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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).
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Which of the following information should the nurse include when teaching the patient with asthma about the prescribed medications?
- A. Utilize the inhaled corticosteroid when shortness of breath occurs.
- B. Inhale slowly and deeply when using the dry-powder inhaler (DPI).
- C. Hold your breath for 5 seconds after using the bronchodilator inhaler.
- D. Tremors are an expected adverse effect of rapidly acting bronchodilators.
Correct Answer: D
Rationale: Tremors are a common adverse effect of short-acting β2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
The nurse is evaluating the effectiveness of therapy for a patient who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective?
- A. No wheezes are audible.
- B. Oxygen saturation is >95%.
- C. Accessory muscle use has decreased.
- D. Respiratory rate is 16 breaths/minute.
Correct Answer: B
Rationale: The goal for treatment of an asthma attack is to keep the oxygen saturation >92%. The other patient data may occur when the patient is too fatigued to continue with the increased work of breathing required in an asthma attack.
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.
The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the patient in to improve gas exchange?
- A. Resting in bed with the head elevated to 45-60 degrees.
- B. Sitting up at the bedside in a chair and leaning slightly forward.
- C. Resting in bed in a high Fowler's position with the knees flexed.
- D. In the Trendelenburg position with several pillows behind the head.
Correct Answer: B
Rationale: Patients with COPD improve the mechanics of breathing by sitting up in the 'tripod' position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.
Which of the following information given by a patient with asthma while the nurse is doing the admission assessment is most indicative of a need for a change in therapy?
- A. The patient uses terbutaline before any aerobic exercise.
- B. The patient says that the asthma symptoms are worse every spring.
- C. The patient's heart rate increases after using the salbutamol inhaler.
- D. The patient's only medications are formoterol and salmeterol.
Correct Answer: D
Rationale: Long-acting β-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. The other information given by the patient requires further assessment by the nurse but is not unusual for a patient with asthma.