EAQ Upper Respiratory
The nurse provides education to a patient with asthma about how to take medication through a metered dose inhaler. Which action performed by the patient indicates effective learning? 1 Cleans the device with water 2 Inhales two puffs, two seconds apart 3 Does not shake the medication before taking it 4 Breathes in rapidly while taking the medication
1 Most of the medications used in the treatment of asthma are delivered through inhalers like metered dose inhalers. This helps to prevent systemic side effects and promote the onset of action. The patient should clean the plastic case of the metered dose inhaler with water. The patient should inhale two puffs per dose and shake the device before use. The patient should breathe slowly for at least 10 seconds after administration of a puff.
A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma? 1 Anxiety 2 Cyanosis 3 Bradycardia 4 Hypercapnia
1 An early manifestation during an asthma attack is anxiety, because the patient is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO2 and increased pH because he is hyperventilating. If cyanosis occurs, it is a later sign. The pulse and blood pressure will be increased.
What instruction should the nurse give to a patient with asthma who has received a prescription for albuterol and ipratropium nebulization? Correct 1 After the treatment, cough effectively. 2 During the treatment, breathe rapidly through the mouth. 3 For the treatment, it is recommended to be in the side-lying position. Incorrect 4 Between treatments, it is sufficient to clean the mouth by gargling with water.
1 The nurse should instruct the patient to cough effectively after the treatment to prevent hypoventilation and local irritation in the throat. This also helps to disperse accumulated drug in the airway. The nurse should advise the patient to sit upright to ensure efficient breathing and adequate penetration of the aerosol. The patient on corticosteroid inhalation needs to clean the mouth by performing mouthwash to avoid local irritation in the throat. While the patient is on aerosolized medication, the nurse should instruct the patient to breathe slowly and deeply.
The nurse is teaching a student nurse about breath sounds in a patient with asthma. Which statement made by the student nurse indicates the need for further teaching? 1 "The patient wheezes loudly during expiration when the asthma is severe." 2 "The patient has no audible sound from the airway when the asthma is severe." 3 "The patient may wheeze during inspiration and expiration as the asthma progresses." 4 "The patient with asthma must able to move enough air through the airway to produce the sound."
1 The patient with a minor attack may wheeze loudly during expiration, but the patient experiencing a severe asthma attack does not wheeze; he or she may have no audible sound on auscultation due to decreased airflow into the lungs. The patient must be able to move enough air through the airway to wheeze. Wheezing usually begins with exhalation and may be present during both inspiration and expiration as asthma progresses.
Which finding indicates to the nurse that a patient's respiratory status is improving following an acute asthma exacerbation? 1 Audible wheezing 2 Pursed lip breathing 3 Use of intercostal muscles 4 Oxygen saturation 89% of room air
1 The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. Pursed lip breathing does not correlate with asthma improvement. The use of intercostal muscles and an oxygen saturation of 89% are evidence of continued asthma exacerbation.
The nurse is providing education about the risk factors of asthma. Which factors does the nurse explain are associated with asthma? Select all that apply. 1 Immune response 2 Sedentary lifestyle 3 History of pancreatitis 4 Genetic predisposition 5 Exposure to air pollutants
1, 4, 5 Risk factors for asthma include immune response, genetic predisposition, and exposure to air pollutants. Exercise, not a sedentary lifestyle, is also a risk factor. A history of gastroesophageal reflux disease is a risk factor, but a history of pancreatitis is not.
A patient presents to the emergency department with sudden-onset wheezing and coughing with progressive respiratory distress. What condition or diagnosis does the nurse recognize? 1 Acute bronchitis 2 An asthma attack 3 Pulmonary edema 4 Congestive heart failure
2 A sudden onset of coughing and wheezing are the initial and most obvious symptoms of an acute asthma attack. An asthma attack may begin mildly but progress to respiratory distress and arrest if it goes untreated. Acute bronchitis is irritation and inflammation of the mucous-membrane lining of the respiratory tract, usually caused by an infectious agent. Pulmonary edema is fluid accumulation in the lungs due to heart failure or lung injury. The fluid collection impairs gas exchange and may result in respiratory failure. Congestive heart failure, or heart failure, is a condition in which the heart cannot pump effectively. Fluid may accumulate in the lungs. Edema may develop in the lower extremities, and shortness of breath may also occur with increasing frequency and severity.
A child with a nonproductive cough states, "I am having trouble breathing." What action should the nurse take to reduce the severity of breathlessness in the child? 1 Assist the child to lie in supine position 2 Instruct the child to bend forward slightly 3 Suggest that the child walk for 30 minutes 4 Instruct the child to take short, quick breaths
2 Cough may be the only symptom in patients with cough-variant asthma. The nurse should instruct the child with asthma to sit upright or slightly bent forward, because these positions would help the child to use accessory muscles for respiration. The child should not lie in a supine position, which may increase bronchial tone and cause irritation with stimulation of cough receptors. The child must not walk for half an hour, because it may trigger the symptoms. The nurse should instruct the child to take deep breaths.
