respiratory Evolve questions 488 week 4

chapter 31 The nurse is teaching a client how to self-administer ipratropium via a metered-dose inhaler. Which of the following instructions should the nurse provide to the client about proper inhalation technique? "Breathe out slowly before positioning the inhaler." "After taking a puff, hold the breath for 30 seconds before exhaling." "Using a spacer should be avoided for this type of medication." "Avoid shaking the inhaler before use."

"Breathe out slowly before positioning the inhaler." It is important to breathe out slowly before positioning the inhaler. This allows the client to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose.

Which statement by a patient best indicates an understanding of the teaching on flunisolide? "I will wash the plastic inhaler casing once a month." "I will take two puffs to treat an acute asthma attack." "I will rinse my mouth with water after each use." "I will not use my albuterol inhaler while I am taking AeroBid."

"I will rinse my mouth with water after each use." Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the patient's bronchodilator medications. The plastic inhaler casing should be washed in warm soapy water every week.

Which of the following statements made by a client with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler? "I should rinse my mouth following the two puffs to get rid of the bad taste." "Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse." "I should wait at least one to two minutes between each puff of the inhaler." "If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily." The client should not take extra puffs of the inhaler at will to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the client's respiratory status.

chapter 31 The nurse is teaching a client about the use of a spacer device when taking inhaled medications. Which of the following client statements indicates that the teaching has been effective? "I will pay less for medication because it will last longer." "This device will make it so much easier and faster to take my inhaled medications." "Now I will not need to breathe in as deeply when taking the inhaler medications." "More of the medication will get down into my lungs to help my breathing."

"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.

chapter 31 The nurse is caring for a client who is receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The client asks the nurse whether oxygen use will be needed at home. Which of the following responses is best? "Oxygen will not be needed until or unless you are in the terminal stages of this disease." "Long-term home oxygen therapy should be used to prevent respiratory failure." "Long-term home oxygen therapy should be used to prevent heart problems related to COPD." "Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia."

"Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia." Long-term oxygen therapy in the home should be considered when the oxygen saturation is 88% or less and the client has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status.

pharm chapter 38 The nurse performs discharge teaching with a patient who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent®). Which statement by the patient indicates to the nurse that the teaching has been successful? "I will not drink grapefruit juice while taking this drug." "Nausea and vomiting are common adverse effects of this medication." "I may gain weight as a result of taking this medication." "This inhaler is not to be used alone to treat an acute asthma attack."

"This inhaler is not to be used alone to treat an acute asthma attack." Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.

Which statement by the nurse should be included when teaching a patient about the proper use of metered-dose inhalers? "Make sure that you puff out air several times after you inhale the medication." "Wait 1 to 2 minutes before you take a second puff of the same drug." "After you inhale the medication once, repeat until you obtain relief." "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."

"Wait 1 to 2 minutes before you take a second puff of the same drug." If a second puff of the same drug is ordered, instruct the patient to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the patient to wait 2 to 5 minutes between the medications or to take as prescribed.

chapter 31 The client has an order for salbutamol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. How many millilitres should the nurse use to prepare the client's dose? 0.2 mL 3.75 mL 2.5 mL 5.0 mL

2.5 mL 5 mg ÷ 2 mg/mL = 2.5 mL.

Lewis 70 For which of the following clients would noninvasive positive pressure ventilation (NIPPV) be an appropriate intervention to promote oxygenation? A client with a diagnosis of cystic fibrosis and who is currently producing copious secretions A client whose respiratory failure is due to a head injury with loss of consciousness A client whose cardiac output and blood pressure are unstable A client who is experiencing respiratory failure as a result of the progression of myasthenia gravis

A client who is experiencing respiratory failure as a result of the progression of myasthenia gravis Noninvasive positive pressure ventilation (NIPPV) is most effective in treating clients with respiratory failure resulting from chest wall and neuro-muscular disease. It is not recommended in clients who are experiencing cardiac instability, decreased level of consciousness, or excessive secretions.

Lewis 70 The nurse is aware of the value of using a mini-tracheostomy to facilitate suctioning when clients are unable to independently mobilize their secretions. For which of the following clients is the use of a mini-trach indicated? A client whose recent ischemic stroke has resulted in the loss of his gag reflex A client with a head injury who has developed aspiration pneumonia after his family insisted on spoon-feeding him A client who requires long-term mechanical ventilation as the result of a spinal cord injury A client whose increased secretions are the result of community-acquired pneumonia

A client whose increased secretions are the result of community-acquired pneumonia It is probably appropriate to suction a client with pneumonia using a mini-trach if blind suctioning is ineffective or difficult. An absent or compromised gag reflex, long-term ventilation, and a history of aspiration contraindicate the use of a mini-trach.

