Nokea
The nurse is preparing a patient with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?
- A. Avoid eating or drinking for several hours before the testing.
- B. Use rescue medications immediately before the tests are done.
- C. Take oral corticosteroids at least 2 hours before the examination.
- D. Withhold bronchodilators for 6-12 hours before the examination.
Correct Answer: D
Rationale: Bronchodilators are held before pulmonary function testing so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the decrease in lung function is reversible. There is no need for the patient to be NPO. Oral corticosteroids also should be held before the examination and corticosteroids given 2 hours before the examination would be at a high level. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
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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.
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.
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.
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.