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A pt is concerned that he may have asthma. Of the s/s, which may suggest asthma or risk factors for asthma?
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Which findings indicate a pt is developing status asthmaticus?
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Ch 28
Obstructive Pulmonary Diseases
| Question | Answer |
|---|---|
| A pt is concerned that he may have asthma. Of the s/s, which may suggest asthma or risk factors for asthma? | a) allergic rhinitis c) cough, esp @ night d) Gastric reflux or heartburn e) h/o chronic sinusitis Allergic rhinitis: major predictor of adult asthma. Acute and chronic sinusitis, esp bacterial rhinosinusitis, may worsen asthma. chronic inflammation of asthma leads to recurrent episodes of wheezing, breathlessness, chest tightness, and cough, particularly at night or in the early morning. GERD is more common in people with asthma & because reflux may trigger bronchoconstriction & cause aspiration. |
| Which findings indicate a pt is developing status asthmaticus? | a) PEFR <300 L/min c) Unable to speak in complete sentences d) Lack of response to conventional treatment |
| Which statement indicates the patient with asthma needs further teaching about self-care? | a) I use my corticosteroid inhaler when I feel short of breath Rationale: A rescue plan for patients with asthma includes taking 2 to 4 puffs of a short-acting bronchodilator (not a corticosteroid) every 20 minutes (3 times) to obtain rapid control of symptoms. |
| Which meds would be most apprpriate to administer to a pt w/an acute asthma attack? | c) albuterol d) ipratroprium Rationale: The mainstay of acute asthmatic treatment is inhalation of short-acting β2-adrenergic agonist (SABA) bronchodilators, such as albuterol (ProAir HFA, Proventil HFA, Ventolin HFA). In patients with a moderate to severe attack, inhaled ipratropium (Atrovent) is used in conjunction with SABA. |
| The plan of care for the patient w/COPD should include? | a) exercise such as walking e) breathing exercises (pursed lip breathing) that focus on exhalation Rationale: Breathing exercises may assist pt during rest and activity by decreasing dyspnea, improving oxygenation, and slowing RR. The main type of breathing exercise taught is pursed-lip breathing. Walking combined with strength training, when possible, are probably the best interventions to strengthen muscles and improve the endurance of a patient with chronic obstructive pulmonary disease (COPD). |
| The major advantage 0f a venturi mask is that it can? | c) deliver a precise concentration of O2 Rationale: The Venturi mask is a high-flow device that delivers fixed concentrations of O2 (e.g., 24% or 28%, independent of the patient’s respiratory pattern). |
| Which guidelines should the include when teaching a pt how to use a MDI? | d) To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. |
| Which treatments would the nurse expect to implement in the management of a pt w/CF? | a) Sperm banking c) airway clearance techniques (Acapella) d) GoLYTELY given as needed for severe constipation e) inhaled tobramycin for Pseudomonas infection Rationale: Guys-no vas deferens to transport sperm, Airway clearance tech's inc CPT, positive expiratory pressure devices, breathing exercises, and high-frequency chest wall oscillation systems. Severe constipation can be treated by thinning bowel contents. Inhaled tobramycin is effective in patients with CF who have Pseudomonas infections. |
| A pt w/bronchiectasis asks the nurse " what condition warrants a call to the clinic?" | a) blood clots in the sputem |
| The nurse determines that ipratropium therapy was effective when? | Peak expiratory flow is increased |
| The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign? | Pulse rate of 72 beats/min Rationale: 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 does not have tachycardia as an adverse effect. |
| During an assessment of a patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change? | Narrowing of the airway Rationale: 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 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? | Wheezing becomes louder. Rationale: 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 |
| When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included? | Increasing dyspnea Rationale: The significant manifestations to report to the health care provider include increasing dyspnea, fever, chills, increased sputum production, bloody sputum, and chest pain. |
| While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse teach the patient to do? | Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. Rationale: 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 provider based on personal peak flow numbers. Peak flow is measured by exhaling into the flowmeter and should be assessed before and after medications to evaluate their effectiveness. |
| The nurse is teaching a patient how to self-administer beclomethasone, 2 puffs inhaled every 6 hours. What should the nurse teach the patient to do to prevent oral infection while taking this medication? | Rinse the mouth with water after the second puff of medication. Rationale: 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. |
| 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? | Effective and productive coughing Rationale: 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, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring which patient parameters? | Daily weight Rationale: 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. |
| A patient with chronic obstructive pulmonary disease (COPD) becomes dyspneic at rest. The baseline ABG results are PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment requires the nurse’s priority intervention? | Arterial pH 7.26 Rationale: The patient’s pH shows acidosis that supports an exacerbation of COPD along with the worsening dyspnea. The PaCO2 has improved from baseline, the tripod position helps the patient’s breathing, and the increase in sputum expectoration will improve the patient’s ventilation. |
| The nurse is teaching the pt how to self-admin ipratrpium via MDI, which instruction should be included? | “Breathe out slowly before positioning the inhaler.” Rationale: 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. |
| 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? | Albuterol Rationale: Albuterol is a short-acting bronchodilator that should be given initially when the patient has an asthma attack. |
| The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-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? | Systemic corticosteroids Rationale: Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient |
