210 Peds Unit 2

A child with asthma is having pulmonary function tests. The purpose of the peak expiratory flow rate (PEFR) is to: confirm the diagnosis of asthma. determine the cause of asthma. identify "triggers" of asthma. assess the severity of asthma.

assess the severity of asthma. (Diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination. The causes of asthma are inflammation, bronchospasm, and obstruction. Some of the triggers of asthma are identified with allergy testing. The peak expiratory flow rate (PEFR) measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared to the child's baseline.)

An infant with a congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: prevent respiratory syncytial virus (RSV) infection. make isolation of infant unnecessary. prevent secondary bacterial infection. decrease toxicity of antiviral agents.

prevent respiratory syncytial virus (RSV) infection. (Synagis is a monoclonal antibody specific for respiratory syncytial virus (RSV). Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on antiviral agents.)

A nurse is charting that a hospitalized child has labored breathing. Which describes labored breathing? Dyspnea Hypopnea Tachypnea Orthopnea

Dyspnea (Dyspnea is labored breathing. Tachypnea is rapid breathing. Hypopnea is breathing that is too shallow. Orthopnea is difficulty breathing except in upright position.)

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which interventions should be included in the child's care (Select all that apply)? Administer antibiotics. Administer cough syrup. Encourage infant to drink 8 ounces of formula every 4 hours. Institute cluster care to encourage adequate rest. Place on noninvasive oxygen monitoring.

Encourage infant to drink 8 ounces of formula every 4 hours. Institute cluster care to encourage adequate rest. Place on noninvasive oxygen monitoring. (Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.)

The nurse is providing instructions about the Advair inhaler (corticosteroid and salmeterol). Which statement about this inhaler is accurate? It is indicated for the treatment of acute bronchospasms. It needs to be used with a spacer for best results. Patients need to avoid drinking water for 1 hour after taking this drug. It is used for prevention of bronchospasms.

It is used for prevention of bronchospasms. (Salmeterol is a long-acting beta₂ agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.)

The nurse is providing instructions about the Advair inhaler (corticosteroid and salmeterol). Which statement about this inhaler is accurate? It is indicated for the treatment of acute bronchospasms. It needs to be used with a spacer for best results. Patients need to avoid drinking water for 1 hour after taking this drug. It is used for the prevention of bronchospasms.

It is used for the prevention of bronchospasms. (Salmeterol is a long-acting beta₂ agonist bronchodilator, while fluticasone is a corticosteroid. In combination, they are used for the maintenance treatment of asthma and COPD. As a long-acting inhaler, Advair is not appropriate for treatment of acute bronchospasms. The other statements are incorrect.)

Which laboratory value would the nurse assess before administering zafirlukast (LTRA) to a client? Renal function tests Complete blood count Liver enzymes Cardiac enzymes

Liver enzymes (Because use of zafirlukast may lead to liver dysfunction, liver enzyme levels should be monitored regularly, especially early in the course of therapy.)

A patient has a new order for an ipratropium (Atrovent) inhaler, an anticholinergic drug. The nurse knows to assess for an allergy to which food before giving this drug? Shellfish Soy products Peanuts Eggs

Peanuts (There have been reported cases of severe anaphylactic reactions to ipratropium inhalers in patients with allergies to peanuts, and such use must be avoided.)

A child is admitted to the hospital with asthma. Which assessment findings support this diagnosis? a. Nonproductive cough, wheezing b. Fever, general malaise c. Productive cough, rales d. Stridor, substernal retractions

a. Nonproductive cough, wheezing (Asthma presents with a nonproductive cough and wheezing. Pneumonia appears with an acute onset, fever, and general malaise. A productive cough and rales would be indicative of pneumonia. Stridor and substernal retractions are indicative of croup.)

A patient who has been taking montelukast (LTRA) for 3 months reports having urine the color of coffee. What is the nurse's best response? a. "You need to increase your intake of water and decrease your intake of coffee." b. "You need to stop taking this drug and notify your prescriber today." c. "Don't worry. All patients taking this drug have dark urine." d. "Do not take this drug any more often than prescribed."

b. "You need to stop taking this drug and notify your prescriber today." (Montelukast is a leukotriene inhibitor and can cause liver damage. Dark urine is one sign of liver damage. The patient needs to stop taking the drug and see his or her health care provider to determine whether liver damage is present.)

An infant is hospitalized with RSV bronchiolitis. What is the priority nursing diagnosis? a. Fatigue related to increased work of breathing b. Ineffective breathing pattern related to airway inflammation and increased secretions c. Risk for fluid volume deficit related to tachypnea and decreased oral intake d. Fear and/or anxiety related to dyspnea and hospitalization

b. Ineffective breathing pattern related to airway inflammation and increased secretions (An ineffective breathing pattern is the priority nursing diagnosis for an infant hospitalized with RSV infection.)

Which statement about sudden infant death syndrome (SIDS) is true? a. SIDS occurs most often in female infants. b. Maternal cigarette smoking increases risk. c. Most deaths occur between 2 and 8 months of age. d. Most victims had previous episode of cyanosis or apnea.

b. Maternal cigarette smoking increases risk. (Maternal smoking increases risk 3 to 4 times. SIDS occurs most often in male infants, most deaths occur between 1 and 5 months, and only a small number of victims have had a previous episode of cyanosis or apnea.)

Asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

b. a viral infection. (Viral illnesses cause inflammation that causes increased airway reactivity in asthma.)

The nurse is performing a medication history on a patient who reports long-term use of montelukast (LTRA) and an albuterol metered-dose inhaler (Proventil). The nurse will contact the provider to discuss an order for which laboratory tests? a. Cardiac enzymes and serum calcium b. Electrolytes and a complete blood count c. Liver function tests and serum glucose d. Urinalysis and serum magnesium

c. Liver function tests and serum glucose (The beta₂ agonists can increase serum glucose levels and montelukast can elevate liver enzymes, so these should be monitored in patients taking these medications.)

The nurse makes a home visit to a child who has recently been diagnosed with asthma. Which environmental finding has the potential to trigger an asthma exacerbation? a. Radiator heating system b. Air conditioner c. Hardwood flooring d. Leaky roof

d. Leaky roof (A leaky roof has the potential to trigger an asthma exacerbation because water or moisture can lead to mold growth, and mold is an allergen that can trigger asthma.)

