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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.
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The nurse is interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
- A. The patient tells the nurse about a family history of bronchitis.
- B. The patient's history indicates a 40 pack-year cigarette history.
- C. The patient denies having any respiratory problems until the last 6 months.
- D. The patient complains about a productive cough every winter for 3 months.
Correct Answer: D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with asthma. Which of the following patients require the most rapid action by the nurse?
- A. 20-year-old with ABG results: pH 7.28, PaCO2: 60 mm Hg, and PaO2: 58 mm Hg.
- B. 32-year-old with ABG results: pH 7.30, PaCO2: 30 mm Hg, and PaO2: 65 mm Hg.
- C. 40-year-old with ABG results: pH 7.34, PaCO2: 33 mm Hg, and PaO2: 80 mm Hg.
- D. 64-year-old with ABG results: pH 7.31, PaCO2: 58 mm Hg, and PaO2: 64 mm Hg.
Correct Answer: A
Rationale: The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible, but do not require interventions as quickly as the 20-year-old.
The nurse is teaching a patient about continuous home oxygen use and cautions the patient to take extra care to not run out of oxygen. Which of the following seasons should the nurse instruct the patient has the highest rate of oxygen evaporation?
- A. Spring.
- B. Summer.
- C. Fall.
- D. Winter.
Correct Answer: B
Rationale: During the summer, with liquid oxygen, evaporation is accelerated and may decrease reservoir duration to less than 1 week.
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 assessing a patient in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take?
- A. Teach the patient about the use of oral corticosteroids.
- B. Administer a bronchodilator and recheck the peak flow.
- C. Instruct the patient to continue to use current medications.
- D. Evaluate whether the peak flow meter is being used correctly.
Correct Answer: C
Rationale: The patient's peak flow readings indicate good asthma control (values over 80%) and no changes are needed. The other actions would be used for patients in the yellow or red zones for peak flow.