Nokea
A nurse is evaluating the diagnostic study data of a patient with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis?
- A. Elevated sweat chloride concentration
- B. Presence of protein in the urine
- C. Positive phenylketonuria
- D. Malignancy on lung biopsy
Correct Answer: A
Rationale: Gene mutations affect transport of chloride ions, leading to CF, which is characterized by thick, viscous secretions in the lungs, pancreas, liver, intestine, and reproductive tract as well as increased salt content in sweat gland secretions. Proteinuria, positive phenylketonuria, and malignancy are not diagnostic for CF.
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A nurses assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the patient is experiencing bronchospasm?
- A. Fine or coarse crackles on auscultation
- B. Wheezes or diminished breath sounds on auscultation
- C. Reduced respiratory rate or lethargy
- D. Slow, deliberate respirations
Correct Answer: B
Rationale: Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, inefficient breathing and agitation.
An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients?
- A. Encouraging patients to carry a corticosteroid rescue inhaler at all times
- B. Educating patients about recognizing and avoiding asthma triggers
- C. Teaching patients to utilize alternative therapies in asthma management
- D. Ensuring that patients keep their immunizations up to date
Correct Answer: B
Rationale: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.
A nursing is planning the care of a patient with emphysema who will soon be discharged. What teaching should the nurse prioritize in the plan of care?
- A. Taking prophylactic antibiotics as ordered
- B. Adhering to the treatment regimen in order to cure the disease
- C. Avoiding airplanes, buses, and other crowded public places
- D. Setting realistic short-term and long-range goals
Correct Answer: D
Rationale: A major area of teaching involves setting and accepting realistic short-term and long-range goals. Emphysema is not considered curable and antibiotics are not used on a preventative basis. The patient does not normally need to avoid public places.
An admitting nurse is assessing a patient with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse to monitor the patient for what?
- A. Kyphosis and clubbing of the fingers
- B. Dyspnea and hypoxemia
- C. Sepsis and pneumothorax
- D. Bradypnea and pursed lip breathing
Correct Answer: B
Rationale: These changes in the airway require that the nurse monitor the patient for dyspnea and hypoxemia. Kyphosis is a musculoskeletal problem. Sepsis and pneumothorax are atypical complications. Tachypnea is much more likely than bradypnea. Pursed lip breathing can relieve dyspnea.
A nurse is planning the care of a client with bronchiectasis. What goal of care should the nurse prioritize?
- A. The patient will successfully mobilize pulmonary secretions.
- B. The patient will maintain an oxygen saturation level of 98%.
- C. The patients pulmonary blood pressure will decrease to within reference ranges.
- D. The patient will resume prediagnosis level of function within 72 hours.
Correct Answer: A
Rationale: Nursing management focuses on alleviating symptoms and helping patients clear pulmonary secretions. Pulmonary pressures are not a central focus in the care of the patient with bronchiectasis. Rapid resumption of prediagnosis function and oxygen saturation above 98% are unrealistic goals.