COPD/ASTHMA questions

The nurse is teaching a patient how to self-administer ipratropium 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.

1. While assisting a patient with intermittent asthma to identify specific triggers of asthma, what should the nurse explain? a. Food and drug allergies do not manifest in respiratory symptoms. b. Exercise-induced asthma is seen only in individuals with sensitivity to cold air. c. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques. d. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.

1. d. Respiratory infections are one of the most common precipitating factors of an acute asthma attack. Sensitivity to food and drugs may also precipitate attacks and exerciseinduced asthma occurs after exercise, especially in cold, dry air. Psychologic factors may interact with the asthmatic response to worsen the disease but it is not a psychosomatic disease.

10. Priority Decision: To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do? a. Leave the patient alone to rest in a quiet, calm environment. b. Stay with the patient and encourage slow, pursed lip breathing. c. Reassure the patient that the attack can be controlled with treatment. d. Let the patient know that frequent monitoring is being done using measurement of vital signs and SpO2.

10. b. The patient in an acute asthma attack is very anxious and fearful. It is important to stay with the patient and interact in a calm, unhurried manner. Helping the patient to breathe with pursed lips will facilitate expiration of trapped air and help the patient to gain control of breathing. Pursed lip breathing also is used with COPD for this same reason.

11. When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse instruct the patient to do? a. Carry the flow meter with the patient at all times in case an asthma attack occurs b. Use the flow meter to check the status of the patient's asthma every time the patient takes quick-relief medication c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone d. Use the flow meter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible

11. c. A yellow zone reading with the PEFR indicates that the patient's asthma is getting worse and quick-relief medications should be used. The meter is routinely used only each morning before taking medications and does not have to be on hand at all times. The meter measures the ability to empty the lungs and involves blowing through the meter.

12. The nurse recognizes that additional teaching is needed when the patient with asthma says a. "I should exercise every day if my symptoms are controlled." b. "I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness." c. "I should inform my spouse about my medications and how to get help if I have a severe asthma attack." d. "A diary to record my medication use, symptoms, peak expiratory flow rates, and activity levels will help in adjusting my therapy."

12. b. Nonprescription drugs should not be used by patients with asthma because of dangers associated with rebound bronchospasm, interactions with prescribed drugs, and undesirable side effects. All of the other responses are appropriate for the patient with asthma.

Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking? a. Bronchospasm and hoarseness b. Decreased mucus secretions and cough c. Increased function of alveolar macrophages d. Increased risk of infection and hyperplasia of mucous glands

13. d. Increased risk of infection, hyperplasia of mucous glands, cancer, and chronic bronchitis are the long-term effects of smoking.

15. What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD? a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long-term low-flow oxygen therapy d. Administration of high concentrations of oxygen

15. b. Constriction of the pulmonary vessels, leading to pulmonary hypertension, is caused by alveolar hypoxia and the acidosis that results from hypercapnia. Polycythemia is a contributing factor in cor pulmonale because it increases the viscosity of blood and the pressure needed to circulate the blood. Long-term low-flow oxygen therapy dilates pulmonary vessels and is used to treat cor pulmonale. High oxygen administration is not related to cor pulmonale.

16. In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease? a. Use of bronchodilator drugs b. Use of inhaled corticosteroids c. Lung volume-reduction surgery d. Prevention of respiratory tract infections

16. d. Smoking cessation is one of the most important factors in preventing further damage to the lungs in COPD but prevention of infections that further increase lung damage is also important. The patient is very susceptible to infections and these infections make the disease worse, creating a vicious cycle. Bronchodilators, inhaled corticosteroids, and lung volume-reduction surgery help to control symptoms but these are symptomatic measures.

19. A patient is being discharged with plans for home O2 therapy provided by an O2 concentrator with an O2-conserving portable unit. In preparing the patient to use the equipment, what should the nurse teach the patient? a. The portable unit will last about 6 to 8 hours. b. The unit is strictly for portable and emergency use. c. The unit concentrates O2 from the air, providing a continuous O2 supply. d. Weekly delivery of one large cylinder of O2 will be necessary for a 7- to 10-day supply of O2.

19. c. Oxygen concentrators or extractors continuously supply O2 concentrated from the air. O2 -conserving units will last for up to 20 hours. Portable liquid O2 units will hold about 6 to 8 hours of O2 but because of the expense they are only used for portable and emergency use. Compressed O2 comes in various tank sizes but generally it requires weekly deliveries of four to five large tanks to meet a 7- to 10-day supply.

