Zerwekh Review- Respiratory

During a routine follow-up visit for a patient with asthma, the patient states that she has been doing fine except that, when she goes out for dinner, she has increased bronchospasm and wheezing. Which of the following would be an appropriate response by the FNP?

"Do you usually have wine with dinner?" ~ Asking the patient about the consumption fo wine with dinner is the most appropriate response. Many wines, especially white wines, contain sulfites, which can trigger a mild allergic reaction

The FNP is teaching a patient about the role of medications in the treatment of asthma, Which statement by the patient would require further teaching?

"I do not need to use a spacer with my MDI" ~ It is important to emphasize how to take medications correctly. The MDI usually has three parts: a mouthpiece, a cap that covers the mouthpiece, and a canister of medicine. A spacer device will help avoid getting less medication in the mouth. The spacer connects to the mouthpiece. Inhaled medicine goes into the spacer tube first. The patient takes 2 deep breaths to get the medicine into the lungs. Waiting a full minute between breaths. Using a spacer wastes a lot less medicine than spraying the medicine in the mouth. MDI technique is important as well as understanding the use of the devices, such as the prescribed valved holding changer, spacer, and nebulizer

The FNP is following up on a patient who is experiencing an acute asthma problem. Albuterol bu MDI has been ordered as treatment. Which patient response would indicate to the FNP that the patient understands hoot take the medication?

"I will take 1puff of the medication, and then wait a minute before taking the second puff" ~ A 1min lapse between the 2 puffs is necessary for the medication to be most effective. The 1st puff opens the upper airways, allowing more effective penetration of the lower track with the 2nd puff. Albuterol should not be used as maintenance therapy. Only inhaled corticosteroids should be taken on a regular basis

A patient who was recently diagnosed with TB calls the clinic because her urine is reddish orange. The patient is taking isoniazid, rifampin, and pyrazinamide. What would be an appropriate response for th FNP to make?

"This is. a normal response to the rifampin" ~ Urine color change is a normal side effect of rifampin and is not a reason for the patient to stop taking their medication. Also, soft contact lenses may become discolored

What is the recommended range for maintaining serum theophylline levels?

10-20mcg/mL ~ Therapeutic plasma levels range from 10-20mcg/mL. Drug levels of ?20 are associated with toxicity

When examining a patient, the FNP suspects a small pleural effusion. What would be the most sensitive diagnostic test to determine a small effusion?

A pleural effusion should always be confirmed by ultrasonography because this will detect effusions as low as 5-50mL, as will a CT scan. A chest radiograph does not always detect small effusions. Spirometry testing will suggest restrictive lung disease but will not identify the potential cause. A ventilation-perfusion scan will identify lung perfusion, but not lung effusion

A young adult patient is seeing the FNP to obtain routine vaccine testing for a nursing program. This patient has had the bacilli Calmette-Guerin (BCG) vaccine administered in another country. The FNP knows that:

A TB titer is the most accurate way of reviewing the effectiveness of the immunity ~ Although a tuberculin skin test is sufficient to test for LTBI, the interferon-gamma release assay is preferred when the patient has received the BCG vaccine. Nursing programs require proof of the absence of infection regardless of vaccination, and there is no test available to measure a TB titer

A patient with a long history of COPD has noticed an increase in dyspnea and a change in sputum over the past few days, with an increased amount of thick, yellow[green mucus and congestion. What would be the appropriate therapy?

Amoxicillin/clavuanate (Augmentin) 500/125mg po tid x10days ~ In someone with COPD, antibiotic therapy is indicated when there is a change in color, consistency, r amount of sputum, and increased symptoms of COPD exacerbation. Antitussives are not recommended in stable COPD. Inhaled corticosteroids should be taken on a schedule and not ordered as needed

And adult female come to the clinic with complaints of cough, clear rhinorrhea,a nd a low-grade fever x2days. The FNP diagnosis acute bronchitis. The FNP knows that with acute bronchitis:

A cough can last for 10-20days ~ Most cases of acute bronchitis are of viral etiology and do not require antibiotic therapy. Approximately 5-10% of acute bronchitis is bacterial. A cough can let for at least 10-20 days, but routine sputum cultures are not helpful

An important anatomic landmark on the anterior thoracic wall is the angle of Louis. Where on the thorax is this landmark present?

At the manubriosternal junction ~ This landmark can be used to determine the position of the 2nd rib and intercostal space and corresponding spaces below that level. The angle of Louis (manubriosternal junction) is visible and palpable angle of the sternum at the point in which the 2nd rib attaches to the sternum

An adult patient tithe FNP's office has been diagnosed with CAP. According to the Infectious Disease Society of America and American Thoracic Society joint guidelines for CAP, criteria indicating the probable need for immediate admission to an inpatient facility include which 3 findings?

ABC of 2500 Respiratory rate of 30 BUN of 32 ~ Criteria for severe CA{ includes ABC less that 4000, temp less than 36C, respiratory rate >30, PaO2/FiO2 ratio less than 250, platelet count <100,000, and BUN>20

A patient with COPD companies of increased dyspnea and sputum volume over the last 2days. The patient presents with a respiratory rate of 20, resting O2 sat of 88% on room air, and no cyanosis or peripheral edema. The patient is currently taking Salmeterol 50mcg, with tiotropium 18mcg daily. What therapy should the FNP start to improve the lung function and recovery time of the patient?

According to 2019 Global Initiative for Obstructive Lung Disease, 80% of COPD exacerbations are managed on an outpatient basis. Systemic corticosteroids are used for an acute exacerbation because they improve lung function, oxygenation, and short recovery time. Although oxygen is a key component, and exacerbation treatment in the hospital, it is not an appropriate first choice in they patient. Antibiotics are recommended when a patient has increased dyspnea, which is not the case here. Methylxanthines such as theophylline are not recommended for exacerbations caused by an increase side effect profile

What would be most appropriate to include in the health promotion plan for an older adult patient who is at risk for developing pneumonia?

Administer the influenza vaccine annually ~ The pneumococcal vaccine should be given to all adults 65yrs+ but is not administered annually. The influenza immunization given annually will decrease complications and hospitalizations for older adult patients. There is no evidence to support the use of an annual sputum culture or chest x-ray for pneumonia prevention. The PPD skin test should be done annual for hit-risk patients and only detects exposure to TB

When assessing for tactile remits, the FNP knows that increased feints:

Occurs with consolidation or compression of lung tissue ~ Consolidation or compression of lung tissue will cause an increase in fremitus, which is noted with lobar pneumonia. Decreased remits occurs with obstruction of vibration, like in emphysema, pneumothorax, or obstructed bronchus. Symmetric transmission of vibration is a normal finding.