| The nurse is evaluating if a patient understands how to safely determine whether a metered-dose inhaler (MDI) is empty. The nurse decides the patient understands this important information when the patient describes which method to check the inhaler? | Keep track of the number of inhalations used. Rationale: 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). |
| 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? | Walk for 20 min/day, keeping the pulse rate less than 130 beats/min. Rationale: 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). |
| 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? | “You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia.” Rationale: 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 determines the patient with asthma has activity intolerance. What is the most likely reason for this problem? | Work of breathing Rationale: 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. |
| When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands the manifestations of the disease are related to what process? | Hyperinflation of alveoli and destruction of alveolar walls Rationale: 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. |
| 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? | “More of the medication will get down into my lungs to help my breathing.” Rationale: A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or increase the speed of using the inhaler. |
| When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? (Select all that apply.) | Exercise Allergies Emotional stress Upper respiratory infections Rationale: 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, stress, and gastroesophageal reflux disease (GERD). |
| When teaching the patient with cystic fibrosis about diet and medications, what priority information should you include? | Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed. Rationale: The patient must take pancreatic enzymes before each meal and snack and adequate fat, calories, protein, and vitamins should be eaten. Fat-soluble vitamins are needed because they are malabsorbed with the excess mucus in the gastrointestinal system. |
| A patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care? | Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours. Rationale: Adequate hydration helps to liquefy secretions and thus make it easier to remove them. Unless there are contraindications, the nurse should teach the patient to drink at least 3 L of fluid daily. |
| 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? | Venturi mask Rationale: 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. |
| Assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)? | Fluid volume excess from cor pulmonale Rationale: 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 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? | Preventing bronchial collapse and air trapping in the lungs during exhalation Rationale: 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. |
| Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching about the use of an ipratropium inhaler? | “If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily.” Rationale: 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. |
| An 18-yr-old patient at the student health center with a history of frequent lung and sinus infections has 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? | “Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF.” Rationale: The diagnostic criteria for CF involve a combination of clinical presentation, sweat chloride testing, and genetic testing to confirm the diagnosis. Values above 60 mmol/L for sweat chloride are consistent with the diagnosis of CF. |
| Which test result identifies that a patient with asthma is responding to treatment? | A decreased exhaled nitric oxide Rationale: 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. |
| The nurse supervises a team including another registered nurse (RN), a licensed practical/vocational nurse (LPN/VN), 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? | Correct Answer: LPN/VN changed the type of oxygen device based on arterial blood gas results. Rationale: 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 provider 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? | “Close lips tightly around the mouthpiece and breathe in deeply and quickly.” Rationale: 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. |
| The nurse teaches a patient with chronic obstructive pulmonary disease (COPD) how to administer fluticasone by metered-dose inhaler (MDI). Which statement indicates a correct understanding of the instructions? | “I will rinse my mouth each time after I use this inhaler.” Rationale: 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. |
| When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse determines that the patient’s nutritional status is impaired after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient? | Order a high-calorie, high-protein diet with six small meals a day. Rationale: The patient w/COPD uses greater energy to breathe, they often dec oral intake r/t dyspnea. A full stomach impairs diaphragm from descending. For these reasons, the patient with COPD should eat 6 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. |
| 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 manifestation would be an early indication of an exacerbation of asthma? | Anxiety Rationale: An early manifestation of 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. |
| When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included about the effects of smoking on the lungs? | Decreased alveolar macrophage function. Rationale: 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 nurse is caring for a patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with an increase in respiratory rate from 26 to 44 breaths/min. Which action by the nurse would be the most appropriate? | Teach the patient to use pursed-lip breathing. Rationale: 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. |
| 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? | Evaluating the use of intercostal muscles Rationale: 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. |
| In which position should the nurse place a patient experiencing an asthma exacerbation? | High Fowler’s Rationale: 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 nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? | Oropharyngeal candidiasis and hoarseness Rationale: 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. |
Created by:
dkorak