2. Priority Decision: A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? a. The presence of a pulsus paradoxus b. Markedly diminished breath sounds with no wheezing c. Use of accessory muscles of respiration and a feeling of suffocation d. A respiratory rate of 34 and increased pulse and blood pressure

2. b. Diminished or absent breath sounds may indicate a significant decrease in air movement resulting from exhaustion and an inability to generate enough muscle force to ventilate and is an ominous sign. The other symptoms are expected in an asthma attack.

The patient has an order for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. Calculate how many milliliters the nurse should use to prepare the patient's dose.__ mL

2.5 5 mg ÷ 2 mg/mL = 2.5 mL

20. Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? a. Huff coughing b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing

20. c. Pursed lip breathing prolongs exhalation and prevents bronchiolar collapse and air trapping. Huff coughing is a technique used to increase coughing patterns to remove secretions. Thoracic breathing is not as effective as diaphragmatic breathing and is the method most naturally used by patients with COPD. Diaphragmatic breathing emphasizes the use of the diaphragm to increase maximum inhalation but it may increase the work of breathing and dyspnea

21. What does the nurse include when planning for postural drainage for the patient with COPD? a. Schedules the procedure 1 hour before and after meals b. Has the patient cough before positioning to clear the lungs c. Assesses the patient's tolerance for dependent (head-down) positions d. Ensures that percussion and vibration are performed before positioning the patient

21. c. Many postural drainage positions require placement in Trendelenburg position but patients with heart disease, hemoptysis, chest trauma, or severe dyspnea should not be placed in these positions. Postural drainage should be done 1 hour before and 3 hours after meals if possible. Coughing, percussion, and vibration are all performed after the patient has been positioned.

22. Which dietary modification helps to meet the nutritional needs of patients with COPD? a. Eating a high-carbohydrate, low-fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digestion

22. b. Eating is an effort for patients with COPD and frequently these patients do not eat because of fatigue, dyspnea, and difficulty holding their breath while swallowing. Foods that require much chewing cause more exhaustion and should be avoided. A low-carbohydrate diet is indicated if the patient has hypercapnia because carbohydrates are metabolized into carbon dioxide. Fluids should be avoided at meals to prevent a full stomach and cold foods seem to give less of a sense of fullness than hot foods.

23. Delegation Decision: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)? a. Assist the patient to get out of bed. b. Auscultate breath sounds every 4 hours. c. Plan patient activities to minimize exertion. d. Teach the patient pursed lip breathing technique.

23. a. Assistance with positioning and activities of daily living (ADL) is within the training of unlicensed assistive personnel (UAP). Teaching, assessing, and planning are all part of the RN's practice.

24. Which medication is a dry powder inhaler (DPI) that is used only for COPD? a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacterol (Arcapta Neohaler)

24. d. Indacterol (Arcapta Neohaler) is a DPI that is used only for COPD. Roflumilast (Daliresp) is an oral medication used for COPD. Salmeterol (Serevent) is a DPI but it is also used in asthma with inhaled corticosteroids. Ipratropium (Atrovent HFA) is used for COPD but it is delivered via metered-dose inhaler or nebulizer.

32. Meeting the developmental tasks of young adults with cystic fibrosis becomes a major problem primarily because a. they eventually need a lung transplant. b. they must also adapt to a chronic disease. c. any children they have will develop cystic fibrosis. d. their illness keeps them from becoming financially independent.

32. b. The presence of a chronic disease that is present at birth and significantly lowers life span and the many treatments needed by those with CF affects all relationships and development of these patients. Although a lung transplant may be needed, not all CF patients need one. Children of a parent with CF will either be carriers of CF or have the disease. Many men with CF are sterile and women may have difficulty becoming pregnant. Educational and vocational goals may be met in those who maintain treatment programs and health.

25. Priority Decision: During an acute exacerbation of mild COPD, the patient is severely short of breath and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to obstruction of airflow and anxiety. What is the best action by the nurse? a. Prepare and administer routine bronchodilator medications. b. Perform chest physiotherapy to promote removal of secretions. c. Administer oxygen at 5 L/min until the shortness of breath is relieved. d. Position the patient upright with the elbows resting on the over-the-bed table.

