Question 1

The nurse has completed patient teaching about the administration of salmeterol (Serevent) using a metered-dose inhaler (MDI). Which action by the patient indicates good understanding of the teaching?

Accepted Answer

Spacers can improve the delivery of medication to the lower airways. The other patient actions indicate a need for further teaching.

Question 2

A patient with chronic bronchitis who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that

Accepted Answer

Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. Neither medication is an antihistamine. Advair is not used during an acute attack because the medications do not work rapidly.

Question 3

When the nurse is interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease ( COPD ), which information will help most in confirming a diagnosis of chronic bronchitis?

Accepted Answer

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 familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.

Question 4

To evaluate the effectiveness of therapy for a patient with cor pulmonale, the nurse will monitor the patient for

Accepted Answer

Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distention. 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.

Question 5

When the nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack, which finding is the best indicator that the therapy has been effective?

Accepted Answer

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.

Question 6

A 32-year-old patient who denies any history of smoking is seen in the clinic with a new diagnosis of emphysema. The nurse will anticipate teaching the patient about

Accepted Answer

When emphysema occurs in young patients, especially without a smoking history, a congenital deficiency in a?-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 emphysema.

Question 7

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?

Accepted Answer

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 8

When a hospitalized patient with chronic obstructive pulmonary disease ( COPD ) is receiving oxygen, the best action by the nurse is to

Accepted Answer

The best way to determine the appropriate oxygen flow rate is by monitoring the patient's 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 not a concern about oxygen dependency. The patient's perceived dyspnea level may be affected by other factors (such as anxiety) besides blood oxygen level.

Question 9

Which information will the nurse include when teaching the patient with asthma about the prescribed medications?

Accepted Answer

Tremors are a common side effect of short-acting β₂-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 10

When developing a teaching plan to help increase activity tolerance at home for a 70-year-old with severe chronic obstructive pulmonary disease ( COPD ), the nurse should teach the patient that an appropriate exercise goal is to

Accepted Answer

The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily. 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-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).

Question 11

After the nurse has finished teaching a patient about pursed lip breathing, which patient action indicates that more teaching is needed?

Accepted Answer

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 12

Postural drainage with percussion and vibration is ordered twice daily for a patient with chronic bronchitis. The nurse will plan to

Accepted Answer

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. Bronchodilators are administered before chest physiotherapy.

Question 13

A patient with chronic bronchitis has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in the plan of care?

Accepted Answer

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.

Question 14

A patient is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse

Accepted Answer

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. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation.

Question 15

A patient with chronic obstructive pulmonary disease ( COPD ) has a nursing diagnosis of imbalanced nutrition: less than body requirements. An appropriate intervention for this problem is to

Accepted Answer

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 may take more energy to eat and lead to decreased intake. Although fruits and juices are not contraindicated, foods high in protein are a better choice.

Question 16

Which information will the nurse include in teaching a patient with chronic obstructive pulmonary disease ( COPD ) who has a new prescription for home oxygen therapy?

Accepted Answer

Research supports the use of home oxygen to improve quality of life and prognosis. Since 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 by using portable oxygen concentrators.

Question 17

A patient seen in the asthma clinic has recorded daily peak flows that are 85% of the baseline. Which action will the nurse plan to take?

Accepted Answer

The patient's peak flow readings indicate good asthma control, and no changes are needed. The other actions would be used for patients in the yellow or red zones for peak flow.

Question 18

When preparing a patient with possible asthma for pulmonary function testing, the nurse will teach the patient to

Accepted Answer

Bronchodilators are held before pulmonary function testing 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 also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.

Question 19

Which information about a newly admitted patient with chronic obstructive pulmonary disease ( COPD ) indicates that the nurse should consult with the health care provider before administering the prescribed theophylline?

Accepted Answer

Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not impact on whether the theophylline should be administered or not.

Question 20

Which action by a patient who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?

Accepted Answer

Readings in the yellow zone indicate a decrease in peak flow; the patient should use short-acting b₂-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. 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.

Quiz 29: Nursing Management: Obstructive Pulmonary Diseases

The nurse has completed patient teaching about the administration of salmeterol (Serevent) using a metered-dose inhaler (MDI) . Which action by the patient indicates good understanding of the teaching?