techniques. What technique should the nurse avoid in a patient with chronic obstructive pulmonary disease (COPD) who has marked hyperinflation? 1 Yoga 2 Huff coughing 3 Pursed-lip breathing 4 Diaphragmatic breathing

4 Diaphragmatic breathing is a technique in which the patient breathes with the diaphragm but does not use accessory muscles. The use of the diaphragm increases the work of breathing, so the patient with COPD may have difficulty in breathing. Yoga involves slow, deep breathing. It is helpful for the patient with COPD to perform yoga. Huff coughing is an effective coughing technique that helps to clear sputum from the airways. Pursed-lip breathing is a prolonged exhalation breathing exercise in which the patient exhales for a prolonged time.

A patient presents with a productive cough and a body temperature of 102° F. The patient's white blood cell (WBC) count is 15,000/mm3. The nurse expects that what diagnostic test will be prescribed? 1 Niox Mino test 2 Allergy skin test 3 Lung function test 4 Sputum culture test

4 Fever, productive cough, and white blood cells of 15,000/mm3 indicate infection in the patient. Evidence of the sputum culture test helps to rule out bacterial infection from other upper respiratory tract problems. Niox Mino test helps to measure airway inflammation related to asthma and an allergy skin test is helpful for assessment of sensitivity for specific allergen. A lung function test helps to evaluate the lung capacity in the patient with respiratory problems.

Which instructions, given by the nurse to the patient with chronic obstructive pulmonary disease (COPD), regarding pursed lip breathing (PLB) are correct? 1 "Inhale slowly and deeply through your mouth." 2 "During exhalation, relax your facial muscles and puff out your cheeks." 3 "Use this action only after any activity that causes you to be short of breath." 4 "Make breathing out (exhalation) three times longer than breathing in (inhalation)."

4 The exhalation period needs to be three times as long as the inhalation period. Patients need to inhale slowly and deeply through the nose, not the mouth, first. PLB should be used before, during, and after, not just after, any activity that causes shortness of breath. While exhaling, the facial muscles need to be relaxed without any puffing out of the cheeks.

What is the best method to prevent oral infection while the patient is taking fluticasone? 1 Rinse the mouth daily with an oral antibiotic solution. 2 Rinse the mouth with water before each puff of medication. 3 Brush the teeth before and after medication administration. 4 Rinse the mouth with water after the second puff of medication.

4 The patient should rinse the mouth with water after the second puff of medication to reduce the risk of fungal overgrowth and oral infection. An oral antibiotic solution is not indicated and would not treat a fungal infection. Brushing the teeth is not necessary before medication administration and the mouth should be rinsed after, not before, medication administration.

The patient has a prescription to receive methylprednisolone sodium succinate 150 mg intravenous (IV) push stat. Available is a solution containing 60 mg/mL. How many mL of methylprednisolone should the nurse administer? 1 1.25 mL 2 1.75 mL 3 2 mL 4 2.5 mL

4 Using ratio and proportion, multiply 60 by x and multiply 150 × 1 to yield 60x = 150. Divide 150 by 60 to yield 2.5 mL.

The nurse provides education to a patient who is prescribed a metered-dose inhaler. Which actions taken by the patient indicate the need for further teaching? Select all that apply. 1 Waits between puffs 2 Activates the inhaler during inspiration 3 Holds the breath for 10 seconds after a puff 4 Inhales more than one puff with each inspiration 5 Does not shake the metered-dose inhaler before use

4,5 The metered-dose inhaler (MDI) has to be shaken before use, and the patient should only inhale one puff per inspiration. The patient using an MDI should wait between each puff. The MDI should be activated during inspiration. The patient should to hold the breath for 10 seconds after each puff.

A patient is prescribed an inhaler for treatment of asthma. The medication canister contains 200 puffs, scheduled to last for 25 days. The nurse should instruct the patient to inhale how many puffs per day to receive the prescribed amount? Record your answer using a whole number. ________

8 puffs/day A patient who is taking medication from a canister of 200 puffs has to take eight puffs per day to completely administer the medication within 25 days.

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."

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.