MED SURG 1

Which instructions would the nurse give to a patient with newly diagnosed asthma? Select all that apply.

"Avoid contact with furred animals." "Wash bed covers in hot water and detergent." "Hire an exterminator to get rid of cockroaches." "Use ranitidine if gastric reflux causes symptoms."

Which action is important for energy conservation for a patient undergoing chronic obstructive pulmonary disease (COPD) rehabilitation?

Exercise training

A patient who is receiving therapy for bronchial hyperresponsiveness has developed oropharyngeal candidiasis, hoarseness, and dry cough. The nurse suspects which medication as the cause of the patient's symptoms?

Inhaled fluticasone

The pathophysiology of asthma occurs in which order?

Irritant encountered Immune activation Inflammatory mediators Vasodilation Edema

Which medication route of administration and schedule would the nurse include in the information provided to a patient who has been prescribed omalizumab?

Subcutaneously every two to four weeks

Which medication on this patient's medication list may be triggering asthma attacks?

Metoprolol

Which statements about health disparities that contribute to chronic obstructive pulmonary diseases are accurate? Select all that apply.

"Asthma prevalence and age-adjusted death rates are the highest among Puerto Ricans." "Hispanics have lower death rates from chronic obstructive pulmonary diseases than other ethnic groups." "Despite higher rates of smoking in other groups, whites have the highest incidence of chronic obstructive pulmonary diseases."

Which patient statement about the use of an ipratropium inhaler for chronic obstructive pulmonary disease (COPD) indicates a need for further teaching?

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

How many minutes is the appropriate recovery period after activity for the patient with chronic obstructive pulmonary disease (COPD)?

5

Which of these is a clinical manifestation of early chronic obstructive pulmonary disease (COPD)?

A chronic, intermittent cough

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

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

Which instruction would the nurse give to a patient with asthma who has received a prescription for albuterol and ipratropium nebulization?

After the treatment, cough effectively

A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates incorporating which medication into the plan of care?

An antibiotic

Which parameter should be monitored for a patient with diabetes mellitus and chronic obstructive pulmonary disease (COPD) who is taking oral prednisone?

blood sugar

The nurse recalls that the steps that lead to airway remodeling occur in which order?

Inhalation of animal dander Degranulation of mast cells Release of inflammatory mediators Cellular infiltration Neuropeptides release

Which assessment finding would the nurse expect when caring for a patient with asthma?

PaCO2 of 30 mm Hg

After the nurse has finished teaching about metered-dose inhaler (MDI) use for asthma, which patient statement indicates the need for additional teaching?

"I should avoid using a spacer with this inhaler because it is ineffective."

The nurse teaches a patient regarding the administration of fluticasone through an inhaler. Which statements made by the patient indicate effective learning? Select all that apply.

"I should keep my medicine away from humid places." "I should engage the lever while loading the medicine."

When a patient hospitalized with chronic obstructive pulmonary disease (COPD) asks the nurse whether oxygen use will be needed at home, which response by the nurse is best?

"You will qualify for supplemental oxygen therapy if your resting oxygen saturation drops to 88%."

The patient has a prescription for albuterol 3 mg by nebulizer. Available is a solution containing 24 mg/mL. How many mL should the nurse administer?

0.125 mL

When caring for a patient diagnosed with cor pulmonale, which finding will the nurse expect?

Ankle edema

Which measure should a patient with chronic obstructive pulmonary disorder (COPD) take when performing physical activity?

Remember to think about steps and breathing while walking

A patient presents with a productive cough, a temperature of 102°F (38.9°C), and a white blood cell (WBC) count of 15,000/mm3. The nurse would expect which diagnostic test to be ordered?

Sputum culture test

Which information about gender, cultural differences, and ethnic differences in patients with obstructive lung disease will the nurse use when planning care?

Whites have the highest incidence of cystic fibrosis

Which information will the nurse include when educating a patient with asthma about use of a peak flow meter?

"You should find your personal best peak flow reading for comparison."

The events of an allergic asthma response occur in which order?