A patient is in an urgent care center with an acute asthma attack. The nurse expects that which medication will be used for initial treatment? An anticholinergic such as ipratropium (Atrovent) A short-acting beta₂ agonist such as albuterol (Proventil) A long-acting beta₂ agonist such as salmeterol (Serevent) A corticosteroid such as fluticasone (Flovent)

A short-acting beta₂ agonist such as albuterol (Proventil) (The short-acting beta₂ agonists are commonly used during the acute phase of an asthmatic attack to reduce airway constriction quickly and to restore airflow to normal levels. The other drugs listed are not appropriate for acute asthma attacks. Anticholinergic drugs and long-acting beta₂ agonists are used to prevent attacks; corticosteroids are used to reduce airway inflammation.)

A patient with long-term asthma develops Cushing syndrome. What is the cause of this condition? a. Taking corticosteroids for many years b. Abruptly withdrawing cortisone therapy c. Lacking ACTH, related to the pituitary gland d. Poorly functioning adrenal glands

a. Taking corticosteroids for many years (Long-term corticosteroid use is a prime cause of Cushing syndrome.)

Which interventions should the nurse implement when caring for a family of a sudden infant death syndrome (SIDS) infant? (select all that apply) Allow parents to say goodbye to their infant. Once parents leave the hospital, no further follow-up is required. Arrange for someone to take the parents home from the hospital. Avoid requesting an autopsy of the deceased infant. Conduct a debriefing session with the parents before they leave the hospital.

Allow parents to say goodbye to their infant. Arrange for someone to take the parents home from the hospital. Conduct a debriefing session with the parents before they leave the hospital. (An important aspect of compassionate care for parents experiencing a SIDS incident is allowing them to say good-bye to their infant. These are the parents' last moments with their infant, and they should be as quiet, meaningful, peaceful, and undisturbed as possible. Because the parents leave the hospital without their infant, it is helpful to accompany them to the car or arrange for someone else to take them home. A debriefing session may help health care workers who dealt with the family and deceased infant to cope with emotions that are often engendered when a SIDS victim is brought into the acute care facility. An autopsy may clear up possible misconceptions regarding the death. When the parents return home, a competent, qualified professional should visit them after the death as soon as possible.)

A school-age child with asthma came to the emergency department with a respiratory rate of 44 breaths/minute and wheezes heard throughout. After two breathing treatments, the nurse assesses a respiratory rate of 8 breaths/minute and hears no wheezing. The child is lying quietly on the bed. What action by the nurse is best? A. Allow the child to rest undisturbed. B. Call for another respiratory treatment. C. Obtain oxygen saturation; notify provider. D. Reassess the child in 30 minutes.

C. Obtain oxygen saturation; notify provider. (This respiratory rate is too low for a child of any age and is indicative of exhaustion and the inability to breathe effectively. The absence of wheezes may indicate lack of ventilation. The nurse should obtain an oxygen saturation and notify the provider immediately. Without action, the child could progress to respiratory arrest. There is no indication that the child needs another breathing treatment.)

Before administering an LTRA medication, the nurse would assess the client for allergies to which substance? (Select all that apply.) Latex Cellulose Chlorhexidine Povidone Lactose

Cellulose Povidone Lactose (Allergies to povidone, lactose, titanium dioxide, or cellulose derivatives are important to note because these are inactive ingredients in LTRAs.)

Which herbal product, when taken with theophylline, can decrease theophylline's serum drug levels? Peppermint oil St. John's wort Garlic Echinacea

St. John's wort (St. John's wort has been shown to enhance the rate of theophylline metabolism, thus decreasing serum levels.)

What is the role of corticosteroids in the treatment of acute respiratory disorders? They increase gas exchange in the alveoli. They stimulate the immune system. They directly dilate the bronchi. They decrease inflammation.

They decrease inflammation. (Corticosteroids can suppress the immune system. They do not directly affect bronchodilation but rather prevent bronchoconstriction as a response to inflammation.)

A patient with asthma asks why he must take regularly scheduled systemic drugs when he can stop several asthma attacks each day within a few minutes of their onset by using a short-acting beta agonist inhaler. What is the nurse's best response? a. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." b. "If asthma attacks are uncontrolled they lead to the eventual development of lung cancer and emphysema." c. "Using only short-acting beta agonists will lead to drug resistance and then the drug won't work when you need it." d. "Inhaled beta agonist drugs only treat the constriction aspects of asthma and do not help the inflammatory aspects of the disease."

a. "Frequent asthma attacks, even if they are halted relatively quickly, damage the bronchial tissues over time." (Because damage can occur with any asthma attack, the main focus of therapy should be on attack prevention rather than just on symptom management.)

Which statement about the pathology of asthma is true? a. Breath sounds are normal between attacks. b. Mucous plugs are the major cause of airway obstruction. c. Eventually the alveoli are destroyed and gas exchange is limited. d. During an attack, arterial oxygen levels and carbon dioxide levels are decreased.

a. Breath sounds are normal between attacks. (The two causes of reversible and intermittent airway obstruction with asthma are bronchoconstriction and inflammation. Between asthma attacks the airways are open and normal breath sounds are heard. Mucous plugs can make the airway obstruction worse, but are not major causes of airway obstruction. Asthma affects only the airways, not the alveoli.)

A nurse is developing an educational program about SIDS for a new mothers' support group in the community. Which of the following information would be included in this presentation? a. Parents are encouraged to place their infants in the supine sleeping position. b. SIDS is the leading cause of death among infants age 6 months to 1 year old. c. SIDS is associated with infants who have had difficulty sleeping at night. d. Parents are encouraged to limit the amount of "tummy time" of their infant.

a. Parents are encouraged to place their infants in the supine sleeping position. (Through the Back to Sleep program developed by the AAP, there has been a lower number of infant deaths from SIDS. This has encouraged the supine sleeping position. One of the consequences of the supine sleeping position is plagiocephaly. The primary intervention to decrease the risk of plagiocephaly is "tummy time." Parents should be instructed to allow supervised tummy time while the infant is awake and cautioned about the amount of time their infant spends in a car seat. SIDS is the leading cause of death among infants 28 to 365 days of age. By definition, the cause of SIDS is not known.)

A patient will begin taking albuterol (Proventil) to treat asthma. When teaching the patient about this drug, the nurse will make which recommendation? a. Report rapid or irregular heart rate. b. Drink 8 to 16 extra ounces of fluid each day. c. Monitor serum glucose daily. d. Take a calcium supplement.

a. Report rapid or irregular heart rate. (High dosages of albuterol may affect beta₁ receptors, causing an increase in heart rate that could be dangerous. It is not necessary to consume extra fluids or take a calcium supplement while using this drug. Serum glucose may be elevated slightly, but this is not a concern in non-diabetic patients.)

