ASTHMA (aeq) PRACTICE
The health care provider has prescribed an inhaled corticosteroid for the patient with asthma. The nurse should provide which instructions to the patient regarding the use of a dry powder inhaler (DPI)? Multiple choice question "Shake the canister vigorously before use." "Keep your inhaler in a warm, humid room to prevent crystallization." "Keep your mouth open slightly to increase dispersion of the medication." "Hold your breath for at least 10 seconds to increase medication absorption by your lungs."
"Hold your breath for at least 10 seconds to increase medication absorption by your lungs." The patient should hold the breath for as long as possible to increase the amount of medication absorbed by the lungs. The DPI should not be shaken and should be stored in a cool area, and the patient's mouth should be closed tightly around the mouthpiece of the inhaler.
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? Multiple choice question "The patient wheezes loudly during expiration when the asthma is severe." "The patient has no audible sound from the airway when the asthma is severe." "The patient may wheeze during inspiration and expiration as the asthma progresses." "The patient with asthma must able to move enough air through the airway to produce the sound."
"The patient wheezes loudly during expiration when the asthma is severe." 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.
The health care provider has prescribed salmeterol for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide? Multiple choice question "Close lips tightly around the mouthpiece and breathe in deeply and quickly." "To administer a DPI, you must use a spacer that holds the medicine so that you can inhale it." "You will know you have correctly used the DPI when you taste or sense the medicine going into your lungs." "Hold the inhaler several inches in front of your mouth and breathe in slowly, holding the medicine as long as possible."
"Close lips tightly around the mouthpiece and breathe in deeply and quickly." The patient should be instructed to tightly close the lips around the mouthpiece and breathe in deeply and quickly to ensure the medicine moves down deeply into the lungs. Dry powder inhalers do not require spacer devices. The patient may not taste or sense the medicine going into the lungs. The inhaler should not be placed several inches in front of the mouth.
The nurse teaches a group of nursing students about lung volume parameter in patients with asthma. Which statement made by a student nurse indicates the need for further teaching? Multiple choice question "With asthma, there is increased residual volume." "With asthma, there is increased total lung capacity." "With asthma, there is increased forced expiratory volume in one second." "With asthma, there is a normal forced expiratory volume to forced vital capacity ratio."
"With asthma, there is increased forced expiratory volume in one second." Lung volumes help to determine the reversibility of bronchoconstriction and establish the diagnosis of asthma. The forced expiratory volume in one second decreases in the patient with asthma. The total lung capacity in a patient with asthma increases due to increase in breathing. Therefore the total residual volume increases. The ratio of forced expiratory volume to forced vital capacity is usually normal or decreased in the patient with asthma.
Which test result identifies that a patient with asthma is responding to treatment? Multiple choice question An increase in CO 2 levels A decrease in exhaled nitric oxide A decrease in white blood cell count An increase in serum bicarbonate levels
A decrease in exhaled nitric oxide 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 CO 2 levels, decreased white blood cell count, and increased serum bicarbonate levels do not indicate a positive response to treatment in the asthma patient.
The nurse is caring for a patient who is being mechanically ventilated that has a PaCO 2 of 60 mm Hg, a respiratory pH of 6.8, and a PaO 2 of 60 mm Hg. Which intervention will benefit the patient? Multiple choice question Administering albuterol Performing a bronchoscopy Providing chest physiotherapy Administering sodium bicarbonate
Administering sodium bicarbonate A patient with PaCO 2 of 60 mm Hg and respiratory pH of 6.8 has severe respiratory acidosis. Therefore such a patient must take sodium bicarbonate to treat extreme acidosis. Bronchodilation by a beta-agonist like albuterol is not possible in the patient with extreme acidosis. Bronchoscopy helps to relieve acute attacks by removing thick mucus plugs. Chest physiotherapy is generally not recommended for asthma because it is too stressful for breathless patients.
An adolescent who has a history of asthma experiences wheezing after vigorous exercise. What nursing instruction is helpful for this patient? Multiple choice question Advise the patient to avoid dry air. Encourage the patient to get exposure to cold air. Recommend the patient to continue vigorous exercise. Advise the patient to avoid swimming in indoor heated pools.
Advise the patient to avoid dry air. The patient is suffering from exercise-induced asthma. The nurse should encourage the patient to avoid exposure to dry air, because it precipitates exercise-induced asthma. Exposure to cold air also precipitates asthma. The patient should be discouraged from performing vigorous exercise, because it can precipitate asthma. Swimming in indoor heated pools should be encouraged over swimming outdoors, because outdoor swimming can trigger asthma attacks.
The patient has a prescription for each of the inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack? Multiple choice question Albuterol Salmeterol Beclomethasone Ipratropium bromide
Albuterol Albuterol is a short-acting bronchodilator that should be given initially when the patient experiences an asthma attack. Salmeterol is a long-acting β 2-adrenergic agonist, which is not used for acute asthma attacks. Beclomethasone is a corticosteroid inhaler and is not recommended for an acute asthma attack. Ipratropium bromide is an anticholinergic agent that is less effective than β 2-adrenergic agonists. It may be used in an emergency with a patient unable to tolerate short-acting β 2-adrenergic agonists (SABAs).
