Asthma

Your pt. with asthma is taking Theophylline. Which product below should the pt avoid consuming? A) Caffeine B) Dairy C) Wheat D) Shellfish

A A) Caffeine Caffeine has the same properties as Theophylline and can increase the effects the drug.

The nurse is collecting a health history for a 12-month-old child. The child lives in a home where both parents smoke, and the child has had Respiratory Synctical Virus twice since birth. The child's older sister was recently diagnosed with asthma. The nurse understands that this child's risk of developing asthma later in life is: A) Above average B) Average C) Below average D) Well below average

A) Above average Risk factors for asthma include exposure to air pollution, including secondary smoke from cigarettes, and early exposure to respiratory syncytial virus. Genetic factors may also play a role in asthma development. Because of the presence of these risk factors, this child has an above average risk of developing asthma later in life.

The nurse is providing care for a client admitted during an acute exacerbation of asthma. Which medication does the nurse anticipate to relieve the acute symptoms exhibited by the client? A) Inhaled short-acting beta-agonists B) Oral corticosteroids C) Inhaled long-acting beta-agonists D) Oral anticholinergics

A) Inhaled short-acting beta-antogonists he client admitted with an acute exacerbation of asthma will require a rescue medication, such as an inhaled short-acting beta-agonist. Oral corticosteroids, inhaled long-acting beta agonists, and oral anticholinergics are maintenance medications used to treat asthma.

A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications? A) The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone. B) The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol. C) The pt. inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone. D) The pt. inhales the Fluticasone and immediately inhales the Salmeterol.

A) The pt. inhales the Salmeterol first and then waits 5 minutes before inhaling Fluticasone. The bronchodilator inhaler (Salmeterol) is administered first to open up the airways. Then the patient is to wait five minutes and then administer the corticosteroid (Fluticasone). The bronchodilator will open the airways so the corticosteroid can easily enter the airways to decrease inflammation.

Which of the following triggers can stimulate an acute asthma attack? SELECT ALL THAT APPLY A) Stress B) Animal dander C) Loud noises D) Exercise E) Bright lights

A, B, D A) Stress B) Animal dander D) Exercise Stress, exercise, and animal dander are all known triggers of asthma. Loud noises may trigger hearing loss or headaches, but they will not trigger asthma. Bright lights are also not known to trigger asthma.

Select all the following that can trigger an asthma attack: A) Sulfites B) Smoke C) Caffeine D) GERD E) Cold, windy weather F) Beta agonist G) Cockroaches

A, B, D, E, G A)Sulfites B) Smoke D) GERD E) Cold, windy weather G) Cockroaches Caffeine has the same properties as theophylline, which is a bronchodilator and is not known to cause asthma. In addition, beta adrenergic blockers that are nonselective (NOT beta agonist...which are used to treat asthma) can cause an asthma attack.

You're providing discharge to a pt. who was admitted with asthma. You discussed the early warning signs of an asthma attack and ask the pt. to list some of them. SELECT ALL THAT APPLY A) Easily fatigued with physical activity B) Reduced peak flow meter reading. C) Chest retractions D) Cyanosis E) Wheezing with activity F) Nighttime coughing G) No relief with short-acting bronchodilator inhaler

A, B, E, F A) Easily fatigued with physical activity B) Reduced peak flow meter reading E) Wheezing with activity F) Nighttime coughing These are all early warning signs an asthma attack is imminent. Options C, D, and G are signs and symptoms of an active asthma attack that requires medical treatment.

The nurse working on a pediatric unit is caring for a client newly diagnosed with asthma. Which assessment data indicate impending respiratory failure and the need for immediate intervention. SELECT ALL THAT APPLY. A) Shallow respirations. B) Slightly diminished breath sounds. C) Decreased wheezing. D) Increased crackles. E) Increased respiratory rate.

A, C A) Shallow respirations C) Decreased wheezing Respiratory status can change rapidly during an acute asthma attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary. Increased crackles are usually associated with heart failure and are not an indication of respiratory failure. An increased respiratory rate indicates respiratory compromise, but not respiratory failure.

The nurse is planning care for a young adolescent client diagnosed with asthma. Which evidence-based age-appropriate interventions will the nurse include in the plan of care? SELECT ALL THAT APPLY A) Referring to a peer-led support group. B) Teaching the parents how to administer maintenance medication prior to teaching the client. C) Assessing peer support when planning care. D) Collaborating with teachers for support in the school setting. E) Telling the client to avoid medication while at school.