Lewis 70 The nurse is caring for a client who is experiencing acute respiratory distress syndrome (ARDS) as a result of sepsis. Which of the following measures would most likely be implemented to maintain cardiac output? Administer crystalloid fluids or colloid solutions. Position the client in the Trendelenburg position. Perform chest physiotherapy and assist with staged coughing. Place the client on fluid restriction and administer diuretics.

Administer crystalloid fluids or colloid solutions. Low cardiac output may necessitate crystalloid fluids or colloid solutions in addition to lowering positive end-expiratory pressure (PEEP) or administering inotropes. The Trendelenburg position (not recommended to treat hypotension) and chest physiotherapy are unlikely to relieve decreased cardiac output, and fluid restriction and diuresis would be inappropriate interventions.

Lewis 70 The nurse is admitting a client with asthma who is in acute respiratory distress. The nurse auscultates the client's lungs and notes cessation of inspiratory wheezing. The client has not yet received any medication. What of the following explanations is most likely related to this clinical presentation? Overworked intercostal muscles resulting in poor air exchange An acute development of bilateral pleural effusions Airway constriction requiring intensive interventions Spontaneous resolution of the acute asthma attack

Airway constriction requiring intensive interventions When the client in respiratory distress has inspiratory wheezing that then ceases, it is an indication of airway obstruction and requires emergency action to restore the airway.

chapter 29 lewis The nurse is discharging a client from the emergency department after being treated for epistaxis. In teaching the family first-aid measures in the event the epistaxis recurs, which of the following measures would the nurse suggest? (Select all that apply.) Apply ice compresses to the forehead. Tilt client's head backwards. Pinch the entire soft lower portion of the nose. Tilt head forward while lying down. Have the client suck on ice chips.

Apply ice compresses to the forehead. Pinch the entire soft lower portion of the nose. Have the client suck on ice chips. First-aid measures to control epistaxis include (1) keep the client quiet; (2) place the client in a sitting position, leaning forward, or if not possible, in a reclining position with head and shoulders elevated; (3) apply direct pressure by pinching the entire soft lower portion of the nose for 10-15 minutes; (4) apply ice compresses to the forehead and have the client suck on ice; (5) apply digital pressure if bleeding continues; and (6) obtain medical assistance if bleeding does not stop.

Lewis 70 The nurse is providing care for an older-adult client who is experiencing low partial pressure of oxygen in arterial blood (PaO2) as a result of worsening left-sided pneumonia. Which of the following interventions should the nurse use to help the client mobilize secretions? Positioning the client side-lying on his left side Augmented coughing or huff coughing Frequent and aggressive nasopharyngeal suctioning Application of noninvasive positive pressure ventilation (NIPPV)

Augmented coughing or huff coughing Augmented coughing (quad coughing) and huff coughing techniques may aid the client in the mobilization of secretions. If positioned side-lying, the client should be positioned on his right side (good lung down). Suctioning may be indicated, but should always be performed cautiously because of the risk of hypoxia. NIPPV is inappropriate in the treatment of clients with excessive secretions.

pharm chapter 38 The nurse is providing care to a patient prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the patient's medical history would alert the nurse to question this prescription? Chronic obstructive pulmonary disease Mycobacterium tuberculosis Thrombocytopenia Coronary artery disease

Coronary artery disease Nonselective adrenergic agonist bronchodilators stimulate β1-receptors in the heart and β2-receptors in the lungs. Stimulation of β1-receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in patients with coronary artery disease.

chapter 31 The nurse is admitting a client with a diagnosis of asthma exacerbation. Which of the following potential triggers should the nurse assess in the client? (Select all that apply.) Decreased humidity Exercise Upper respiratory infections Emotional stress Allergies

Exercise Upper respiratory infections Emotional stress Allergies 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, psychological factors, and gastro-esophageal reflux disease (GERD)

chapter 31 The nurse is caring for a client with emphysema and notes jugular vein distension and pedal edema. Which of the following possible complications of emphysema are these symptoms reflective of? Pulmonary edema caused by left-sided heart failure Secondary respiratory infection Fluid volume excess resulting from cor pulmonale Acute respiratory failure

Fluid volume excess resulting from cor pulmonale Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distension and pedal edema.

