Chapter 29: Nursing Management: Obstructive Pulmonary Diseases 9th Edition 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
c. The patient rapidly inhales the medication.
- 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.
d. The patient removes the facial mask when misting has ceased.
- 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.
c.
Withhold bronchodilators for 6 to 12 hours before the examination.
- 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
d. Tremors are an expected side effect of rapidly acting bronchodilators
- 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.
b. Oxygen saturation is >90%.
- 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.
c. Administer a bronchodilator and recheck the peak flow.
- 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.
d. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.
- 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.
a. a1-antitrypsin testing.
- 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.
c. The patient takes cimetidine (Tagamet) 150 mg daily.
- 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.
d. Teach the patient how to effectively use pursed lip breathing.
- 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.
c. Offer high-calorie snacks between meals and at bedtime.
- 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.
c.
The patient complains about a productive cough every winter for 3 months.
- 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.
b.
The patient puffs up the cheeks while exhaling.
- 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
b.
Pulse oximetry reading of 92%
- 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
a.
Peripheral edema
- 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.
b.
Maintain the pulse oximetry level at 90% or greater.
- 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.
d.
Oxygen use can improve the patients prognosis and quality of life.
- 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.
b.
Keep the air entrainment ports clean and unobstructed
- 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.
d.
Give the ordered albuterol (Proventil) before the patient receives the therapy.
- 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.
d.
Walk 15 to 20 minutes daily at least 3 times/week.
- 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
d.
Chronic low self-esteem related to increased physical dependence
- 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.
c.
Encourage the patient to sit up at the bedside in a chair and lean slightly forward.
- 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?
d.
Have you taken any bronchodilators in the past 6 hours?
- 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.
d.
Perform chest physiotherapy every 4 hours.