A patient with an acute attack of asthma is in a state of panic. Which nursing measures help to relieve the panic? Select all that apply. Multiple selection question Use sedation. Be calm, quiet, and reassuring. Encourage pursed-lip breathing. Utilize a "walking down" technique. Utilize the "talking down" technique.
Be calm, quiet, and reassuring. Encourage pursed-lip breathing. Utilize the "talking down" technique Pursed-lip breathing keeps the airways open, slows down the respiratory rate, and encourages deep breathing. "Talking down" is a technique that helps to calm the patient. A calm, quiet, and reassuring nurse helps to pacify the patient. Use of sedatives should not be encouraged, because they may cause respiratory depression. There is no technique called "walking down."
The nurse is collecting data on four patients with a history of mild asthma. Which patient is most likely to experience wheezing, congestion and angioedema? A - Hypertension; lisinopril B - Glaucoma; takes timolol C - Dysmenorrhea, takes iburprofen D - GERD, epinephrine
C - Dysmenorrhea, takes iburprofen Patient C, who has dysmenorrhea and takes ibuprofen, is more likely to have wheezing within two hours of drug administration. In addition, the patient usually presents with profound rhinorrhea, congestion, tearing, and angioedema. Patient A, who has hypertension and takes lisinopril, may have a cough, which exacerbates asthma. Patient B who has glaucoma and who is taking timolol, may experience bronchospasm. Patient D, who has gastroesophageal reflux disease and is taking epinephrine, has a low incidence of asthma.
Which corticosteroid can be administered directly through inhalation? Multiple choice question Fluticasone Ciclesonide Budesonide Mometasone
Ciclesonide Ciclesonide has reduced local side effects like oropharyngeal candidiasis, hoarseness, and dry cough because it activates the lungs and is administered directly through inhalation. Drugs such as fluticasone, budesonide, and mometasone cause local irritation as they are activated in the pharynx. Therefore these medications require a spacer for delivery into the lungs.
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? Multiple choice question Cleans the device with water Inhales two puffs, two seconds apart Does not shake the medication before taking it Breathes in rapidly while taking the medication
Cleans the device with water 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.
The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? Multiple choice question Clear lung sounds Heart rate 80 beats/minute Capillary refill less than three seconds Positive bowel sounds in all quadrants
Clear lung sounds Ipratropium is an inhaled anticholinergic used for asthma management. Clear lung sounds would indicate full passage of air and well-controlled symptom management. Heart rate, capillary refill, and bowel sounds are not associated with the benefits of ipratropium administration for bronchoconstriction and inflammation.
The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters? Multiple choice question Apical pulse Daily weight Bowel sounds Deep tendon reflexes
Daily weight Corticosteroids such as prednisone can lead to weight gain. For this reason, it is important to monitor the patient's daily weight. The drug should not affect the apical pulse, bowel sounds, or deep tendon reflexes.
The nurse would monitor which comorbidity in the patient treated for an asthma exacerbation with methylprednisolone? Multiple choice question Hyperlipidemia Hypothyroidism Diabetes mellitus Raynaud's phenomenon
Diabetes mellitus Hyperglycemia or increased blood glucose level is an adverse effect of methylprednisolone, so the patient with diabetes mellitus should be monitored for elevations in blood sugar. Methylprednisolone will not affect elevated cholesterol, hypothyroidism, or Raynaud's phenomenon.
A patient with asthma is prescribed ipratropium bromide. The nurse recognizes that the patient may develop what side effect of the medication? Multiple choice question Anxiety Insomnia Dry cough Dry mouth
Dry mouth A patient who is taking ipratropium bromide may develop dry mouth due to inhibition of parasympathetic nervous system. Anxiety is a side effect in the patient who is taking an oral medication of a beta-adrenergic agonist. Insomnia is the common side effect of methylxanthine. Corticosteroids upon inhalation may produce local irritation, such as dry cough.
When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers? Select all that apply. Multiple selection question Exercise Allergies Emotional stress Decreased humidity Upper respiratory infections
Exercise Allergies Emotional stress Upper respiratory infections Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychologic factors, and gastroesophageal reflux disease (GERD). Decreased humidity is not a trigger.
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. Multiple selection question Immune response Sedentary lifestyle History of pancreatitis Genetic predisposition Exposure to air pollutants
Immune response Genetic predisposition Exposure to air pollutant 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.
When teaching a patient about using a dry powder inhaler, what instructions should be included in this teaching? Select all that apply. Multiple selection question Increase the inspiration. Slow down the inspiration. Keep the device moisture-free. Shake the inhaler well before use. Avoid shaking the inhaler before use.
