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The nurse teaches a 33-year-old male patient with asthma how to administer fluticasone (Flovent HFA) by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions? "I should not use a spacer device with this inhaler." "I will rinse my mouth each time after I use this inhaler." "I will feel my breathing improve over the next 2 to 3 hours." "I should use this inhaler immediately if I have trouble breathing."

"I will rinse my mouth each time after I use this inhaler." Fluticasone (Flovent HFA) may cause oral candidiasis (thrush). The patient should rinse the mouth with water or mouthwash after use or use a spacer device to prevent oral fungal infections. Fluticasone is an inhaled corticosteroid, and it may take 2 weeks of regular use for effects to be evident. This medication is not recommended for an acute asthma attack.

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler? - "I can rinse my mouth following the two puffs to get rid of the bad taste." - "I should wait at least 1 to 2 minutes between each puff of the inhaler." - "Because this medication is not fast-acting, I cannot use it in an emergency if my breathing gets worse." - "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." The patient should not just keep taking extra puffs of the inhaler to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status. Rinsing the mouth after the puffs will eliminate a bad taste. Waiting 1 to 2 minutes between each puff will facilitate the effectiveness of the administration. Ipratropium is not used in an emergency for COPD.

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique? - "Avoid shaking the inhaler before use." - "Breathe out slowly before positioning the inhaler." - "Using a spacer should be avoided for this type of medication." - "After taking a puff, hold the breath for 30 seconds before exhaling."

- "Breathe out slowly before positioning the inhaler." It is important to breathe out slowly before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose. The inhaler should be shaken well. A spacer may be used. Holding the breath after the inhalation of medication helps keep the medication in the lungs, but 30 seconds will not be possible for a patient with COPD.

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? - "Close lips tightly around the mouthpiece and breathe in deeply and quickly." - "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." - "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." - "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

- "Close lips tightly around the mouthpiece and breathe in deeply and quickly." The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs.

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? - "I will pay less for medication because it will last longer." - "More of the medication will get down into my lungs to help my breathing." - "Now I will not need to breathe in as deeply when taking the inhaler medications." - "This device will make it so much easier and faster to take my inhaled medications."

- "More of the medication will get down into my lungs to help my breathing." A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.

Although a diagnosis of cystic fibrosis is most often made before age 2, an 18-year-old patient at the student health center with a history of frequent lung and sinus infections has clinical manifestations consistent with undiagnosed cystic fibrosis (CF). Which information would be accurate for the nurse to include when teaching the patient about a scheduled sweat chloride test? - "Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF." - "If sweating occurs after an oral dose of pilocarpine, the test for CP is positive." - "The test measures the amount of sodium chloride in your postexercise sweat." - "If the sweat chloride test is positive on two occasions, genetic testing will be necessary."

- "Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF." The diagnostic criteria for CF involve a combination of clinical presentation, sweat chloride testing, and genetic testing to confirm the diagnosis. The sweat chloride test is performed by placing pilocarpine on the skin and carried by a small electric current to stimulate sweat production. This takes about 5 minutes, and the patient feels a slight tingling or warmth. The sweat is collected on filter paper or gauze and then analyzed for sweat chloride concentrations (for about 1 hour). Values above 60 mmol/L for sweat chloride are consistent with the diagnosis of CF. However, a second sweat chloride test is recommended to confirm the diagnosis, unless genetic testing identifies a CF mutation. Genetic testing is used if the results from a sweat chloride test are unclear.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? - "Long-term home oxygen therapy should be used to prevent respiratory failure." - "Oxygen will not be needed until or unless you are in the terminal stages of this disease." - "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." - "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia.

- "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia. Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered.

Which test result identifies that a patient with asthma is responding to treatment? - An increase in CO2 levels - A decreased exhaled nitric oxide - A decrease in white blood cell count - An increase in serum bicarbonate levels

- A decreased exhaled nitric oxide Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the asthma patient.

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

- Arterial pH 7.26 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.

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? - Smoking causes a hoarse voice. - Cough will become nonproductive. - Decreased alveolar macrophage function - Sense of smell is decreased with smoking.

- Decreased alveolar macrophage function 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 already be aware of respiratory mucosa damage with hoarseness and decreased sense of smell and taste, but these do not increase the incidence of pulmonary infection.

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which finding? - Absence of dyspnea - Improved mental status - Effective and productive coughing - PaO2 within normal range for the patient

- Effective and productive coughing Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing. Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved respiratory status but do not evaluate airway clearance.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? - Allow time to calm the patient. - Observe for signs of diaphoresis. - Evaluate the use of intercostal muscles. - Monitor the patient for bilateral chest expansion.

- Evaluate the use of intercostal muscles. The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. The other options may also occur, but they are not the primary reason for inspecting the chest wall of this patient.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers (select all that apply)? - Exercise - Allergies - Emotional stress - Decreased humidity - Upper respiratory infections

- Exercise - Allergies - Emotional stress - Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD).

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? - Acute respiratory failure - Secondary respiratory infection - Fluid volume excess resulting from cor pulmonale - Pulmonary edema caused by left-sided heart failure

- Fluid volume excess resulting from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? - Supine - Lithotomy - High Fowler's - Reverse Trendelenburg

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

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? - An overproduction of the antiprotease α1-antitrypsin - Hyperinflation of alveoli and destruction of alveolar walls - Hypertrophy and hyperplasia of goblet cells in the bronchi - Collapse and hypoventilation of the terminal respiratory unit

- Hyperinflation of alveoli and destruction of alveolar walls In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

A 68-year-old patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care for this patient? - Use the incentive spirometer for at least 10 breaths every 2 hours. - Administer prescribed antibiotics and antitussives on a scheduled basis. - Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. - Provide nutritional supplements that are high in protein and carbohydrates.

- Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. Adequate hydration helps to liquefy secretions and thus make it easier to remove them. Unless there are contraindications, the nurse should instruct the patient to drink at least 3 liters of fluid daily. Although nutrition, breathing exercises, and antibiotics may be indicated, these interventions will not liquefy or thin secretions. Antitussives may reduce the urge to cough and clear sputum, increasing congestion. Expectorants may be used to liquefy and facilitate clearing secretions.

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which assessment finding? - Decreased respiratory rate - Increased respiratory rate - Increased peak flow readings - Decreased sputum production

- Increased peak flow readings Ipratropium is a bronchodilator that should result in increased peak expiratory flow rates (PEFRs).

When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included? - Increasing dyspnea - Temperature below 98.6° F - Decreased sputum production - Unable to drink 3 L low-sodium fluids

- Increasing dyspnea The significant clinical manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain. Although drinking at least 3 L of low-sodium fluid will help liquefy secretions to make them easier to expectorate, the health care provider does not need to be notified if the patient cannot do this one day.

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

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

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

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

The nurse supervises a team including another registered nurse (RN), a licensed practical/vocational nurse (LPN/LVN), and unlicensed assistive personnel (UAP) on a medical unit. The team is caring for many patients with respiratory problems. In what situation should the nurse intervene with teaching for a team member? - LPN/LVN obtained a pulse oximetry reading of 94% but did not report it. - RN taught the patient about home oxygen safety in preparation for discharge. - UAP report to the nurse that the patient is complaining of difficulty breathing. - LPN/LVN changed the type of oxygen device based on arterial blood gas results.

- LPN/LVN changed the type of oxygen device based on arterial blood gas results. It is not within the LPN scope to change oxygen devices based on analysis of lab results. It is within the scope of practice of the RN to assess, teach, and evaluate. The LPN provides care for stable patients and may adjust oxygen flow rates depending on desired oxygen saturation levels of stable patients. The UAP may obtain oxygen saturation levels, assist patients with comfort adjustment of oxygen devices, and report changes in patient's level of consciousness or difficulty breathing.

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? - Laryngospasm - Pulmonary edema - Narrowing of the airway - Overdistention of the alveoli

- Narrowing of the airway 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.

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? - Order fruits and fruit juices to be offered between meals. - Order a high-calorie, high-protein diet with six small meals a day. - Teach the patient to use frozen meals at home that can be microwaved. - Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

- Order a high-calorie, high-protein diet with six small meals a day. Because the patient with COPD needs to use greater energy to breathe, there is often 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. The other interventions will not increase the patient's caloric intake.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after what occurs? - Hypertension and pulmonary edema - Oropharyngeal candidiasis and hoarseness - Elevation of blood glucose and calcium levels - Adrenocortical dysfunction and hyperglycemia

- Oropharyngeal candidiasis and hoarseness Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose.

The nurse teaches pursed lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism? - Loosening secretions so that they may be coughed up more easily - Promoting maximal inhalation for better oxygenation of the lungs - Preventing bronchial collapse and air trapping in the lungs during exhalation - Increasing the respiratory rate and giving the patient control of respiratory patterns

- Preventing bronchial collapse and air trapping in the lungs during exhalation The purpose of pursed lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. It does not affect secretions, inhalation, or increase the rate of breathing.

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? - Pulse rate of 72/minute - Temperature of 98.4° F - Oxygen saturation 96% - Respiratory rate of 18/minute

- Pulse rate of 72/minute lbuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as an adverse effect.

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every 6 hours. What should the nurse explain as the best way to prevent oral infection while taking this medication? - Chew a hard candy before the first puff of medication. - Rinse the mouth with water before each puff of medication. - Ask for a breath mint following the second puff of medication. - Rinse the mouth with water following the second puff of medication.

- Rinse the mouth with water following the second puff of medication. Because beclamethosone 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 nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic 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? - IV fluids - Biofeedback therapy - Systemic corticosteroids - Pulmonary function testing

- Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic 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 is caring for a 48-year-old male patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with a change in respiratory rate from 26 breaths/minute to 44 breaths/minute. Which action by the nurse would be the most appropriate? - Have the patient perform huff coughing. - Perform chest physiotherapy for 5 minutes. - Teach the patient to use pursed-lip breathing. - Instruct the patient in diaphragmatic breathing.

- Teach the patient to use pursed-lip breathing. Pursed-lip breathing (PLB) prolongs exhalation and prevents bronchiolar collapse and air trapping. PLB is simple and easy to teach and learn. It also gives the patient more control over breathing. Evidence from controlled studies does not support the use of diaphragmatic breathing in patients with COPD. Diaphragmatic breathing results in hyperinflation because of increased fatigue and dyspnea and abdominal paradoxical breathing rather than with normal chest wall motion. Chest physiotherapy (percussion and vibration) is used primarily for patients with excessive bronchial secretions who have difficulty clearing them. Huff coughing is a technique that helps patients with COPD to use a forced expiratory technique to clear secretions.

