Asthma

Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma?

1. Cough productive of yellow sputum 2. bilateral expiratory wheezing 3. chest tightness 4. respiratory rate of 30 breaths per minute rationale: A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms - wheezing, chest tightness, and increased respiratory rate - are all findings associated with an asthma attack and do not necessarily mean an infection is present

Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma?

1. Incorporate physical exercise as tolerated into the daily routine 2. Monitor peak flow numbers after meals and at bedtime 3. Eliminate stressors in the work and home environment 4. use a sedative to ensure uninterrupted sleep at night rationale: Physical exercise is beneficial and should be incorporated as tolerated into the clients schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the clients life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely to mebe routinely taken to induce sleep

The nurse is caring for a client who has asthma. The nurse should conduct a focused assessment to detect which of the following?

1. Increased forced expiratory volume 2. normal breath sounds 3. inspiratory and expiratory wheezing 4. morning headaches rationale: The Hallmark signs of asthma or chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations there may be some soft wheezing, so a finding of a normal breath sounds would be expected in the absence of asthma. The expected finding is decreased forced expiratory volume [FEF is the flow of air coming out of the lungs during the middle portion of a forced expiration] due to block your constriction. Morning headaches are found in the more advanced cases of COPD signal nocturnal hypercapnia or hypoxemia

The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack?

1. Occupational exposure to toxins 2. viral respiratory infections 3. exposure to cigarette smoke 4. exercising in cold temperatures rationale: The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins then are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather

A nurse is teaching a client to use a MDI to administer bronchodilator medication. Indicate the correct order of the steps the client should take to use the MDI appropriately.

1. Shake the inhaler immediately before use 4. breathe out through the mouth 3. Activate the MDI on inhalation 2. hold breath for 5 to 10 seconds and then exhale rationale: when using inhalers, clients should first shake the inhaler to activate the MDI, and then breathe out through the mouth. Next, the client should activate the MDI while inhaling, hold the breath for 5 to 10 seconds, and then exhale normally

A client uses a MDI to aid in management of asthma. Which action indicates to the nurse that the client needs further instruction regarding its use? SATA

1. activation of the MDI is not coordinated w/inspiration 2. the client inspires rapidly when using the MDI 3. the client holds breath for 3 secs after inhaling w/the MDI 4. the client shakes the MDI after use 5. the client performs puffs in rapid succession rationale: utilization of an MDI requires coordination between activation and inspiration; deep breath's to ensure that medication is distributed into the lungs, holding the breath for 10 seconds or as long as possible to disperse the medication into go lungs, shaking up the medication in the MDI before use, and a sufficient amount of time between classes to provide an adequate amount of inhalation medication

a client experiencing a severe asthma attack has the following ABG results: PH 7.33 Pco2 48 Po2 58 HCO3 26 which of the following prescriptions should the nurse perform first?

1. albuterol nebulizer 2. CXR 3. ipratropium inhaler 4. sputum culture rationale: The ABG reveals a respiratory acidosis with hypoxia. A quick acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and urine sample can be obtained once the client is stable

A 34-year-old female w/a Hx asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, w/a RR of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client?

1. initiate oxygen therapy as prescribed and reassess the client in 10 min 2. draw blood for an ABG 3. encourage the client to relax and breathe slowly through the mouth 4. administer bronchodilators as prescribed rationale: in an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled knuckle dilators, IV corticosteroids, and, possibly, IV theophylline. Administering oxygen and reassessing the client 10 minutes later with the lady needed medical intervention, as were drawing blood for an ABG analysis. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacological intervention.

A client who has been taking flunisolide nasal spray, two inhalations a day, for treatment of asthma has painful, white patches in the mouth. which response by the nurse would be most appropriate?

1. " this is an anticipated adverse effects of your medication. It should go away in a couple of weeks." 2. You are using your inhaler too much in it has irritated your mouth 3. you have developed a fungal infection from your medication. It will need to be treated with an antifungal agent. 4. be sure to brush your teeth and floss daily. Good oral hygiene Will treat this problem. rationale: use of oral inhalant corticosteroids such as flunisolide can lead to the development of oral brush, a fungal infection. Once developed, trash must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem

Which of the following is an expected outcome for an adult client with well-controlled asthma?

1. Chest x-ray demonstrates minimal hyper inflation 2. temperature remains lower than 100°F 3. ABG analysis demonstrates a decrease in PaO2 4. Breath sounds are clear rationale: between attacks, breath sounds should be clear on auscultation with good airflow present throughout long fields. Chest x-ray should be normal. The client should remain afebrile. Arterial blood gases should be normal

Th nurse is teaching the client how to use a MDI to administer a corticosteroid. Which of the following indicates that the client is using the MDI correctly? SATA

1. the inhaler is held upright 2. the head is tilted down while inhaling the medicine 3. the client waits 5 min between puffs 4. the client rinses the mouth w/water following administration 5. the client lies supine for 15 min following administration rationale: The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe my freely if sitting upright

A client diagnosed with asthma has been prescribed flute as one (Flovet) one puff every 12 hours per inhaler. Place in correct order the same as the nurse would use when teaching the client how to properly use the inhaler with a spacer.

2. Take off the cap and shake the inhaler 6. attach the spacer 4. breathe out all of your air. Hold the mouthpiece of your inhaler and spacer between your teeth with your lips closed around it 5. Press down on the inhaler once and breathe in slowly 1. hold your breath for at least 10 seconds, then breathe in and out slowly 3. rinse your mouth rationale: using a spacer, especially with an inhaled corticosteroid, can make it easier for the medication to reach the lungs; it can also prevent excess medication remaining in the mouth and throat where it can lead to minor irritation. It is important for the client to empty the lungs, breath in slowly, and hold breath in order to draw as much medication into the lungs as possible. Rinsing after using a corticosteroid inhaler may help prevent irritation and infection; rinsing will also reduce the amount of drug swallowed and absorbed systemically

a client is prescribed metaproterenol via a MDI, two puffs q4hrs. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?

1. irregular heartbeat 2. constipation 3. pedal edema 4. decreased pule rate rationale: Irregular heartbeats should be reported promptly to the care provider.. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effects on beta adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia

a client w/acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients w/asthma?

1. promote bronchodilation 2. act as an expectorant 3. have an anti-inflammatory effect 4. prevent development of resp. infections rationale: corticosteroids have an anti-inflammatory effect an act to decrease Adema in the bronchial airways and decreased mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorant, or prevent respiratory infections