EAQ Asthma, COPD,
What is the purpose of dornase alfa, which is often prescribed for a patient with cystic fibrosis (CF)? To avoid bronchospasm To manage pancreatic insufficiency To degrade deoxyribonucleic acid in sputum To control recurrent episodes of pneumothorax
To degrade deoxyribonucleic acid in sputum Dornase alfa helps to degrade deoxyribonucleic acid in the sputum, thereby increasing the airflow and reducing the number of acute pulmonary exacerbations
Which position of the patient with hemoptysis may result in further complications while a nurse performs postural drainage? Supine position Side-lying position Trendelenburg position Dorsal recumbent position
Trendelenburg position the patient is in the supine position and his or her feet are raised 15 to 30 degrees higher than the head will increase the risk of blood flow to brain, which could lead to the patient having blood in the mucus
The nurse is discharging a patient with COPD who will be attending an outpatient pulmonary rehabilitation (PR) program. The nurse knows that components of this type of program generally include: (Select all that apply) a. Education b. Exercise training c. Smoking reduction d. Nutrition counseling e. On-site breathing treatments f. Attendance by at least one family member or significant other.
a. Education b. Exercise training d. Nutrition counseling Smoking cessation, not reduction, is needed. On-site breathing treatments are not offered. Family or significant other is not required
When teaching a patient about COPD rehabilitation, what strategy should the nurse teach the patient as essential to perform for energy conservation? a. Exercise training b. Complete inactivity c. Reducing food intake d. Reducing water intake
a. Exercise training leads to energy conservation & reduce dyspnea Complete inactivity may relieve acute symptoms, but not helpful in long term - need to improve muscle function Increased water & food intake essential to maintain energy & loosen secretions
The nurse is assessing a patient with asthma who has been diagnosed with a severe and life-threatening exacerbation. What findings would the nurse find? a. Increased CO2 level b. Speaking in short sentences c. Increased pH level on an arterial blood gas (ABG) d. Peak expiratory flow rate (PEFR) is 70% of the personal best
a. Increased CO2 level Early in exacerbation the CO2 level is decreased, but increases if exacerbation is prolonged or severe. Patient unable to speak in sentences & only speak a few words at a time. pH level on ABG decreases as episode is prolonged, but is increased early in exacerbation. PEFR is 40% of patient's personal best
While teaching a 45-year-old patient with asthma about the appropriate use of a peak flow meter, the nurse instructs the patient to notify the health care provider immediately if which situation occurs? a. Less than 50% of the patient's personal best is achieved. b. Peak flow measurements remain unchanged after exercise. c. Wheezing is improved moderately with the use of a bronchodilator. d. The short-acting bronchodilator is being used every 3-4 days.
a. Less than 50% of the patient's personal best is achieved. indicates medical emergency related to poor gas exchange and air flow. Wheezing should be improved with bronchodilator.
A nurse is caring for a patient with COPD postoperatively. After assessing the patient, the nurse finds that the patient has respiratory failure. Which classes of medications should the nurse question if ordered by the primary health care provider? (Select all that apply) a. Opioids b. Diuretics c. Sedatives d. Benzodiazepines e. Beta2 adrenergic blockers
a. Opioids c. Sedatives d. Benzodiazepines suppress ventilator drive & increase risk of respiratory failure Diuretics = reduce risk of cardiac failure & may experience fluid imbalance Beta2 adrenergic blockers reduce exacerbations of COPD & improve survival
Pulmonary rehabilitation (PR) is an evidence-based intervention that includes many disciplines working together to individualize treatment of the symptomatic COPD patient. What is PR designed to do? (Select all that apply) a. Reduce symptoms b. Improve quality of life c. Reduce effort by teaching to inhale when pushing d. Enhance rest by teaching to exhale with relaxation e. Provide a "last ditch" effort for patients with COPD
a. Reduce symptoms b. Improve quality of life PR improve exercise capacity & decrease hospitalizations, anxiety, & depression Energy-saving tip is exhale when pushing, pulling, or exerting effort during activity & inhale during rest
The nurse is teaching a patient how to use a hand-help nebulizer. Which guideline is correct? a. Sit in an upright position during the treatment b. Take short, shallow breaths while inhaling the medication c. Rinse the nebulizer equipment under running water once a week d. During the treatment, breath in & hold the breath for five seconds.
a. Sit in an upright position during the treatment allows for most efficient breathing to ensure adequate penetration & deposition of aerosolized medication. Breath slowly & deeply through mouth & hold inspirations for 2-3 seconds. Breath normally in between these large forced breaths to prevent alveolar hypoventilation & dizziness. After treatment, instruct patient to cough effectively. Wash nebulizer equipment daily in soap & water, rinse with water & soak for 20-30 min in 1:1 white vinegar-water solution, followed by water rinse & air drying
The patient is receiving 3 L of oxygen (O 2) via nasal cannula. Which action by the nurse is most appropriate? Assesses eyes for dryness Realizes that humidification is never needed Adjusts humidification according to patient comfort Assesses the bubble-through humidifier if humidity is used Assures that the patient is wearing the nasal cannula correctly
Adjusts humidification according to patient comfort Assesses the bubble-through humidifier if humidity is used Assures that the patient is wearing the nasal cannula correctly because oxygen (O 2) obtained from cylinders or wall systems is dry. Dry O 2 has an irritating effect on mucous membranes and dries secretions. A common device used for humidification when the patient has a cannula or a mask is a bubble-through humidifier. It is important for the nurse to assess the bubble-through humidifier if humidity is used to make sure the humidification is on. This adds to the comfort of the patient. The nurse assesses the patient to make sure the nasal cannula is worn correctly for optimal effect. The cannula can become easily dislodged. Humidification is adjusted according to the patient's comfort level. When oxygen levels are 1 to 4 L, the use of humidification may not be the preference of all patients
Which nursing intervention will the nurse include in the teaching plan for a patient with difficulty in breathing due to low oxygen level in the blood? Suggest that the patient breathe slowly with an open mouth. Advise the patient to refrain from sexual activity after eating. Ask the patient to plan sexual activity during the late afternoon. Suggest that the patient choose the missionary position during intercourse.
Advise the patient to refrain from sexual activity after eating. For males, erectile dysfunction can occur with COPD, as with many chronic diseases. The nurse may suggest that the patient refrain from sexual activity after eating to prevent breathlessness during intercourse. The patient should use pursed lips to breathe slowly. It is better to plan sexual activity during the day, when the patient's breathing is best. The patient should choose a less stressful position during intercourse and avoid the missionary position.