A patient with asthma is prescribed albuterol (Proventil) as needed and salmeterol (Serevent) every 12 hours. When the patient asks the nurse why two inhaler drugs are needed, what is the nurse's best response? a. "Albuterol opens your airways and salmeterol decreases the inflammation." b. "I will check with the prescriber to determine whether you can just use one drug." c. "Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks." d. "Salmeterol helps you breathe better and albuterol opens alveoli for gas exchange."

c. "Albuterol is a rescue drug to stop asthma attacks and salmeterol prevents attacks." (Even though both drugs are beta₂ agonists, they are both normally prescribed for the patient with asthma. Short-acting (but rapid-acting) beta₂ agonists (albuterol) are used to reduce the severity or stop an asthma attack. Long-acting beta₂ agonists (salmeterol) can prevent attacks when taken daily; however, their onset of action is so slow that these drugs are not helpful to stop an attack that has already started.)

A patient is starting on the drug cromolyn sodium (mast cell stabilizer). Which statement made by the patient indicates a need for clarification about the purpose, administration schedule, or side effects of this drug? a. "If I get a skin rash, I will call my doctor right away." b. "I will keep using the drug even if I don't notice a difference in my asthma after the first week." c. "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs." d. "I have been trying to inhale deeply when I trigger the inhaler so that more of the drug reaches my lungs."

c. "I will keep the inhaler with me at all times so that I can use it quickly when an asthma attack occurs." (Cromolyn sodium is a prophylactic (preventive) drug that stabilizes mast cell membranes, inhibiting inflammatory responses in the tissues it contacts. It is not useful during acute attacks.)

When auscultating breath sounds of an infant with respiratory syncytial virus, which assessment would the nurse immediately report? a. Respiration rate decrease from 40 to 32 breaths/min b. Heart rate decrease from 110 to 100 beats/min c. "Quiet chest" from previous assessment of wheezing d. Oxygen saturation of 90%

c. "Quiet chest" from previous assessment of wheezing (A "quiet chest" after assessment of wheezing indicates occlusion of air pathways and impending respiratory arrest. All other options are within normal range for infants undergoing oxygen administration.)

A nurse assesses a client with asthma and notes bilateral wheezing, decreased pulse oxygen saturation, and suprasternal retraction on inhalation. Which actions should the nurse take? (Select all that apply.) a. Administer prescribed salmeterol (Serevent) inhaler. b. Assess the client for a tracheal deviation. c. Administer oxygen to keep saturations greater than 94%. d. Perform peak expiratory flow readings. e. Administer prescribed albuterol (Proventil) inhaler.

c. Administer oxygen to keep saturations greater than 94%. e. Administer prescribed albuterol (Proventil) inhaler. (Suprasternal retraction caused by inhalation usually indicates that the client is using accessory muscles and is having difficulty moving air into the respiratory passages because of airway narrowing. Wheezing indicates a narrowed airway; a decreased pulse oxygen saturation also supports this finding. The asthma is not responding to the medication, and intervention is needed. Administration of a rescue inhaler is indicated, probably along with administration of oxygen. The nurse would not do a peak flow reading at this time, nor would a code be called. Midline trachea is a normal and expected finding.)

A patient will be discharged home with albuterol (Proventil) to use for asthma symptoms. What information will the nurse include when teaching this patient about this medication? a. Failure to respond to the medication indicates a need for a higher dose. b. Monitor for hypoglycemia symptoms when using this medication. c. Palpitations are common with this drug even at normal, therapeutic doses. d. Overuse of this medication can result in airway narrowing and bronchospasm.

d. Overuse of this medication can result in airway narrowing and bronchospasm. (Excessive use of an aerosol drug can occasionally cause severe paradoxical airway resistance, so patients should be cautioned against overuse. Excessive use can also lead to tolerance and loss of drug effectiveness, but patients should not increase the dose because of the risk of bronchospasm and the increased incidence of adverse effects such as tremors and tachycardia. Hyperglycemia can occur. Palpitations are common with increased doses but not at therapeutic doses.)

A patient has been medicated during an asthma attack. Which assessment finding indicates to the nurse that the therapy is ineffective? a. Trachea is at the midline. b. Oxygen saturation is 96%. c. Respiratory rate is 22 breaths per minute d. Peak expiratory flow is 40% below expected value

d. Peak expiratory flow is 40% below expected value (A peak expiratory flow rate of 40% below the patient's personal best indicates that the patient is still having difficulty moving air into the respiratory passages because of airway narrowing. The asthma is not responding sufficiently to the drug. Although the respiratory rate is slightly high, many conditions can cause this and it alone is not an indication of ineffective drug response.)

Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline (xanthine) c. Aminophylline (xanthine) d. Short-acting β₂ agonists

d. Short-acting β₂ agonists (Short-acting β₂ agonists are the first treatment in an acute asthma exacerbation.)

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8 week old make which statement? Select all that apply. "I only smoke in the kitchen." "I put my baby to sleep on her back." "I have my baby sleep with me instead of alone in the crib." "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

"I only smoke in the kitchen." "I have my baby sleep with me instead of alone in the crib." "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night." (Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The "Back to Sleep" Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS. Overheating increases the risk of SIDS. Leaving a stuffed animal in the crib is a suffocation risk but still needs to be addressed as a safety hazard.)

The nurse is providing instructions to a patient who has a new prescription for a corticosteroid metered-dose inhaler. Which statement by the patient indicates that further instruction is needed? (Select all that apply.) "I will rinse my mouth with water after using the inhaler and then spit out the water." "I will gargle after using the inhaler and then swallow." "I will clean the plastic inhaler casing weekly by removing the canister and then washing the casing in warm soapy water. I will then let it dry before reassembling." "I will use this inhaler for asthma attacks." "I will continue to use this inhaler, even if I am feeling better." "I will use a peak flow meter to measure my response to therapy."

"I will gargle after using the inhaler and then swallow." "I will use this inhaler for asthma attacks." (The inhaled corticosteroid is a maintenance drug used to prevent asthma attacks; it is not indicated for acute asthma attacks. Rinsing the mouth with water is appropriate and necessary to prevent oral fungal infections; the water is not to be swallowed after rinsing. The patient needs to be given instructions about keeping the inhaler clean, including removing the canister from the plastic casing weekly and washing the casing in warm soapy water. Once the casing is dry, the canister and mouthpiece may be put back together and the cap applied. The glucocorticoid may predispose the patient to oral fungal overgrowth, thus the need for implicit instructions about cleaning inhaling devices. Use of a peak flow meter assists in monitoring the patient's response to therapy. The medication needs to be taken as ordered every day, regardless of whether the patient is feeling better.)