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? - Oxygen tent - Venturi mask - Nasal cannula - Oxygen-conserving cannula

- Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness? - Slightly increase activity over the current level. - Swim for 10 min/day, gradually increasing to 30 min/day. - Limit exercise to activities of daily living to conserve energy. - Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

- Walk for 20 min/day, keeping the pulse rate less than 130 beats/min. The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 min/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).

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

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

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis? - Work of breathing - Fear of suffocation - Effects of medications - Anxiety and restlessness

- Work of breathing When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.

A nurse is using an airway clearance device to mobilize secretions in a patient with chronic obstructive pulmonary disease (COPD). The nurse instructs the patient, "You must sit in an upright position during the process." Which device does the nurse use during this procedure? 1 Flutter 2 Acapella 3 SmartVest 4 TheraPEP therapy system

1 Flutter is an airway clearance device that helps to mobilize lung secretions by increasing oscillations. Patients breathe into the mouthpiece, which has a steel ball. The patient must be upright, and the angle at which the Flutter is held is critical. Acapella, a small hand-held device, combines the benefits of both positive expiratory pressure (PEP) therapy and airway vibrations to mobilize pulmonary secretions. Patients are free to stand, sit, or recline. SmartVest is a high-frequency chest wall oscillation device that helps to mobilize secretions. It can be used in a variety of positions. The TheraPEP therapy system also helps to mobilize secretions. This device has a mouthpiece connected to a cylindrical resistor so the patient does not need to stay in an upright position. Text Reference - p. 595

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. Test-Taking Tip: Read every word of each question and option before responding to the item. Glossing over the questions just to get through the examination quickly can cause you to misread or misinterpret the real intent of the question. Text Reference - p. 594

The nurse is teaching a class about smoking cessation. Select the respiratory-related symptoms associated with cigarette smoking. Select all that apply. 1 Chronic cough 2 Decreased sense of taste 3 Decreased sputum production 4 Paralysis of the cilia inside the lungs 5 Increased function of alveolar macrophages

1, 2, 4 The effects of cigarette smoking on the respiratory system include development of a chronic cough, paralysis of the cilia, decreased sense of taste and smell, increased sputum production (not decreased), and decreased (not increased) function of alveolar macrophages. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that would appear right but would in fact be incorrect. Text Reference - p. 582

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. Text Reference - p. 589

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? 1 An overproduction of the antiprotease a1 antitrypsin 2 Hyperinflation of alveoli and destruction of alveolar walls 3 Hypertrophy and hyperplasia of goblet cells in the bronchi 4 Collapse and hypoventilation of the terminal respiratory unit

2 In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antiproteaste α1-antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells. Text Reference - p. 582

Which complications, along with edema in the ankles, does the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Leukopenia 2 Weight gain 3 Polycythemia 4 Hepatomegaly 5 Jugular vein distension

2, 4, 5 The presence of edema in the ankles indicates that the patient has the cardiac complication cor pulmonale, or failure in the right side of the heart. Cor pulmonale is associated with peripheral edema, especially in the ankles, so the patient will have weight gain. The patient with cor pulmonale will have tissue damage, resulting in hepatomegaly. The patient with cor pulmonale will have improper blood flow from the right atrium to the right ventricle, resulting in jugular vein distension. The patient with COPD will not have a decrease in white blood cells. The patient with COPD will have increased red blood cells due to hypoxemia, but will not have polycythemia. Text Reference - p. 586

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? 1 Acute respiratory failure 2 Secondary respiratory infection 3 Fluid volume excess resulting from cor pulmonale 4 Pulmonary edema caused by left-sided heart failure

3 Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema. Text Reference - p. 586

The nurse cares for a patient with emphysema. What change in the alveolar sacs is the pathophysiological change in the lungs most characteristic of this disease? 1 The alveolar sacs collapse. 2 The alveolar sacs retain CO2. 3 The alveolar sacs are overdistended. 4 The alveolar sacs become filled with fluid

3 In emphysema the alveolar sacs lose elasticity, become distended with trapped air, and may rupture. This causes obstruction of the alveolar capillary bed and impairs gas exchange. Alveolar sacs do not collapse or become filled with fluid. However, as a result of the overdistention and impaired gas exchange, carbon dioxide will be retained, but this is not the correct answer option because it is not the characteristic of emphysema. Text Reference - p. 580

Which position of the patient with hemoptysis may result in further complications while a nurse performs postural drainage? 1 Supine position 2 Side-lying position 3 Trendelenburg position 4 Dorsal recumbent position

3 In the Trendelenburg position, the patient is in the supine position and his or her feet are raised 15 to 30 degrees higher than the head. This position will increase the risk of blood flow to brain, which could lead to the patient having blood in the mucus. The supine position, side-lying position, and dorsal recumbent position do not cause any complications during postural drainage, because the patient will not have any difficulty breathing or coughing. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. Text Reference - p. 594

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. Text Reference - p. 595

A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? 1 "Long-term home oxygen therapy should be used to prevent respiratory failure." 2 "Oxygen will not be needed until or unless you are in the terminal stages of this disease." 3 "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." 4 "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

4 Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg also will cause home oxygen therapy to be considered. Test-Taking Tip: Never leave a question unanswered. Even if answering is no more than an educated guess on your part, go ahead and mark an answer. You might be right, but if you leave it blank, you will certainly be wrong and lose precious points. Text Reference - p. 593

A patient with emphysema is receiving oxygen at 1 L/min by way of nasal cannula. The nurse understands that this prescription is appropriate because: 1 The patient does not require more than 1 L of oxygen 2 High concentrations of oxygen may rupture the alveoli 3 Oxygen is the natural stimulus for breathing and not required 4 High concentrations of oxygen eliminate the respiratory drive

4 Patients with emphysema become accustomed to a high level of carbon dioxide and low level of oxygen. This situation reverses the natural breathing stimulus. A low oxygen level then becomes the stimulus for breathing, and too much oxygen will eliminate the stimulus to breathe. There is not enough information to determine that the patient does not need more than 1 L of oxygen. A high concentrations of oxygen does not rupture alveoli. In healthy individuals, increased carbon dioxide, not oxygen, is the stimulus for breathing. Text Reference - p. 580

Which laboratory finding helped the nurse reach the conclusion that a patient with a chronic cough and dyspnea has hypercapnia? 1 Hemoglobin concentration is 14 g/dL. 2 Red blood cell count is 4.9 million cells/microliter. 3 Partial pressure of arterial oxygen (PaO2) is 75 mm Hg. 4 Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg

4 The patient has a chronic cough and dyspnea, indicating that he or she has chronic obstructive pulmonary disease (COPD). The normal range of PaCO2 is 35 to 45 mm Hg. The PaCO2 of the patient is 55 mm Hg, which indicates hypercapnia. Normal hemoglobin levels are 13.5 to 17.5 g/dL. The patient has a hemoglobin concentration of 12 g/dL, which is a normal finding and does not indicate that the patient has any complication. The normal range for red blood cell count is 4.7 to 6.1 million cells/microliter. A patient with COPD may develop polycythemia but this patient has a normal red blood cell count of 4.9 million cells/µL. A PaO2 level of above 70 mm Hg indicates that the patient does not have hypoxemia. The partial pressure of arterial oxygen is 75 mm Hg, which is a normal finding. Text Reference - p. 585

Which inhaler should the nurse be prepared to administer to the patient at the onset of an asthma attack? A. Albuterol B. Fluticasone/Salmeterol C. Fluticasone D. Salmeterol

A Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone/salmeterol, fluticasone, and salmeterol are not short-acting bronchodilators and will not relieve the patient's symptoms of an acute asthma exacerbation.

The patient has a prescription for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? A. Albuterol B. Salmeterol C. Beclomethasone D. Ipratropium bromide

A Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol is a long-acting β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone is a corticosteroid inhaler and is not recommended for an acute asthma attack. Ipratropium bromide is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists (SABAs).

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? A. Anxiety B. Cyanosis C. Bradycardia D. Hypercapnia

A An early manifestation during an asthma attack is anxiety, because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH because he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.

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? A. Chronic obstructive pulmonary disease (COPD) B. Tuberculosis C. Pneumonia D. Influenza

A 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 provides teaching to a patient with asthma who has been advised to use nebulization. What should the nurse include in the instructions about nebulization? A. Sit in an upright position during the treatment. B. Hold the inspiration for 10 seconds. C. Breathe rapidly between forced breaths. D. Do not cough after the nebulization treatment.

A Nebulization involves administering drug solution as mists produced by small machines called nebulizers. An upright position allows for efficient breathing that ensures adequate penetration and deposition of the aerosolized medication. The patient should hold the inspiration for two to three seconds to ensure penetration of the medication. The patient should practice deep breathing in between the forced breathing to prevent alveolar hypoventilation. The patient should be encouraged to cough effectively after the nebulization to mobilize the secretions.

The nurse is evaluating an asthmatic patient's knowledge of self-care. Which statement by the patient indicates an adequate understanding of the instructions given? A. "I will keep my rescue inhaler with me at all times." B. "I do not need to get a flu shot because I'm under age 50." C. "I will use my peak flow meter only when I feel like I'm getting sick." D. "I will use my corticosteroid inhaler only when I feel short of breath."

A Part of a rescue plan for asthma patients is to have access to a short-acting bronchodilator, such as albuterol, to use for rapid control of symptoms. Asthma patients should get a flu shot annually, and the self-monitoring of one's "Personal Best" with a peak flow meter should be done at least daily as part of an asthma action plan. Corticosteroids cannot abort an asthma attack.

When should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? A. One hour before a meal B. Immediately after meals C. After providing juice to the patient D. After administering nasal medications

A 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.

Prolonged exposure to a high level of oxygen leads to pulmonary damage caused by: A. Oxygen toxicity B. Normoxia C. Anoxia D. Hypoxia

A Pulmonary O2 toxicity may result from prolonged exposure to a high level of O2 (PaO2). High concentrations of oxygen can result in a severe inflammatory response because of oxygen radicals and damage to alveolar-capillary membranes resulting in severe pulmonary edema, shunting of blood, and hypoxemia. These individuals develop acute respiratory distress syndrome (ARDS). Normoxia is not a condition of having too much oxygen, but a normal amount. Anoxia and hypoxia are conditions of having too little oxygen, not too much.

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

A 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.

