Question 1

A patient with chronic obstructive pulmonary disease ( COPD ) is admitted to the hospital. How can the nurse best position the patient to improve gas exchange?

Accepted Answer

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.

Question 2

Which action should the nurse anticipate taking first when a patient who is experiencing an asthma attack develops bradycardia and a decrease in wheezing?

Accepted Answer

The patient's assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.

Question 3

When teaching the patient with chronic obstructive pulmonary disease ( COPD ) about exercise, which information should the nurse include?

Accepted Answer

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.

Question 4

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 patient statement indicates that the teaching has been effective?

Accepted Answer

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.

Question 5

A patient who is experiencing an acute asthma attack is admitted to the emergency department. The nurse's first action should be to

Accepted Answer

Assessment of the patient's breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient's status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient is using but not as important as assessing the breath sounds.

Question 6

Which diagnostic test will the nurse plan to discuss with a 54-year-old patient with progressively increasing dyspnea who is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease ( COPD )?

Accepted Answer

Pulmonary function testing will help establish the COPD diagnosis. The other tests would be used to test for an allergic component for asthma, but will not be used in the diagnosis of COPD.

Question 7

A patient with asthma who has a baseline peak flow reading of 600 mL calls the nurse, stating that the current peak flow is 420 mL. Which action should the nurse take first?

Accepted Answer

The patient's peak flow is 70% of normal, indicating a need for immediate use of short-acting b₂-adrenergic SABA medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.

Question 8

A 20-year-old patient with cystic fibrosis (CF) tells the nurse that she is considering having a child. Which initial response by the nurse is best?

Accepted Answer

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.

Question 9

The nurse in the emergency department receives arterial blood gas results for four recently admitted patients with obstructive pulmonary disease. Which patient will require the most rapid action by the nurse?

Accepted Answer

The pH, PaCO₂, and PaO₂ indicate that the patient has severe uncompensated respiratory acidosis and hypoxemia. Rapid action will be required to prevent increasing hypoxemia and correct the acidosis. The other patients also should be assessed as quickly as possible, but do not require interventions as quickly as the 20-year-old.

Question 10

A patient with cystic fibrosis (CF) has blood glucose levels that are consistently 200 to 250 mg/dL. Which nursing action will the nurse plan to implement?

Accepted Answer

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.

Question 11

Which finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider?

Accepted Answer

Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction; immediate intervention is needed. The other information also should be reported, but do not indicate possibly life-threatening complications of the omalizumab therapy.

Question 12

A patient who is hospitalized with cystic fibrosis (CF) coughs up large quantities of thick green mucus. The nurse will plan to teach the patient about

Accepted Answer

The color of the mucus and the patient's history of CF suggest Pseudomonas infection; TOBI is the standard of care for treatment of Pseudomonas in patients with CF. Oral corticosteroids and inhaled bronchodilators will not be effective in treating the respiratory infection; the effectiveness of bronchodilators has not been established for CF. Pseudomonas infections are usually responsive (not resistant) to TOBI.

Question 13

A patient with severe chronic obstructive pulmonary disease ( COPD ) tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, which nursing diagnosis is most appropriate?

Accepted Answer

The patient's statement about not being able to do anything for himself or herself supports this diagnosis. Although deficient knowledge, complicated grieving, and ineffective coping also may be appropriate diagnoses for patients with COPD, the data for this patient do not support these diagnoses.

Question 14

Which information given by an asthmatic patient while the nurse is doing the admission assessment is most indicative of a need for a change in therapy?

Accepted Answer

Long-acting b₂-agonists should be used only in patients who also are using an inhaled cortico-steroid for long-term control. Salmeterol should not be used as the first-line therapy 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.

Question 15

Which of these nursing actions included in the care plan for a patient with chronic obstructive pulmonary disease ( COPD ) should the nurse delegate to experienced nursing assistive personnel ( NAP )?

Accepted Answer

NAP can obtain oxygen saturation (after being trained and evaluated in the skill). The other actions require more education scope of practice and should be done by LPN/LVNs or by RNs.

Question 16

A patient with chronic obstructive pulmonary disease ( COPD ) has rhonchi throughout the lung fields and a chronic, nonproductive cough. Which nursing action will be most effective?

Accepted Answer

Airway clearance devices assist with moving mucus into larger airways where it can more easily be expectorated. The other actions may be appropriate for some patients with COPD, but they are not indicated for this patient's problem of thick mucous secretions.

Question 17

Which topic will the nurse include in medication teaching for a patient with newly-diagnosed persistent asthma?

Accepted Answer

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.

Question 18

When caring for a patient with a history of asthma, which assessment finding should the nurse communicate immediately to the health care provider?

Accepted Answer

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.

Question 19

Which action will be included in the plan of care for a 23-year-old with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea?

Accepted Answer

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.

Question 20

When the nurse takes an admission history for a patient with possible asthma who has new-onset wheezing and shortness of breath, which information may indicate a need for a change in therapy?

Accepted Answer

b-blockers such as propranolol can cause bronchospasm in some patients. The other information will be documented in the health history but does not indicate a need for a change in therapy.

Quiz 29: Nursing Management: Obstructive Pulmonary Diseases