A, C, D A) Referring to a peer-led support group C) Assessing peer support when planning care. D) Collaborating with teachers for support in the school setting. Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthma include referral to a peer-led support group, assessing peer support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents. Avoiding medication administration while in school could lead to an acute asthma attack.

The nurse is instructing a client who is prescribed ipratropium bromide (Atrovent) for asthma. SELECT ALL THAT APPLY A) Take no more than the prescribed number of doses each day. B) Rinse the mouth after taking this medication. C) Take on an empty stomach. D) Take with meals or a full glass of water. E) Use hard candy or drink extra fluids to help with a dry mouth.

A, E A) Take no more than the prescribed number of doses each day. E) Use hard candy or drink extra fluids to help with a dry mouth. Appropriate teaching for a client prescribed ipratropium bromide (Atrovent) includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. The mouth does not need to be rinsed after taking this medication. This medication does not need to be taken with meals or a full glass of water, or on an empty stomach.

A nurse is teaching environmental control to the parents of a child with asthma. Which statement by the parents indicates effective teaching? A) "We'll be sure to use the fireplace often to keep the house warm in the winter." B) "We will replace the carpet in our child's bedroom with tile." C) "We'll keep the plants in our child's room dusted." D) "We're glad the dog can continue to sleep in our child's room."

B) "We will replace the carpet in our child's bedroom with tile." Control of dust in the child's bedroom is an important aspect of environmental control for asthma management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

The nurse is caring for a 72-year-old client who has presented to the emergency department for the third time in 8 months with acute asthma exacerbation. The client states that he has trouble holding the inhaler, and sometimes he forgets to take his medication. He is also worried because he thinks his new drugs are adversely interacting with medications for his other conditions. What nursing diagnosis is appropriate for this client? A) Deficient knowledge B) Ineffective health management C) Risk for aspiration D) Ineffective coping

B) Ineffective health management Based on his repeated trips to the emergency department, his reported trouble holding his inhaler, and his inconsistency with taking his medications, an appropriate nursing diagnosis for this client is Ineffective Health Management. The client appears to have adequate knowledge about how to cope with his diseases; he is just unable to follow through with managing his medications at all times. Therefore, Deficient Knowledge and Ineffective Coping are not appropriate diagnoses based on this information. Not enough information is provided to determine if the client is at risk for aspiration

The pathophysiologic stimulus that initiates asthma is: A) bronchoconstriction B) inflammation in the airways C) airway edema D) mucus secretion

B) Inflammation in the airways. In asthma, the airways are in a persistent state of inflammation. This inflammation can lead to bronchoconstriction, airway edema, and increased mucus secretion. Therefore, inflammation is the primary stimulus that initiates asthma.

Your pt's asthma is poorly controlled. The pt. reports using their rescue inhaler 4 times a week. In addition, the pt's asthma is not responding to other treatments. The physician orders the pt. to take a medication that works by blocking the role of immunoglobulin IgE. This describes which medication below? A) Montelukast B) Omalizumab C) Cromolyn D) Sameterol

B) Omalizumab Omalizumab blocks the role of the immunoglobulin IgE, which will decrease the allergic response...hence asthma attacks. It is given subcutaneously and used when a patient's asthma is poorly controlled and other treatments are not working. It is NOT used for quick relief. It is important the patient receives NO LIVE vaccines while receiving this medication.

A pt. received a nebulizer of Albuterol. What is a side effect of this medication? A) Bradycardia B) Tachycardia C) Drowsiness D) Feeling cold

B) Tachycardia

The nurse instructs a client with asthma on bronchodilator therapy. Which statement indicates client understanding of how the drug works? A) "The medication widens the airways by causing airway muscle contraction." B) "The medication widens the airways by causing airway muscle contraction." C) "The medication widens the airways by decreasing histamine production." D) "The medication widens the airways by decreasing mucus production."

B) The medication widens the airways by causing airway muscle contractions. Bronchodilators stimulate bronchiolar smooth muscle relaxation, not contraction. Smooth muscle relaxation increases the diameter of the airway lumen to enhance airflow. Bronchodilators do not decrease the production of mucus or the production of histamine.

A client asks why asthma medication is needed even though the client's last attack was several months ago. Which response by the nurse is appropriate? A) "The medication needs to be taken or your lungs will be severely damaged and we will not be able to prevent an acute attack." B) "The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him." C) "The medication is still needed to decrease inflammation in your airways and help prevent an attack." D) "The medication needs to be taken for at least a year. Then, if you have not had an acute attack, you can stop it."