25. d. The tripod position with an elevated backrest and supported upper extremities to fix the shoulder girdle maximizes respiratory excursion and an effective breathing pattern. Staying with the patient and encouraging pursed lip breathing also helps. Bronchodilators may help but can also increase nervousness and anxiety; rescue inhalers would be used before routine bronchodilators. Postural drainage is not tolerated by a patient in acute respiratory distress and oxygen is titrated to an effective rate based on ABGs because of the possibility of carbon dioxide narcosis.

26. The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurse's best response? a. "You need to discuss your feelings and needs with your wife so she knows what you expect of her." b. "There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath." c. "You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity." d. "Would you like for me to talk to you and your wife about some modifications that can be made to maintain sexual activity?"

26. d. Specific guidelines for sexual activity help to preserve energy and prevent dyspnea and maintenance of sexual activity is important to the healthy psychologic well-being of the patient. Open communication between partners is needed so that the modifications can be made with consideration of both partners.

27. What should the nurse include when teaching the patient with COPD about the need for physical exercise? a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day. b. A bronchodilator inhaler should be used to relieve exercise-induced dyspnea immediately after exercise. c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes after the exercise. d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.

27. c. Shortness of breath usually increases during exercise but the activity is not being overdone if breathing returns to baseline within 5 minutes after stopping. Bronchodilators can be administered 10 minutes before exercise but should not be administered for at least 5 minutes after activity to allow recovery. Patients are encouraged to walk 15 to 20 minutes per day with gradual increases but actual patterns will depend on patient tolerance. Dyspnea most frequently limits exercise and is a better indication of exercise tolerance than is heart rate in the patient with COPD.

28. The patient has had COPD for years and his ABGs usually show hypoxia (PaO2 <60 mm Hg or SaO2 <88%) and hypercapnia (PaCO2 >45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg

28. b. These results show worsening respiratory function and failure. The results in option a show potential normal results for the patient described. The results in option c show normal ABGs. The results in option d show alkalosis, probably respiratory, but the HCO3 - results are needed to be sure.

29. Pulmonary rehabilitation (PR) is designed to reduce symptoms and improve the patient's quality of life. Along with improving exercise capacity, what are the anticipated results of PR (select all that apply)? a. Decreased FEV1 b. Decreased anxiety c. Decreased depression d. Increased oxygen need e. Decreased hospitalizations

29. b, c, e. Decreasing anxiety, depression, and hospitalizations along with improving exercise capacity are the anticipated effects of pulmonary rehabilitation. The other options may occur but are not predicted.

3. A patient with asthma has the following arterial blood gas (ABG) results early in an acute asthma attack: pH 7.48, PaCO2 30 mm Hg, PaO2 78 mm Hg. What is the most appropriate action by the nurse? a. Prepare the patient for mechanical ventilation. b. Have the patient breathe in a paper bag to raise the PaCO2. c. Document the findings and monitor the ABGs for a trend toward alkalosis. d. Reduce the patient's oxygen flow rate to keep the PaO2 at the current level

3. c. Early in an asthma attack, an increased respiratory rate and hyperventilation create a respiratory alkalosis with increased pH and decreased PaCO2 , accompanied by hypoxemia. As the attack progresses, pH shifts to normal, then decreases, with arterial blood gases (ABGs) that reflect respiratory acidosis with hypoxemia. During the attack, high-flow oxygen should be provided. Breathing in a paper bag, although used to treat some types of hyperventilation, would increase the hypoxemia

30. What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease? a. Fibrosis of mucous glands and destruction of bronchial walls b. Destruction of lung parenchyma from inflammation and scarring c. Production of secretions low in sodium chloride and therefore thickened mucus d. Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa

30. c. Cystic fibrosis (CF) is an autosomal recessive, multisystem disease involving altered transport of sodium and chloride ions in and out of epithelial cells, which affects the lungs, pancreas, and sweat glands. Abnormally thick, abundant secretions from mucous glands lead to a chronic, diffuse, obstructive pulmonary disorder in almost all patients, whereas exocrine pancreatic insufficiency occurs in about 85% to 90% of patients with CF.

31. What is the most effective treatment for cystic fibrosis? a. Heart-lung transplant b. Administration of prophylactic antibiotics c. Administration of nebulized bronchodilators d. Vigorous and consistent chest physiotherapy

31. d. The major objective of therapy in CF is to promote removal of the secretions and performance of postural drainage, vibration, and percussion has been the mainstay of treatment. Aerobic exercise also seems to be effective in clearing the airways and is an important part of treatment. Antibiotics are used for early signs of infection and long courses are necessary but they are not used prophylactically. Bronchodilators have no long-term benefit. Although CF has become a leading indication for heart-lung transplant, this treatment option is not available for most patients.