Allergen triggers B lymphocytes Plasma cells activate immunoglobulin E (IgE) antibodies. Mast cells release histamine. Inflammation and mucous production occur.

A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. Which condition would the nurse associate with these manifestations?

An asthma attack

Which surgical option may be utilized to reduce the size of hyperinflated emphysematous lungs and decrease airway obstruction for a patient with severe chronic obstructive pulmonary disease (COPD)?

Lung volume reduction surgery (LVRS)

Which finding indicates that a patient with chronic obstructive pulmonary disease (COPD) requires home oxygen therapy?

Oxygen saturation (SaO2) 87% at rest

Which delivery device is used for long-term oxygen therapy?

Oxygen-conserving cannula

Which intervention in a hospitalized patient can be delegated to unlicensed assistive personnel?

Patient B

Which action by the student nurse while performing chest percussion indicates the need for further teaching?

Percussing with both hands simultaneously

Which instruction will the nurse include when teaching a patient with chronic obstructive pulmonary disease (COPD) about using pursed lip breathing (PLB)?

Perform PLB before, during, and after activities that cause shortness of breath.

Which teaching will the nurse include for a patient with difficulty in breathing due to a low oxygen level in the blood?

Refrain from sexual activity after eating.

The nurse will suggest which intervention for the patient experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD)?

Use typed messages to communicate

Which interventions does the nurse anticipate will be included in pulmonary rehabilitation (PR)? Select all that apply.

Using the Internet to deliver daily motivational messages Teaching exercises that focus on the muscles used for ambulation along with upper limb exercises

Which oxygen delivery device may be used for a patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who requires precise amounts of oxygen?

Venturi mask

Which instruction will the nurse give a patient whose peak flow meter reading indicates peak flow at 80% of the personal best?

"You should take your medicines as usual."

A patient with asthma has been taking low-dose inhaled corticosteroids along with long-acting ß 2-agonists for three months and shows signs of inadequate control. Which treatment would the nurse expect to incorporate into the plan of care?

Medium-dose inhaled corticosteroids and long-acting ß 2-agonist

Which action will the nurse take to prevent complications when a patient is using an oxygen-conserving cannula?

Pad the tubing over the patient's ears.

Which laboratory finding for a patient with chronic obstructive pulmonary disease (COPD) is most important to report to the health care provider?

Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg

The nurse gathers data related to individual patients' values for forced expiratory volume in one second. The nurse suspects that which patient has intermittent asthma?

Patient A

After the nurse has taught the technique of pursed lip breathing, which patient action indicates a need for correction?

Puffing of cheeks while exhaling air

Which exercise will the nurse teach to improve expiratory effort and decrease air trapping for a patient with chronic obstructive pulmonary disease?

Pursed lip breathing (PLB)

The nurse is teaching a patient with chronic obstructive pulmonary disease how to huff cough to move secretions. Place the steps of huff coughing in the correct order.

Sit up with feet on the floor. Inhale slowly through the mouth Hold breath for 2 to 3 seconds Exhale quickly as if fogging up a mirror.

Which diagnostic test will the clinic nurse anticipate to confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea?

Spirometry

A patient with asthma calls the clinic and reports chest tightness, a peak flow meter reading at 65% of personal best, and waking up short of breath frequently during the night. Which interprofessional action will the nurse anticipate being taken first?

Start oral corticosteroid

Which oxygen delivery device will the nurse set up for a patient who needs to receive oxygen at a 28% concentration?

Venturi mask

Which type of equipment will the nurse use to deliver a precise amount of oxygen to a patient experiencing an exacerbation of chronic obstructive pulmonary disease (COPD)?

Venturi mask

Which instruction should be included in teaching a patient with chronic obstructive pulmonary disease (COPD) how to self-administer ipratropium via a metered-dose inhaler (MDI)?

"Breathe out slowly before positioning the inhaler."

Which instruction will the nurse include in the diet plan for a patient with chronic obstructive pulmonary disease (COPD)?

"Eat ice cream every day."