C) "The medication is still needed to decrease inflammation in your airways and help prevent an attack." Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just 1 year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.

The charge nurse is observing a newly licensed nurse conduct an admission assessment on a client with asthma. Which action by the newly licensed nurse requires immediate intervention? A) The newly licensed nurse is observed obtaining the pulse oximetry reading 10 minutes after the client used an albuterol inhaler. B) The newly licensed nurse is observed continuing to ask the client questions regarding history while the client demonstrates difficulty breathing and signs of respiratory impairment. C) The newly licensed nurse is observed assessing the client's thoracic wall, skin, and nail beds. D) The newly licensed nurse is observed auscultating breath sounds with a stethoscope.

B) The newly licensed nurse is observed continuing to ask the client regarding history while the client demonstrates difficulty breathing and signs of respiratory impairment. The charge nurse should intervene immediately if the nurse observes the client is demonstrating impairment at or near respiratory failure; the client will not be able to respond to questions. Assessment questions should be tailored and asked of any family member or friend accompanying the client. Although the pulse oximetry reading may not be a true indicator of the level of respiratory distress of the client because of the use of an albuterol inhaler within 30-60 minutes of this assessment, it is still an appropriate action for the newly licensed nurse to take and does not require the charge nurse to intervene immediately. The charge nurse may speak to the newly licensed nurse later with regard to this assessment. Assessing the client's thoracic wall, skin, and nail beds is an appropriate action at this time. Auscultating the client's breath sounds with the use of a stethoscope is appropriate.

Select ALL the correct options that represent the pathophysiology of an asthma attack. A) The smooth muscle surrounding the alveoli constricts, limiting oxygenation. B) The mucosa lining experiences severe inflammation. C) The goblet cells within the mucosa lining produce excessive amounts of mucous. D) Too much carbon dioxide is exhaled due to hyperventilation and the pt. experiences respiratory alkalosis.

B, C B) The mucosa lining experiences severe inflammation C) The goblet cells within the mucosa lining produce excessive amounts of mucous. Option A is wrong because the smooth muscle surrounding the BRONCHI AND BRONCHIOLES CONSTRICTS (not alveoli), limiting oxygenation. Option D is wrong become the patient does NOT experience respiratory alkalosis but respiratory ACIDOSIS. During an asthma attack, the patient is unable to exhale fully and air trapping occurs. Therefore, gas exchange does NOT occur, leaving carbon dioxide to build up in the blood and NO oxygen to enter the bloodstream. The CO2 builds up in the system and oxygen saturations drop....hence acidosis. Remember CO2 is acidic.

A pt has exercise-induced asthma. Which of the following actions can the pt perform to help prevent an attack during exercise? SATA A) Avoid warming up before exercise. B) Administer a short-acting beta agonist before exercise C) Administer a short-acting beta agonist after exercise D) Avoid exercising when experiencing a respiratory illness

B, D B) Administer a short-acting beta agonist before exercise D) Avoid exercising when experiencing a respiratory illness Option A is wrong because the patient should warm up for at least 10-15 minutes before exercising, and option C is wrong because the beta agonist should be administered BEFORE exercise (not after).

You're educating a pt. on how to use a peak flow meter to help monitor the status of their asthma. Which statement made by the pt. demonstrates they understand how to use the device? A) "This device will help keep my lungs strong so I don't have another asthma attack." B) "I will inhale as hard as I can while using the device." C) "I will use this device at the same time, either in the morning or before bedtime, and compare the readings with my personal best reading." D) "I will notify the doctor if my peak flow rating is 90% or more than my personal best peak flow."

C) "I will use this device at the same time, either in the morning or before bedtime and compare the readings with my personal best reading." Option A is wrong because this device monitors how controlled a patient's asthma is and if it is getting worst. It doesn't make the lung stronger. Option B is wrong because the patient exhales as hard as they can onto the device. Option D is wrong because a flow rate of 90% of the personal best peak flow is a good reading.

The nurse is reviewing discharge instructions with a client who is newly diagnosed with asthma. Which client statement indicates a need for further teaching? A) "I need to rinse my mouth after every use of my inhaler." B) "I need to take my Singulair at least 1 hour before I eat." C) "When inhaling two different medications, I should use the bronchodilator last." D) "Because I'm on theophylline, I will need to have therapeutic blood levels drawn."