The nurse recognizes that which treatment regimen would be helpful for a patient with a G551D mutation pancreatic enzyme deficiency who has decreased absorption of protein and fat absorption with poor growth and oily stools? A. Ivacaftor B. Tobramycin C. Dornase alfa D. Azithromycin

A The patient with a G551D mutation pancreatic enzyme deficiency who has decreased absorption of protein and fat absorption with poor growth and oily stools has pancreatic insufficiency. Ivacaftor is useful and effective in the patient with a G551D mutation. Tobramycin helps to treat the patient with cystic fibrosis affected by Pseudomonas. Dornase alfa helps to degrade deoxyribonucleic acid (DNA) of neutrophils in the patient with cystic fibrosis. Azithromycin also helps to treat the patient with cystic fibrosis affected by Pseudomonas.

What is the most common sign during an initial assessment that alerts the nurse that the patient has chronic obstructive pulmonary disease? A. Barrel chest B. Sunken chest C. Hyperventilation D. Circumoral cyanosis

A The patient with chronic obstructive pulmonary disease (COPD) develops a barrel chest over time because trapped air enlarges the lungs and thoracic cavity, thereby reducing chest flexibility. Sunken chest, also known as funnel chest or pectus excavatum, is not related to COPD. Hyperventilation is not characteristically seen with COPD. Instead, the patient usually displays persistent dyspnea on exertion, with or without a chronic cough. Circumoral cyanosis is a bluish discoloration of the skin surrounding the mouth. It is usually an indication of a severely diminished level of oxygen and respiratory distress. Circumoral cyanosis can result from a variety of respiratory diseases and may be a late sign of the COPD disease process.

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis? A. Work of breathing B. Fear of suffocation C. Effects of medications D. Anxiety and restlessness

A When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.

A 61-year-old patient with asthma is admitted to the hospital. The nurse understands that symptoms of asthma include which of the following? Select all that apply. A. Wheezing B. Chest tightness C. Crackles D. Cough E. Pink frothy sputum

A, B, D Symptoms of asthma include cough, chest tightness, and wheezing. Crackles are heard when fluid has accumulated in the lungs, which is not consistent with asthma. Pink frothy sputum is seen with pulmonary edema.

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

ANS: 320 A PEFR less than 80% of the personal best indicates that the patient is in the yellow zone where changes in therapy are needed to prevent progression of the airway narrowing.

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

ANS: A Added dietary salt is indicated whenever sweating is excessive, such as during hot weather, when fever is present, or from intense physical activity. The management of pancreatic insufficiency includes pancreatic enzyme replacement of lipase, protease, and amylase (e.g., Pancreaze, Creon, Ultresa, Zenpep) administered before each meal and snack. This patient is at risk for hyponatremia based on reported symptoms. Adequate intake of fat, calories, protein, and vitamins is important. Fat-soluble vitamins (vitamins A, D, E, and K) must be supplemented because they are malabsorbed. Use of caloric supplements improves nutritional status. Hyperglycemia due to pancreatic insufficiency is more likely to occur than hypoglycemia.

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

ANS: A Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

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

ANS: A Assessment of the patient's breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient's status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient is using but not as important as assessing the breath sounds.

15. The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? a. Peripheral edema b. Elevated temperature c. Clubbing of the fingers d. Complaints of chest pain

ANS: A Cor pulmonale causes clinical manifestations of right ventricular failure, such as peripheral edema. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.

43. Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider? a. Cough productive of bloody, purulent mucus b. Scattered rhonchi and wheezes heard bilaterally c. Respiratory rate 28 breaths/minute while ambulating in hallway d. Complaint of sharp chest pain with deep breathing

ANS: A Hemoptysis may indicate life-threatening hemorrhage and should be reported immediately to the health care provider. The other findings are frequently noted in patients with bronchiectasis and may need further assessment but are not indicators of life-threatening complications.

38. The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse? a. 22-year-old with ABG results: pH 7.28, PaCO2 60 mm Hg, and PaO2 58 mm Hg b. 34-year-old with ABG results: pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg c. 45-year-old with ABG results: pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg d. 65-year-old with ABG results: pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

ANS: A The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible but do not require interventions as quickly as the 22-year-old.

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

ANS: A The patient's assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation after notifying the health care provider. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.

39. Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Obtain oxygen saturation using pulse oximetry. b. Monitor for increased oxygen need with exercise. c. Teach the patient about safe use of oxygen at home. d. Adjust oxygen to keep saturation in prescribed parameters.

ANS: A UAP can obtain oxygen saturation (after being trained and evaluated in the skill). The other actions require more education and a scope of practice that licensed practical/vocational nurses (LPN/LVNs) or registered nurses (RNs) would have.

8. A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). It is most appropriate for the nurse to teach the patient about a. a1-antitrypsin testing. b. use of the nicotine patch. c. continuous pulse oximetry. d. effects of leukotriene modifiers.

ANS: A When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in a1-antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be ordered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with COPD.

11. While teaching a patient with asthma the appropriate use of a peak flow meter, the nurse instructs the patient to implement which of the following actions? a. Take and record peak flow readings when having asthma symptoms or an attack. b. Increase the doses of long-term control medications if the peak flow numbers decrease. c. Use the flow meter each morning after taking medications to evaluate the effectiveness of the medications. d. Empty the lungs, and then inhale as rapidly as possible through the mouthpiece to measure how fast air can be inhaled.

ANS: A It is recommended that patients check peak flows when asthma symptoms or attacks occur to compare the peak flow with the baseline. PTS: 1 DIF: Cognitive Level: Application REF: page 732, Table 31-13 OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: CH-12

7. The nurse evaluates the effectiveness of therapy for a patient with an acute asthma exacerbation. Which of the following findings indicates to the nurse that the patient's respiratory function is beginning to improve? a. Wheezing becomes louder. b. The cough remains unproductive. c. Vesicular breath sounds decrease. d. Aerosol bronchodilators stimulate coughing.

ANS: A Louder wheezes indicate that more air is moving through the airways and that the bronchodilator therapy is working. PTS: 1 DIF: Cognitive Level: Application REF: page 719 OBJ: 1 TOP: Nursing Process: Evaluation MSC: CRNE: CH-48

33. A 19-year-old male with CF and his wife are considering having a child. In counselling the patient and his wife, the nurse determines their knowledge of the situation by asking them for which following information? a. Whether they have considered that the patient is probably sterile b. Whether they have thought about the patient's ability to care for a child c. Whether they have considered adoption as a solution to their desire to have a family d. Whether they know that any children produced by them will have CF

ANS: A Most men with CF are sterile. PTS: 1 DIF: Cognitive Level: Application REF: page 757, Table 31-23 OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

27. A patient with COPD is admitted to the hospital. How can the nurse best position the patient to improve gas exchange? a. Sitting up at the bedside in a chair and leaning slightly forward b. Resting in bed with the head elevated to 45 to 60 degrees c. In the Trendelenburg's position, with several pillows behind the head d. Resting in bed in a high-Fowler's position with the knees flexed

ANS: A Patients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 752 OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-39

22. A patient has been receiving oxygen per nasal cannula during her hospitalization for emphysema. She asks the nurse whether she will have to use oxygen at home. What should the nurse tell the patient about long-term home oxygen therapy? a. It can improve the patient's prognosis and quality of life. b. It is contraindicated in patients with COPD to prevent oxygen dependency. c. It is used only for patients who have severe end-stage respiratory disease. d. It should never be used at night because the patient cannot monitor its effect.

ANS: A Research supports the use of home oxygen to improve quality of life and prognosis. PTS: 1 DIF: Cognitive Level: Application REF: page 744 OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-12

29. The nurse has completed teaching a patient about MDI use. Which statement by the patient indicates to the nurse that further patient teaching is needed? a. "I will shake the MDI to check for fullness each time before using." b. "I will take a slow, deep breath in after pushing down on the MDI." c. "I will check the MDI counter." d. "I will attach a spacer to the MDI to make it easier for me to use."

ANS: A Shaking the container is no longer recommended as a means of determining whether the medication needs replacement because the patient may be hearing only the propellant move in the canister when the MDI is nearly empty. PTS: 1 DIF: Cognitive Level: Application REF: page 726, Table 31-9 OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: NCP-14

6. The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. Which common etiological factor would the nurse document for this nursing diagnosis in patients with asthma? a. Work of breathing b. Fear of suffocation c. Anxiety and restlessness d. Side effects of medications

ANS: A The activity intolerance patients with asthma experience is related to the increased effort needed to breathe when airways are inflamed and narrowed, and interventions are focused on decreasing inflammation and bronchoconstriction. PTS: 1 DIF: Cognitive Level: Application REF: page 728, Table 31-11 OBJ: 2 TOP: Nursing Process: Diagnosis MSC: CRNE: CH-15

23. A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, what is it most important for the nurse to do? a. Keep the air entrainment ports clean and unobstructed. b. Apply an adaptor to increase humidification of the oxygen. c. Drain moisture condensation from the oxygen tubing every hour. d. Keep the flow rate high enough to keep the bag from collapsing during inspiration.

ANS: A The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 741, Table 31-17 OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-32

19. The nurse makes a diagnosis of impaired gas exchange for a patient with COPD in acute respiratory distress based on which of the following assessment findings? a. An SpO2 of 86% b. Dyspnea and a respiratory rate of 32 breaths/min c. Use of the accessory muscles of respiration d. The presence of crackles and coarse rales in the lungs

ANS: A The best data to support the diagnosis of impaired gas exchange are abnormalities in the ABGs or pulse oximetry. PTS: 1 DIF: Cognitive Level: Application REF: page 748, Table 31-21 OBJ: 5 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

15. A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO2 58 mm Hg, PaCO2 55 mm Hg, and SaO2 86%. What does the nurse recognize these values as evidence of? a. Respiratory acidosis b. Respiratory alkalosis c. Normal acid-base balance with hypoxemia d. Normal acid-base balance with hypercapnia

ANS: A The elevated PaCO2 and low pH indicate respiratory acidosis. The patient is hypoxemic and hypercapnic, but the pH indicates acidosis, not a normal acid-base balance. PTS: 1 DIF: Cognitive Level: Analysis REF: page 715 OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-6

12. A 32-year-old patient is seen in the clinic for dyspnea associated with the diagnosis of emphysema. The patient denies any history of smoking. The nurse will anticipate teaching the patient about which of the following? a. 1-Antitrypsin testing b. Use of the nicotine patch c. Continuous pulse oximetry d. Effects of leukotriene modifiers

ANS: A When emphysema occurs in young patients, especially without a smoking history, a congenital deficiency in 1-antitrypsin should be suspected. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 733 OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

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

ANS: B A respiratory rate of 38/minute indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the tachypneic patient.