Increase the inspiration. Keep the device moisture-free. Avoid shaking the inhaler before use With dry powder inhalers, there is no need to shake before use. Inspiration should be rapid, and the device should be kept moisture-free to protect the dry powder. Shaking the inhaler well before use and slow inspiration are actions performed when using metered-dose inhalers
The nurse is assessing a patient with asthma who has been diagnosed with a severe and life-threatening exacerbation. What findings would the nurse find? Multiple choice question Increased CO 2 level Speaking in short sentences Increased pH level on an arterial blood gas (ABG) Peak expiratory flow rate (PEFR) is 70% of the personal best
Increased CO 2 level Early in exacerbation the CO 2 level is decreased, but increases if exacerbation is prolonged or severe. With an asthma exacerbation, patients are unable to speak in sentences and only speak a few words at a time before taking a breath. The pH level on an ABG decreases as the episode is prolonged, but is increased early in the exacerbation. With a life-threatening asthma attack, PEFR is 40% of the patient's personal best.
The nurse provides education to a patient who is prescribed a metered-dose inhaler. Which actions taken by the patient indicate the need for further teaching? Select all that apply. Multiple selection question Waits between puffs Activates the inhaler during inspiration Holds the breath for 10 seconds after a puff Inhales more than one puff with each inspiration Does not shake the metered-dose inhaler before use
Inhales more than one puff with each inspiration Does not shake the metered-dose inhaler before use The metered-dose inhaler (MDI) has to be shaken before use, and the patient should only inhale one puff per inspiration. The patient using an MDI should wait between each puff. The MDI should be activated during inspiration. The patient should to hold the breath for 10 seconds after each puff.
What is a priority nursing assessment for a 38-year-old patient experiencing an acute asthma exacerbation? Multiple choice question Pupillary response to light Inspection of the chest wall Measurement of pedal pulses Percussion for costovertebral angle (CVA) tenderness
Inspection of the chest wall The nurse physically inspects the chest wall to evaluate the use of intercostal muscles, which gives an indication of the degree of respiratory distress experienced by the patient. Pupillary response is a neurologic, not respiratory, assessment. Pedal pulses are measured to assess circulatory function. CVA tenderness is indicative of kidney inflammation, not asthma
A nurse is caring for a patient who is having an acute asthma attack. Which interventions should the nurse question? Select all that apply. Multiple selection question Peak flow reading Arterial blood gases Prednisone 10 mg, PO X1 stat Continuous oxygen to keep oxygen saturation above 90% Administration of blood products to increase oxygen saturation
Prednisone 10 mg, PO X1 stat Administration of blood products to increase oxygen saturation The nurse should question prednisone 10 mg, PO because this is an urgent situation that requires intravenous, intramuscular, and inhaled medications, rather than oral ones. There is not enough documentation to indicate that this patient requires administration of blood products, and blood products are not used to treat oxygen saturation. Peak flow readings, arterial blood gases, and continuous oxygen would be considered the standard of care for this patient.
A nurse has taught the technique of pursed-lip breathing to a patient. During a return demonstration, what patient action requires correction? Multiple choice question Puffing of cheeks while exhaling air Slow and deep inhalation through the nose Slow exhalation through pursed lips, as if whistling Exhalation time three times as long as inhalation time
Puffing of cheeks while exhaling air In pursed-lip breathing, the patient should avoid puffing of the cheeks while exhaling the air. Puffing of the cheeks makes the technique less effective. Slow and deep inhalation, slow exhalation through pursed lips as if whistling, and exhalation time thrice as long as inhalation time are correct techniques of pursed-lip breathing.
The nurse determines that the patient with chronic obstructive pulmonary disease (COPD) and diabetes mellitus is experiencing adverse effects of albuterol after noting which finding? Multiple choice question Blood sugar 139 mg/dL Temperature of 99.1° F Respiratory rate of 21 breaths/minute Pulse rate of 102 beats/minutes
Pulse rate of 102 beats/minutes Albuterol is a β2-agonist that sometimes can cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 102 indicates that the patient is experiencing tachycardia as an adverse effect. This medication will not affect the blood sugar or the temperature. The respiratory rate is normal and does not indicate any adverse reaction is occurring.
A patient is having an asthma attack, and is short of breath and appears frightened. The nurse understands that possible triggers for asthma exacerbations include which factors? Select all that apply. Multiple selection question Alcohol Perfumes Animal dander Humid weather Gastroesophageal reflux disease (GERD)
Alcohol Perfumes Animal dander Gastroesophageal reflux disease (GERD) Alcohol, GERD, animal dander, perfumes, and cold weather (not humid) are all possible triggers for acute asthma exacerbations
The nurse determines that the patient has understood medication instructions about the use of a metered dose inhaler (MDI) when the patient performs which action? Multiple choice question Inhales rapidly when activating the inhaler Holds the MDI sideways to increase ease of use Waits one minute between each puff from the MDI Breathes through the nose with activation of the MDI
Waits one minute between each puff from the MDI The patient should wait at least one minute in between puffs to increase medication dispersion throughout the lungs. The patient should inhale slowly, hold the MDI upright, and breathe through the mouth.
