1601 Asthma and COPD adaptive quizzing

In teaching a patient about asthma medication management, the nurse reinforces the need to use a long-acting beta agonist (LABA) as directed. Which statement by the patient indicates a need for further teaching? 1 "I may use the LABA as needed for wheezing and coughing." 2 "I should use the LABA twice daily even when I am not having symptoms." 3 "Overuse of the LABA may result in severe worsening of symptoms." 4 "The LABA is not used as the only medication for treating asthma."

1. "I may use the LABA as needed for wheezing and coughing." LABAs are long-acting bronchodilators that take time to build up a therapeutic effect. They are used as controller medications and should not be used as needed. Overuse of the LABA may result in worsening of symptoms and death. LABAs are given twice daily every day and are not to be used as the only medication for treating asthma

The nurse is caring for a patient with COPD who reports increased fatigue and nausea. The nurse notes distended neck veins, bounding peripheral pulses, dependent edema, and cyanosis of the lips and hands. The nurse notifies the health care provider of which condition? 1 Cor pulmonale 2 Hypercapnea 3 Orthopnea 4 Respiratory distress

1. Cor pulmonale Patients develop cor pulmonale when air trapping, airway collapse, and stiff alveolar walls increase lung tissue pressure and make blood flow through lung vessels more difficult. The right side of the heart eventually enlarges and thickens, leading to right-sided heart failure with backup of blood into the general venous system. Hypercapnea is an increase in partial pressure of arterial carbon dioxide (Paco2). Orthopnea (difficulty breathing while lying down) is often a symptom of cor pulmonale. Signs of respiratory distress include tachypnea, nasal flaring, anxiety, sternal retraction, shortness of breath, restlessness, decreased oxygen saturation, decreased level of consciousness, and stridor.

A patient with asthma asks the nurse about engaging in exercise. What does the nurse tell this patient? 1 "Adjust your exercise routine as needed to avoid asthma triggers." 2 "Aerobic exercise is considered too strenuous for people with asthma." 3 "Keep a short-acting beta agonist on hand to use as needed while exercising." 4 "Strenuous exercise is not recommended for people who have asthma."

1. "Adjust your exercise routine as needed to avoid asthma triggers." Patients who have asthma are encouraged to exercise to maintain cardiac health, enhance skeletal muscle strength, and promote ventilation and perfusion. Patients should be taught to modify routines as needed to avoid triggering attacks, but may participate in aerobic exercise. Short-acting beta agonists (SABAs) may be used prior to exercise to prevent bronchospasm.

Why are agonist and beta-adrenergic drugs ineffective in treating asthma in older adults? 1 Due to decreased sensitivity of receptors 2 Due to quick response to reliever therapy 3 Due to no response from reliever therapy 4 Due to the receptors causing bronchodilation

1. Due to decreased sensitivity of receptors With increasing age, the receptors become less sensitive. The decreased sensitivity of receptors leads to diminished response to agonist drugs and beta receptor drugs. Quick response to reliever drug therapy and quick relaxation of smooth muscle causes bronchodilation, which is seen in younger adults rather than older adults. Therefore, in older adults there is a decreased response to reliever therapy and the receptors do not dilate

Which clinical manifestations during status asthmaticus require immediate action? Select all that apply. 1 Absence of response to usual therapy 2 Irregular episodes of shortness of breath 3 Audible wheezing and increased respiratory rate 4 Sudden absence of wheezing, indicating airway obstruction 5 Development of pneumothorax and cardiac or respiratory arrest 6 Use of accessory muscles while breathing and distention of neck veins

1. Absence of response to usual therapy 4. Sudden absence of wheezing, indicating airway obstruction 5. Development of pneumothorax and cardiac or respiratory arrest 6. Use of accessory muscles while breathing and distention of neck veins Status asthmaticus is a severe and life-threatening condition. In this state, there is an absence of response to the usual therapy administered to acute asthma patients. The patient suddenly stops wheezing, which indicates an airway obstruction. If this condition is not reversed, the patient can develop a pneumothorax and go into cardiac or respiratory arrest. If the patient is using accessory muscles while breathing and distended neck veins are observed, the patient may require tracheotomy or intubation. Intermittent episodes of shortness of breath, audible wheezing, and increased respiratory rate are the usual symptoms observed during an asthma attack.

A patient with status asthmaticus has an initial assessment revealing a respiratory rate of 35 breaths/min, a heart rate of 110 beats/min, high-pitched wheezes in all lung fields, and marked use of accessory muscles to breathe. The patient is receiving an intravenous steroid and a continuous nebulized bronchodilator medication. Which assessment reveals a worsening of this patient's condition? 1 Absence of wheezing 2 Decreased respiratory rate to 20 breaths/min 3 Heart rate decreased to 90 beats/min 4 Tremors in both hands

1. Absence of wheezing Patients in status asthmaticus who exhibit a sudden absence of wheezing may have a complete airway obstruction. The respiratory rate and heart rate decreases indicate improved oxygenation and represent improvement. Tremors are an adverse effect of the bronchodilator and do not represent worsening of the asthma attack.