How will the nurse respond to a patient who has been prescribed oxygen (O2) for home use and states, "Does this mean that I will not be able to go anywhere?"

Encourage the patient to continue normal activity and travel plans.

Which physiologic effect of ongoing tobacco smoking leads to chronic obstructive pulmonary disease (COPD)?

Respiratory tract cell hyperplasia

Which instruction will the nurse include when teaching a patient to use a dry powder inhaler (DPI)?

Try to hold your breath for at least 10 seconds after inhaling the medication."

Which patient action promotes energy conservation?

Using a tripod posture and placing the mirror on the table while using an electric razor

Which statement by the caregiver of a patient with asthma indicates a need for more education about management of the disease?

"If the peak flow is in the yellow zone, we will need to go to the hospital."

The nurse is explaining the pathophysiology of asthma to a patient. Which is the most appropriate explanation?

"Inflammation causes bronchoconstriction, hyperreactivity, and edema of the airways."

The nurse will provide which instructions to the patient with chronic obstructive pulmonary disease (COPD) about pursed lip breathing (PLB)?

"Make breathing out (exhalation) three times longer than breathing in (inhalation)."

Which patient statement indicates understanding of teaching about pursed lip breathing (PLB)?

"My exhalation should be longer than my inhalation." 4

Which response by the nurse is best when a patient with asthma asks "How will I know when my metered-dose inhaler (MDI) is empty?"

"You need to keep track of how many puffs you have used."

The patient has a prescription to receive methylprednisolone sodium succinate 150 mg IV push stat. Available is a solution containing 60 mg/mL. How many mL of methylprednisolone should the nurse administer?

2.5 mL

The patient has a prescription to receive 600 mg of guaifenesin every four hours PRN. Available are 400-mg tablets. How many tablets should the nurse prepare to give?

1.5 tablets

When a patient has a prescription for albuterol 5 mg via nebulizer and the albuterol is available as a solution containing 2.5 mg/3 mL, how many mL will the nurse use for the correct dose? Fill in the blank. __ mL

2.5 mg/3 mL = 5 mg/6 mL. Therefore the nurse will use 6 mL.

Which treatment will the nurse expect to be prescribed for a patient who has had chronic obstructive pulmonary disease (COPD) for three months and whose forced expiratory volume in one second (FEV1) is 65%?

Albuterol and ipratropium combination

Which is the purpose of lung reduction surgery for the patient with chronic obstructive pulmonary disease (COPD)?

Allows more room for normal alveoli to expand

Which clinical manifestation would alert the nurse to an early manifestation of an exacerbation of asthma in a patient brought to the emergency department following an automobile accident?

Anxiety

Which clinical manifestations indicate an exacerbation of chronic obstructive pulmonary disease (COPD)? Select all that apply.

Arterial pH 7.26 Patient in tripod position Increased difficulty sleeping Increased sputum expectoration

Which factors are possible triggers for asthma exacerbations? Select all that apply.

Aspirin Perfumes Animal dander Gastroesophageal reflux disease (GERD)

Which actions will the nurse take when a patient is receiving oxygen (O2) through a nasal cannula? Select all that apply.

Assess ears for skin breakdown caused by the cannula Assist the patient to position the nasal cannula correctly Assure that there is water in the bubble-through humidifier

In which order should the nurse explain the steps for teaching a patient with chronic obstructive pulmonary disease (COPD) about effective huff coughing?

Assume a sitting position Inhale slowly through your mouth Hold your breath for two to three seconds Exhale forcefully and quickly.

Which findings will the nurse expect when assessing a clinic patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.

Barrel chest on inspection Wheezes on auscultation

Which benefits of a pulmonary rehabilitation (PR) program will the nurse include when encouraging a patient to consider PR? Select all that apply.

Boosts mood Reduces dyspnea Enhances quality of life

Which parameter is most important to monitor for the patient who has been started on prednisone for an asthma exacerbation?

Breath sounds

In which order would the nurse instruct a patient to perform the steps for administering an albuterol metered-dose inhaler (MDI)?

