The nurse interviews a patient with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which information is most specific in confirming a diagnosis of chronic bronchitis?

Correct Answer: C

Rationale: The correct answer is C) The patient reports a productive cough for 3 months every winter. This is specific to chronic bronchitis because chronic bronchitis is defined by a productive cough that lasts for at least 3 months in two consecutive years. This information aligns with the diagnostic criteria for chronic bronchitis, making it the most specific indicator in confirming the diagnosis. Option A (The patient tells the nurse about a family history of bronchitis) is incorrect because a family history of bronchitis does not confirm the individual's own diagnosis of chronic bronchitis. Option B (The patient indicates a 30 pack-year cigarette smoking history) is incorrect as it is a risk factor for developing COPD in general but not specific to chronic bronchitis. Option D (The patient denies having respiratory problems until the past 12 months) is incorrect as chronic bronchitis is characterized by a long-standing history of respiratory symptoms, not a sudden onset within the past year. Educationally, understanding the specific diagnostic criteria for chronic bronchitis is crucial for nurses to accurately assess, diagnose, and manage patients with this condition. This question highlights the importance of recognizing key clinical indicators to differentiate between various respiratory conditions.

Correct Answer: B

Rationale: Listening only during inspiration indicates the student needs a review of respiratory assessment skills. At each placement of the stethoscope, listen to at least one cycle of inspiration and expiration. During chest auscultation, instruct the patient to breathe slowly and a little deeper than normal through the mouth.

Correct Answer: A

Rationale: The correct answer is A) Cover with an occlusive dressing. This statement requires correction because covering the stoma with an occlusive dressing can lead to suffocation and obstructed breathing. Stomas are created after a laryngectomy to provide a new way for the patient to breathe. Placing an occlusive dressing over the stoma would block the airflow, endangering the patient's life. Option B) Swim with a stoma guard is a correct statement as using a stoma guard can protect the stoma during activities like swimming by preventing water from entering the stoma. Option C) Shower with a shield is also a correct statement. Using a shield during showering can help prevent water from getting into the stoma, reducing the risk of infection. Option D) Cover with clothing is incorrect because clothing should not be used to cover the stoma after a laryngectomy. It is important to keep the stoma open to ensure proper oxygenation and breathing for the patient. In an educational context, it is crucial for healthcare providers to have a thorough understanding of proper stoma care after laryngectomy to ensure the safety and well-being of their patients. Providing accurate information and correcting misconceptions about stoma care can prevent potentially life-threatening situations.

Correct Answer: B

Rationale: Directly observed therapy is the most effective means for ensuring compliance with the treatment regimen, and arranging a daily meal will help ensure that the patient is available to receive the medication. The other nursing interventions may be appropriate but are not as helpful for this situation.

Correct Answer: D

Rationale: In the context of pneumonia, the correct position to avoid for a patient is option D) Head of bed lowered. When a patient has pneumonia, it is important to maintain proper oxygenation and ventilation to prevent complications such as hypoxia. By lowering the head of the bed, it can worsen the patient's respiratory status by increasing pressure on the chest and limiting lung expansion, which can lead to decreased oxygenation. Option A) Head of bed elevated is actually beneficial for a patient with pneumonia as it can help improve oxygenation by aiding in lung expansion and reducing respiratory effort. Option B) Side-lying position can also be beneficial for patients with pneumonia as it can help with drainage and ventilation of the affected lung areas. Option C) Supine position is generally acceptable for a patient with pneumonia, although it may not be the most optimal position for maximizing oxygenation and ventilation. Educationally, it is important for healthcare providers to understand the rationale behind positioning for patients with pneumonia to provide optimal care and prevent complications. Proper positioning can significantly impact a patient's respiratory status and overall recovery. By knowing which positions to avoid and which are beneficial, healthcare providers can improve patient outcomes and ensure safe and effective care.