A patient with asthma reports having chronic pain. The nurse anticipates the provider will recommend which pain medication for this patient? 1 Acetaminophen 2 Aspirin 3 Ibuprofen 4 Hydrocodone

1. Acetaminophen Acetaminophen is safe to give to patients who have asthma because it will not trigger an asthma exacerbation. Aspirin and ibuprofen can trigger symptoms in some patients. Hydrocodone would not be a first choice for chronic pain unless the pain becomes more severe.

A patient with asthma performs a peak flow assessment, which is 60% of normal and in the yellow range, and has an oxygen saturation of 94% on room air. Which initial action does the nurse take? 1 Administer the ordered PRN short-acting beta2agonist. 2 Give the patient oxygen by nasal cannula. 3 Notify the Rapid Response Team. 4 Request an order for an oral corticosteroid medication.

1. Administer the ordered PRN short-acting beta2agonist. A peak flow assessment between 50% and 80% of normal indicates that the patient is in the yellow zone. A short-acting beta2agonist is indicated. If the patient is hypoxic, oxygen is indicated. An oxygen saturation of 94% or greater does not indicate hypoxia. It is not necessary to notify the Rapid Response Team unless the patient continues to deteriorate in spite of adequate treatment. If the patient progresses to the red zone, a systemic corticosteroid would be indicated.

The nurse is teaching a patient approaches for administering inhaled asthma medication. What principles does the nurse include in the teaching? Select all that apply. 1 An inhaler can deliver the drug directly to the site of action. 2 The use of a spacer decreases the amount of drug reaching the tissues. 3 Breath should be held for at least 20 seconds to allow the drug to work. 4 A dry powder inhaler (DPI) provides for drug delivery in dry powder form. 5 DPIs may be either preloaded with medication or may require loading.

1. An inhaler can deliver the drug directly to the site of action. 4. A dry powder inhaler (DPI) provides for drug delivery in dry powder form. 5. DPIs may be either preloaded with medication or may require loading. The advantage of using an inhaler for drug delivery is that the medication is delivered directly to the lungs for action, thus decreasing the systemic effect of the drug. Inhalers come in either metered-dose aerosol or a dry powder form. DPIs deliver a dry powder to the lungs during inhalation. DPIs come either preloaded or may require loading by the patient. An inhaler that includes a spacer actually increases the amount of drug potentially delivered to the lungs. The breath should be held for at least 10 seconds to allow the medication to reach the lungs.

A newly admitted patient with chronic obstructive pulmonary disease (COPD) reports increased dyspnea over the last month. What is the nurse's first action? 1 Ask the patient to describe the daily medication routine and any change in medications. 2 Assess the patient's breath sounds and evaluate for clubbing of the fingers. 3 Request an order for a nebulized bronchodilator and systemic corticosteroids. 4 Tell the patient that the disease is most likely progressing and becoming more severe.

1. Ask the patient to describe the daily medication routine and any change in medications. When a patient reports a change in condition, it is important to assess medication compliance to make sure the change is not related to poor adherence. If the patient is following the prescribed medication regimen, a physical assessment should be performed. Bronchodilator medications and systemic corticosteroids are not indicated for this patient. Until other factors are ruled out, it is not appropriate to tell the patient that this is a progression of the disease

Which signs/symptoms are indicators of an asthma attack? Select all that apply. 1 Audible wheeze, especially on exhalation 2 Muscle retraction between the ribs 3 Decreased forced expiratory volume in the first second (FEV1) on flowmeter 4 Eosinophils in the sputum 5 Increased, then decreased arterial carbon dioxide (PaCO2) level

1. Audible wheeze, especially on exhalation 2. Muscle retraction between the ribs 3. Decreased forced expiratory volume in the first second (FEV1) on flowmeter 4. Eosinophils in the sputum During an acute episode of asthma, the most common manifestations are an audible wheeze and increased respiratory rate. At first, the wheeze is louder on exhalation; when inflammation occurs with asthma, coughing may increase. The patient may use accessory muscles to help breathe during an attack, which the retraction of muscles between the ribs would indicate. A decrease in either the FEV1 or the peak expiratory flow (PEF) of 15% to 20% below the expected value for age, gender, and size is common for the patient with asthma. In allergic asthma, the sputum may contain eosinophils and mucus plugs with shed epithelial cells. Early in an attack, the PaCO2 level may be decreased as the patient increases respiratory effort; later in the episode, PaCO2 rises, indicating carbon dioxide retention.