Which statement by a client best indicates an understanding of the teaching on flunisolide (corticosteroid)? "I will wash the plastic inhaler casing once a month." "I will not use my albuterol inhaler while I am taking AeroBid." "I will rinse my mouth with water after each use." "I will take two puffs to treat an acute asthma attack."

"I will rinse my mouth with water after each use." (Flunisolide is an inhaled corticosteroid. Rinsing the mouth immediately after each use of the inhaler or nebulizer will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. The plastic inhaler casing is washed in warm, soapy water every week.)

The nurse admits a patient who has a diagnosis of an acute asthma attack. Which statement indicates that the patient may need teaching regarding medication use? "I have not had any acute asthma attacks during the last year." "I became short of breath an hour before coming to the hospital." "I've been taking Tylenol 650 mg every 6 hours for chest-wall pain." "I've been using my albuterol inhaler more frequently over the last 4 days."

"I've been using my albuterol inhaler more frequently over the last 4 days." (The increased need for a rapid-acting bronchodilator should alert the patient that an acute attack may be imminent and that a change in therapy may be needed. The patient should be taught to contact a health care provider if this occurs. The other data do not indicate any need for additional teaching.)

The nurse is discussing child care strategies with a mother of a newborn. The mother asks the nurse, "What causes sudden infant death syndrome (SIDS)?" Which of the following responses is most likely to answer the mother's question therapeutically? "SIDS is a common fear for new mothers. The best advice is to put your baby to sleep on her back." "We aren't sure exactly, but it may have something to do with undetected cardiac or oxygen problems." "Research is inconclusive, but it's thought to be a result of a nervous system problem that occurs when the baby is asleep." "Your pediatrician wants you to put your baby to sleep on her back because research has shown that more stomach sleepers are victims."

"Research is inconclusive, but it's thought to be a result of a nervous system problem that occurs when the baby is asleep." (Some have hypothesized that sudden infant death syndrome (SIDS) is caused by abnormalities in the autonomic nervous system that are manifested during sleep, resulting in apnea, hypoxia, and/or cardiac dysrhythmias. This answer provides the most thorough answer to the mother's question, whereas the remaining options stress preventive measures.)

A patient has prescriptions for two inhalers. One inhaler is a bronchodilator, and the other is a corticosteroid. Which instruction regarding these inhalers will the nurse give to the patient? "Take the corticosteroid inhaler first." "Take the bronchodilator inhaler first." "Take these two drugs at least 2 hours apart." "It does not matter which inhaler you use first."

"Take the bronchodilator inhaler first." (An inhaled bronchodilator is used before the inhaled corticosteroid to provide bronchodilation before administration of the anti-inflammatory drug.)

The nurse performs discharge teaching with a client who is prescribed the anticholinergic inhaler ipratropium bromide (Atrovent). Which statement by the client indicates to the nurse that teaching has been successful? "Nausea and vomiting are common adverse effects of this medication." "I may gain weight as a result of taking this medication." "I will not drink grapefruit juice while taking this drug." "This inhaler is not to be used alone to treat an acute asthma attack."

"This inhaler is not to be used alone to treat an acute asthma attack." (Although ipratropium works to prevent bronchoconstriction and thus secondarily leads to bronchodilation, a direct-acting bronchodilator is needed to treat an acute asthma attack.)

After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response? "This is an expected adverse effect. Let me take your pulse." "The next scheduled nebulizer treatment will be skipped." "I will notify the physician about this adverse effect." "We will hold the treatment for 24 hours."

"This is an expected adverse effect. Let me take your pulse." (Nervousness, tremors, and cardiac stimulation are possible and expected adverse effects of beta agonists. The other options are incorrect responses.)

A 14-year-old patient has been treated for asthma for almost 4 months. Two weeks ago, she was given salmeterol as part of her medication regimen. However, her mother has called the clinic to report that it does not seem to work when her daughter is having an asthma attack. Which response by the nurse is appropriate? "It takes time for a therapeutic response to develop." "She is too young for this particular medication; it will be changed." "She needs to take up to two puffs every 4 hours to ensure adequate blood levels." "This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms."

"This medication is indicated for prevention of bronchospasms, not for relief of acute symptoms." (Salmeterol is indicated for the prevention of bronchospasms, not treatment of acute symptoms. The dosage is usually two puffs twice daily, 12 hours apart, for maintenance effects in patients older than 12 years of age. The other options are incorrect.)

Client teaching regarding the use of leukotriene receptor antagonists (LTRAs) drugs such as zafirlukast (Accolate) would include which statement by the nurse? "It will take about 3 or 4 weeks before you notice a therapeutic effect." "This medication works by preventing the inflammation that causes your asthma attack." "Increase fiber and fluid in your diet to prevent the common adverse effect of constipation." "Take the medication when you are short of breath and begin wheezing."

"This medication works by preventing the inflammation that causes your asthma attack." (LTRAs drugs block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat acute asthma attacks. Diarrhea, not constipation, is a common adverse effect of montelukast and zafirlukast.)

Which statement by the nurse should be included when teaching a client about the proper use of metered-dose inhalers? "After you inhale the medication once, repeat until you obtain relief." "Make sure that you puff out air several times after you inhale the medication." "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler." "Wait 1 to 2 minutes before you take a second puff of the same drug."

"Wait 1 to 2 minutes before you take a second puff of the same drug." (If a second puff of the same drug is ordered, instruct the client to wait 1 to 2 minutes between puffs. If a second type of inhaled drug is prescribed, instruct the client to wait 2 to 5 minutes between the medications or to take as prescribed.)

An infant has been pronounced dead from sudden infant death syndrome (SIDS) in the emergency department. Which is an appropriate question to ask the parents? "Did you hear the infant cry out?" "Why didn't you check on the infant earlier?" "What time did you find the infant?" "Was the head buried in a blanket?"

"What time did you find the infant?" (During a SIDS incident, if the infant is not pronounced dead at the scene, he or she may be transported to the emergency department to be pronounced dead by a physician. While they are in the emergency department, the parents are asked only factual questions, such as when they found the infant, how he or she looked, and whom they called for help. The nurse avoids any remarks that may suggest responsibility, such as "Why didn't you go in earlier?" "Didn't you hear the infant cry out?" or "Was the head buried in a blanket?")

A nurse is planning a seminar to address asthma in the community. To have the greatest impact, which demographic group should the nurse target? A. African American children B. Children with allergies C. Inner-city youth, all ethnicities D. School-age children

A. African American children (African American children have a 60% higher prevalence of asthma, a 260% higher rate of emergency department visits, a 250% higher hospitalization rate, and a 500% higher mortality rate than white children. To have the greatest impact on this chronic disease, the nurse should target African American children and their parents/guardians and caretakers. Up to 40% of children with asthma have no allergies. Low socioeconomic status is a risk factor, not living in an inner city specifically. Children of all ages are affected.)

