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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.
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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.
Which of the following findings by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?
- A. Pulse oximetry reading of 91.9%.
- B. Absence of wheezes or crackles.
- C. Decreased use of accessory muscles.
- D. Respiratory rate of 22 breaths/minute.
Correct Answer: A
Rationale: For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.
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.
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 developing a teaching plan to help increase activity tolerance at home for a 70-year-old patient with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the patient?
- A. Walk until pulse rate exceeds 130.
- B. Walk for a total of 20 minutes daily.
- C. Exercise until shortness of breath occurs.
- D. Limit exercise to activities of daily living (ADLs).
Correct Answer: B
Rationale: The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patient's exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).