MS - Obstructive Pulmonary Diseases Chapter 28

Question 1

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 rapidly inhales the medication.
c. The patient attaches a spacer to the Diskus.
d. The patient performs huff coughing after inhalation.

Answer 1

b. The patient rapidly inhales the medication.

ANS: B
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.

Question 2

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 removes the facial mask when misting stops.
d. The patient activates the inhaler at the onset of expiration.

Answer 2

c. The patient removes the facial mask when misting stops

ANS: C
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.

Question 3

A patient is scheduled for spirometry. 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.

Answer 3

c. Withhold bronchodilators for 6 to 12 hours before the examination.

ANS: C
Bronchodilators are held before spirometry 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 spirometry. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

Question 4

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.

Answer 4

d. Tremors are an expected side effect of rapidly acting bronchodilators.

ANS: D
Tremors are a common side effect of short-acting 2-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.

Question 5

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. O2 saturation is >90%.
c. Accessory muscle use has decreased.
d. Respiratory rate is 16 breaths/minute.

Answer 5

b. O2 saturation is >90%.

ANS: B
The goal for treatment of an asthma attack is to keep the O2 saturation above 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.

Question 6

A patient seen in the asthma clinic has recorded daily peak flow rates 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 scheduled follow-up appointment.

Answer 6

c. Administer a bronchodilator and recheck the peak flow.

ANS: C
The patient’s 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.

Question 7

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 an albuterol (Ventolin HFA) inhaler for peak flows in the yellow zone.

Answer 7

d. The patient uses an albuterol (Ventolin HFA) inhaler 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 2-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.

Question 8

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). The nurse should plan to teach the patient about

a. 1-antitrypsin testing.
b. leukotriene modifiers.
c. use of the nicotine patch.
d. continuous pulse oximetry.

Answer 8

a. 1-antitrypsin testing.

ANS: A
When COPD occurs in young patients, especially without a smoking history, a genetic deficiency in 1-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.

Question 9

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-lb weight gain.
b. The patient denies shortness of breath at present.
c. The patient takes cimetidine (Tagamet HB) daily.
d. The patient complains of coughing up green mucus.

Answer 9

c. The patient takes cimetidine (Tagamet HB) daily.

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.

Question 10

The home health nurse is visiting a patient with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety?

a. Titrate O2 to keep saturation at least 90%.
b. Teach the patient how to use pursed-lip breathing.
c. Discuss a high-protein, high-calorie diet with the patient.
d. Suggest the use of over-the-counter sedative medications.

Answer 10

b. Teach the patient how to use pursed-lip breathing.

ANS: B
Pursed-lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires O2 therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

Question 11

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 patient’s intake of fruits and fruit juices.
c. Offer high-calorie protein snacks between meals and at bedtime.
d. Assist the patient in choosing foods with high vegetable content.

Answer 11

c. Offer high-calorie protein snacks between meals and at bedtime.

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 such as whole grains may take more energy to eat and get absorbed and lead to decreased intake. Although fruits, juices, and minerals are not contraindicated, foods high in protein are a better choice.

Question 12

The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis?

a. The patient tells the nurse about a family history of bronchitis.
b. The patient indicates a 30 pack-year cigarette smoking history.
c. The patient reports a productive cough for 3 months every winter.
d. The patient denies having respiratory problems until the past 12 months.

Answer 12

c. The patient reports a productive cough for 3 months every winter.

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.

Question 13

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 patient’s ratio of inhalation to exhalation is 1:3.

Answer 13

b. The patient puffs up the cheeks while exhaling.

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.

Question 14

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. Absence of wheezes or crackles
d. Respiratory rate of 18 breaths/min

Answer 14

b. Pulse oximetry reading of 92%

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.

Question 15

The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?

a. Chest pain
b. Finger clubbing
c. Peripheral edema
d. Elevated temperature

Answer 15

c. Peripheral edema

ANS: C
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 but are not indicators of cor pulmonale.

Question 16

The nurse is admitting a patient diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD). How should the nurse determine the appropriate O2 flow rate?

a. Minimize O2 use to avoid O2 dependency.
b. Maintain the pulse oximetry level at 90% or greater.
c. Administer O2 according to the patient’s level of dyspnea.
d. Avoid administration of O2 at a rate of more than 2 L/min.

Answer 16

b. Maintain the pulse oximetry level at 90% or greater.