The nurse is caring for the patient with chronic obstructive pulmonary disease (COPD). The nurse will include in the patient plan of care: Teach the patient to discontinue oxygen while eating Advise the patient to rest at least 30 minutes before eating Tell the patient to avoid taking bronchodilators before meals Encourage the patient to perform mild exercises 60 minutes before eating
Advise the patient to rest at least 30 minutes before eating to decrease dyspnea and conserve energy okay for the patient to use a bronchodilator before meals if prescribed, because it will decrease dyspnea and conserve energy use of supplemental O 2 by nasal cannula while eating may be beneficial
A patient with Pseudomonas aeruginosa infection experiences thick and sticky mucus and nasal polyps. The nurse recognizes that which treatment regimen will help reduce the symptoms of infection and enhance lung function? Inhaled hypertonic saline (7%) daily Azithromycin for three subsequent months Aerosolized tobramycin daily, twice a day, every other month Two- to four-week course of intravenous antimicrobial therapy
Aerosolized tobramycin daily, twice a day, every other month has cystic fibrosis Aerosolized tobramycin every other month, daily, twice a day helps to reduce infection, decreases exacerbations, and improves lung function
The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? Clear lung sounds Heart rate 80 beats/minute Capillary refill less than three seconds Positive bowel sounds in all quadrants
Clear lung sounds Ipratropium is an inhaled anticholinergic used for asthma management. Clear lung sounds would indicate full passage of air and well-controlled symptom management
What are late complications of cystic fibrosis (CF) caused by pulmonary hypertension? (Select all that apply) Pneumonia Cor pulmonale Pneumothorax Respiratory failure Massive hemoptysis
Cor pulmonale Respiratory failure Cor pulmonale, or right-sided heart failure, occurs due to the increased pressure in the lungs. Respiratory failure occurs due to the accumulation of effects of lung damage
What is an autosomal recessive, multisystem disease characterized by altered function of the exocrine glands? Sickle-cell disease Tay-Sachs disease Cystic fibrosis (CF) Spinal muscular atrophy
Cystic fibrosis (CF)
The nurse would monitor which comorbidity in the patient treated for an asthma exacerbation with methylprednisolone? Hyperlipidemia Hypothyroidism Diabetes mellitus Raynaud's phenomenon
Diabetes mellitus Hyperglycemia is adverse effect of methylprednisolone
A patient is hospitalized with a cough, weight loss, increased sputum, and decreased pulmonary function. The patient reports pain in the lower right quadrant, nausea, and emesis. The nurse suspects that the patient is experiencing what condition? Gallstones Pancreatitis Liver cirrhosis Distal intestinal obstructive syndrome
Distal intestinal obstructive syndrome having a cystic fibrosis (CF) exacerbation. The patient with CF exacerbation and distal intestinal obstructive syndrome (DIOS) experiences pain in the right lower quadrant, the area of the ileocecal valve; loss of appetite; nausea; and emesis
Which assessment finding does the nurse expect when caring for a patient with asthma? pH of 5.11 PaCO 2 of 30 mm Hg Blood pressure of 110/60 mm Hg Respiratory rate of 25 breaths/minute
PaCO 2 of 30 mm Hg signs of hypoxemia and hyperventilation due to air flow limitation, indicated by a low level of partial pressure of carbon dioxide in blood (PaCO 2), such as 30 mmHg This condition leads to a rise in pH leading to respiratory alkalosis; however, a pH of 5.11 is low. The respiratory rate of the asthmatic patient increases to more than 30 breaths/minute due to the use of accessory muscles. The patient with anxiety due to breathlessness has an increase in pulse and blood pressure.
A nurse is caring for a patient diagnosed with chronic obstructive pulmonary disease (COPD). The lab reports of the patient reveal a hemoglobin level of 20 g/dL. What could be the reason for the increased hemoglobin? The patient no longer has COPD. The patient consumes iron-rich food. The heart is functioning well in response to COPD treatments. The production of red blood cells increases in response to hypoxia.
The production of red blood cells increases in response to hypoxia. In COPD, there is chronic hypoxia. To compensate for it, the production of RBC increases, leading to polycythemia or increased hemoglobin levels
The health care provider has prescribed an inhaled corticosteroid for the patient with asthma. The nurse should provide which instructions to the patient regarding the use of a dry powder inhaler (DPI)? "Shake the canister vigorously before use." "Keep your inhaler in a warm, humid room to prevent crystallization." "Keep your mouth open slightly to increase dispersion of the medication." "Hold your breath for at least 10 seconds to increase medication absorption by your lungs."
"Hold your breath for at least 10 seconds to increase medication absorption by your lungs."
The registered nurse is teaching a student nurse about care management in a patient with oxygen saturation less than 90 percent, dyspnea, breathlessness, and forced expiratory volume in one second (FEV 1) less than 60 percent. Which statement made by the student nurse indicates effective learning? "I should advise the patient to eat more cabbage, beans, and cauliflower." "I should advise the patient to avoid smoking and occupational exposure to irritants." "I should advise the patient to breathe rapidly while performing effective Huff coughing." "I should advise the patient to avoid high-calorie foods like butter, cheese, and margarine."
"I should advise the patient to avoid smoking and occupational exposure to irritants." has COPD stop smoking = only way to slow progression of COPD Avoid gas-forming foods like cabbage, beans, & cauliflower Breath slowly while performing effective Huff coughing eat more high-calorie food, divided into 6 small meals/day
The nurse provides education to a caregiver of a patient with bloody sputum, dyspnea, fever, chills, and chest pain. Which statement made by the caregiver indicates effective learning? "I should give the patient fluids high in sodium." "I should ask the patient to drink three liters of water daily." "I should place the patient in a supine position when bloody sputum occurs." "I should refrain from providing oral hygiene to the patient to prevent bleeding in the mouth."
"I should ask the patient to drink three liters of water daily." focus of the care is to promote drainage and removal of mucus in the airway. The patient must hydrate by drinking three liters of water per day. This helps to liquefy the secretions and thereby make it easier to remove them
A patient with asthma is prescribed formoterol. What should the nurse include in the medication education provided to the patient? "Take the medication once every 24 hours." "Side effects include cold or flu-like symptoms." "Formoterol is the best medication to take to obtain quick relief from bronchospasms." "Formoterol is not the only medication that you will need to treat your asthma." "If wheezing gets worse, there are other types of medications that are more beneficial than formoterol."
"Side effects include cold or flu-like symptoms." "Formoterol is not the only medication that you will need to treat your asthma." "If wheezing gets worse, there are other types of medications that are more beneficial than formoterol." Formoterol is a long-acting β 2-adrenergic agonist (LABA) and is effective in treating symptoms of asthma that persist at night. Formoterol is not helpful to treat wheezing that gets worse
The nurse is caring for a child who is suspected of having cystic fibrosis (CF). The nurse knows that the gold standard of diagnosing this condition is: Genetic test Lung biopsy The sweat chloride test Test for pancreatic insufficiency
The sweat chloride test most definitive test in children, but may not be conclusive in adults. Patients with CF secrete four times the normal amounts of sodium and chloride in their sweat. Genetic tests may be used if the sweat test is inconclusive
A patient with a forced expiratory volume of 80 percent and a three-day history of breathlessness develops nausea, vomiting, headache, tachycardia, and dysrhythmias. The nurse suspects that which medication that the patient takes is the cause of the patient's symptoms? Albuterol Omalizumab Mometasone Theophylline
Theophylline Theophylline is a methylxanthine bronchodilator with narrow therapeutic use
The nurse recognizes that which intervention will be beneficial to the patient with pleuritic chest pain, dyspnea, wheezing, and mouth bleeding? a. To loosen dried sputum crusts, administer dietary liquids before providing mouth care. b. To prevent infection, encourage the patient to receive the pneumococcal and influenza vaccinations. c. When the mouth is bleeding, raise the head of the bed and place the patient in the supine position. d. To avoid patient overexertion, refrain from hydrating the respiratory system with hypertonic saline.