On assessment of the patient's respiratory status, creation is felt over the 3rd rib at the midaxillary line on the left side. What is the interpretation of this finding?

Air is present in the subcutaneous tissue ~ Crepitation or crepitus (also called subcutaneous emphysema) usually results from. ait bubbles under the skin caused by leakage of air into the subcutaneous tissue. Infection by a gas-producing organism is a less common cause. Crepitation always requires attention. Severe inflammation of the pleural surface would not have a palpable abnormality. Fluid consolidation would cause an increased asymmetric fremitus on palpation

The FNP is treating a patient recently diagnosed iwtn interstitial pneumonitis. The FNP knows that this was most likely caused by:

Amiodarone ~ Amiodarone can cause interstitial pneumonitis. All patients taking this medication should have yearly PFTs with diffuse lung capacity measurement to ensure early prevention and treatment. Methadone, propranolol, and amlodipine do not cause interstitial pneumonitis

The FNP knows that screening for lung cancer includes:

Annual CT scan of the chest in an asymptomatic individual between the ages of 55-80yrs who have a >30ppy smoking history and continue to smoke or have quit less than 15yrs ago ~ Current recommendations for lung cancer screening from the USPSTF is for individuals 55-80yrs to have an LDCT who have a >30ppy smoking history and currently smoke or have quit within the last 15yrs. This has proven to be the most effective in decreasing lung cancer-related death. Screening should be discontinued once a person has not smoked for 15yrs or develops a health problem that substantially limits life expectancy or the ability or willingness to have the curative lung surgery

A patient tested positive for latent TB infections from a TB skin test. What should the FNP do next?

Asses for aiding or symptoms suggestive of infection ~ A chest CT is not indicated for the initial assessment of active TB infection. Isoniazid is not indicated unless the patient is gouda to have an active TB infection. If a positive skin test is found, the patient should the tested for active infection by assessing for sign and symptoms and obtaining a chest X-ray

An immunocompromised patient in a long-term acolyte has a roommate who's been diagnosed with active TB. When should the paten be started on latent TB infection (LTBI) treatment?

As soon as possible and initiate at the time of the TB skin testing(TST) ~ LTBI treatment is initiate at the time of the TST. TST testing should be repeated in 3mos if initial test results are negative. If the second TST is negative, LTBI treatment can be discontinued

The FNP understands that pleural friction rubs are:

Auscultated best in the lower anterolateral chest ~ Pleural friction rubs are loud, dry, creaking, or grating sounds produced by the rubbing together of inflamed and roughened pleural surfaces. Rubs are best heard during the latter part of inspirations and the beginning of expiration, and in the lower anterolateral chest in which the lung expands the most. A continuous, low-pitched, snoring sound that is heard early inspiration is characteristic of sonorous rhonchi. Wgophony is noted when the patient says "e-e-e-", and the examiner hear through the stethoscope "a-a-a", which is suggestive of lung consolidation

An adult teacher comes to the office with a loud cough starting 2days before. She says that several children in her 4th-grade class have been out sick because of whooping cough. There is a high probability of exposure to pertussis. Which treatment option does the FNP this is the best?

Azithromycin 500mg once, then 250mg qd x4days ~ In patients with a high probability of exposure to pertussis, 1st line therapy with a macrolide antibiotic will improve symptoms if started within 5-7days of symptom onset. Doxycycline is not a 1st line cough for pertussis. Waiting delays the possibility of limiting the spread and treatment of pertussis. Oseltamivir is an antiviral and will not be effective against pertussis

The FNP has diagnosed an adult patient with CAP. What should the FNP prescribe for this healthy patient with no commodities and no previous antibiotic use within the last 3mos?

Azithromycin 500mg once, then 250mg qd x4days ~ In the absence of drug-resistant Strep pneumoniae (DRSP) or other comorbidities, the Infectious Disease Society of America guidelines suggest azithromycin is the best choice with Level 1 Evidence, and doxycycline is a weak recommendation with Level 3 evidence. If a B-lactam like amoxicillin is used, a macrolide should also be prescribed for better coverage. A respiratory fluoroquinolone is recommended in instances of comorbid conditions or the presence of additional risk factors for DRSP, and Cipro is not a respiratory fluoroquinolone. Moxifloxacin, levofloxacin, and gemifloxacin are respiratory fluoroquinolones

Which medication is most effective in promoting a decrease in airway inflammation and providing long-term medication coverage in a patient with asthma?

Beclomethasone ~ Beclomethasone is a long-acting corticosteroid that stabilizes mast cells and greatly reduces mast-cell degranulating when exposed to allergens. Albuterol is a short-acting bronchodilator use as a rescue medication. Salmeterol is a long-acting bronchodilator most useful in controlling nocturnal asthma symptoms. Montelukast, a leukotriene receptor antagonist, inhibits bronchoconstriction and is used as an adjunct to bronchodilators an corticosteroids

An older adult patient presents with postural hypotension, and laboratory studies reveal hyponatremia. the patient is currently not taking any medications that may cause this. Which condition is likely the cause of these findings?

Bronchogenic carcinoma ~ Hyponatremia results from the syndrome of inappropriate antidiuretic hormone secretion and can be caused by a bronchogenic tumor (small cell lung cancer). Blunt chest trauma could result in hemorrhage and fluid loss, causing hyponatremia. Bronchitis and respiratory acidosis do not usually cause sodium abnormalities

When auscultating for vocal resonance in a patient with possible consolidation of lung tissue, the FNP tells the patient to say "ninety-nine" and the voice remains loud and distinct over the area of suspected consolidation. What is this called?

Bronchophony ~ Greater clarity and increased loudness of spoken sounds are defined as bronchophony. If bronchophony is extreme (in the presence of consolidation of the lungs), even a whisper can be heard clearly and intelligibly through the stethoscope (whispered pectoriloquy). During auscultation, if the patient is speaking, their voice is normally heard as soft, muffled, and indistinct. When you ask the patient to say "ninety-nine", during auscultation, you will hear an abnormally clear distinct sound of ninety-nine, if there is lung consolidation. Whispered pectoriloquy is exaggerated bronchophony and is heard through a stethoscope when the patient whispers a series of words. In egophony, the spoken voice has a nasal or bleating quality when heard through a stethoscope, and the spoken "e-e-e" sounds like "a-a-a". Tactile fremitus is a palpable vibration of the thoracic wall that is produced when the patient speaks

The FNP is auscultating a patient's chest and asks the patient to say "ninety-nine". With the stethoscope, a clear transmission of the works is heard indicating increased lung density. Which voice sound does this describe?