The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is: Unacceptable because of the risk of sudden infant death syndrome (SIDS). Unacceptable because it does not encourage achievement of developmental milestones. Unacceptable to encourage fine motor development. Acceptable to encourage head control and turning over.

Acceptable to encourage head control and turning over. (These parents are implementing the guidelines to reduce the risk of SIDS. Infants should sleep on their backs and then be placed on their abdomens when awake to enhance development of milestones such as head control. The face-down position while awake and positioning on the back for sleep are acceptable because they reduce risk of SIDS and allow achievement of developmental milestones. These position changes encourage gross motor, not fine motor, development.)

The nurse is reviewing medications for the treatment of asthma. Which drugs are used for acute asthma attacks? (Select all that apply.) Salmeterol (Serevent) inhaler Albuterol (Proventil) nebulizer solution Epinephrine Montelukast (LTRA) Fluticasone (corticosteroid) Rotadisk inhaler

Albuterol (Proventil) nebulizer solution Epinephrine (Albuterol (a short-acting beta₂ agonist) and epinephrine (a beta₁ and beta₂ agonist) are used for acute bronchospasms. Salmeterol is a long-acting beta₂ agonist that is indicated for maintenance treatment, not acute episodes. Fluticasone is an inhaled corticosteroid; montelukast is a leukotriene receptor antagonist (LTRA). These types of medications are used for asthma prophylaxis.)

An 11-year-old child who has a history of asthma is brought to the family practice clinic by a parent who reports that the child has white plaque over the inside of the mouth and coating the tongue. Which question by the nurse would elicit the most useful information? A. "Are you brushing your teeth and tongue regularly?" B. "Do you rinse your mouth after using your inhaler?" C. "Have you ever had something like this before?" D. "When was the last time you went to the dentist?"

B. "Do you rinse your mouth after using your inhaler?" (Use of inhalers for asthma, especially corticosteroids, can cause yeast infection (candidiasis) if the patient does not rinse the mouth afterward. The other questions are not helpful in this situation.)

An infant is being discharged from the hospital after treatment for respiratory syncytial virus (RSV). The infant still has some mild respiratory distress at times. Which discharge instruction is the priority for this infant? A. "Bring the child back if she runs a temperature." B. "Feed baby small amounts while she is sitting up." C. "Give her antibiotics right after feeding her." D. "If you need to use the bulb suction, bring her back."

B. "Feed baby small amounts while she is sitting up." (Guidelines for feeding a child with respiratory distress revolve around preventing aspiration. The child should be fed in an upright position and given small amounts, perhaps more often. An elevated temperature is usually seen in RSV. Antibiotics are not generally used for this disease. Parents needs to know how to use the bulb suction to help manage the accompanying rhinitis.)

A child is admitted after a severe asthma attack. Respiratory status is stable at this time. Which is the priority intervention for this child? A. Determining the trigger B. Ensuring hydration C. Promoting rest D. Providing support

B. Ensuring hydration (Priorities in any emergency are airway, breathing, and circulation. Because the respiratory status is now stable, attention is placed on ensuring that the child is hydrated. This is important for two reasons: first, hydration helps liquefy secretions; second, the mouth-breathing child will have lost a great deal of fluid through insensible loss, which needs to be replaced. All other options are important parts of care of this child; however, hydration is the priority.)

A child is admitted to the pediatric unit with respiratory syncytial virus (RSV). Which action by the nurse is best for infection control? A. Adhere to policy on hand hygiene. B. Do not assign pregnant caregivers. C. Place the child in contact isolation. D. Use meticulous standard precautions.

C. Place the child in contact isolation. (Children with RSV are placed in contact isolation due to the ease of spreading the disease. Of course nurses should adhere to facility policy on hand washing, but further action is required. There is no precaution against pregnant caregivers. Standard precautions are used on all patients, but a child with RSV needs contact isolation.)

The nurse is providing care to a client prescribed a nonselective adrenergic agonist bronchodilator. Which condition documented in the client's medical history would alert the nurse to question this prescription? Coronary artery disease Thrombocytopenia Chronic obstructive pulmonary disease Mycobacterium tuberculosis

Coronary artery disease (Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta₂ receptors in the lungs. Stimulation of beta₁ receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in clients with coronary artery disease.)

A nurse is explaining to a student that sudden infant death syndrome (SIDS) has been reduced due mostly to what trend? A. A decrease in preterm births B. Decreased maternal smoking C. Fewer drug-addicted mothers D. The "Back to Sleep" campaign

D. The "Back to Sleep" campaign (The "Back to Sleep" campaign of the American Academy of Pediatrics aims for all infants to sleep on their backs, every time. Since initiation of this campaign, there a has been a 50% reduction in SIDS deaths. The other factors are not as firmly related to SIDS as is sleeping supine.)

A 5-year-old child is having an acute asthma attack. How does the nurse position the child while waiting for a respiratory treatment? A. Prone across the parent's lap B. Semi-Fowler's position in bed C. Upright in a hard-backed chair D. Upright in the tripod position

D. Upright in the tripod position (Tripod positioning is often seen in children with respiratory distress. In this position the child sits upright leaning forward on outstretched arms with the jaw thrust forward. This position maximizes airway opening and use of accessory muscles. The nurse can assist the child into this position. The other positions will not be as helpful. However, it is important to note that because children having respiratory distress are often anxious, it is important to allow the child to assume the position in which he or she is most comfortable.)

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? Liquefy secretions Reduce inflammation of the lungs Dilate the bronchioles Reduce infection

Dilate the bronchioles (These medications work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.)

A nurse explains to a family how the asthma attack progresses by using a progressive list of pathologic events. (Place the options in the correct sequence.) A. Bronchoconstriction B. Ventilation-perfusion mismatch C. Production of mucous plugs D. Hypoxemia with compensatory hyperventilation E. Triggering of inflammatory process

E. Triggering of inflammatory process A. Bronchoconstriction C. Production of mucous plugs B. Ventilation-perfusion mismatch D. Hypoxemia with compensatory hyperventilation (After the allergen has triggered the inflammatory response, bronchoconstriction occurs, which leads to the formation of mucous plugs in the bronchioles that block O₂ from entering the alveoli, causing a ventilation-perfusion mismatch and resulting in hypoxemia and hyperventilation.)