ANS: B
The best way to determine the appropriate O2 flow rate is by monitoring the patient’s oxygenation either by arterial blood gases (ABGs) or pulse oximetry. An O2 saturation of 90% indicates adequate blood O2 level without the danger of suppressing the respiratory drive. For patients with an exacerbation of COPD, an O2 flow rate of 2 L/min may not be adequate. Because O2 use improves survival rate in patients with COPD, there is no concern about O2 dependency. The patient’s perceived dyspnea level may be affected by other factors (e.g., anxiety) besides blood O2 level.

Question 17

A patient hospitalized with chronic obstructive pulmonary disease (COPD) is being discharged home on O2 therapy. Which instruction should the nurse include in the discharge teaching?

a. Travel is not possible with the use of O2 devices.
b. O2 flow should be increased if the patient has more dyspnea.
c. O2 use can improve the patient’s prognosis and quality of life.
d. Storage of O2 requires large metals tanks that each last 4 to 6 hours.

Answer 17

c. O2 use can improve the patient’s prognosis and quality of life.

ANS: C
The use of home O2 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 health care provider rather than increasing the O2 flow rate if dyspnea becomes worse. O2 can be supplied using liquid, storage tanks, or concentrators, depending on individual patient circumstances. Travel is possible using portable O2 concentrators.

Question 18

A patient is receiving 35% O2 via a Venturi mask. To ensure the correct amount of O2 delivery, which action by the nurse is important?

a. Teach the patient to keep the mask on during meals.
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 corrugated tubing every hour.

Answer 18

b. Keep the air entrainment ports clean and unobstructed.

ANS: B
The air entrainment ports regulate the O2 percentage delivered to the patient, so they must be unobstructed. The other options refer to other types of O2 devices. A high O2 flow rate is needed when giving O2by partial rebreather or nonrebreather masks. Draining O2 tubing is necessary when caring for a patient receiving mechanical ventilation. The mask can be removed or changed to a nasal cannula at a prescribed setting when the patient eats.

Question 19

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. Give the prescribed albuterol (Ventolin HFA) before the therapy.
d. Perform percussion before assisting the patient to the drainage position.

Answer 19

c. Give the prescribed albuterol (Ventolin HFA) before the therapy.

ANS: C
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.

Question 20

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 appropriate for the nurse to include in the plan of care?

a. Stop exercising when you feel 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 a day at least 3 times/week.

Answer 20

d. Walk 15 to 20 minutes a day 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 patient’s exercise tolerance. A 70-yr-old patient should have a pulse rate of 120 beats/min or less with exercise (80% of the maximal heart rate of 150 beats/min ).

Question 21

A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, “I wish I were dead! I’m just a burden on everybody.” Based on this information, which nursing diagnosis is most appropriate?

a. Complicated grieving related to expectation of death
b. Chronic low self-esteem related to physical dependence
c. Ineffective coping related to unknown outcome of illness
d. Deficient knowledge related to lack of education about COPD

Answer 21

b. Chronic low self-esteem related to physical dependence

ANS: B
The patient’s 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.

Question 22

A patient with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the patient’s ventilation?

a. Have the patient rest in bed with the head elevated to 15 to 20 degrees.
b. Encourage the patient to sit up at the bedside in a chair and lean forward.
c. Ask the patient to rest in bed in a high-Fowler’s position with the knees flexed.
d. Place the patient in the Trendelenburg position with pillows behind the head.

Answer 22

b. Encourage the patient to sit up at the bedside in a chair and lean forward.

ANS: B
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-Fowler’s 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 patient’s ability to ventilate well.

Question 23

A 55-yr-old patient with increasing dyspnea is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a patient about pulmonary spirometry for this condition, what is the most important question the nurse should ask?

a. “Are you claustrophobic?”
b. “Are you allergic to shellfish?”
c. “Have you taken any bronchodilators today?”
d. “Do you have any metal implants or prostheses?”

Answer 23

c. “Have you taken any bronchodilators today?”

ANS: C
Spirometry will help establish the COPD diagnosis. Bronchodilators should be avoided at least 6 hours before the test. Spirometry does not involve being placed in an enclosed area such as for magnetic resonance imaging (MRI). Contrast dye is not used for spirometry. The patient may still have spirometry done if metal implants or prostheses are present because they are contraindications for an MRI.

Question 24

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.

Answer 24

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.

Question 25

A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate?

a. Teach the patient signs of hypoglycemia.
b. Have the patient add dietary salt to meals.
c. Suggest decreasing intake of dietary fat and calories.
d. Instruct the patient about pancreatic enzyme replacements.

Answer 25

b. Have the patient add dietary salt to meals.

