Chapter 29: Nursing Management: Obstructive Pulmonary Diseases Flashcards
- The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined fluticasone and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful?
a.
The patient shakes the device before use.
b.
The patient attaches a spacer to the Diskus.
c.
The patient rapidly inhales the medication.
d.
The patient performs huff coughing after inhalation.
ANS: C
The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.
- The nurse teaches a patient how to administer formoterol (Perforomist) through a nebulizer. Which action by the patient indicates good understanding of the teaching?
a.
The patient attaches a spacer before using the inhaler.
b.
The patient coughs vigorously after using the inhaler.
c.
The patient activates the inhaler at the onset of expiration.
d.
The patient removes the facial mask when misting has ceased.
NS: D
A nebulizer is used to administer aerosolized medication. A mist is seen when the medication is aerosolized, and when all of the medication has been used, the misting stops. The other options refer to inhaler use. Coughing vigorously after inhaling and activating the inhaler at the onset of expiration are both incorrect techniques when using an inhaler.
- A patient is scheduled for pulmonary function testing. Which action should the nurse take to prepare the patient for this procedure?
a.
Give the rescue medication immediately before testing.
b.
Administer oral corticosteroids 2 hours before the procedure.
c.
Withhold bronchodilators for 6 to 12 hours before the examination.
d.
Ensure that the patient has been NPO for several hours before the test.
ANS: C
Bronchodilators are held before pulmonary function testing (PFT) so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids should be held before PFTs. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
- Which information will the nurse include in the asthma teaching plan for a patient being discharged?
a.
Use the inhaled corticosteroid when shortness of breath occurs.
b.
Inhale slowly and deeply when using the dry powder inhaler (DPI).
c.
Hold your breath for 5 seconds after using the bronchodilator inhaler.
d.
Tremors are an expected side effect of rapidly acting bronchodilators.
ANS: D
Tremors are a common side effect of short-acting b2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
- The emergency department nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which assessment finding is the best indicator that the therapy has been effective?
a.
No wheezes are audible.
b.
Oxygen saturation is >90%.
c.
Accessory muscle use has decreased.
d.
Respiratory rate is 16 breaths/minute.
ANS: B
The goal for treatment of an asthma attack is to keep the oxygen saturation >90%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.
- A patient seen in the asthma clinic has recorded daily peak flows that are 75% of the baseline. Which action will the nurse plan to take next?
a.
Increase the dose of the leukotriene inhibitor.
b.
Teach the patient about the use of oral corticosteroids.
c.
Administer a bronchodilator and recheck the peak flow.
d.
Instruct the patient to keep the next scheduled follow-up appointment.
ANS: C
The patients peak flow reading indicates that the condition is worsening (yellow zone). The patient should take the bronchodilator and recheck the peak flow. Depending on whether the patient returns to the green zone, indicating well-controlled symptoms, the patient may be prescribed oral corticosteroids or a change in dosing of other medications. Keeping the next appointment is appropriate, but the patient also needs to be taught how to control symptoms now and use the bronchodilator.
- The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?
a.
The patient inhales rapidly through the peak flow meter mouthpiece.
b.
The patient takes montelukast (Singulair) for peak flows in the red zone.
c.
The patient calls the health care provider when the peak flow is in the green zone.
d.
The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.
ANS: D
Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting b2-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy.
- A young adult patient who denies any history of smoking is seen in the clinic with a new diagnosis of chronic obstructive pulmonary disease (COPD). It is most appropriate for the nurse to teach the patient about
a.
a1-antitrypsin testing.
b.
use of the nicotine patch.
c.
continuous pulse oximetry.
d.
effects of leukotriene modifiers.
ANS: A
When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in a1-antitrypsin should be suspected. Because the patient does not smoke, a nicotine patch would not be ordered. There is no indication that the patient requires continuous pulse oximetry. Leukotriene modifiers would be used in patients with asthma, not with COPD.
- The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which information obtained from the patient would prompt the nurse to consult with the health care provider before administering the prescribed theophylline?
a.
The patient reports a recent 15-pound weight gain.
b.
The patient denies any shortness of breath at present.
c.
The patient takes cimetidine (Tagamet) 150 mg daily.
d.
The patient complains about coughing up green mucus.
ANS: C
Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not affect whether the theophylline should be administered or not.
- A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care?
a.
Titrate oxygen to keep saturation at least 90%.
b.
Discuss a high-protein, high-calorie diet with the patient.
c.
Suggest the use of over-the-counter sedative medications.
d.
Teach the patient how to effectively use pursed lip breathing.
ANS: D
Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.
- A patient with chronic obstructive pulmonary disease (COPD) has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care?
a.
Encourage increased intake of whole grains.
b.
Increase the patients intake of fruits and fruit juices.
c.
Offer high-calorie snacks between meals and at bedtime.
d.
Assist the patient in choosing foods with high vegetable and mineral content.
ANS: C
Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture like whole grains may take more energy to eat and get absorbed and lead to decreased intake. Although fruits, juices, and vegetables are not contraindicated, foods high in protein are a better choice.
- The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most helpful in confirming a diagnosis of chronic bronchitis?
a.
The patient tells the nurse about a family history of bronchitis.
b.
The patients history indicates a 30 pack-year cigarette history.
c.
The patient complains about a productive cough every winter for 3 months.
d.
The patient denies having any respiratory problems until the last 12 months.
ANS: C
A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no family tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
- The nurse teaches a patient about pursed lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?
a.
The patient inhales slowly through the nose.
b.
The patient puffs up the cheeks while exhaling.
c.