Bronchophony ~Bronchophony is the clear loud transmission of sound usually through abnormally consolidated lung tissue. Extreme bronchophony results in the ability to hear whispered words over the involved area (whispered pectoriolquy). With normal voice transmission, the sound is soft, muffled, and indistinct; the sound can be heard through the stethoscope but cannot be distinguished as to what is being said. Egophony is a change to a more nasal quality of the sound, best demonstrated by asking the patient to say a long set of "e-e-e" sounds. Normally these sounds are clearly heard through the stethoscope; with consolidation or compression, the e-e-e sounds change to a bleating long a-a-a sound (similar to a goat sound) A pleural friction rub is a dry, crackly, garnet, low-pitched sound suggesting pleural inflammation. Rhonchal fremitus is vibration felt when inhaled air passes through thick secretions in the larger bronchi

An older adult pt who recently traveled outside the country is presenting to your office with significant dyspnea. The pt recently returned from Japan on a 12hr flight. the pt's lungs are clear, heart rate and bp are mildly elevated, and oxygen saturation 88%. The pt has bilateral 1+ pedal edema. What is the most important diagnostic study to complete emergently?

CT Pulmonary Angio (CTPA) ~ Given the patient's recent 12hr flight, the patient is at high risk for DVT & PE. The best test choice that would show a PE is the CTPA. A V/Q scan is useful only in hemodynamically stable patients with a normal chest x-ray, which would need to be completed before the V/Q scan. An EKG may have some nonspecific changes but is not diagnostic. A chest x-ray may likely be normal. Spirometry may be abnormal but not specific. The patient will need emergent care

Which 2 medications are prescribed and used in smoking cessation?

Chantix Bupropion ~ Bupropion was originally marketed as an antidepressant, and later it was used for smoking cessation under the trade name of Zyban. It is thought to reduce cravings for nicotine and symptoms of withdrawal because of its capacity to block neural reuptake of the neurotransmitters, dopamine, and norepinephrine. Varenicline (Chanitx) interferes with nicotine receptors in the brain, which decreases the pleasurable effect of the nicotine and reduces symptoms of nicotine withdrawal. Valtrex is used in the treatment of herpes virus infections, including shingles, cold sores, and genital herpes. Lisinopril is an ACE inhibitor used to treat HRN and HF. Zyrtec is an antihistamine used to relieve allergy symptoms

A patient with a history of bronchial asthmas is seen in the clinic for increased episodes of difficulty breathing. He has been taking theophylline 100mg po tid. He is 40yrs old and obese with an 18ppy history of cigarette smoking and excessive intake of coffee daily. He eats a low carbohydrate, high-protein diet. Which identified factors decrease the therapeutic effects of theophylline?

Coffee intake and weight ~ Because tobacco increases the metabolism of theophylline, a higher dose is required in a smoker than in nonsmokers. A high-protein, low carbohydrate diet increases the metabolism of theophylline and decreases serum concentrations. Coffee (and other xanthine-containing beverages) may increase the central nervous system effects of xanthine derivatives

The FNP understands that in percussion of the lungs, hyperresonance is:

Common when the lungs are hyperinflated, like with chronic emphysema ~ Hyperresonance is a percussion assessment finding suggestive of air trapping, which can be found in obstructive lung conditions like emphysema. It is characterized by very loud intensity, very low pitch, long duration, and a booming quality. It is not a normal finding

An adult patient comes to the clonic with the chief complaint of "coughing up blood" and night sweats. The patient has no history of respiratory or cardiac problems. Their visual signs are pulse of 96, respirations of 28, bp of 140/92, and temp of 99F orally. The initial diagnostic evaluation of this patient includes:

Complete CBC, chest x-ray, and sputum smear for acid-fast bacillus ~ The patient should be initially evaluated for TB, which includes a chest X-ray, sputum smear for acid-fast bacillus, and a CBC. PFTs, ABGs, and bronchoscopy are not indicated initially. Complement fixation studies are done to diagnose atypical pneumonia

Which can elevate theophylline levels?

Concomitant treatment with cimetidine ~ Theophylline is used in the treatment of chronic lung disease and can accumulate at toxic levels. Cimetidine decreases the hepatic clearance of theophylline because it is a cytochrome P450 1A2 and 3A4 inhibitor. Nicotine and some anti-seizure drugs may increase clearance, and ampicillin does not change the clearance

An older adult patient presents with sighs and symptoms that suggest CAP. What assessment findings are specific to an olde adult patient with this condition?

Confusion/disorientation with or without a low-grade fever ~ Confusion/disorientation with or without a low-grade temperature may be the first sign that the older adult patient has an infection. The older adult patient may not have a fever or leukocytosis; however, leukopenia may suggest severe CAP and require hospitalization. The older adult patient may not experience any discomfort or cough with the onset of infection

A patient was hit in the chest. Which assessment finding would suggest a serious respiratory complications requiring immediate attention?

Decreased breathing sounds on the affected side ~ The most common respiration complication after a traumatic injury to the chest is pneumothorax caused fro a fractured rib. Oximetry readings less than 90-% and increased pain are expected at this point and may bot =be indicative of a problem. Although fever and increased sputum are problems, they are not associated with early manifestations of blunt trauma chest injury

An adult patient is seen in the clinic complaining of increased difficulty breathing and an intermittent productive cough that worsens in the evening. The history reveals that the patient has a 20ppy smoking history. Breath sounds are clear to auscultation, there is no evidence of five, and chest X-ray is within normal limits. The FNP instructs the patient concerning the importance of smoking cessation and fluid therapy. After that, what does the FNP prescribe?

Cough, cold, and antiinflammatories for symptom control ~ Most patients with acute bronchitis benefit from symptomatic treatment with antiinflammatory cough and cold preparations. Because underlying asthma and pneumonia differential diagnoses have been eliminated current clinical guidelines do not support routine bronchodilator use or antibiotic therapy for acute bronchitis. Research has demonstrated that antibiotic-susceptible organisms rarely cause acute bronchitis

A patient's history strongly suggests the possibility of a foreign body in the bronchi. What assessment finding would support this diagnosis?

