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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.
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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.
The nurse is caring for a patient with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the patient asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse's response?
- A. One drug decreases inflammation, and the other is a bronchodilator.
- B. It is a combination of long-acting and slow-acting bronchodilators.
- C. The combination of two drugs works more quickly in an acute asthma attack.
- D. The two drugs work together to block the effects of histamine on the bronchioles.
Correct Answer: A
Rationale: Salmeterol is a long-acting bronchodilator, and fluticasone is a corticosteroid. They work together to prevent asthma attacks. Neither medication is an antihistamine. The two-drug combination of salmeterol and fluticasone is not used during an acute attack because the medications do not work rapidly.
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.
The nurse is assessing a patient in the asthma clinic who has recorded daily peak flows that are 85% of the baseline. Which of the following actions should the nurse plan to take?
- A. Teach the patient about the use of oral corticosteroids.
- B. Administer a bronchodilator and recheck the peak flow.
- C. Instruct the patient to continue to use current medications.
- D. Evaluate whether the peak flow meter is being used correctly.
Correct Answer: C
Rationale: The patient's peak flow readings indicate good asthma control (values over 80%) and no changes are needed. The other actions would be used for patients in the yellow or red zones for peak flow.
The nurse has completed patient teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the patient indicates good understanding of the teaching?
- A. The patient attaches a spacer (aerochamber) before using the MDI.
- B. The patient coughs vigorously after using the inhaler.
- C. The patient floats the MDI in water to see if it is empty.
- D. The patient activates the inhaler at the onset of expiration.
Correct Answer: A
Rationale: Spacers can improve the delivery of medication to the lower airways. The other patient actions indicate a need for further teaching.