33. In an adult patient with bronchiectasis, what is a nursing assessment likely to reveal? a. Chest trauma b. Childhood asthma c. Smoking or oral tobacco use d. Recurrent lower respiratory tract infections

33. d. In adults, most forms of bronchiectasis are associated with bacterial infections that damage the bronchial walls. In children, cystic fibrosis is the prominent cause of bronchiectasis. The incidence of bronchiectasis has decreased with the use of measles and pertussis vaccines and better treatment of lower respiratory tract infections

34. In planning care for the patient with bronchiectasis, which nursing intervention should the nurse include? a. Relieve or reduce pain b. Prevent paroxysmal coughing c. Prevent spread of the disease to others d. Promote drainage and removal of mucus

34. d. Mucus production is increased in bronchiectasis and collects in the dilated, pouched bronchi. A major goal of treatment is to promote drainage and removal of the mucus, primarily through deep breathing, coughing, and postural drainage..

35. Which obstructive pulmonary disease would a 30-year-old white female patient with a parent with the disease be most likely to be diagnosed with? a. COPD b. Asthma c. Cystic fibrosis d. α1-Antitrypsin (AAT) deficiency

35. d. α1 -Antitrypsin (AAT) deficiency is an autosomal recessive disorder that is a genetic risk factor for COPD. AAT occurs in 1 in 1700 to 3500 live births with an onset between ages 20 and 40 years. Although cystic fibrosis occurs in 1 in 3000 white births, legislation requires babies to be screened at birth, so it would have been previously diagnosed. Asthma is a multifactorial genetic disorder.

36. What is the primary principle involved in the various airway clearance devices used for mobilizing secretions? a. Vibration b. Inhalation therapy c. Chest physiotherapy d. Positive expiratory pressure

36. d. Positive expiratory pressure (PEP) is the principle behind the airway clearance devices (ACDs) that mobilize secretions and benefit patients. Vibration, a form of chest physiotherapy, and inhalation therapy are therapies to assist patients with excessive secretions or to increase bronchodilation but they are not principles of ACDs'

5. What is an indication of marked bronchoconstriction with air trapping and hyperinflation of the lungs in a patient with asthma? a. SaO2 of 85% b. PEF rate of <150 L/min c. FEV1 of 85% of predicted d. Chest x-ray showing a flattened diaphragm

5. b. Peak expiratory flow rates (PEFR) are normally up to 600 L/min and in status asthmaticus may be as low as 100 to 150 L/min. An SaO2 of 85% and a FEV1 of 85% of predicted are typical of mild to moderate asthma. A flattened diaphragm may be present in the patient with long-standing asthma but does not reflect current bronchoconstriction.

6. Priority Decision: Which medication should the nurse anticipate being used first in the emergency department for relief of severe respiratory distress related to asthma? a. Prednisone orally b. Ipratopium inhaler c. Fluticasone inhaler d. Albuterol nebulizer

6. d. The albuterol nebulizer will rapidly cause bronchodilation and be easier to use in an emergency situation than an inhaler. It will be used every 20 minutes to 4 hours as needed. The ipratropium inhaler could be used if the patient does not tolerate the short-acting β2 -adrenergic agonists (SABA) but its onset is slower than albuterol. Inhaled or oral corticosteroids will be used to decrease the inflammation and provide better symptom control after the emergency situation is over.

Which medications are the most effective in improving asthma control by reducing bronchial hyperresponsiveness, blocking the late-phase reaction, and inhibiting migration of inflammatory cells (select all that apply)? a. Zileuton (Zyflo CR) b. Omalizumab (Xolair) c. Fluticasone (Flovent) d. Salmeterol (Serevent) e. Montelukast (Singulair) f. Budesonide (Pulmicort) g. Beclomethasone (Qvar) h. Methylxanthine (theophylline) i. Mometasone (Asmanex Twisthaler)

7. c, f, g, i. These are the corticosteroids described. Zileuton (Zyflo CR) and montelukast (Singulair) are leukotriene modifiers that interfere with the synthesis or block the action of the leukotriene inflammatory mediators that cause bronchoconstriction. Omalizumab (Xolair) is an anti-IgE, which prevents IgE from attaching to mast cells and prevents the release of chemical mediators. Salmeterol (Serevent) is a long-acting β2 -adrenergic agonist bronchodilator. Methylxanthine (theophylline) is used when other long-term bronchodilators are not available or affordable.

