Nokea
Which of the following information should the nurse include in teaching a patient with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy?
- A. Storage of oxygen tanks will require adequate space in the home.
- B. Travel opportunities will be limited because of the use of oxygen.
- C. Oxygen flow should be increased if the patient has dyspnea.
- D. Oxygen use can improve the patient's quality of life and survival.
Correct Answer: D
Rationale: Research shows that oxygen use can improve quality of life and survival in patients with COPD. Storage considerations, travel limitations, and oxygen flow adjustments require specific guidance, but the primary benefit to emphasize is the improvement in quality of life and survival.
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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 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.
After the nurse has completed diet teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following patient statements indicate that the teaching has been effective?
- A. I will drink lots of fluids with my meals.'
- B. I will have ice cream as a snack every day.'
- C. I will exercise for 10 minutes before meals.'
- D. I will decrease my intake of meat or poultry.'
Correct Answer: B
Rationale: High-calorie foods like ice cream are an appropriate snack for patients with COPD. Fluid intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods. The patient should avoid exercise for an hour before meals to prevent fatigue while eating. Meat and dairy products are high in protein and are good choices for the patient with COPD.
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.
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.