ANS: B
Added dietary salt is indicated whenever sweating is excessive, such as during hot weather, when fever is present, or from intense physical activity. The management of pancreatic insufficiency includes pancreatic enzyme replacement of lipase, protease, and amylase (e.g., Pancreaze, Creon, Ultresa, Zenpep) administered before each meal and snack. This patient is at risk for hyponatremia based on reported symptoms. Adequate intake of fat, calories, protein, and vitamins is important. Fat-soluble vitamins (vitamins A, D, E, and K) must be supplemented because they are malabsorbed. Use of caloric supplements improves nutritional status. Hyperglycemia caused by pancreatic insufficiency is more likely to occur than hypoglycemia.

Question 26

A young adult female patient with cystic fibrosis (CF) tells the nurse that she is considering getting married and wondering about having children. Which initial response by the nurse is best?

a. “Are you aware of the normal lifespan for patients with CF?”
b. “Would like more information to help you with that decision?”
c. “Many women with CF do not have difficulty conceiving children.”
d. “You will need to have genetic counseling before making a decision.”

Answer 26

b. “Would like more information to help you with that decision?”

ANS: B
The nurse’s initial response should be to assess the patient’s knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patient’s comments. The other responses have accurate information, but the nurse should first assess the patient’s understanding about the issues surrounding pregnancy.

Question 27

A patient with chronic obstructive pulmonary disease (COPD) has coarse crackles throughout the lung fields and a chronic, nonproductive cough. Which nursing intervention will be most effective?

a. Change the O2 flow rate to the highest prescribed rate.
b. Teach the patient to use the Flutter airway clearance device.
c. Reinforce the ongoing use of pursed-lip breathing techniques.
d. Teach the patient about consistent use of inhaled corticosteroids.

Answer 27

b. Teach the patient to use the Flutter airway clearance device.

ANS: B
Airway clearance devices assist with moving mucus into larger airways, where it can more easily be expectorated. The other actions may be appropriate for some patients with COPD, but they are not indicated for this patient’s problem of thick mucus secretions.

Question 28

The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective?

a. “I will drink lots of fluids with my meals.”
b. “I can have ice cream as a snack every day.”
c. “I will exercise for 15 minutes before meals.”
d. “I will decrease my intake of meat and poultry.”

Answer 28

b. “I can have ice cream as a snack every day.”

ANS: B
High-calorie foods such as ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.

Question 29

Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease (COPD)?

a. “Avoid upper body exercise to prevent dyspnea.”
b. “Stop exercising if you start to feel short of breath.”
c. “Use the bronchodilator before you start to exercise.”
d. “Breathe in and out through the mouth while you exercise.”

Answer 29

c. “Use the bronchodilator before you start to exercise.”

ANS: C
Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed-lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.

Question 30

The nurse completes an admission assessment on a patient with asthma. Which information given by patient is indicates a need for a change in therapy?

a. The patient uses albuterol (Ventolin HFA) before aerobic exercise.
b. The patient says that the asthma symptoms are worse every spring.
c. The patient’s heart rate increases after using the albuterol (Ventolin HFA) inhaler.
d. The patient’s only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).

Answer 30

d. The patient’s only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).

ANS: D
Long-acting 2-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires

Question 31

The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy?

a. The patient has chronic inflammatory bowel disease.
b. The patient has a history of pneumonia 6 months ago.
c. The patient takes propranolol (Inderal) for hypertension.
d. The patient uses acetaminophen (Tylenol) for headaches.

Answer 31

c. The patient takes propranolol (Inderal) for hypertension.

ANS: C
-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.

Question 32

A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching?

a. Use of long-acting -adrenergic medications
b. Side effects of sustained-release theophylline
c. Self-administration of inhaled corticosteroids
d. Complications associated with O2 therapy

Answer 32

c. Self-administration of inhaled corticosteroids

ANS: C
Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.

Question 33

A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/dL. Which nursing action will the nurse plan to implement?

a. Discuss the role of diet in blood glucose control.
b. Evaluate the patient’s use of pancreatic enzymes.
c. Teach the patient about administration of insulin.
d. Give oral hypoglycemic medications before meals.

Answer 33

c. Teach the patient about administration of insulin.

ANS: C
The glucose levels indicate that the patient has developed CF-related diabetes, and insulin therapy is required. Because the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.

Question 34

The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action?

a. Pulse oximetry reading of 91%
b. Respiratory rate of 26 breaths/min
c. Use of accessory muscles in breathing
d. Peak expiratory flow rate of 240 L/min

Answer 34

c. Use of accessory muscles in breathing

ANS: C
Use of accessory muscle indicates that the patient is experiencing respiratory distress, and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.

Question 35

A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first?

a. Notify the health care provider.
b. Document changes in respiratory status.
c. Encourage the patient to cough and deep breathe.
d. Administer IV methylprednisolone (Solu-Medrol).