Which information should the nurse teach workers at a day care center about respiratory syncytial virus (RSV)? RSV is transmitted through particles in the air. RSV can live on skin or paper for up to a few seconds after contact. RSV can survive on nonporous surfaces for about 60 minutes. Frequent hand washing can decrease the spread of the virus.

Frequent hand washing can decrease the spread of the virus. (Meticulous hand washing can decrease the spread of organisms. RSV infection is not airborne. It is acquired mainly through contact with contaminated surfaces. RSV can live on skin or paper for up to 1 hour and on cribs and other nonporous surfaces for up to 6 hours.)

The clinic nurse makes a follow-up telephone call to a patient with asthma. The patient reports having a baseline peak flow reading of 600 L/minute and the current peak flow is 420 L/minute. Which action should the nurse take first? Tell the patient to go to the hospital emergency department. Instruct the patient to use the prescribed albuterol (Proventil). Ask about recent exposure to any new allergens or asthma triggers. Question the patient about use of the prescribed inhaled corticosteroids.

Instruct the patient to use the prescribed albuterol (Proventil). (The patient's peak flow is 70% of normal, indicating a need for immediate use of short-acting β₂-adrenergic SABA medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.)

The prescriber has changed the patient's medication regimen to include the leukotriene receptor antagonist (LTRA) montelukast (Singulair) to treat asthma. The nurse will emphasize which point about this medication? The proper technique for inhalation must be followed. The patient needs to keep it close by at all times to treat acute asthma attacks. It needs to be taken every day on a continuous schedule, even if symptoms improve. When the asthma symptoms improve, the dosage schedule can be tapered and eventually discontinued.

It needs to be taken every day on a continuous schedule, even if symptoms improve. (These drugs are indicated for chronic, not acute, asthma and are to be taken every day on a continuous schedule, even if symptoms improve. These drugs are taken orally.)

A nurse is providing education to a client taking two different bronchodilator medications. The nurse identifies which characteristic as the advantage of salmeterol (Serevent) over other beta₂ agonists such as albuterol (Proventil)? Shorter onset of action Extended time of action Longer duration of action Quicker peak action

Longer duration of action (Salmeterol has a longer duration of action, requiring the client to use it only twice a day instead of three or four times a day with albuterol.)

A nurse is conducting education classes for parents of infants. The nurse plans to discuss sudden infant death syndrome (SIDS). Which risk factors should the nurse include as increasing an infant's risk of a SIDS incident? (select all that apply) Breastfeeding Low Apgar scores Male sex Birth weight in the 50th or higher percentile Recent viral illness

Low Apgar scores Male sex Recent viral illness (Certain groups of infants are at increased risk for SIDS: those with low birth weight, low Apgar scores, or recent viral illness, and those of male sex. Breastfed infants and infants of average or above-average weight are not at higher risk for SIDS.)

An important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS) is to: Explain how SIDS could have been predicted and prevented. Interview parents in depth concerning the circumstances surrounding the infant's death. Discourage parents from making a last visit with the infant. Make a follow-up home visit to parents as soon as possible after the infant's death.

Make a follow-up home visit to parents as soon as possible after the infant's death. (A competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS. An explanation of how SIDS could have been predicted and prevented is inappropriate. SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt. The parents should be asked only factual questions to determine the cause of death. Parents should be allowed and encouraged to make a last visit with their infant.)

A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations? Diphenhydramine (Benadryl) Montelukast (LTRA) Albuterol sulfate (Ventolin) Epinephrine

Montelukast (LTRA) (Many manifestations of inflammation can be attributed in part to leukotrienes. Medications categorized as leukotriene antagonists or modifiers such as montelukast (Singulair) block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma. Diphenhydramine prevents histamine's effect on smooth muscle. Albuterol sulfate relaxes smooth muscle during an asthma attack. Epinephrine relaxes bronchial smooth muscle but is not used on a preventative basis.)

Why do infants and young children quickly have respiratory distress in acute and chronic alterations of the respiratory system? They have a widened, shorter airway. There is a defect in their sucking ability. The gag reflex increases mucus production. Mucus and edema obstruct small airways.

Mucus and edema obstruct small airways. (The airway in infants and young children is narrower, not wider, and respiratory distress can occur quickly because mucus and edema can cause obstruction to their small airways. Sucking is not necessarily related to problems with the airway. The gag reflex is necessary to prevent aspiration. It does not produce mucus.)

When evaluating a patient's use of a metered-dose inhaler (MDI), the nurse notes that the patient is unable to coordinate the activation of the inhaler with her breathing. What intervention is most appropriate at this time? Notify the doctor that the patient is unable to use the MDI. Obtain an order for a peak flow meter. Obtain an order for a spacer device. Ask the prescriber if the medication can be given orally.

Obtain an order for a spacer device. (The use of a spacer may be indicated with metered-dose inhalers, especially if success with inhalation is limited. The other options are not appropriate interventions.)

When educating a patient recently placed on inhaled corticosteroids, the nurse will discuss which potential adverse effects? Fatigue and depression Anxiety and palpitations Headache and rapid heart rate Oral candidiasis and dry mouth

Oral candidiasis and dry mouth (Oral candidiasis and dry mouth are two possible adverse effects of inhaled corticosteroids. The other responses are incorrect.)

Which information should the nurse teach families about reducing exposure to pollens and dust? (Select all that apply) Replace wall-to-wall carpeting with wood and tile floors. Use an air conditioner. Put dust-proof covers on pillows and mattresses. Keep humidity in the house above 60%. Keep pets outside.

Replace wall-to-wall carpeting with wood and tile floors. Use an air conditioner. Put dust-proof covers on pillows and mattresses. (Carpets retain dust. To reduce exposure to dust, carpeting should be replaced with wood, tile, slate, or vinyl. These floors can be cleaned easily. For anyone with pollen allergies, it is best to keep the windows closed and to run the air conditioner. Covering mattresses and pillows with dust-proof covers will reduce exposure to dust. A humidity level above 60% promotes dust mites. It is recommended that household humidity be kept between 40% and 50% to reduce dust mites inside the house. Keeping pets outside will help to decrease exposure to dander, but will not affect exposure to pollen and dust.)

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because they may develop: Cough. Slowed growth. Osteoporosis. Cushing's syndrome.

Slowed growth. (The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. Cough is prevented by inhaled steroids. No evidence exists that inhaled steroids cause osteoporosis. Cushing's syndrome is caused by long-term systemic steroids.)

A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend: Soccer. Swimming. Running. Basketball.

Swimming. (Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Exercise-induced bronchospasm is more common in sports that involve endurance, such as soccer, running, and basketball. Prophylaxis with medications may be necessary.)

