Med Surg Exam 3 - Chapter 29

1. A patient who has bronchiectasis asks the nurse, "What conditions would warrant a call to the clinic?"

Blood clots in the sputum

Sticky sputum on a hot day

Increased shortness of breath after eating a large meal

Production of large amounts of sputum on a daily basis

Blood clots in the sputum would warrant a call to the clinic because it may indicate a more serious condition such as a pulmonary embolism or lung infection. This symptom should not be ignored and requires immediate medical attention to determine the cause and provide appropriate treatment.

Explanation

Blood clots in the sputum would warrant a call to the clinic because it may indicate a more serious condition such as a pulmonary embolism or lung infection. This symptom should not be ignored and requires immediate medical attention to determine the cause and provide appropriate treatment.

2. The major advantage of a Venturi mask is that it can

Deliver up to 80% O2

Provide continuous 100% humidity

Deliver a precise concentration of O2

Be used while a patient eats and sleeps

A Venturi mask is designed to deliver a precise concentration of oxygen to the patient. It achieves this by using a specific combination of air and oxygen flow rates, which creates a controlled amount of oxygen concentration. This is particularly useful in situations where accurate oxygen delivery is crucial, such as in patients with respiratory conditions who require a specific oxygen concentration to maintain their oxygen levels within a desired range. The Venturi mask allows healthcare professionals to adjust the oxygen concentration precisely, ensuring optimal oxygen therapy for the patient.

Explanation

A Venturi mask is designed to deliver a precise concentration of oxygen to the patient. It achieves this by using a specific combination of air and oxygen flow rates, which creates a controlled amount of oxygen concentration. This is particularly useful in situations where accurate oxygen delivery is crucial, such as in patients with respiratory conditions who require a specific oxygen concentration to maintain their oxygen levels within a desired range. The Venturi mask allows healthcare professionals to adjust the oxygen concentration precisely, ensuring optimal oxygen therapy for the patient.

3. In evaluating an asthmatic patient's knowledge of self-care, the nurse recognizes that additional instruction is needed when the patient says,

"I use my corticosteroid inhaler when I feel short of breath."

"I get a flu shot eery year and see my health care provider if I have an upper respiratory infection."

The correct answer is "I use my corticosteroid inhaler when I feel short of breath." This statement suggests that the patient is not using their inhaler as a preventive measure but only when they are already experiencing symptoms. The nurse recognizes that the patient should be using the inhaler regularly as prescribed, regardless of whether they feel short of breath or not. Regular use of corticosteroid inhalers helps to control inflammation and prevent asthma symptoms from occurring.

Explanation

The correct answer is "I use my corticosteroid inhaler when I feel short of breath." This statement suggests that the patient is not using their inhaler as a preventive measure but only when they are already experiencing symptoms. The nurse recognizes that the patient should be using the inhaler regularly as prescribed, regardless of whether they feel short of breath or not. Regular use of corticosteroid inhalers helps to control inflammation and prevent asthma symptoms from occurring.

4. Which of the following guidelines would be a part of teaching patients how to use a metered dose-inhaler (MDI)?

After activating the MDI, breathe in as quickly as you can.

Estimate the amount of remaining medicine in the MDI by floating the canister in water.

Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week.

The correct answer is to determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. This guideline is important because it helps patients understand how long their medication will last and when they need to refill their prescription. By dividing the total number of puffs in the canister by the puffs needed per day, patients can calculate the number of days the canister will last and ensure they have enough medication on hand. This promotes proper medication management and adherence to the prescribed dosage.

Explanation

The correct answer is to determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. This guideline is important because it helps patients understand how long their medication will last and when they need to refill their prescription. By dividing the total number of puffs in the canister by the puffs needed per day, patients can calculate the number of days the canister will last and ensure they have enough medication on hand. This promotes proper medication management and adherence to the prescribed dosage.

5. The effects of cigarette soking on the respiratory system include

Hypertrophy of capillaries causing hemoptysis

Hyperplasia of goblet cells and increased production of mucus

Proliferation of alveolar macrophages thus increasing chance of infection

Increased proliferation of cilia and decreased clearance of mucus

Cigarette smoking has been shown to cause hyperplasia of goblet cells in the respiratory system, leading to an increased production of mucus. This excessive mucus production can impair the normal clearance of mucus from the airways, leading to congestion and difficulty breathing. The increased mucus also provides a favorable environment for the growth of bacteria, increasing the risk of respiratory infections. This is why hyperplasia of goblet cells and increased production of mucus is a known effect of cigarette smoking on the respiratory system.