What discharge instructions should the nurse include for the patient with asthma? Select all that apply. Multiple selection question Wash the nebulizer regularly. Wash the mouth after taking albuterol. Medication noncompliance may lead to exacerbations. It is important to know the purpose and side effects of prescribed medications. Wash respiratory equipment with a solution of one-part water to two parts white vinegar.
Wash the nebulizer regularly. Medication noncompliance may lead to exacerbations. It is important to know the purpose and side effects of prescribed medications. The nurse should advise the patient to soak the nebulizer in soap and water as the hot water kills the germs on it. Educating the patient about drugs and devices before discharge from the hospital is the responsibility of the nurse. The nurse should warn the patient about the dangers of noncompliance with the medications to avoid triggering asthma attacks. The patient should wash the mouth after inhalation of corticosteroids. The patient must wash respiratory equipment with 1:1 water and white vinegar.
The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving? Multiple choice question Wheezing becomes louder. Cough remains nonproductive. Vesicular breath sounds decrease. Aerosol bronchodilators stimulate coughing.
Wheezing becomes louder. 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. After a severe asthma exacerbation, the cough may be productive and stringy. Vesicular breath sounds will increase with improved respiratory status. Coughing after aerosol bronchodilators may indicate a problem with the inhaler or its use.
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. Multiple selection question "I have to shake the medicine bottle before use." "I should keep my medicine away from humid places." "I should engage the lever while loading the medicine." "I should hold my breath for 20 to 30 seconds after a puff." "I have to raise my head forward and breathe into my inhaler."
"I should keep my medicine away from humid places." "I should engage the lever while loading the medicine." 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.
The nurse is evaluating an asthmatic patient's knowledge of self-care. Which statement by the patient indicates an adequate understanding of the instructions given? Multiple choice question "I will keep my rescue inhaler with me at all times." "I do not need to get a flu shot because I'm under age 50." "I will use my peak flow meter only when I feel like I'm getting sick." "I will use my corticosteroid inhaler only when I feel short of breath."
"I will keep my rescue inhaler with me at all times." Part of a rescue plan for asthma patients is to have access to a short-acting bronchodilator, such as albuterol, to use for rapid control of symptoms. Asthma patients should get a flu shot annually, and the self-monitoring of one's "Personal Best" with a peak flow meter should be done at least daily as part of an asthma action plan. Corticosteroids cannot abort an asthma attack.
The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit? Multiple choice question "I will pay less for medication because it will last longer." "More of the medication will get down into my lungs to help my breathing." "Now I will not need to breathe in as deeply when taking the inhaler medications." "This device will make it so much easier and faster to take my inhaled medications."
"More of the medication will get down into my lungs to help my breathing." A spacer assists more medication to reach the lungs, with less being deposited in the mouth and the back of the throat. It does not affect the cost or the increase the speed of using the inhaler.
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? Multiple choice question "Taper the intravenous dose of corticosteroids slowly." "Administer the patient's corticosteroids every 12 hours." "Lower the dose of inhaled corticosteroids to prevent asthma relapse." "Provide inhaled corticosteroids to the patient while still in the hospital."
"Provide inhaled corticosteroids to the patient while still in the hospital. 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.
Which nursing instructions would be beneficial to the patient who has shortness of breath, wheezing, and chest tightness? Select all that apply. Multiple selection question "You should avoid contact with furred animals." "You should wash bed covers in hot water and detergent." "You should avoid wearing masks in cold climate conditions." "You should take aspirin when you have shortness of breath." "You should take propanol when you have excess wheezing." "You should ensure that the household does not have any cockroaches."
"You should avoid contact with furred animals." "You should wash bed covers in hot water and detergent." "You should ensure that the household does not have any cockroaches." Shortness of breath, wheezing, and chest tightness indicate that the patient has asthma. Fur acts as an irritant and increases the allergic reactions associated with asthma. Dust mites also trigger asthma, so the patient should wash bed covers with hot water and detergent because this reduces allergens. Danders such as cockroach remains and droppings trigger asthma. Propanol is a nonselective β-blocker that inhibits bronchodilation and should be avoided by patients with asthma. Cold climate conditions are an irritant that triggers asthma, so the patient should wear a mask or scarf in a cold environment. Aspirin precipitates attacks of asthma; therefore the patient should avoid taking aspirin.
The nurse is educating a patient who was recently diagnosed with asthma about the use of a peak flow meter. Which statement is the nurse's priority? Multiple choice question "The peak flow meter should be used weekly." "The peak flow meter reduces asthma attacks." "The peak flow meter should be used before the use of an inhaler." "You should find your personal best peak flow reading for comparison."
"You should find your personal best peak flow reading for comparison." It is important that the patient identify his or her personal best readings to evaluate when the symptoms are evolving into a medical emergency. The peak flow meter does not reduce asthma attacks; it helps monitor symptoms of asthma. It should be used at least twice a day for the first two weeks to determine the patient's personal best, which will be used to monitor airway constriction. The peak flow meter is used after the use of an inhaler, not before, to measure the effectiveness of the medication.
