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Which of the following actions by a patient who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?
- A. The patient records an average of three peak flow readings every day.
- B. The patient inhales rapidly through the peak flow meter mouthpiece.
- C. The patient uses the salbutamol metered-dose inhaler (MDI) for peak flows in the yellow zone.
- D. The patient calls the health care provider when the peak flow is in the green zone.
Correct Answer: C
Rationale: Readings in the yellow zone indicate a decrease in peak flow; the patient should use short-acting β-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings.
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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 caring for a patient with cystic fibrosis (CF) who has blood glucose levels that are consistently 11-14 mmol/L. Which of the following nursing actions should the nurse plan to implement?
- A. Discuss the role of diet in blood glucose control.
- B. Educate the patient about administration of insulin.
- C. Give oral hypoglycemic medications before meals.
- D. Evaluate the patient's home use of pancreatic enzymes.
Correct Answer: B
Rationale: The glucose levels indicate that the patient has developed CF-related diabetes; insulin therapy will be required. Since the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.
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.
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.