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The nurse is caring for a patient with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care?
- A. Titrate oxygen to keep saturation at least 90%.
- B. Discuss a high-protein, high-calorie diet with the patient.
- C. Suggest the use of over-the-counter sedative medications.
- D. Teach the patient how to effectively use pursed lip breathing.
Correct Answer: D
Rationale: Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.
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The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with asthma. Which of the following patients require the most rapid action by the nurse?
- A. 20-year-old with ABG results: pH 7.28, PaCO2: 60 mm Hg, and PaO2: 58 mm Hg.
- B. 32-year-old with ABG results: pH 7.30, PaCO2: 30 mm Hg, and PaO2: 65 mm Hg.
- C. 40-year-old with ABG results: pH 7.34, PaCO2: 33 mm Hg, and PaO2: 80 mm Hg.
- D. 64-year-old with ABG results: pH 7.31, PaCO2: 58 mm Hg, and PaO2: 64 mm Hg.
Correct Answer: A
Rationale: The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible, but do not require interventions as quickly as the 20-year-old.
Which of the following information should the nurse teach a patient with COPD?
- A. To exercise immediately before a meal.
- B. To eat a high-calorie, low-protein diet.
- C. To have 5 or 6 small meals a day.
- D. Avoid foods that are cooked in a microwave.
Correct Answer: C
Rationale: Eating five to six small meals per day helps avoid feelings of bloating and early satiety. The use of frozen foods and a microwave oven may help conserve a patient's energy in food preparation. Exercises should be avoided for at least 1 hour before and after eating. A high-calorie, high-protein diet is recommended.
Which of the following information should the nurse include when teaching the patient with asthma about the prescribed medications?
- A. Utilize the inhaled corticosteroid when shortness of breath occurs.
- B. Inhale slowly and deeply when using the dry-powder inhaler (DPI).
- C. Hold your breath for 5 seconds after using the bronchodilator inhaler.
- D. Tremors are an expected adverse effect of rapidly acting bronchodilators.
Correct Answer: D
Rationale: Tremors are a common adverse effect of short-acting β2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
The nurse is preparing a patient with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?
- A. Avoid eating or drinking for several hours before the testing.
- B. Use rescue medications immediately before the tests are done.
- C. Take oral corticosteroids at least 2 hours before the examination.
- D. Withhold bronchodilators for 6-12 hours before the examination.
Correct Answer: D
Rationale: Bronchodilators are held before pulmonary function testing so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
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.