The nurse assesses a patient with emphysema and notes a barrel chest. What is the
reason for this patient's chest anomaly? - Hyperinflation of the
... [Show More] lungs
Rationale: A patient with emphysema develops a barrel chest as a result of the
trapping of air in the lungs, which causes them to hyperinflate. Collapsed alveoli,
use of accessory muscles, and long-term, chronic hypoxia do not cause a barrel
chest.
The nurse notes that the respiratory symptoms of the patient with chronic
obstructive pulmonary disease (COPD) have affected his nutrition. Which would
most help improve the patient's nutrition? - Extra protein is required to repair
damaged tissues
Rationale: Nutrition is very important for the patient with COPD because the extra
work to breathe properly uses more calories and anorexia may be present. Extra
protein is required to repair damaged tissues. It is helpful to drink six to eight
glasses of noncaffeinated fluids per day to keep mucus thin and easier to cough up,
unless the physician has the patient on a fluid restriction. The patient should rest
before eating, not exercise before meals. The patient should avoid overeating and
should eat four to six small meals a day rather than three regular meals to decrease
stomach fullness and reduce fatigue.
A patient with COPD asks the nurse to turn his oxygen up from 3 L/min via nasal
cannula to 5 L/min. The nurse asseses the patient and finds that the oxygen
saturation level is at 91%. The nurse explains to the patient that she cannot turn his
oxygen up this high for what reason? - Oxygen is titrated to maintain saturation
levels.
Rationale: O2 should be titrated to maintain an oxygen saturation of 88% to 92%.
COPD patients have adjusted to chronic hypoxia and to high CO2 levels. Closely
monitor the pulse oximetry readings and titrate the oxygen as needed. Hypercapnia
is the result of hypoventilation, during which the usual amount of carbon dioxide is
not eliminated by exhalation. Carbon dioxide is a respiratory stimulant, and thenormal response to excessive levels of carbon dioxide is an increase in respiratory
rate. Increasing the oxygen flow unnecessarily will not relieve increased
respirations. Low oxygen levels, not high carbon dioxide levels, are the stimulus
for breathing for a patient with COPD. Higher concentrations of oxygen will not be
required for ABGs or result in a headache.
A patient taking aminophylline tells the nurse that he is going to begin a smoking
cessation program when he is discharged from the hospital. Why should the nurse
tell this patient to notify his physician if his smoking pattern changes? - The patient
will need his aminophylline dosage adjusted.
Rationale: The length of the action of aminophylline is decreased by smoking.
Therefore, changes in smoking patterns should be discussed with the physician or
other health care provider because this may affect the dosage of aminophylline
needed. Patients COPD are managed with expectorants, not antitussives. Annual
influenza vaccine is recommended for all patients with lung disease. The patient
should experience increased benefits from inhaler use following smoking
cessation.
A patient with emphysema may lose weight despite having an adequate caloric
intake. What advice should the nurse give the patient regarding ways to maintain
an optimal weight? - Increase calories, protein, vitamins, and minerals.
Rationale: Due to the amount of energy expended for breathing, patients with
emphysema often need additional calories, protein, vitamins, and minerals. Patients
require more calories but not more fats. Increasing activity will increase oxygen
demand and result in further weight loss.
The student nurse is caring for a patient with a restrictive respiratory disease.
Which description demonstrates the student's knowledge of the disease? - The
disease is characterized by decreased lung expansion.
Rationale :Restrictive respiratory disorders may be caused by decreased elasticity
or compliance of the lungs, decreased ability of the chest wall to expand, or
disorders of the central nervous system. Increased lung volumes, lung obstruction,or narrowed tracheobronchial tree openings are not characteristics of restrictive
respiratory disease.
A patient who experienced high fever and chills, a productive cough, chest pain,
general malaise, and aching muscles during the past week is admitted to the
hospital. The nurse realizes these symptoms correspond most closely with which
disease? - Pneumonia
Rationale: Typical signs and symptoms of pneumonia include high fever, chills, a
cough that produces rusty or blood-flecked sputum, sweating, chest pain, a general
feeling of malaise, and aching muscles. These symptoms do not describe type A
influenza, pleurisy with effusion, or S. empyema infection.
A patient with asthma is suddenly experiencing difficulty breathing, tachypnea, and
wheezing. Which medication listed on the medication administration record,
administered through an inhaler, should the nurse administer to this patient? -
Albuterol
Rationale: Albuterol is a fast-acting bronchodilator and can be given during an
acute episode of asthma symptoms. Its onset of action is 5 to 10 minutes and its
duration is 3 to 4 h. Cromolyn is an inhaled antiinflammatory agent that may take
up to 2 weeks to produce a therapeutic effect. Salmeterol and formoterol are longacting bronchodilators that should not be used to treat acute episodes of asthma.
The nurse is caring for a patient with viral pneumonia. Which intervention(s)
should the nurse expect to be included in the care plan?
Select all apply - -Providing adequate rest periods
-Maintaining adequate fluid intake
-Monitoring vital signs and respiratory status
-providing oral hygiene before and after meals
rationale: Antibiotics are effective only for bacterial, not viral, infections.
Antibiotics would be given only for secondary bacterial infections. The care plan
should include provision of adequate rest periods, maintaining adequate fluidintake, monitoring vital signs and respiratory status, and providing oral hygiene
before and after meals.
The student nurse is preparing a report about COPD. The student would be correct
in including which disease(s) in the report? (Select all that apply.) - -emphysema
-chronic bronchitis
rationale: Chronic bronchitis and emphysema are categorized as COPD. They are
obstructive pulmonary disorders characterized by problems with moving air into
and out of the lungs and progressive dyspnea. Asthma is considered a chronic
airflow limitation disorder. Pleurisy is inflammation of the pleura. Pulmonary
tuberculosis is an infection of the lungs.
The nurse is suctioning a patient who is unable to expectorate respiratory
secretions from his tracheotomy. How can the nurse avoid the serious
consequences of removing oxygen when suctioning this patient? - Do not suction
the patient for more than 10 to 15 seconds.
Rationale: Limiting suctioning to 10 to 15 seconds per suction attempt will help
prevent the removal of too much oxygen from the patient. The patient should be
preoxygenated before suctioning, and the pressure should be between 80 and 100
mm Hg. Suction should be applied only while the catheter is being removed.
Which finding in a female patient should indicate to the LPN/LVN that the patient
is likely to have a respiratory problem? - Clubbing of the fingers
Rationale: Clubbing of the fingers may be seen in patients with chronic respiratory
or heart disease. Clubbing is characterized by the fingers being wider than normal
at the distal end, similar in shape of a club. Also, there is marked rounded
curvature of the fingernails. Inverted breast nipples, the inability to rotate the
shoulder joint, and a fine maculopapular rash over the anterior of the chest do not
indicate respiratory problems. [Show Less]