f. Budesonide
g. Beclomethasone (Qvar) h. Theophylline (Elixophyllin) i. Mometasone (Asmanex Twisthaler)
8. When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which statement by the patient shows the nurse that the patient needs more teaching?
a. “I do not need to use the spacer like I used to.”
b. “I will hold my breath for 10 seconds or longer if I can.”
c. “I will not shake this inhaler like I did with my old inhaler.”
d. “I will store it in the bathroom so I will be able to clean it when I need to.”
9. Which statements by a patient with moderate asthma inform the nurse that the patient needs more teaching about medications (select all that apply)?
a. “If I can't afford all of my medicines, I will only use the salmeterol (Serevent).”
b. “I will stay inside if there is a high pollen count to prevent having an asthma attack.”
c. “I will rinse my mouth after using fluticasone (Flovent HFA) to prevent oral candidiasis.”
d. “I must have omalizumab (Xolair) injected every 2 to 4 weeks because inhalers don't help my asthma.”
e. “I can use my inhaler three times, every 20 minutes, before going to the hospital if my peak flow has not improved.”
f. “My gastroesophageal reflux disease (GERD) medications will help my asthma, and my asthma medications will help my GERD.”
10. Priority Decision: To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do?
a. Leave the patient alone to rest in a quiet, calm environment.
b. Stay with the patient and encourage slow, pursed lip breathing.
c. Reassure the patient that the attack can be controlled with treatment.
d. Let the patient know that frequent monitoring is being done using measurement of vital signs and SpO2.
11. When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse instruct the patient to do?
a. Carry the flowmeter with the patient at all times in case an asthma attack occurs.
b. Use the flowmeter to check the status of the patient's asthma every time the patient takes quick- relief medication.
c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone.
d. Use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible.
12. The nurse recognizes that additional teaching is needed when the patient with asthma says a. “I should exercise every day if my symptoms are controlled.”
b. “I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness.”
c. “I should inform my spouse about my medications and how to get help if I have a severe asthma attack.”
d. “A diary to record my medication use, symptoms, peak expiratory flow rates, and activity levels will help in adjusting my therapy.”
13. Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking?
a. Bronchospasm and hoarseness
b. Decreased mucus secretions and cough
c. Increased function of alveolar macrophages
d. Increased risk of infection and hyperplasia of mucous glands
14. Indicate whether the following clinical manifestations are most characteristic of asthma (A), chronic obstructive pulmonary disease (COPD) (C), or both (B).
______ a. Wheezing ______ b. Weight loss ______ c. Barrel chest ______ d. Polycythemia ______ e. Cor pulmonale ______ f. Flattened diaphragm ______ g. Decreased breath sounds ______ h. Increased total lung capacity ______ i. Frequent sputum production
______ j. Increased fractional exhaled nitric oxide (FENO)
15. What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD?
a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long-term low-flow oxygen therapy
d. Administration of high concentrations of oxygen
16. In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease?
a. Use of bronchodilator drugs b. Use of inhaled corticosteroids c. Lung volume–reduction surgery
d. Prevention of respiratory tract infections
17. Which method of oxygen administration is the safest system to use for a patient with COPD exacerbation?
a. Venturi mask b. Nasal cannula c. Simple face mask d. Non-rebreather mask
18. What is characteristic of a partial rebreather mask?
a. Used for long-term O2 therapy b. Reservoir bag conserves oxygen
c. Provides highest oxygen concentrations
d. Most comfortable and causes the least restriction on activities
19. A patient is being discharged with plans for home O2 therapy provided by an O2 concentrator with a portable O2-concentrator unit. In preparing the patient to use the equipment, what should the nurse teach the patient?
a. The portable unit will last about 6 to 8 hours.
b. The unit is strictly for portable and emergency use.
c. The unit concentrates O2 from the air, providing a continuous O2 supply.
d. Weekly delivery of one large cylinder of O2 will be necessary for a 7- to 10-day supply of O2. 20. Which breathing technique should the nurse teach the patient with moderate COPD to promote
exhalation?
a. Huff coughing
b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing
21. What does the nurse include when planning for postural drainage for the patient with COPD?
a. Schedules the procedure 1 hour before and after meals b. Has the patient cough before positioning to clear the lungs
c. Assesses the patient's tolerance for dependent (head-down) positions
d. Ensures that percussion and vibration are performed before positioning the patient 22. Which dietary modification helps to meet the nutritional needs of patients with COPD?
a. Eating a high-carbohydrate, low-fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digestion
23. Teamwork and Collaboration: The nurse is caring for a patient with COPD. Which intervention could be delegated to unlicensed assistive personnel (UAP)?
a. Assist the patient to get out of bed.
b. Auscultate breath sounds every 4 hours.
c. Plan patient activities to minimize exertion.
d. Teach the patient pursed lip breathing technique.
24. Which medication is a long-acting β2-adrenergic agonist and DPI that is used only for COPD?
a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacaterol (Arcapta Neohaler)
25. Priority Decision: During an acute exacerbation of mild COPD, the patient is severely short of breath, and the nurse identifies a nursing diagnosis of ineffective breathing pattern related to alveolar hypoventilation and anxiety. What is the best nursing action?
a. Prepare and administer routine bronchodilator medications.
b. Perform chest physiotherapy to promote removal of secretions.
c. Administer oxygen at 5 L/min until the shortness of breath is relieved.
d. Position the patient upright with the elbows resting on the over-the-bed table.
