Nokea
After the nurse has completed diet teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following patient statements indicate that the teaching has been effective?
- A. I will drink lots of fluids with my meals.'
- B. I will have ice cream as a snack every day.'
- C. I will exercise for 10 minutes before meals.'
- D. I will decrease my intake of meat or poultry.'
Correct Answer: B
Rationale: High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.
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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.
Which of the following topics should the nurse include in medication teaching for a patient with newly diagnosed persistent asthma?
- A. Use of long-acting β-adrenergic medications.
- B. Adverse effects of sustained-release theophylline.
- C. Self-administration of inhaled corticosteroids.
- D. Complications associated with oxygen therapy.
Correct Answer: C
Rationale: Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.
Which of the following actions should be included in the plan of care for a patient with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea?
- A. Schedule a sweat chloride test.
- B. Arrange for a hospice nurse visit.
- C. Place the patient on a low-sodium diet.
- D. Perform chest physiotherapy every 4 hours.
Correct Answer: D
Rationale: Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the patient is terminally ill. Patients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.
Which of the following actions by a patient who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?
- A. The patient records an average of three peak flow readings every day.
- B. The patient inhales rapidly through the peak flow meter mouthpiece.
- C. The patient uses the salbutamol metered-dose inhaler (MDI) for peak flows in the yellow zone.
- D. The patient calls the health care provider when the peak flow is in the green zone.
Correct Answer: C
Rationale: Readings in the yellow zone indicate a decrease in peak flow; the patient should use short-acting β-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings.
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.