Ex 3

The nurse is assessing a patient with a cough. Which question about the cough, if answered in the affirmative, is most concerning to the nurse? "Do you cough up clear sputum and how often?" "Are you experiencing a dry cough?" "Do you cough up blood and how often?" "Do you have clear drainage from the nose?"

"Do you cough up blood and how often?"

While teaching parents about toy safety, a parent asks the nurse why their toddler is not able to play with their 10-year-old sibling's toys. Which explanation should the nurse provide? "Toddlers' ribs are less flexible and may impede their ability to cough and clear their airway." "Due to children's narrower airways, toddlers are at risk for airway obstruction." "Toddlers' have more alveoli that require more air to move through the lungs." "Toddlers' have lymph tissue that has astrophied and can lead to airway obstruction."

"Due to children's narrower airways, toddlers are at risk for airway obstruction."

The nurse taught a patient with alterations in the respiratory system about lifestyle alterations. Which patient statement indicates an understanding of the teaching? "I will need to decrease my activities to preserve my strength." "I should space activities with plenty of rest periods when I am short of breath." "I should have someone get me dressed when I am short of breath." "I should take up some aerobic exercise in order to increase my ability to breathe."

"I should space activities with plenty of rest periods when I am short of breath."

A patient asks, "why do I need to have my position changed every 2 hours?" Which response should the nurse provide? "Changing positions frequently helps increase oxygen in your lungs." "Low oxygen in the tissues increases the risk of skin breakdown." "A change of position helps you clear the airway." "You need to be moved to prevent muscle atrophy from occurring."

"Low oxygen in the tissues increases the risk of skin breakdown."

A patient who takes an inhaled corticosteroid reports dizziness and heart palpitations and has a heart rate of 110 beats/min and a blood pressure of 88/44 mmHg. Which question should the nurse ask first? "Are you having difficulty with urination?" "When did you last take your corticosteroid?" "Did you use your Albuterol inhaler today?" "Does your mouth feel dry?"

"When did you last take your corticosteroid?"

How many puffs of an inhaled anticholinergic should a patient take in a dose?

2

Which structural difference should the nurse expect when assessing a preschooler compared to an adult patient?

Narrow nasopharynx

How many minutes should a patient wait between two inhalation medications?

5

The nurse is assessing a group of patients. Which patient should the nurse consider to be the greatest risk for an alteration in oxygenation? A 67-year-old patient A 22-year-old patient A 62-year-old patient A 2-year-old patient

A 67-year-old patient

A nurse is teaching a client who has a new prescription for beclomethasone. Which of the following instructions should the nurse include? A. "Rinse your mouth after each use of this medication." B. "Limit fluid intake while taking this medication." C. "Increase your intake of vitamin B12 while taking this medication." D. "You can take the medication as needed."

A. "Rinse your mouth after each use of this medication."

A patient with respiratory distress is showing signs of decreasing cardiac output and hypoxemia. Which action should the nurse take first? Administer oxygen via face mask Assess the patients arterial blood gases Assess the nail beds for cyanosis Assess pulmonary function

Administer oxygen via face mask

A patient is experiencing decreased tissue perfusion, hypovolemia, and hypoxemia. Which action by the nurse is most important? Changing the face mask to a nasal cannula Positioning the patient in the prone position Encouraging nutritional intake Administering fluids

Administering fluids

The nurse is assessing an older patient at home who has suctioning equipment at the bedside. The patient has a history of aspiration pneumonia. Which action is the priority? Suctioning the patient Positioning the patient on their side Assessing the gag reflex Requesting a prescription for a cough suppressant

Assessing the gag reflex

Inhaled glucocorticoids are used for long term prophylaxis of?

Asthma

A nurse is providing instructions to a client who has a new prescription for Albuterol, PO. Which of the following instructions should the nurse include? A. "You can take this medication to abort an acute asthma attack." B. "Tremors are an adverse effect of this medication." C. "Prolonged use of this medication can cause hyperglycemia." D. "This medication can slow skeletal growth rate."

B. "Tremors are an adverse effect of this medication." Tremors can occur due to excessive stimulation of beta2 receptors of skeletal muscles.

Which type of medication prevents inflammation, suppressed airway mucus production, reduction in airway mucosa edema, and promotes responsiveness of beta2 receptors in the bronchial tree?

Glucocorticoids

A nurse is providing instructions to a client who has a new prescription for Albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching? A. Take the Albuterol at the same time each day. B. Administer the Albuterol inhaler prior to using the beclomethasone inhaler. C. Use beclomethasone if experiencing an acute episode. D. Avoid shaking the beclomethasone before use.