After assessing the peak flow meter readings of a patient with asthma, the nurse concludes that the patient should inhale quick relief medicine right away. What could be the peak flow number of the patient? Multiple choice question 40 percent of personal best number 60 percent of personal best number 75 percent of personal best number 85 percent of personal best number
40 percent of personal best number The patient with asthma whose peak flow meter reading is in the red zone or less than 50 percent of his or her personal best number is instructed to inhale a quick relief medicine immediately, which is a short-acting β-adrenergic agonist. Therefore the peak flow meter reading of the patient could be 40 percent of his or her personal best number. The patient who has a peak flow meter reading between 50 percent and 80 percent will require an increase in medication dosage, but not immediate treatment. Therefore the patient with a peak flow meter reading of 60 percent or 75 percent of his or her personal best number will not require immediate treatment. The patient with a peak flow meter reading of 85 percent of his or her personal best number is in the green zone of peak flow zone and does require any further change in the treatment strategy.
The patient is receiving 3 L of oxygen (O 2) via nasal cannula. Which action by the nurse is most appropriate? Select all that apply. Multiple selection question Assesses eyes for dryness Realizes that humidification is never needed Adjusts humidification according to patient comfort Assesses the bubble-through humidifier if humidity is used Assures that the patient is wearing the nasal cannula correctly
Adjusts humidification according to patient comfort Assesses the bubble-through humidifier if humidity is used Assures that the patient is wearing the nasal cannula correctly Assessing the bubble-through humidifier if humidity is used, assuring that the patient is wearing the nasal cannula correctly, and adjusting humidification according to patient comfort are correct because oxygen (O 2) obtained from cylinders or wall systems is dry. Dry O 2 has an irritating effect on mucous membranes and dries secretions. A common device used for humidification when the patient has a cannula or a mask is a bubble-through humidifier. It is important for the nurse to assess the bubble-through humidifier if humidity is used to make sure the humidification is on. This adds to the comfort of the patient. The nurse assesses the patient to make sure the nasal cannula is worn correctly for optimal effect. The cannula can become easily dislodged. Humidification is adjusted according to the patient's comfort level. When oxygen levels are 1 to 4 L, the use of humidification may not be the preference of all patients. Believing that humidification is never needed is incorrect because the use of humidification is a patient preference. The nurse should assess the patient's nose for dryness, not the eyes.
Which finding indicates to the nurse that a patient's respiratory status is improving following an acute asthma exacerbation? Multiple choice question Audible wheezing Pursed lip breathing Use of intercostal muscles Oxygen saturation 89% of room air
Audible wheezing 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.
A patient presents to the emergency department with acute exacerbation of asthma. What actions should the nurse perform to monitor the patient's respiratory and cardiovascular systems? Select all that apply. Multiple selection question Take a chest radiograph. Auscultate the lung sounds. Check the patient's temperature. Measure blood pressure and respiratory rate. Monitor arterial blood gases (ABGs) and pulse oximetry.
Auscultate the lung sounds. Measure blood pressure and respiratory rate. Monitor arterial blood gases (ABGs) and pulse oximetry. It is essential to monitor respiratory and cardiovascular systems in case of acute exacerbation of asthma. Auscultating lung sounds, measuring blood pressure and respiratory rate, and monitoring ABGs and pulse oximetry are required to monitor these systems. Chest radiographs are seldom useful in the management of an acute asthma attack. Checking the temperature may not contribute to monitoring respiratory and cardiovascular systems.
When teaching a patient with asthma about ways to reduce the severity of asthma and asthma attacks, which measures should be included? Select all that apply. Multiple selection question Avoid food irritants. Avoid animals with fur. Identify personal triggers. Go out in the cold air for a walk. Use nonsteroidal antiinflammatory drugs (NSAIDs).
Avoid food irritants. Avoid animals with fur. Identify personal triggers Patients with asthma should be taught to avoid food irritants and animals with fur. Identifying personal triggers can help to avoid them. Going out in the cold air and the use of NSAIDs are not recommended, because they can precipitate an asthma attack.
The nurse finds that a patient is experiencing breathlessness, chest tightness, and a cough after climbing stairs. What is the most likely reason for these symptoms? Multiple choice question Edema of airway walls Capillary leakage in the airway Change in the responsiveness of airways Immunoglobulin E-mediated allergic response
Capillary leakage in the airway Asthma that is induced or exacerbated during physical exertion is called exercise-induced asthma (EIA). Typically, EIA occurs after vigorous exercise, not during it. Airway obstruction may occur due to changes in the airway mucosa caused by hyperventilation during exercise, with either cooling or rewarming of air and capillary leakage in the airway wall. Edema of airway walls occurs during respiratory tract infections. A change in responsiveness of the airway occurs on exposure to irritants, as seen with occupational asthma. Patients who are genetically predisposed to develop an allergic (immunoglobulin E-mediated) response have an increased risk of allergic asthma, but it would not cause an exacerbation after climbing stairs.