27. A patient with chronic obstructive pulmonary disease (COPD) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective? a. Change the oxygen flow rate to the highest prescribed rate. b. Teach the patient to use the Flutter airway clearance device. c. Reinforce the ongoing use of pursed lip breathing techniques. d. Teach the patient about consistent use of inhaled corticosteroids.

ANS: B Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some patients with COPD, but they are not indicated for this patient's problem of thick mucus secretions.

37. Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? a. Pain at injection site b. Flushing and dizziness c. Peak flow reading 75% of normal d. Respiratory rate 22 breaths/minute

ANS: B Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction, and immediate intervention is needed. The other information should also be reported, but do not indicate possibly life-threatening complications of omalizumab therapy.

14. Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment? a. Even, unlabored respirations b. Pulse oximetry reading of 92% c. Respiratory rate of 18 breaths/minute d. Absence of wheezes, rhonchi, or crackles

ANS: B For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.

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

ANS: B High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.

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

ANS: B The patient should relax the facial muscles without puffing the cheeks while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.

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

ANS: B The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or non-rebreather masks. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation. The mask is uncomfortable and can be removed when the patient eats.

16. The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD).What is the best way for the nurse to determine the appropriate oxygen flow rate? a. Minimize oxygen use to avoid oxygen dependency. b. Maintain the pulse oximetry level at 90% or greater. c. Administer oxygen according to the patient's level of dyspnea. d. Avoid administration of oxygen at a rate of more than 2 L/minute.

ANS: B The best way to determine the appropriate oxygen flow rate is by monitoring the patient's oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use improves survival rate in patients with COPD, there is no concern about oxygen dependency. The patient's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

33. A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/dL. Which nursing action will the nurse plan to implement? a. Discuss the role of diet in blood glucose control. b. Teach the patient about administration of insulin. c. Give oral hypoglycemic medications before meals. d. Evaluate the patient's home use of pancreatic enzymes.

ANS: B The glucose levels indicate that the patient has developed CF-related diabetes, and insulin therapy is required. Because the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.

5. The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective? a. No wheezes are audible. b. Oxygen saturation is >90%. c. Accessory muscle use has decreased. d. Respiratory rate is 16 breaths/minute.

ANS: B The goal for treatment of an asthma attack is to keep the oxygen saturation >90%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.

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

ANS: B The nurse's initial response should be to assess the patient's knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patient's comments. The other responses have accurate information, but the nurse should first assess the patient's understanding about the issues surrounding pregnancy.

40. The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse takefirst? a. Tell the patient to go to the hospital emergency department. b. Instruct the patient to use the prescribed albuterol (Proventil). c. Ask about recent exposure to any new allergens or asthma triggers. d. Question the patient about use of the prescribed inhaled corticosteroids.

ANS: B The patient's peak flow is 70% of normal, indicating a need for immediate use of short-acting b2-adrenergic SABA medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.

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

ANS: B Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD

40. When taking an admission history of a patient with COPD who has new-onset wheezing and shortness of breath, the nurse will be most concerned about which information? a. The patient has a history of pneumonia 2 years ago. b. The patient takes propranolol (Inderal) for hypertension. c. The patient uses acetaminophen (Tylenol) for headaches. d. The patient has chronic inflammatory bowel disease.

ANS: B -Adrenergic blockers such as propranolol can cause bronchospasm in some patients. PTS: 1 DIF: Cognitive Level: Application REF: page 738 OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

13. A patient with chronic obstructive pulmonary disease (COPD) asks the nurse how his smoking caused his lung disease. The nurse explains that long-term exposure to tobacco smoke leads to which of the following? a. Weakening of the smooth muscle lining the airways b. Decrease in the area available for oxygen absorption c. A reduction in the number of red blood cells available for oxygen delivery d. Decreased production of protective respiratory secretions

ANS: B Carbon monoxide is a component of tobacco smoke. Carbon monoxide has a high affinity for hemoglobin and combines with it more readily than does oxygen, thereby reducing the smoker's oxygen-carrying capacity. Smokers inhale a lower percentage of oxygen than normal; as a result, less oxygen is available at the alveolar level. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 733 OBJ: 4 TOP: Nursing Process: Implementation MSC: CRNE: CH-8

5. Clinically significant airway obstruction develops in what percentage of smokers? a. 5% to 10% b. 15% to 20% c. 25% to 30% d. 40% to 50%

ANS: B Clinically significant airway obstruction develops in 15% to 20% of smokers. PTS: 1 DIF: Cognitive Level: Knowledge REF: page 732 OBJ: 4 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

38. When teaching a patient about continuous home oxygen use, the nurse tells the patient that evaporation of the oxygen accelerates during which season, and they should take extra care to ensure that they do not run out of oxygen? a. Spring b. Summer c. Fall d. Winter

ANS: B During the summer, with liquid oxygen, evaporation is accelerated and may decrease reservoir duration to less than 1 week. PTS: 1 DIF: Cognitive Level: Application REF: page 745, Table 31-18 OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: HW-11

16. The nurse identifies the nursing diagnosis of imbalanced nutrition: less than body requirements for a patient with COPD. What is an appropriate intervention for this problem? a. Order fruits and fruit juices to be offered between meals. b. Order a high-calorie, high-protein diet with six small meals a day. c. Teach the patient to use frozen meals that can be microwaved at home. d. Provide a high-calorie, high-carbohydrate, nonirritating, frequent-feeding diet.

ANS: B Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. PTS: 1 DIF: Cognitive Level: Application REF: page 749, Nursing Care Plan 31-2 OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-35

36. Which following statement by the patient with COPD indicates that the nurse's teaching about nutrition has been effective? a. "I will drink a lot of fluids with my meals." b. "I will have ice cream as a snack every day." c. "I should exercise for 15 minutes before meals." d. "I should avoid too much meat or dairy products."

ANS: B High-calorie foods such as ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 747 OBJ: 7 TOP: Nursing Process: Evaluation MSC: CRNE: CH-35

39. Which information given by an asthmatic patient during the admission assessment will be of most concern to the nurse? a. The patient says that the asthma symptoms are worse every spring. b. The patient's only asthma medications are albuterol (Ventolin) and salmeterol. c. The patient uses hydrocortisone (Solu-Cortef) before any aerobic exercise. d. The patient's heart rate increases after using the albuterol (Ventolin) inhaler.

ANS: B Long-acting 2-adrenergic agonists should be used only in patients who are also using another medication for long-term control (typically an inhaled corticosteroid). Salmeterol should not be used as the first-line therapy for long-term control. PTS: 1 DIF: Cognitive Level: Application REF: page 720 OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-44

4. The physician has prescribed a budesonide metered-dose inhaler (MDI) two puffs every 8 hours and ciclesonide MDI one puff twice daily (BID). In teaching the patient about the use of the inhalers, what is the best instruction? a. "Use the budesonide inhaler first, wait a few minutes, then use the ciclesonide inhaler." b. "Using a spacer with the MDIs will improve the inhalation of the medications." c. "To avoid side effects, the inhalers should not be used within 1 hour of each other." d. "To maximize the effectiveness of the medications, inhale quickly when using the inhalers."

ANS: B More medication reaches the bronchioles when a spacer is used along with an MDI. PTS: 1 DIF: Cognitive Level: Application REF: page 722, Table 31-7 OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-44

30. To promote healthy coping in the patient with COPD, what should the nurse do? a. Assist the patient to identify strengths and ignore limitations. b. Teach the patient relaxation techniques and other alternative therapies. c. Encourage family members to include the patient in family and social activities. d. Refer the patient to a support group at the local chapter of the Lung Association.

ANS: B Relaxation techniques may provide benefit in terms of relief of dyspnea for some patients, but the evidence for this is unclear. Relaxation techniques include progressive muscular relaxation; positive thinking and visualization; and use of music, yoga, massage, and humour. PTS: 1 DIF: Cognitive Level: Application REF: page 739, Table 31-16 OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-42

8. A 25-year-old patient has had moderate asthma for 10 years. She uses an salbutamol (Apo-Salvent) inhaler when she develops chest tightness and wheezing but does not use her salmeterol (Serevent) as prescribed. To increase the patient's management and control of her asthma, what should the nurse teach the patient? a. She should use the salmeterol when the albuterol does not relieve her symptoms. b. Using the salmeterol helps prevent the early-phase response of bronchospasm and thus further inflammatory changes. c. Salmeterol should be used when she uses the -agonist inhaler to decrease the late-phase inflammatory reaction of asthma. d. Asthma attacks can be prevented if she uses both the albuterol and the salmeterol as prescribed and not just when symptoms develop.

ANS: B Salmeterol is prescribed to reduce airway inflammation. It takes several weeks for maximal effect and is not used to treat acute asthma symptoms. PTS: 1 DIF: Cognitive Level: Application REF: page 720, Table 31-7 OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-44

25. A 70-year-old patient is recovering from an acute episode of COPD. In planning with the patient to increase his activity tolerance at home, which of the following activities does the nurse understand is an appropriate exercise goal for the patient? a. Increase his activity any amount over his current level. b. Walk for 20 minutes a day with his pulse rate less than 150 beats/min. c. Limit his exercise to activities of daily living to conserve his energy. d. Swim for 10 minutes a day, gradually increasing to 30 minutes a day.

ANS: B The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily, with the pulse rate not to exceed 150 beats/min. PTS: 1 DIF: Cognitive Level: Application REF: page 750-752 OBJ: 5 TOP: Nursing Process: Planning MSC: CRNE: CH-40

10. A patient with an acute attack of asthma comes to the emergency department, where blood is drawn for ABGs. The nurse determines the patient is in the early phase of the attack, based on which of the following ABG results? a. pH 7.0, PaCO2 50 mm Hg, and PaO2 74 mm Hg b. pH 7.4, PaCO2 32 mm Hg, and PaO2 70 mm Hg c. pH 7.36, PaCO2 40 mm Hg, and PaO2 80 mm Hg d. pH 7.32, PaCO2 58 mm Hg, and PaO2 60 mm Hg

ANS: B The initial response to hypoxemia caused by airway narrowing in a patient having an acute asthma attack is an increase in respiratory rate, which causes a drop in PaCO2. PTS: 1 DIF: Cognitive Level: Analysis REF: page 715 OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-6

37. When teaching the patient with COPD about exercise, which information should the nurse include? a. "Stop exercising if you start to feel short of breath." b. "Use the bronchodilator before you start to exercise." c. "Breathe in and out through the mouth while you exercise." d. "Upper body exercise should be avoided to prevent dyspnea."