Coughing and unilateral wheezing ~ The most common area for a foreign body obstruction is the right bronchus, which produces a unilateral retraction of the right chest wall and leads to cough and unilateral wheezing with diminished breath sounds to that area. Retraction of the lower chest occurs with lower respiratory problems, such as asthma. A pleural friction rub is heard when there is inflammation between the visceral and parietal pleura. Crepitation is present when air is leaking into the subcutaneous tissue

A patient reports being exposed to secondhand smoke frequently at their place employment. The FNP knows that secondhand smoke exposure:

Could cause lung cancer even though the patient does not smoke ~ Secondhand smoke is a known carcinogen and increases the patient's risk of lung cancer. In addition, there is a 20-30% increase in stroke and heart disease with there is significant exposure to secondhand smoke

When assessing the pulmonary function studies of a patient, which assessment finding is seen in chronic obstructive disease, such as emphysema?

Decreased forced vital capacity (FVC) and decreased forced expiratory volume in 1sec (FEV1) ~ Hyperinflation caused by air trapping causes an increase in FRC. RV, and TLC., which may be 2x normal.A corresponding decrease in FVC and FEV1 occurs. This causes a flattening of the diaphragm, decreased inspiratory efficiency, and increased work of breathing

The FNP understands that one of the following OTC preparations in high doses can cause euphoria, disorientation, paranoia, and hallucinations and has been known to be abused by adolescents. Which OTC preparation is it?

Dextromethorphan ~Dextremoethorphan is a widely used cough suppressant and is found in many cough and cold remedies. At low doses used for cough suppression, dextromethorphan lacks psychological effect. However, at doses 5-10x higher, it can cause euphoria, disorientation, paranoia, and altered sense of time, as well as visual, auditory, and tactile hallucinations. Guaifenesin is an expectorant, pseudoephedrine is a decongestant, and diphenhydramine is an antihistamine

Age-associated changes that increase the risk for respiratory symptoms in the older adult patient include an increase in:

Diameter of trachea and bronchi ~ Age-associated physiologic changes include decreased compliance of the chest wall, making deep inspiration difficult. Increased trachea and bronchi diameters that increase dead space result in a decreased volume of air teaching the alveoli. An increase in small airway closure results in decreased vital capacity and increased residual come. Less elastic lung parenchyma results in decreased function of the alveoli. Shallow breathing and less forceful cough occurs because respiratory muscles weaken

And adult patient comes to the clinic with complaints of increased difficulty breathing over ruth past few days. Patient has a history of asthma, CAD, and recently diagnosed HTN. Examination reveals no JVD and no productive cough.Breath sounds are present, but expiratory wheezes are noted bilaterally. Patient denies any chest pain. Vital sign include pulse 72, respirations 34, and bp fo 170/100. Current medication are albuterol inhaler, nitroglycerin patch, and propranolol. What is the best treatment for this patient?

Discontinue propranolol and begin amlodipine ~ Beta-blockers are known to exacerbate chronic respiratory problems, especially reactive airway disease. Another antihypertensive, such as a CCB (amlodipine), should be considered. The patient's pulse is 7w and bp remains elevated, which indicates the beta-blocker is probably not effective in decreasing bp in this patient. Prednisone is not indicated unless other medications are not effective. Although beclomethasone may be appropriate to start, discontinuing the beta-blocker, which is likely exacerbating the problem is the better choice

The FNP is rerating a patient with CAP. There has been a high rate of macrolide-resistant Strep pneumoniae in the area. What should the patient be started?

Doxycycline 100mg bid x5days ~ In the presence of macrolide resistance, clarithromycin (a macrolide) would not be a safe choice. Doxycycline is the best alternative. In cases in which the patient is unable to take doxycycline, a combination beta lactic and macrolide or respiratory fluoroquinolone should be considered

During a 1sts time office visit, the FNP sees an adult female with a history of asthma. She has been using an albuterol metered-dose inhaler (MDI) one inhalation twice-monthly for the last several years. More recently, she has been using her NDI 5-7x/wk. Based on FINA guidelines, the FNP diagnosis of early controlled asthma and stater hon "step 2 therapy. What does Step 2 therapy include?

Fluticasone 44mcg 2inhalations qd ~According to FINA guidelines, Step 2 therapy should start with a low-dose inhaled corticosteroid (ICS). Flovent (fluticasone) is an ICS and would be the most appropriate therapy to start, based on FINA guidelines. Fluticasone and salmeterol are a combination of ICS and LABA used when reaching Step 3, and it should bot be used for initial therapy. Salmeterol is a LAVA and should not be used initially

When initiating preventive care to decrease the incidence of pneumonia in patients in an extended care facility, the FNP would identify high-risk patients as those who receive immunosuppressive therapy, use antibiotics frequently, have a cognitive impairment, and this taking:

Histamine (H2) angtagonists ~ H2 antagonists neutralize the normal gastric acid barrier, allowing for increased colonization of gram-negative bacilli and Staph aureus

A patient with a history of Parkinson's disease has an initial positive TB skin test, and isoniazid (INH) is ordered for treatment of latent TB infection. before beginning INH, it is important for the FNP to determine:

If the patients Parkinson's condition is being teated with levodopa ~ INH requires concurrent administration of vit B6 to prevent problems of optic neuritis. Vit B6 will decreased the effectiveness if levodopa. If the patient is to receive INH his anti-Parkinson medication need to be reevaluated

An adult patient arrives at the family practice clinic complaining of difficulty breathing, a cough a nd chest pain. History indicates that she was discharged fro m the hospital 2days age, after a cesarean section, and has a 15ppy smoking history. What would be an appropriate action?

Immediately transfer to the ED ~ The patient is at risk for PE, as a result of hypercoagulation related to giving birth, smoking, and vascular injury from surgery. Immediate testing and treatment is critical to the survival of someone with a PE, so they should be referred or transpire dot the highest level of care available. Assessment reveals common symptoms of a PE: dyspnea, cough, and pleuritic pain. Diagnosis tests include D-dimer test, chest X-ray, ventilation-perfusion (V/Q) scan, Ct scan, and/or pulmonary angiogram, which would be ordered at the ED

In adults with asthma, the most common reason outpatient treatment fails, resulting in hospitalization, is"

Improper inhaler technique ~ One of themes common cause of outpatient treatment failure is improper inhaler technique. Exposure to allergens may trigger an asthma attack, but proper use of inhalers will control the attack in many cases. Use of both steroids and cromolyn inhalers have decreased the severity of asthma attacks

The FNP is aware that the flu or influenza:

In older adult may persist for weeks and increase the prevalence of bacterial pneumonia ~ The flu is highly contagious respiratory infection that occurs epidemically during the winter months and may increase the prevalence of bacterial pneumonia. It is characterized by a sudden onset of chills, elevated temperature, headache, fatigue, muscle pain, dry cough. laryngitis, rhinorrhea, and red eyes 24-48hrs after exposure directly through respiratory droplets from an infected person or indirectly by drinking from a contained glass. Flu vaccines do not cause the flu regardless of being manufactured with a live attenuated or killed virus

What are normal physiologic changes in the respiratory system of the geriatric patient?

