Nokea
A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process?
- A. Intermittent episodes of acute bronchospasm
- B. Alveolar distention and impaired diffusion
- C. Dilation of bronchi and bronchioles
- D. Excessive gas exchange in the bronchioles
Correct Answer: C
Rationale: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. It is not characterized by acute bronchospasm, alveolar distention, or excessive gas exchange.
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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.
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 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.
A nurse is working with a child who is undergoing a diagnostic workup for suspected asthma. What are the signs and symptoms that are consistent with a diagnosis of asthma?
- A. Chest tightness
- B. Crackles
- C. Bradypnea
- D. Wheezing
- E. Cough
Correct Answer: A,D,E
Rationale: Asthma is a chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production. This inflammation ultimately leads to recurrent episodes of asthma symptoms: cough, chest tightness, wheezing, and dyspnea. Crackles and bradypnea are not typical symptoms of asthma.