8. When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which statement by the patient shows the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath for 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom so I will be able to clean it when I need to."

8. d. Storing the dry powder inhaler (DPI) in the bathroom will expose it to moisture, which could cause clumping of the medication and an altered dose. The other statements show patient understanding.

9. Which statements by a patient with moderate asthma inform the nurse that the patient needs more teaching about medications (select all that apply)? a. "If I can't afford all of my medicines, I will only use the salmeterol (Serevent)." b. "I will stay inside if there is a high pollen count to prevent having an asthma attack." c. "I will rinse my mouth after using fluticasone (Flovent HFA) to prevent oral candidiasis." d. "I must have omalizumab (Xolair) injected every 2 to 4 weeks because inhalers don't help my asthma." e. "I can use my inhaler three times, every 20 minutes, before going to the hospital if my peak flow has not improved." f. "My gastroesophageal reflux disease (GERD) medications will help my asthma and my asthma medications will help my GERD."

9. a, f. Salmeterol (Serevent) should not be taken without inhaled corticosteroids. Asthma medications may make gastroesophageal reflux disease (GERD) symptoms worse and GERD medications may make asthma symptoms worse. The rest of the statements show patient understanding.

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).

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 B. Ipratropium bromide C.Salmeterol (Serevent) D.Beclomethasone (Qvar)

A. Albuterol 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 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-yr-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.

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 of 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. After 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.

A patient with severe, chronic COPD uses an inhaled LABA/glucocorticoid but continues to have frequent exacerbations of symptoms. The nurse will contact the provider to discuss: a. adding roflumilast [Daliresp] once daily. b. changing to oral theophylline twice daily. c. prescribing oral steroids once daily. d.Using an ipratropium/albuterol combination twice daily.

ANS: A For patients with chronic, severe COPD, the risk of exacerbations may be reduced with roflumilast. Theophylline is used only when other bronchodilators are not effective. Oral steroids are not indicated for this use. Ipratropium is used to treat bronchospasm in COPD.

A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient? a. A long-acting inhaled beta2 agonist b. An oral beta2 agonist c. A short-acting beta2 agonist d. An intravenous methylxanthine

ANS: A LABAs are preferred over SABAs for COPD. Oral beta2 agonists are not first-line therapy. Although theophylline, a methylxanthine, was once standard therapy in COPD, it is no longer recommended. It is used only if beta2 agonists are not available

A patient has just received a prescription for fluticasone/salmeterol [Advair Diskus]. What will the nurse include as part of the teaching for this patient about the use of this device? a. "You do not need good hand-lung coordination to use this device." b. "You will begin to inhale before activating the device." c. "You will need to use a spacer to help control the medication." d. "You will take 2 inhalations twice daily."

ANS: A The Advair Diskus is a dry powder inhaler and is activated by inhalation; therefore, hand-lung coordination is not required. There is no need for a spacer. Patients who use the Diskus take 1 inhalation twice daily.

3. A patient who uses an inhaled glucocorticoid for chronic asthma calls the nurse to report hoarseness. What will the nurse do? a. Ask whether the patient is rinsing the mouth after each dose. b. Request an order for an antifungal medication c. Suggest that the patient be tested for a bronchial infection. d. Tell the patient to discontinue use of the glucocorticoid.

ANS: A The most common side effects of inhaled glucocorticoids are oropharyngeal candidiasis and dysphonia. To minimize these, patients should be advised to gargle after each administration. Antifungal medications are used after a fungal infection has been diagnosed. Hoarseness is not a sign of a bronchial infection. There is no need to discontinue the glucocorticoid.

A patient who has been newly diagnosed with asthma is referred to an asthma clinic. The patient reports daily symptoms requiring short-acting beta2-agonist treatments for relief. The patient has used oral glucocorticoids three times in the past 3 months and reports awakening at night with symptoms about once a week. The patient's forced expiratory volume in 1 second (FEV1) is 75% of predicted values. The nurse will expect this patient to be started on which regimen? a. Daily low-dose inhaled glucocorticoid/LABA with a SABA as needed b. Daily low-dose inhaled glucocorticoid and a SABA as needed c. Daily medium-dose inhaled glucocorticoid/LABA combination d. No daily medications; just a SABA as needed

ANS: A This patient has moderate persistent asthma, which requires step 3 management for initial treatment. Step 3 includes daily inhalation of a low-dose glucocorticoid/LABA combination supplemented with a SABA as needed. A daily low-dose glucocorticoid with an as-needed SABA is used for step 2 management. A daily medium-dose glucocorticoid/LABA is used for step 4 management. Patients requiring step 1 management do not need daily medications.