On examining a patient with asthma the nurse finds that the patient experiences asthmatic symptoms throughout the day, besides experiencing night-time awakenings more than four times a week. The patient's forced expiratory volume in the first second of expiration (FEV 1) is less than 60%, and normal activity is very limited. Which treatment option should the nurse consider appropriate? Multiple choice question Follow up after a month. Consider oral corticosteroids. Reevaluate in two to six weeks. Advise maintaining control of asthma symptoms.
Consider oral corticosteroids. Experiencing symptoms of asthma throughout the day and also experiencing nighttime awakenings more than four times a week is suggestive of poorly controlled asthma. This patient also has an FEV 1 less than 60%; normal activity being very limited correlates with that. Treatment with oral corticosteroids should be considered. Advice for maintaining control of asthma symptoms and following up after a month can be given in case of well controlled asthma. Reevaluation in two to six weeks is suggested if the asthma is not well controlled or if the patient experiences symptoms more than two times a month.
A 61-year-old patient with asthma is admitted to the hospital. The nurse understands that symptoms of asthma include what? Select all that apply. Multiple selection question Cough Crackles Wheezing Chest tightness Pink frothy sputum
Cough Wheezing Chest tightness Symptoms of asthma include cough, chest tightness, and wheezing. Crackles are heard when fluid has accumulated in the lungs, which is not consistent with asthma. Pink frothy sputum is seen with pulmonary edema.
A patient with allergic asthma has been prescribed omalizumab. The patient requests that the medication be administered at home for convenience. Which nursing action is appropriate in this case? Multiple choice question Administer the injection to the patient on a home visit. Ask a family member to administer the medication at home. Load the injection and provide it to the patient for self-administration. Explain to the patient that the medication should be administered strictly at the clinic.
Explain to the patient that the medication should be administered strictly at the clinic. Omalizumab is a monoclonal antibody to IgE that decreases circulating free IgE levels. The drug prevents IgE from attaching to mast cells, preventing the release of chemical mediators that may exacerbate asthma. The medication can cause anaphylactic reaction and should be administered at a clinic that is well-equipped to handle emergencies. The nurse should not encourage self-administration of the medication at home, because the anaphylactic reaction can be life-threatening. The nurse may not be well equipped to handle emergencies at home, so the medication should not be administered during a home visit. A family member should not be asked to administer the medication for the same reason.
The nurse is caring for a patient who has just been diagnosed with asthma. The nurse knows what? Multiple choice question Asthma also is considered a psychosomatic disease. Food allergies frequently trigger an asthma attack in adults. The asthma triad refers to nasal polyps, asthma, and sensitivity to acetaminophen (Tylenol) products. Gastroesophageal reflux disease (GERD) is more common in people with asthma than in the general population.
Gastroesophageal reflux disease (GERD) is more common in people with asthma than in the general population. 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).
In which position is it most appropriate for the nurse to place a patient experiencing an asthma exacerbation? Multiple choice question Supine Lithotomy High-Fowler's Reverse Trendelenburg
High-Fowler's The patient experiencing an asthma attack should be placed in high-Fowler's position and may need to lean forward to allow for optimal chest expansion and enlist the aid of gravity during inspiration. The supine, lithotomy , and reverse Trendelenburg positions will not facilitate ventilation.
What are the structural changes that occur during chronic inflammation? Select all that apply. Multiple selection question Fibrosis of epithelium Smooth muscle atrophy Hypersecretion of mucus Progressive loss of lung function Proliferation of new blood vessels
Hypersecretion of mucus Progressive loss of lung function Proliferation of new blood vessels Chronic inflammation of the airway results in remodeling of the bronchial wall. This includes hypersecretion of mucus, progressive lung function loss, and proliferation of new blood vessels. The changes may also include fibrosis of the subepithelium and smooth muscle hypertrophy of the airways.
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? Multiple choice question Recommend that the patient pauses between the puffs Instruct the patient to rinse the mouth with water after inhalation Assist the patient in obtaining a spacer or holding device for inhalation Wait until the cough subsides before administering the patient's next dose
Instruct the patient to rinse the mouth with water after inhalation 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 recalls that which type of asthma involves an acute asthma attack triggered by an upper respiratory infection? Multiple choice question Intrinsic Allergic Extrinsic Emotional
Intrinsic Intrinsic asthma does not have an easily identifiable allergen and may be related to internal factors such as an upper respiratory infection. Extrinsic asthma includes allergic triggers such as dust, molds, and pet dander. Asthma related to emotional causes is also considered extrinsic.
What are the advantages of a diskus over a metered-dose inhaler? Select all that apply. Multiple selection question It requires less manual dexterity. It includes coordination of device puffs with inhalation. The medication does not clump upon exposure to the humidity. It contains an easily visible color that indicates the number of doses left. A patient with low forced expiratory volume in one second can easily inhale the medication using the diskus.