Breathe all air out completely as much as possible. Hold the inhaler straight or as recommended. Begin to inhale slowly and evenly through the mouth. Press down on the MDI while still inhaling slowly Hold the breath for 10 seconds after taking a full breath Wait for one minute before starting a second puff.

The nurse assesses a patient with wheezing and dyspnea and determines that these symptoms are related to which pathophysiologic feature asthma?

Bronchoconstriction

The nurse notes that a patient is experiencing breathlessness, chest tightness, and a cough after climbing stairs. Which cause is the most likely reason for these symptoms?

Capillary leakage in the airway

When educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes, which complication of smoking would the nurse discuss with the patient?

Cardiovascular disease

Which nursing actions will be included for a patient with chronic obstructive pulmonary disease (COPD) who is receiving oxygen therapy through a mask? Select all that apply.

Choose the optimal oxygen device. Assess the need to adjust the oxygen flow rate Monitor for signs of adverse effects of oxygen therapy.

When caring for a patient with chronic obstructive pulmonary disease (COPD), which assessment finding will the nurse expect?

Chronic intermittent cough

Which corticosteroid would the nurse administer to a patient directly through inhalation?

Ciclesonide

Which manifestations would the nurse identify with asthma? Select all that apply.

Cough Wheezing Chest tightness

Smoking may have which effects that increase the risk of pulmonary infections in the lungs of a patient with chronic obstructive pulmonary disease (COPD

Decreased alveolar macrophage function

Which instructions will the nurse give to the patient with chronic obstructive pulmonary disease (COPD) to promote sleep? Select all that apply.

Do not smoke between periods of sleep Ask the health care provider about testing for sleep apnea Use saline nasal sprays before sleep if experiencing postnasal drip

Outpatient pulmonary rehabilitation (PR) for a patient with chronic obstructive lung disease (COPD) usually includes which components? Select all that apply.

Education Exercise training Nutrition counseling

Which interventions may be included in the plan of care for a patient with advanced stage chronic obstructive pulmonary disease (COPD) who has experienced significant weight loss? Select all that apply.

Encourage rest before meals. Encourage high-protein supplements between meals

Which finding would confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea and a history of tobacco use?

FEV1/FVC ratio of 65%

The nurse should instruct a patient with chronic obstructive pulmonary disease (COPD) to perform which action for effective huff coughing?

Forcefully exhale quickly and cough when mucus is felt in the breathing tubes.

Which factor on this patient's health history is a known trigger for asthma attacks?

Gastroesophageal reflux

Before administering ipratropium bromide, the nurse must confirm that the patient does not have which comorbidity?

Glaucoma

The nurse would identify which structural changes as occurring during chronic inflammation? Select all that apply.

Hypersecretion of mucus Progressive loss of lung function Proliferation of new blood vessels

Which explanation is likely when the nurse notes a hemoglobin level of 20 g/dL in a patient admitted with chronic obstructive pulmonary disease (COPD)?

Hypoxia has stimulated erythropoiesis

Which interprofessional action would the nurse anticipate next when a patient having an asthma attack has used albuterol and oxygen with inadequate improvement?

IV corticosteroids

Which factor contributes to loss of lung elastic recoil in a patient with chronic obstructive pulmonary disease (COPD) due to cigarette smoking?

Imbalance of protease and antiprotease activity

The nurse is providing education about the risk factors of asthma. Which factors would the nurse explain are associated with asthma? Select all that apply.

Immune response Genetic predisposition Exposure to air pollutants

Which factor causes the clinical manifestations of chronic obstructive pulmonary disease (COPD)?

Inability to effectively expire air

When a patient presents with acute exacerbation of asthma, which actions will the nurse anticipate as part of the interprofessional treatment plan? Select all that apply.

Infuse IV corticosteroids Provide oxygen through a non-rebreather mask. Start nebulized short-acting β2-adrenergic agonist

Which nursing action may be included in the plan of care for a patient with chronic obstructive pulmonary disease (COPD) who is complaining of difficulty breathing?

