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Which of the following information should the nurse teach a patient with COPD?
- A. To exercise immediately before a meal.
- B. To eat a high-calorie, low-protein diet.
- C. To have 5 or 6 small meals a day.
- D. Avoid foods that are cooked in a microwave.
Correct Answer: C
Rationale: Eating five to six small meals per day helps avoid feelings of bloating and early satiety. The use of frozen foods and a microwave oven may help conserve a patient's energy in food preparation. Exercises should be avoided for at least 1 hour before and after eating. A high-calorie, high-protein diet is recommended.
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The nurse is caring for a patient with a history of asthma. Which of the following assessment findings should the nurse communicate immediately to the health care provider?
- A. Pulse oximetry reading of 94%.
- B. Respiratory rate of 26 breaths/minute.
- C. Use of accessory muscles in breathing.
- D. Peak expiratory flow rate of 240 mL/minute.
Correct Answer: C
Rationale: Use of accessory muscle indicates that the patient is experiencing respiratory distress and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.
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 teaching a patient with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include?
- A. Stop exercising if you start to feel short of breath.'
- B. Use the bronchodilator before you start to exercise.'
- C. Breathe in and out through the mouth while you exercise.'
- D. Upper body exercise should be avoided to prevent dyspnea.'
Correct Answer: B
Rationale: Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath is normal with exercise and not a reason to stop. Patients should be taught to breathe in through the nose and out through the mouth (using a pursed lip technique). Upper-body exercise can improve the mechanics of breathing in patients with COPD.
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.
Which of the following topics should the nurse include in medication teaching for a patient with newly diagnosed persistent asthma?
- A. Use of long-acting β-adrenergic medications.
- B. Adverse effects of sustained-release theophylline.
- C. Self-administration of inhaled corticosteroids.
- D. Complications associated with oxygen therapy.
Correct Answer: C
Rationale: Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.