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A nurse is reviewing the pathophysiology of cystic fibrosis (CF) in anticipation of a new admission. The nurse should identify what characteristic aspects of CF?
- A. Alveolar mucus plugging, infection, and eventual bronchiectasis
- B. Bronchial mucus plugging, inflammation, and eventual bronchiectasis
- C. Atelectasis, infection, and eventual COPD
- D. Bronchial mucus plugging, infection, and eventual COPD
Correct Answer: B
Rationale: The hallmark pathology of CF is bronchial mucus plugging, inflammation, and eventual bronchiectasis. Commonly, the bronchiectasis begins in the upper lobes and progresses to involve all lobes. Infection, atelectasis, and COPD are not hallmark pathologies of CF.
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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.
A student nurse is developing a teaching plan for an adult patient with asthma. Which teaching point should have the highest priority in the plan of care that the student is developing?
- A. Gradually increase levels of physical exertion.
- B. Change filters on heaters and air conditioners frequently.
- C. Take prescribed medications as scheduled.
- D. Avoid goose-down pillows.
Correct Answer: C
Rationale: Although all of the measures are appropriate for a client with asthma, taking prescribed medications on time is the most important measure in preventing asthma attacks.
A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
- A. Teach the patient strategies for promoting diaphragmatic breathing.
- B. Administer supplementary oxygen by simple face mask.
- C. Teach the patient to perform airway suctioning.
- D. Assist the patient in developing an appropriate exercise program.
Correct Answer: A
Rationale: The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in patients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.
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 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.