Which statements about chronic obstructive pulmonary disease (COPD) are correct? Select all that apply. 1 Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue. 2 Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. 3 COPD includes emphysema and chronic bronchitis. 4 Due to increased mucus production, bronchitis leads to breathing problems in the alveoli. 5 The increased risk of infection in COPD is related to increased mucus and poor oxygenation.

1. Emphysematous lungs contain an increased number of proteases that destroy the normal lung tissue. 2. Most emphysema is associated with smoking or chronic exposure to other inhalation irritants. 3. COPD includes emphysema and chronic bronchitis. 5. The increased risk of infection in COPD is related to increased mucus and poor oxygenation. Cigarette smoking is the greatest risk factor for COPD; both active smoking and secondhand smoke contribute to upper and lower respiratory problems. Chronic inhalation of other irritants also contributes to this risk. Although they are different diseases, both emphysema and chronic bronchitis fall under the COPD umbrella. Acute lung infections make COPD worse due to increased inflammation and mucus production. Emphysematous lungs contain a higher number of proteases that damage the alveoli and the small airways by breaking down elastin. High protease levels cause the alveolar sacs to lose their elasticity and the small airways to collapse or narrow. Some alveoli are destroyed, and others become large and flabby, with decreased area for effective gas exchange. Chronic bronchitis leads to increased mucus production and airway problems; emphysema affects the alveoli.

All of these patients are being cared for on the intensive care step-down unit. Which patient should the charge nurse assign to an RN who has floated from the pediatric unit? 1 Patient with acute asthma episode who is receiving oxygen at Fio2 of 60% by nonrebreather mask. 2 Patient with chronic pleural effusions who is scheduled for a paracentesis in the next hour. 3 Patient with emphysema who requires instruction about correct use of oxygen at home. 4 Patient with lung cancer who has just been transferred from the ICU after having a left lower lobectomy the previous day.

1. Patient with acute asthma episode who is receiving oxygen at Fio2 of 60% by nonrebreather mask. Because asthma is a common pediatric diagnosis, the pediatric nurse would be familiar with the assessment and care needed for a patient with this diagnosis. Although chronic pleural effusions can occur in the pediatric population, this diagnosis is more common in the adult population. If this patient has not already received teaching for this procedure, he may have questions that the pediatric nurse would not be as comfortable answering as a nurse who is regularly assigned to the step-down unit. Emphysema is a diagnosis associated with an adult population; although an RN could instruct a patient about home oxygen therapy, this patient might have questions that would be better answered by an RN with adult experience. The adult patient who has just had a lobectomy needs careful assessment from an RN with adult step-down experience.

A patient is brought to the emergency department with labored breathing, wheezing, and marked use of accessory muscles. The patient has a low Pao2 and low Paco2 and is receiving oxygen by nasal cannula at a rate of 2 L/min. After the patient has received an aerosolized bronchodilator medication, the nurse assesses no wheezes and an oxygen saturation of 82%. What is the next action by the nurse? 1 Prepare for emergency intubation. 2 Administer a second aerosolized bronchodilator. 3 Increase the oxygen flow to 4 L/min. 4 Request an order for a systemic steroid medication.

1. Prepare for emergency intubation. Sudden absence of wheezing in a patient with severe asthma symptoms can indicate complete airway obstruction and may require tracheotomy. The nurse should prepare for emergency intubation. Administering more medication or increasing the oxygen will not be effective if the airway is obstructed. Systemic steroid medications do not have a rapid onset.

Which medication is an example of a long-acting beta2agonist (LABA) used in asthma management? 1 Salmeterol 2 Albuterol 3 Levalbuterol 4 Terbutaline

1. Salmeterol Salmeterol is a LABA. Albuterol, levalbuterol, and terbutaline are all short-acting beta2 agonists (SABAs).

A patient has been diagnosed with asthma. Which statement below indicates that the patient correctly understands how to use an inhaler with a spacer correctly? 1 "I don't have to wait between the two puffs if I use a spacer." 2 "If the spacer makes a whistling sound, I am breathing in too rapidly." 3 "I should rinse my mouth and then swallow the water to get all of the medicine." 4 "I should shake the inhaler only if I want to see whether it is empty."

2. "If the spacer makes a whistling sound, I am breathing in too rapidly." Slow and deep breaths ensure that the medication is reaching deeply into the lungs. The whistling noise serves as a reminder to the patient of which technique needs to be used. The patient must wait 1 minute between puffs. The patient should rinse the mouth but not swallow the water. The mouth needs to be rinsed after using an inhaler with or without a spacer. This is especially important to prevent the development of an oral fungal infection if the inhaled medication is a corticosteroid. An empty inhaler will float on its side in water; a full inhaler will sink. Shaking an inhaler helps ensure that the same dose is delivered in each puff.

