Nokea
The nurse is caring for a patient with severe chronic obstructive pulmonary disease (COPD) who tells the nurse, 'I wish I were dead! I cannot do anything for myself anymore.' Based on this information, which of the following nursing diagnoses is best?
- A. Hopelessness related to chronic stress (expectation of death).
- B. Ineffective coping related to insufficient sense of control.
- C. Deficient knowledge related to insufficient information (education about COPD).
- D. Social isolation related to insufficient personal resources (increased physical dependence).
Correct Answer: D
Rationale: The patient's statement about not being able to do anything for himself or herself supports this diagnosis. Emotions frequently encountered include guilt, depression, anxiety, social isolation, denial, and dependence. Although deficient knowledge, hopelessness, and ineffective coping also may be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.
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After the nurse has completed diet teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following patient statements indicate that the teaching has been effective?
- A. I will drink lots of fluids with my meals.'
- B. I will have ice cream as a snack every day.'
- C. I will exercise for 10 minutes before meals.'
- D. I will decrease my intake of meat or poultry.'
Correct Answer: B
Rationale: High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.
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.
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.
After the nurse has finished teaching a patient about pursed lip breathing, which of the following patient actions indicate that more teaching is needed?
- A. The patient inhales slowly through the nose.
- B. The patient tenses the neck muscles while exhaling.
- C. The patient practises by blowing through a straw.
- D. The patient's ratio of inhalation to exhalation is 1:3.
Correct Answer: B
Rationale: The patient should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.
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.