26. The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath.
What is the nurse's best response?
a. “You need to discuss your feelings and needs with your wife so that she knows what you expect of her.”
b. “There are other ways to maintain intimacy besides sexual intercourse that will not make her short of breath.”
c. “You should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity.”
d. “Would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?”
27. What should the nurse include when teaching the patient with COPD about the need for physical exercise?
a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day.
b. A bronchodilator inhaler should be used to relieve exercise-induced dyspnea immediately after exercise.
c. Shortness of breath is expected during exercise but should return to baseline within 5 minutes
after the exercise.
d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated.
28. The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 <60 mm Hg or SaO2 <88%) and hypercapnia (PaCO2 >45 mm Hg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure?
a. pH 7.35, PaO2 62 mm Hg, PaCO2 45 mm Hg b. pH 7.34, PaO2 45 mm Hg, PaCO2 65 mm Hg c. pH 7.42, PaO2 90 mm Hg, PaCO2 43 mm Hg d. pH 7.46, PaO2 92 mm Hg, PaCO2 32 mm Hg
29. Pulmonary rehabilitation (PR) is designed to reduce symptoms and improve the patient's quality of life. Along with improving exercise capacity, what are anticipated results of PR (select all that apply)?
a. Decreased FEV1
b. Decreased depression c. Increased oxygen need d. Decreased fear of exercise e. Decreased hospitalizations
30. What is the pathophysiologic mechanism of cystic fibrosis leading to obstructive lung disease?
a. Fibrosis of mucous glands and destruction of bronchial walls b. Destruction of lung parenchyma from inflammation and scarring
c. Production of secretions low in sodium chloride and resulting thickened mucus
d. Increased serum levels of pancreatic enzymes that are deposited in the bronchial mucosa 31. What is the most effective treatment for cystic fibrosis?
a. Heart-lung transplant
b. Administration of prophylactic antibiotics c. Administration of nebulized bronchodilators
d. Vigorous and consistent airway clearance techniques
32. Meeting the developmental tasks of young adults with cystic fibrosis becomes a major problem primarily because
a. they eventually need a lung transplant.
b. they must also adapt to a chronic disease.
c. any children they have will develop cystic fibrosis.
d. their illness keeps them from becoming financially independent.
33. In an adult patient with bronchiectasis, what is a nursing assessment likely to reveal?
a. Chest trauma b. Childhood asthma
c. Smoking or oral tobacco use
d. Recurrent lower respiratory tract infections
34. Priority Decision: In planning care for the patient with bronchiectasis, which nursing intervention is the priority?
a. Relieve or reduce pain
b. Prevent paroxysmal coughing
c. Prevent spread of the disease to others d. Promote drainage and removal of mucus
35. Which obstructive pulmonary disease would a 30-yr-old white female patient with a parent with the disease be most likely to be diagnosed with?
a. COPD b. Asthma c. Cystic fibrosis
d. α1-Antitrypsin (AAT) deficiency
36. What is the primary principle involved in the various airway clearance devices used for mobilizing secretions?
a. Vibration
b. Inhalation therapy c. Chest physiotherapy
d. Positive expiratory pressure
Case Study
Asthma
(©Wavebreakmedia/iStock/Thinkstock)
Patient Profile
E.S. is a 35-yr-old mother of two school-age boys who arrives via ambulance in the emergency department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED 6 hours earlier with an asthma attack.
Subjective Data
• Treated during previous ED visit with nebulized albuterol and responded quickly
• Allergic to cigarette smoke
• Began to experience increasing tightness in her chest and shortness of breath when she returned home following her previous ED visit
• Used the albuterol several times after she returned home with no relief
• Diagnosed with asthma 2 years ago
• Does not have a health care provider and is not on any medications Objective Data
Physical Examination
• Sitting upright and using accessory muscles to breathe
• Talks in one- to three-word sentences
• RR: 34 breaths/min and shallow
• Audible wheezing
• Auscultation of lung fields reveals no air movement in lower lobes
• HR: 126 bpm
• Noted to be extremely anxious and restless Diagnostic Studies
• ABGs: pH 7.46, PaCO 36 mm Hg, PaO 76 mm Hg, O saturation 88%
• Chest x-ray: bilateral lung hyperinflation with lower lobe atelectasis
• CBC with differential and electrolytes: within normal limits
An IV is started in her left forearm with normal saline infusing at 100 mL/hr.
Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What other assessment information should be obtained from E.S.?
2. Teamwork and Collaboration: What are the priority interprofessional team's interventions for E.S.?
3. What data obtained from the brief history, physical examination, and diagnostic studies indicate that E.S. is experiencing a severe or life-threatening asthma attack?
4. Identify two classifications of medications the nurse should expect to be administered to this patient. What effect is expected with these medications?
5. Patient-Centered Care: In addition to medication administration and close monitoring of the patient, what other key role can the nurse take in helping the patient through this episode?
6. What value would peak expiratory flow rate (PEFR) measures have during the care of E.S.?
7. Patient-Centered Care: What health care teaching should be included for this patient related to her asthma?
8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? What are the collaborative problems?
S E C T I O N 6
Problems of Oxygenation: Transport
OUTLINE
29 Assessment of Hematologic System 30 Hematologic Problems