Chapter 28 Obstructive Pulmonary Diseases PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter28:ObstructivePulmonaryDiseases TestBank MULTIPLECHOICE 1.ThenurseteachesapatientwithchronicbronchitisaboutanewprescriptionforAdvairDiskus(combined fluticasoneandsalmeterol).Whichactionbythepatientwouldindicatetothenursethatteachingabout medicationadministrationhasbeensuccessful? a.

Thepatientshakesthedevicebeforeuse.

b.

ThepatientattachesaspacertotheDiskus.

c.

Thepatientrapidlyinhalesthemedication.

d.

Thepatientperformshuffcoughingafterinhalation.

ANS:C Thepatientshouldinhalethemedicationrapidly.Otherwisethedryparticleswillsticktothetongueandoral mucosaandnotgetinhaledintothelungs.AdvairDiskusisadrypowderinhaler;shakingisnotrecommended Spacersarenotusedwithdrypowderinhalers.Huffcoughingisatechniquetomovemucusintolarger airwaystoexpectorate.ThepatientshouldnothuffcoughorexhaleforcefullyaftertakingAdvairinorderto keepthemedicationinthelungs. DIF:CognitiveLevel:Apply(application)REF:552 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 2.Thenurseteachesapatienthowtoadministerformoterol(Perforomist)throughanebulizer.Whichactionby thepatientindicatesgoodunderstandingoftheteaching? a.

Thepatientattachesaspacerbeforeusingtheinhaler.

b.

Thepatientcoughsvigorouslyafterusingtheinhaler.

c.

Thepatientactivatestheinhalerattheonsetofexpiration.

d.

Thepatientremovesthefacialmaskwhenmistinghasceased.

ANS:D Anebulizerisusedtoadministeraerosolizedmedication.Amistisseenwhenthemedicationisaerosolized, andwhenallofthemedicationhasbeenused,themistingstops.Theotheroptionsrefertoinhaleruse. Coughingvigorouslyafterinhalingandactivatingtheinhalerattheonsetofexpirationarebothincorrect techniqueswhenusinganinhaler. DIF:CognitiveLevel:Apply(application)REF:552 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity

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3.Apatientisscheduledforpulmonaryfunctiontesting.Whichactionshouldthenursetaketopreparethe patientforthisprocedure? a.

Givetherescuemedicationimmediatelybeforetesting.

b.

Administeroralcorticosteroids2hoursbeforetheprocedure.

c.

Withholdbronchodilatorsfor6to12hoursbeforetheexamination.

d.

EnsurethatthepatienthasbeenNPOforseveralhoursbeforethetest.

ANS:C Bronchodilatorsareheldbeforepulmonaryfunctiontesting(PFT)sothatabaselineassessmentofairway functioncanbedetermined.Testingisrepeatedafterbronchodilatorusetodeterminewhetherthedecreasein lungfunctionisreversible.ThereisnoneedforthepatienttobeNPO.Oralcorticosteroidsshouldbeheld beforePFTs.Rescuemedications(whicharebronchodilators)wouldnotbegivenuntilafterthebaseline pulmonaryfunctionwasassessed. DIF:CognitiveLevel:Apply(application)REF:544 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 4.Whichinformationwillthenurseincludeintheasthmateachingplanforapatientbeingdischarged? a.

Use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sideeffectofrapidlyactingbronchodilators.

ANS:D Tremorsareacommonsideeffectofshort-actingb2-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. DIF:CognitiveLevel:Apply(application)REF:550 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 5.Theemergencydepartmentnurseisevaluatingtheeffectivenessoftherapyforapatientwhohasreceived treatmentduringanasthmaattack.Whichassessmentfindingisthebestindicatorthatthetherapyhasbeen effective? a.

Nowheezesareaudible.

b.

Oxygensaturationis>90%.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

c.

Accessorymuscleusehasdecreased.

d.

Respiratoryrateis16breaths/minute.

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ANS:B Thegoalfortreatmentofanasthmaattackistokeeptheoxygensaturation>90%.Theotherpatientdatamay occurwhenthepatientistoofatiguedtocontinuewiththeincreasedworkofbreathingrequiredinanasthma attack. DIF:CognitiveLevel:Apply(application)REF:547 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 6.Apatientseenintheasthmaclinichasrecordeddailypeakflowsthatare75%ofthebaseline.Whichaction willthenurseplantotakenext? a.

