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The nurse has completed patient teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the patient indicates good understanding of the teaching?
- A. The patient attaches a spacer (aerochamber) before using the MDI.
- B. The patient coughs vigorously after using the inhaler.
- C. The patient floats the MDI in water to see if it is empty.
- D. The patient activates the inhaler at the onset of expiration.
Correct Answer: A
Rationale: Spacers can improve the delivery of medication to the lower airways. The other patient actions indicate a need for further teaching.
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The nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective?
- A. No wheezes are audible.
- B. Oxygen saturation is >95%.
- C. Accessory muscle use has decreased.
- D. Respiratory rate is 16 breaths/minute.
Correct Answer: B
Rationale: The goal for treatment of an asthma attack is to keep the oxygen saturation >92%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.
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 caring for a patient with chronic obstructive pulmonary disease (COPD) who is about to be discharged and is to continue theophylline at home. Which of the following patient statements indicates a need for further teaching by the nurse?
- A. I will avoid drinking coffee or colas.
- B. I know I should take the medication with food.
- C. I will check my heart rate before taking the theophylline.
- D. I will let my health care provider know if I start to feel unusually nervous.
Correct Answer: A
Rationale: Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not impact whether the theophylline should be administered or not. Avoiding caffeine-containing beverages like coffee or colas is appropriate to prevent additive stimulant effects.
Which of the following diagnostic tests should the nurse plan to discuss with a patient who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)?
- A. Eosinophil count.
- B. Spirometry.
- C. Immunoglobin E (IgE) levels.
- D. Radioallergosorbent test (RAST).
Correct Answer: B
Rationale: The diagnosis of COPD is confirmed by spirometry regardless of whether the patient has chronic symptoms. The other tests would be used to test for an allergic component for asthma, but will not be used in the diagnosis of COPD.
The nurse is caring for a patient in the emergency department who is experiencing an acute asthma attack. After listening to the patient's breath sounds, which of the following should the nurse take next?
- A. Start an intravenous with Ringer's Lactate.
- B. Ask about inhaled corticosteroid use.
- C. Determine when the dyspnea started.
- D. Obtain a peak expiratory flow rate (PEFR).
Correct Answer: D
Rationale: The examiner can assess the degree of severity by measuring FEV1 or PEFR, identifying the degree of change in objective measurements, and evaluating the baseline pulse oximetry value. The length of time the attack has persisted is not as important as determining the patient's status at present. It is important to know about the medications the patient is using but not as important as assessing the breath sounds. Initiating IV therapy is not a priority at this time.