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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.
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A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD?
- A. Lung cancer
- B. Cystic fibrosis
- C. Respiratory failure
- D. Hemothorax
Correct Answer: C
Rationale: Complications of COPD include respiratory failure, pneumothorax, atelectasis, pneumonia, and pulmonary hypertension (cor pulmonale). Lung cancer, cystic fibrosis, and hemothorax are not common complications.
A school nurse is caring for a 10-year-old girl who is having an asthma attack. What is the preferred intervention to alleviate this clients airflow obstruction?
- A. Administer corticosteroids by metered dose inhaler
- B. Administer inhaled anticholinergics
- C. Administer an inhaled beta-adrenergic agonist
- D. Utilize a peak flow monitoring device
Correct Answer: C
Rationale: Asthma exacerbations are best managed by early treatment and education of the patient. Quick-acting beta-adrenergic medications are the first used for prompt relief of airflow obstruction. Systemic corticosteroids may be necessary to decrease airway inflammation in patients who fail to respond to inhaled beta-adrenergic medication. A peak flow device will not resolve short-term shortness of breath.
A nurse is documenting the results of assessment of a patient with bronchiectasis. What would the nurse most likely include in documentation?
- A. Sudden onset of pleuritic chest pain
- B. Wheezes on auscultation
- C. Increased anterior-posterior (A-P) diameter
- D. Clubbing of the fingers
Correct Answer: D
Rationale: Characteristic symptoms of bronchiectasis include chronic cough and production of purulent sputum in copious amounts. Clubbing of the fingers also is common because of respiratory insufficiency. Sudden pleuritic chest pain is a common manifestation of a pulmonary embolism. Wheezes on auscultation are common in patients with asthma. An increased A-P diameter is noted in patients with COPD.
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.
An interdisciplinary team is planning the care of a patient with bronchiectasis. What aspects of care should the nurse anticipate?
- A. Occupational therapy
- B. Antimicrobial therapy
- C. Positive pressure isolation
- D. Chest physiotherapy
- E. Smoking cessation
Correct Answer: B,D,E
Rationale: Chest physiotherapy, antibiotics, and smoking cessation are cornerstones of the care of patients with bronchiectasis. Occupational therapy and isolation are not normally indicated.