Initiate oxygen (O2) administration at low flow rates

Which is the priority assessment for a patient experiencing an acute asthma exacerbation?

Inspection of the chest wall

A child with a nonproductive cough states, "I am having trouble breathing." Which action would the nurse take to reduce the severity of breathlessness in the child?

Instruct the child to bend forward slightly

Which intervention by the nurse is the priority for a patient with expiratory airflow obstruction, ineffective cough, decreased airway humidity, and abnormal breath sounds?

Instruct the patient to inhale deeply, bend forward slightly, and perform three or four huffs.

After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness, and dry cough. Which action would the nurse take to reduce the symptoms?

Instruct the patient to rinse the mouth with water after inhalation.

A patient with chronic obstructive pulmonary disease (COPD) is suspected to have developed cor pulmonale. The nurse recognizes that which test result would confirm the diagnosis

Large pulmonary vessels on chest x-ray

A patient with chronic obstructive pulmonary disease (COPD) is suspected to have developed cor pulmonale. The nurse recognizes that which test result would confirm the diagnosis?

Large pulmonary vessels on chest x-ray

Which action may be beneficial to a patient with chronic obstructive pulmonary disease (COPD) to maximize food intake?

Limiting fluids during mealtimes

When teaching a class on smoking cessation, which benefits of tobacco cessation will the nurse include? Select all that apply.

Lower cancer risk Improvement in chronic cough Enhanced sense of taste and smell

Which are the predominant inflammatory cells in chronic obstructive pulmonary disease (COPD)? Select all that apply.

Neutrophils Lymphocytes Macrophages

Which type of medication may be included in the plan of care for a patient with chronic obstructive pulmonary disease (COPD) who experiences dyspnea and has a forced expiratory volume (FEV1) of 70% of predicted value?

Short-acting bronchodilator

Which assessment finding indicates a life-threatening situation for a patient experiencing an acute asthma attack?

Silent chest

When the nurse needs to transport a patient who needs an FiO2 of 45% to a different department, which oxygen delivery device will be best to use?

Simple face mask

Which instruction will the nurse give to the patient who is receiving a nebulized bronchodilator treatment?

Sit in an upright position during the treatment

Which instruction will the nurse give a patient with chronic obstructive pulmonary disease who is using the Flutter airway clearance device?

Sit upright while using the device

Which instruction will the nurse include when teaching a patient with chronic obstructive pulmonary disease (COPD) about use of theophylline?

Take the medication with food

In which order will the patient need to take these steps for effective huff coughing?

The patient will initially sit upright in a comfortable position that will allow deep breathing, then take a deep breath and hold it for a few seconds to prepare for the cough. Next, the patient will exhale forcefully as if fogging a mirror, which will help mucus move into the larger airways. The patient will repeat the huff several more times to move mucus further into the larger airways. When the patient feels mucus in the airways, coughing is used to help expel mucus.

A patient with asthma develops nausea, vomiting, headache, tachycardia, and dysrhythmias. The nurse would suspect which medication as the cause of the symptoms?

Theophylline

The nurse recognizes that which number of nighttime awakenings caused by asthma symptomology would be classified as mild disease?

Three to four days per month

The nurse is assigned to care for a patient who is experiencing an exacerbation of asthma and is very anxious. Which would be the primary reason for the nurse to carefully inspect the chest wall of this patient?

To evaluate the use of intercostal muscles

Which postural drainage position will the nurse avoid when caring for a patient with chronic obstructive pulmonary disease and cor pulmonale?

Trendelenburg position

Which etiologic factor would the nurse use when choosing the nursing diagnosis of activity intolerance for a patient with asthma?

Work of breathing

Which position will the nurse use when caring for a patient who is experiencing an asthma exacerbation?

high fowler

Which assessment finding is the most common clinical manifestation of an asthma attack?

wheezing

Which oxygen delivery device may be used for a patient who requires oxygen administration in low concentrations of 24% at 1 L/min for a long duration?

Nasal cannula

When would the nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)?

