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Which of the following actions should be included in the plan of care for a patient with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea?
- A. Schedule a sweat chloride test.
- B. Arrange for a hospice nurse visit.
- C. Place the patient on a low-sodium diet.
- D. Perform chest physiotherapy every 4 hours.
Correct Answer: D
Rationale: Routine scheduling of airway clearance techniques is an essential intervention for patients with CF. A sweat chloride test is used to diagnose CF, but it does not provide any information about the effectiveness of therapy. There is no indication that the patient is terminally ill. Patients with CF lose excessive sodium in their sweat and require high amounts of dietary sodium.
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The nurse is caring for a patient with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
- A. Tell the patient to go to the hospital emergency department.
- B. Instruct the patient to use the prescribed salbutamol.
- C. Ask about recent exposure to any new allergens or asthma triggers.
- D. Question the patient about use of the prescribed inhaled corticosteroids.
Correct Answer: B
Rationale: The patient's peak flow is 70% of normal, in the yellow zone, indicating a need for immediate use of short-acting β-adrenergic (SABA) medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.
The nurse is conducting an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
- A. The patient has a history of pneumonia 2 years ago.
- B. The patient has chronic inflammatory bowel disease.
- C. The patient takes propranolol for hypertension.
- D. The patient uses acetaminophen for headaches.
Correct Answer: C
Rationale: β-Blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem?
- A. Increase the patient's intake of fruits and fruit juices.
- B. Have the patient exercise for 10 minutes before meals.
- C. Assist the patient in choosing foods with a lot of texture.
- D. Offer high calorie snacks between meals and at bedtime.
Correct Answer: D
Rationale: Eating small amounts more frequently (as occurs with snacking) will increase caloric intake by decreasing the fatigue and feelings of fullness associated with large meals. Patients with COPD should rest before meals. Foods that have a lot of texture may take more energy to eat and lead to decreased intake. Although fruits and juices are not contraindicated, foods high in protein are a better choice.
The nurse has received a change-of-shift report about the following patients with chronic obstructive pulmonary disease (COPD). Which patient should the nurse assess first?
- A. A patient with a respiratory rate of 38.
- B. A patient with loud expiratory wheezes.
- C. A patient with jugular vein distension and peripheral edema.
- D. A patient who has a cough productive of thick, green mucus.
Correct Answer: A
Rationale: A respiratory rate of 38 indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest. The other patients also need assessment as soon as possible, but they do not need to be assessed as urgently as the patient with tachypnea.
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.