Nokea
Which of the following information should the nurse include when teaching the patient with asthma about the prescribed medications?
- A. Utilize the inhaled corticosteroid when shortness of breath occurs.
- B. Inhale slowly and deeply when using the dry-powder inhaler (DPI).
- C. Hold your breath for 5 seconds after using the bronchodilator inhaler.
- D. Tremors are an expected adverse effect of rapidly acting bronchodilators.
Correct Answer: D
Rationale: Tremors are a common adverse effect of short-acting β2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
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After the nurse has finished teaching a patient about pursed lip breathing, which of the following patient actions indicate that more teaching is needed?
- A. The patient inhales slowly through the nose.
- B. The patient tenses the neck muscles while exhaling.
- C. The patient practises by blowing through a straw.
- D. The patient's ratio of inhalation to exhalation is 1:3.
Correct Answer: B
Rationale: The patient should relax the neck and shoulder muscles while doing pursed lip breathing. The other actions by the patient indicate a good understanding of pursed lip breathing.
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 caring for a patient with chronic obstructive pulmonary disease (COPD) who is receiving oxygen through a Venturi mask. Which of the following actions should the nurse take?
- A. Ensure that the oxygen flow is at least 10 L/min.
- B. Keep the air entrainment ports free of obstruction.
- C. Attach a humidifier to the oxygen delivery system.
- D. Drain condensation from the oxygen tubing every hour.
Correct Answer: B
Rationale: The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or nonrebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation.
Which of the following findings by the nurse for a patient with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?
- A. Pulse oximetry reading of 91.9%.
- B. Absence of wheezes or crackles.
- C. Decreased use of accessory muscles.
- D. Respiratory rate of 22 breaths/minute.
Correct Answer: A
Rationale: For the nursing diagnosis of impaired gas exchange, the best data for evaluation are arterial blood gases (ABGs) or pulse oximetry. The other data may indicate either improvement or impending respiratory failure caused by fatigue.
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.