Asthma Medications

When preparing a child with asthma for discharge, which instructions would the nurse emphasize to the family? Select all that apply. One, some, or all responses may be correct. A. Limit allergens in the home. B. Maintain a dry home environment. C. Avoid placing limits on the child's behavior expectations. D. Continue the medications even if the child is asymptomatic. E. Prevent exposure to infection by having the child tutored at home.

A, D Parents should be taught to limit allergens in the home that can precipitate asthma attacks (e.g., no carpets, no down pillows, no scented products; wet-mopping floors, vacuuming when the child is not in the home). Medications to control inflammation, including inhaled corticosteroids and long-acting β 2-agonists, must be continued to suppress exacerbations of asthma. Environmental moisture is necessary for these children; in addition, cold environments should be avoided. Consistent limits should be placed on the child's behavior, regardless of the illness; a chronic illness does not eliminate the need for limit setting. The child should return to school and continue to interact with schoolmates and friends.

A client is prescribed albuterol to relieve severe asthma. Which adverse effects will the nurse instruct the client to anticipate? Select all that apply. One, some, or all responses may be correct. A. Tremors B. Lethargy C. Palpitations D. Bronchoconstriction D. Decreased pulse rate

A,C Albuterol's sympathomimetic effect causes central nervous system (CNS) stimulation, precipitating tremors, tachycardia, and palpitations. Lethargy is an adverse effect of medications that cause CNS depression, not CNS stimulation. Albuterol causes bronchodilation, not bronchoconstriction. Albuterol will cause tachycardia, not bradycardia.

After the nurse has taught a client about how to use a dry powder inhaler, which statement by the client indicates understanding of how to use the medication safely and effectively? A. "I will forcefully inhale the powder." B. "I will exhale into the delivery device." C. "I will shake the inhaler before using it." D. "I will submerge the inhaler in water to wash it."

A. Dry powder inhalers do not contain a propellant; clients will forcefully inhale the powder. Clients should never exhale into the device because their breath will moisten the powder. Dry powder inhalers should be held still and steady, not shaken; to do so would disperse the powder. Dry powder inhalers should not be used with water or submerged in water, to prevent the powder from becoming moistened.

Which goal is the priority for a client with asthma who has a prescription for an inhaled bronchodilator? A. Is able to obtain pulse oximeter readings B. Demonstrates use of a metered-dose inhaler C. Knows the health care provider's office hours D. Can identify triggers that may cause wheezing

B. Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have. Home management typically includes self-monitoring of the peak expiratory flow rate rather than pulse oximetry. Although knowing the health care provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Although it is important to be able to identify triggers that may cause wheezing, knowing these cannot prevent all wheezing; therefore, being able to abort wheezing with a bronchodilator is the greater priority.

Which finding would be of most concern when the nurse assesses a client with emphysema? A. Barrel chest B. Oral cyanosis C. Pursed-lip expiration D. Respirations 26 breaths per minute

B. Central cyanosis indicates hypoxemia and requires further assessment and actions such as checking oxygen saturation and administration of oxygen. Clients with chronic obstructive pulmonary disease (COPD) often develop a barrel chest over time because of air being trapped, thus resulting in enlarged lungs and thoracic cavity. Pursed-lip expiration is commonly used by clients with COPD to improve expiratory effort and volumes. An elevated respiratory rate is common in COPD as a compensatory mechanism to improve gas exchange.

When a client with chronic obstructive pulmonary disease (COPD) reports a 5-lb (2.3-kg) weight gain in 1 week, the nurse will assess for other signs and symptoms of which complication? A. Polycythemia B. Cor pulmonale C. Compensated acidosis D. Left ventricular failure

B. Fluid retention and weight gain caused by right ventricular failure is a clinical manifestation of cor pulmonale, or right ventricular failure caused by pulmonary hypertension associated with COPD. Polycythemia may be caused by COPD, but it does not cause weight gain. Compensated respiratory acidosis is caused by COPD, but it would not lead to weight gain. Left ventricular failure may lead to weight gain, but it is not a complication of COPD.

Which assessment findings would indicate a possible asthma exacerbation? Select all that apply. One, some, or all responses may be correct. A. Fever B. Stridor C. Wheezing D. Tachycardia E. Hypotension

C,D Bronchial constriction with mucus production causes wheezing. With the decrease in arterial oxygenation associated with asthma, the heart rate will increase (tachycardia). An increased temperature is characteristic of infection, not asthma. Stridor is usually caused by foreign body obstruction and/or upper airway obstruction (such as croup), not asthma. Hypertension, not hypotension, may occur with asthma.

A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. Which intervention would be a priority for the nurse? A. Having the child rest as much as possible B. Checking the child's eosinophil count daily C. Preventing exposure of the child to infection D. Offering sips of water when administering the medication

C. Prednisone reduces the child's resistance to certain infectious processes and, as an anti-inflammatory medication, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate hydration to help loosen and expel mucus.

The nurse provides instructions about how to use a metered-dose inhaler (MDI) to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique? A. Places the tip of the inhaler just past the lips B. Holds the inspired breath for at least 3 seconds C. Activates the inhaler during inspiration D. Inhales rapidly with the lips sealed around the nebulizer opening

D. The client should inhale slowly rather than rapidly when using a metered-dose inhaler (MDI) to optimize delivery of the nebulized medication into the lungs. If the client has a dry powder inhaler (DPI), then rapid inhaling would be an important action because the powder is not nebulized. The MDI should be gently held in the mouth just past the lips to deliver the medication into the airway. Holding the inspired breath for at least 3 seconds promotes contact of the medication with the bronchial mucosa. The inhaler should be activated during inspiration.

A child is prescribed fluticasone after an acute asthma attack. Which instruction would the nurse give the family about the administration of this medication? A. "Fluticasone needs to be taken with food or milk." B. "Fluticasone is primarily used to treat acute asthma attacks." C. "The child should suck on hard candy to help relieve dry mouth." D. "Watch for white patches in the mouth and report to the health care provider."

D. Fluticasone is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Fluticasone is administered via inhalation so food or milk is not needed before administration. Dry mouth is not a side effect of fluticasone.