It requires less manual dexterity It contains an easily visible color that indicates the number of doses left. A diskus has several advantages over metered-dose inhaler. There is less need for manual dexterity through a diskus. The visible color indicator on a diskus helps to estimate the number of doses left. There is no need to coordinate device puffs with inhalation. The medication in the diskus may clump upon exposure to the humid environment. The patient has to apply inspiratory effort to administer the drug. Therefore the patient who has low forced expiratory volume in one second cannot inhale the medication.
While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do? Multiple choice question Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. Use the flow meter each morning after taking medications to evaluate their effectiveness. Increase the doses of the long-term control medication if the peak flow numbers decrease. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled.
Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse. It is important to keep track of peak flow readings daily, especially when the patient's symptoms are getting worse. The patient should have specific directions as to when to call the health care provider based on personal peak flow numbers. Peak flow is measured by exhaling into the flow meter, and should be assessed before and after medications to evaluate their effectiveness.
A patient with chronic obstructive pulmonary disease (COPD) is suspected to have developed cor pulmonale. The nurse recognizes that which test result helps confirm the diagnosis? Multiple choice question Large pulmonary vessels on chest x-ray Left-sided heart enlargement on echocardiogram Decreased B-type natriuretic peptide (BNP) levels Decreased pressure found in a right heart catheterization
Large pulmonary vessels on chest x-ray Cor pulmonale is a cardiac complication of COPD resulting from pulmonary hypertension. Due to pulmonary hypertension, the pulmonary vessel may appear enlarged in a chest x-ray. There may be increased pressure found in a right heart catheterization due to pulmonary hypertension. Cor pulmonale is usually associated with right-sided heart enlargement, because there is increased pressure in the blood vessels of lungs. The BNP levels are increased due to the stretching of the right ventricle.
A patient with dyspnea and hypoxemia has received an initial nebulized short-acting β 2-adrenergic agonist (SABA) with ipratropium treatment. The patient's forced expiratory volume in one second is 60 percent, and the peak flow is less than 25 percent of personal best. The nurse anticipates that which medication will be administered? Multiple choice question Epinephrine Theophylline Magnesium sulfate Sodium bicarbonate
Magnesium sulfate A patient with dyspnea and hypoxemia and who is on initial treatment with ipratropium has severe asthma. Such a patient has low forced expiratory volume in one second of 60 percent and peak flow less than 25 percent of personal best. Intravenous administration of magnesium sulfate helps to resolve the patient's condition faster. Administration of epinephrine is not indicated for the treatment of asthma exacerbations. However, a subcutaneous or intramuscular injection may be used for acute treatment of anaphylaxis. Administration of theophylline is no longer recommended for asthma exacerbations. Sodium bicarbonate administration is limited to the treatment of severe metabolic or respiratory acidosis.
An asthmatic patient was prescribed theophylline. A nurse understands that the patient is at risk for tachycardia and seizures. In regard to safety, the nurse expects that what will be included on the patient's treatment plan? Multiple choice question Encourage the use of caffeine. Use diazepam to prevent seizures. Monitor serum blood levels of adrenaline. Monitor serum blood levels of theophylline.
Monitor serum blood levels of theophylline. Tachycardia and seizures are known toxic effects of theophylline at higher blood levels. In addition, the drug has a narrow margin of safety. Therefore monitoring blood levels of theophylline helps to reduce such toxic effects. Caffeine increases the toxic effects of theophylline. Monitoring plasma levels of adrenaline may not help, because tachycardia is not associated with adrenaline in this case. Prophylactic use of diazepam may not prevent seizures that are caused by the use of theophylline.
The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs? Multiple choice question Hypertension and pulmonary edema Oropharyngeal candidiasis and hoarseness Elevation of blood glucose and calcium levels Adrenocortical dysfunction and hyperglycemia
Oropharyngeal candidiasis and hoarseness Oropharyngeal candidiasis and hoarseness are common adverse effects from the use of inhaled corticosteroids because the medication can lead to overgrowth of organisms and local irritation if the patient does not rinse the mouth following each dose. Beclomethasone does not cause hypertension, pulmonary edema, elevated calcium levels or blood glucose levels, or adrenocortical dysfunction.
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? Multiple choice question Prescribing a beta-antagonist for the patient Administering intravenous corticosteroids to the patient Advising the patient to exercise when the air is cool and dry Referring the patient to a surgeon for the removal of nasal polyps
Referring the patient to a surgeon for the removal of nasal polyps 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 provides teaching to a patient with asthma who has been advised to use nebulization. What should the nurse include in the instructions about nebulization? Multiple choice question Hold the inspiration for 10 seconds. Breathe rapidly between forced breaths. Sit in an upright position during the treatment. Do not cough after the nebulization treatment.
Sit in an upright position during the treatment. Nebulization involves administering drug solution as mists produced by small machines called nebulizers. An upright position allows for efficient breathing that ensures adequate penetration and deposition of the aerosolized medication. The patient should hold the inspiration for two to three seconds to ensure penetration of the medication. The patient should practice deep breathing in between the forced breathing to prevent alveolar hypoventilation. The patient should be encouraged to cough effectively after the nebulization to mobilize the secretions.
