Ch. 30 Asthma and COPD
A patient with asthma asks the nurse about engaging in exercise. What does the nurse tell this patient?
"Adjust your exercise routine as needed to avoid asthma triggers."
Which statement by a patient with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction?
"I don't need to get a flu shot."
After receiving education on the correct use of emergency drug therapy for asthma, which statement by the patient indicates a correct understanding of the nurse's instructions?
"I must have my emergency inhaler with me at all times."
A patient who has a risk of a faulty pair of alleles for the alpha1-antitrypsin (AAT) protein gene and who has a history of cigarette smoking is concerned about the risk of chronic obstructive pulmonary disease (COPD). Which statement by the nurse accurately answers the patient's concerns?
"If both pairs of AAT genes are faulty, you are likely to develop COPD, even if you don't smoke."
The nurse is providing teaching about home management of chronic obstructive pulmonary disease (COPD). The patient says, "What difference does it make? This isn't going to get any better anyway." What is the nurse's best response?
"This is a chronic condition with exacerbations and remissions, and with proper care, you can slow the progression of COPD."
A patient who has been diagnosed with asthma a few months ago is using a salmeterol inhaler as a reliever therapy, but has no relief from the symptoms. Which statement made by the nurse would benefit the patient?
"Use a short-acting inhaler such as albuterol for reliever therapy."
Which patient may be an ideal candidate for the surgical treatment of chronic obstructive pulmonary disease (COPD)?
A patient with minimal chronic bronchitis and stable cardiac function
Which clinical manifestations during status asthmaticus require immediate action? Select all that apply.
Absence of response to usual therapy Sudden absence of wheezing, indicating airway obstruction Development of pneumothorax and cardiac or respiratory arrest Use of accessory muscles while breathing and distention of neck veins
What best describes the pathophysiology involved in a patient who has asthma as a lower respiratory disease?
Airway obstruction secondary to inflammation and/or bronchoconstriction secondary to airway hyperresponsiveness
A patient with asthma has pneumonia, is reporting increased shortness of breath, and has inspiratory and expiratory wheezes. All of these medications are prescribed. Which medication should the nurse administer first?
Albuterol 2 inhalations
The nurse is teaching a patient with asthma about using the following medications. Which medication does the nurse teach the patient to use first?
Albuterol 2 puffs
A patient with asthma tells the nurse that prescribed montelukast does not help with symptoms when having an asthma attack. Which action by the nurse is correct?
Ask the patient to describe how and when the medication is taken.
Which signs/symptoms are indicators of an asthma attack? Select all that apply.
Audible wheeze, especially on exhalation Muscle retraction between the ribs Decreased forced expiratory volume in the first second (FEV1) on flowmeter Eosinophils in the sputum
Which assessment finding is associated with obstructive lung disease and not with interstitial lung disease?
Barrel chest
What two assessment findings are changes secondary to chronic obstructive pulmonary disease (COPD)?
Barrel chest and finger clubbing
The nurse is preparing to administer oxygen to a patient with chronic obstructive pulmonary disease (COPD) who is hypoxemic and hypercarbic. How will the nurse administer the oxygen for this patient?
By maintaining oxygen saturations greater than 88%
Which disorders are lung diseases that cause chronic airflow limitation? Select all that apply.
Chronic bronchitis Intermittent asthma
Pulmonary function tests for a patient with chronic respiratory symptoms reveal an initial decrease in FEV1, but an increase in FEV1 of 5% after treatment with a bronchodilator medication. Which diagnosis does the nurse anticipate for this patient?
Chronic obstructive pulmonary disease (COPD)
When reviewing asthma management with a 65-year-old patient, what topic is most important for the nurse to include?
Correct use of controller medications
The nurse is reviewing the medical record of a patient with asthma and notes elevated serum eosinophils and elevated immunoglobulin E levels. Which medication does the nurse expect the provider to order for this patient based on this finding?
