Chapter 30 - Care of Patients with Noninfectious Lower Respiratory Problems
After receiving education on the correct use of emergency drug therapy for asthma, which statement by the client indicates a correct understanding of the nurse’s instructions?
- “All asthma drugs help everybody breathe better.”
- “I must carry my emergency inhaler when activity is anticipated.”
- “I must have my emergency inhaler with me at all times.”
- “Preventive drugs can stop an attack.”
C. “I must have my emergency inhaler with me at all times.”
A client recently diagnosed with asthma has a prescription to use an inhaled medication with a spacer. The nurse evaluates the client has correct understanding of the use of an inhaler with a spacer when the client states which of these? Select all that apply.
- “I don’t have to wait a minute between the two puffs if I use a spacer.”
- “If the spacer makes a whistling sound, I am breathing in too rapidly.”
- “I should rinse my mouth and then swallow the water to get all of the medicine.”
- “I should shake the canister when I want to see whether it is empty.”
- “I should hold my breath for at least ten seconds after inhaling the medication.”
B. “If the spacer makes a whistling sound, I am breathing in too rapidly.”
E. “I should hold my breath for at least ten seconds after inhaling the medication.”
The nurse is assessing a client admitted with status asthmaticus. The nurse finds a sudden absence of wheezing in the lung fields and sets which of these as the priority action?
- Education to prevent future exacerbations
- Administration of a bronchodilator
- Measures to reduce anxiety
- Activation of the rapid response team to secure an airway
D. Activation of the rapid response team to secure an airway
The nurse on a medical surgical unit is planning bed assignments for a new admission who has cystic fibrosis (CF) and is infected with Burkholderia cepacia. Which of these room assignments is most appropriate for this client?
- A room with laminar air flow
- A room with a client who has Down syndrome and pneumonia
- A room with another client who has cystic fibrosis
- A private room with a bathroom
D. A private room with a bathroom
When caring for the client returning from thoracotomy and placement of a chest tube, the client reports severe pain. What does the nurse do first?
- Assess location and quality of pain.
- Call for the Rapid Response Team (RRT).
- Check the patency of the chest tubes.
- Call the health care provider.
A. Assess location and quality of pain.
A client has just been admitted to the intensive care unit after having a left lower lobectomy via video-assisted thorascopic surgery. Which of these prescriptions will the nurse implement first?
- Titrate oxygen flow rate to keep O2 saturation at or greater than 93%.
- Administer 2 g of cephazolin IV now.
- Give morphine sulfate 4 to 6 mg IV for pain.
- Transfuse 1 unit of packed red blood cells (PRBCs) over 2 hours.
A. Titrate oxygen flow rate to keep O2 saturation at or greater than 93%.
The nurse is providing teaching for a client who has been newly diagnosed with lung cancer and will be undergoing radiation therapy. Which of these points would be covered in the teaching session? Select all that apply.
- Hair loss will occur.
- Do not expose the site to sun.
- Loss of appetite may develop.
- Pain in the area is expected.
- Fatigue may occur.
- Changes in taste may occur.
B. Do not expose the site to sun.
E. Fatigue may occur.
F. Changes in taste may occur.
The nurse is providing preoperative teaching for the client with lung cancer for whom a lobectomy is planned. Which of these does the nurse include in the preoperative education session? Select all that apply.
- “You will wake up with a drain in your chest which removes blood and allows the remaining lung to expand.”
- “You will be able to get out of bed after the chest tube is removed.”
- “Plan to request pain medication before your pain becomes severe.”
- “You may have a tube in your throat connected to a mechanical ventilator to assist you with breathing.”
- “You will need to lie on the operative side until the area of tissue removal heals.”
A. “You will wake up with a drain in your chest which removes blood and allows the remaining lung to expand.”
C. “Plan to request pain medication before your pain becomes severe.”
D. “You may have a tube in your throat connected to a mechanical ventilator to assist you with breathing.”
The nurse is evaluating understanding of the treatment regimen for a client newly diagnosed with asthma. Which of these statements by the client indicates understanding of the regimen?
- “I will take albuterol when I go to sleep.”
- “I will keep the rescue medication readily accessible on the first floor of my home.”
- “I will take the long acting beta agonist even when my breathing seems OK.”
- “I will immediately take the anti-inflammatory medication for an acute asthma attack.”
C. “I will take the long acting beta agonist even when my breathing seems OK.”
The school nurse is teaching a group of adolescents about risk factors for lung cancer and lung disease. Which of these would be included in the discussion?