A patient with asthma experiences anaphylaxis. Which medication should the nurse prepare to administer? 1 Timolol 2 Epinephrine 3 Magnesium sulfate 4 Sodium bicarbonate
2 Epinephrine helps to resolve anaphylactic reactions in the patient with asthma. Administer epinephrine either subcutaneously or intramuscularly to treat the patient. The nurse should monitor the blood pressure and electrocardiogram of the patient closely after administration of the drug. Timolol is a beta-blocker that may trigger the symptoms of asthma in the patient. Magnesium sulfate helps to treat the patient with severe or life threatening asthma. Sodium bicarbonate helps to treat severe metabolic or respiratory acidosis.
Which test result identifies that a patient with asthma is responding to treatment? 1 An increase in CO2 levels 2 A decrease in exhaled nitric oxide 3 A decrease in white blood cell count 4 An increase in serum bicarbonate levels
2 Nitric oxide levels are increased in the breath of people with asthma. A decrease in the exhaled nitric oxide concentration suggests that the treatment may be decreasing the lung inflammation associated with asthma and adherence to treatment. An increase in CO2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the asthma patient.
Which assessment finding does the nurse expect when caring for a patient with asthma? 1 pH of 5.11 2 PaCO2 of 30 mm Hg 3 Blood pressure of 110/60 mm Hg 4 Respiratory rate of 25 breaths/minute
2 The patient with acute asthma may reveal signs of hypoxemia and hyperventilation due to air flow limitation, indicated by a low level of partial pressure of carbon dioxide in blood (PaCO2), such as 30 mmHg. This condition leads to a rise in pH leading to respiratory alkalosis; however, a pH of 5.11 is low. The respiratory rate of the asthmatic patient increases to more than 30 breaths/minute due to the use of accessory muscles. The patient with anxiety due to breathlessness has an increase in pulse and blood pressure.
The nurse is explaining the pathophysiology of asthma to a patient. Which is the most appropriate explanation? 1 "An acid-base imbalance causes bronchoconstriction and edema of the airways." 2 "Inflammation causes bronchoconstriction, hyperreactivity, and edema of the airways." 3 "Inflammation causes bronchodilation, hyperreactivity, and pressure of the airways." 4 "An immune response causes bronchodilation, hyperreactivity, and edema of the airway."
2 The primary pathophysiologic process in asthma is persistent but variable inflammation of the airways. The airflow is limited because the inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways. Exposure to allergens or irritants initiates the inflammatory cascade. An immune response does not trigger asthma. Inflammation causes edema, not pressure, of the airways. Acid-base imbalances do not trigger asthma.
After the inhalation of puffs of mometasone, a patient develops oropharyngeal candidiasis, hoarseness and dry cough. What action should the nurse take to reduce the symptoms? 1 Recommend that the patient pauses between the puffs 2 Instruct the patient to rinse the mouth with water after inhalation 3 Assist the patient in obtaining a spacer or holding device for inhalation 4 Wait until the cough subsides before administering the patient's next dose
2 Upon inhalation into the pharynx, mometasone may cause local irritation such as oropharyngeal candidiasis, hoarseness, and dry cough. Hence the patient should rinse the mouth either with water or with mouthwash after inhalation. The patient may not be benefit by pausing between the puffs. Asking the patient to use a spacer or holding device for inhalation of corticosteroids can be helpful in getting more medication into the lungs. However, it does not reduce the symptoms of candidiasis. The next dose is given to the patient only upon further advice from the practitioner.
The nurse teaches a patient regarding the administration of fluticasone through an inhaler. Which statements made by the patient indicate effective learning? Select all that apply. 1 "I have to shake the medicine bottle before use." 2 "I should keep my medicine away from humid places." 3 "I should engage the lever while loading the medicine." 4 "I should hold my breath for 20 to 30 seconds after a puff." 5 "I have to raise my head forward and breathe into my inhaler."
2, 3 The nurse should advise the patient to store the medication in a dry place away from humid places to avoid clumping of the medication. The patient should load the medication into the inhaler and engage the lever to allow the medication to become available. The patient should not shake the medicine bottle. The patient should hold the breath for 10 seconds or as long as possible to disperse the medicine into the lungs. The patient should tilt the head back and breathe out to get maximum air out of lungs, and then inhale the medication. The patient should not breathe into the inhaler, because this will affect the dose.
A patient with asthma is prescribed formoterol. What should the nurse include in the medication education provided to the patient? Select all that apply. 1 "Take the medication once every 24 hours." 2 "Side effects include cold or flu-like symptoms." 3 "Formoterol is the best medication to take to obtain quick relief from bronchospasms." 4 "Formoterol is not the only medication that you will need to treat your asthma." 5 "If wheezing gets worse, there are other types of medications that are more beneficial than formoterol."
