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The nurse is assessing a patient whose respiratory disease is characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient?
- A. Signs of oxygen toxicity
- B. Chronic chest pain
- C. A barrel chest
- D. Long, thin fingers
Correct Answer: C
Rationale: In COPD patients with a primary emphysematous component, chronic hyperinflation leads to the barrel chest thorax configuration. The nurse most likely would not assess chest pain or long, thin fingers; these are not characteristic of emphysema. The patient would not show signs of oxygen toxicity unless he or she received excess supplementary oxygen.
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An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients?
- A. Encouraging patients to carry a corticosteroid rescue inhaler at all times
- B. Educating patients about recognizing and avoiding asthma triggers
- C. Teaching patients to utilize alternative therapies in asthma management
- D. Ensuring that patients keep their immunizations up to date
Correct Answer: B
Rationale: Asthma exacerbations are best managed by early treatment and education, including the use of written action plans as part of any overall effort to educate patients about self-management techniques, especially those with moderate or severe persistent asthma or with a history of severe exacerbations. Corticosteroids are not used as rescue inhalers. Alternative therapies are not normally a high priority, though their use may be appropriate in some cases. Immunizations should be kept up to date, but this does not necessarily prevent asthma exacerbations.
A nurses assessment reveals that a client with COPD may be experiencing bronchospasm. What assessment finding would suggest that the patient is experiencing bronchospasm?
- A. Fine or coarse crackles on auscultation
- B. Wheezes or diminished breath sounds on auscultation
- C. Reduced respiratory rate or lethargy
- D. Slow, deliberate respirations
Correct Answer: B
Rationale: Wheezing and diminished breath sounds are consistent with bronchospasm. Crackles are usually attributable to other respiratory or cardiac pathologies. Bronchospasm usually results in rapid, inefficient breathing and agitation.
A nurse is caring for a young adult patient whose medical history includes an alpha-antitrypsin deficiency. This deficiency predisposes the patient to what health problem?
- A. Pulmonary edema
- B. Lobular emphysema
- C. Cystic fibrosis (CF)
- D. Empyema
Correct Answer: B
Rationale: A host risk factor for COPD is a deficiency of alpha-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury. This deficiency predisposes young patients to rapid development of lobular emphysema even in the absence of smoking. This deficiency does not influence the patients risk of pulmonary edema, CF, or empyema.
A student nurse is preparing to care for a patient with bronchiectasis. The student nurse should recognize that this patient is likely to experience respiratory difficulties related to what pathophysiologic process?
- A. Intermittent episodes of acute bronchospasm
- B. Alveolar distention and impaired diffusion
- C. Dilation of bronchi and bronchioles
- D. Excessive gas exchange in the bronchioles
Correct Answer: C
Rationale: Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. It is not characterized by acute bronchospasm, alveolar distention, or excessive gas exchange.
A patient arrives in the emergency department with an attack of acute bronchiectasis. Chest auscultation reveals the presence of copious secretions. What intervention should the nurse prioritize in this patients care?
- A. Oral administration of diuretics
- B. Intravenous fluids to reduce the viscosity of secretions
- C. Postural chest drainage
- D. Pulmonary function testing
Correct Answer: C
Rationale: Postural drainage is part of all treatment plans for bronchiectasis, because draining of the bronchiectatic areas by gravity reduces the amount of secretions and the degree of infection. Diuretics and IV fluids will not aid in the mobilization of secretions. Lung function testing may be indicated, but this assessment will not relieve the patients symptoms.