b. To prevent infection, encourage the patient to receive the pneumococcal and influenza vaccinations. may have bronchiectasis with hemoptysis = difficult to treat Aim to treat acute flare-ups & should try to prevent a decline in lung function. Allow patient to consume dietary liquids after clearing the mouth of dried sputum crusts = increase appetite Raise head of bed & place patient in side-lying position to allow expectoration & prevent aspiration. Hydrating respiratory system with hypertonic saline improves expectoration of secretions & is likely beneficial
A patient with chronic obstructive pulmonary disease (COPD) has severe dyspnea. The nurse is educating the patient about necessary interventions to conserve energy and avoid further complications. Which statement made by the patient indicates the need for further teaching? a. "I should eat three low-calorie, high fat meals a day." b. "I should rest for half an hour before eating." c. "I should perform deep breathing and effective coughing before meals." d. "I should take supplemental oxygen through a nasal cannula while eating."
c. "I should perform deep breathing and effective coughing before meals." strenuous activity for patient with dyspnea & would cause patient to have difficulty eating Should try consuming several high-calorie small meals a day to conserve energy & increase caloric intake to maintain healthy weight. Conserve energy to chew & swallow if rest for 1/2 hour before meals Pt. on supplemental oxygen should take oxygen through nasal cannula while eating - prevents episode of dyspnea during meals.
A patient who has been taking low-dose inhaled corticosteroids along with long-acting Beta2 agonists for three months is assessed for control of asthma. The patient's laboratory reports reveal inadequate control of asthma. Which treatment does the nurse expect to be prescribed? a. Leukotriene receptor antagonist b. Short-acting Beta2 agonist as needed c. Medium dose inhaled corticosteroids and long-acting Beta2 agonist d. High-dose inhaled corticosteroids, long-acting Beta2 agonist, and oral corticosteroids
c. Medium dose inhaled corticosteroids and long-acting Beta2 agonist Low dose inhaled corticosteroids + long-acting Beta2 agonists = Step 3 care to control exacerbations Patient needs Step 4 to control symptoms = includes medium dose inhaled corticosteroids + long-acting Beta2 agonist Short-acting Beta2 agonists used for intermittent asthma Leukotriene receptor antagonists = Step 2 High dose inhaled corticosteroids + long-acting Beta2 agonists + oral corticosteroids = Step 6 = severe & life threatening asthma exacerbations that did not respond to dual therapy
A patient receives a prescription for amalizumab. What medication route of administration and schedule will the nurse include in the information provided to the patient? a. IV, every 4-6 hr b. 2-4 puffs, every 20-30 min c. Subcu, every 2-4 weeks d. Orally, 1 hr before meals or 2 hr after meals
c. Subcu, every 2-4 weeks monoclonal antibody that decreases circulating free IgE levels
The nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) 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? "Avoid shaking the inhaler before use." "Breathe out slowly before positioning the inhaler." "Using a spacer should be avoided for this type of medication." "After taking a puff, hold the breath for 30 seconds before exhaling."
"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
Which instruction does the nurse document in the diet plan for the patient with chronic obstructive pulmonary disease (COPD)? "Eat egg custard every day." "Include cabbage in your diet." "Include cauliflower in your diet." "Eat hot tomato soup as much as possible."
"Eat egg custard every day." Egg custard is a cold dessert containing egg, which soothes inflammation and provides high calories to the patient. Cabbage and cauliflower produce gas; they should be avoided in the patient's diet. Hot food may increase inflammation. So hot tomato soup should not be eaten
The nurse teaches a patient regarding the administration of fluticasone through an inhaler. Which statements made by the patient indicate effective learning? (Select all that apply) "I have to shake the medicine bottle before use." "I should keep my medicine away from humid places." "I should engage the lever while loading the medicine." "I should hold my breath for 20 to 30 seconds after a puff." "I have to raise my head forward and breathe into my inhaler."
"I should keep my medicine away from humid places." "I should engage the lever while loading the medicine." avoid clumping of the medication engage the lever to allow the medication to become available hold the breath for 10 seconds or as long as possible to disperse the medicine into the lungs tilt the head back and breathe out to get maximum air out of lungs, and then inhale the medication
A patient has frequent attacks of difficulty breathing and wheezing. The nurse is teaching the caregiver about the proper way of positioning the patient to decrease the sense of panic during an attack. Which statement of the caregiver indicates the need for further teaching? "I should make the patient lay in a side-lying position." "I should ask the patient to perform abdominal breathing." "I should ask the patient to purse the lips while breathing." "I should make sure that the patient's environment is calm."
"I should make the patient lay in a side-lying position." Unlike a sitting position, a side-lying position does not provide for maximum chest expansion. Abdominal breathing will reduce the respiratory rate as deep breathing increases, which reduces the asthma attack. Pursed-lip breathing will help keep the airways open, which reduces the effect of asthma. A calm environment also helps reduce asthma attack.
The nurse is teaching a patient pursed-lip breathing (PLB). What instructions by the nurse are correct? "Inhale slowly and deeply through your mouth." "During exhalation, relax your facial muscles and puff out your cheeks." "Only use this action after any activity that causes you to be short of breath." "Make breathing out (exhalation) three times longer than breathing in (inhalation)."
"Make breathing out (exhalation) three times longer than breathing in (inhalation)." Inhale slowly & deeply through nose first PLB used before, during, & after any activity that causes SOB While exhaling, facial muscles need to be relaxed without puffing out cheeks
The nurse reviews pursed-lip breathing with a 61-year-old patient with emphysema. Which statement made by the patient indicates correct understanding of this technique? "I should purse my lips while I inhale." "I will puff out my cheeks while exhaling." "My exhalation should be longer than my inhalation." "Lying flat will increase effectiveness of this technique."
"My exhalation should be longer than my inhalation."
The nurse teaches a group of nursing students about lung volume parameter in patients with asthma. Which statement made by a student nurse indicates the need for further teaching? "With asthma, there is increased residual volume." "With asthma, there is increased total lung capacity." "With asthma, there is increased forced expiratory volume in one second." "With asthma, there is a normal forced expiratory volume to forced vital capacity ratio."
"With asthma, there is increased forced expiratory volume in one second." Lung volumes help to determine the reversibility of bronchoconstriction and establish the diagnosis of asthma. The forced expiratory volume in one second decreases in the patient with asthma. The total lung capacity in a patient with asthma increases due to increase in breathing. Therefore the total residual volume increases. The ratio of forced expiratory volume to forced vital capacity is usually normal or decreased in the patient with asthma
The patient with asthma asks the nurse, "How will I know when my inhaler is empty?" What is the best response by the nurse? "The canister will float in water." "There will be no sound when shaking the canister." "Your wheezing will not improve despite inhaler use." "You need to keep track of how many puffs you have used and how many puffs are available."