Which drugs are used to treat COPD? (Select all that apply.) a. Anticholinergic medications b. Glucocorticoids c. Leukotriene modifiers d. Long-acting beta2 agonists e. Monoclonal antibodies

ANS: A, B, D Anticholinergic drugs, glucocorticoids, and LABAs are used to treat COPD. Leukotriene modifiers and monoclonal antibodies are used only to treat asthma.

What are the results of using glucocorticoid drugs to treat asthma? (Select all that apply.) a. Reduced bronchial hyperreactivity b. Reduced edema of the airway c. Reduced number of bronchial beta2 receptors d. Increased responsiveness to beta2-adrenergic agonists e.Increased synthesis of inflammatory mediators

ANS: A, B, D Glucocorticoids act by reducing bronchial hyperreactivity and airway edema and increasing airway responsiveness to beta2-adrenergic agonists. They do not reduce the number of beta2-adrenergic agonist receptors. They help reduce the synthesis of inflammatory mediators.

A nurse and a nursing student are reviewing the care of a 30-kg patient who will receive intravenous aminophylline. Which statement by the student indicates an understanding of the administration of this medication? a. "After the loading dose has been given, the patient will receive 6 mg/kg/hr." b."Dosing is titrated based on the serum theophylline l evels." c."If the patient's serum theophylline level is less than 15 mcg/mL, the rate should be reduced." d."The patient will receive a loading dose of 180 mg over 5 minutes."

ANS: B Dosing for aminophylline is based on each patient's serum theophylline levels. The loading dose usually is 6 mg/kg; after that, the maintenance infusion is titrated according to the theophylline levels. A serum theophylline level of 15 mcg/mL is within the therapeutic range, so dosing would not need to change. The patient's total loading dose will be 180 mg, but infusions should never be given at a rate faster than 25 mg/min.

A patient who takes oral theophylline [Theochron] twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss: a. changing to a different antibiotic. b. reducing the theophylline dose. c. giving theophylline once daily. d. switching from theophylline to a LABA.

ANS: B Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.

A young adult woman will begin using an inhaled glucocorticoid to treat asthma. The nurse will teach this patient about the importance of which action? a.Lowering her calcium intake and increasing her vitamin D intake b. Participating in weight-bearing exercises on a regular basis c.Taking oral glucocorticoids during times of acute stress d. Using two reliable forms of birth control to prevent pregnancy

ANS: B Like oral glucocorticoids, inhaled glucocorticoids can promote bone loss in premenopausal women. Patients should be encouraged to participate in weight-bearing exercises to help minimize this side effect. Patients should increase both their calcium and vitamin D intakes. Patients taking oral glucocorticoids need increased steroids in times of stress. It is not necessary to use two reliable forms of birth control.

A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug? a. Four puffs of albuterol, oxygen, and intravenous theophylline b. Intramuscular glucocorticoids and salmeterol by metered-dose inhaler c. Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen d.Intravenous theophylline, oxygen, and fluticasone (Flovent HFA) 220 mcg

ANS: C Patients using inhaled glucocorticoids should be given IV or oral glucocorticoids for acute exacerbations. During asthma flares, nebulized albuterol with ipratropium may be better tolerated and more effective. Oxygen is indicated, because oxygen saturations are low despite the increased work of breathing. Increasing the dose of albuterol and giving theophylline are not indicated. Salmeterol is a long-term beta agonist and is not useful in an acute attack.

A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a ."I should use the glucocorticoid as needed when symptoms flare." b ."I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."

ANS: D Inhaled glucocorticoids are used daily to prevent acute attacks. They are not used PRN. The beta2-adrenergic agonist drugs should not be used daily; they are used to treat symptoms as needed. They do not suppress mediators of inflammation.

A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2-agonist medication. What will the nurse tell this patient? a. LABAs are safer than short-acting beta2 agonists. b.LABAs can be used on an as-needed basis to treat symptoms. c. LABAs reduce the risk of asthma-related deaths. d. LABAs should be combined with an inhaled glucocorticoid.