ANS: B Use of a bronchodilator before exercise improves airflow for some patients and is recommended. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 752 OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: HW-13

32. When teaching a patient about the various methods of oxygen administration, the nurse tells the patient that, with high flow rates, pain may develop in the frontal sinuses as a result of which of the following methods? a. Simple face mask b. Nasal cannula c. Partial rebreathing mask d. Transtracheal catheter

ANS: B When using nasal prongs, high-flow rates often cause dry nasal membranes and pain in the frontal sinuses. PTS: 1 DIF: Cognitive Level: Application REF: page 741, Table 31-17 OBJ: 6 TOP: Nursing Process: Implementation MSC: CRNE: CH-32

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

ANS: C A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no family tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

3. A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure? a. Give the rescue medication immediately before testing. b. Administer oral corticosteroids 2 hours before the procedure. c. Withhold bronchodilators for 6 to 12 hours before the examination. d. Ensure that the patient has been NPO for several hours before the test.

ANS: C Bronchodilators are held before pulmonary function testing (PFT) so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should be held before PFTs. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

9. The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline? a. The patient reports a recent 15-pound weight gain. b. The patient denies any shortness of breath at present. c. The patient takes cimetidine (Tagamet) 150 mg daily. d. The patient complains about coughing up green mucus.

ANS: C Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.

11. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? a. Encourage increased intake of whole grains. b. Increase the patient's intake of fruits and fruit juices. c. Offer high-calorie snacks between meals and at bedtime. d. Assist the patient in choosing foods with high vegetable and mineral content.

ANS: C Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture like whole grains may take more energy to eat and get absorbed and lead to decreased intake. Although fruits, juices, and vegetables are not contraindicated, foods high in protein are a better choice.

32. A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching? a. Use of long-acting b-adrenergic medications b. Side effects of sustained-release theophylline c. Self-administration of inhaled corticosteroids d. Complications associated with oxygen therapy

ANS: C Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.

22. A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate? a. Have the patient rest in bed with the head elevated to 15 to 20 degrees. b. Ask the patient to rest in bed in a high-Fowler's position with the knees flexed. c. Encourage the patient to sit up at the bedside in a chair and lean slightly forward. d. Place the patient in the Trendelenburg position with several pillows behind the head.

ANS: C Patients with COPD improve the mechanics of breathing by sitting up in the "tripod" position. Resting in bed with the head elevated in a semi-Fowler's position would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.

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

ANS: C The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.

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

ANS: C The patient's peak flow reading indicates that the condition is worsening (yellow zone). The patient should take the bronchodilator and recheck the peak flow. Depending on whether the patient returns to the green zone, indicating well-controlled symptoms, the patient may be prescribed oral corticosteroids or a change in dosing of other medications. Keeping the next appointment is appropriate, but the patient also needs to be taught how to control symptoms now and use the bronchodilator.

34. The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action? a. Pulse oximetry reading of 91% b. Respiratory rate of 26 breaths/minute c. Use of accessory muscles in breathing d. Peak expiratory flow rate of 240 L/minute

ANS: C Use of accessory muscle indicates that the patient is experiencing respiratory distress and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.

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

ANS: C b-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.

24. What grade of dyspnea would the nurse document when a patient with COPD walks slower than his peers of the same age and needs to stop for breath when walking at his own pace on a flat surface? a. Grade 1 b. Grade 2 c. Grade 3 d. Grade 4

ANS: C A patient with grade 3 dyspnea walks slower than people of the same age on the level or stops for breath while walking at his or her own pace on the level. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 738, Figure 31-11 OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-15

41. A patient who is experiencing an acute asthma attack is admitted to the emergency department. What is the priority nursing action? a. Determine when the dyspnea started. b. Obtain the forced expiratory flow rate. c. Listen to the patient's breath sounds. d. Ask about inhaled corticosteroid use.

ANS: C Assessment of the patient's breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. PTS: 1 DIF: Cognitive Level: Application REF: page 715 OBJ: 1 TOP: Nursing Process: Assessment MSC: CRNE: CH-63

34. When caring for a patient with CF, the nurse recognizes that the manifestations of the disease are caused by which of the following pathophysiological processes? a. Inflammation and fibrosis of lung tissue b. Failure of the bronchial goblet cells to produce mucus c. Altered function of exocrine glands, with abnormally thick, viscous secretions d. Thickening and fibrosis of the pleural linings of the lungs, causing thoracic wall changes

ANS: C CF is characterized by abnormal secretions of exocrine glands, mainly of the lungs, pancreas, and sweat glands. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 754 OBJ: 7 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

20. When reading the chart for a patient with COPD, the nurse notes that the patient has cor pulmonale. The nurse will monitor which of the following to assess for cor pulmonale? a. Elevated temperature b. Complaints of chest pain c. Jugular vein distension d. Clubbing of the fingers

ANS: C Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. PTS: 1 DIF: Cognitive Level: Application REF: page 737 OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

1. A patient with a history of asthma is admitted to the hospital in acute respiratory distress. During assessment of the patient, the nurse would notify the physician immediately on finding which of the following assessment data? a. An SpO2 of 90% b. A peak expiratory flow rate of 240 mL/min c. Decreased breath sounds and decreased audible wheezing d. Arterial blood gas (ABG) results of pH 7.4, PaCO2 50 mm Hg, and PaO2 74 mm Hg

ANS: C Decreased breath sounds and wheezing would indicate that the patient was experiencing an asthma attack, and immediate bronchodilator treatment would be indicated. PTS: 1 DIF: Cognitive Level: Application REF: page 710 OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: CH-63

18. The nurse teaches a patient with COPD how to perform pursed-lip breathing, explaining that this technique will assist respiration by which of the following methods? a. Loosening secretions so that they may be coughed up more easily b. Promoting maximal inhalation for better oxygenation of the lungs c. Preventing bronchial collapse and air trapping in the lungs during expiration d. Slowing the respiratory rate and giving the patient control of respiratory patterns

ANS: C Pursed-lip breathing increases the airway pressure during the expiratory phase and prevents collapse of the airways, allowing for more complete exhalation. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 747 OBJ: 5 TOP: Nursing Process: Implementation MSC: CRNE: CH-32

3. An Advair Diskus DPI (combined fluticasone and salmeterol) dry powder inhaler is prescribed for a patient diagnosed with mild, persistent asthma. The patient asks the nurse why she must use two different drugs. What should the nurse explain about this treatment? a. Both drugs are bronchodilators, but the exact mechanism of action of fluticasone is not known. b. Both the salmeterol and the fluticasone are bronchodilators but act in different ways to decrease bronchospasm. c. The salmeterol is used to decrease the bronchospasm, and the fluticasone helps control the inflammatory response. d. The salmeterol stimulates the bronchodilator effect of 2 receptors, and the fluticasone blocks the bronchoconstrictor effect of the parasympathetic nervous system.

ANS: C Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. PTS: 1 DIF: Cognitive Level: Application REF: page 720, Table 31-7 OBJ: 1 TOP: Nursing Process: Implementation MSC: CRNE: CH-44

14. The nurse knows that the interventions carried out to promote airway clearance in the patient with COPD are successful based on which of the following findings? a. The patient has no dyspnea. b. The patient's mental status is improved. c. The patient has effective and productive coughing. d. The PaO2 is within the normal range for the patient.

ANS: C The goal for the nursing diagnosis of ineffective airway clearance is to maintain a clear airway by coughing effectively. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 748, Nursing Care Plan 31-2 OBJ: 3 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25

9. During assessment of a patient with asthma, the nurse notes wheezing and dyspnea, recognizing that these symptoms are related to which of the following pathophysiological features? a. Laryngospasm b. Pulmonary edema c. Airway narrowing d. Overdistension of the alveoli

ANS: C The symptoms of asthma are caused by inflammation and spasm of the bronchioles, leading to airway narrowing. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 714 OBJ: 2 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

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

ANS: D A nebulizer is used to administer aerosolized medication. A mist is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. The other options refer to inhaler use. Coughing vigorously after inhaling and activating the inhaler at the onset of expiration are both incorrect techniques when using an inhaler.

19. Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care? a. Schedule the procedure 1 hour after the patient eats. b. Maintain the patient in the lateral position for 20 minutes. c. Perform percussion before assisting the patient to the drainage position. d. Give the ordered albuterol (Proventil) before the patient receives the therapy.

ANS: D Bronchodilators are administered before chest physiotherapy. Postural drainage, percussion, and vibration should be done 1 hour before or 3 hours after meals. Patients remain in each postural drainage position for 5 minutes. Percussion is done while the patient is in the postural drainage position.

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

ANS: D Encourage the patient to walk 15 to 20 minutes a day at least three times a week with gradual increases. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patient's exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

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

ANS: D Long-acting b2-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires further assessment by the nurse, but is not unusual for a patient with asthma.

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

ANS: D Pulmonary function testing will help establish the COPD diagnosis. Bronchodilators should be avoided at least 6 hours before the test. PFTs do not involve being placed in an enclosed area such as for magnetic resonance imaging (MRI). Contrast dye is not used for PFTs. The patient may still have PFTs done if metal implants or prostheses are present, as these are contraindications for an MRI.

10. A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care? a. Titrate oxygen to keep saturation at least 90%. b. Discuss a high-protein, high-calorie diet with the patient. c. Suggest the use of over-the-counter sedative medications. d. Teach the patient how to effectively use pursed lip breathing.

ANS: D Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

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

ANS: D Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting b2-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy.

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

ANS: D Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the patient is terminally ill. Patients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.

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

ANS: D The patient's statement about not being able to do anything for himself or herself supports this diagnosis. Although deficient knowledge, complicated grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.

17. A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching? a. Storage of oxygen tanks will require adequate space in the home. b. Travel opportunities will be limited because of the use of oxygen. c. Oxygen flow should be increased if the patient has more dyspnea. d. Oxygen use can improve the patient's prognosis and quality of life.

ANS: D The use of home oxygen improves quality of life and prognosis. Because increased dyspnea may be a symptom of an acute process such as pneumonia, the patient should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual patient circumstances. Travel is possible using portable oxygen concentrators.

4. Which information will the nurse include in the asthma teaching plan for a patient being discharged? a. Use the inhaled corticosteroid when shortness of breath occurs. b. Inhale slowly and deeply when using the dry powder inhaler (DPI). c. Hold your breath for 5 seconds after using the bronchodilator inhaler. d. Tremors are an expected side effect of rapidly acting bronchodilators.