"You need to keep track of how many puffs you have used and how many puffs are available." document each time a puff is used water can enter the chamber
The patient has a prescription for albuterol 3 mg by nebulizer. Available is a solution containing 24mg/mL. How many mL should the nurse administer? 0.125 mL 0.15 mL 0.6 mL 0.75 mL
0.125 mL
The nurse is overseeing an exercise program for patients with mild chronic obstructive pulmonary disease (COPD). Part of the program involves walking. Vital signs are taken after walking. The nurse becomes concerned when a 60-year-old patient's pulse rate is what? 90 beats/minute 100 beats/minute 110 beats/minute 120 beats/minute
120 beats/min Pulse rate after walking should not exceed 75% to 80% of the maximum heart rate (maximum heart rate is age in years subtracted from 220). 220 - age (60) = 160 (maximum heart rate). 120 is 75% of the patient's maximum heart rate.
The nurse gathers data related to individual patients' forced expiratory volume in one-second values. The nurse suspects that which patient has intermittent asthma? A 90 B 80 C 70 D 50
A 90 Patient A with normal forced expiratory volume in one second between exacerbations is suspected to have intermittent asthma. Forced expiratory volume in one second above 80 is normal. If the forced expiratory volume in one second is more than or equal to 80, it indicates that patient B has mild asthma. If the forced expiratory volume in one second is less than 80, it indicates that patient C has moderate asthma. If the forced expiratory volume in one second is less than 60, it indicates that patient D has severe asthma.
Which test result identifies that a patient with asthma is responding to treatment? An increase in CO 2 levels A decrease in exhaled nitric oxide A decrease in white blood cell count An increase in serum bicarbonate levels
A decrease in exhaled nitric oxide Nitric oxide levels are increased in breath of people with asthma. Decrease in exhaled nitric oxide concentration suggests treatment may be decreasing lung inflammation.
A patient experiences intermittent obstruction of the terminal ileum, thickened and dehydrated stools, increased mucus production, a temperature of 99.8° F, and profuse perspiration due to hot weather conditions. The nurse should make what dietary recommendation? Increase protein intake. Add caloric supplements. Add foods rich in dietary salt. Increase fat-soluble, vitamin-rich foods.
Add foods rich in dietary salt. The patient must be supplied with dietary salt to avoid an excess of chloride loss
The licensed practical nurse is caring for a chronic obstructive pulmonary disease (COPD) patient who has severe hypoxemia. The primary health care provider prescribed oxygen administration for this patient. Which intervention can the nurse perform for the patient? Teach about home oxygen use. Provide a high amount of oxygen. Provide a continuous supply of oxygen. Adjust the oxygen flow rate depending on the desired oxygen level
Adjust the oxygen flow rate depending on the desired oxygen level
The nurse is caring for a patient who is being mechanically ventilated that has a PaCO 2 of 60 mm Hg, a respiratory pH of 6.8, and a PaO 2 of 60 mm Hg. Which intervention will benefit the patient? Administering albuterol Performing a bronchoscopy Providing chest physiotherapy Administering sodium bicarbonate
Administering sodium bicarbonate has severe respiratory acidosis. Therefore such a patient must take sodium bicarbonate to treat extreme acidosis
A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates that which drug will be prescribed? A sedative A mucolytic An antibiotic Epinephrine
An antibiotic may have bacterial infection
A patient presents to the emergency department with acute exacerbation of asthma. What actions should the nurse perform to monitor the patient's respiratory and cardiovascular systems? Take a chest radiograph. Auscultate the lung sounds. Check the patient's temperature. Measure blood pressure and respiratory rate. Monitor arterial blood gases (ABGs) and pulse oximetry.
Auscultate the lung sounds. Measure blood pressure and respiratory rate. Monitor arterial blood gases (ABGs) and pulse oximetry.
What is the most common sign during an initial assessment that alerts the nurse that the patient has chronic obstructive pulmonary disease? Barrel chest Sunken chest Hyperventilation Circumoral cyanosis
Barrel chest
A patient with an acute attack of asthma is in a state of panic. Which nursing measures help to relieve the panic? Use sedation. Be calm, quiet, and reassuring. Encourage pursed-lip breathing. Utilize a "walking down" technique. Utilize the "talking down" technique.
Be calm, quiet, and reassuring. Encourage pursed-lip breathing. Utilize the "talking down" technique. Pursed-lip breathing keeps the airways open, slows down the respiratory rate, and encourages deep breathing. "Talking down" is a technique that helps to calm the patient. A calm, quiet, and reassuring nurse helps to pacify the patient
The nurse recognizes that which treatment may provide relief to a patient with asthma that has a PaO 2 of 60 mm Hg and dyspnea? Aromatherapy Chest physiotherapy Bronchial thermoplasty 30 minutes of daily exercise
Bronchial thermoplasty Bronchial thermoplasty uses a catheter and fiberoptic bronchoscope, which applies heat and reduces muscle mass in the bronchial wall reverses accumulation of excessive tissue that narrows the airway.
During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse determines that these symptoms are related to which pathophysiologic feature of the disease? Laryngeal stridor Alveolar collapse Mucous production Bronchoconstriction
Bronchoconstriction Narrowing (constriction) of the airway leads to reduced airflow, making it difficult for the patient to breathe and producing the characteristic wheezing
The nurse is preparing a patient for a procedure with the thoracoscope to reduce the exacerbations of chronic obstructive pulmonary disease (COPD). What procedure should the nurse be sure the patient understands? Bullectomy Airway bypass Lung transplantation Lung volume reduction surgery
Bullectomy is a surgical procedure to reduce the exacerbations of COPD. The patient with COPD may have large bullae, which are resected through a thoracoscope Not use thoracoscope: Airway bypass is a bronchoscopic procedure that helps to treat COPD by creating extra anatomic openings between the diseased lung and bronchi
A nurse is assessing four patients on oxygen therapy. Which patient requires a device change? A on short-term oxygen therapy w/ an oxygen concentration of 70% at 12L/min; on Partial & non-rebreather masks B being transported to hospital setting from accident site & is provided with O2 of 40% at 6L/min; on simple face mask C has COPD & requires 24% O2 at 1L/min; on Oxygen-conserving cannula D underwent a surgery of the windpipe; on tracheostomy collar
C has COPD & requires 24% O2 at 1L/min; on Oxygen-conserving cannula indicates a very low concentration = a nasal cannula would be more appropriate for the patient
The nurse is educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes despite the diagnosis. What complication of smoking should the nurse discuss with the patient? Cachexia Osteoporosis Metabolic syndrome Cardiovascular disease
Cardiovascular disease Chronic smokers develop COPD and are more prone to cardiac complications, because smoking directly affects the function of the lungs and heart
A patient experiences chronic sinusitis. The nurse recognizes that which treatment strategy may help relieve the patient's symptoms caused by impaired ciliary movement in the airway? Dornase alfa Chest wall oscillation β 2-adrenergic agonists Huff's coughing method
Chest wall oscillation Sinusitis is a painful inflammation of the sinuses due to mucus plugging the nasal passages. A patient with sinusitis has impaired ciliary movement due to airway obstruction by the mucus. An airway clearance technique through postural drainage by percussion and vibration or frequent chest wall oscillation helps to relieve symptoms of sinusitis.