Lewis 70 The nurse is caring for a client who is admitted with a barbiturate overdose. The client is comatose with BP 90/60, apical pulse 110, and respiratory rate 8/minute. Based upon the initial assessment findings, the nurse recognizes that the client is at risk for which of the following types of respiratory failure? Hypoxemic respiratory failure related to shunting of blood Hypercapnic respiratory failure related to increased airway resistance Hypercapnic respiratory failure related to alveolar hypoventilation Hypoxemic respiratory failure related to diffusion limitation

Hypercapnic respiratory failure related to alveolar hypoventilation The client's respiratory rate is decreased as a result of barbiturate overdose, which causes respiratory depression. The client is at risk for hypercapnic respiratory failure resulting from the decreased respiratory rate and thus decreased CO2 exchange.

chapter 31 The nurse is providing client teaching about chronic obstructive pulmonary disease (COPD) and the client asks the nurse what is the cause of COPD symptoms. Which of the following information is the basis for the nurse's response? Hypertrophy and hyperplasia of goblet cells in the bronchi An overproduction of the antiprotease α1-antitrypsin Hyperinflation of alveoli and destruction of alveolar walls Collapse and hypoventilation of the terminal respiratory unit

Hyperinflation of alveoli and destruction of alveolar walls In COPD, there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.

chapter 29 lewis The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. Which of the following criteria would contraindicate the administration of the vaccine to a resident? History of upper respiratory infections Chronic obstructive pulmonary disease (COPD) Age greater than 80 years Hypersensitivity to eggs

Hypersensitivity to eggs Although current vaccines are highly purified, and reactions are extremely uncommon, a hypersensitivity to eggs precludes vaccination because the vaccine is produced in eggs. Advanced age and a history of respiratory illness are not contraindications for influenza vaccination.

chapter 31 The nurse is evaluating a client who taking ipratropium. Which of the following assessment findings indicates that the medication is beneficial? Decreased sputum production Increased peak flow readings Decreased respiratory rate Increased respiratory rate

Increased peak flow readings Ipratropium is a bronchodilator that should lead to increased peak expiratory flow rates (PEFRs).

The nurse, who has administered a first dose of oral prednisone to a client with asthma, writes on the care plan to begin monitoring which of the following client parameters? Apical pulse Intake and output Deep tendon reflexes Bowel sounds

Intake and output Corticosteroids such as prednisone can lead to fluid retention. For this reason, it is important to monitor the client's intake and output

chapter 31 The nurse is teaching a client with asthma about the appropriate use of a peak flowmeter. Which of the following instructions should the nurse include in the teaching plan? Increase the doses of the long-term control medication if the peak flow numbers decrease. Keep a record of the peak flowmeter numbers if symptoms of asthma are getting worse. Empty the lungs and then inhale quickly through the mouthpiece to measure how fast air can be inhaled. Use the flowmeter each morning after taking medications to evaluate their effectiveness.

Keep a record of the peak flowmeter numbers if symptoms of asthma are getting worse. It is important to keep track of peak flow readings daily, especially when the client's symptoms are getting worse. The client should have specific directions as to when to call the physician, based on personal peak flow numbers. Peak flow is measured by exhaling into the flowmeter and should be assessed before and after medications to evaluate their effectiveness.

Which laboratory value would the nurse assess before administering zafirlukast (Accolate) to a patient? Cardiac enzymes Complete blood count Renal function Liver enzymes

Liver enzymes Because the use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) and identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 14 kg. Which of the following actions should the nurse include in the plan of care for this client? Teach the client to use frozen meals at home that can be microwaved. Provide a high-calorie, high-carbohydrate, nonirritating, frequent feeding diet. Order a high-calorie, high-protein diet with five to six small meals a day. Order fruits and fruit juices to be offered between meals.

Order a high-calorie, high-protein diet with five to six small meals a day. Because the client with COPD needs to use greater energy to breathe, there is often decreased oral intake because of dyspnea. A full stomach also impairs the ability of the diaphragm to descend during inspiration, interfering with the work of breathing. Finally, the metabolism of a high-carbohydrate diet yields large amounts of CO2, which may lead to acidosis in clients with pulmonary disease. For these reasons, the client with COPD should take in a high-calorie, high-protein diet, eating five to six small meals per day.

mat child 45 What is an immediate intervention when an infant chokes on a piece of food? Have the infant lie quietly while a call is placed for emergency help. Position the infant in a head-down, face-down position and administer back blows between the shoulder blades. Administer mouth-to-mouth resuscitation. Give water by cup to relieve the obstruction.

