← Back

Chapter 13: Applying Clinical Judgment to Promote Nutrition for Pulmonary Wellness

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 13: Applying Clinical Judgment to Promote Nutrition for Pulmonary Wellness

16 problems · 0 figures

Case Study 13.1.1 §13.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

In this visit with Katrice and her parents, the health care team wants to collect a complete client history including Katrice’s medical and social history, family history, and current asthma symptoms. Katrice reports utilizing her asthma inhaler before exercise but has rarely needed the inhaler outside of exercise. They deny audible wheezing, nighttime cough, or asthma attacks that have required hospitalization. They are pleased overall with her asthma control. The provider notices on exam that Katrice’s body mass index (BMI) has increased since her last visit, taking her from overweight to obese.

Which statement indicates Katrice and her parents understand the normal function of the pulmonary system?
  1. a.
    “It’s ok if I wheeze every day; as long as I use the inhaler, my lung function will stay the same for my whole life.”
  2. b.
    “The pulmonary system goes from my mouth through to the bottom of my lungs; it’s how my body gets oxygen.”
  3. c.
    “Wheezing is a sign that my airways have expanded too much, and air is moving through them too fast.”
  4. d.
    “Secondhand smoke doesn’t affect the lung tissue.”

Answer

B. “The pulmonary system goes from my mouth through to the bottom of my lungs; it’s how my body gets oxygen.”
The pulmonary or respiratory system comprises the upper airways, the lower airways, lungs, and alveolar sacs. The primary function of the pulmonary system is to ensure adequate oxygenation throughout the body.

Case Study 13.1.2 §13.1 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

In this visit with Katrice and her parents, the health care team wants to collect a complete client history including Katrice’s medical and social history, family history, and current asthma symptoms. Katrice reports utilizing her asthma inhaler before exercise but has rarely needed the inhaler outside of exercise. They deny audible wheezing, nighttime cough, or asthma attacks that have required hospitalization. They are pleased overall with her asthma control. The provider notices on exam that Katrice’s body mass index (BMI) has increased since her last visit, taking her from overweight to obese.

What additional history information would signal the need for additional intervention by the nurse?
  1. a.
    The family of five living in a four-bedroom single-family home
  2. b.
    Wearing masks and playing inside when visiting family who live near a factory in a high-pollution area
  3. c.
    Wheezing sometimes associated with taking NSAIDS before exercise
  4. d.
    Having grandma smoke outside, away from the house, and covering her clothing with a “smoking jacket”

Answer

C. Wheezing sometimes associated with taking NSAIDS before exercise
Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) can induce bronchospasm in clients who are sensitive and have had reactions to these medications in the past.

Case Study 13.2.3 §13.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Katrice is in today for a routine asthma follow-up. The provider collects and reviews the 24-hour food recall with Katrice and her parents, praising the few high-quality food choices and providing education about MyPlate as a guide for the types and quantities of food that will better support Katrice’s nutrition. Katrice admits to having donuts or other sweet items for breakfast because they are “easy to grab and have in the car.” She also has candy daily and fast-food meals at least 4–5 times a week. The provider explains the physiologic changes associated with obesity and increased BMI, which can worsen Katrice’s asthma and impact her health during sports and play. Katrice and her parents verbalize understanding. They will implement the new knowledge over the next 2 weeks, and return for follow-up, bringing a food log with them and any questions. The provider also discusses a referral to physical therapy for assessment and post-exercise stretches to support less pain and need for medication. The provider educates about the risks of bronchospasm with NSAID use and recommends acetaminophen instead. Katrice’s parents verbalize understanding and are receptive to education.

Which of the following statements by the client indicates additional diet instruction is needed?
  1. a.
    “I will try to cut back on the amount of fast food I eat.”
  2. b.
    “I am going to get some deli meat so I can make sandwiches to eat at school.”
  3. c.
    “I’m going to try to eat sandwiches made with whole grain tortillas.”
  4. d.
    “I will try to eat baked chicken instead of fried.”

Answer

B. “I am going to get some deli meat so I can make sandwiches to eat at school.”
Processed meats and aged cheeses are high in histamines and can cause increased mucus production, which can worsen asthma symptoms.

