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The nurse instructs a client on how to correctly use an inhaler with a spacer. In which order should these steps occur? 1. Press down firmly on the canister to release one dose of medication. 2. Breathe in slowly and deeply. 3. Shake the whole unit vigorously three or four times. 4. Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. 5. Place the mouthpiece into the mouth, over the tongue, and seal the lips tightly around it. 6. Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds.
- A. 2,3,5,1,6,2
- B. 3,4,5,1,2,6
- C. 4,3,5,1,2,6
- D. 1,3,2,5,6,7,4
Correct Answer: C
Rationale: The correct order is: insert the inhaler into the spacer (4), shake the unit (3), place the mouthpiece in the mouth (5), release the medication (1), breathe in slowly and deeply (2), and hold the breath for 10 seconds (6).
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A nurse cares for a client with arthritis who reports frequent asthma attacks. Which action should the nurse take first?
- A. Review the client's pulmonary function test results.
- B. Review medications the client is currently taking.
- C. Assess how frequently the client uses a bronchodilator.
- D. Consider the report of the client with asthma phases.
Correct Answer: B
Rationale: Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) can trigger asthma in some people due to increased production of leukotrienes when aspirin or NSAIDs suppress other inflammatory pathways. This is a high-priority action given the client's history. Reviewing pulmonary function test results will not address the immediate problem of frequent asthma attacks. Assessing bronchodilator use addresses interventions for attacks but not their cause. Considering asthma phases is not a priority action.
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.
A nurse cares for a client with chronic obstructive pulmonary disease (COPD). The client states that he no longer enjoys going out with his friends. How should the nurse respond?
- A. There are a variety of support groups for people who have COPD.
- B. I will ask your provider to prescribe an antianxiety agent.
- C. Friends can be a good support system for clients with chronic disorders.
- D. Encourage the client to participate in social activities.
Correct Answer: A
Rationale: Many clients with moderate to severe COPD become socially isolated due to embarrassment from frequent coughing and mucus production or fatigue. Suggesting a support group addresses this issue by connecting the client with others who share similar experiences. Antianxiety agents or encouraging social activities without addressing the underlying cause are less effective.
A nurse cares for a client who is prescribed an intravenous prostacyclin agent. Which actions should the nurse take? (Select all that apply.)
- A. Keep an intravenous line dedicated strictly to the infusion.
- B. Teach the client that this medication increases pulmonary pressures.
- C. Ensure that there is always a backup drug cassette available.
- D. Start a large-bore peripheral intravenous line.
- E. Use strict aseptic technique when using the drug delivery system.
Correct Answer: A,C,E
Rationale: Prostacyclin should be administered via a dedicated central venous catheter with strict aseptic technique to prevent infection. A backup cassette is essential due to risks of interruption. The medication decreases pulmonary pressures, and a central line, not peripheral, is used.
After teaching a client how to perform diaphragmatic breathing, the nurse assesses the client's understanding. Which action demonstrates that the client correctly understands the teaching?
- A. The client lays on his or her side with knees bent.
- B. The client places his or her hands on his or her abdomen.
- C. The client lays in a prone position with his or her legs straight.
- D. The client places his or her hands above his or her head.
Correct Answer: B
Rationale: To perform diaphragmatic breathing correctly, the client should place their hands on their abdomen to feel the rise and fall of the diaphragm. This type of breathing cannot be performed effectively while lying on the side, in a prone position, or with hands above the head.