C) "When inhaling two different medications, I should use the bronchodilator last." When using two different medications taken by inhalation, the bronchodilator should always be used first. This helps open the airways to enhance the effectiveness of the second medication. The other statements are accurate and require no further education.

You're assisting a pt. who has asthma to bed. The pt. is experiencing a frequent cough and chest tightness. You auscultate the pt.'s lung fields and note expiratory wheezes. The pt's peak flow rate is 78% less than their best peak flow reading. Which medication will provide the pt. with the fastest relief from these signs and symptoms of an asthma attack? A) Theophylline B) Tiotropium C) Albuterol D) Cromolyn

C) Albuterol During an asthma attack, the pt. needs a medication that will quickly open the airways. Medications that are best for this include short-acting bronchodilators such as Albuterol, short-acting beta antagonists.

The nurse is providing care to a client admitted after experiencing an acute asthma attack. Which assessment findings should the nurse identify as signs that the client has progressed to respiratory failure? Select all that apply. A) Retractions and fatigue B) Tachycardia and tachypnea C) Inaudible breath sounds D) Diffuse wheezing and the use of accessory muscles when inhaling E) Reduced wheezing and an ineffective cough

C) Inaudible breath sounds E) Reduced wheezing and an ineffective cough. Inaudible breath sounds, reduced wheezing, and ineffective cough indicate that the client is progressing to respiratory failure, and immediate interventions are necessary. During an asthma attack, tachycardia and tachypnea are common. They are early symptoms of the disease process and can be addressed without urgency. Diffuse wheezing, the use of accessory muscles when inhaling, retractions, and fatigue indicate a progression of the severity of the symptoms and may require nursing intervention, but they do not indicate respiratory failure.

A client diagnosed with asthma has a respiratory rate of 28 at rest with audible wheezes upon inspiration. Based on this data, which nursing diagnosis is the most appropriate? A) Ineffective Airway Clearance. B) Impaired tissue perfusion C) Ineffective breathing pattern. D) Activity intolerance.

C) Ineffective breathing. The client is experiencing an increased respiratory rate and is wheezing, which is an ineffective breathing pattern. Not enough information is provided to determine whether the client has ineffective airway clearance, activity intolerance, or impaired tissue perfusion.

You assist your pt. with using their inhaler. The inhaler contains the medication Budesonide. Before adminstering the inhaler, you will want to connect what deveice to the inhaler to help decrease the pt. from developing _____________? A) Peak flow meter; pneumonia B) Incentive spirometer; thrush C) Spacer; thrush D) Peak flow meter; mouth sores

C) Spacer; thrush Budesonide is a corticosteroid. Inhaled corticosteroids can cause thrush. Therefore, it's important to connect a spacer to the inhaler before usage to help prevent the pt. from developing thrush and for the pt. to gargle and rinse the mouth with water.

Friends of a client hospitalized with asthma would like to bring the client a gift. Which gift should the nurse recommend for this client? A) A basket of flowers. B) A stuffed animal C) Fruit and Candy D) A book

D) A book A client with asthma must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.

Which medication blocks the function of Leukotriene for the treatment of asthma? A) Salmeterol B) Theophylline C) Tiotropim D) Montelukast

D) Montelukast

The nurse is providing care to a client with asthma. When developing the client's plan of care, which intervention would be most appropriate to promote effective gas exchange? A) Provide adequate rest periods. B) Reduce excessive stimuli C) Assist with activities of daily living. D) Place in Fowler position

D) Place in Fowler position. Placing the client in Fowler position facilitates breathing and lung expansion, promoting effective gas exchange. Providing adequate rest periods prevents fatigue and reduces oxygen demands. Reducing excessive stimuli promotes rest. Assisting with activities of daily living conserves energy and reduces oxygen demands.

A pt. with asthma is receiving a nebulizer of Cromolyn. The pt. reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will? A) Immediately stop the nebulizer. B) Re-adjust the nebulizer C) Call a rapid response because the pt. is having a potential anaphylactic reaction to the medication. D) Reassure the pt. this is a temporary side effect of this medication.

D) Reassure the pt. this is a temporary side effect of this medication. Cromolyn can temporarily cause the following side effects during administration: sneezing, burning in nose, itchy/watery eyes, bad taste in mouth. Reassure the pt. that these are temporary side effects of this medication.

The physician orders the pt to start taking Omalizumab. How will you administer this medication as a nurse? A) Intravenous B) Intramuscular C) Orally D) Subcutaneously

D) Subcutaneously