Case Study 13.2.4 §13.2 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

Katrice is in today for a routine asthma follow-up. The provider collects and reviews the 24-hour food recall with Katrice and her parents, praising the few high-quality food choices and providing education about MyPlate as a guide for the types and quantities of food that will better support Katrice’s nutrition. Katrice admits to having donuts or other sweet items for breakfast because they are “easy to grab and have in the car.” She also has candy daily and fast-food meals at least 4–5 times a week. The provider explains the physiologic changes associated with obesity and increased BMI, which can worsen Katrice’s asthma and impact her health during sports and play. Katrice and her parents verbalize understanding. They will implement the new knowledge over the next 2 weeks, and return for follow-up, bringing a food log with them and any questions. The provider also discusses a referral to physical therapy for assessment and post-exercise stretches to support less pain and need for medication. The provider educates about the risks of bronchospasm with NSAID use and recommends acetaminophen instead. Katrice’s parents verbalize understanding and are receptive to education.

Which of the following breakfast options is the best choice for the client?
  1. a.
    A whey protein shake
  2. b.
    Two strawberry toaster tarts
  3. c.
    Pancakes and bacon
  4. d.
    Whole grain toast

Answer

A. A whey protein shake
Protein drinks provide high protein amounts in low-volume portions to provide the nutritional components necessary for muscle synthesis and improved muscle strength.

Case Study 13.3.5 §13.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Katrice and her mother return after 2 weeks, bringing the food log from the past 2 weeks. They report that they used the MyPlate website and games to help the whole family understand a healthier diet. They have not been as compliant with the healthy eating principles as they would like due to “already having food at home that still needed to be eaten.” However, Katrice’s mother reports that during their grocery shopping yesterday, they used the MyPlate guidelines to focus on fresh food, complex carbohydrates, high-protein snacks, and limiting nonwater beverages to low-sugar or sugar-free options.

Which snack item demonstrates Katrice’s understanding of healthy eating when choosing food for pre-game energy?
  1. a.
    Low-fat string cheese and a handful of almonds
  2. b.
    Canned peaches and crackers
  3. c.
    Peanut butter cookies
  4. d.
    Pudding and a bag of chips

Answer

A. Low-fat string cheese and a handful of almonds
Eating protein, found in foods like cheese and nuts, at least twice daily will help with strong respiratory muscles.

Case Study 13.3.6 §13.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

Katrice and her mother return after 2 weeks, bringing the food log from the past 2 weeks. They report that they used the MyPlate website and games to help the whole family understand a healthier diet. They have not been as compliant with the healthy eating principles as they would like due to “already having food at home that still needed to be eaten.” However, Katrice’s mother reports that during their grocery shopping yesterday, they used the MyPlate guidelines to focus on fresh food, complex carbohydrates, high-protein snacks, and limiting nonwater beverages to low-sugar or sugar-free options.

Which statement explains the correlation of Katrice’s obesity and her pulmonary health?
  1. a.
    Obesity is a nonmodifiable risk factor and shouldn’t be the focus for asthma clients.
  2. b.
    Obesity increases a client’s likelihood of access to vital nutrients.
  3. c.
    Obesity alters the mechanics of the pulmonary system, leading to wheezing and airway hyperresponsiveness.
  4. d.
    Obesity can be reversed by eating the largest meal of the day right before bed.

Answer

C. Obesity alters the mechanics of the pulmonary system, leading to wheezing and airway hyperresponsiveness.
Obesity alters the mechanics of the pulmonary system leading to dyspnea, wheezing, airway hyperresponsiveness, and increased work of breathing.

13-1 §13.RQ source ↗

Which disease-related alteration can potentially place an older client with chronic obstructive pulmonary disease (COPD) at risk for altered nutrition?
  1. a.
    Altered taste
  2. b.
    Decreased energy requirements
  3. c.
    Fatigue
  4. d.
    Altered smell

Answer

C. Fatigue
Fatigue is a common symptom of COPD that can make it difficult for the client to prepare and eat nutritious foods.

13-2 §13.RQ source ↗

On initial laboratory tests, an adult client’s albumin level is below 3.5 g/dL. Which additional test could potentially be utilized to gather additional information about nutritional risk for malnutrition?
  1. a.
    Hemoglobin A1C
  2. b.
    Antinuclear antibodies (ANA)
  3. c.
    Prealbumin
  4. d.
    Chest x-ray

Answer

C. Prealbumin
Albumin is the primary protein of the body. Decreased levels may indicate chronic disease, malabsorption, malnutrition with low protein, or dilution by IV fluids. Follow-on diagnostics would be pre-albumin and blood urea nitrogen.