Which corticosteroid can be administered directly through inhalation? Fluticasone Ciclesonide Budesonide Mometasone
Ciclesonide reduced local side effects like oropharyngeal candidiasis, hoarseness, and dry cough because it activates the lungs and is administered directly through inhalation Drugs such as fluticasone, budesonide, and mometasone cause local irritation as they are activated in the pharynx. Therefore these medications require a spacer for delivery into the lungs.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has increased B-type natriuretic peptide (BNP) levels. What treatment option does the nurse anticipate administering to this patient? Diuretics Albuterol Roflumilast Long-acting beta agonists
Diuretics indicates the presence of cor pulmonale, or failure in the right side of heart. Diuretics will help to reduce a cardiac anomaly like cor pulmonale
The nurse is caring for a patient with an oxygen saturation of 45 percent of personal best who stops breathing while sleeping and has a tendency to sleep during the day. Which intervention by the nurse will help the patient most while recovering? Advise the patient to walk for 30 minutes. Encourage the patient to drink more fluids at mealtime. Encourage the patient to use typed messages to communicate. Ask the patient to speak continuously in sentences by taking deep breaths
Encourage the patient to use typed messages to communicate. severe breathlessness and hypoxemia may need immediate medical attention and regular follow-up avoid exercise or walking during the attack because severe dyspnea may lead to respiratory failure
A patient with asthma experiences anaphylaxis. Which medication should the nurse prepare to administer? Timolol Epinephrine Magnesium sulfate Sodium bicarbonate
Epinephrine helps to resolve anaphylactic reactions in the patient with asthma. Administer epinephrine either subcutaneously or intramuscularly to treat the patient. The nurse should monitor the blood pressure and electrocardiogram of the patient closely after administration of the drug
A patient experiences pleuritic chest pain, dyspnea, wheezing, clubbing of digits, weight loss, and blood streaked sputum. The nurse anticipates that which test will be prescribed? Tissue biopsy Buccal smear test Pilocarpine iontophoresis High-resolution computer tomography
High-resolution computer tomography patient with bronchiectasis experiences pleuritic chest pain, dyspnea, wheezing and clubbing of digits. Hemoptysis may develop related to weight loss and blood streaked sputum. High-resolution computer tomography is the preferred method for diagnosis of bronchiectasis
The patient with COPD has a prescription for ibuprofen 600 mg. The nurse questions the prescription, knowing that ibuprofen interacts with which concurrent medication? Sertraline Ipratropium Azithromycin Hydrocortisone
Hydrocortisone use of these medications together increases the risk of gastrointestinal bleeding
A 71-year-old patient with chronic obstructive pulmonary disorder (COPD) has a 40-pack a year history of cigarette smoking. The nurse recognizes that history of smoking most likely has decreased the patient's underlying respiratory defenses related to what? Hyperplasia of cells Impaired cough reflex Reversible airway inflammation Decreased perfusion of air pollutants
Hyperplasia of cells Over time, cells become hyperplastic, leading to symptoms of COPD. Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions, chronic cough, and frequent respiratory infections
A patient who is a chronic smoker is diagnosed with chronic obstructive pulmonary disease (COPD). What causes the loss of elastic recoil in the patient's lungs and the destruction of alveoli? Secretion of leukotrienes and cytokines Secretion of neutrophils and lymphocytes Inhalation of noxious particles into the lungs Imbalance of protease and antiprotease ratio
Imbalance of protease and antiprotease ratio will result in the destruction of alveoli and the loss of elastic recoil in the lungs
What is a priority nursing assessment for a 38-year-old patient experiencing an acute asthma exacerbation? Pupillary response to light Inspection of the chest wall Measurement of pedal pulses Percussion for costovertebral angle (CVA) tenderness
Inspection of the chest wall nurse physically inspects the chest wall to evaluate the use of intercostal muscles, which gives an indication of the degree of respiratory distress experienced by the patient
A child with a nonproductive cough states, "I am having trouble breathing." What action should the nurse take to reduce the severity of breathlessness in the child? Assist the child to lie in supine position Instruct the child to bend forward slightly Suggest that the child walk for 30 minutes Instruct the child to take short, quick breaths
Instruct the child to bend forward slightly Cough may be the only symptom in patients with cough-variant asthma. The nurse should instruct the child with asthma to sit upright or slightly bent forward, because these positions would help the child to use accessory muscles for respiration
After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness and dry cough. What action should the nurse take to reduce the symptoms? Recommend that the patient pauses between the puffs Instruct the patient to rinse the mouth with water after inhalation Assist the patient in obtaining a spacer or holding device for inhalation Wait until the cough subsides before administering the patient's next dose
Instruct the patient to rinse the mouth with water after inhalation mometasone may cause local irritation such as oropharyngeal candidiasis, hoarseness, and dry cough. Hence the patient should rinse the mouth either with water or with mouthwash after inhalation. The patient may not be benefit by pausing between the puffs
Assessment findings of a patient with cystic fibrosis (CF) include a PaO 2 of 50 mm Hg, arteriolar vasoconstriction, and cor pulmonale. What does the nurse expect to find on the patient's home care treatment plan? Azithromycin for six months Tobramycin twice daily every other month Intravenous antimicrobial therapy for two to three weeks Intravenous cephalosporin and aminoglycoside therapy
Intravenous cephalosporin and aminoglycoside therapy patient may be administered intravenous antibiotics at home. The regimen should contain two antibiotics with different mechanisms of action
The nurse is evaluating if a patient understands how to determine safely 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? Place it in water to see if it floats. Keep track of the number of inhalations used. Shake the canister while holding it next to the ear. Check the indicator line on the side of the canister
Keep track of the number of inhalations used.
What complication does the nurse expect in a child with chronic pulmonary disease who is diagnosed with α 1-antitrypsin (AAT) deficiency? Liver disease Renal disease Intestinal dysfunction Urinary tract dysfunction
Liver disease AAT deficiency is an autosomal recessive disorder associated with mutations in the SERPINA1 gene, S and Z alleles. These mutations result in abnormalities of the lungs and liver
An asthmatic patient was prescribed theophylline. A nurse understands that the patient is at risk for tachycardia and seizures. In regard to safety, the nurse expects that what will be included on the patient's treatment plan? Encourage the use of caffeine. Use diazepam to prevent seizures. Monitor serum blood levels of adrenaline. Monitor serum blood levels of theophylline.
Monitor serum blood levels of theophylline. Tachycardia and seizures are known toxic effects of theophylline at higher blood levels. In addition, the drug has a narrow margin of safety. Therefore monitoring blood levels of theophylline helps to reduce such toxic effects
The nurse is caring for a patient with cystic fibrosis (CF). What is the most important factor for the nurse to consider when using clearance techniques and devices? No single technique has shown superiority over the others. Acapella devices have better results than other techniques. Pursed-lip breathing is critical for the success of any technique. Positive expiratory pressure (PEP) devices are the method of choice as a clearing technique.