The patient says, "I hate this stupid COPD." What is the best response by the nurse? 1 "Then you need to stop smoking." 2 "What is bothering you?" 3 "Why do you feel this way?" 4 "You will get used to it."

2. "What is bothering you?" Encourage the patient and the family to express their feelings about limitations on their lifestyle and about disease progression. This is not the time to lecture the patient regarding his smoking habits; the patient is expressing a need for support. "Why" questions can seem accusatory and may make a patient less likely to talk about what he or she is feeling. The patient's feelings should never be minimized.

Inhaled corticosteroids are typically used to treat which symptom of asthma? 1 Airway hyperresponsiveness 2 Airway inflammation 3 Bronchial spasms 4 Bronchial secretions

2. Airway inflammation Inhaled corticosteroids are given to minimize inflammation and do so partly by preventing the synthesis of chemical mediators of inflammation. By preventing inflammation, they indirectly make hyperresponsive episodes less frequent and will decrease bronchial spasms and possibly bronchial secretions.

The nurse is performing an admission history on a patient with COPD. The patient reports increased difficulty sleeping, eating, and dressing and has trouble walking even short distances. To facilitate completion of the assessment, what does the nurse do next ? 1 Addresses the remaining questions to the patient's family members 2 Asks the patient to sit on the edge of the bed and lean forward over the bedside table 3 Assists the patient to put on a hospital gown and lie down as quickly as possible 4 Initiates oxygen therapy at a rate of 2 L/min with a nasal cannula

2. Asks the patient to sit on the edge of the bed and lean forward over the bedside table Patients with orthopnea have difficulty breathing while lying down. To help with comfort, the nurse will encourage the patient to sit leaning forward in an orthopnea position. Talking to the patient directly allows the nurse to make observations about the patient's ability to speak and interact and its effect on breathing. Patients with orthopnea will not be able to lie down without exacerbating this symptom. Oxygen is given for low oxygen saturations, and this must be assessed prior to starting oxygen therapy.

Which statements are correct regarding the drug management of asthma? Select all that apply. 1 Long-acting beta agonists are indicated to relieve acute attack symptoms. 2 Control therapy medications are used to prevent asthma attacks from occurring. 3 Control therapy medications are used to reduce airway responsiveness. 4 Reliever medications are used to stop an asthma attack once it has started. 5 Anti-inflammatory medications are used to cause bronchodilation.

2. Control therapy medications are used to prevent asthma attacks from occurring. 3. Control therapy medications are used to reduce airway responsiveness. 4. Reliever medications are used to stop an asthma attack once it has started Control (formerly called preventive) therapy is used to reduce airway responsiveness to prevent the occurrence of asthma attacks. This therapy is used every day, regardless of symptoms. Reliever drugs [1] [2] are indicated when symptoms of an attack occur to decrease the duration and severity of the attack. Long-acting beta agonists do not act quickly enough to relieve acute symptoms; they are indicated for their long-term impact on symptoms. Anti-inflammatory drugs decrease inflammation and can be beneficial in the treatment of asthma; however, they do not cause bronchodilation.

What are the two major categories of asthma medications? 1 Preventive and quick-acting 2 Control and reliever 3 Bronchodilators and anti-inflammatories 4 Steroids and bronchodilators

2. Controler and reliever The categories for asthma drug therapy are control therapy (formerly called preventive drugs), which are designed to reduce airway responsiveness and prevent asthma attacks, and reliever drugs, which are those used to actually stop an attack once it has started. "Quick-acting" is not a category of asthma medication. Bronchodilators, steroids, and anti-inflammatory drugs are medications that are given for asthma, but these are considered drug classes, not categories

The nurse is reviewing the medical record of a patient with asthma and notes elevated serum eosinophils and elevated immunoglobulin E levels. Which medication does the nurse expect the provider to order for this patient based on this finding? 1 Albuterol 2 Cromolyn sodium 3 Fluticasone 4 Ipratropium bromide

2. Cromolyn Sodium Cromolyn sodium is a mast cell stabilizer that prevents mast cells from opening when an allergen binds to immunoglobulin E (IgE) and helps to block this trigger of asthma. When patients have elevated eosinophils and elevated IgE, they have allergic asthma that is triggered by allergens binding to IgE. The other medications may all be prescribed for any patient with asthma but not based on this finding.

The nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD). Which intervention to facilitate adequate caloric intake for this patient is included in the plan of care? 1 Administer bronchodilator medications after meals. 2 Encourage frequent rest periods, especially before meals. 3 Include high-calorie protein drinks as part of each meal. 4 Recommend a high-calorie, high-carbohydrate diet.

