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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.
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Which of the following findings in a patient who has received omalizumab is considered an adverse effect?
- A. Pain at injection site.
- B. Flushing and dizziness.
- C. Respiratory rate 22 breaths/minute.
- D. Peak flow reading 75% of normal.
Correct Answer: A
Rationale: Reaction at injection site is the only adverse effect of omalizumab. The other information is not related to omalizumab therapy.
Which of the following actions should the nurse take when a patient experiencing an asthma attack develops bradycardia and a decrease in wheezes?
- A. Administer oxygen at 100% per nonrebreather mask.
- B. Assist with endotracheal intubation.
- C. Encourage the patient to cough and deep breathe.
- D. Administer IV methylprednisolone.
Correct Answer: A
Rationale: The patient's assessment indicates impending respiratory failure, requiring immediate oxygen administration at 100% via nonrebreather mask to improve oxygenation. Endotracheal intubation may be needed if the condition worsens, but oxygen is the first action. IV corticosteroids require several hours to take effect. Coughing and deep breathing are not feasible during severe respiratory distress.
The nurse has received a change-of-shift report about the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?
- A. A patient with a respiratory rate of 38.
- B. A patient with loud expiratory wheezes.
- C. A patient with jugular vein distension and peripheral edema.
- D. A patient who has a cough productive of thick, green mucus.
Correct Answer: A
Rationale: A respiratory rate of 38 indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the patient with tachypnea.
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 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.