Position the infant in a head-down, face-down position and administer back blows between the shoulder blades. The infant needs to receive treatment immediately. Emergency help is called after attempting to remove the obstruction. Blind sweeps are not recommended in infants and children under the age of 8 years. Positioning the infant in a head-down, face-down position and administering back blows is the correct initial sequence of actions for an infant with an obstructed airway and is to be alternated with chest thrusts on the sternum. Mouth-to-mouth resuscitation should not be used. This may push the object further into the child's respiratory system. If the child's airway is obstructed, the water will not be able to pass. This will increase the risk of aspiration.

chapter 31 The nurse reviews pursed-lip breathing with a client newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which of the following mechanisms? Increasing the respiratory rate and giving the client control of respiratory patterns Preventing bronchial collapse and air trapping in the lungs during exhalation Loosening secretions so that they may be coughed up more easily Promoting maximal inhalation for better oxygenation of the lungs

Preventing bronchial collapse and air trapping in the lungs during exhalation The focus of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation.

chapter 31 The nurse is caring for a client who is prescribed salbutamol. Which of the following client vital signs indicates that the client is not experiencing any adverse effects from this medication? Oxygen saturation of 96% Temperature of 36.9° C (98.4°C) Respiratory rate of 18 Pulse rate of 76

Pulse rate of 76 Salbutamol is a β2-agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 76 indicates that the client did not experience tachycardia as an adverse effect.

The nurse is assisting a client to learn self-administration of beclomethasone. Which of the following actions should the nurse include in the teaching plan as the best way to prevent an oral infection while taking this medication? Rinse the mouth with water following the second puff of medication. Rinse the mouth with water before each puff of medication. Ask for a breath mint following the second puff of medication. Chew a hard candy before the first puff of medication.

Rinse the mouth with water following the second puff of medication. The client should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection.

chapter 31 The nurse is caring for a client who has a prescription for each of the following inhalers. Which of the following medications should the nurse administer to the client at the onset of an asthma attack? Salbutamol Beclomethasone Salmeterol Ipratropium bromide

Salbutamol Salbutamol is a short-acting bronchodilator that should be given initially when the client experiences an asthma attack.

pharm chapter 38 Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? St. John's wort Echinacea Peppermint oil Garlic

St. John's wort St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.

chapter 31 The nurse is caring for a client in the emergency department admitted with an exacerbation of asthma. The client has received a β-adrenergic bronchodilator and supplemental oxygen with no improvement in symptoms. Which of the following actions should the nurse anticipate next? Intravenous fluids Systemic corticosteroids Biofeedback therapy Pulmonary function testing

Systemic corticosteroids Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient.

pharmacology chapter 38 Discharge teaching to a patient receiving a β-agonist bronchodilator should emphasize reporting which side effect? Sedation Hypoglycemia Tachycardia Nonproductive cough

Tachycardia A β-agonist bronchodilator stimulates the β-receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.

pharm chapter 38 What is the role of corticosteroids in the treatment of acute respiratory disorders? To increase gas exchange in the alveoli To directly dilate the bronchi To stimulate the immune system To decrease inflammation

To decrease inflammation Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.

chapter 31 The nurse is caring for a client with COPD and the rexpresses concerns related to sexual intercourse. Which of the following information should the nurse provide to the client? Use slow pursed-lip breathing during intercourse Assume the dominant position during intercourse Abstain from intercourse but not intimacy Increase the time spent in foreplay

Use slow pursed-lip breathing during intercourse Clients with COPD may need modifications related to sexual activity but abstaining from intercourse is not required. Clients with COPD also need less energy if these guidelines are followed: (a) have sexual activity during the part of the day when breathing is best, (b) use slow pursed-lip breathing, (c) refrain from sexual activity after eating or other strenuous activity, (d) do not assume a dominant position, and (e) do not prolong foreplay.

chapter 31 The nurse is caring for a client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use? Nasal cannula Oxygen tent Venturi mask Partial non-rebreather mask

Venturi mask The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered.

mat child 45 A 5-year-old child is brought to the emergency department with abrupt onset of sore throat, pain with swallowing, fever, and sitting upright and forward. Acute epiglottitis is suspected. What are the most appropriate nursing interventions? Select all that apply. Vital signs Throat culture Medical history Assessment of breath sounds Emergency airway equipment readily available