ANS: D LABAs can increase the risk of asthma-related deaths when used improperly; this risk is minimized when LABAs are combined with an inhaled glucocorticoid. LABAs are not safer than SABAs, and they are not used PRN. LABAs increase the risk of asthma-related deaths.

A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates understanding of the teaching? a."Beta2-adrenergic agonists provide quick relief via any formulation." b. "Long-acting beta2 agonists may be used alone to prevent attacks." c. "Short-acting beta2 agonists are usually given by nebulizer." d. "Oral beta2 agonists are not useful for short-term treatment."

ANS: D Oral beta2 agonists are used only for long-term control. All formulations vary; long-acting beta2 agonists (LABAs) and oral preparations are used for long-term control, whereas short-acting beta2 agonists (SABAs) are useful for acute episodes. LABAs are used in conjunction with inhaled glucocorticoids to prevent attacks. SABAs may be given by MDI or nebulizer and usually are given by MDI.

Which medication should be used for asthma patients as part of step 1 management? a. Combination inhaled glucocorticoids/long-acting beta2 agonists b. Inhaled low-dose glucocorticoids c. Long-acting beta2 agonists d. Short-acting beta2 agonists

ANS: D Patients needing step 1 management have intermittent, mild symptoms and can be managed with a SABA as needed. Combination inhaled glucocorticoids/LABAs are used for step 3 management. Inhaled low-dose glucocorticoids are used for step 2 management. LABAs, along with inhaled glucocorticoids, are used for step 3 management.

A child is receiving a combination albuterol/ipratropium [DuoNeb] inhalation treatment. The patient complains of a dry mouth and sore throat. What will the nurse do? a. Contact the provider to report systemic anticholinergic side effects. b.Discontinue the aerosol treatment immediately. c. Notify the provider of a possible allergic reaction. d. Reassure the patient that these are expected side effects.

ANS: D The most common adverse effects of this combination drug are dry mouth and irritation of the pharynx. The patient should be reassured that these are common and minor effects. Systemic anticholinergic side effects are rare. It is not necessary to discontinue the medication. Patients with peanut allergy may have severe anaphylactic reactions, but the patient's symptoms are not those associated with anaphylaxis.

A patient with COPD is prescribed tiotropium [Spiriva]. After the initial dose, the patient reports only mild relief within 30 minutes. What will the nurse tell the patient? a. "You may have another dose in 4 hours." b. "You may need to take two inhalations instead of one." c. "You should have peak effects in about 6 hours." d."You should see improved effects within the next week."

ANS: D Tiotropium shows therapeutic effects in about 30 minutes, with improved bronchodilation occurring with subsequent doses, up to 8 days. The medication is given once daily, with inhalation of one capsule. Peak effects occur in 3 hours.

A patient with asthma comes to a clinic for treatment of an asthma exacerbation. The patient's medication history lists an inhaled glucocorticoid, montelukast [Singulair], and a SABA as needed via MDI. The nurse assesses the patient and notes a respiratory rate of 18 breaths per minute, a heart rate of 96 beats per minute, and an oxygen saturation of 95%. The nurse auscultates mild expiratory wheezes and equal breath sounds bilaterally. What will the nurse do? a. Contact the provider to request a systemic glucocorticoid. b.Contact the provider to suggest using a long-acting beta2 agonist. c. Evaluate the need for teaching about MDI use. d.Question the patient about how much albuterol has been used.

ANS: D To determine the next course of action, it is important to assess the drugs given before these symptoms were observed. Patients who continue to wheeze after using a SABA need systemic glucocorticoids and nebulized albuterol. If a SABA has not been used, that will be the first intervention. LABAs are not used for exacerbations. If a patient reports using a SABA without good results, evaluating the MDI technique may be warranted.

1. A patient with asthma will be using a metered-dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered 2 puffs to be given twice daily. It is important for the nurse to teach this patient that: a. the patient should inhale suddenly to receive the maximum dose. b. the patient should activate the device and then inhale. c. the patient should store the MDI in the refrigerator between doses. d. the patient should wait 1 minute between puffs.

ANS: D When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Sudden inhalation can cause bronchospasm. The patient should begin inhaling and then activate the device. There is no need to store the drug in the refrigerator.

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."

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 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. Hyperinflation of alveoli and destruction of alveolar walls In COPD, structural changes 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.

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.

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 nonprotein calories divided evenly between fat and carbohydrate. The other interventions will not increase the patient's caloric intake.