Increasethedoseoftheleukotrieneinhibitor.

b.

Teachthepatientabouttheuseoforalcorticosteroids.

c.

Administerabronchodilatorandrecheckthepeakflow.

d.

Instructthepatienttokeepthenextscheduledfollow-upappointment.

ANS:C Thepatientspeakflowreadingindicatesthattheconditionisworsening(yellowzone).Thepatientshouldtake thebronchodilatorandrecheckthepeakflow.Dependingonwhetherthepatientreturnstothegreenzone, indicatingwell-controlledsymptoms,thepatientmaybeprescribedoralcorticosteroidsorachangeindosing ofothermedications.Keepingthenextappointmentisappropriate,butthepatientalsoneedstobetaughthow tocontrolsymptomsnowandusethebronchodilator. DIF:CognitiveLevel:Apply(application)REF:558 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 7.Thenurseteachesapatientwhohasasthmaaboutpeakflowmeteruse.Whichactionbythepatient indicatesthatteachingwassuccessful? a.

Thepatientinhalesrapidlythroughthepeakflowmetermouthpiece.

b.

Thepatienttakesmontelukast(Singulair)forpeakflowsintheredzone.

c.

Thepatientcallsthehealthcareproviderwhenthepeakflowisinthegreenzone.

d.

Thepatientusesalbuterol(Proventil)metereddoseinhaler(MDI)forpeakflowsintheyellow zone.

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ANS:D Readingsintheyellowzoneindicateadecreaseinpeakflow.Thepatientshoulduseshort-actingb2adrenergic(SABA)medications.Readingsinthegreenzoneindicategoodasthmacontrol.Thepatientshould exhalequicklyandforcefullythroughthepeakflowmetermouthpiecetoobtainthereadings.Readingsinthe redzonedonotindicategoodpeakflow,andthepatientshouldtakeafast-actingbronchodilatorandcallthe healthcareproviderforfurtherinstructions.Singulairisnotindicatedforacuteattacksbutratherisusedfor maintenancetherapy. DIF:CognitiveLevel:Apply(application)REF:546 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 8.Ayoungadultpatientwhodeniesanyhistoryofsmokingisseenintheclinicwithanewdiagnosisof chronicobstructivepulmonarydisease(COPD).Itismostappropriateforthenursetoteachthepatientabout a.

a1-antitrypsintesting.

b.

useofthenicotinepatch.

c.

continuouspulseoximetry.

d.

effectsofleukotrienemodifiers.

ANS:A WhenCOPDoccursinyoungpatients,especiallywithoutasmokinghistory,ageneticdeficiencyina1antitrypsinshouldbesuspected.Becausethepatientdoesnotsmoke,anicotinepatchwouldnotbeordered. Thereisnoindicationthatthepatientrequirescontinuouspulseoximetry.Leukotrienemodifierswouldbe usedinpatientswithasthma,notwithCOPD. DIF:CognitiveLevel:Apply(application)REF:560 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 9.Thenurseiscaringforapatientwithchronicobstructivepulmonarydisease(COPD).Whichinformation obtainedfromthepatientwouldpromptthenursetoconsultwiththehealthcareproviderbeforeadministering theprescribedtheophylline? a.

Thepatientreportsarecent15-poundweightgain.

b.

Thepatientdeniesanyshortnessofbreathatpresent.

c.

Thepatienttakescimetidine(Tagamet)150mgdaily.

d.

Thepatientcomplainsaboutcoughingupgreenmucus.

ANS:C Cimetidineinterfereswiththemetabolismoftheophylline,andconcomitantadministrationmayleadrapidlyto theophyllinetoxicity.Theotherpatientinformationwouldnotaffectwhetherthetheophyllineshouldbe administeredornot.

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DIF:CognitiveLevel:Apply(application)REF:549 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 10.Apatientwithchronicobstructivepulmonarydisease(COPD)hasanursingdiagnosisofimpaired breathingpatternrelatedtoanxiety.Whichnursingactionismostappropriatetoincludeintheplanofcare? a.

