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A young adult patient with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which of the following responses is best for the nurse to respond initially?
- A. Are you aware of the normal lifespan for patients with CF?'
- B. Do you need any information to help you with the decision?'
- C. You will need to have genetic counselling before making a decision.'
- D. Many women with CF do not have difficulty in conceiving children.'
Correct Answer: B
Rationale: The nurse's initial response should be to assess the patient's knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patient's comments. The other responses are accurate, but the nurse should first assess the patient's understanding about the issues surrounding pregnancy.
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After the nurse has finished teaching a patient about pursed lip breathing, which of the following patient actions indicate that more teaching is needed?
- A. The patient inhales slowly through the nose.
- B. The patient tenses the neck muscles while exhaling.
- C. The patient practises by blowing through a straw.
- D. The patient's ratio of inhalation to exhalation is 1:3.
Correct Answer: B
Rationale: The patient should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.
The nurse is interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
- A. The patient tells the nurse about a family history of bronchitis.
- B. The patient's history indicates a 40 pack-year cigarette history.
- C. The patient denies having any respiratory problems until the last 6 months.
- D. The patient complains about a productive cough every winter for 3 months.
Correct Answer: D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse is conducting an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
- A. The patient has a history of pneumonia 2 years ago.
- B. The patient has chronic inflammatory bowel disease.
- C. The patient takes propranolol for hypertension.
- D. The patient uses acetaminophen for headaches.
Correct Answer: C
Rationale: β-Blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.
The nurse is caring for a patient with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
- A. Tell the patient to go to the hospital emergency department.
- B. Instruct the patient to use the prescribed salbutamol.
- C. Ask about recent exposure to any new allergens or asthma triggers.
- D. Question the patient about use of the prescribed inhaled corticosteroids.
Correct Answer: B
Rationale: The patient's peak flow is 70% of normal, in the yellow zone, indicating a need for immediate use of short-acting β-adrenergic (SABA) medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.
The nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include?
- A. Stop exercising if you start to feel short of breath.'
- B. Use the bronchodilator before you start to exercise.'
- C. Breathe in and out through the mouth while you exercise.'
- D. Upper body exercise should be avoided to prevent dyspnea.'
Correct Answer: B
Rationale: Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.