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After teaching a client who is prescribed a long-acting beta2 agonist medication, a nurse assesses the client's understanding. Which statement indicates the client comprehends the teaching?
- A. I will carry this medication with me at all times in case I need it.
- B. I will take this medication when I start to experience an asthma attack.
- C. I will take this medication every morning to help prevent an acute attack.
- D. I will be weaned off this medication when I no longer need it.
Correct Answer: C
Rationale: Long-acting beta2 agonist medications are used to prevent asthma attacks due to their long-acting nature. The client should take this medication daily for best effect. It is not a rescue medication, so it does not need to be carried at all times or used during an attack. Clients are not typically weaned off this medication as it is likely a daily maintenance therapy.
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A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first?
- A. A 46-year-old with a 30-year history of smoking.
- B. A 52-year-old in a tripod position using accessory muscles to breathe.
- C. A 50-year-old with dependent edema and clubbed fingers.
- D. A 74-year-old with a chronic cough and thick, tenacious secretions.
Correct Answer: B
Rationale: A client in a tripod position using accessory muscles is in acute respiratory distress and requires immediate assessment to prevent respiratory failure. The other clients' symptoms, while concerning, do not indicate immediate distress.
While assessing a client who is 12 hours postoperative after a thoracotomy for lung cancer, a nurse notices that the lower chest tube is dislodged. Which action should the nurse take first?
- A. Assess for drainage from the site.
- B. Cover the insertion site with sterile gauze.
- C. Contact the provider and obtain a suture kit.
- D. Reinsert the tube using sterile technique.
Correct Answer: B
Rationale: Covering the insertion site with sterile gauze prevents air from entering the pleural space, which could cause a pneumothorax. Assessing drainage, contacting the provider, or reinserting the tube are secondary actions after securing the site to prevent complications.
The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, 'The medication is too expensive to use every day. I only use my inhaler when I have an attack.' How should the nurse respond?
- A. You are using the inhaler incorrectly. This medication should be taken daily.
- B. If you avoid environmental stimuli, it will be okay to use the inhaler only for asthma attacks.
- C. Tell me more about your fears related to feelings of breathlessness.
- D. It is important to use this type of inhaler every day. Let's identify potential community services to help you.
Correct Answer: D
Rationale: Long-acting beta2 agonists are maintenance medications to prevent asthma attacks and should be used daily. Addressing the client's financial concerns by identifying community resources is the most effective response. Simply stating the inhaler is used incorrectly or exploring fears does not address the financial barrier.
A nurse auscultates a client's lung fields. Which pathophysiologic process should the nurse associate with this breath sound? (Click the media button to hear the audio clip)
- A. Inflammation of the pleura
- B. Upper airway obstruction
- C. Pulmonary vascular edema
- D. Bronchospasm
Correct Answer: A
Rationale: A pleural friction rub, heard when the pleura is inflamed, is associated with inflammation of the pleura rubbing against the lung wall. Upper airway obstruction causes stridor, pulmonary edema causes crackles, and bronchospasm causes wheezing.
A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which pathophysiologic process should the nurse associate with these clinical manifestations?
- A. Increased pulmonary pressure creating a higher workload on the right side of the heart.
- B. Increased pulmonary inflammation of the bronchi and bronchioles.
- C. Increased number and size of mucus glands producing large amounts of thick mucus.
- D. Left ventricular hypertrophy creating a decrease in cardiac output.
Correct Answer: A
Rationale: Smoking can lead to pulmonary hypertension, causing cor pulmonale (right-sided heart failure). This results in increased pulmonary pressure, backing up blood into the right heart and peripheral venous system, leading to distended neck veins and edema. The other options describe different pathophysiological processes not directly linked to these symptoms.