2. Encourage frequent rest periods, especially before meals Patients with chronic lung disease fatigue easily and are often unable to consume the amounts of food necessary to prevent weight loss. The nurse should encourage frequent rest periods to help patients with the energy necessary to eat. Bronchodilator medications should be given before meals to improve oxygenation. High-calorie protein drinks are recommended but not with meals because patients will be unable to consume both. Diets should be high in calories and protein.

A patient admitted with chronic obstructive pulmonary disease (COPD) has a barrel chest with expiratory wheezes in the lower lobes, decreased fremitus, and hyperresonance with chest percussion. What does the nurse expect to see on this patient's chest x-ray? 1 Atelectasis 2 Flattening of the diaphragm 3 Hypoexpansion of the lungs 4 Infiltrates in the lower lobes

2. Flattening of the diaphragm Patients with COPD often have air trapping, characterized by decreased fremitus and hyperresonance with percussion. A radiographic finding would be flattening of the diaphragm that occurs with hyperexpansion of the lungs. Atelectasis may occur as the disease progresses. Hyperexpansion, not hypoexpansion, is common. A patient with lower lobe infiltrates, common with an infectious process, will have infiltrates on chest x-ray

A patient with moderate chronic obstructive pulmonary disease (COPD) has begun a pulmonary rehabilitation program. The patient usually has an oxygen saturation of 88% to 90% with 2 L/min of oxygen via nasal cannula and walks to the end of the driveway and back each day. The patient's ideal body weight is 150 pounds, but the patient currently weighs 130 pounds. What is an expected outcome for this patient? 1 Ambulate around the block and back. 2 Increase weight to at least 135 pounds. 3 Maintain oxygen saturation of 92% to 94%. 4 Wean off of supplemental oxygen.

2. Increase weight to at least 165 pounds Patients with COPD should attempt to maintain their weight within 10% of their ideal body weight. For this patient, that would be 135 lb or greater. Patients are encouraged to increase their activity to a level they can accept and do not need to push their limits. This patient has oxygen saturation levels consistent with those of others with COPD, so an increase is not a reasonable expectation. It is not likely that this patient can wean off of supplemental oxygen.

The nurse is performing an admission assessment on a patient with chronic obstructive pulmonary disease (COPD) who is admitted for treatment of pneumonia. The patient exhibits pursed-lip breathing. Which action by the nurse is correct? 1 Administer supplemental oxygen. 2 Note the breathing pattern and continue the assessment. 3 Notify the provider of the patient's status. 4 Request an order for a chest x-ray.

2. Note the breathing pattern and continue the assessment. Pursed-lip breathing is an adaptive technique taught to patients with COPD to promote positive airway pressure and does not need to be reported. The nurse should continue with the admission assessment. It is not necessary to administer oxygen unless the patient is more hypoxic than usual. A chest x-ray is not indicated.

The nurse is teaching a patient about self-management of asthma. Which statement by the patient indicates a need for further teaching? 1 "I may need oral steroid medications when my asthma action plan is not working." 2 "I will use the albuterol inhaler when I am wheezing or short of breath." 3 "The fluticasone inhaler is used as a rescue medication." 4 "When I have symptoms in the yellow zone, I will need to take more medicine."

3. "The fluticasone inhaler is used as a rescue medication." Flovent is a maintenance medication to prevent or reduce the incidence of asthma flares. Systemic steroids are added when medications used in the yellow zone are not effective. Albuterol is a rescue medication that is used to treat symptoms such as wheezing or shortness of breath. The yellow zone requires an increase in medications

To some degree, most patients with chronic obstructive pulmonary disease (COPD) have which pathologic processes present? Select all that apply. 1 Pneumonia 2 Sarcoidosis 3 Bronchitis 4 Emphysema 5 Pulmonary tuberculosis 6 Cystic fibrosis

3. Bronchitis 4. Emphysema The patient with COPD experiences emphysema and chronic bronchitis. Pneumonia and tuberculosis are respiratory infections for which patients with COPD are at risk, but they are not a usual occurrence. Sarcoidosis and cystic fibrosis are not seen in most patients with COPD.

The nurse is assisting a patient who has severe emphysema with meal and snack choices for the next day. Which selection is appropriate for this patient? 1 Apple slices with caramel dip 2 Bean soup and crackers 3 Ice cream with fudge topping 4 Salted peanuts and string cheese

3. Ice cream with fudge topping High-calorie, high-protein meals are recommended to prevent weight loss in patients with severe lung disease. Ice cream is the best snack of those listed. Apple slices are low-calorie and low in protein as well. Gas-producing foods such as beans can cause abdominal bloating. Salted peanuts are dry and can induce coughing.