Increased residual volume ~With aging the number of alveoli decreases. The alveoli become rigid and lost their recoil and elasticity, which affects the patient's ability to exhale effectively. This increases a patient's residual volume (the amount of air left in the chest after expiration). Residual volume increases, whereas basilar inflation and ability to expel foreign matter decrease. The A{ diameter of the chest increases, as skin in patients with kyphosis

When interpreting purified protein derivative (PPD) skin tests in patients at a long-term care facility, the FNP identifies positive results in individuals with:

Induration reaction >10mm ~ Positive interpretation of PPD skin test results are as follows based on the criteria from the CDC: >5mm individuals with HIV, recent close contact with a person who has active TB, individual with chest X-ray indicating healed TB >10mm medically underserved individuals, IV drug users, residents in long-term care facilities, and health care workers >15mm all individuals

The FNP is planning regular daily treatment for a patient with asthma. Which is the preferred medication for the asthmatic patient who is not currently experiencing an exacerbation?

Inhaled corticosteroids ~ Preferred, regular daily treatment (long-term) of the patient with asthma include inhaled corticosteroid for their anti-inflammatory effects. Antibiotics are indicated if there is a concurrent infection, such as acute bronchitis. Beta-agonists are used for their bronchodilator effects and rapid onset of actions when a patient may need "rescue" or acute treatment for symptoms with quick-relief medications. Leukotriene receptor antagonist is another option but it is not preferred to inhale corticosteroid for regular daily treatment

What is the pharmacologic treatment show to be superior in multiple studies for the treatment of COPD by reducing exacerbation, lowering cost, and improving lung function and quality of life?

Ipratropium bromide and albuterol combined ~ Multiple studies show that the combination of an anticholinergic and beta-agonist, particularly ipratropium bromide and albuterol rescue exacerbation, lower cost, and improve lung function and quality of life

Which 2 statement are accurate regarding sarcoidosis?

Is a noninfectious, multisystem granulomatous disease May resolve spontaneously within 2yrs ~ Sarcoidosis is a noninfectious, multisystem granulomatous disease that may affect almost any organ system; however, 90% of affected individuals have pulmonary involvement. It most commonly affects young and middle-aged adults, with 80% of the presenting patients between 20-45yrs. The majority of patients have a spontaneous resolution within 2yrs. NSAIDs and low-dose steroids are used to treat symptoms; however, many patients are asymptomatic and do not require medication. Higher dose steroids are prescribed when patients have an acute respiratory failure or cardiac, neurologic, or ocular disease

A young adult is recovering from TB. What information should =be included in a teaching plan for home care?

It is critical for the young adult to take medications at the prescribed time; do not skip doses or allow the supply to run out ~ On discharge, a patient must understand the importance of taking medication as prescribed. Missed doses increase the mutation of the tubercle bacillus and decrease the medication's effeteness. Respiratory isolation at home is not necessary, and if the patient experiences problems of rash, nausea, and vomiting, he or she should contact the health care provider. Patients should never change a medication dosage without first consulting with a health care provider. Weekly sputum checks are not necessary

The FNP evaluates and older adult patient with a current history of alcoholism. The patient presents with an elevated temperature, congestion cough with rusty sputum, and occasional chills, The suspected diagnosis is bacterial pneumonia. The Gram stain sputum smear would most likely reveal which organism?

Klebsiella pneumoniae ~ K. Pneumoniae is an important pathogen in patients with alcoholism. S. aura generally affects older adult patients revering from influenza and is also common in hospitalized patients with DM and IV drug users. P aeruginosa is most likely found in someone with structural lung disease (bronchiectasis)

The FNP is planning a community screening program for lung cancer in older adult patients. What does the current EBP suggest?

Low-dose CT (LDCT) should be used in high-risk individuals ~ According to 2012 guidelines. the USPSTF recommends annual screening for lung cancer with LDCT in adults aged 55-80yrs who have a calculated smoking history of 30ppy and currently smoke or have quit within the last 15yrs. This should be discontinued after they have not been smoking for 15yrs. Current EB research does support routine screening for lung cancer in the general population. There is insufficient evidence that lung cancer screening by x-ray or sputum cytology reduces mortality. Bronchoscopy with biopsy is a diagnostic test, not a screening test

An older adult female comes in for a follow-up for COPD. She notes an increased frequency of morning headaches and daytime somnolence. A CBC notes her HCT is 52%. The FNP understands that a common but not always recognized complication of COPD this patient could have is:

Nocturnal oxygen desaturation ~ Although acute respiratory failure, cor pulmonale, and depression are common complications of COPD, they are less likely to cause the patient's current symptoms. Elevated HCT, morning headaches, and daytime somnolence are all potential signs of decreased oxygen saturation at night and would be an indication for home overnight oxygen monitory or sleep disorder specialist referral

A 65yrs old obese patient presents to the clinic with difficulty breathing. On examination, there is a low suspicion of a PE. Which of the following should the FNP use to rule out the likelihood of a PE?

Normal fibrin D-dimer ~ Fibrin D-dimer is normally <500 and is elevated when plasmin cross-links fibrin and creates degradation production in the blood Unless the suspicion of a PE is high, a D-dimer level of <500 can be used to rule out PE. D-dimer is sensitize but not specific and cannot be used to diagnose PE

The FNP is evaluating an adult with symptoms characteristic of obstructive sleep apnea, An overnight polysomnography is ordered. What is the characteristic result of this study that would be indicative of sleep apnea?

Oxygen desaturation and 10sec periods of apnea ~ Desaturation and 10sec periods of apnea that occur 10-15 times per hour are considered clinically significant of OSA. Loud snoring at night, frequent arousals during the night, and sleeping during the day are characteristic fo the problem but are not diagnostic

What is the correct procedure when percussing the anterior and posterior chest?

