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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.
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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 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 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.
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.
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.