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The nurse is teaching a patient with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include?
- A. Stop exercising if you start to feel short of breath.'
- B. Use the bronchodilator before you start to exercise.'
- C. Breathe in and out through the mouth while you exercise.'
- D. Upper body exercise should be avoided to prevent dyspnea.'
Correct Answer: B
Rationale: Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.
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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.
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.
The nurse is caring for a patient with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care?
- A. Titrate oxygen to keep saturation at least 90%.
- B. Discuss a high-protein, high-calorie diet with the patient.
- C. Suggest the use of over-the-counter sedative medications.
- D. Teach the patient how to effectively use pursed lip breathing.
Correct Answer: D
Rationale: Pursed lip breathing techniques assist in prolonging the expiratory phase of respiration and decrease air trapping. There is no indication that the patient requires oxygen therapy or an improved diet. Sedative medications should be avoided because they decrease respiratory drive.
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.
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.