Discharge teaching to a patient receiving a beta-agonist bronchodilator should emphasize reporting which side effect? Tachycardia Nonproductive cough Hypoglycemia Sedation

Tachycardia (A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia, and increased alertness.)

The nurse teaches a patient with chronic bronchitis about a new prescription for Advair Diskus (combined corticosteroid and salmeterol). Which action by the patient would indicate to the nurse that teaching about medication administration has been successful? The patient shakes the device before use. The patient attaches a spacer to the Diskus. The patient rapidly inhales the medication. The patient performs huff coughing after inhalation.

The patient rapidly inhales the medication. (The patient should inhale the medication rapidly. Otherwise the dry particles will stick to the tongue and oral mucosa and not get inhaled into the lungs. Advair Diskus is a dry powder inhaler; shaking is not recommended. Spacers are not used with dry powder inhalers. Huff coughing is a technique to move mucus into larger airways to expectorate. The patient should not huff cough or exhale forcefully after taking Advair in order to keep the medication in the lungs.)

The nurse teaches a patient who has asthma about peak flow meter use. Which action by the patient indicates that teaching was successful? The patient inhales rapidly through the peak flow meter mouthpiece. The patient takes montelukast (Singulair) for peak flows in the red zone. The patient calls the health care provider when the peak flow is in the green zone. The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone.

The patient uses albuterol (Proventil) metered dose inhaler (MDI) for peak flows in the yellow zone. (Readings in the yellow zone indicate a decrease in peak flow. The patient should use short-acting β₂-adrenergic (SABA) medications. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow, and the patient should take a fast-acting bronchodilator and call the health care provider for further instructions. Singulair is not indicated for acute attacks but rather is used for maintenance therapy.)

The nurse completes an admission assessment on a patient with asthma. Which information given by patient is most indicative of a need for a change in therapy? The patient uses albuterol (Proventil) before any aerobic exercise. The patient says that the asthma symptoms are worse every spring. The patient's heart rate increases after using the albuterol (Proventil) inhaler. The patient's only medications are albuterol (Proventil) and salmeterol (Serevent).

The patient's only medications are albuterol (Proventil) and salmeterol (Serevent). (Long-acting β₂-agonists should be used only in patients who also are using an inhaled corticosteroid for long-term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires further assessment by the nurse, but is not unusual for a patient with asthma.)

A nurse is conducting an in-service on asthma. Which statement is the most descriptive of bronchial asthma? There is heightened airway reactivity. There is decreased resistance in the airway. The single cause of asthma is an allergic hypersensitivity. It is inherited.

There is heightened airway reactivity. (In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. In bronchial asthma, there is increased resistance in the airway. There are multiple causes of asthma, including allergens, irritants, exercise, cold air, infections, medications, medical conditions, and endocrine factors. Atopy or development of an immunoglobulin E (IgE)-mediated response is inherited but is not the only cause of asthma.)

A nurse is assessing a patient admitted for an asthma exacerbation. Which breath sounds does the nurse expect to assess? Rubs Rattles Wheezes Crackles

Wheezes (Asthma causes bronchoconstriction and narrowed passageways. Wheezes are produced as air passes through narrowed passageways. Rubs are the sound created by the friction of one surface rubbing over another. Pleural friction rub is caused by inflammation of the pleural space. Rattles is the term formerly used for crackles. Crackles are the sounds made when air passes through fluid or moisture.)

A school-age child has been admitted with an acute asthma episode. The child is receiving oxygen by nasal prongs at 2 liters. How often should the nurse plan to monitor the child's pulse oximetry status? a. Continuous b. Every 30 minutes c. Every hour d. Every 2 hours

a. Continuous (The child on supplemental oxygen requires intermittent or continuous oxygenation monitoring, depending on severity of respiratory compromise and initial oxygenation status. The child in status asthmaticus should be placed on continuous cardiorespiratory (including blood pressure) and pulse oximetry monitoring.)

Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

a. There is heightened airway reactivity. (In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function.)

A patient reaches for the salmeterol (Serevent) inhaler with the onset of an asthma attack. What is the nurse's best instruction to the patient? a. Use the albuterol (Proventil) inhaler instead. b. Wait at least one full minute between puffs. c. Attach the spacer to the inhaler before using it. d. Take a deep breath, hold it for 15 seconds, and then exhale before using the inhaler.

a. Use the albuterol (Proventil) inhaler instead. (Salmeterol is a long-acting beta₂ agonist. This type of drug needs time to build up an effect and is useful in preventing asthma attacks. The effects of this drug are longer lasting, but are not of value during an acute asthma attack.)

A patient will begin using an albuterol metered-dose inhaler to treat asthma symptoms. The patient asks the nurse about the difference between using an oral form of albuterol and the inhaled form. The nurse will explain that the inhaled form of albuterol a. has a more immediate onset than the oral form. b. may cause more side effects than the oral preparation. c. requires an increased dose in order to have therapeutic effects. d. will not lead to tolerance with increased doses.

a. has a more immediate onset than the oral form. (Inhaled medications have more immediate effects than oral preparations. As long as they are used correctly, systemic side effects are less common. Less drug is needed for therapeutic effects, since the drug is delivered directly to target tissues. Increased doses will lead to drug tolerance.)

An adult patient is brought to the emergency department for treatment of an asthma exacerbation. The patient uses inhaled albuterol as needed to control wheezing. The nurse notes expiratory wheezing, tremors, restlessness, and a heart rate of 120 beats per minute. The nurse suspects that the patient has a. over-used the albuterol. b. not been using albuterol. c. taken a beta-adrenergic blocker. d. taken a monoamine oxidase (MAO) inhibitor.

a. over-used the albuterol. (High doses of albuterol may affect beta₁ receptors, causing an increase in heart rate. Patients having an asthma exacerbation may over-use their albuterol inhalers when seeking relief. Patients may have wheezing and increased heart rate during an untreated asthma exacerbation, but they will not have tremors and restlessness.)

Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: Select all that apply. pulmonary lung function tests. associated allergies. frequency of symptoms. frequency and severity of exacerbations.

associated allergies. frequency of symptoms. (Pulmonary lung function tests that include the peak expiratory flow rate is used as one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.)