Vital signs Medical history Assessment of breath sounds Emergency airway equipment readily available Vital signs should always be taken as a part of the assessment. Medical history is important in assisting with the diagnosis, in addition to knowing immunization status. Assessment of breath sounds is also important in assisting with the diagnosis. Suprasternal and substernal retractions may be noted. Emergency airway equipment must be readily available in case the airway becomes obstructed. Throat culture should never be done when diagnosis of epiglottis is suspected. Manipulation of the throat can stimulate the gag reflex in an already inflamed airway and cause laryngeal spasm that will cause occlusion of the airway.

chapter 31 The nurse is providing discharge information related to activity levels to a 61-year-old client with chronic obstructive pulmonary disease (COPD) and pneumonia. Which of the following exercise goals is most appropriate once the client is fully recovered from this episode of illness? Slightly increase activity over the current level. Limit exercise to activities of daily living to conserve energy. Walk for 20 minutes/day, keeping the pulse rate less than 130 beats/min. Swim for 10 minutes/day, gradually increasing to 30 minutes/day.

Walk for 20 minutes/day, keeping the pulse rate less than 130 beats/min. The client will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The client should be encouraged to walk for 15-20 minutes/day, keeping the pulse rate <75% to 80% of maximum heart rate (220—client's age). With this client, the maximum heart rate is 162(220 - 58) × 80% = 129.6 beats/min.

chapter 31 The nurse is caring for a client with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the client's respiratory status is improving? The cough remains nonproductive. Vesicular breath sounds decrease. Aerosol bronchodilators stimulate coughing. Wheezing becomes louder.

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.

Pharm 38 the nurse is teaching a patient about the inhaler advair (salmeterol and fluticasone). which statements by the patient indicate a correct understanding of this medication? select all that apply a. "I will rinse my mouth with water after each dose" b. "i need to use this inhaler whenever I feel short of breath, but make sure its not less than 4 hours between doses" c. "this medication is taken twice a day, every 12 hours" d. "I can take this inhaler if I get short of breath while exercising" e. "I will call my doctor if I notice white patches inside my mouth"

a, c, e

Pharm 38 a patient who has a history of asthma is experiencing an acute episode of shortness of breath and needs to take a medication for immediate relief. Which medication will the nurse chose for this situation a. A beta agonist, such as salbutamol b. a leukotriene receptor antagonist, such as montelukast c. a corticosteroid, such as fluticasone d. an anticholinergic, such as ipratropium

a. A beta agonist, such as salbutamol

pharm 38 after a nebulizer treatment with the beta agonist salbutamol, the p/t reports feeling a little 'shaky' w slight tremors of the hands. The Pts hr is 98 beats/minute, increased form the pretreatment rate of 88 beats/minute. the nurse knows that this reaction is a result of which effect? a. an expected adverse effect of the medication b. an allergic reaction to the medication c. an indication that the pt has received an overdose of the medication d. an idiosyncratic reactiont to the medication

a. an expected adverse effect of the medication

Chapter 30 lewis what clinical manifestations should the nurse expect when assessing a client with pneumococcal pneumonia? a. fever, chills, and a productive cough w purulent sputum b. nonproductive cough and night sweats that are usually self-limiting c. gradual onset of nasal stuffiness, sore throat, and purulent productive cough d. abrupt onset of fever, nonproductive cough, and formation of lung abscesses

a. fever, chills, and a productive cough w purulent sputum

chapter 30 lewis a client with pneumonia has the nursing diagnosis of ineffective airway clearance related to excessive mucus and retained secretions. what would be an appropriate nursing intervention? a. promote fluid hydration, as appropriate, to help liquefy secretions b. provide analgesics as ordered to promote client comfort administer oxygen as prescribed to maintain optimal 02 levels. d. teach the client how to cough effectively to bring secretions to the mouth

a. promote fluid hydration, as appropriate, to help liquefy secretions

pharm 38 a patient has been given an MDI salbutamol (Ventolin) and is instructed to take 2 puffs 3 times a day with doses 6 hours apart. the inhaler contains 200 acutations, but does not have a dose counter. Calculate how many days the inhaler will deliver this ordered dose.

approximately 33 days. (2 puffs x 3 times a day= 6 puffs a day. 200 units/ 6 puffs a day = 33 days

mat child 45 a child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: confirm the diagnosis of asthma. determine the cause of asthma. identify "triggers" of asthma. assess the severity of asthma.

