Nokea
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.
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The case manager for a group of patients with COPD is providing health education. What is most important for the nurse to assess when providing instructions on self-management to these patients?
- A. Knowledge of alternative treatment modalities
- B. Family awareness of functional ability and activities of daily living (ADLs)
- C. Knowledge of the pathophysiology of the disease process
- D. Knowledge about self-care and their therapeutic regimen
Correct Answer: D
Rationale: When providing instructions about self-management, it is important for the nurse to assess the knowledge of patients and family members about self-care and the therapeutic regimen. This supersedes knowledge of alternative treatments or the pathophysiology of the disease, neither of which is absolutely necessary for patients to know. The patients own knowledge is more important than that of the family.
A nurse is assessing a patient who is suspected of having bronchiectasis. The nurse should consider which of the following potential causes?
- A. Pulmonary hypertension
- B. Airway obstruction
- C. Pulmonary infections
- D. Genetic disorders
- E. Atelectasis
Correct Answer: B,C,D
Rationale: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles. Under the new definition of COPD, it is considered a disease process separate from COPD. Bronchiectasis may be caused by a variety of conditions, including airway obstruction, diffuse airway injury, pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections, or genetic disorders such as cystic fibrosis. Bronchiectasis is not caused by pulmonary hypertension or atelectasis.
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.
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.
A nurse is admitting a new patient who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the patient achieve the goal of maintaining effective oxygenation?
- A. Teach the patient strategies for promoting diaphragmatic breathing.
- B. Administer supplementary oxygen by simple face mask.
- C. Teach the patient to perform airway suctioning.
- D. Assist the patient in developing an appropriate exercise program.
Correct Answer: A
Rationale: The breathing pattern of most people with COPD is shallow, rapid, and inefficient; the more severe the disease, the more inefficient the breathing pattern. With practice, this type of upper chest breathing can be changed to diaphragmatic breathing, which reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Suctioning is not normally necessary in patients with COPD. Supplementary oxygen is not normally delivered by simple face mask and exercise may or may not be appropriate.