ANS: D Tremors are a common side effect of short-acting b2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.

17. A patient is seen in the clinic with COPD. Which information given by the patient would help most in confirming a diagnosis of chronic bronchitis? a. The patient tells the nurse about a family history of bronchitis. b. The patient denies having any respiratory problems until the last 6 months. c. The patient's history indicates a 40-pack-year cigarette history. d. The patient complains about having a productive cough all winter for the past 2 years.

ANS: D A diagnosis of chronic bronchitis is based on a history of having a productive cough for at least 3 months for at least 2 consecutive years. PTS: 1 DIF: Cognitive Level: Application REF: page 732 OBJ: 3 TOP: Nursing Process: Assessment MSC: CRNE: CH-8

35. All of the following orders are received for a patient having an acute asthma attack. Which one will the nurse administer first? a. Intravenous methylprednisolone (Solu-Medrol) 60 mg b. Triamcinolone (Azmacort) two puffs per MDI c. Salmeterol 50 mcg per dry-powder inhaler (DPI) d. Albuterol (Ventolin) 2.5 mg per nebulizer

ANS: D Albuterol (Ventolin) is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 720, Table 31-7 OBJ: 7 TOP: Nursing Process: Implementation MSC: CRNE: CH-49

2. The nurse recognizes that intubation and mechanical ventilation are indicated for a patient experiencing a severe asthma attach when which one of the following changes occurs? a. Ventricular dysrhythmias occur. b. The thorax becomes hyperinflated. c. Pulsus paradoxus is greater than 40 mm Hg. d. Fatigue leads to increased hypercapnia and hypoxemia.

ANS: D Although all of the assessment data indicate the need for rapid intervention, the fatigue and hypoxia indicate that the patient is no longer able to maintain an adequate respiratory effort and needs mechanical ventilation. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 715 OBJ: 2 TOP: Nursing Process: Implementation MSC: CRNE: CH-63

28. When evaluating a patient's oral intake, the nurse knows that which fluid intake would be considered adequate for the patient with COPD? a. 1200 mL b. 2000 mL c. 2500 mL d. 3000 mL

ANS: D Collaborative care for the patient with COPD includes hydration of 3 L/day. PTS: 1 DIF: Cognitive Level: Application REF: page 739, Table 31-16 OBJ: 2 TOP: Nursing Process: Assessment MSC: CRNE: CH-34

42. After teaching the patient with asthma about home care, the nurse will evaluate that the teaching has been successful if the patient states which of the following? a. "I will use my corticosteroid inhaler as soon as I start to get short of breath." b. "I will turn the home oxygen level up only after checking with the doctor first." c. "My medications are working if I wake up short of breath only once during the night." d. "No changes in my medications are needed if my peak flow is at 80% of normal."

ANS: D Peak flows of 80% or greater indicate that the asthma is well controlled. PTS: 1 DIF: Cognitive Level: Application REF: page 730 OBJ: 1 TOP: Nursing Process: Evaluation

31. In planning care for the patient with cystic fibrosis (CF), the nurse understands that which of the following interventions is the most important therapeutic approach to promote pulmonary function in the patient? a. Regular administration of bronchodilators b. Administration of continuous low-flow oxygen c. Maintenance of prophylactic doses of antibiotics d. Chest physiotherapy every 4 hours to mobilize secretions

ANS: D Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. PTS: 1 DIF: Cognitive Level: Comprehension REF: page 755 OBJ: 7 TOP: Nursing Process: Implementation MSC: CRNE: CH-32

21. What is the best nursing action when a patient with COPD is receiving oxygen? a. Avoid administration of oxygen at a rate of more than 2 L/min. b. Minimize oxygen use to avoid oxygen dependency. c. Administer oxygen according to the patient's level of dyspnea. d. Maintain the pulse oximetry level at 90% or greater.

ANS: D The best way to determine the appropriate oxygen flow rate is by monitoring the patient's oxygenation either by ABGs or pulse oximetry. An oxygen saturation of 90% indicates an adequate blood oxygen level without the danger of suppressing the respiratory drive. PTS: 1 DIF: Cognitive Level: Application REF: page 719 OBJ: 5 TOP: Nursing Process: Evaluation MSC: CRNE: CH-25

26. A patient with severe COPD tells the nurse he wishes he would die because he is so disabled with his disease that he just cannot do anything for himself. Based on this information, the nurse identifies which of the following nursing diagnoses? a. Hopelessness related to long-term stress b. Anticipatory grieving related to expectation of death c. Ineffective coping related to unknown outcome of illness d. Depression related to physical and psychological dependence

ANS: D The patient's statement about not being able to do anything for himself supports this diagnosis. Although hopelessness, anticipatory grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the patient does not mention long-term stress, death, or an unknown outcome as being concerns. PTS: 1 DIF: Cognitive Level: Application REF: page 749 OBJ: 5 TOP: Nursing Process: Diagnosis MSC: [n/a]

The patient has an order for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? - Albuterol (Proventil) - Salmeterol (Serevent) - Beclomethasone (Qvar) - Ipratropium bromide (Atrovent)

Albuterol (Proventil) Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol (Serevent) is a long-acting β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone (Qvar) is a corticosteroid inhaler and not recommended for an acute asthma attack. Ipratropium bromide (Atrovent) is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists (SABAs).

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? - Anxiety - Cyanosis - Bradycardia - Hypercapnia

Anxiety An early manifestation during an asthma attack is anxiety because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.

A patient requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration. Which device is the most appropriate for this patient? A. Face mask B. Nasal cannula C. Partial and non-rebreather masks D. Tracheostomy collar

B A nasal cannula is the most commonly used device for a patient requiring low concentrations of oxygen of 24% at 1 L/min. It is safe and simple and allows freedom of movement. It can be used for a long time. Simple face masks can be used only for a short duration, especially during transportation. Partial and non-rebreather masks are useful for short-term therapy with high concentrations of oxygen. A tracheostomy collar is used to deliver high humidity and oxygen.

The nurse expects that what diagnosis will be made for a patient that has permanent, abnormal dilation of medium-sized bronchi, inflammation, and elastic and muscular structural destruction of the bronchial wall? A. Cystic fibrosis B. Bronchiectasis C. Cor pulmonale D. Pneumothorax

B A patient who has permanent, abnormal dilation of medium-sized bronchi, inflammation, and elastic and muscular structural destruction of the bronchial wall has bronchiectasis. Cystic fibrosis (CF) is an autosomal recessive, multi-system disease, which alters transport of sodium and chloride ions in and out of epithelial cells. Cor pulmonale occurs due to an increase in vascular resistance or pulmonary hypertension. Pneumothorax is a condition where air accumulates in the plural space.

The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? A. Heart rate 80 beats per minute B. Clear lung sounds C. Capillary refill less than three seconds D. Positive bowel sounds in all quadrants

B 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 registered nurse is teaching a student nurse about care management in a patient with oxygen saturation less than 90 percent, dyspnea, breathlessness, and forced expiratory volume in one second (FEV1) less than 60 percent. Which statement made by the student nurse indicates effective learning? A. "I should advise the patient to eat more cabbage, beans, and cauliflower." B. "I should advise the patient to avoid smoking and occupational exposure to irritants." C. "I should advise the patient to breathe rapidly while performing effective Huff coughing." D. "I should advise the patient to avoid high-calorie foods like butter, cheese, and margarine."

B A patient with oxygen saturation less than 90%, dyspnea, and breathlessness has chronic obstructive pulmonary disease (COPD). The nurse should advise the patient to cease smoking and to avoid exposure to irritants to maintain healthy lungs. The nurse should counsel the patient to stop smoking because it is the only way to slow the progression of COPD. The patient should avoid gas-forming foods such as cabbage, beans, and cauliflower. The nurse should advise the patient to breathe slowly while performing effective Huff coughing. The patient with COPD has to eat more high-calorie food, divided into six small meals per day.

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit? A. "I will pay less for medication because it will last longer." B. "More of the medication will get down into my lungs to help my breathing." C. "Now I will not need to breathe in as deeply when taking the inhaler medications." D. "This device will make it so much easier and faster to take my inhaled medications."

B 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? A. Acute bronchitis B. An asthma attack C. Pulmonary edema D. Congestive heart failure

B 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.

While teaching a 45-year-old patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to notify the health care provider immediately if which situation occurs? A. Wheezing is improved moderately with the use of a bronchodilator. B. Less than 50% of the patient's personal best is achieved. C. The short-acting bronchodilator is being used every three to four days. D. Peak flow measurements remain unchanged after exercise.

B Achieving less than 50% of the patient's personal best on the peak flow meter indicates a medical emergency related to poor gas exchange and air flow. The patient should notify the health care provider immediately. Wheezing should be improved with a bronchodilator. Short acting bronchodilators used every one to two days indicate the need for additional asthma treatment. Peak flow measurements should not decrease following exercise if asthma is well-controlled.

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? A. Prescribe fruits and fruit juices to be offered between meals B. Prescribe a high-calorie, high-protein diet with six small meals a day C. Teach the patient to use frozen meals at home that can be microwaved D. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet

B 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 a patient diagnosed with cor pulmonale. What symptoms assessed by the nurse correlate with the assigned diagnosis? A. Oxygen saturation of 92% B. Presence of edema in the ankles C. Yellowish discoloration of the skin D. Partial pressure of arterial oxygen (PaO2) is 60 mm Hg

B 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.

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? A. An overproduction of the antiprotease a1 antitrypsin B. Hyperinflation of alveoli and destruction of alveolar walls C. Hypertrophy and hyperplasia of goblet cells in the bronchi D. Collapse and hypoventilation of the terminal respiratory unit

B In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antiproteaste α1-antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse determines that these symptoms are related to which pathophysiologic feature of the disease? A. Mucous production B. Bronchoconstriction C. Alveolar collapse D. Laryngeal stridor

B Narrowing (constriction) of the airway leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing. Mucous production may occur but is not responsible for wheezing. Alveolar collapse and laryngeal stridor are not related to asthma.

A patient with asthma has a body temperature of 102o F and produces purulent sputum. The nurse anticipates that which drug will be prescribed? A. A sedative B. An antibiotic C. A mucolytic D. Epinephrine

B The patient with body temperature of 102o 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.

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? A. Complete inactivity B. Exercise training C. Reduced water intake D. Reduced food intake

B VExercise 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.