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 because 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).

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.

Question 5 of 40 A 68-yr-old patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care for this patient? A. Use the incentive spirometer for at least 10 breaths every 2 hours. B. Administer prescribed antibiotics and antitussives on a scheduled basis. C. Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. D. Provide nutritional supplements that are high in protein and carbohydrates.

C. 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 L 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 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.

During an assessment of a 45-yr-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.

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 â-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 nurse is caring for a 48-yr-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/min to 44 breaths/min. Which action by the nurse would be the most appropriate? A. Have the patient perform huff coughing. B.Perform chest physiotherapy for 5 minutes. C. Teach the patient to use pursed-lip breathing. D. Instruct the patient in diaphragmatic breathing.

C. 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.

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.

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.

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? A. Temperature of 98.4°F B.Oxygen saturation 96% C.Pulse rate of 72 beats/min D. Respiratory rate of 18/ breaths/min

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

A male patient with chronic obstructive pulmonary disease (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? CORRECT A. Arterial pH 7.26 B. PaCO2 50 mm Hg C. Patient in tripod position D. Increased sputum expectoration

CORRECT A. Arterial pH 7.26

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

CORRECT A. "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.

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

CORRECT 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.

The nurse teaches a 53-yr-old male patient with chronic obstructive pulmonary disease (COPD) how to administer fluticasone by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions? A. "I should not use a spacer device with this inhaler." B. "I will rinse my mouth each time after I use this inhaler." C. "I will feel my breathing improve over the next 2 to 3 days." D. "I should use this inhaler immediately if I have trouble breathing."

CORRECT B. "I will rinse my mouth each time after I use this inhaler." Fluticasone 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 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

CORRECT 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 a patient with asthma.

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone 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

CORRECT 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.

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with chronic obstructive pulmonary disease (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

CORRECT 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.

CORRECT 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.

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

CORRECT 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.

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? 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."

CORRECT 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 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? A. LPN/LVN obtained a pulse oximetry reading of 94% but did not report it. B. RN taught the patient about home oxygen safety in preparation for discharge. C. UAP report to the nurse that the patient is complaining of difficulty breathing. D. LPN/LVN changed the type of oxygen device based on arterial blood gas results.

CORRECT D. 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.

Question 6 of 40 Before discharge, the nurse discusses activity levels with a 61-yr-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.

CORRECT 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 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.

For long term maintenance of Asthma, what kind of medications are indicated?

Laba or lama for long term maintenance use

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 after the second puff of medication. D. Rinse the mouth with water after the second puff of medication.

D. Rinse the mouth with water after the second puff of medication. Because beclomethasone is a corticosteroid, the patient should rinse the mouth with water after the second puff of medication to reduce the risk of fungal overgrowth and oral infection.

During an Acute Exacerbation of Asthma, what route of steroid is indicated?

Oral or IV for systemic effect. Long term Steroids will be inhaled.

For acute exacerbation of asthma, what kind of inhalers are indicated?

Saba and SAMA

17. Which method of oxygen administration is the safest system to use for a patient with COPD? a. Venturi mask b. Nasal cannula c. Simple face mask d. Non-rebreathing mask

a. A Venturi mask is helpful to administer low, constant O2 concentrations to patients with COPD and can be set to administer a varied percentage of O2 . The amount of O2 inhaled via the nasal cannula depends on room air and the patient's breathing pattern. The simple face mask must have a tight seal and may generate heat under the mask. The non-rebreathing mask is more useful for short-term therapy with patients needing high O2 concentrations.

18. What is characteristic of a partial rebreathing mask? a. Used for long-term O2 therapy b. Reservoir bag conserves oxygen c. Provides highest oxygen concentrations d. Most comfortable and causes the least restriction on activities

b. The partial rebreathing mask has O2 flow into the reservoir bag and mask during inhalation. Agent Role or Relationship to Asthma Salicylates Associated with the asthma triad— people with nasal polyps, asthma, and sensitivity to salicylates and nonsteroidal antiinflammatory drugs (NSAIDs) α-Adrenergic blockers Contraindicated in patients with asthma because they prevent bronchodilation Beer and wine Contain sulfites that are common triggers of asthma. The O2 -conserving cannula is used for long-term therapy at home versus during hospitalization. The Venturi mask is able to deliver the highest concentrations of O2 . The nasal cannula is the most comfortable and mobile delivery device.