A patient who is admitted for treatment of an acute asthma exacerbation has a low Pao2 and an elevated Paco2. These lab values indicate which phase or type of asthma attack? 1 Allergic asthma 2 Early phase 3 Late phase 4 Viral asthma

3. Late phase Early in an asthma attack, the patient will have a normal or reduced Paco2 as the respiratory rate increases. Carbon dioxide levels increase later in the attack. Allergic asthma often occurs with an elevated serum eosinophil count and increased immunoglobulin E (IgE) levels. Viral symptoms are accompanied by other viral upper respiratory infection symptoms and possibly fever.

A patient's family is expressing concern about the new diagnosis of chronic obstructive pulmonary disease (COPD) in their loved one. What does the nurse do next ? 1 Assure the family that with appropriate management, their loved one can lead a quality life. 2 Refer them to a community-based support group to meet other families with similar concerns. 3 Listen to the basis of the family's concerns and then develop a focused teaching plan. 4 Discuss the importance of smoking cessation as it is a leading cause of emphysema.

3. Listen to the basis of the family's concerns and then develop a focused teaching plan. It is important to determine the basis of the family's concerns before anything else. Do they have prior experience with COPD? Do they have accurate information? What is their greatest concern? Once the appropriate information is obtained, a well-developed teaching plan will be of greatest benefit to the patient and family. Assurance of the ability to lead a meaningful life is important, but their greatest concern may be financial or based on misinformation. Community support groups may be helpful in the future to meet other family members, but only if they see it as potentially beneficial. Smoking is indeed a leading cause for COPD, but it is not the time to focus on causation; hearing the family's concerns is the priority.

A patient has asthma that gets worse during the summer. She tells the nurse she takes a medication every day so she does not get short of breath when she walks to work. About which medicine does the nurse need to educate the patient? 1 Albuterol inhaler 2 Guaifenesin 3 Montelukast 4 Omalizumab

3. Montelukast Montelukast is a leukotriene antagonist that works well for asthma that occurs during certain seasons. It is taken on a daily basis as a preventive medication. Albuterol inhalers are beta2agonists that are rescue medications used on an as-needed basis only. Guaifenesin is a mucolytic that does not provide any bronchodilation; it may or may not be taken daily. Omalizumab is an immunomodulator that is injected subcutaneously every 2-3 weeks; it is not commonly used because a high rate of anaphylaxis is associated with it.

The nurse assesses a patient who has chronic obstructive pulmonary disease (COPD) 15 minutes after an aerosolized bronchodilator has been administered. Which finding prompts the nurse to notify the provider? 1 Barrel chest 2 Clubbing of the fingers 3 Oxygen saturation of 87% 4 Paco₂of 68 mm Hg

3. Oxygen saturation of 87% For patients with COPD, an oxygen saturation less than 88% indicates hypoxemia and should be reported. Findings of a barrel chest and clubbing of the fingers are typical of COPD and do not warrant notifying the provider since they do not improve with treatment. A Paco2that is elevated is common in chronic lung disease.

Which interventions to improve oxygenation and decrease carbon dioxide retention does the nurse teach the patient with chronic obstructive pulmonary disease (COPD)? Select all that apply. 1 Maintaining hydration to loosen secretions and suctioning frequently to eliminate buildup 2 Limiting dietary intake to avoid weight gain, which will add to activity intolerance 3 Partnering with the family in COPD management by adhering to prescribed therapies 4 Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity 5 Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea

3. Partnering with the family in COPD management by adhering to prescribed therapies 4. Monitoring for changes in respiratory status including rate and rhythm and tolerance of activity 5. Practicing diaphragmatic and pursed-lip breathing to manage episodes of dyspnea Optimum COPD management requires an active partnership between the patient/family and the health care team. COPD is a chronic disease, and it is important for patients/families to learn symptom management and when to seek medical care. A change in respiratory rate and rhythm may indicate the presence of an infection or buildup of respiratory secretions. In addition, a change in activity tolerance should trigger more in-depth assessment of respiratory status changes. Breathing techniques may be helpful for managing dyspneic episodes; the amount of stale air in the lungs is reduced, and the patient gains confidence and control in managing dyspnea. Although hydration is important, routine suctioning of the patient with COPD is not indicated. Excessive weight gain from overeating is not desirable; however, COPD patients are more likely to experience inadequate nutrition and weight loss secondary to the work of breathing and decreased appetite.

A patient with severe chronic obstructive pulmonary disease (COPD) is using home oxygen at a flow rate of 4 L/min via nasal cannula. He calls the clinic to report only moderate improvement in shortness of breath. What does the nurse advise this patient? 1 Increase the oxygen flow rate to 6 L/min to improve dyspnea. 2 Oxygen therapy will eventually reverse the symptoms of COPD. 3 Shortness of breath may continue even with oxygen therapy. 4 Use the bronchodilator medication more frequently to improve dyspnea.