Cromolyn sodium
Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults?
Due to decreased sensitivity of receptors
Which statements about chronic obstructive pulmonary disease (COPD) are correct? Select all that apply.
Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. COPD includes emphysema and chronic bronchitis. The increased risk of infection in COPD is related to increased mucus and poor oxygenation.
The nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD). Which intervention to facilitate adequate caloric intake for this patient is included in the plan of care?
Encourage frequent rest periods, especially before meals.
What does the nurse do first when setting up a safe environment for the new patient on oxygen?
Ensures that no combustion hazards are present in the room
A patient admitted with chronic obstructive pulmonary disease (COPD) has a barrel chest with expiratory wheezes in the lower lobes, decreased fremitus, and hyperresonance with chest percussion. What does the nurse expect to see on this patient's chest x-ray?
Flattening of the diaphragm
The rehabilitation unit nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). When the dinner tray arrives, the patient reports having no appetite. Which action by the nurse is correct?
Get the patient to the unit dining room with other patients to eat the meal.
A patient with chronic obstructive pulmonary disease (COPD) reports having off-and-on symptoms of dyspnea, coughing, and sputum production. The patient's FEV1/FVC is 65% of predicted value and the FEV1 is 55% of predicted value. Which level of COPD severity does this patient have?
II - moderate
What is the nurse's priority for care in the postoperative period for a patient with severe chronic obstructive pulmonary disease (COPD) who has undergone lung reduction surgery?
Monitor the patient's oxygen saturation levels continuously and use the incentive spirometer.
A patient has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this patient?
Mucolytics thin secretions, making them easier to expectorate.
Which interventions to improve oxygenation and decrease carbon dioxide retention does the nurse teach the patient with chronic obstructive pulmonary disease (COPD)? Select all that apply.
Partnering with the family in COPD management by adhering to prescribed therapies Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea
A patient with asthma reports being afraid to begin an aerobic exercise program because exercise sometimes triggers asthma symptoms. What does the nurse recommend for this patient?
Premedicating with a short-acting bronchodilator before exercise
A patient is brought to the emergency department with labored breathing, wheezing, and marked use of accessory muscles. The patient has a low Pao2 and low Paco2 and is receiving oxygen by nasal cannula at a rate of 2 L/min. After the patient has received an aerosolized bronchodilator medication, the nurse assesses no wheezes and an oxygen saturation of 82%. What is the next action by the nurse?
Prepare for emergency intubation
A newly diagnosed patient with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do?
Repeat the peak flow test.
The nurse is teaching a patient with asthma how to use a peak flowmeter. What does the nurse include when teaching this patient?
Test symptom severity twice daily or more often if needed.
A patient is admitted with asthma. How is this disease differentiated from other chronic lung disorders?
The patient is symptom-free between exacerbations.
Which sign/symptom is significant in diagnosing asthma in a nonsmoker?
Wheezing
A patient who has a history of asthma is prescribed a medicine to prevent further asthma attacks. Which statement made by the patient indicates ineffective learning about how to use the medication?
"I should use the inhaler only when I have an asthma attack."
The nurse is performing a medication history for a patient who reports using salmeterol as needed for asthma exacerbations. What does the nurse tell the patient about this practice?
"Using salmeterol as a reliever medication can lead to sudden death."
A patient who has emphysema tells the nurse that the prescribed inhaled corticosteroid medication does not help at all. Which action by the nurse is correct?
Ask the patient to describe how frequently the medication is used.
A patient with asthma asks the nurse why it is necessary to use an inhaled corticosteroid every day. Which answer by the nurse is correct?
Daily medications help reduce the risk of irreversible changes in your lungs.
The nurse is teaching a patient who has chronic obstructive pulmonary disease (COPD) about the need to prevent respiratory infections. Which topic does the nurse include in the patient's teaching?
Getting an annual influenza vaccine
The patient is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler?
Short-acting beta agonists