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The nurse is conducting an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
- A. The patient has a history of pneumonia 2 years ago.
- B. The patient has chronic inflammatory bowel disease.
- C. The patient takes propranolol for hypertension.
- D. The patient uses acetaminophen for headaches.
Correct Answer: C
Rationale: β-Blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.
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Which of the following diagnostic tests should the nurse plan to discuss with a patient who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)?
- A. Eosinophil count.
- B. Spirometry.
- C. Immunoglobin E (IgE) levels.
- D. Radioallergosorbent test (RAST).
Correct Answer: B
Rationale: The diagnosis of COPD is confirmed by spirometry regardless of whether the patient has chronic symptoms. The other tests would be used to test for an allergic component for asthma, but will not be used in the diagnosis of COPD.
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 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.
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 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.