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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.
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A young adult patient with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which of the following responses is best for the nurse to respond initially?
- A. Are you aware of the normal lifespan for patients with CF?'
- B. Do you need any information to help you with the decision?'
- C. You will need to have genetic counselling before making a decision.'
- D. Many women with CF do not have difficulty in conceiving children.'
Correct Answer: B
Rationale: The nurse's initial response should be to assess the patient's knowledge level and need for information. Although the lifespan for patients with CF is likely to be shorter than normal, it would not be appropriate for the nurse to address this as the initial response to the patient's comments. The other responses are accurate, but the nurse should first assess the patient's understanding about the issues surrounding pregnancy.
The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old patient with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the patient?
- A. Walk until pulse rate exceeds 130.
- B. Walk for a total of 20 minutes daily.
- C. Exercise until shortness of breath occurs.
- D. Limit exercise to activities of daily living (ADLs).
Correct Answer: B
Rationale: The goal for exercise programs for patients with COPD is to increase exercise time gradually to a total of 20 minutes daily. Shortness of breath is normal with exercise and not an indication that the patient should stop. Limiting exercise to ADLs will not improve the patient's exercise tolerance. A 70-year-old patient should have a pulse rate of 120 or less with exercise (80% of the maximal heart rate of 150).
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.
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 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.