Nokea
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.
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A nurse is caring for a patient who has been admitted with an exacerbation of chronic bronchiectasis. The nurse should expect to assess the patient for which of the following clinical manifestations?
- A. Copious sputum production
- B. Pain on inspiration
- C. Pigeon chest
- D. Dry cough
Correct Answer: A
Rationale: Clinical manifestations of bronchiectasis include hemoptysis, chronic cough, copious purulent sputum, and clubbing of the fingers. Because of the copious production of sputum, the cough is rarely dry. A pigeon chest is not associated with the disease and patients do not normally experience pain on inspiration.
A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurses best answer?
- A. The most important risk factor for COPD is exposure to occupational toxins.
- B. The most important risk factor for COPD is inadequate exercise.
- C. The most important risk factor for COPD is exposure to dust and pollen.
- D. The most important risk factor for COPD is cigarette smoking.
Correct Answer: D
Rationale: The most important risk factor for COPD is cigarette smoking. Lack of exercise and exposure to dust and pollen are not risk factors for COPD. Occupational risks are significant but are far exceeded by smoking.
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 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 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.