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A patient with emphysema is experiencing shortness of breath. To relieve this patients symptoms, the nurse should assist her into what position?
- A. Sitting upright, leaning forward slightly
- B. Low Fowlers, with the neck slightly hyperextended
- C. Prone
- D. Trendelenburg
Correct Answer: A
Rationale: The typical posture of a person with COPD is to lean forward and use the accessory muscles of respiration to breathe. Low Fowlers positioning would be less likely to aid oxygenation. Prone or Trendelenburg positioning would exacerbate shortness of breath.
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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.
A nurse is caring for a young adult patient whose medical history includes an alpha-antitrypsin deficiency. This deficiency predisposes the patient to what health problem?
- A. Pulmonary edema
- B. Lobular emphysema
- C. Cystic fibrosis (CF)
- D. Empyema
Correct Answer: B
Rationale: A host risk factor for COPD is a deficiency of alpha-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patients risk of pulmonary edema, CF, or empyema.
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.
An asthma educator is teaching a patient newly diagnosed with asthma and her family about the use of a peak flow meter. The educator should teach the patient that a peak flow meter measures what value?
- A. Highest airflow during a forced inspiration
- B. Highest airflow during a forced expiration
- C. Airflow during a normal inspiration
- D. Airflow during a normal expiration
Correct Answer: B
Rationale: Peak flow meters measure the highest airflow during a forced expiration.
An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients?
- A. Encouraging patients to carry a corticosteroid rescue inhaler at all times
- B. Educating patients about recognizing and avoiding asthma triggers
- C. Teaching patients to utilize alternative therapies in asthma management
- D. Ensuring that patients keep their immunizations up to date
Correct Answer: B
Rationale: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.