Explanation

Cigarette smoking has been shown to cause hyperplasia of goblet cells in the respiratory system, leading to an increased production of mucus. This excessive mucus production can impair the normal clearance of mucus from the airways, leading to congestion and difficulty breathing. The increased mucus also provides a favorable environment for the growth of bacteria, increasing the risk of respiratory infections. This is why hyperplasia of goblet cells and increased production of mucus is a known effect of cigarette smoking on the respiratory system.

6. A patient is concerned that he may have Asthma. Of the symptoms that he relates to the nurse, which ones suggest asthma or risk factors for asthma (select all that apply)?

Allergic rhinitis

Prolonged inhalation

History of skin allergies

Cough, especially at night

Gastric reflux or heartburn

The symptoms that suggest asthma or risk factors for asthma are allergic rhinitis, history of skin allergies, cough, especially at night, and gastric reflux or heartburn. Allergic rhinitis and history of skin allergies indicate an allergic predisposition, which is commonly associated with asthma. Cough, especially at night, is a common symptom of asthma, as the airways tend to be more reactive during sleep. Gastric reflux or heartburn can trigger or worsen asthma symptoms, as the acid can irritate the airways. Prolonged inhalation is not specifically mentioned as a symptom or risk factor for asthma, so it is not included in the answer.

Explanation

The symptoms that suggest asthma or risk factors for asthma are allergic rhinitis, history of skin allergies, cough, especially at night, and gastric reflux or heartburn. Allergic rhinitis and history of skin allergies indicate an allergic predisposition, which is commonly associated with asthma. Cough, especially at night, is a common symptom of asthma, as the airways tend to be more reactive during sleep. Gastric reflux or heartburn can trigger or worsen asthma symptoms, as the acid can irritate the airways. Prolonged inhalation is not specifically mentioned as a symptom or risk factor for asthma, so it is not included in the answer.

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7. A plan of care for the patient with COPD could include (select all that apply)

Exercise such as walking

High flow rate of O2 administration

Low-dose chronic oral corticosteroid therapy

Use of peak flow meter to monitor the progression of COPD

Breathing exercises such as pursed-lip breathing that focus on exhalation

The plan of care for a patient with COPD may include exercise such as walking to improve cardiovascular fitness and strengthen respiratory muscles. Breathing exercises such as pursed-lip breathing that focus on exhalation can help improve breathing efficiency and reduce shortness of breath. These interventions aim to increase the patient's exercise tolerance and overall lung function. The other options, high flow rate of O2 administration and low-dose chronic oral corticosteroid therapy, may be appropriate for some patients with severe COPD, but they are not universally included in the plan of care. The use of a peak flow meter to monitor the progression of COPD is not typically part of the plan of care for COPD.

Explanation

The plan of care for a patient with COPD may include exercise such as walking to improve cardiovascular fitness and strengthen respiratory muscles. Breathing exercises such as pursed-lip breathing that focus on exhalation can help improve breathing efficiency and reduce shortness of breath. These interventions aim to increase the patient's exercise tolerance and overall lung function. The other options, high flow rate of O2 administration and low-dose chronic oral corticosteroid therapy, may be appropriate for some patients with severe COPD, but they are not universally included in the plan of care. The use of a peak flow meter to monitor the progression of COPD is not typically part of the plan of care for COPD.

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8. Which of the following treatments in CF would the nurse expect to implement as collaborative management of patients with CF (select all that apply)?

Sperm banking

IV corticosteroids on a chronic basis

Airway clearance techniques (e.g., Acapella)

GoLYTELY given PRN for severe constipation

Inhaled tobramycin to combat Pseudomonas infection

The nurse would expect to implement sperm banking as a collaborative management strategy for patients with CF because CF can cause infertility in males. Airway clearance techniques, such as using an Acapella device, would also be implemented to help clear mucus from the airways and improve lung function. GoLYTELY would be given as needed for severe constipation because constipation is a common symptom in CF. Inhaled tobramycin would be used to combat Pseudomonas infection, which is a common type of bacterial infection in CF patients.

Explanation

The nurse would expect to implement sperm banking as a collaborative management strategy for patients with CF because CF can cause infertility in males. Airway clearance techniques, such as using an Acapella device, would also be implemented to help clear mucus from the airways and improve lung function. GoLYTELY would be given as needed for severe constipation because constipation is a common symptom in CF. Inhaled tobramycin would be used to combat Pseudomonas infection, which is a common type of bacterial infection in CF patients.

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