The patient practices by blowing through a straw.
d.
The patients ratio of inhalation to exhalation is 1:3.
ANS: B
The patient should relax the facial muscles without puffing the cheeks while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.
- Which finding by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?
a.
Even, unlabored respirations
b.
Pulse oximetry reading of 92%
c.
Respiratory rate of 18 breaths/minute
d.
Absence of wheezes, rhonchi, or crackles
ANS: B
For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.
- The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?
a.
Peripheral edema
b.
Elevated temperature
c.
Clubbing of the fingers
d.
Complaints of chest pain
ANS: A
Cor pulmonale causes clinical manifestations of right ventricular failure, such as peripheral edema. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.
- The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD).What is the best way for the nurse to determine the appropriate oxygen flow rate?
a.
Minimize oxygen use to avoid oxygen dependency.
b.
Maintain the pulse oximetry level at 90% or greater.
c.
Administer oxygen according to the patients level of dyspnea.
d.
Avoid administration of oxygen at a rate of more than 2 L/minute.
ANS: B
The best way to determine the appropriate oxygen flow rate is by monitoring the patients oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An oxygen saturation of 90% indicates adequate blood oxygen level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an oxygen flow rate of 2 L/min may not be adequate. Because oxygen use improves survival rate in patients with COPD, there is no concern about oxygen dependency. The patients perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.
- A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on oxygen therapy. Which instruction should the nurse include in the discharge teaching?
a.
Storage of oxygen tanks will require adequate space in the home.
b.
Travel opportunities will be limited because of the use of oxygen.
c.
Oxygen flow should be increased if the patient has more dyspnea.
d.
Oxygen use can improve the patients prognosis and quality of life.
ANS: D
The use of home oxygen improves quality of life and prognosis. Because increased dyspnea may be a symptom of an acute process such as pneumonia, the patient should notify the physician rather than increasing the oxygen flow rate if dyspnea becomes worse. Oxygen can be supplied using liquid, storage tanks, or concentrators, depending on individual patient circumstances. Travel is possible using portable oxygen concentrators.
- A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, which action by the nurse is most important?
a.
Teach the patient to keep mask on at all times.
b.
Keep the air entrainment ports clean and unobstructed.
c.
Give a high enough flow rate to keep the bag from collapsing.
d.
Drain moisture condensation from the oxygen tubing every hour.
ANS: B
The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or non-rebreather masks. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation. The mask is uncomfortable and can be removed when the patient eats.
- Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. Which intervention should the nurse include in the plan of care?
a.
Schedule the procedure 1 hour after the patient eats.
b.
Maintain the patient in the lateral position for 20 minutes.
c.
Perform percussion before assisting the patient to the drainage position.
d.
Give the ordered albuterol (Proventil) before the patient receives the therapy.
ANS: D
Bronchodilators are administered before chest physiotherapy. Postural drainage, percussion, and vibration should be done 1 hour before or 3 hours after meals. Patients remain in each postural drainage position for 5 minutes. Percussion is done while the patient is in the postural drainage position.
- The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe chronic obstructive pulmonary disease (COPD). Which instructions would be most appropriate for the nurse to include in the plan of care?
a.
Stop exercising when short of breath.
b.
Walk until pulse rate exceeds 130 beats/minute.
c.
Limit exercise to activities of daily living (ADLs).
d.
Walk 15 to 20 minutes daily at least 3 times/week.
ANS: D
Encourage the patient to walk 15 to 20 minutes a day at least three times a week with gradual increases. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patients exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).
- A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, I wish I were dead! Im just a burden on everybody. Based on this information, which nursing diagnosis is most appropriate?
a.
Complicated grieving related to expectation of death
b.
Ineffective coping related to unknown outcome of illness
c.
Deficient knowledge related to lack of education about COPD
d.
Chronic low self-esteem related to increased physical dependence
ANS: D
The patients statement about not being able to do anything for himself or herself supports this diagnosis. Although deficient knowledge, complicated grieving, and ineffective coping may also be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.
- A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would be most appropriate?
a.
Have the patient rest in bed with the head elevated to 15 to 20 degrees.
b.
Ask the patient to rest in bed in a high-Fowlers position with the knees flexed.
c.
Encourage the patient to sit up at the bedside in a chair and lean slightly forward.
d.
Place the patient in the Trendelenburg position with several pillows behind the head.
ANS: C
Patients with COPD improve the mechanics of breathing by sitting up in the tripod position. Resting in bed with the head elevated in a semi-Fowlers position would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patients ability to ventilate well.
- A 55-year-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary function testing (PFT) for this condition, what is the most important question the nurse should ask?
a.
Are you claustrophobic?
b.
Are you allergic to shellfish?
c.
Do you have any metal implants or prostheses?
d.
Have you taken any bronchodilators in the past 6 hours?
ANS: D
Pulmonary function testing will help establish the COPD diagnosis. Bronchodilators should be avoided at least 6 hours before the test. PFTs do not involve being placed in an enclosed area such as for magnetic resonance imaging (MRI). Contrast dye is not used for PFTs. The patient may still have PFTs done if metal implants or prostheses are present, as these are contraindications for an MRI.
- A young adult patient with cystic fibrosis (CF) is admitted to the hospital with increased dyspnea. Which intervention should the nurse include in the plan of care?
a.
Schedule a sweat chloride test.
b.
Arrange for a hospice nurse visit.
c.
Place the patient on a low-sodium diet.
d.
Perform chest physiotherapy every 4 hours.
ANS: D
Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the patient is terminally ill. Patients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.
