Question 1

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?

Accepted Answer

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 2

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?

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 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 3

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?

Accepted Answer

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 4

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

Accepted Answer

When COPD occurs in young patients,especially without a smoking history,a genetic 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 COPD.

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?

Accepted Answer

The goal for treatment of an asthma attack is to keep the O? 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 is receiving 35% O₂ via a Venturi mask. To ensure the correct amount of O₂ delivery,which action by the nurse is important?

Accepted Answer

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 7

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?

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

Question 8

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?

Accepted Answer

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 9

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

Accepted Answer

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 10

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?

Accepted Answer

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 11

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 12

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?

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 O? therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.

Question 13

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?

Accepted Answer

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 14

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?

Accepted Answer

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 O₂saturation 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 15

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?

Accepted Answer

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 16

The nurse teaches a patient how to administer formoterol (Perforomist)through a nebulizer. Which action by the patient indicates good understanding of the teaching?

Accepted Answer

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 17

A patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?

Accepted Answer

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 18

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?

Accepted Answer

Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting b?-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 19

The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further 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 20

Which information will the nurse include in the asthma teaching plan for a patient being discharged?

Accepted Answer

Tremors are a common side effect of short-acting b?-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.

Quiz 28: Obstructive Pulmonary Diseases

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 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?

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 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

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

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?

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?

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

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?

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?

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?

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?

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 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?

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 patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?

The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?

Which information will the nurse include in the asthma teaching plan for a patient being discharged?

Quiz 28: Obstructive Pulmonary Diseases

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 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?

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 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

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

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?

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?

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

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?

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?

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?

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?

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 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?

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 patient is scheduled for spirometry. Which action should the nurse take to prepare the patient for this procedure?

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful?

The nurse teaches a patient about pursed-lip breathing. Which action by the patient would indicate to the nurse that further teaching is needed?

Which information will the nurse include in the asthma teaching plan for a patient being discharged?

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 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?

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?