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The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the patient in to improve gas exchange?
- A. Resting in bed with the head elevated to 45-60 degrees.
- B. Sitting up at the bedside in a chair and leaning slightly forward.
- C. Resting in bed in a high Fowler's position with the knees flexed.
- D. In the Trendelenburg position with several pillows behind the head.
Correct Answer: B
Rationale: Patients with COPD improve the mechanics of breathing by sitting up in the 'tripod' position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.
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The nurse is assessing a patient in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take?
- A. Teach the patient about the use of oral corticosteroids.
- B. Administer a bronchodilator and recheck the peak flow.
- C. Instruct the patient to continue to use current medications.
- D. Evaluate whether the peak flow meter is being used correctly.
Correct Answer: C
Rationale: The patient's peak flow readings indicate good asthma control (values over 80%) and no changes are needed. The other actions would be used for patients in the yellow or red zones for peak flow.
A young adult patient with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which of the following responses is best for the nurse to respond initially?
- A. Are you aware of the normal lifespan for patients with CF?'
- B. Do you need any information to help you with the decision?'
- C. You will need to have genetic counselling before making a decision.'
- D. Many women with CF do not have difficulty in conceiving children.'
Correct Answer: B
Rationale: The nurse's initial response should be to assess the patient's knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patient's comments. The other responses are accurate, but the nurse should first assess the patient's understanding about the issues surrounding pregnancy.
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.
The nurse is conducting an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
- A. The patient has a history of pneumonia 2 years ago.
- B. The patient has chronic inflammatory bowel disease.
- C. The patient takes propranolol for hypertension.
- D. The patient uses acetaminophen for headaches.
Correct Answer: C
Rationale: β-Blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.
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.