An asthmatic patient is in acute respiratory distress. The nurse auscultates the lungs and notes cessation of inspiratory wheezing. How does the nurse interpret this finding? A. The patient has developed a pneumothorax B. There is worsening airway inflammation and bronchoconstriction C. Airflow has now improved through the bronchioles D. A mucus plug has developed within a main stem bronchus

B When the patient in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway.. A pneumothorax would be evidenced by absent breath sounds. Absence of wheezing does not correlate with improved airflow if the patient is also in current respiratory distress. A mucus plug would result in crackles in the lungs.

A patient is hospitalized with an acute exacerbation of cystic fibrosis (CF). The nurse recognizes that which organisms may be present in the patient's sputum? Select all that apply. A. Burkholderia cepacia B. Staphylococcus aureus C. Haemophilus influenzae D. Pseudomonas aeruginosa E. Streptococcus pneumoniae

B, C, E Staphylococcus aureus, Haemophilus influenza, and Pseudomonas aeruginosa cause exacerbations of both cystic fibrosis and bronchiectasis. Burkholderia cepacia is rare but causes serious exacerbations of cystic fibrosis. Streptococcus pneumoniae causes more frequent exacerbations and rapid decline in lung function in bronchiectasis.

Which finding helped the nurse reach the conclusion that a patient with chronic obstructive pulmonary disease (COPD) requires oxygen therapy? A. Hemoglobin levels of 13.6 g/dL B. Saturation of hemoglobin (SaO2) 90% at rest C. Partial pressure of oxygen (PaO2) 52 mm Hg D. Red blood cell count 5 million cells/microliter

C A patient with a PaO2 less than 55 mm Hg requires oxygen therapy. A PaO2 level of 52 mm Hg indicates that the patient requires oxygen therapy. The normal level of hemoglobin is 13.5 to 17.5 grams per dL. The hemoglobin level of 13.6 gm/dL is a normal hemoglobin level and does not require oxygen therapy. A patient with a saturation of hemoglobin less than 88% requires oxygen therapy. A normal red blood cell count is 4.7 to 6.1 million cells/microliter.

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? A. Acute respiratory failure B. Secondary respiratory infection C. Fluid volume excess resulting from cor pulmonale D. Pulmonary edema caused by left-sided heart failure

C Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

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: A. Explain the need to minimize activity in the home to conserve oxygen use B. Point out that distance traveling may not be possible because oxygen tanks are so small C. Encourage the patient to continue normal activity and travel plans D. Point out that most travel companies do not accommodate travelers with oxygen

C 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.

A nurse is caring for a patient diagnosed with chronic obstructive pulmonary disease (COPD). The lab reports of the patient reveal a hemoglobin level of 20 g/dL. What could be the reason for the increased hemoglobin? A. The patient consumes iron-rich food. B. The production of red blood cells increases in response to hypoxia. C. The heart is functioning well in response to COPD treatments. D. The patient no longer has COPD.

C In COPD, there is chronic hypoxia. To compensate for it, the production of RBC increases, leading to polycythemia or increased hemoglobin levels. The patient cannot have a hemoglobin level of 20 g/dL by eating iron-rich food. Patients with COPD usually have compromised heart function. The patient does have COPD and polycythemia is a defense response of the body against hypoxemia.

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? A. Laryngospasm B. Pulmonary edema C. Narrowing of the airway D. Overdistention of the alveoli

C 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 β-adrenergic 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? A. Intravenous (IV) fluids B. Biofeedback therapy C. Systemic corticosteroids D. Pulmonary function testing

C Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic 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.

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? A. Smoking causes a hoarse voice B. Cough will become nonproductive C. Decreased alveolar macrophage function D. Sense of smell is decreased with smoking

C 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.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? A. Allow time to calm the patient B. Observe for signs of diaphoresis C. Evaluate the use of intercostal muscles D. Monitor the patient for bilateral chest expansion

C The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Allowing time to calm the patient, observing for diaphoresis, and monitoring for bilateral chest expansion are correct, but they are not the primary reason for inspecting the chest wall of this patient.

A 45-year-old patient is experiencing an asthma exacerbation. To facilitate airflow, the nurse should place the patient in which position? A. Prone B. Supine C. High-Fowler's D. Trendelenburg's

C The patient experiencing an asthma attack should be placed in high-Fowler's position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. Prone, supine, and Trendelenburg's positions do not facilitate airflow or decrease chest expansion, and may cause respiratory distress.

When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion? A. Fat-soluble vitamins and dietary salt should be avoided. B. Insulin may be needed with a diabetic diet if diabetes mellitus develops. C. Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. D. Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.

C The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed, because they are malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but there is no longer a diabetic diet and this is not priority information at this time. DIOS develops in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution (MiraLax) to thin bowel contents.

The nurse determines that a 61-year-old patient with chronic bronchitis has a nursing diagnosis of "impaired gas exchange," after noting an oxygen saturation of 88%. What is an appropriate intervention to add to the care plan? A. Obtain an arterial blood gas (ABG) B. Place the patient in the prone position to increase postural drainage C. Sit the patient upright in a chair leaning slightly forward D. Administer 6 L oxygen via nasal cannula

C The patient with chronic bronchitis can engage in better gas exchange in an upright position leaning slightly forward. Once the patient's oxygen increases, the nurse may obtain an ABG, if requested by the health care provider. Placing the patient in a prone position would further impair gas exchange. Six liters of oxygen is too much oxygen for a patient with chronic bronchitis.

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

C The side effects of the glucocorticoid include oral candida, which can be prevented through rinsing the mouth with water or mouthwash after each use. This medication should be used on a schedule, not as needed, a spacer is encouraged, and it will not be helpful at the onset of an asthma attack because it is not an abortive medication; it is a preventative medication.

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

D 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.

The nurse is educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes despite the diagnosis. What complication of smoking should the nurse discuss with the patient? A. Cachexia B. Osteoporosis C. Metabolic syndrome D. Cardiovascular disease

D Chronic smokers develop COPD and are more prone to cardiac complications, because smoking directly affects the function of the lungs and heart. The patient with COPD may experience a loss of appetite due to dyspnea, which may lead to the development of cachexia. Osteoporosis is a complication of COPD that is associated with continuous systemic inflammation. Dyspnea and a loss of appetite are associated with COPD and may manifest as a metabolic syndrome. Cachexia, osteoporosis, and metabolic syndrome are not associated with smoking.

On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than four times a week. The patient's forced expiratory volume in the first second of expiration (FEV1) is less than 60%, and normal activity is very limited. Which treatment option should the nurse consider appropriate? A. Advise maintaining control of asthma symptoms. B. Follow up after a month. C. Reevaluate in two to six weeks. D. Consider oral corticosteroids.

D Experiencing symptoms of asthma throughout the day and also experiencing nighttime awakenings more than four times a week is suggestive of poorly controlled asthma. This patient also has an FEV1 less than 60%; normal activity being very limited correlates with that. Treatment with oral corticosteroids should be considered. Advice for maintaining control of asthma symptoms and following up after a month can be given in case of well controlled asthma. Reevaluation in two to six weeks is suggested if the asthma is not well controlled or if the patient experiences symptoms more than two times a month.

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

D 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.

The nurse is overseeing an exercise program for patients with mild chronic obstructive pulmonary disease (COPD). Part of the program involves walking. Vital signs are taken after walking. The nurse becomes concerned when a 60-year-old patient's pulse rate is: A. 90 beats/minute B. 100 beats/minute C. 110 beats/minute D. 120 beats/minute

D Parameters that may be monitored in the patient with mild COPD are resting pulse and pulse rate after walking. Pulse rate after walking should not exceed 75% to 80% of the maximum heart rate (maximum heart rate is age in years subtracted from 220). 220 - age (60) = 160 (maximum heart rate). 120 is 75% of the patient's maximum heart rate.

A patient with emphysema is receiving oxygen at 1 L/min by way of nasal cannula. The nurse understands that this prescription is appropriate because: The patient does not require more than 1 L of oxygen High concentrations of oxygen may rupture the alveoli Oxygen is the natural stimulus for breathing and not required High concentrations of oxygen eliminate the respiratory drive

D Patients with emphysema become accustomed to a high level of carbon dioxide and low level of oxygen. This situation reverses the natural breathing stimulus. A low oxygen level then becomes the stimulus for breathing, and too much oxygen will eliminate the stimulus to breathe. There is not enough information to determine that the patient does not need more than 1 L of oxygen. A high concentrations of oxygen does not rupture alveoli. In healthy individuals, increased carbon dioxide, not oxygen, is the stimulus for breathing.

Infection can be a major hazard of O2 administration. Heated nebulizers present the highest risk. The most common organism found is: A. Rickettsia prowazekii B. Clostridium perfringens C. Bordatella pertussis D. Pseudomonas aeruginosa

D The constant use of humidity supports bacterial growth, with the most common organism being P. aeruginosa. Rickettsia prowazekii, Clostridium perfringens, and Bordatella pertussis are not the most common organisms found in this case.

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? A. 1.25 mL B. 1.75 mL C. 2 mL D. 2.5 mL

D VUsing 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, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters? - Apical pulse - Daily weight - Bowel sounds - Deep tendon reflexes

Daily weight Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.

When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion? - Fat soluble vitamins and dietary salt should be avoided. - Insulin may be needed with a diabetic diet if diabetes mellitus develops. - Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. - Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.

Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but there is no longer a diabetic diet, and this is not priority information at this time. DIOS develops in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution (MiraLAX) to thin bowel contents.

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? a) Pulse rate of 72/minute b) Temperature of 98.4° F c) Oxygen saturation 96% d) Respiratory rate of 18/minute

a) Pulse rate of 72/minute Albuterol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 72 indicates that the patient did not experience tachycardia as an adverse effect.

A plan of care for the patient with COPD could include (select all that apply): a. exercise such as walking b. high flow rate of O2 administration c. low-dose chronic oral corticosteroid therapy d. use of peak flow meter to monitor the progression of COPD e. breathing exercises such as pursed-lip breathing that focus on exhalation

a & e

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? a) "Close lips tightly around the mouthpiece and breathe in deeply and quickly." b) "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." c) "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." d) "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."

a) "Close lips tightly around the mouthpiece and breathe in deeply and quickly." The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs.

The patient has an order for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? a) Albuterol (Proventil) b) Salmeterol (Serevent) c) Beclomethasone (Qvar) d) Ipratropium bromide (Atrovent)

a) Albuterol (Proventil) Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol (Serevent) is a long-acting β2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone (Qvar) is a corticosteroid inhaler and not recommended for an acute asthma attack. Ipratropium bromide (Atrovent) is an anticholinergic agent that is less effective than β2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β2-adrenergic agonists (SABAs).

