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Which of the following actions should the nurse take when a patient experiencing an asthma attack develops bradycardia and a decrease in wheezes?
- A. Administer oxygen at 100% per nonrebreather mask.
- B. Assist with endotracheal intubation.
- C. Encourage the patient to cough and deep breathe.
- D. Administer IV methylprednisolone.
Correct Answer: A
Rationale: The patient's assessment indicates impending respiratory failure, requiring immediate oxygen administration at 100% via nonrebreather mask to improve oxygenation. Endotracheal intubation may be needed if the condition worsens, but oxygen is the first action. IV corticosteroids require several hours to take effect. Coughing and deep breathing are not feasible during severe respiratory distress.
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The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with asthma. Which of the following patients require the most rapid action by the nurse?
- A. 20-year-old with ABG results: pH 7.28, PaCO2: 60 mm Hg, and PaO2: 58 mm Hg.
- B. 32-year-old with ABG results: pH 7.30, PaCO2: 30 mm Hg, and PaO2: 65 mm Hg.
- C. 40-year-old with ABG results: pH 7.34, PaCO2: 33 mm Hg, and PaO2: 80 mm Hg.
- D. 64-year-old with ABG results: pH 7.31, PaCO2: 58 mm Hg, and PaO2: 64 mm Hg.
Correct Answer: A
Rationale: The pH, PaCO2, and PaO2 indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible, but do not require interventions as quickly as the 20-year-old.
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 with cor pulmonale. Which of the following findings should the nurse assess for in the patient?
- A. Elevated temperature.
- B. Clubbing of the fingers.
- C. Jugular vein distension.
- D. Complaints of chest pain.
Correct Answer: C
Rationale: Cor pulmonale causes clinical manifestations of right ventricular failure, such as jugular vein distension. The other clinical manifestations may occur in the patient with other complications of chronic obstructive pulmonary disease (COPD) but are not indicators of cor pulmonale.
The nurse is interviewing a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
- A. The patient tells the nurse about a family history of bronchitis.
- B. The patient's history indicates a 40 pack-year cigarette history.
- C. The patient denies having any respiratory problems until the last 6 months.
- D. The patient complains about a productive cough every winter for 3 months.
Correct Answer: D
Rationale: A diagnosis of chronic bronchitis is based on a history of having a productive cough for 3 months for at least 2 consecutive years. There is no familial tendency for chronic bronchitis. Although smoking is the major risk factor for chronic bronchitis, a smoking history does not confirm the diagnosis.
The nurse is admitting a patient with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the patient in to improve gas exchange?
- A. Resting in bed with the head elevated to 45-60 degrees.
- B. Sitting up at the bedside in a chair and leaning slightly forward.
- C. Resting in bed in a high Fowler's position with the knees flexed.
- D. In the Trendelenburg position with several pillows behind the head.
Correct Answer: B
Rationale: Patients with COPD improve the mechanics of breathing by sitting up in the 'tripod' position. Resting in bed with the head elevated would be an alternative position if the patient was confined to bed, but sitting in a chair allows better ventilation. The Trendelenburg position or sitting upright in bed with the knees flexed would decrease the patient's ability to ventilate well.