B. Administer the Albuterol inhaler prior to using the beclomethasone inhaler.

Beta2-adrenergic blockers should not be used concurrently with what medication because it can negate the effects of both medications?

Beta2-adrenergic agonists

Complications of this medication orally include tachycardia and angina so the dosage of the medication may need to be reduced and the patient should avoid caffeine.

Beta2-adrenergic agonists

This medication is contraindicated (Do Not Use) for patients with tachydysrhythmia and should be used cautiously for patients with diabetes mellitus, hyperthyroidism, heart disease, hypertension, and angina.

Beta2-adrenergic agonists

What medication results in bronchodilation, relieving bronchospasms, histamine release is inhibited and ciliary motility is increased?

Beta2-adrenergic agonists

A patient has increased shortness of breath and mucous plugs in the lungs. Which test should the nurse expect to be performed? Arterial blood gases (ABGs) Thoracentesis Bronchoscopy Pulmonary function test (PFT)

Bronchoscopy

Medication management involving bronchodilator agents (beta2-adrenergic agonists), methylxanthines, inhaled anticholinergics, and anti-inflammatory agents ( glucocorticoids, mast cell stabilizers, and leukotriene modifiers) usually addresses both inflammation and bronchoconstriction in asthma and what other disease?

COPD

A patient with respiratory difficulties lost weight over the last few months. Which action should the nurse take? Obtain an order for feeding the patient through a nasogastric tube. Begin feeding through an intravenous route. Encourage increased activity to improve stamina in the patient. Consult with dietary services to provide small, frequent meals.

Consult with dietary services to provide small, frequent meals.

Interaction: the use of Prednisone (a glucocorticoid) and concurrent use of hypoglycemic agents (oral and insulin) ________ the effects

Counteract

Which type of medication should you use cautiously in children and clients with: diabetes mellitus, hypertension, heart failure, peptic ulcer disease, osteoporosis, and/or kidney dysfunction?

Glucocorticoids

Complications of leukotriene modifiers include _______, _________, and __________ (some leukotriene modifers not all will cause this complication).

Depression, suicidal ideation, liver damage (some not all can cause this).

Contraindications of glucocorticoids

Do not use for clients who have received a live virus vaccine or have a systemic fungal infection.

What are the complications of local anticholinergic effects?

Dry mouth, hoarseness

Interaction: the use of Prednisone (a glucocorticoid) and concurrent use of NSAIDs increases the risk of?

GI ulceration

The use of ___________ does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks.

Glucocorticoids

The nurse is auscultating tracheal sounds of a patient. Which sound should the nurse recognize as a normal finding? Sound that is medium in loudness and pitch Harsh, high-pitched sound Loud, high-pitched sound Soft, low-pitched sound

Harsh, high-pitched sound

The nurse is caring for an older adult with a decreased gag reflex. Which nursing intervention is a priority? Administer oxygen at 1L/min as ordered. Administer anticholinergic medications as ordered. Encourage use of incentive spirometer hourly. Have suction equipment available.

Have suction equipment available.

Which cause of an alteration in oxygenation should the nurse consider to be a no modifiable risk factor? Obesity Cardiovascular disease Hemoglobin disorder Cigarette smoke

Hemoglobin disorder

The nurse is assessing a patient with emphysema. Which symptom of emphysema is not obvious from inspections and direct observation by the nurse? Hyperresonance sounds from the lungs Shortness of breath Barrell chest Pursed-lip breathing

Hyperresonance sounds from the lungs

Interaction: the use of Prednisone (a glucocorticoid) and concurrent use of potassium-depleting diuretics increase the risk of what?

Hypokalemia

Leukotriene modifiers inhibit metabolism of warfarin, theophylline which leads to __________ warfarin, theophylline levels

Increased

Asthma is a chronic _________ disorder that causes (hypo/hyper)-responsive airways leading to airflow _________ and causes __________.

Inflammatory, obstruction, bronchoconstriction

This medication blocks muscarinic receptors of the bronchi, resulting in bronchodilation, relieves bronchospasm associated with COPD, allergen and exercise induced bronchospasm and only FDA approved for COPD bronchospasm and is inhaled.

Inhaled anticholinergics (ipatropium)

Which type of medication is used for long term therapy of asthma in adults and children, and to prevent exercise induced bronchospasm?

Leukotriene modifier

_________ ___________ suppress the effects of ________, thereby reducing inflammation, bronchoconstriction, airway edema, and mucus production.