2, 4, 5 Formoterol is a long-acting β2-adrenergic agonist (LABA) and is effective in treating symptoms of asthma that persist at night. Formoterol is not helpful to treat wheezing that gets worse, because short-acting beta blockers may be more beneficial. Side effects include cold or flu-like symptoms. LABAs should never be used as monotherapy for asthma, and they should only be used if the patient is taking inhaled corticosteroids. Short-acting beta blockers help the patient to obtain quick relief from bronchospasm. The patient must take the drug every 12 hours. The nurse should instruct the patient not to overuse formoterol, because there are other options also available.
The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient? 1 Allow time to calm the patient 2 Observe for signs of diaphoresis 3 Evaluate the use of intercostal muscles 4 Monitor the patient for bilateral chest expansion
3 The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Allowing time to calm the patient, observing for diaphoresis, and monitoring for bilateral chest expansion are correct, but they are not the primary reason for inspecting the chest wall of this patient.
A patient in the emergency ward is dyspneic and speaks unclear words. Assessment findings include a respiratory rate of 45 breaths/minute, a pulse of 130 beats/minute, oxygen saturation of 90%, and neck vein distention. Which treatment does the nurse expect will help alleviate the patient's symptoms? 1 Administration of ipratropium orally 2 Three puffs of albuterol every 30 minutes 3 Supplementary oxygen through nasal cannula 4 Obtaining peak flow rate and monitoring the patient continuously
3 The patient with a severe attack of asthma has an elevated respiratory rate, decreased oxygen saturation and elevated pulse, and the inability to speak, which indicate a severe airway obstruction. The patient may also have neck vein distension. Hence the nurse should anticipate correction of hypoxemia and improve ventilation in the patient with supplementary oxygenation by nasal prongs. This helps to keep oxygen saturation above 90 percent. Administration of ipratropium does not provide additional benefits to the patient. Three puffs of albuterol every 30 minutes help to resolve the symptoms in the patients with mild asthma. Obtaining the peak flow rate and continuous monitoring of the patient is critical during asthma attack, but will not alleviate the patient's symptoms.
A patient with asthma has a body temperature of 102° F and produces purulent sputum. The nurse anticipates that which drug will be prescribed? 1 A sedative 2 A mucolytic 3 An antibiotic 4 Epinephrine
3 The patient with body temperature of 102° F and purulent sputum may have bacterial infection. Hence the treatment with antibiotics would benefit the patient. Sedatives may result in respiratory depression and death. Mucolytics are not recommended, because they are not beneficial to the patient suffering from asthma. Epinephrine helps to treat acute anaphylaxis. Test-Taking Tip: A patient with fever and purulent sputum may be at more risk for infection.
10. A patient experiences exacerbations of wheezing and breathlessness when exercising in the early morning. The nurse learns that patient has a three-year history of sinusitis. What is appropriate to be included on the patient's plan of care? 1 Prescribing a beta-antagonist for the patient 2 Administering intravenous corticosteroids to the patient 3 Advising the patient to exercise when the air is cool and dry 4 Referring the patient to a surgeon for the removal of nasal polyps
4 Both acute and chronic sinusitis make asthma worse, causing severe inflammation of the mucous membranes. Such patients should undergo removal of large nasal polyps to help control exacerbations of asthma. Beta-antagonists promote bronchoconstriction, leading to further airway obstruction and breathlessness in the patient. The nurse should advise the patient to avoid exercise when the air is cool and dry to prevent exacerbations. Intravenous corticosteroids are as effective as inhaled corticosteroids. However, the patient may experience exacerbations upon administration of corticosteroids intravenously. This intervention may increase fluid accumulation in the sinuses, further leading to pain.
The nurse is caring for a patient who has just been diagnosed with asthma. The nurse knows what? 1 Asthma also is considered a psychosomatic disease. 2 Food allergies frequently trigger an asthma attack in adults. 3 The asthma triad refers to nasal polyps, asthma, and sensitivity to acetaminophen (Tylenol) products. 4 Gastroesophageal reflux disease (GERD) is more common in people with asthma than in the general population.
4 GERD occurs more often in people with asthma than in the general population. Asthma is not a psychosomatic disease, although symptoms can worsen with stress. A food allergy triggering an asthma attack in adults is rare. The asthma triad refers to nasal polyps, asthma, and sensitivity to aspirin and nonsteroidal antiinflammatory drugs (NSAIDs).
The nurse teaches a student nurse regarding the administration of corticosteroids to a patient with wheezing, dyspnea and chest tenderness. Which statement made by the student nurse indicates effective learning? 1 "Taper the intravenous dose of corticosteroids slowly." 2 "Administer the patient's corticosteroids every 12 hours." 3 "Lower the dose of inhaled corticosteroids to prevent asthma relapse." 4 "Provide inhaled corticosteroids to the patient while still in the hospital."
4 The patient has asthma, a chronic inflammatory disorder of the airways. Corticosteroid inhalation may lead to local infections such as candidiasis and sore throat. Therefore the nurse should provide inhaled corticosteroids to the patient while still in the hospital to check the effectiveness of the therapy and provide immediate relief. Corticosteroids should be administered every four to six hours, and the dose of intravenous corticosteroids should be tapered rapidly. High-dose inhaled corticosteroids help in preventing asthma relapse.