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? a) Anxiety b) Cyanosis c) Bradycardia d) Hypercapnia

a) Anxiety An early manifestation during an asthma attack is anxiety because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH as he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.

A male patient with COPD becomes dyspneic at rest. His baseline blood gas results are PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention? a) Arterial pH 7.26 b) PaCO2 50 mm Hg c) Patient in tripod position d) Increased sputum expectoration

a) Arterial pH 7.26 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.

When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included? a) Increasing dyspnea b) Temperature below 98.6° F c) Decreased sputum production d) Unable to drink 3 L low-sodium fluids

a) Increasing dyspnea The significant clinical manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain. Although drinking at least 3 L of low-sodium fluid will help liquefy secretions to make them easier to expectorate, the health care provider does not need to be notified if the patient cannot do this one day.

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

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

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

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

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis? a) Work of breathing b) Fear of suffocation c) Effects of medications d) Anxiety and restlessness

a) Work of breathing When the patient does not have sufficient gas exchange to engage in activity, the etiologic factor is often the work of breathing. When patients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. Fear of suffocation, effects of medications or anxiety, and restlessness are not etiologies for activity intolerance for a patient with asthma.

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers (select all that apply)? a) Exercise b) Allergies c) Emotional stress d) Decreased humidity e) Upper respiratory infections

a, b, c, & e Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD).

A patient is concerned that he may have asthma. Of the symptoms that he relates to the nurse, which ones suggest asthma or risk factors for asthma (select all that apply)? a. Allergic rhinitis b. Prolonged inhalation c. History of skin allergies d. Cough, especially at night e. Gastric reflux or heartburn

a, c, d, & e

Which treatments in CF would the nurse expect to implement in the management plan of patients with CF (select all that apply)? a. sperm banking b. IV corticosteroids on a chronic basis c. Airway clearance techniques (e.g., Acapella) d. GoLYTELY given PRN for severe constipation e. Inhaled tobramycin to combat Pseudomonas infection

a, c, d, & e

In evaluating an asthmatic patient's knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient says, a. "I use my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my health care provider if I have an upper respiratory tract infection." c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." d. "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath."

a. "I use my corticosteroid inhaler when I feel short of breath."

A patient who has bronchiectasis asks the nurse, "What conditions would warrant a call to the clinic?" a. Blood clots in the sputum b. Sticky sputum on a hot day c. Increased shortness of breath after eating a large meal d. Production of large amounts of sputum on a daily basis

a. Blood clots in the sputum

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique? a) "Avoid shaking the inhaler before use." b) "Breathe out slowly before positioning the inhaler." c) "Using a spacer should be avoided for this type of medication." d) "After taking a puff, hold the breath for 30 seconds before exhaling."

b) "Breathe out slowly before positioning the inhaler." It is important to breathe out slowly before positioning the inhaler. This allows the patient to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose. The inhaler should be shaken well. A spacer may be used. Holding the breath after the inhalation of medication helps keep the medication in the lungs, but 30 seconds will not be possible for a patient with COPD.

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? a) "I will pay less for medication because it will last longer." b) "More of the medication will get down into my lungs to help my breathing." c) "Now I will not need to breathe in as deeply when taking the inhaler medications." d) "This device will make it so much easier and faster to take my inhaled medications."

b) "More of the medication will get down into my lungs to help my breathing." A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.

Which test result identifies that a patient with asthma is responding to treatment? a) An increase in CO2 levels b) A decreased exhaled nitric oxide c) A decrease in white blood cell count d) An increase in serum bicarbonate levels

b) A decreased exhaled nitric oxide Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the asthma patient.

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters? a) Apical pulse b) Daily weight c) Bowel sounds d) Deep tendon reflexes

b) Daily weight Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease? a) An overproduction of the antiprotease α1 -antitrypsin b) Hyperinflation of alveoli and destruction of alveolar walls c) Hypertrophy and hyperplasia of goblet cells in the bronchi d) Collapse and hypoventilation of the terminal respiratory unit

b) Hyperinflation of alveoli and destruction of alveolar walls In COPD there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity. An autosomal recessive deficiency of antitrypsin may cause COPD. Not all patients with COPD have excess mucus production by the increased number of goblet cells.

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

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

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? a) Order fruits and fruit juices to be offered between meals. b) Order a high-calorie, high-protein diet with six small meals a day. c) Teach the patient to use frozen meals at home that can be microwaved. d) Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

b) Order a high-calorie, high-protein diet with six small meals a day. Because the patient with COPD needs to use greater energy to breathe, there is often 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. The other interventions will not increase the patient's caloric intake.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after what occurs? a) Hypertension and pulmonary edema b) Oropharyngeal candidiasis and hoarseness c) Elevation of blood glucose and calcium levels d) Adrenocortical dysfunction and hyperglycemia

b) Oropharyngeal candidiasis and hoarseness Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose.

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? a) Oxygen tent b) Venturi mask c) Nasal cannula d Oxygen-conserving cannula

b) Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

The effects of cigarette smoking on the respiratory system include: a. hypertrophy of capillaries causing hemoptysis b. hyperplasia of goblet cells and increased production of mucus c. increased proliferationof cilia and decreased clearance of mucus d. proliferation of alveolar macrophages to decrease the risk for infection

b. hyperplasia of goblet cells and increased production of mucus

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? a) Smoking causes a hoarse voice. b) Cough will become nonproductive. c) Decreased alveolar macrophage function d) Sense of smell is decreased with smoking.

c) Decreased alveolar macrophage function 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 already be aware of respiratory mucosa damage with hoarseness and decreased sense of smell and taste, but these do not increase the incidence of pulmonary infection.

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which finding? a) Absence of dyspnea b) Improved mental status c) Effective and productive coughing d) PaO2 within normal range for the patient

c) Effective and productive coughing Airway clearance is most directly evaluated as successful if the patient can engage in effective and productive coughing. Absence of dyspnea, improved mental status, and PaO2 within normal range for the patient show improved respiratory status but do not evaluate airway clearance.

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? a) Allow time to calm the patient. b) Observe for signs of diaphoresis. c) Evaluate the use of intercostal muscles. d) Monitor the patient for bilateral chest expansion.

c) Evaluate the use of intercostal muscles. The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. The other options may also occur, but they are not the primary reason for inspecting the chest wall of this patient.

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? a) Acute respiratory failure b) Secondary respiratory infection c) Fluid volume excess resulting from cor pulmonale d) Pulmonary edema caused by left-sided heart failure

c) Fluid volume excess resulting from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distention and pedal edema.

Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation? a) Supine b) Lithotomy c) High Fowler's d) Reverse Trendelenburg

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

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which assessment finding? a) Decreased respiratory rate b) Increased respiratory rate c) Increased peak flow readings d) Decreased sputum production

c) Increased peak flow readings Ipratropium is a bronchodilator that should result in increased peak expiratory flow rates (PEFRs).

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? a) Laryngospasm b) Pulmonary edema c) Narrowing of the airway d) Overdistention of the alveoli

c) Narrowing of the airway 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.

When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion? a) Fat soluble vitamins and dietary salt should be avoided. b) Insulin may be needed with a diabetic diet if diabetes mellitus develops. c) Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. d) Distal intestinal obstruction syndrome (DIOS) can be treated with increased water.

c) Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are malabsorbed with the excess mucus in the gastrointestinal system. Insulin may be needed, but there is no longer a diabetic diet, and this is not priority information at this time. DIOS develops in the terminal ileum and is treated with balanced polyethylene glycol electrolyte solution (MiraLAX) to thin bowel contents.

The nurse teaches pursed lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism? a) Loosening secretions so that they may be coughed up more easily b) Promoting maximal inhalation for better oxygenation of the lungs c) Preventing bronchial collapse and air trapping in the lungs during exhalation d) Increasing the respiratory rate and giving the patient control of respiratory patterns

c) Preventing bronchial collapse and air trapping in the lungs during exhalation The purpose of pursed lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. It does not affect secretions, inhalation, or increase the rate of breathing.

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic 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? a) IV fluids b) Biofeedback therapy c) Systemic corticosteroids d) Pulmonary function testing

c) Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic 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 major advantage of a Venturi mask is that it can: a. deliver up to 80% O2. b. provide continuous 100% humidity c. deliver a precise concentration of O2. d. be used while a patient eats and sleeps

c. deliver a precise concentration of O2.

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler? a) "I can rinse my mouth following the two puffs to get rid of the bad taste." b) "I should wait at least 1 to 2 minutes between each puff of the inhaler." c) "Because this medication is not fast-acting, I cannot use it in an emergency if my breathing gets worse." d) "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

d) "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." The patient should not just keep taking extra puffs of the inhaler to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status. Rinsing the mouth after the puffs will eliminate a bad taste. Waiting 1 to 2 minutes between each puff will facilitate the effectiveness of the administration. Ipratropium is not used in an emergency for COPD.

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse? a) "Long-term home oxygen therapy should be used to prevent respiratory failure." b) "Oxygen will not be needed until or unless you are in the terminal stages of this disease." c) "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." d) "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

d) "You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia." Long-term oxygen therapy in the home will not be considered until the oxygen saturation is less than or equal to 88% and the patient has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status. PaO2 less than 55 mm Hg will also allow home oxygen therapy to be considered.

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every 6 hours. What should the nurse explain as the best way to prevent oral infection while taking this medication? a) Chew a hard candy before the first puff of medication. b) Rinse the mouth with water before each puff of medication. c) Ask for a breath mint following the second puff of medication. d) Rinse the mouth with water following the second puff of medication.

d) Rinse the mouth with water following the second puff of medication. Because beclamethosone 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.

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness? a) Slightly increase activity over the current level. b) Swim for 10 min/day, gradually increasing to 30 min/day. c) Limit exercise to activities of daily living to conserve energy. d) Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

d) Walk for 20 min/day, keeping the pulse rate less than 130 beats/min. The patient will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The patient should be encouraged to walk for 20 min/day, keeping the pulse rate less than 75% to 80% of maximum heart rate (220 - patient's age).

Which guideline would be a part of teaching patients how to use a metered-dose inhaler (MDI)? a. After activating the MDI, breathe in as quickly as you can b. Estimate the amount of remaining medicine in the MDI by floating the canister in water. c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week d. To determine how long the canister will last, divide the total number of puffs in the canister by puffs needed per day

d. To determine how long the canister will last, divide the total number of puffs in the canister by puffs needed per day