No single technique has shown superiority over the others. irway clearance techniques are critical, because the normal ciliary motion in CF airways is impaired. Chest physical therapy (CPT) (including postural drainage with percussion and vibration) and high-frequency chest wall oscillation loosen mucus. Clearance is achieved by the specialized expiratory techniques aimed at using airflow to remove the loosened secretions. Examples of clearance techniques and devices are PEP devices (e.g., flutter device), acapella, breathing exercises (autogenic drainage), pursed-lip breathing, and huff coughing. Individuals with CF may prefer a certain technique or device that works well for them in a daily routine. No clear evidence exists that any of the airway clearance techniques are superior to the others
When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion? Fat-soluble vitamins and dietary salt should be avoided. Insulin may be needed with a diabetic diet if diabetes mellitus develops. Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. Distal intestinal obstruction syndrome (DIOS) can be treated with increased water
Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. fat-soluble vitamins are malabsorbed with excess mucus in GI system
Which finding helped the nurse reach the conclusion that a patient with chronic obstructive pulmonary disease (COPD) requires oxygen therapy? Hemoglobin levels of 13.6 g/dL Red blood cell count 5 million cells/microliter Partial pressure of oxygen (PaO 2) 52 mm Hg Saturation of hemoglobin (SaO 2) 90% at rest
Partial pressure of oxygen (PaO 2) 52 mm Hg A patient with a PaO 2 less than 55 mm Hg requires oxygen therapy normal level of hemoglobin is 13.5 to 17.5 grams per dL saturation of hemoglobin less than 88% requires oxygen therapy. A normal red blood cell count is 4.7 to 6.1 million cells/microliter
The nurse checks for which abnormal physical assessment findings consistent with cor pulmonale? (Select all that apply) Crackles Wheezing Pedal edema Hepatomegaly Jugular vein distention
Pedal edema Hepatomegaly Jugular vein distention Cor pulmonale = RHF caused by resistance to RV outflow cuased by lung disease
Which complications in a patient with chronic obstructive pulmonary disorder (COPD) require acute intervention? Atelectasis Pneumonia Cor pulmonale Mucoid impact Exacerbations
Pneumonia Cor pulmonale Exacerbations
A patient reports severe abdominal pain, and the laboratory report indicates accumulation of mucus and high levels of liver enzymes. Which condition may develop if the patient is left untreated? Steatorrhea Diabetes mellitus Diabetes insipidus Portal hypertension
Portal hypertension Accumulation of mucus in the liver and a high level of liver enzymes indicate that the patient has cystic fibrosis of the liver. Cystic fibrosis leads to gastrointestinal problems that cause severe abdominal pain. If the patient is left untreated, he or she may develop gallstones, pancreatitis, and portal hypertension
The nurse teaches pursed-lip breathing to a patient with emphysema. The nurse explains that the primary reason for this technique is what? Conserving energy Relieving chest pain Promoting oxygen saturation Promoting carbon dioxide elimination
Promoting carbon dioxide elimination Pursed-lip breathing promotes elimination of carbon dioxide by increasing positive pressure within the alveoli and making it easier to expel air from the lungs. This procedure also helps the patient slow the breathing and increase the depth of respirations.
A nurse has taught the technique of pursed-lip breathing to a patient. During a return demonstration, what patient action requires correction? Puffing of cheeks while exhaling air Slow and deep inhalation through the nose Slow exhalation through pursed lips, as if whistling Exhalation time three times as long as inhalation time
Puffing of cheeks while exhaling air Puffing of the cheeks makes the technique less effective
The nurse determines that the patient with chronic obstructive pulmonary disease (COPD) and diabetes mellitus is experiencing adverse effects of albuterol after noting which finding? Blood sugar 139 mg/dL Temperature of 99.1° F Respiratory rate of 21 breaths/minute Pulse rate of 102 beats/minutes
Pulse rate of 102 beats/minutes Albuterol is a β2-agonist that sometimes can cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 102 indicates that the patient is experiencing tachycardia as an adverse effect
The nurse determines that the patient is not experiencing adverse effects of albuterol after noting which patient vital sign? Pulse rate of 72 beats/minute Temperature of 98.4° F Oxygen saturation 96% Respiratory rate of 18 breaths/minute
Pulse rate of 72 beats/minute Albuterol is a β 2-adrenergic agonist that sometimes can cause adverse cardiovascular effects. These would include tachycardia and angina
The nurse is caring for a patient with severe chronic obstructive pulmonary disease (COPD) who has frequent exacerbations. What treatment strategy does the nurse recognize would be most beneficial for this patient? Roflumilast Indacaterol Ipratropium Salmeterol and formoterol
Roflumilast is an antiinflammatory drug that reduces cytokines and helps to limit the exacerbations of COPD.
While reviewing the laboratory reports of a patient with a chronic cough, dyspnea, and lung inflammation, the nurse finds that the patient has a forced expiratory volume of 55%. Which treatment strategy would be most effective for this patient? Roflumilast Salmeterol and formoterol Lung volume reduction surgery 50% oxygen at 8 L/minute concentration
Salmeterol and formoterol LABA indicates COPD - moderate (55% expiratory volume)
The nurse provides teaching to a patient with asthma who has been advised to use nebulization. What should the nurse include in the instructions about nebulization? Hold the inspiration for 10 seconds. Breathe rapidly between forced breaths. Sit in an upright position during the treatment. Do not cough after the nebulization treatment.
Sit in an upright position during the treatment. allows for efficient breathing that ensures adequate penetration & deposition of aerosolized med Deep breathing between forced breathing to prevent alveolar hypoventilation encouraged to cough effectively after nebulization to mobilize secretions.
The nurse is caring for a patient who is suspected of having chronic obstructive pulmonary disease (COPD). The nurse knows that what type of diagnostic test would confirm this diagnosis? Spirometry Chest x-ray Arterial blood gas (ABG) Computed tomography (CT) scan of the chest
Spirometry Spirometry is needed to confirm the presence of airflow obstruction and the severity of COPD.
A patient who has a family history of α 1-protease inhibitor deficiency reports fever of unknown cause, malaise, and cough associated with purulent sputum. Which test should the patient undergo regularly to assess the severity of the condition? Spirometry Liver enzyme tests Renal hormone tests Computerized tomography
Spirometry autosomal recessive disorder that affects the lungs or liver. AAT deficiency is a genetic risk factor for chronic obstructive pulmonary disease (COPD). The patient with a family history of α 1-protease inhibitor deficiency should consult a pulmonologist about regular spirometry screening. This helps the patient get appropriate genetic counseling.
A patient presents with a productive cough and a body temperature of 102° F. The patient's white blood cell (WBC) count is 15,000/mm 3. The nurse expects that what diagnostic test will be prescribed? Niox Mino test Allergy skin test Lung function test Sputum culture test
Sputum culture test indicate infection in the patient.