Titrateoxygentokeepsaturationatleast90%.

b.

Discussahigh-protein,high-caloriedietwiththepatient.

c.

Suggesttheuseofover-the-countersedativemedications.

d.

Teachthepatienthowtoeffectivelyusepursedlipbreathing.

ANS:D Pursedlipbreathingtechniquesassistinprolongingtheexpiratoryphaseofrespirationanddecreaseair trapping.Thereisnoindicationthatthepatientrequiresoxygentherapyoranimproveddiet.Sedative medicationsshouldbeavoidedbecausetheydecreaserespiratorydrive. DIF:CognitiveLevel:Apply(application)REF:556 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 11.Apatientwithchronicobstructivepulmonarydisease(COPD)hasanursingdiagnosisofimbalanced nutrition:lessthanbodyrequirements.Whichinterventionwouldbemostappropriateforthenursetoinclude intheplanofcare? a.

Encourageincreasedintakeofwholegrains.

b.

Increasethepatientsintakeoffruitsandfruitjuices.

c.

Offerhigh-caloriesnacksbetweenmealsandatbedtime.

d.

Assistthepatientinchoosingfoodswithhighvegetableandmineralcontent.

ANS:C Eatingsmallamountsmorefrequently(asoccurswithsnacking)willincreasecaloricintakebydecreasingthe fatigueandfeelingsoffullnessassociatedwithlargemeals.PatientswithCOPDshouldrestbeforemeals. Foodsthathavealotoftexturelikewholegrainsmaytakemoreenergytoeatandgetabsorbedandleadto decreasedintake.Althoughfruits,juices,andvegetablesarenotcontraindicated,foodshighinproteinarea betterchoice. DIF:CognitiveLevel:Apply(application)REF:574 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 12.Thenurseinterviewsapatientwithanewdiagnosisofchronicobstructivepulmonarydisease(COPD). Whichinformationismosthelpfulinconfirmingadiagnosisofchronicbronchitis?

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a.

Thepatienttellsthenurseaboutafamilyhistoryofbronchitis.

b.

Thepatientshistoryindicatesa30pack-yearcigarettehistory.

c.

Thepatientcomplainsaboutaproductivecougheverywinterfor3months.

d.

Thepatientdenieshavinganyrespiratoryproblemsuntilthelast12months.

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ANS:C Adiagnosisofchronicbronchitisisbasedonahistoryofhavingaproductivecoughfor3monthsforatleast2 consecutiveyears.Thereisnofamilytendencyforchronicbronchitis.Althoughsmokingisthemajorrisk factorforchronicbronchitis,asmokinghistorydoesnotconfirmthediagnosis. DIF:CognitiveLevel:Apply(application)REF:557 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 13.Thenurseteachesapatientaboutpursedlipbreathing.Whichactionbythepatientwouldindicatetothe nursethatfurtherteachingisneeded? a.

Thepatientinhalesslowlythroughthenose.

b.

Thepatientpuffsupthecheekswhileexhaling.

c.

Thepatientpracticesbyblowingthroughastraw.

d.

Thepatientsratioofinhalationtoexhalationis1:3.

ANS:B Thepatientshouldrelaxthefacialmuscleswithoutpuffingthecheekswhiledoingpursedlipbreathing.The otheractionsbythepatientindicateagoodunderstandingofpursedlipbreathing. DIF:CognitiveLevel:Apply(application)REF:557 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 14.Whichfinding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.

Even,unlaboredrespirations

b.

Pulseoximetryreadingof92%

c.

Respiratoryrateof18breaths/minute

d.

Absenceofwheezes,rhonchi,orcrackles

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ANS:B 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. DIF:CognitiveLevel:Apply(application)REF:576 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 15.Thenurseiscaringforapatientwithcorpulmonale.Thenurseshouldmonitorthepatientforwhich expectedfinding? a.

Peripheraledema

b.

Elevatedtemperature

c.

Clubbingofthefingers

d.