Percuss systematically and symmetrically the intercostal spaces of the posterior chest, moving from the left to the right side, and then percuss the anterior chest ~ Both the anterior and posterior chest should be percussed systematically and symmetrically at 4-5cm intervals over the intercostal spaces, moving from the left to right. Begin posteriorly with patient sitting with head bent forward and arms folded. As percussion moves laterally and anteriorly have the patient lift their arms up. Care is needed to ensure percussion is done in the intercostal spaces moving superior to inferior and medial to lateral. Diaphragmatic excursion is usually measured only on the posterior chest

A FNP performing a lung assessment using percussion is aware that:

Percussion should start medial to lateral moving superior to inferior beginning in the posterior chest ~ Percussion should start posteriorly and move from medial to lateral and superior to inferior. As the FNP moves laterally, the patient is asked to raise his or her arms to make lateral access easier. The percussion assessment should start with the patient sitting with his or her head lowered and arms folded in front

A patient comes to the clinic complaining of difficulty breathing, lethargy, and coughing up blood in the sputum. They have no history of chronic illness or major health problems. The FNP orders diagnosticc test to determine the problem. What diagnostic test result would require immediate treatment of this patient?

Positive sputum smear for acid-fast bacillus ~ The positive sputum for acid-fast bacillus is indicative of active TB. P. carinii is a common organism in healthy respiratory tracts; it becomes a problem if the patient sis immunocompromised. Hemolysis on a complement fixation testis a negative finding. When oxygen saturation is low and WBC is within normal range, treatment is not as important as it is with TB

An adult patient with a history of COPD presents to the clinic with increased dyspnea, a temperature of 102, a pulse of 104, respirations of 44, and O2 sat of 84%. Physical exam reveals diffuse rales and chinch bilaterally. Medications include atenolol 25mg qd, prednisone 10mg qd, ipratropium bromide 1-2puffs 18mcg aid prn, and fluticasone and salmeterol 2puffs bid. The FNP preliminary diagnosis is pneumonia, pending chest X-ray results. Which medication put this patient at risk to become immunocompromised?

Prednisone ~ Prednisone is a corticosteroid that suppresses the immune response and puts the patient in an immunocompromised state, increasing susceptibility to infections. Patients on prednisone therapy should be educated about the risk of developing infections and the need to seek medical attention if they suspect illness. Atenolol is a beta-blocker used as an antihypertensive. Ipratropium is an anticholinergic used in the acute treatment of asthma. Fluticasone propionate and salmeterol is a combination of inhaled corticosteroid and a LABA. Although inhaled corticosteroids can suppress the immune response, absorption is considerably less than oral prednisone

An older adult patient presents with new complaints of dynes, cough, fatigue, and dependant edema that has been worsening over the past few days. What shout the FNP consider when planning treatment?

Referral for hospitalization for evaluation of heart function ~ Worsening dyspnea and fatigue with increasing cough may indicate early pulmonary edema. A patient with this requires hospitalization with oxygen therapy, IV Lasix, and morphine. Patients suspected of having new-onset pulmonary edema should not be treated as outpatients. CCBs are of little benefit in HF and can make dependent edema worse. Empirical antibiotics are not indicated in this situation and may delay proper diagnosis of a serious condition

During the assessment of an older adult patient's respiratory status , the FNP determines increased tactile feremitus posteriorly at the 2nd intercostal space. What is the best interpretation of this finding?

Presence of fluid or cold mass within the lungs ~. Fluid or a solid mass will increase the transmission of vibration. Increased air trapping decreases or masks the transmission of vibration. A reactive airway results ion wheezing because of mucous and inflamed airways. Increased pressure in the bronchial tree is not measurable and will not cause asymmetric vibratory changes

An adult patient comes into the clinic complaining of increased fatigue and irritability. The patient has gained approximately 20lbs over the last year. Although the patient states sleeping through the night, the partner says the patient seems somewhat restless. Based on these symptoms, what else should be determined?

Presence of ongoing daytime sleepiness ~ A patient with recent weight gain and restless sleep is at risk for having obstructive sleep apnea (OSA). Ongoing daytime sleepiness is the hallmark sign of OSA. Although recurring depression could be a cause, a provider should consider the physical causes of presenting symptoms first. Fluctuation in BP including HTN can be seen in OSA, but they would not cause fatigue and nighttime restlessness. Recent changes in medication should be evaluated but are unlikely to cause all his symptoms. Although men are 2-3x as likely to have OSA at ta younger age, the number of women with OSA is equal approaching menopause

A patient with severe COPD says he experience fatigue and dyspnea with activity In determining his activity level, the FNP understands:

Pulmonary rehabilitation has been shown to improve symptoms and quality of life in everyday activities ~ According to the 2019 Global Initiative for Obstructive Lung Disease standards, pulmonary rehabilitation has been shown to improve exercise capacity and quality of life across all levels of severity in COPD. It has been shown to be the most cost-effective treatment strategy available. COPD patients should not avoid physical activity because this will only dd additional immobility issues. Although it is important to optimize pharmacologic therapy, pulmonary rehabilitation is beneficial with any COPD patient. Supplemental oxygen should bot be prescribed routinely even in patients who moderately desaturate wit activity

The FNP knows that Horner syndrome, a condition that can cause unilateral pupillary constriction and anhidrosis, soften associated with:

Pulmonary sulcus (Pancoast) tumor ~ Horner syndrome, which is a paralysis of the cervical sympathetic nerves that result in ptosis, loss of sweating, pupillary constriction, and sometimes enophthalmos, is often associated wth malignant tumors in the upper lung, leading to nerve compression (pulmonary sulcus [Pancoast] tumor or superior sulcus tumor found in smokers)

The FNP understands which of th following characteristics is more likely to occur when the adult patient has pneumonia (caused by Strep pneumoniae) rather than bronchitis?

Purulent sputum production ~ CAP caused by S. pneumoniae often presents abruptly with high fever, shaking chills (rigor), cough production of purulent sputum, and pleuritic chest pain. In acute bronchitis, cough is the primary symptoms and initially is dry and nonproductive. Fever, dyspnea, wheezing, and possible mucoid sputum production are also characteristic of acute bronchitis

An older adult patient is evaluated by the FNP for a complaint of cough, fever, pleuritic chest pain , and sputum production, In gathering a history on this patient, it is most important to know if the patient has:

Received the pneumococcal vaccine ~The pneumococcal vaccine is recommended for older adult patients because their immune system. is less efficient. The symptoms of fever, chest pain, and sputum production suggest pneumococcal pneumonia

A young adult presents at the clinic with complaints of tingling in the face and hands, sudden shortness of breath, and vague chest discomfort. The patient appears very anxious and denies any history of respiratory problems. On examination, hands are cool to the touch; vital signs include resperations 34, pulse regular 100, bp 110/76, and normal temperature. Respiratory examination reveals bilateral breath sounds with tachypnea, no adventitious sounds, and normal percussion and visual examination of the chest. What is the best immediate treatment?