One hour before a meal

Which intervention should be included in the plan of care for a patient who has lost 30 lb and has a nursing diagnosis of impaired nutritional status?

Suggest a high-calorie, high-protein diet with six small meals a day.

A patient with asthma is prescribed formoterol. Which directive would the nurse include in the medication education provided to the patient? Select all that apply.

"Side effects include cold or flu-like symptoms." "Formoterol is not the only medication that you will need to treat your asthma." "If wheezing gets worse, there are other types of medications that are more beneficial than formoterol."

The nurse is teaching a student nurse about breath sounds in a patient with asthma. Which statement made by the student indicates the need for further teaching?

"The patient wheezes loudly during expiration when the asthma is severe."

The nurse is assessing a patient who is having an acute asthma attack. Which nursing intervention would be the priority for this patient?

Administering an albuterol bronchodilator

Which nursing intervention is appropriate for a patient whose laboratory report shows oxygen saturation of 45 mm Hg and carbon dioxide saturation of 60 mm Hg?

Advise the patient to plan sexual activity during the early afternoon

Which interventions would the nurse question when caring for a patient who is having an acute asthma attack? Select all that apply.

Prednisone 10 mg, PO X1 stat Administration of blood products to increase oxygen saturation

A patient with dyspnea and who is unable to speak clearly has a respiratory rate of 45 breaths/min, a pulse of 130 beats/min, oxygen saturation of 90%, and neck vein distention. Which treatment would the nurse expect to incorporate into the plan of care?

Supplementary oxygen through nasal cannula

Which patient action indicates good understanding of the nurse's instructions about the use of a metered-dose inhaler (MDI)?

Waits one minute between each puff from the MDI

Which discharge instructions would the nurse include for the patient with asthma? Select all that apply.

Wash the nebulizer regularly Medication noncompliance may lead to exacerbations It is important to know the purpose and side effects of prescribed medications

Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)?

β2 agonists

Which action will the nurse suggest to decrease anxiety related to chronic obstructive pulmonary disease (COPD)?

Perform pursed lip breathing.

Which complication would the nurse expect in a patient with chronic obstructive pulmonary disease who has α1-antitrypsin (AAT) deficiency?

Liver disease

Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Select all that apply.

Pneumonia Cor pulmonale Exacerbations

Which information about the purpose of pursed-lip breathing will the nurse include when teaching a patient with chronic obstructive pulmonary disease about breathing exercises?

Preventing air trapping

Which description best characterizes chronic obstructive pulmonary disease (COPD)?

Progressive persistent expiratory airflow limitation

Which is the most common organism found in heated nebulizers used for humidification during oxygen administration?

Pseudomonas aeruginosa

Which patient care goals are appropriate for a patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.

Relief of symptoms Improved quality of life Prevention of disease progression Ability to perform activities of daily living (ADLs)

Which actions will the nurse take to relieve anxiety for a patient who is experiencing an acute asthma attack? Select all that apply.

Remain calm, quiet, and reassuring Utilize the "talking down" technique. Place the patient in a semi-Fowler's position Coach the patient to use pursed lip breathing

Which discharge teaching about nutrition will the nurse include for a patient with chronic obstructive pulmonary disease (COPD) and pneumonia?

Rest for 30 minutes before eating

Which method of oral care helps to prevent oral infection for the patient who is taking fluticasone?

Rinse the mouth with water after the second puff of medication

Which patient actions indicate a need for more education about how to use a dry powder inhaler device? Select all that apply.

The patient breathes into the inhaler The patient shakes the medicine before using it The patient inhales more than 1 puff with each inspiration.

In which order will a patient who has asthma take these steps when using a peak flow meter?

Venturi mask Mechanical ventilator

Which actions will the nurse include when performing chest physiotherapy on a patient with chronic obstructive pulmonary disease? Select all that apply.

Vibration Percussion Postural drainage

Which complications would the nurse monitor for when caring for a patient with chronic obstructive pulmonary disease (COPD) and cor pulmonale? Select all that apply.

Weight gain Polycythemia Hepatomegaly Jugular vein distension