Answer 35

a. Notify the health care provider.

ANS: A
The patient’s assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation after notifying the health care provider. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.

Question 36

A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?

a. Listen to the patient’s breath sounds.
b. Ask about inhaled corticosteroid use.
c. Determine when the dyspnea started.
d. Obtain the forced expiratory volume (FEV) flow rate.

Answer 36

a. Listen to the patient’s breath sounds.

ANS: A
Assessment of the patient’s breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient’s status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient is using but not as important as assessing the breath sounds.

Question 37

Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider?

a. Pain at injection site
b. Flushing and dizziness
c. Peak flow reading 75% of normal
d. Respiratory rate 24 breaths/minute

Answer 37

b. Flushing and dizziness

ANS: B
Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction, and immediate intervention is needed. The other information should also be reported, but do not indicate possibly life-threatening complications of omalizumab therapy.

Question 38

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. The results for which patient will require the most rapid action by the nurse?

a. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg
b. pH 7.48, PaCO2 30 mm Hg, and PaO2 65 mm Hg
c. pH 7.34, PaCO2 33 mm Hg, and PaO2 80 mm Hg
d. pH 7.31, PaCO2 58 mm Hg, and PaO2 64 mm Hg

Answer 38

a. pH 7.28, PaCO2 50 mm Hg, and PaO2 58 mm Hg

ANS: A
The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis.

Question 39

Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)?

a. Obtain O2 saturation using pulse oximetry.
b. Monitor for increased O2 need with exercise.
c. Teach the patient about safe use of O2 at home.
d. Adjust O2 to keep saturation in prescribed parameters.

Answer 39

a. Obtain O2 saturation using pulse oximetry.

ANS: A
UAP can obtain O2 saturation (after being trained and evaluated in the skill). The other actions require more education and a scope of practice that licensed practical/vocational nurses (LPN/LVNs) or registered nurses (RNs) would have.

Question 40

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/min, and the current peak flow is 420 L/min. Which action should the nurse take first?

a. Tell the patient to go to the hospital emergency department.
b. Instruct the patient to use the prescribed albuterol (Ventolin HFA).
c. Ask about recent exposure to any new allergens or asthma triggers.
d. Question the patient about use of the prescribed inhaled corticosteroids.

Answer 40

b. Instruct the patient to use the prescribed albuterol (Ventolin HFA).

ANS: B
The patient’s peak flow is 70% of normal, indicating a need for immediate use of short-acting 2-adrenergic SABA medications. Assessing for correct use of medications or exposure to allergens is also appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.

Question 41

The nurse reviews the medication administration record (MAR) for a patient having an acute asthma attack. Which medication should the nurse administer first?

a. Methylprednisolone (Solu-Medrol) 60 mg IV
b. Albuterol (Ventolin HFA) 2.5 mg per nebulizer
c. Salmeterol (Serevent) 50 mcg per dry-powder inhaler (DPI)
d. Ipratropium (Atrovent) 2 puffs per metered-dose inhaler (MDI)

Answer 41

a. Methylprednisolone (Solu-Medrol) 60 mg IV

ANS: A
Albuterol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. The other medications work more slowly.

Question 42

The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?

a. A patient with loud expiratory wheezes
b. A patient with a respiratory rate of 38 breaths/min
c. A patient who has a cough productive of thick, green mucus
d. A patient with jugular venous distention and peripheral edema

Answer 42

b. A patient with a respiratory rate of 38 breaths/min

ANS: B
A respiratory rate of 38/min indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the patient with tachypnea.

Question 43

Which finding in a patient hospitalized with bronchiectasis is most important to report to the health care provider?

a. Cough productive of bloody, purulent mucus
b. Scattered crackles and wheezes heard bilaterally
c. Complaint of sharp chest pain with deep breathing
d. Respiratory rate 28 breaths/minute while ambulating

Answer 43

a. Cough productive of bloody, purulent mucus

ANS: A
Hemoptysis may indicate life-threatening hemorrhage, and should be reported immediately to the health care provider. The other findings are frequently noted in patients with bronchiectasis and may need further assessment but are not indicators of life-threatening complications.

Question 44

A patient with asthma has a personal best peak expiratory flow rate (PEFR) of 400 L/min. When explaining the asthma action plan, the nurse will teach the patient that a change in therapy is needed when the PEFR is less than ___ L/minute

Answer 44

ANS:
320

A PEFR less than 80% of the personal best indicates that the patient is in the yellow zone where changes in therapy are needed to prevent progression of the airway narrowing.