CRE Patient Education & Management Strategies 3 — Questions and Answers
Question 1: A patient on long-term oxygen therapy (LTOT) asks if they can adjust their flow rate when they feel more short of breath. The educator should respond that:
- Patients may increase their flow rate by 1-2 LPM as needed
- Flow rates should only be adjusted based on physician-prescribed parameters and activity levels (Correct answer)
- Higher flow rates always improve dyspnea regardless of diagnosis
- Self-adjusting oxygen is safe because oxygen is not a medication
Correct answer: Flow rates should only be adjusted based on physician-prescribed parameters and activity levels
Oxygen flow rates must be adjusted only within physician-prescribed parameters since inappropriate increases can cause CO2 retention in some patients.
Question 2: During an asthma action plan review, a patient's peak flow drops to 55% of personal best with moderate symptoms. According to a standard action plan, the patient should:
- Continue usual medications and recheck in 24 hours
- Move to the yellow zone protocol and use rescue bronchodilator (Correct answer)
- Immediately call 911
- Reduce activity and drink more fluids
Correct answer: Move to the yellow zone protocol and use rescue bronchodilator
A peak flow of 50-79% of personal best places the patient in the yellow zone, requiring rescue bronchodilator use and caution.
Question 3: Which statement BEST describes motivational interviewing (MI) in respiratory patient education?
- The educator tells patients exactly what behavior changes they must make
- The educator uses open-ended questions and reflective listening to elicit the patient's own motivation for change (Correct answer)
- MI focuses exclusively on medication adherence and not lifestyle changes
- The educator provides detailed medical lectures to overcome resistance
Correct answer: The educator uses open-ended questions and reflective listening to elicit the patient's own motivation for change
Motivational interviewing uses open-ended questions, affirmations, reflective listening, and summaries to elicit intrinsic motivation for behavior change.
Question 4: A patient with asthma is prescribed a combination inhaled corticosteroid/long-acting beta-agonist (ICS/LABA). The educator should emphasize that this inhaler should NEVER be used as:
- A maintenance medication taken twice daily
- A rescue medication during acute symptoms (Correct answer)
- A preventive therapy before allergen exposure
- A long-term controller medication
Correct answer: A rescue medication during acute symptoms
ICS/LABA combination inhalers are controller medications and must never be used for acute symptom relief due to the delayed onset of the LABA component.
Question 5: Which approach BEST supports self-management in a patient with chronic lung disease who has low self-efficacy?
- Providing an extensive list of all possible complications
- Setting small, achievable goals and providing frequent positive reinforcement (Correct answer)
- Emphasizing that non-adherence will lead to hospitalization
- Referring the patient to a specialist without follow-up education
Correct answer: Setting small, achievable goals and providing frequent positive reinforcement
Small achievable goals build confidence and self-efficacy through successive mastery experiences, which is fundamental to Bandura's self-efficacy theory.
Question 6: A patient using a dry powder inhaler (DPI) asks why they should not exhale into the device before inhaling. The BEST explanation is that:
- Exhaling into the DPI wastes the dose and may clump the powder with moisture (Correct answer)
- Exhaling first is actually recommended to empty the lungs before inhalation
- The DPI mechanism is not affected by moisture or exhalation direction
- Exhaling after inhalation is the step that should be avoided
Correct answer: Exhaling into the DPI wastes the dose and may clump the powder with moisture
Exhaling into a DPI introduces moisture that can clump the powder and clog the device, reducing the delivered dose.
Question 7: A parent asks how to identify whether a child's asthma symptoms are exercise-induced. The educator should explain that exercise-induced bronchoconstriction (EIB) typically causes symptoms:
- During the first 2 minutes of exercise and resolve immediately
- 5-10 minutes after stopping exercise and may last 30-60 minutes (Correct answer)
- Only during very high-intensity activity lasting over 60 minutes
- Exclusively in cold weather and not during warm-weather activity
Correct answer: 5-10 minutes after stopping exercise and may last 30-60 minutes
EIB typically begins 5-10 minutes after stopping exercise and symptoms peak within 5-15 minutes before spontaneously resolving.
CRE Patient Education & Management Strategies 3
A patient on long-term oxygen therapy (LTOT) asks if they can adjust their flow rate when they feel more short of breath.
The educator should respond that: