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The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is receiving oxygen through a Venturi mask. Which of the following actions should the nurse take?
- A. Ensure that the oxygen flow is at least 10 L/min.
- B. Keep the air entrainment ports free of obstruction.
- C. Attach a humidifier to the oxygen delivery system.
- D. Drain condensation from the oxygen tubing every hour.
Correct Answer: B
Rationale: The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or nonrebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation.
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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 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 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.
Which of the following information should the nurse include in teaching a patient with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy?
- A. Storage of oxygen tanks will require adequate space in the home.
- B. Travel opportunities will be limited because of the use of oxygen.
- C. Oxygen flow should be increased if the patient has dyspnea.
- D. Oxygen use can improve the patient's quality of life and survival.
Correct Answer: D
Rationale: Research shows that oxygen use can improve quality of life and survival in patients with COPD. Storage considerations, travel limitations, and oxygen flow adjustments require specific guidance, but the primary benefit to emphasize is the improvement in quality of life and survival.
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).