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The nurse is caring for a patient with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the patient asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse's response?
- A. One drug decreases inflammation, and the other is a bronchodilator.
- B. It is a combination of long-acting and slow-acting bronchodilators.
- C. The combination of two drugs works more quickly in an acute asthma attack.
- D. The two drugs work together to block the effects of histamine on the bronchioles.
Correct Answer: A
Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. Neither medication is an antihistamine. The two-drug combination of salmeterol and fluticasone is not used during an acute attack because the medications do not work rapidly.
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The nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include?
- A. Stop exercising if you start to feel short of breath.'
- B. Use the bronchodilator before you start to exercise.'
- C. Breathe in and out through the mouth while you exercise.'
- D. Upper body exercise should be avoided to prevent dyspnea.'
Correct Answer: B
Rationale: Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.
Which of the following actions by a patient who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?
- A. The patient records an average of three peak flow readings every day.
- B. The patient inhales rapidly through the peak flow meter mouthpiece.
- C. The patient uses the salbutamol metered-dose inhaler (MDI) for peak flows in the yellow zone.
- D. The patient calls the health care provider when the peak flow is in the green zone.
Correct Answer: C
Rationale: Readings in the yellow zone indicate a decrease in peak flow; the patient should use short-acting β-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings.
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 interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
- A. The patient tells the nurse about a family history of bronchitis.
- B. The patient's history indicates a 40 pack-year cigarette history.
- C. The patient denies having any respiratory problems until the last 6 months.
- D. The patient complains about a productive cough every winter for 3 months.
Correct Answer: D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is about to be discharged and is to continue theophylline at home. Which of the following patient statements indicates a need for further teaching by the nurse?
- A. I will avoid drinking coffee or colas.
- B. I know I should take the medication with food.
- C. I will check my heart rate before taking the theophylline.
- D. I will let my health care provider know if I start to feel unusually nervous.
Correct Answer: A
Rationale: Cimetidine interferes with the metabolism of theophylline, and concomitant administration may lead rapidly to theophylline toxicity. The other patient information would not impact whether the theophylline should be administered or not. Avoiding caffeine-containing beverages like coffee or colas is appropriate to prevent additive stimulant effects.