COPD/Asthma

The nurse teaches pursed-lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism?

• Loosening secretions so that they may be coughed up more easily

• Promoting maximal inhalation for better oxygenation of the lungs

• Preventing bronchial collapse and air trapping in the lungs during exhalation

• Increasing the respiratory rate and giving the patient control of respiratory patterns

Assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?

• Acute respiratory failure

• Secondary respiratory infection

• Fluid volume excess from cor pulmonale

• Pulmonary edema caused by left-sided heart failure

The nurse determines that therapy with ipratropium is effective after noting which assessment finding?

• Decreased respiratory rate

• Increased respiratory rate

• Increased peak flow readings

• Decreased sputum production

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse teach the patient to do?

• Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse.

• Increase the dose of the long-term control medication if the peak flow numbers decrease.

• Use the flowmeter each morning after taking medications to evaluate their effectiveness.

• Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.

The nurse teaches a patient with COPD how to administer fluticasone by MDI. Which statement indicates an understanding of the instructions?

• "I should not use a spacer device with this inhaler"

• "I will rinse my mouth each time I use this inhaler"

• "I will feel my breathing improve over the next 2-3 days"

• "I should use this inhaler immediately if I start to have trouble breathing"

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse determines that the patient’s nutritional status is impaired after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient?

• Order fruits and fruit juices to be offered between meals.

• Order a high-calorie, high-protein diet with six small meals a day.

• Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet.

• Encourage the patient to double carbohydrate consumption and decrease fat intake.

The provider has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide?

• “Close lips tightly around the mouthpiece and breathe in deeply and quickly.”

• “To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it.”

• “You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs.”

• “Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible.”

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit?

• “I will pay less for medication because it will last longer.”

• “More of the medication will get down into my lungs to help my breathing.”

• “Now I will not need to breathe in as deeply when taking the inhaler medications.”

• “This device will make it so much easier and faster to take my inhaled medications.”

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? (Select all that apply.)

• Exercise

• Allergies

• Emotional Stress

• Decreased Humidity

• Upper respiratory infections

ABGs: pH 7.30, PO2 60 mm Hg, PCO2 55 mm Hg, HCO3 20 mEq/L and oxygen saturation of 86%.

What do these ABG values indicate?

• Respiratory acidosis with hypoxemia

• Normal acid-base balance

• Normal acid-base balance with hypercapnia

• Respiratory acidosis with normal oxygen levels