Relaxation techniques and encouraging controlled diaphragmatic breathing ~ The situation described is hyperventilation syndrome (HVS); treatment should be concentrated on patient education through reassurance and suggested breathing and relaxation techniques. Albuterol, oxygen, and ABGs are not appropriate initial treatments. Breathing into a paper bag is not recommended because significant hypoxemia and death has occurred int he past from this treatment

An older adult patient reading in a nursing home has recently been exposed to TB. During the contact investigation, the FNP interprets the initial PPD skin test to be negative. Which plan would be most appropriate at this time?

Repeat PPD test in 8-10wks ~ If a person is infected, a delayed-type reaction may occur 2-8wks after infection. In a contact exposure, if the initial PPD is negative, a repeat PPD 8-10wks later is recommended in all patients. A patient should not be treated empirically for TB exposure. 6mos is too long to wait for someone who could have active TB. A yearly evaluation should be reserved for those who work or live in high-risk environments but have not been exposed

A patient with COPD smokes one pack of cigarettes daily. In approaching the patient about smoking cessation, the FNP knows:

Smoking cessation counseling should be done at every clinic visit ~According to the 2019 Global Initiative for Obstructive Lung Disease standards, there is no current research supporting the safe use of e-cigarettes in smoking cessation. Smoking cessation has the strongest ability to influence the natural course of COPD. There is a strong relationship between counseling by health care professionals, legislative smoking bans, and increased cessation success. Every tobacco user should be offered smoking cessation advice at every visit

A 22yrs old male comes to the office complaining of chest pain and shortness of breath. He states the problems started suddenly after running sprints in basketball practice. He states he has no past history of pulmonary problems. He is about 72" tall and 145lbs, with pulse o 118, respirations 30, decreased breath sounds, and hyper-resonance over the left lung. Based on these findings, what is the best diagnosis for this patient?

Spontaneous pneumothorax ~ Spontaneous pneumothroax occur in healthy, thin, young adults, especially after strenuous exercise, predominant symptoms include sudden pain, dyspnea, and asymmetric chest expansion. The clinical hallmark of asthma is wheezing; with pulmonary edema, there is frequently coughing, frothy sputum, and crackles heard on auscultations. Bronchiectasis is most often chronic ans is characterized by moist crackles and wheezing on auscultation; cough is usually present

What would be a priority intervention for a patient experiencing respiratory arrest, who has a pulse?

Starting rescue breathing, which is 1 breath ever 5-6 secs, or about 10-12 breaths per min ~ According to the AHA, the protocol for respiratory arrest (has a pulse) is rescue breathing, which is to give 1 breath every 5-6 secs or about 10-12 breaths/min. Pulse should be checked every 2 minutes, if no pulse, then begin CPR with 30 chest compressions followed by 2 breaths

An otherwise healthy nonsmoking patient presents with a dry cough for the past 5mos. She has a history of HTN and GERD. She is on ranting and lisinopril daily. Which treatment would yield the highest probability of success?

Switching from lisinopril to amlodipine ~ the most likely causes of subacute cough include post infection, GERD or asthma. This patient has been healthy and is currently being treated for GERD symptoms. A likely cause fo this cough is lisinopril, and ACE inhibitor. Albuterol and dextromethorphan may be a good option if the cough does not clear within 4wks of discontinuing the lisinopril in favor of a different antiyhypertensive medication

In developing a plan for a healthy older patient with typical pneumonia, the FNP understand that 60-65% of CAP is caused by which organism?

Streptococcus pneumoniae ~ S. pneumoniae is the most common cause of CAP and SNF acquired bacterial pneumonia. H. influenzae is common in older adult patients with underlying chronic diseases (COPD, DM). K. Pneumoniae and other gram-negative bacteria are pathogens in patients with alcoholism, immunocompromised hosts, and hospitalized patients. M. tuberculosis is an infrequent cause of pneumonia

When the lateral diameter of the chest is the same size as the anteroposterior (AP) diameter, the FNP correctly identifies this finding as:

Suggestive of obstructive lung disease ~ The adult chest is usually symmetric and the AP diameter is often half the lateral diameter. Pigeon chest (precuts carinatum) is a forward protrusion of the sternum with the ribs sloping back. Funnel chest (precuts excavatum) is a depression of the sternum. Barrel chest occurs when the AP diameter equals the transverse diameter and is usually a sign of advancing obstructive lung disease

An adult patient who smokes presents with complaints of orthopnea. The FNP notes on examination distention of chest wall veins, and mild edema of the head and neck. The FNP recognizes this condition as:

Superior vena cava syndrome (SVCS) ~ Over 70% of cases of SVCS occur as a complication of lung malignancy involving the mediastinum. This is considered an oncologic emergency and requires an immediate referral. Although chronic bronchitis or heart failure may cause orthopnea, upper extremity edema is usually not present. A thyroid abnormality usually results in unilateral or bilateral thyroid enlargement in the neck. Asthma does not cause fluid retention

In treating a patient iwht acute bronchitis, the FNP understands:

Symptom management should be the primary focus of treatment ~ Most cases of acute bronchitis rely on symptom management as the primary treatment choices In most cases, antibiotics are discouraged because of increased resistance and lack of EB efficacy. There is no significant evidence for or against the usage of OTC preparations. Although a Bets agonist has been shown to resolve cough faster in those with underlying wheezing, there is nothing recommending wide use

Patients with asthma need to be instructed to:

Take 1-2 puffs of Beta-agonist as needed using a metered-dose inhaler ~ Patients with asthma should be instructed to keep their inhaled B2 agonists with them at all times in case of bronchospasm and use them prn. The B2 against are effective in reversing bronchospasm and should be used only for rescue symptoms. Inhaled corticosteroids are one acting and will not give immediate relief, so the patient should die instructed to use them as prescribed. Antibiotics are not incited for acute bronchospasm

An adult male is started on ciprofloxacin 500mg bid x60days fo possible exposure to anthrax. %days later, on return to the clinic, he noted increased pain in his posterior angle. Understanding the potential complications with fluoroquinolone therapy, the FNP knows:

This is a known adverse reaction and the ciprofloxacin should be discontinued ~ Posterior ankle pain is suggestive of Achilles tenonditis. Tendon ruptures are a known adverse reaction to fluoroquinoline therapy, and there have been a significant number of cases in the U.S. If tendon inflammation or pain occurs, the fluoroquinolone should be discontinued immediately. Cipro is recommened for 60days as part of empiric treatment of anthrax, as postexposure prophylaxis

An adult male comes into the office with a complaint of a chronic cough. The cough has persisted for 6wks and continued following resolution of his upper respiratory infection, The FNP understands that:

