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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.
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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 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).
The nurse is caring for a patient who is hospitalized with cystic fibrosis (CF) and is coughing up large quantities of thick green mucus. Which of the following treatments should the nurse include in the teaching plan?
- A. Antibiotic resistance.
- B. Inhaled bronchodilators.
- C. Oral corticosteroid therapy.
- D. Aerosolized amoxicillin.
Correct Answer: D
Rationale: The colour of the mucus and the patient's history of CF suggests Pseudomonas infection; an antibiotic is required. Oral corticosteroids and inhaled bronchodilators will not be effective in treating the respiratory infection; the effectiveness of bronchodilators has not been established for CF. Pseudomonas infections are usually responsive (not resistant) to TOBI.
The nurse is caring for a patient in the emergency department who is experiencing an acute asthma attack. After listening to the patient's breath sounds, which of the following should the nurse take next?
- A. Start an intravenous with Ringer's Lactate.
- B. Ask about inhaled corticosteroid use.
- C. Determine when the dyspnea started.
- D. Obtain a peak expiratory flow rate (PEFR).
Correct Answer: D
Rationale: The examiner can assess the degree of severity by measuring FEV1 or PEFR, identifying the degree of change in objective measurements, and evaluating the baseline pulse oximetry value. The length of time the attack has persisted is not as important as determining the patient's status at present. It is important to know about the medications the patient is using but not as important as assessing the breath sounds. Initiating IV therapy is not a priority at this time.
The nurse is caring for a patient with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
- A. Tell the patient to go to the hospital emergency department.
- B. Instruct the patient to use the prescribed salbutamol.
- C. Ask about recent exposure to any new allergens or asthma triggers.
- D. Question the patient about use of the prescribed inhaled corticosteroids.
Correct Answer: B
Rationale: The patient's peak flow is 70% of normal, in the yellow zone, indicating a need for immediate use of short-acting β-adrenergic (SABA) medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.