Asthma & COPD quiz

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."

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 A patient with loud expiratory wheezes A patient with jugular venous distention and peripheral edema A patient who has a cough productive of thick, green mucus

A patient with a respiratory rate of 38 breaths/min

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

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 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg

pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding? Elevated temperature Finger clubbing Peripheral edema Chest pain

peripheral edema

The home care nurse is caring for a patient who has severe COPD and home oxygen therapy. The patient tells the nurse that she feels much better after increasing the oxygen flowmeter from 2 L to 5 L/min. The patients pulse oximetry is 98%. What is the priority action of the nurse?

reduce the oxygen flow rate until the pt's pulse oximetry value is 90% to 92%

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. The patient practices by blowing through a straw. The patient inhales slowly through the nose. The patient's ratio of inhalation to exhalation is 1:3.

the patient puffs up the cheeks while exhaling

The nurse is caring for a patient who is hospitalized for pneumonia. Which nursing diagnosis has the highest priority?

ineffective airway clearance r/t thick secretions in trachea and bronchi

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. Reinforce the ongoing use of pursed-lip breathing techniques. Change the O2 flow rate to the highest prescribed rate. Teach the patient about consistent use of inhaled corticosteroids

teach the pt to use the Flutter airway clearance device

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?" "Are you claustrophobic?" "Are you allergic to shellfish?" "Do you have any metal implants or prostheses?"

"have you taken any bronchodilators today?"

Which of the following patients would benefit from postural drainage?

A patient with chronic bronchitis and congested cough

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

Encourage the patient to sit up at the bedside in a chair and lean forward.

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

Listen to the patient's breath sounds.

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

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. Encourage the patient to cough and deep breathe. Document changes in respiratory status. Administer IV methylprednisolone (Solu-Medrol).

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? Accessory muscle use has decreased. O2 saturation is >90%. Respiratory rate is 16 breaths/minute. No wheezes are audible.

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.

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? Absence of wheezes or crackles Even, unlabored respirations Pulse oximetry reading of 92% Respiratory rate of 18 breaths/min

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 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? Suggest the use of over-the-counter sedative medications. Titrate O2 to keep saturation at least 90%. Discuss a high-protein, high-calorie diet with the patient. Teach the patient how to use pursed-lip breathing.

Teach the patient how to use pursed-lip breathing.

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 complains of coughing up green mucus. The patient reports a recent 15-lb weight gain. The patient takes cimetidine (Tagamet HB) daily. The patient denies shortness of breath at present.

The patient takes cimetidine (Tagamet HB) daily.

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. Use the inhaled corticosteroid when shortness of breath occurs. Hold your breath for 5 seconds after using the bronchodilator inhaler. Inhale slowly and deeply when using the dry powder inhaler (DPI).

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 until pulse rate exceeds 130 beats/minute. Limit exercise to activities of daily living (ADLs). Walk 15 to 20 minutes a day at least 3 times/week. Stop exercising when you feel short of breath.

Walk 15 to 20 minutes a day at least 3 times/week.

The nurse finds the patient in cardiopulmonary arrest with no pulse or respirations. Which oxygen delivery device will the nurse use for this patient?

bag-valve-mask unit

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? Question the patient about use of the prescribed inhaled corticosteroids. Instruct the patient to use the prescribed albuterol (Ventolin HFA). Ask about recent exposure to any new allergens or asthma triggers. Tell the patient to go to the hospital emergency department.

instruct the pt 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? Give a high enough flow rate to keep the bag from collapsing. Teach the patient to keep the mask on during meals. Drain moisture condensation from the corrugated tubing every hour. Keep the air entrainment ports clean and unobstructed.

keep the air entrainment ports clean and unobstructed

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. Teach the patient about the use of oral corticosteroids. Increase the dose of the leukotriene inhibitor. Instruct the patient to keep the scheduled follow-up appointment.

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. Teach the patient about safe use of O2 at home. Monitor for increased O2 need with exercise. Adjust O2 to keep saturation in prescribed parameters.

Obtain O2 saturation using pulse oximetry

The nurse is caring for a patient with severe COPD who is becoming increasingly confused and disoriented. What is the priority action of the nurse?

Obtain an arterial blood gas to check for carbon dioxide retention

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 uses acetaminophen (Tylenol) for headaches. The patient has a history of pneumonia 6 months ago. The patient takes propranolol (Inderal) for hypertension. The patient has chronic inflammatory bowel disease.

The patient takes propranolol (Inderal) for hypertension.

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

Withhold bronchodilators for 6 to 12 hours before the examination.

The nurse is caring for a patient with advanced COPD who reports feeling short of breath. The nurse notes that the patients lung sounds are diminished bilaterally and the patients pulse oximetry is 91% on 2 L/min oxygen via nasal cannula. What actions will the nurse take to make the patient more comfortable?

maintain eye contact and provide calm reassurance elevate the head of the pt's bed to fully upright administer the ordered nebulized bronchodilator

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. Administer O2 according to the patient's level of dyspnea. Minimize O2 use to avoid O2 dependency. Avoid administration of O2 at a rate of more than 2 L/min.

maintain the pulse oximetry level of 90% or greater

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 tells the nurse about a family history of bronchitis. The patient reports a productive cough for 3 months every winter. The patient indicates a 30 pack-year cigarette smoking history. The patient denies having respiratory problems until the past 12 months.

the patient reports a productive cough for 3 months every winter

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. The patient takes montelukast (Singulair) for peak flows in the red zone. The patient inhales rapidly through the peak flow meter mouthpiece. The patient calls the health care provider when the peak flow is in the green zone.

the patient uses an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone

The nurse is caring for a patient who developed a pulmonary embolism after surgery. Which goal statement is the highest priority for the nurse to include in the patients care plan for the diagnosis Impaired gas exchange r/t impaired pulmonary blood flow from embolus?

the pt will maintain pulse oximetry values of at least 95% on room air

The nurse is performing a respiratory assessment on a patient. Which assessment findings indicate to the nurse that the patient has a history of long-standing chronic respiratory disease?

the pt's chest has equal antero-posterior and transverse diameters the pt needs to sleep on at least four to five pillows at night all of the pt's fingernails are noticeably clubbed

The nurse notes the following findings when assessing a patient with COPD. Which require prompt nursing intervention?

the pt's sputum has turned from yellow to greenish-brown the pt has become confused and mildly disoriented the pt is unable to count out loud past 15 after a deep breath the pt has stridor with wheezes heard in all lung fields

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 continuous pulse oximetry. leukotriene modifiers. use of the nicotine patch. α1-antitrypsin testing.

α1-antitrypsin testing.