This is a subacute cough and is likely postinfectious ~ The patient most likely has a subacute, post infectious cough, which can last up to 8wks. After 8wks, it would more likely be a chronic cough related to environmental factors like smoking, asthma exacerbation, or GERD

An adult patient with asthma has had uncontrolled symptoms after starting treatment 3mos ago. Before considering any step up in treatment, the FNP should consider that the current treatment may be ineffective because:

The patient is using the inhaler incorrectly ~ When initiating pharmacologic therapy for asthma, patients should use a SABA as needed for shortness of breath. Most inhaled corticosteroids should be taken only once-twice daily. Montelukast is indicated for the treatment of seasonal allergies and fr the treatment of asthma. Up to 80% of patients use their inhalers incorrectly

The FNP is assessing an adult patient who is complaining of shortness of breath and chest discomfort. His respirations are shallow at 26. When evaluating the diaphragmatic excursion, it is determined that the diaphragm on the right side is slightly higher than on the left side. What is the best interpretation of these findings?

This is normal because the liver is located on the right side ~ This is a normal finding because of the anatomic location of the bulk liver. Atelectasis and consolidation present with normal diaphragmatic movement, but with dullness to percussion over the affected area. Severe obstructive lung disease results in hyperinflation and limited diaphragmatic excursion but is bilateral

An adult patient with chronic asthma is seen in the clinic complaining of vomiting and stomach cramps. He is confused and unsure what medications he is currently taking. His vital signs are BP of 158/92, pulse of 152 and irregular, and respirations of 28 and shallow. What STAT diagnostic study should be obtained?

Theophylline level ~The drug therapy regimen for chronic asthma may include theophylline. Symptoms of toxicity include anorexia, nausea, vomiting, confusion, restlessness, tachycardia, dysrhythmias, and seizures

The FNP is screening an older adult patient for problems related to OSA. What risk factors are typically associated with this condition?

Usage of sleep aids ~ Frequent substance use, including alcohol, benzodiazepines, sleep aids, opiates, and muscle relaxants, can exacerbate OSA. obesity, weight gain, nasal allergies, and polyps are common factors associated with this condition. Most patients with sleep apnea will not report nighttime sleep disturbances even though a spouse may witness nighttime restlessness. Snoring, daytime sleepiness and fatigue are frequently reported symptoms,. Men are more likely than premenopausal women to have OSA

A patient comes to the PCP clinic complaining of difficulty breathing. what is most important to establish initially in this patient?

Type of activity that produces the dyspnea ~ It is most important to obtain more information about dyspnea. This information is necessary to determine the severity of the patient's complaint. A chest X-ray gives only limited information and may be normal in conditions like asthma. Ab ABG result is abnormal when the symptoms are severe. The presence of bilateral breath sound over the lower lobes is a normal finding

How would an adult, who has an FEV1 >80%, has been experiencing nighttime awakenings (4-5x/wk) and using SABA 3-4x/wk, and reports minimal limitation to normal activity, be classified?

Uncontrolled ~ According to the 2019 Global Initiative on Asthma, asthma control is evaluated based on the presence or absence of symptoms. Symptoms suggesting the asthma is not well controlled include daytime symptoms more than 2x/wk, night waking because of fo asthma, Andy activity limitation caused by asthma, and usage of an asthma reliever (SABA) more than 2x/wk. 1-2 of the criteria being true suggests the asthma is partly controlled, more than 2 being true suggests uncontrolled asthma

When examining the chest X-ray of a patient with an initial TB infection, you would expect to see changes most often in what part oft lung?

Upper lobes ~TB infections are seen most often in the upper lobes of the lung. In 13-30% of the cases, adults may have "atypical" radiographic patterns with infiltrates in the middle or lower lung zones. The local lymph nodes are infected and enlarged (hilar adenopathy) An asymptomatic period usually follows the primary infection and can last for years or decades before clinical symptoms develop. When there is a reactivation of the disease in a previously infected person, this scenario is more likely to occur in a situation when defenses are lowered, such as with older adults and people with HIV disease. The apical posterior segments of the upper lobes are the most common sight of reactivation

An adult patient with a history of asthma calls to tell the FNP that she is achieving 65% of her personal best of the peak flow meter. She is talking in phrases and sounds calm. What advice would the FNP give this patient?

Use a bronchodilator now and come in for evaluation in the office today ~ According to the 2019 Global Initiative for Asthma guidelines, this patient does not need immediate transfer to an acute care facility because she is not achieving less than 60% of personal best on her peak flow meter, remains calm, and is speaking in phrases. The patient should use her bronchodilator immediately and be evaluated urgently. If she does not improve or becomes worse, she will need emergency intervention. Inhaled corticosteroids are used for maintenance therapy and are not for "rescue" symptoms. A referral to a pulmonologist may be necessary at some point, but not immediately

A patient with newly diagnosed COPD is being discharged from the hospital. What information is important to include in the home care teaching?

Use the bronchodilator before exercising ~ To prevent dyspnea on activity, the bronchodilator should be used before walking or increased physical activity. The patient should not stay in bed and should be encouraged to increase activity gradually. Fluid intake of 2-3L/day should be encouraged, unless there are cardiac problems. A corticosteroid inhaler should be used at regular intervals as ordered and is not meant for rescue during periods of acute dyspnea

The FNP knows that normal breath sounds that have a low pitch, soft intensity, and are heard best on inspiration over the posterior lung fields are called:

Vesicular ~ Vesicular breath sounds are normal low-pitched, low-intensity sounds heard in the peripheral lung fields. Inspiration is 2.5 times longer than the expiratory phase. Bronchial breath sounds, normally heard over the trachea and larynx, are high-pitched loud sounds with a shortened inspiratory and lengthened expiratory phase. Bronchovesicular breath sounds that are heard mainly where fewer alveoli are located, which is over the 2nd intercostal space anteriorly and between the scapulae posteriorly, have a moderate pitch and intensity with equal duration of expiratory and inspiratory sounds. Rhonchi are adventitious breath sounds that are usually not heard during normal respiration

When determining reclassification of asthma control in an adult patient with symptoms fewer than 2days/wk, no interference with normal activity, no reports of nighttime awakening, and use of a short-acting beta agonist 2x/wk, the FNP would classify the patient as:

Well controlled ~ According to the 2019 Global Initiative of Asthma, the level of control is based on the most severe impairment or risk category. This patient is well controlled. The components of well-controlled asthma are daytime symptoms ,2x/wk, no nighttime awakening, no interference with normal activity, and using a SABA <2x/wk