MCA-2 Adaptive Quiz #3 Asthma Management

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? "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." Rationale 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. p. 547

The patient with asthma asks the nurse, "How will I know when my inhaler is empty?" What is the best response by the nurse? "The canister will float in water." "There will be no sound when shaking the canister." "Your wheezing will not improve despite inhaler use." "You need to keep track of how many puffs you have used and how many puffs are available."

"You need to keep track of how many puffs you have used and how many puffs are available." Rationale Show the patient how to determine how many puffs are available in the canister. Then teach the patient to document each time a puff is used. It is important to teach the patient this simple way to check the inhaler. The canister may or may not produce a sound when shaking. Floating the canister in water used to be recommended, but is no longer recommended because water can enter the chamber. It is not reasonable to wait for the patient's wheezing to worsen before getting a new inhaler. p. 550

The nurse determines that the patient has experienced the full benefits of medication therapy with ipratropium when which assessment finding is noted? Clear lung sounds Heart rate 80 beats/minute Capillary refill less than three seconds Positive bowel sounds in all quadrants

Clear lung sounds Rationale 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. p. 552

The nurse determines that a patient is not experiencing the beneficial effects of ipratropium after noting which finding in the patient? Expiratory wheezing Elevated blood pressure Increased low back pain Hypoactive bowel sounds

Expiratory wheezing Rationale Ipratropium, a bronchodilator, decreases wheezing; if wheezing persists, the medication has not been effective. Ipratropium will have no effect on bowel sounds, blood pressure, or pain of any kind. p. 563

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? "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." Rationale 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. p. 556

Which diagnostic findings indicate that a patient has asthma? Select all that apply. Decrease in serum IgE Increase in oxygen saturation Positive skin test for allergens Serum and sputum eosinophilia Chest x-ray indicating hyperinflation

Positive skin test for allergens Serum and sputum eosinophilia Chest x-ray indicating hyperinflation Rationale Asthma is usually triggered due to allergens; therefore the patient will have a positive skin test for allergens. Eosinophils are a type of white blood cells that help defend the body from inflammation. The patient with asthma will have acute inflammation, which results in an increase of eosinophils in serum and sputum. The patient with asthma has shortness of breath, which results in hyperinflation of the lungs. Therefore the chest x-ray shows hyperinflation. IgE antibodies bind to allergens that cause inflammation. Therefore the patient with asthma will have high serum IgE levels. Patients with asthma have breathlessness, which reduces oxygen concentration in the lungs. Therefore the patient will have a decrease of oxygen saturation. p. 543

Fill in the blankThe patient has a prescription for albuterol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. Calculate how many mL the nurse should use to prepare the patient's dose. Fill in the blank using one decimal place. mL

Rationale 5 mg ÷ 2 mg/mL = 2.5 mL p. 548

Fill in the blankAn asthmatic patient has been prescribed 4 puffs of salmeterol daily. The canister of the meter dose inhaler has 200 puffs. The nurse instructs the patient that the canister will be empty and will need to be replaced in how many days? Record your answer using a whole number. days Rationale To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. Since the canister has a capacity of 200 puffs and the patient needs 4 puffs daily, the number of days for which the canister may be used is 200/4 = 50. p. 549

Rationale To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day. Since the canister has a capacity of 200 puffs and the patient needs 4 puffs daily, the number of days for which the canister may be used is 200/4 = 50. p. 549

In which position is it most appropriate for the nurse to place a patient experiencing an asthma exacerbation? Supine Lithotomy High-Fowler's Reverse Trendelenburg

Reverse Trendelenburg Rationale 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. p. 554

The nurse administering beclomethasone to a patient can help reduce side effects by instructing the patient to perform which action? Use this medication only as needed Rinse mouth thoroughly after each use Use the inhaler at the onset of an asthma attack Avoid use of a spacer to increase the amount of medication absorption

Rinse mouth thoroughly after each use Rationale The side effects of the glucocorticoid include oral candida, which can be prevented through rinsing the mouth with water or mouthwash after each use. This medication should be used on a schedule, not as needed, a spacer is encouraged, and it will not be helpful at the onset of an asthma attack because it is not an abortive medication; it is a preventative medication. p. 548

The nurse is teaching a patient how to use a hand-held nebulizer. Which guideline is correct? 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 Rationale 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. p. 552

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? 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. Rationale 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. p. 552

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? Biofeedback therapy Intravenous (IV) fluids Systemic corticosteroids Pulmonary function testing

Systemic corticosteroids Rationale 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. p. 564

The nurse determines that a patient is experiencing the most common adverse effect of albuterol after noting which sign? Diarrhea Headache Tachycardia Oral candidiasis

Tachycardia Rationale 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. p. 549

Which inhaler should the nurse be prepared to administer to the patient at the onset of an asthma attack? Albuterol Fluticasone Salmeterol Fluticasone/Salmeterol

albuterol Rationale Albuterol is a short-acting bronchodilator that should be given first when the patient experiences an asthma attack. Fluticasone/salmeterol, fluticasone, and salmeterol are not short-acting bronchodilators and will not relieve the patient's symptoms of an acute asthma exacerbation. pp. 546-547