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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.
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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 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.
A nurse is developing the teaching portion of a care plan for a patient with COPD. What would be the most important component for the nurse to emphasize?
- A. Smoking up to one-half of a pack of cigarettes weekly is allowable.
- B. Chronic inhalation of indoor toxins can cause lung damage.
- C. Minor respiratory infections are considered to be self-limited and are not treated.
- D. Activities of daily living (ADLs) should be clustered in the early morning hours.
Correct Answer: B
Rationale: Environmental risk factors for COPD include prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution, and outdoor air pollution. Smoking cessation should be taught to all patients who are currently smoking. Minor respiratory infections that are of no consequence to the person with normal lungs can produce fatal disturbances in the lungs of the person with emphysema. ADLs should be paced throughout the day to permit patients to perform these without excessive distress.
A nurse is providing health education to the family of a patient with bronchiectasis. What should the nurse teach the patients family members?
- A. The correct technique for chest palpation and auscultation
- B. Techniques for assessing the patients fluid balance
- C. The technique for providing deep nasotracheal suctioning
- D. The correct technique for providing postural drainage
Correct Answer: D
Rationale: A focus of the care of bronchiectasis is helping patients clear pulmonary secretions; consequently, patients and families are taught to perform postural drainage. Chest palpation and auscultation and assessment of fluid balance are not prioritized over postural drainage. Nasotracheal suctioning is not normally necessary.
A nurse is preparing to perform an admission assessment on a patient with COPD. It is most important for the nurse to review which of the following?
- A. Social work assessment
- B. Insurance coverage
- C. Chloride levels
- D. Available diagnostic tests
Correct Answer: D
Rationale: In addition to the patients history, the nurse reviews the results of available diagnostic tests. Social work assessment is not a priority for the majority of patients. Chloride levels are relevant to CF, not COPD. Insurance coverage is not normally the domain of the nurse.