assess the severity of asthma. Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and airflow limitation or obstruction. Some of the triggers of asthma are identified with allergy testing. The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 second. This can provide an objective measure of pulmonary function when compared to the child's baseline.

pharm 38 a patient has been receiving an theophylline (xanthine derivative) infusion for 24 hours. the nurse will observe for which adverse effect when assessing the patient during the infusion? a. CNS depression b. Sinus tachycardia c. increased appetite d. temporary urinary retention

b. Sinus tachycardia

Pharm 38 after a pt takes a dose of inhaled corticosteroid such as fluticasone, what is the most important action the patient needs to do next? a. hold the breath for 60 seconds b. rinse mouth the mouth w water c. follow the corticosteroid w a bronchodilator inhaler, if ordered d. repeat the dose in 15 minutes if feeling short of breath

b. rinse mouth the mouth w water

Chapter 29 lewis a client is seen at the clinic w a fever, myalgia, sore throat w yellowish exudate, and a headache. which of the following does the nurse anticipate that the collaborative management will include? (select all that apply) a. antiviral agents to treat influenza b. treatment with antibiotics starting ASAP c. a throat culture or rapid strep antigen test d. supportive care including cool, bland liquids e. comprehensive history to determine possible etiology

c. a throat culture or rapid strep antigen test d. supportive care including cool, bland liquids e. comprehensive history to determine possible etiology

pharm 38 during a teaching session for a patient who will be receiving a new prescription for the LTRA montelukast, the nurse will tell the patient that the drug has which therapeutic effect? a. improves the respiratory drive b. loosens and removes thickened secretions c. reduces inflammation in the airway d. stimulates immediate bronchodilation

c. reduces inflammation in the airway

mat child 45 One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: lessens effectiveness of medications. encourages exercise-induced asthma. increases sensitivity to allergens. can trigger an episode or aggravate an asthmatic state.

can trigger an episode or aggravate an asthmatic state. The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean and free from mold.

Chapter 29 lewis a client is seen at the clinic for an episode of epistaxis, which is controlled by placement of anterior nasal packing. During discharge teaching, what should the nurse instruct the client to do? a. use ASA (aspirin) for pain relief b. remove the packing later that day c. skip the next dose of antihypertensive medication d. avoid vigorous nose blowing and strenuous activity

d. avoid vigorous nose blowing and strenuous activity

chapter 31 The nurse evaluates that nursing interventions to promote airway clearance in a client admitted with chronic obstructive pulmonary disease (COPD) are successful based on which of the following findings? Effective and productive coughing Improved mental status PaO2 within normal range for the client Absence of dyspnea

effective and productive coughing Airway clearance is most directly evaluated as successful if the client can engage in effective and productive coughing.

Chapter 31 Which of the following positions is best for the nurse to place a client who is experiencing an asthma exacerbation? supine lithotomy reverse trendelenburg high fowlers

high fowlers

mat child 45 A 4-year-old girl is brought to the emergency room. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: examine her oral pharynx and report to the physician. make her lie down and rest quietly. auscultate her lungs and make preparations for placement in a mist tent. notify the physician immediately and be prepared to assist with a tracheostomy or intubation.

notify the physician immediately and be prepared to assist with a tracheostomy or intubation. Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a froglike cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.

mat child 45 A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because this environment facilitates: liquefying secretions. improving oxygenation. promoting ventilation. soothing inflamed mucous membrane.

soothing inflamed mucous membrane. The size of the droplets is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation. By humidifying the inspired air, the membranes inflamed by the infection and dry air are soothed, providing symptomatic relief.

mat child 45 A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: spacer. nebulizer. peak expiratory flow meter. trial of chest physiotherapy.

spacer. The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flow meter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.

mat child 45 The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37°C. The nurse suspects croup and should recommend: controlling fever with acetaminophen and calling if the cough gets worse during the night. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. trying over-the-counter cough medicine and coming to the clinic in the morning if there is no improvement. admitting to the hospital and observing for impending epiglottitis.

trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if these signs develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated for a child under the age of 6 years. This cough is characteristic of laryngotracheobronchitis, not epiglottitis.

chapter 31 The nurse identifies the nursing diagnosis of activity intolerance for a client with asthma. Which of the following etiological factors should the nurse assess in the client? Fear of suffocation Effects of medications Anxiety and restlessness Work of breathing

work of breathing