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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.
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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 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 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.
A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patients care?
- A. Oral administration of diuretics
- B. Intravenous fluids to reduce the viscosity of secretions
- C. Postural chest drainage
- D. Pulmonary function testing
Correct Answer: C
Rationale: Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Diuretics and IV fluids will not aid in the mobilization of secretions. Lung function testing may be indicated, but this assessment will not relieve the patients symptoms.
A nurse is developing a teaching plan for a patient with COPD. What should the nurse include as the most important area of teaching?
- A. Avoiding extremes of heat and cold
- B. Setting and accepting realistic short- and long-range goals
- C. Adopting a lifestyle of moderate activity
- D. Avoiding emotional disturbances and stressful situations
Correct Answer: B
Rationale: A major area of teaching involves setting and accepting realistic short-term and long-range goals. The other options should also be included in the teaching plan, but they are not areas that are as high a priority as setting and accepting realistic goals.