A patient is hospitalized with an acute exacerbation of cystic fibrosis (CF). The nurse recognizes that which organisms may be present in the patient's sputum? Burkholderia cepacia Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa Streptococcus pneumoniae
Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa exacerbations of both cystic fibrosis and bronchiectasis
The nurse identifies that which treatment strategy will likely be prescribed for a patient with cor pulmonale, arteriolar vasoconstriction, and a PaO 2 of 50 mm Hg? Chest tube drainage Lung transplantation Supplemental oxygenation Bronchial artery embolization
Supplemental oxygenation in respiratory failure. The patient needs supplementation of oxygen for speedy recovery
The nurse determines that a patient is experiencing the most common adverse effect of albuterol after noting which sign? Diarrhea Headache Tachycardia Oral candidiasis
Tachycardia Tachycardia is a common adverse effect of the use of inhaled β 2-adrenergic agonists because of its stimulant effect
A nurse observes a patient using a dry powder inhaler device. The nurse should correct which patient actions? (Select all that apply) The patient breathes into the inhaler. The patient performs deep and quick breathing. The patient shakes the medicine before using it. The patient holds the breath for more than 10 seconds. The patient inhales more than 1 puff with each inspiration.
The patient breathes into the inhaler. The patient shakes the medicine before using it. The patient inhales more than 1 puff with each inspiration. Breathing into inhaler affects dosing. Inhaling > 1 puff with each inspiration may cause waste of med. Not shake before using because it can alter dosing. Deep & quick breathing is proper technique - ensures med moves deep into lungs Encourage to hold breath beyond 10 seconds to help penetration of dry powder
A patient experiencing severe wheezing arrives in the emergency department and is diagnosed with severe exacerbation of asthma. During the admission assessment, the nurse on the inpatient unit notes that the patient continues to struggle with breathing; however, there is an absence of wheezing. How should the nurse interpret the assessment findings? The patient is hypoxic and needs oxygen therapy. The patient has improved because there is no wheezing. The patient has respiratory failure and needs mechanical ventilation. The patient has retained secretions and needs chest physiotherapy
The patient has respiratory failure and needs mechanical ventilation. A silent chest or absence of wheezing in a patient who had been having severe wheezing indicates an impending respiratory failure. The patient may need mechanical ventilation to support respiration. It is a sign of severe obstruction and it is a life-threatening condition. It is not a sign of improvement
What does the nurse interpret from finding that a patient, after being treated for chronic cough and dyspnea associated with inflammation in lung parenchyma, loses muscle mass? The patient is on diuretic therapy. The patient is on theophylline therapy. The patient is on corticosteroid therapy. The patient is on bronchodilator therapy.
The patient is on corticosteroid therapy. indicates COPD corticosteroids may cause muscle loss due to protein catabolism
The nurse is caring for an adult patient with bronchiectasis. The nurse knows that the primary cause of this disease in adults is related to what? Adult-onset asthma Heavy smoking for more than 20 years Untreated or delayed treatment of bacterial lung infections Genetic predisposition and family members with the same diagnosis
Untreated or delayed treatment of bacterial lung infections Bronchiectasis is an obstructive lung disease, generally caused by bacterial lung infections that are either not treated or treatment is delayed, leading to inflammation, airway damage, and remodeling can even follow a single severe bacterial infection if treatment is not given or delayed
The nurse is teaching energy conservation techniques to a patient with severe dyspnea and oxygen saturation of 50 mm Hg. Which action of the patient indicates effective learning? Standing up while performing activities Using diaphragm muscles to breathe deeply Inhaling a lot of air while exerting effort and exhaling at rest Using a tripod posture and placing the mirror on the table while using an electric razor
Using a tripod posture and placing the mirror on the table while using an electric razor has chronic obstructive pulmonary disease (COPD). try to sit as much as possible when performing activities use the upper thoracic and neck muscles to breathe rather than the diaphragm exhale while pulling, pushing, or lifting and inhale while at rest
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? Oxygen tent Venturi mask Nasal cannula Oxygen-conserving cannula
Venturi mask Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern
The nurse determines that the patient has understood medication instructions about the use of a metered dose inhaler (MDI) when the patient performs which action? Inhales rapidly when activating the inhaler Holds the MDI sideways to increase ease of use Waits one minute between each puff from the MDI Breathes through the nose with activation of the MDI
Waits one minute between each puff from the MDI The patient should wait at least one minute in between puffs to increase medication dispersion throughout the lungs. The patient should inhale slowly, hold the MDI upright, and breathe through the mouth
Which complications, along with edema in the ankles, does the nurse expect in a patient with chronic obstructive pulmonary disease (COPD)? (Select all that apply) Leukopenia Weight gain Polycythemia Hepatomegaly Jugular vein distension
Weight gain Hepatomegaly Jugular vein distension presence of edema in the ankles indicates that the patient has the cardiac complication cor pulmonale, or failure in the right side of the heart. Cor pulmonale is associated with peripheral edema, especially in the ankles, so the patient will have weight gain. The patient with cor pulmonale will have tissue damage, resulting in hepatomegaly. The patient with cor pulmonale will have improper blood flow from the right atrium to the right ventricle, resulting in jugular vein distension
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? Work of breathing Fear of suffocation Effects of medications Anxiety and restlessness
Work of breathing When pt not have sufficient gas exchange for activity, usually due to work of breathing; use all available energy to breath have little left for activity
When should a nurse schedule postural drainage for a patient who has chronic obstructive pulmonary disease (COPD)? a. 1 hour before a meal b. Immediately after meals c. After providing juice to the patient d. After administering nasal medications
a. 1 hour before a meal OR 3 hours after meals to avoid nausea & vomiting Juice may make patient feel nausea Nasal medications may be excreted during drainage
The patient has a prescription for each of the inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? a. Albuterol b. Salmeterol c. Beclomethasone d. Ipratropium bromide
a. Albuterol Short-acting Bronchodilator - given initially when patient experiences asthma attack. Salmeterol - long-acting Beta2 adrenergic agonist - not used for acute asthma attacks Beclomethasone - anticholinergic aget - less effective than Beta2 adrenergic agonists; may be used in emergency with patient unable to tolerate short-acting Beta2 adrenergic agonists (SABAs)
A 45-year-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 Patient is acutely aware of the inability to get sufficient air to breathe. Hypoxic early on with decreased PaCO2 & increased pH because hyperventilating Cyanosis - later sign HR & BP will be increased.
What are complications associated with pancreatic insufficiency? (Select all that apply) a. Steatorrhea b. Osteopenia c. Liver cirrhosis d. Low body mass index e. Distal intestinal obstruction syndrome
a. Steatorrhea d. Low body mass index Pancreatic insufficiency = protein & fat malabsorption = thin/low BMI & bulky, foul-smelling stools Osteopenia occurs with chromosome 7 mutation's effect on development of bone Chronic elevated liver enzymes leads to liver cirrhosis in patient w/ cystic fibrosis. Distal intestinal obstruction syndrome results from intermitten obstruction in terminal ileum.
A 61-year-old patient with asthma is admitted to the hospital. The nurse understands that symptoms of asthma include what? (Select all that apply) a. cough b. crackles c. wheezing d. chest tightness e. pink frothy sputum
a. cough c. wheezing d. chest tightness Crackles = fluid in lungs; not asthma Pink frothy sputum = Pulmonary edema
Before administering ipratropium bromide, the nurse must confirm that the patient does not have which comorbidity? a. glaucoma b. depression c. Hypertension d. COPD
a. glaucoma Ipratropium bromide is anticholinergic - increases intraocular pressure.
