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A nurse is caring for a patient who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the patient for which of the following clinical manifestations?
- A. Copious sputum production
- B. Pain on inspiration
- C. Pigeon chest
- D. Dry cough
Correct Answer: A
Rationale: Clinical manifestations of bronchiectasis include hemoptysis, chronic cough, copious purulent sputum, and clubbing of the fingers. Because of the copious production of sputum, the cough is rarely dry. A pigeon chest is not associated with the disease and patients do not normally experience pain on inspiration.
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A nurse is caring for a young adult patient whose medical history includes an alpha-antitrypsin deficiency. This deficiency predisposes the patient to what health problem?
- A. Pulmonary edema
- B. Lobular emphysema
- C. Cystic fibrosis (CF)
- D. Empyema
Correct Answer: B
Rationale: A host risk factor for COPD is a deficiency of alpha-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patients risk of pulmonary edema, CF, or empyema.
A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patients care?
- A. Oral administration of diuretics
- B. Intravenous fluids to reduce the viscosity of secretions
- C. Postural chest drainage
- D. Pulmonary function testing
Correct Answer: C
Rationale: Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Diuretics and IV fluids will not aid in the mobilization of secretions. Lung function testing may be indicated, but this assessment will not relieve the patients symptoms.
A patient is having pulmonary-function studies performed. The patient performs a spirometry test, revealing an FEV1/FVC ratio of 60%. How should the nurse interpret this assessment finding?
- A. Strong exercise tolerance
- B. Exhalation volume is normal
- C. Respiratory infection
- D. Obstructive lung disease
Correct Answer: D
Rationale: Spirometry is used to evaluate airflow obstruction, which is determined by the ratio of forced expiration volume in 1 second to forced vital capacity. Obstructive lung disease is apparent when an FEV1/FVC ratio is less than 70%.
A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following?
- A. Social work assessment
- B. Insurance coverage
- C. Chloride levels
- D. Available diagnostic tests
Correct Answer: D
Rationale: In addition to the patients history, the nurse reviews the results of available diagnostic tests. Social work assessment is not a priority for the majority of patients. Chloride levels are relevant to CF, not COPD. Insurance coverage is not normally the domain of the nurse.
A patient with emphysema is experiencing shortness of breath. To relieve this patients symptoms, the nurse should assist her into what position?
- A. Sitting upright, leaning forward slightly
- B. Low Fowlers, with the neck slightly hyperextended
- C. Prone
- D. Trendelenburg
Correct Answer: A
Rationale: The typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breathe. Low Fowlers positioning would be less likely to aid oxygenation. Prone or Trendelenburg positioning would exacerbate shortness of breath.