Lewis Chapter 28: Obstructive Pulmonary Diseases
A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask?
"Have you taken any bronchodilators today?"
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 patient with a respiratory rate of 38 breaths/min
Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider?
Cough productive of bloody, purulent mucus
A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient's ventilation?
Encourage the patient to sit up at the bedside in a chair and lean forward.
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?
Chronic low self-esteem related to physical dependence
A patient with chronic obstructive pulmonary disease (COPD) has coarse crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective?
Teach the patient to use the Flutter airway clearance device.
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?
The patient takes propranolol (Inderal) for hypertension.
The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse?
pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg
Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider?
Flushing and dizziness
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?
Give the prescribed albuterol (Ventolin HFA) before the therapy.
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?
Have the patient add dietary salt to meals.
The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action should the nurse take first?
Instruct the patient to use the prescribed albuterol (Ventolin HFA).
A patient is receiving 35% O2 via a Venturi mask. To ensure the correct amount of O2 delivery, which action by the nurse is important?
Keep the air entrainment ports clean and unobstructed.
A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?
Listen to the patient's breath sounds.
The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flow rate?
Maintain the pulse oximetry level at 90% or greater.
The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first?
Methylprednisolone (Solu-Medrol) 60 mg IV
A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first?
Notify the health care provider.
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?
O2 saturation is >90%.
A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching?
O2 use can improve the patient's prognosis and quality of life.
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?
Offer high-calorie protein snacks between meals and at bedtime.
The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?
Peripheral edema
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?
Pulse oximetry reading of 92%
A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching?
Self-administration of inhaled corticosteroids
The nurse completes an admission assessment on a patient with asthma. Which information given by patient is indicates a need for a change in therapy?
The patient's only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).
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?
Teach the patient about administration of insulin.
The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety?
Teach the patient how to use pursed-lip breathing.
The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?
The patient puffs up the cheeks while exhaling.
Which information will the nurse include in the asthma teaching plan for a patient being discharged?
Tremors are an expected side effect of rapidly acting bronchodilators.
The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action?
Use of accessory muscles in breathing
The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be appropriate for the nurse to include in the plan of care?
Walk 15 to 20 minutes a day at least 3 times/week.
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?
"I can have ice cream as a snack every day."
Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)?
"Use the bronchodilator before you start to exercise."
A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering getting married and wondering about having children. Which initial response by the nurse is best?
"Would like more information to help you with that decision?"
A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute
320 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.
A patient seen in the asthma clinic has recorded daily peak flow rates that are 75% of the baseline. Which action will the nurse plan to take next?
Administer a bronchodilator and recheck the peak flow.
Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)?
Obtain O2 saturation using pulse oximetry.
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?
Perform chest physiotherapy every 4 hours.
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?
The patient rapidly inhales the medication.
The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching?
The patient removes the facial mask when misting stops.
The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis?
The patient reports a productive cough for 3 months every winter.
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?
The patient takes cimetidine (Tagamet HB) daily.
The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?
The patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.
A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?
Withhold bronchodilators for 6 to 12 hours before the examination.
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). The nurse should plan to teach the patient about
a. alpha 1-antitrypsin testing.