13-3 §13.RQ source ↗

What is the process for carbon dioxide and oxygen exchange?
  1. a.
    Ventilation
  2. b.
    Gas exchange
  3. c.
    Perfusion
  4. d.
    Diffusion

Answer

B. Gas exchange
The process of gas exchange is when oxygen and carbon dioxide are exchanged in the alveoli of the lungs.

13-4 §13.RQ source ↗

The nurse is instructing an older client on the importance of adequate calcium and vitamin D intake. Which of the following age-related changes would this intervention affect?
  1. a.
    Decreased lung capacity
  2. b.
    Increased muscle atrophy
  3. c.
    Decreased elasticity
  4. d.
    Increased vascular resistance

Answer

A. Decreased lung capacity
Calcium and vitamin D intake reduce the risk of osteoporosis and kyphoscoliosis that decrease the size and diameter of the rib cage and reduce lung capacity.

13-5 §13.RQ source ↗

For the client with chronic obstructive pulmonary disease (COPD), which dietary teaching should be incorporated?
  1. a.
    High-fat food choices
  2. b.
    Simple carbohydrates as primary food choice
  3. c.
    High-protein, calorie-dense food choices
  4. d.
    Low-fiber food choices

Answer

C. High-protein, calorie-dense food choices
The client should eat high-protein, calorie-dense meals to maintain nutritional status and prevent weight loss that results from increased work of breathing.

13-6 §13.RQ source ↗

Which of the following is a primary goal of nutrition therapy for a client with chronic obstructive pulmonary disease (COPD)?
  1. a.
    Maintaining a healthy body weight
  2. b.
    Improving oxygenation status
  3. c.
    Preventing muscle wasting
  4. d.
    Lowering CO2 levels

Answer

A. Maintaining a healthy body weight
A primary goal of nutrition therapy for pulmonary wellness is to maintain adequate respiratory function to decrease or prevent malnutrition and obesity. Healthy body weight will help preserve muscle strength and help maintain the integrity of the immune system.

13-7 §13.RQ source ↗

The nurse is instructing a client with chronic obstructive pulmonary disease (COPD) on strategies to maximize food intake. Which of the following responses by the client indicates additional education is needed?
  1. a.
    “I will treat myself to cake or pudding for dessert.”
  2. b.
    “I will eat add cheese to my food whenever possible.”
  3. c.
    “I will eat more cold foods rather than hot meals.”
  4. d.
    “I will try to eat as much as I can during the evening before I go to bed.”

Answer

D. “I will try to eat as much as I can during the evening before I go to bed.”
The client should eat smaller, more frequent meals. Larger meals should be consumed earlier in the day when the client is less tired.

13-8 §13.RQ source ↗

A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. With palpitation, the nurse feels crackling. What does the crackling most likely indicate?
  1. a.
    Fremitus
  2. b.
    Orthopnea
  3. c.
    Crepitus
  4. d.
    Tuberculosis

Answer

C. Crepitus
Crackles indicate crepitus, or air trapped in and under the skin.

13-9 §13.RQ source ↗

Which of the following findings is the best indicator that the client has followed the prescribed nutritional plan to maintain a healthy weight?
  1. a.
    The client can verbalize why obesity is detrimental to pulmonary health.
  2. b.
    The client can describe the MyPlate approach to food selection.
  3. c.
    The client’s food log demonstrates adherence to healthy nutritional plan.
  4. d.
    The client has reached their recommended weight range.

Answer

D. The client has reached their recommended weight range.
While all of these findings can indicate the client is knowledgeable of and is following the prescribed nutritional plan, actually maintaining the recommended weight is an objective measure that indicates adherence.

13-10 §13.RQ source ↗

A client states that they are experiencing a nighttime cough. Which medication could explain this symptom?
  1. a.
    Acetaminophen
  2. b.
    Ibuprofen
  3. c.
    Beta-2 agonist
  4. d.
    Angiotensin-converting enzyme (ACE) inhibitors

Answer

D. Angiotensin-converting enzyme (ACE) inhibitors
ACE inhibitors are known to induce nighttime coughing.

Loading chapter 14…

Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.