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A nurse is caring for a patient with COPD. The patients medication regimen has been recently changed and the nurse is assessing for therapeutic effect of a new bronchodilator. What assessment parameters suggest a consequent improvement in respiratory status?
- A. Negative sputum culture
- B. Increased viscosity of lung secretions
- C. Increased respiratory rate
- D. Increased expiratory flow rate
- E. Relief of dyspnea
Correct Answer: D,E
Rationale: The relief of bronchospasm is confirmed by measuring improvement in expiratory flow rates and volumes (the force of expiration, how long it takes to exhale, and the amount of air exhaled) as well as by assessing the dyspnea and making sure that it has lessened. Increased respiratory rate and viscosity of secretions would suggest a worsening of the patients respiratory status. Bronchodilators would not have a direct result on the patients infectious process.
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A nurse is providing discharge teaching for a client with COPD. When teaching the client about breathing exercises, what should the nurse include in the teaching?
- A. Lie supine to facilitate air entry
- B. Avoid pursed lip breathing
- C. Use diaphragmatic breathing
- D. Use chest breathing
Correct Answer: C
Rationale: Inspiratory muscle training and breathing retraining may help improve breathing patterns in patients with COPD. Training in diaphragmatic breathing reduces the respiratory rate, increases alveolar ventilation, and, sometimes, helps expel as much air as possible during expiration. Pursed-lip breathing helps slow expiration, prevents collapse of small airways, and controls the rate and depth of respiration. Diaphragmatic breathing, not chest breathing, increases lung expansion. Supine positioning does not aid breathing.
A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma?
- A. Shallow respirations
- B. Increased anterior-posterior (A-P) diameter
- C. Bilateral wheezes
- D. Bradypnea
Correct Answer: C
Rationale: The three most common symptoms of asthma are cough, dyspnea, and wheezing. There may be generalized wheezing (the sound of airflow through narrowed airways), first on expiration and then, possibly, during inspiration as well. Respirations are not usually slow and the childs A-P diameter does not normally change.
A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation?
- A. Sudden onset of pleuritic chest pain
- B. Wheezes on auscultation
- C. Increased anterior-posterior (A-P) diameter
- D. Clubbing of the fingers
Correct Answer: D
Rationale: Characteristic symptoms of bronchiectasis include chronic cough and production of purulent sputum in copious amounts. Clubbing of the fingers also is common because of respiratory insufficiency. Sudden pleuritic chest pain is a common manifestation of a pulmonary embolism. Wheezes on auscultation are common in patients with asthma. An increased A-P diameter is noted in patients with COPD.
A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process?
- A. Intermittent episodes of acute bronchospasm
- B. Alveolar distention and impaired diffusion
- C. Dilation of bronchi and bronchioles
- D. Excessive gas exchange in the bronchioles
Correct Answer: C
Rationale: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. It is not characterized by acute bronchospasm, alveolar distention, or excessive gas exchange.
The nurse is assessing a patient whose respiratory disease is characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
- A. Signs of oxygen toxicity
- B. Chronic chest pain
- C. A barrel chest
- D. Long, thin fingers
Correct Answer: C
Rationale: In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The patient would not show signs of oxygen toxicity unless he or she received excess supplementary oxygen.