- Alcohol consumption
- Cocaine use
- Cigarette smoking
- Heroin use
C. Cigarette smoking
When caring for the client with chronic bronchitis, which of these interventions will assist the client in mobilizing secretions?
- Elevate the head of the bed 45 degrees
- Consume at least 2 liters of fluid daily
- Avoid triggers which cause coughing
- Assume the tripod position
B. Consume at least 2 liters of fluid daily
The nurse is educating the client with COPD who requires home oxygen therapy for discharge. Which of these teaching points takes the highest priority?
- Correct performance when setting up the oxygen delivery system
- Removing combustion hazards present in the home
- Understanding the signs and symptoms of hypoxemia
- Demonstrating how to use a pulse oximetry device
B. Removing combustion hazards present in the home
The nurse is preparing to administer oxygen to a client with chronic obstructive pulmonary disease (COPD) who has hypoxemia and hypercarbia. The nurse recognizes that a positive outcome to therapy has been achieved by which of these findings?
- The pCO2 is within normal range.
- The client’s face is very pink.
- The client reports decreased distress.
- The oxygen saturation is between 88% and 90%.
D. The oxygen saturation is between 88% and 90%.
The nurse is caring for a client who has had a lobectomy and placement of a chest tube 8 hours ago. When performing an initial assessment, which of these requires immediate follow up?
- 200 mL red drainage from chest tube over 2 hours
- Client sleepy but able to be aroused
- 3 cm area of red drainage on the incisional dressing
- Report of pain at the chest tube insertion site
A. 200 mL red drainage from chest tube over 2 hours
A client with acute exacerbation of asthma has been admitted to the medical surgical unit for treatment. The client is reporting increased shortness of breath with inspiratory and expiratory wheezes. When planning care for this client, which medication will the nurse administer first?
- Albuterol-2 inhalations
- Fluticasone-2 inhalations
- Ipratropium-2 inhalations
- Salmeterol-2 inhalations
A. Albuterol-2 inhalations
The change-of-shift report has just been completed on the medical-surgical unit. Which client will the oncoming nurse plan to assess first?
- Client with chronic obstructive pulmonary disease (COPD) who is ready for discharge, but is unable to afford prescribed medications.
- Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min.
- Hospice client with end-stage pulmonary fibrosis and an oxygen saturation level of 89%.
- Client with lung cancer who needs an IV antibiotic administered before going to surgery.
B. Client with cystic fibrosis (CF) who has an elevated temperature and a respiratory rate of 38 breaths/min.
Which statement by a client with chronic obstructive pulmonary disease (COPD) and a 10 pound (4.5 kg) weight loss indicates the need for additional follow-up instruction?
- “I should consume plenty of fluids with my meal.”
- “I will try eating smaller more frequent meals.”
- “I will try to eat more protein.”
- “I will perform mouth care prior to eating.”
A. “I should consume plenty of fluids with my meal.”
A client with COPD calls the pulmonary clinic reporting the last 24 hours the peak flow meter readings have been in the yellow range. Which of these interventions by the nurse is appropriate at this time?
- Use your prescription for rescue medication and retest yourself.
- This is a satisfactory reading, continue your present regimen.
- Go to the nearest emergency department.
- Increase your controller medication dose.
A. Use your prescription for rescue medication and retest yourself.
The nurse is providing education to a client with chronic bronchitis who has a new prescription for a mucolytic. Which of these will the nurse teach the client about the purpose of the medication?
- Mucolytics decrease secretion production.
- Mucolytics increase gas exchange in the lower airways.
- Mucolytics provide bronchodilation in clients with chronic obstructive pulmonary disease.
- Mucolytics thin secretions, allowing for easier expectoration.
D. Mucolytics thin secretions, allowing for easier expectoration.
The client says, “I hate this stupid COPD.” What is the best response by the nurse?
- “Stopping smoking will help your lungs heal.”
- “You sound fed up with managing your illness.”
- “Does anyone in your family have COPD?”
- “Most clients get used to it after a few months.”
B. “You sound fed up with managing your illness.”
The charge nurse is making assignments for clients cared for on the intensive care stepdown unit. Which client will the charge nurse assign to the RN who has floated from the pediatric unit?
- Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask
- Client with chronic pleural effusions who is scheduled for a paracentesis in the next hour
- Client with emphysema who requires instruction about correct use of oxygen at home
- Client with lung cancer who has just been transferred from the intensive care unit after a left lower lobectomy yesterday
A. Client with acute asthma episode who is receiving oxygen at FiO2 of 60% by non-rebreather mask
The nurse in the clinic is following up on diagnostic testing for a client recently diagnosed with metastatic lung cancer and back pain. Which of these findings does the nurse expect to uncover?