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The nurse is assessing a young adult patient in the outpatient clinic who has a new diagnosis of emphysema and does not have a history of smoking. Which of the following information should the nurse anticipate teaching the patient about?
- A. ?±1-antitrypsin testing
- B. Use of the nicotine patch
- C. Techniques for smoking cessation
- D. Avoidance of upper respiratory infections
Correct Answer: A
Rationale: Since the patient does not have a history of smoking, ?±1-antitrypsin deficiency is a likely cause of early-onset emphysema and should be investigated. The other options are not relevant since the patient is a non-smoker, and there is no indication of current respiratory infections.
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The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which of the following nursing actions is best?
- A. Change the oxygen flow rate to the highest prescribed rate.
- B. Reinforce the ongoing use of pursed lip breathing techniques.
- C. Educate the patient to use the Flutter airway clearance device.
- D. Teach the patient about consistent use of inhaled corticosteroids.
Correct Answer: C
Rationale: Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some patients with COPD, but they are not as effective for addressing rhonchi and nonproductive cough.
Which of the following information given by a patient with asthma while the nurse is doing the admission assessment is most indicative of a need for a change in therapy?
- A. The patient uses terbutaline before any aerobic exercise.
- B. The patient says that the asthma symptoms are worse every spring.
- C. The patient's heart rate increases after using the salbutamol inhaler.
- D. The patient's only medications are formoterol and salmeterol.
Correct Answer: D
Rationale: Long-acting β-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. The other information given by the patient requires further assessment by the nurse but is not unusual for a patient with asthma.
The nurse is evaluating the effectiveness of therapy for a patient with cor pulmonale. Which of the following findings should the nurse assess for in the patient?
- A. Elevated temperature.
- B. Clubbing of the fingers.
- C. Jugular vein distension.
- D. Complaints of chest pain.
Correct Answer: C
Rationale: Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.
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.
Which of the following topics should the nurse include in medication teaching for a patient with newly diagnosed persistent asthma?
- A. Use of long-acting β-adrenergic medications.
- B. Adverse effects of sustained-release theophylline.
- C. Self-administration of inhaled corticosteroids.
- D. Complications associated with oxygen therapy.
Correct Answer: C
Rationale: Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.