Leukotriene modifiers, leukotrienes

Leukotriene modifiers should be used cautiously in clients who have?

Liver dysfunction

Caffeine can increase CNS and cardiac adverse effects as an interaction with which medication?

Methylxanthine

Complications of this medication include: mild toxicity reaction by GI distress and restlessness, more severe reactions from higher doses are dysrythmias and seizures so blood levels should be monitored periodically.

Methylxanthines

This medication should be used cautiously in clients who have heart disease, hypertension, liver and kidney dysfunction, diabetes mellitus, children and older adults (65 and older).

Methylxanthines

Which medication results in bronchodilation and it's prototype medication oral theophylline is used for long term control of chronic asthma or COPD

Methylxanthines

Can a patient swallow a tiotropium capsule?

No, an inhalation device is used for administration of the capsule

Which oxygen delivery device should the nurse understand is indicated for a patient with a CO2 level of 55 mmHg? Nasal cannula Simple face mask Oxymizer Nonrebreather mask

Nonrebreather mask

What routes are glucocorticoids administered?

Oral: Prednisone, inhalation: beclomethasone, inhalation: 5 different types, IV: hydrocortisone and methylprednisolone

Which breathing difficulty should the nurse understand is associated with body position? Tachypnea Hypoxia Orthopnea Apnea

Orthopnea

Where should the nurse feel the strongest vibration when performing tactile fremitus on a patient? Over the bronchioles Over the lower half sternum Over the trachea Over the alveoli

Over the trachea

What are the contraindications (Do Not Use) and precautions of inhaled anticholinergics?

Patients who have peanut allergies do not use this because the medicine preparations can contain soy lecithin. Use cautiously with patients with narrow-angle glaucoma and benign prostatic hyperplasia because of the drug effects.

A patient presents with chest congestion and a cough. Which skill should the nurse expect to use to specifically assess for chest congestion? Percussion and auscultation Palpation and percussion Auscultation and inspection Inspection and palpation

Percussion and auscultation

Which independent nursing intervention is a priority for a patient who is experiencing dyspnea?

Place the patient in high Fowler position

A patient who has been receiving intravenous fluids to increase perfusion now has crackles in the lungs. Which action should the nurse perform first? Place the patient in high Fowler's position. Administer oxygen to the patient. Administer the ordered short-acting beta-agonist (SABA). Obtain arterial blood gases (ABGs).

Place the patient in high Fowler's position.

The nurse is caring for a patient with a history of respiratory issues. Which lifestyle factor is the priority to address? Gender identity Age Weight Smoking history

Smoking history

A patient is being evaluated for the source of a productive cough and shortness of breath. Which diagnostic test should the nurse expect to be ordered first? Sputum specimen Thoracentesis Pulmonary function test (PFT) Bronchoscopy

Sputum specimen

Glucocorticoids in short term IV agents are used for?

Status asthmaticus

A patient with diffuse emphysema asks about options for improving lung health. Which statement by the nurse is correct? Diffuse emphysema is a terminal disease. Exercise can be used to improve lung health and endurance. Surgical options can be considered to improve lung health with diffuse emphysema. There are no options to treat diffuse emphysema other than medications.

Surgical options can be considered to improve lung health with diffuse emphysema.

Beta2-adrenergic agonists interact with MAOIs and tricyclic antidepressants by increasing the risk of ___________ and ____________.

Tachycardia, angina

A patient with alterations in the respiratory system tells the nurse, "I need to stop and rest often." Which intervention should the nurse suggest? Teach the patient to decrease activities to preserve strength Encourage the patient to increase activities to increase the ability to breath. Encourage the patient to have someone else get the patient dressed and ready to leave. Teach the patient to space activities with rest periods.

Teach the patient to space activities with rest periods.

Nausea, diarrhea, or restlessness are signs of what in methylxanthines?

Toxicity

The nurse is caring for a patient with a pneumothorax. Which factor should the nurse suspect caused this alteration? Obesity Asthma Trauma Pneumonia

Trauma

True or false: when a client is using an inhaled beta2-adrenergic agonists and an inhaled glucocorticoid, you should advise the client to inhale the beta2-adrenergic agonist first to promote bronchodilation and enhance the absorption of the glucocorticoid.

True

A hairdresser whose father recently died of emphysema reports a cough lasting several months. Which factor should the nurse consider as contributing to the patients condition? Residing in a rural environment Recent flu vaccine Early parental death from emphysema due to smoking Workplace exposure to chemicals

Workplace exposure to chemicals