Complaintsofchestpain

ANS:A Corpulmonalecausesclinicalmanifestationsofrightventricularfailure,suchasperipheraledema.Theother clinicalmanifestationsmayoccurinthepatientwithothercomplicationsofchronicobstructivepulmonary disease(COPD)butarenotindicatorsofcorpulmonale. DIF:CognitiveLevel:Apply(application)REF:564 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 16.Thenurseisadmittingapatientdiagnosedwithanacuteexacerbationofchronicobstructivepulmonary disease(COPD).Whatisthebestwayforthenursetodeterminetheappropriateoxygenflowrate? a.

Minimizeoxygenusetoavoidoxygendependency.

b.

Maintainthepulseoximetrylevelat90%orgreater.

c.

Administeroxygenaccordingtothepatientslevelofdyspnea.

d.

Avoidadministrationofoxygenatarateofmorethan2L/minute.

ANS:B Thebestwaytodeterminetheappropriateoxygenflowrateisbymonitoringthepatientsoxygenationeitherby arterialbloodgases(ABGs)orpulseoximetry.Anoxygensaturationof90%indicatesadequatebloodoxygen levelwithoutthedangerofsuppressingtherespiratorydrive.ForpatientswithanexacerbationofCOPD,an oxygenflowrateof2L/minmaynotbeadequate.Becauseoxygenuseimprovessurvivalrateinpatientswith COPD,thereisnoconcernaboutoxygendependency.Thepatientsperceiveddyspnealevelmaybeaffectedby otherfactors(suchasanxiety)besidesbloodoxygenlevel. DIF:CognitiveLevel:Apply(application)REF:567

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TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 17.Apatienthospitalizedwithchronicobstructivepulmonarydisease(COPD)isbeingdischargedhomeon oxygentherapy.Whichinstructionshouldthenurseincludeinthedischargeteaching? a.

Storageofoxygentankswillrequireadequatespaceinthehome.

b.

Travelopportunitieswillbelimitedbecauseoftheuseofoxygen.

c.

Oxygenflowshouldbeincreasedifthepatienthasmoredyspnea.

d.

Oxygenusecanimprovethepatientsprognosisandqualityoflife.

ANS:D Theuseofhomeoxygenimprovesqualityoflifeandprognosis.Becauseincreaseddyspneamaybeasymptom ofanacuteprocesssuchaspneumonia,thepatientshouldnotifythephysicianratherthanincreasingthe oxygenflowrateifdyspneabecomesworse.Oxygencanbesuppliedusingliquid,storagetanks,or concentrators,dependingonindividualpatientcircumstances.Travelispossibleusingportableoxygen concentrators. DIF:CognitiveLevel:Apply(application)REF:570 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 18.Apatientisreceiving35%oxygenviaaVenturimask.Toensurethecorrectamountofoxygendelivery, whichactionbythenurseismostimportant? a.

Teachthepatienttokeepmaskonatalltimes.

b.

Keeptheairentrainmentportscleanandunobstructed.

c.

Giveahighenoughflowratetokeepthebagfromcollapsing.

d.

Drainmoisturecondensationfromtheoxygentubingeveryhour.

ANS:B 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non-rebreather masks.Drainingoxygentubingisnecessarywhencaringforapatientreceivingmechanicalventilation.The maskisuncomfortableandcanberemovedwhenthepatienteats. DIF:CognitiveLevel:Apply(application)REF:569 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 19.Posturaldrainagewithpercussionandvibrationisorderedtwicedailyforapatientwithchronicbronchitis. Whichinterventionshouldthenurseincludeintheplanofcare? a.

Scheduletheprocedure1hourafterthepatienteats.

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

b.

Maintainthepatientinthelateralpositionfor20minutes.

c.

Performpercussionbeforeassistingthepatienttothedrainageposition.

d.

Givetheorderedalbuterol(Proventil)beforethepatientreceivesthetherapy.

315

ANS:D Bronchodilatorsareadministeredbeforechestphysiotherapy.Posturaldrainage,percussion,andvibration shouldbedone1hourbeforeor3hoursaftermeals.Patientsremainineachposturaldrainagepositionfor5 minutes.Percussionisdonewhilethepatientisintheposturaldrainageposition. DIF:CognitiveLevel:Apply(application)REF:572 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 20.Thenursedevelopsateachingplantohelpincreaseactivitytoleranceathomeforanolderadultwith severechronicobstructivepulmonarydisease(COPD).Whichinstructionswouldbemostap...