A nurse cares for a client with a 40-year smoking history who is ...

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A nurse cares for a client with a 40-year smoking history who is experiencing distended neck veins and dependent edema. Which physiologic process should the nurse correlate with this client's history and clinical manifestations?
 
  a. Increased pulmonary pressure creating a higher workload on the right side of the heart
  b. Exposure to irritants resulting in increased inflammation of the bronchi and bronchioles
  c. Increased number and size of mucus glands producing large amounts of thick mucus
  d. Left ventricular hypertrophy creating a decrease in cardiac output

Question 2

The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, The medication is too expensive to use every day. I only use my inhaler when I have an attack. How should the nurse respond?
 
  a. You are using the inhaler incorrectly. This medication should be taken daily.
  b. If you decrease environmental stimuli, it will be okay for you to use the inhaler only for asthma attacks.
  c. Tell me more about your fears related to feelings of breathlessness.
  d. It is important to use this type of inhaler every day. Let's identify potential community services to help you.

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Answer to Question 1

ANS: A
Smoking increases pulmonary hypertension, resulting in cor pulmonale, or right-sided heart failure. Increased pressures in the lungs make it more difficult for blood to flow through the lungs. Blood backs up into the right side of the heart and then into the peripheral venous system, creating distended neck veins and dependent edema. Inflammation in bronchi and bronchioles creates an airway obstruction which manifests as wheezes. Thick mucus in the lungs has no impact on distended neck veins and edema. Left ventricular hypertrophy is associated with left heart failure and is not caused by a 40-year smoking history.

Answer to Question 2

ANS: D
Long-acting beta2 agonists should be used every day to prevent asthma attacks. This medication should not be taken when an attack starts. Asthma medications can be expensive. Telling the client that he or she is using the inhaler incorrectly does not address the client's financial situation, which is the main issue here. Clients with limited incomes should be provided with community resources. Asking the client about fears related to breathlessness does not address the client's immediate concerns.

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