3. Shortness of breath may continue even with oxygen therapy. Patients with COPD have irreversible lung damage that does not improve with oxygen therapy. The goal of oxygen therapy in patients with COPD is to maintain oxygen saturation of 88%, so dyspnea with activity is still likely. Increasing the oxygen flow rate is incorrect because patients with chronic lung disease rely on low Pao2 as a stimulus to breathe. Using the bronchodilator more frequently is not recommended.

The nurse has been teaching improved airflow techniques to the patient, who has continued to have restrictive breathing problems. Which is the best indicator of success? 1 Peak flowmeter readings that are yellow after the third reading 2 Productive cough 3 Spo2 level of 92% after ambulating 50 feet 4 Stable arterial blood gases (ABGs)

3. Spo2 level of 92% after ambulating 50 feet Maintaining a baseline Spo2 of 92% after ambulating 50 feet is an excellent indicator that the patient has achieved better airflow and that the nurse's teaching has been effective. A yellow reading means "caution," which indicates narrowing airways. Although a productive cough may be an indication of success, it can also be an indication of infection. ABGs are invasive, costly, and painful and are not the most effective indicator of successful teaching in this situation.

The nurse finds that a patient is experiencing air hunger and has uncoordinated breathing. Laboratory tests reveal normal arterial blood gasses as well as a normal eosinophil count. What should the nurse infer from the diagnostic tests? 1 The patient has asthma. 2 The patient has allergic asthma. 3 The patient has acute emphysema. 4 The patient has severe emphysema.

3. The patient has acute emphysema A patient with acute emphysema experiences weakening of the diaphragm muscle, which leads to an increased need for oxygen, or air hunger. Due to increased work of breathing and loss of alveolar tissue, gas exchange is affected. Arterial blood gas (ABG) values will be normal as the patient adjusts to it by increasing respiratory rate. Uncoordinated breathing is observed due to incomplete cycles of inhalation and exhalation. A patient with asthma shows irregular episodes of dyspnea, chest tightness, coughing, wheezing, and increased mucus production. Allergic asthma occurs due to inflammatory responses. A patient with severe emphysema shows an increased arterial carbon dioxide level (PaCO2) level, indicating carbon dioxide retention.

Why must patients with asthma avoid taking aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain or fever? 1 Aspirin and NSAIDs can cause bronchoconstriction. 2 They increase the risk for gastroesophageal reflux. 3 They allow increased production of leukotrienes. 4 A patient with asthma is likely allergic to these drugs.

3. They allow increased production of leukotrienes. Patients with asthma are often restricted from taking aspirin (ASA) and NSAIDs because they can trigger an asthma attack by allowing increased production of leukotrienes as they suppress other inflammatory pathways. They do not directly cause bronchoconstriction or increase the risk of gastroesophageal reflux disease (GERD). Patients who are sensitive to the effects of these drugs do not have a true allergy to them.

Which sign/symptom is significant in diagnosing asthma in a nonsmoker? 1 Dyspnea 2 Chest tightness 3 Wheezing 4 Increased mucus production

3. Wheezing Wheezing in a patient who is a nonsmoker is an indicator of airway obstruction. Although dyspnea, chest tightness, and increased mucus production can also be seen with asthma, these signs and symptoms are also more often present with other respiratory conditions.

A patient asks the nurse how montelukast helps asthma. What is the best response by the nurse? 1 "It is a cholinergic antagonist which opens your airway and decreases lung secretions." 2 "It is a corticosteroid which decreases inflammatory and immune responses in the airways." 3 "It is a monoclonal antibody which decreases the body's allergic response." 4 "It prevents the synthesis of leukotrienes that can cause bronchoconstriction and inflammation."

4. "It prevents the synthesis of leukotrienes that can cause bronchoconstriction and inflammation." Montelukast, zafirlukast, and zileutin are all leukotriene modifiers, which prevent, but do not reverse, symptoms during an asthma attack. Montelukast is not a cholinergic agonist, steroid, or monoclonal antibody

An asthmatic patient who is allergic to pollen is prescribed cromolyn sodium; however, the patient reports that it does not help relieve symptoms during an asthma attack. Which instruction would be beneficial to the patient? 1 "Include an exercise program in your daily life to improve your health." 2 "Use proper technique while inhaling the drug for maximum effectiveness." 3 "Refrain from exposure to allergens that will aggravate the allergic reaction." 4 "Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler."

4. "Use cromolyn sodium on a routine basis to prevent an asthma attack, not as a rescue inhaler." Anti-inflammatory drugs such as cromolyn sodium are useful as a controller drug. This drug decreases inflammation by releasing inflammatory chemicals or preventing mast cell membranes from opening when an allergen binds to immunoglobulin E. Therefore, taking a controller drug instead of the reliever drug is the reason the patient's symptoms are not relieved during an asthma attack. Adding a reliever drug to the patient's medication regimen along with the controller drug will help decrease the symptoms during an asthma attack. A regular exercise routine, proper inhaler use, and refraining from allergen exposure are general self-management tips for patients with asthma.