A patient with COPD is receiving O2 therapy through a mask. Which nursing actions should the nurse perform to ensure proper care of the patient? (Select all that apply) a. Take a chest radiograph b. Choose the optimal oxygen device c. Assess the need to change IV fluids d. Assess the need to adjust O2 flow rate e. Monitor for signs of adverse effects of O2 therapy.
b. Choose the optimal oxygen device d. Assess the need to adjust O2 flow rate e. Monitor for signs of adverse effects of O2 therapy.
On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than 4 times a week. The patient's forced expiratory volume in the first second of expiration (FEV1) is < 60%, and normal activity is very limited. Which treatment options should the nurse consider appropriate? a. Follow up after a month b. Consider oral corticosteroids c. Reevaluate in 2-6 weeks d. Advise maintaining control of asthma symptoms
b. Consider oral corticosteroids poorly controlled asthma If well controlled - advice & month follow-up 2-6 week reevaluation if not well controlled or pt. experiences symptoms > 2/month
Which change occurs during cystic fibrosis? a. severe weight gain b. Increased inflation of lungs c. Increased ciliary movement d. Lower than normal level of salt in the sweat
b. Increased inflation of lungs Cystic fibrosis affects both upper & lower respiratory tracts. Affects small airway first & progresses to larger airways, finally passing into lungs, causing hyperinflation of lungs due to obstruction of bronchioles by thick mucus that traps air. Mucus dehydrates & becomes thick due to decreased ciliary movement. One of first signs is strong salty taste to skin. Result of higher levels of salt in sweat. Hallmark of CF in children = poor weight gain & growth; unable to get enough nutrients from food because of lack of enzymes to help absorb fats & proteins
A patient is concerned that he or she may have asthma. The nurse assesses the severity of the symptoms. Based on this information, how would the nurse classify the patient's asthma? Refer to chart. symptoms 1-2/week wake up @ night w/ problems breathing - yes, 3-4/month SABA/Albuterol use 2-3/week, not daily symptoms interfere w/ normal acrivity - not much FEV1 90% FEV1/FVC NL a. Intermittent severity b. Mild persistent c. Moderate persistent d. Severe persistent
b. Mild persistent symptoms > 2x/wk, not daily Wakes up w/ symptoms 3-4 x/month Uses SABA > 2x/wk, not daily Reports minor limitation in activity FEV1 >80% FEV1/FVC NL
When caring for a patient with COPD, the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting weight loss of 30lb. Which intervention should the nurse add to the plan of care for this patient? a. Prescribe fruits & fruit juices to be offered between meals b. Prescribe 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 d. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet
b. Prescribe a high-calorie, high-protein diet with six small meals a day COPD = greater energy to breath; often decreased oral intake because of dyspnea; full stomach impairs ability of diaphragm to descend during inspiration - interfering with breathing. 6 small meals/day, taking in high-calorie, high-protein diet, with non-protein calories divided evenly between fat & carbohydrate.
The nurse is assessing a patient who is having an acute asthma attack. Which nursing intervention is the priority for this patient? a. Hymidifying the room b. Administering oral corticosteroids c. Administering an albuterol bronchodilator d. Placing the patient in a high-Fowler's position
c. Administering an albuterol bronchodilator providing quick relief for acute asthma attack. Humidification used for COPD Oral corticosteroids may be used in long-term management of asthma High-Fowler's good, but albuterol first
A 45-year-old patient is experiencing an asthma exacerbation. To facilitate airflow, the nurse should place the patient in which position? a. Prone b. Supine c. High-Fowler's d. Trendelenburg
c. High-Fowler's allows for optimal chest expansion & enlist aid of gravity during inspiration.
The nurse recognizes that which patient condition is associated with a sweat chloride level of 75 mmol/L and chromosome 7 mutation's effect on the development of bone? a. Malabsorption of Vit A b. Malabsorption of dietary salt c. Insufficient testosterone levels d. Insufficient levels of lipase enzyme
c. Insufficient testosterone levels may have cystic fibrosis - related osteopenia or osteoporosis Could imply malabsorption of Vit D, insufficient testosterone levels, & chronically elevated inflammatory cytokines.
A patient with dyspnea and hypoxemia has received an initial nebulized short-acting Beta2 adrenergic agonist (SABA) with ipratropium treatment. The patient's forced expiratory volume in one second is 60%, and the peak flow is less than 25% of personal best. The nurse anticipates that which medication will be administered? a. Epinephrine b. Theophylline c. Magnesium sulfate d. Sodium bicarbonate
c. Magnesium sulfate dyspnea & hypoxemia w/ initial treatment with ipratropium has severe asthma = low forced expiratory volume in 1 sec of 60% & peak flow < 25%. IV mag sulfate helps resolve patient's condition faster
Before discharge, the nurse discusses nutrition with the patient with emphysema and pneumonia. The nurse instructs the patient to do what? a. Increase intake of hot foods b. Eat three large meals per day c. Rest for 30 min before eating d. Exercise before meals to increase appetite
c. Rest for 30 min before eating should conserve energy to eat & should rest for at least 30 min before eating to increase energy needed to eat. Patient should consume 5-6 meals per day Avoid hot foods Exercise after eating to conserve energy.
Which statement made by the patient with 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 1-2 min 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." Excessive treatment could trigger paradoxical bronchospasm, which would worsen the patient's respiratory status.
Before discharge, the nurse discusses activity levels with a 61-year-old patient with COPD and pneumonia. Which exercise goal is most appropriate once the patient is recovered fully from this episode of illness? a. Slightly increase activity over the current level b. Limit exercise to activities of daily living to conserve energy c. Swim for 10 min/day, gradually increasing to 30 min/day d. Walk for 20 min/day, keeping pulse rate < 130 beats/min
d. Walk for 20 min/day, keeping pulse rate < 130 beats/min mild aerobic exercise that does not stress the cardiorespiratory system. Should walk 20 min/day, keeping pulse rate < 75-80% of maximum heart rate (220- patient's age)
The nurse observes that a patient with cystic fibrosis (CF) has a body temp 102F, SOB, sore throat, & purulent mucous. The nurse expects what other assessment finding? a. digital clubbing b. blood in sputum c. chronic elevation of liver enzymes d. formation of bullae & blebs in lungs
d. formation of bullae & blebs in lungs CF = bullae & blebs in lungs Symptoms indicative of chronic lung infection
A patient with cystic fibrosis (CF) is hospitalized with exacerbation of symptoms, wheezing, purulent sputum, and a fasting blood glucose level of 194 mmol/L. The nurse anticipates that what medication will be prescribed? Insulin Ivacaftor Dornase alfa Pancrelipase
insulin associated with destruction of islets of pancreas has cystic fibrosis-related hyperglycemia (CFRD) patient with CFRD has characteristics of both type 1 and type 2 diabetes mellitus Ivacaftor is useful in the patient with a G551D mutation of CF. Dornase alfa degrades deoxyribonucleic acid (DNA) of neutrophils in the sputum of the patient with CF. Pancrelipase helps to manage pancreatic insufficiency
Which treatment may increase restlessness and insomnia in a patient with chronic obstructive pulmonary disease (COPD)? β 2 agonists Anticholinergics Massage and postural drainage techniques Oxygen supplementation through a nasal mask
β 2 agonists