The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct? Multiple choice question Sit in an upright position during the treatment. Take short, shallow breaths while inhaling the medication. Rinse the nebulizer equipment under running water once a week. During the treatment, breathe in and hold the breath for five seconds.
Sit in an upright position during the treatment. The patient is placed in an upright position that allows for most efficient breathing to ensure adequate penetration and deposition of the aerosolized medication. The patient must breathe slowly and deeply through the mouth and hold inspirations for two or three seconds. Deep diaphragmatic breathing helps ensure deposition of the medication. Instruct the patient to breathe normally in between these large forced breaths to prevent alveolar hypoventilation and dizziness. After the treatment instruct the patient to cough effectively. An effective home-cleaning method is to wash the nebulizer equipment daily in soap and water, rinse it with water, and soak it for 20 to 30 minutes in a 1:1 white vinegar-water solution, followed by a water rinse and air drying.
To promote airway clearance in a patient with pneumonia and asthma, the nurse instructs the patient to perform which action? Multiple choice question Perform pursed-lip breathing Wear supplemental oxygen at all times Sit upright while using the flutter device Use the incentive spirometer 10 times per hour
Sit upright while using the flutter device The flutter device is used to increase mucus production to promote airway clearance and gas exchange; it should be used while the patient is in an upright position. Supplemental oxygen may not be indicated depending on the oxygen saturation level. Pursed-lip breathing and the incentive spirometer will not promote airway clearance.
A patient receives a prescription for omalizumab. What medication route of administration and schedule will the nurse include in the information provided to the patient? Multiple choice question Intravenously, every four to six hours Two to four puffs, every 20 to 30 minutes Subcutaneously, every two to four weeks Orally, one hour before meals or two hours after meals
Subcutaneously, every two to four weeks Omalizumab is a monoclonal antibody that decreases circulating free IgE levels. The patient with asthma will take the medication subcutaneously every two to four weeks. Intravenous corticosteroids are administered every four to six hours. Albuterol nebulization in the patient with asthma is given two to four puffs at a time, every 20 to 30 minutes. Leukotriene modifiers are taken orally, one hour before meals or two hours after meals.
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? Multiple choice question Administration of ipratropium orally Three puffs of albuterol every 30 minutes Supplementary oxygen through nasal cannula Obtaining peak flow rate and monitoring the patient continuously
Supplementary oxygen through nasal cannula 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.
The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β 2-adrenergic agonists bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment? Multiple choice question Biofeedback therapy Intravenous (IV) fluids Systemic corticosteroids Pulmonary function testing
Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β 2-adrenergic agonists bronchodilator is insufficient. IV fluids may be used, but not to improve ventilation. Biofeedback therapy and pulmonary function testing may be used after recovery to assist the patient and monitor the asthma.
The nurse determines that a patient is experiencing the most common adverse effect of albuterol after noting which sign? Multiple choice question Diarrhea Headache Tachycardia Oral candidiasis
Tachycardia Tachycardia is a common adverse effect of the use of inhaled β 2-adrenergic agonists because of its stimulant effect. Headache, diarrhea, and oral candidiasis are not associated adverse effects of albuterol.
A patient experiencing severe wheezing arrives in the emergency department and is diagnosed with severe exacerbation of asthma. During the admission assessment, the nurse on the inpatient unit notes that the patient continues to struggle with breathing; however, there is an absence of wheezing. How should the nurse interpret the assessment findings? Multiple choice question The patient is hypoxic and needs oxygen therapy. The patient has improved because there is no wheezing. The patient has respiratory failure and needs mechanical ventilation. The patient has retained secretions and needs chest physiotherapy.
The patient has respiratory failure and needs mechanical ventilation. A silent chest or absence of wheezing in a patient who had been having severe wheezing indicates an impending respiratory failure. The patient may need mechanical ventilation to support respiration. It is a sign of severe obstruction and it is a life-threatening condition. It is not a sign of improvement. Oxygen therapy may not help the patient, because there is an obstruction in the airway. Chest physiotherapy helps in removing secretions from the airway, but may not be helpful in patients who are at risk of respiratory failure.
A patient with a forced expiratory volume of 80 percent and a three-day history of breathlessness develops nausea, vomiting, headache, tachycardia, and dysrhythmias. The nurse suspects that which medication that the patient takes is the cause of the patient's symptoms? Multiple choice question Albuterol Omalizumab Mometasone Theophylline
Theophylline A patient with forced expiratory volume of 80 percent and breathlessness for three days has mild asthma. The patient may develop nausea, vomiting, headache, tachycardia, and dysrhythmias upon theophylline use. Theophylline is a methylxanthine bronchodilator with narrow therapeutic use. Therefore its use is very limited. The patient's serum concentration levels should be monitored regularly to determine that the drug is within therapeutic window. Albuterol is a short-acting beta agonist that is safe in the patient with mild asthma. Mometasone is a corticosteroid that may cause local irritation like cough and hoarseness upon inhalation. Omalizumab is a monoclonal antibody that decreases circulating free IgE levels in the patient with allergic asthma.
