AH2 - Exam 1 - Lippincott 11ed - Test 4 - The Client with Asthma

96. Which of the following is an expected outcome for an adult client with well-controlled asthma? 1. Chest x-ray demonstrates minimal hyperinflation 2. Temperature remains lower than 100°F (37.8°C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.

4. Breath sounds are clear. Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest x-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.

95. A nurse is teaching a client to use a metered-dose inhaler (MDI) to administer bronchodilator medication. Indicate the correct order of the steps the client should take to use the MDI appropriately. 1. Shake the inhaler immediately before use. 2. Hold breath for 5 to 10 seconds and then exhale. 3. Activate the MDI on inhalation. 4. Breathe out through the mouth.

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

98. The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory infections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.

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

91. A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilatior 2. Act as an expectorant. 3. Have an anti-infammatory effect. 4. Prevent development of respiratory infections.

3. Have an anti-infammatory effect. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial air-ways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.

88. A client uses a metered-dose inhaler (MDI) to aid in management of asthma. Which action indicates to the nurse that the client needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.

1, 2, 3, 4, 5 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession. Utilization of an MDI requires coordination between activation and inspiration; deep breaths to ensure that medication is distributed into the lungs, holding the breath for 10 seconds or as long as possible to disperse the medication into the lungs, shaking up the medication in the MDI before use, and a suffcient amount of time between puffs to provide an adequate amount of inhalation medication.

92. The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which o the following indicates that the client is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between puffs. 4. The client rinses the mouth with water following administration. 5. The client lies supine for 15 minutes following administration.

1, 4 1. The inhaler is held upright. 4. The client rinses the mouth with water following administration. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.

90. A client experiencing a severe asthma attack has the following arterial blood gas results:pH 7.33; Pco2 48 (6.4 kPa); Po2 58 (7.7 kPa); HCO3 26 (26 mmol/L).Which of the following prescriptions should the nurse perform frst? 1. Albuterol nebulizer. 2. Chest x-ray. 3. Ipratropium inhaler. 4. Sputum culture.

1. Albuterol nebulizer. The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a mainte-nance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.

99. Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma? 1. Cough productive of yellow sputum. 2. Bilateral expiratory wheezing. 3. Chest tightness. 4. Respiratory rate o 30 breaths/min.

1. Cough productive of yellow sputum. A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms—wheezing, chest tightness, and increased respiratory rate—are all findings associated with an asthma attack and do not necessarily mean an infection is present.

97. Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak flow numbers after meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4. Use sedatives to ensure uninterrupted sleep at night.

1. Incorporate physical exercise as tolerated into the daily routine. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the client's life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.

93. A client is prescribed metaproterenol via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? 1. Irregular heartbeat. 2. Constipation. 3. Pedal edema. 4. Decreased pulse rate.

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

100. A client diagnosed with asthma has been prescribed fluticasone (Flovent) one puff every 12 hours per inhaler. Place in correct order the statements the nurse would use when teaching the client how to properly use the inhaler with a spacer. 1. "Hold your breath for at least 10 seconds, then breathe in and out slowly." 2. "Take off the cap and shake the inhaler." 3. "Rinse your mouth." 4. "Breathe out all of your air. Hold the mouth-piece of your inhaler and spacer between your teeth with your lips closed around it."1. "Hold your breath for at least 10 seconds, then breathe in and out slowly." 5. "Press down on the inhaler once and breathe in slowly." 6. "Attach the spacer."

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

94. A client who has been taking flunisolide nasal spray, two inhalations a day, for treatment of asthma has painful, white patches in the mouth. Which response by the nurse would be most appropriate? 1. "This is an anticipated adverse effect of your medication. It should go away in a couple oc weeks." 2. "You are using your inhaler too much and it has irritated your mouth." 3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." 4. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."

3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." Use of oral inhalant corticosteroids such as funisolide can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.

101. The nurse is caring for a client who has asthma. The nurse should conduct a focused assessment to detect which of the following? 1. Increased forced expiratory volume. 2. Normal breath sounds. 3. Inspiratory and expiratory wheezing. 4. Morning headaches.

3. Inspiratory and expiratory wheezing. The hallmark signs of asthma are chest tightness, audible wheezing, and coughing. Inspiratory and expiratory wheezing is the result of bronchoconstriction. Even between exacerbations there may be some soft wheezing, so a finding of normal breath sounds would be expected in the absence of asthma. The expected fnding is decreased forced expiratory volume [Forced Expiratory Flow (FEF) is the flow (or speed) of air coming out of the lung during the middle portion of a forced expiration] due to bronchial constriction. Morning headaches are found in more advanced cases of COPD signal nocturnal hypercapnia or hypoxemia

89. A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/min, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators as prescribed.

4. Administer bronchodilators as prescribed. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids, and, possibly, IV theopylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an arterial blood gas analysis. It would be futile to encourage the client to relax and breathe slowly without pro-viding the necessary pharmacologic intervention.