The nurse is performing a medication history for a patient who reports using salmeterol as needed for asthma exacerbations. What does the nurse tell the patient about this practice? 1 "Daily use of salmeterol leads to a tolerance of desired medication effects." 2 "Salmeterol should be used with a steroid to relieve acute asthma symptoms." 3 "Salmeterol should be used at the onset of symptoms for best effect." 4 "Using salmeterol as a reliever medication can lead to sudden death."

4. "Using salmeterol as a reliever medication can lead to sudden death." Salmeterol is a long-acting beta-adrenergic [1] [2](LABA) medication. It is used for maintenance and not to relieve acute symptoms; doing so can worsen symptoms and lead to death. It should be used daily; frequent use does not lead to tolerance. Salmeterol is often used with a steroid but not to relieve acute symptoms. It should be used daily, whether symptoms are present or not.

The family of a patient having an asthma attack has called in seeking guidance for treatment recommendations on the STEP protocol. Which reported factor indicates the patient should go to the emergency department immediately ? 1 Peak expiratory flow (PEF) of 60% of personal best 2 Wheezing, especially on exhalation 3 Increased mucus production and coughing 4 Decreasing PEF despite the use of reliever drugs

4. Decreasing PEF despite the use of reliever drugs A decreasing PEF is not uncommon with an acute asthma attack; however, reliever drugs should provide stabilization or improvement. If this is not occurring, the patient should receive emergency care immediately. A PEF reading in the yellow range is 50% to 80% of personal best; a patient with a reading in this range should use the prescribed reliever drug. Within a few minutes after using the drug, another PEF reading should be made to determine whether the drug is working. Wheezing is the most common manifestation of an asthma attack. Asthma attacks often lead to increased mucus production and coughing when inflammation is present.

Which chemical is responsible for a prolonged inflammatory response, leading to airway obstruction? 1 Kinins 2 Heparin 3 Histamine 4 Leukotriene

4. Leukotriene Leukotriene is a slow-acting chemical that is released slowly, causing a prolonged inflammatory response. Kinins dilate arterioles and increase capillary permeability. Heparin inhibits blood and protein clotting. Histamine starts immediate inflammatory response by constricting small veins, inhibiting blood flow, and decreasing the venous return.

What is the most important reason for ordering inhaled, rather than oral, corticosteroids for patients with asthma? 1 Inhaled corticosteroids are more effective. 2 Inhaled corticosteroids are easier to use. 3 Oral corticosteroids have less predictable effects. 4 Oral corticosteroids have more adverse effects.

4. Oral corticosteroids have more adverse effects Inhaled corticosteroids are given because they have direct actions on the target tissues in the lungs, causing fewer systemic adverse effects than oral corticosteroids. They are not necessarily more effective, nor are they easier to use. Oral corticosteroids do not have less predictable effects.

A newly diagnosed patient with asthma says that his peak flowmeter is reading 82% of his personal best. What does the nurse do? 1 Nothing. This is in the green zone. 2 Provide the rescue drug and reassess. 3 Provide the rescue drug and seek emergency help. 4 Repeat the peak flow test.

4. Repeat the peak flow test Since the patient is newly diagnosed with asthma, this would be an excellent opportunity for the nurse to observe the patient using the peak flowmeter to ensure that the patient is using it properly, so readings are accurate and in the green zone, at least 80% of the patient's personal best. The result of 82% is in the green zone, but this is not the best answer for a newly diagnosed patient. Rescue drugs should be used only in the yellow zone, between 50% and 80% of the patient's personal best. They should not be used in this situation, and the nurse does not need to seek emergency help until readings are in the red zone, or below 50% of the patient's personal best.

The patient is a marathon runner who has asthma. Which category of medication is used as a rescue inhaler? 1 Corticosteroids 2 Long-acting beta agonists 3 Nonsteroidal anti-inflammatory drugs (NSAIDs) 4 Short-acting beta agonists

4. Short-acting beta agonists Short-acting beta agonist medications have a rapid onset and cause bronchodilation; they would be excellent for marathon running because some types of asthma may be exercise-induced. Corticosteroids disrupt production pathways of inflammatory mediators. Maximum effectiveness requires 48-72 hours of continued use, therefore, they are not appropriate as a rescue medication. Long-acting beta agonists do cause bronchodilation but have a slow onset; they are not used as rescue inhalers. NSAIDs stabilize the membranes of mast cells and prevent release of inflammatory mediators. They have a slow onset of action and are used for prevention of symptoms, not as rescue medication.