Nokea
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.
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An older adult patient has been diagnosed with COPD. What characteristic of the patients current health status would preclude the safe and effective use of a metered-dose inhaler (MDI)?
- A. The patient has not yet quit smoking.
- B. The patient has severe arthritis in her hands.
- C. The patient requires both corticosteroids and beta-agonists.
- D. The patient has cataracts.
Correct Answer: B
Rationale: Safe and effective MDI use requires the patient to be able to manipulate the device independently, which may be difficult if the patient has arthritis. Smoking does not preclude MDI use. A modest loss of vision does not preclude the use of an MDI and a patient can safely use more than one MDI.
A nurse is teaching a patient with asthma about Azmacort, an inhaled corticosteroid. Which adverse effects should the nurse be sure to address in patient teaching?
- A. Dyspnea and increased respiratory secretions
- B. Nausea and vomiting
- C. Cough and oral thrush
- D. Fatigue and decreased level of consciousness
Correct Answer: C
Rationale: Azmacort has possible adverse effects of cough, dysphonia, oral thrush (candidiasis), and headache. In high doses, systemic effects may occur (e.g., adrenal suppression, osteoporosis, skin thinning, and easy bruising). The other listed adverse effects are not associated with this drug.
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 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.
A nurse is assessing a patient who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes?
- A. Pulmonary hypertension
- B. Airway obstruction
- C. Pulmonary infections
- D. Genetic disorders
- E. Atelectasis
Correct Answer: B,C,D
Rationale: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD. Bronchiectasis may be caused by a variety of conditions, including airway obstruction, diffuse airway injury, pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections, or genetic disorders such as cystic fibrosis. Bronchiectasis is not caused by pulmonary hypertension or atelectasis.