Nokea
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.
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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.
A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize?
- A. Smoking up to one-half of a pack of cigarettes weekly is allowable.
- B. Chronic inhalation of indoor toxins can cause lung damage.
- C. Minor respiratory infections are considered to be self-limited and are not treated.
- D. Activities of daily living (ADLs) should be clustered in the early morning hours.
Correct Answer: B
Rationale: Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all patients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. ADLs should be paced throughout the day to permit patients to perform these without excessive distress.
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.
A nurse is caring for a 6-year-old patient with cystic fibrosis. In order to enhance the childs nutritional status, what intervention should most likely be included in the plan of care?
- A. Pancreatic enzyme supplementation with meals
- B. Provision of five to six small meals per day rather than three larger meals
- C. Total parenteral nutrition (TPN)
- D. Magnesium, thiamine, and iron supplementation
Correct Answer: A
Rationale: Nearly 90% of patients with CF have pancreatic exocrine insufficiency and require oral pancreatic enzyme supplementation with meals. Frequent, small meals or TPN are not normally indicated. Vitamin supplements are required, but specific replacement of magnesium, thiamine, and iron is not typical.
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%.