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The patient with long-term emphysema is admitted with a secondary diagnosis of cor pulmonale. Which symptoms will the patient likely exhibit?
- A. Edema of the lower extremities and extended neck veins due to hypertension of the pulmonary circulation.
- B. A dry hacking cough and chest pain due to constriction of the pulmonary vein.
- C. Hypertension and a headache related to pulmonary hypertension.
- D. Unlabored respiration and cyanosis around the mouth.
Correct Answer: A
Rationale: COPD can lead to cor pulmonale, an abnormal cardiac condition characterized by hypertrophy of the right ventricle of the heart as a result of hypertension of the pulmonary circulation. Cor pulmonale results in the presence of edema in the lower extremities, as well as in the sacral and perineal area, distended neck veins, and enlargement of the liver with ascites.
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The patient has advanced emphysema and reports experiencing dyspnea and fatigue. Which nursing intervention would be appropriate for the patient who is having difficulty with activity tolerance?
- A. Direct patient in vigorous independent ROM.
- B. Allow to exercise until respirations are over 20 breaths/min over baseline.
- C. Plan care to provide optimum rest.
- D. Provide frequent cool showers.
Correct Answer: C
Rationale: Nursing interventions will be directed at attempting to decrease the patient's anxiety and promote optimal air exchange. The nurse should allow sufficient rest periods and should assist the patient in activities of daily living.
Which intervention should the nurse use to keep the chest tubes from becoming occluded?
- A. Irrigate tubes as needed.
- B. Prevent the patient from lying on it.
- C. Loop the tube over the bed rail.
- D. Milk' the tube frequently.
Correct Answer: B
Rationale: To keep the tubes patent, the patient should not lie on the tubing. These tubes are not irrigated and should not be milked frequently.
The nurse explains that the diagnostic test that can scan the chest and the abdomen in less than 30 seconds is the ___ CT scan.
Correct Answer: spiral
Rationale: The spiral or helical CT scan can scan the chest and the abdomen in less than 30 seconds. This test is faster and more accurate.
A patient, age 69, has emphysema. On assessment, the nurse notes the presence of a 'barrel chest.' Which pathology causes this to occur?
- A. An increase in the lateromedial area from hypertrophy of mucous glands in the bronchi
- B. An increased anteroposterior diameter caused by overinflation of the alveoli
- C. A decrease in anteroposterior diameter caused by chronic dilation of the bronchi
- D. A widening of the sternocostal area secondary to chronic constriction of smooth muscles in the airways leading to bronchospasms
Correct Answer: B
Rationale: The patient will eventually appear barrel chested (an increased anteroposterior diameter caused by overinflation).
In which way does pursed lip breathing assist patients with asthma during an attack?
- A. It distracts the patient with breathing technique to reduce anxiety.
- B. It gets rid of CO2 faster.
- C. It decreases breathing efforts.
- D. It increases PACO2.
Correct Answer: C
Rationale: Pursed lip breathing decreases the effort of breathing.