How are asthma and chronic obstructive pulmonary disease (COPD) different? a. COPD is a genetic disease whereas asthma is largely caused by allergies. b. Breathing problems with asthma are reversible but those with COPD are permanent. c. Asthma is a disease of children and younger adults whereas COPD is found only in older adults. d. Breathing problems with COPD can lead to death, whereas those with asthma are not severe enough to be fatal.

b. Breathing problems with asthma are reversible but those with COPD are permanent. (Asthma is a problem of airway obstruction caused by constriction of the bronchial smooth muscles that surround the airways and by inflammation in the airways. It occurs in episodes or attacks. Between attacks, the airways are open. Thus the problem is intermittent and reversible. COPD, however, has permanent airway changes and is not cured by therapy. Both disorders can cause such severe airway obstruction that death occurs.)

A patient taking montelukast (LTRA) for the last 2 months has the following blood laboratory test values. Which value does the nurse report to the prescriber immediately? a. White blood cell count of 10,500 cells/mm3 b. Lactate dehydrogenase 950 IU/L c. Potassium 3.6 mEq/L d. Hematocrit 32%

b. Lactate dehydrogenase 950 IU/L (The white blood cell count, lactate dehydrogenase, and hematocrit values are abnormal; however, only the lactate dehydrogenase level is very high (four to five times normal). This value indicates liver impairment. Leukotriene inhibitors can cause liver impairment. This value must be reported immediately so that liver function can be explored and any needed changes in drug therapy made before irreversible liver damage occurs.)

A patient with asthma asks the purpose of learning how to use a peak expiratory flow rate (PEFR) device. What is the nurse's best response regarding PEFR? a. Dilates the bronchi to relieve dyspnea b. Measures expired air to evaluate ventilation c. Soothes inflamed bronchi, reducing spasm d. Liquefies sputum for easier expectoration

b. Measures expired air to evaluate ventilation (The PEFR measures expired air. When the PEFR rate decreases 20% below the baseline, adjustments are usually made in the medications.)

How do corticosteroids improve breathing in patients with asthma or chronic obstructive pulmonary disease (COPD)? a. Relaxing bronchial smooth muscle, leading to wider airways b. Reducing mucosal swelling in the lumens, leading to wider airways c. Triggering the sympathetic nervous system, leading to deeper respirations d. Controlling anxiety, leading to an increased ability to focus on respiratory effort

b. Reducing mucosal swelling in the lumens, leading to wider airways (Corticosteroids decrease the production of the body chemicals that trigger inflammation. Inhaled corticosteroids can prevent or reduce the inflammation in the airways that leads to mucosal swelling in the airway lumen. This swelling narrows the lumen, reducing airflow.)

The nurse suspects a 5-year-old child has asthma. Which information from the child's past medical history is a risk factor? a. The child was breast-fed. b. The child had respiratory infections as an infant. c. The child was born via a C-section. d. The child had pressure equalizer tubes as an infant.

b. The child had respiratory infections as an infant. (Having respiratory infections (such as RSV) as an infant is a risk factor for asthma. Other potential causes of asthma include genetic predisposition, allergens such as animal dander or dust mites, and other nonspecific precipitants such as exercise, weather, or stress.)

After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.) a. SIDS b. Torticollis c. Failure to thrive d. Apnea of infancy e. Plagiocephaly

b. Torticollis e. Plagiocephaly (Plagiocephaly is a misshapen head caused by the prolonged pressure on one side of the skull. If that side becomes misshapen, facial asymmetry may result. The sternocleidomastoid muscle may tighten on the affected side, causing torticollis.)

After teaching a client who is prescribed salmeterol (Serevent), the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching? a. "I will be certain to shake the inhaler well before I use it." b. "It may take a while before I notice a change in my asthma." c. "I will use the drug when I have an asthma attack." d. "I will be careful not to let the drug escape out of my nose and mouth."

c. "I will use the drug when I have an asthma attack." (Salmeterol is designed to prevent an asthma attack; it does not relieve or reverse symptoms. Salmeterol has a slow onset of action; therefore, it should not be used as a rescue drug. The drug must be shaken well because it has a tendency to separate easily. Poor technique on the client's part allows the drug to escape through the nose and mouth.)

The mother of a 4-month-old infant is concerned about the possibility of SIDS because her neighbor's daughter passed away last year as a result of SIDS. The mother reports she is so nervous that she has taken up smoking again. The mother informs you that the 4-month-old sleeps supine and takes a pacifier to help her fall asleep. Which of the following statements would be the best response from the nurse? a. "You should place the infant in the bed with you until 6 months of age." b. "You should never give the infant a pacifier while she is sleeping." c. "You should try to stop smoking." d. "You should place the infant on her stomach."

c. "You should try to stop smoking." (The 2011 report from the American Academy of Pediatrics Task Force on SIDS recommended the following: healthy infants should be placed to sleep in the supine position; infants should be placed on a firm sleep surface keeping soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib; avoid the infant getting too hot by dressing him/her in too many clothes for the environment; keep the infant away from smokers and places where people smoke; sleep with the infant in the same room where you sleep, but not the same bed, for 6 months; and offer a pacifier at nap time and bedtime.)

Which assessment made by a nurse indicates that respiratory arrest is imminent in a patient with asthma? a. Agitation b. Tachycardia c. Absence of wheezing d. Flaring nares

c. Absence of wheezing (An absence of wheezing indicates a diminished ventilation effort.)

One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: lessens effectiveness of medications. encourages exercise-induced asthma. increases sensitivity to allergens. can trigger an episode or aggravate an asthmatic state.

can trigger an episode or aggravate an asthmatic state. (The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.)

The nurse provides teaching for patient who will begin taking montelukast sodium (LTRA). The patient reports sensitivity to aspirin. Which statement by the patient indicates a need for further teaching? a. "I will need to have periodic laboratory tests while taking this medication." b. "I will not take ibuprofen for pain or fever while taking this drug." c. "I will take one tablet daily at bedtime." d. "I will use this as needed for acute symptoms."

d. "I will use this as needed for acute symptoms." (Montelukast and other leukotriene receptor antagonists are not used to treat acute symptoms. Because they can affect liver enzymes, periodic liver function tests should be performed. Patients taking this drug should not use ibuprofen or aspirin for pain or fever if they have an aspirin sensitivity. Patients will achieve maximum effectiveness if the drug is taken in the evening.)

A nurse is caring for a patient with asthma with a nursing diagnosis of "Impaired gas exchange, related to air trapping." Which intervention is the most appropriate to add to the nursing care plan? a. Provide postural drainage. b. Administer oxygen (O₂) at 8 L/min. c. Position the patient flat in bed with small pillow. d. Increase fluid intake.

d. Increase fluid intake. (Increasing fluid intake thins the mucus in the lungs, making it easier to cough up, which helps clear the bronchioles and decrease ventilation-perfusion mismatch. Increasing O₂ is not helpful if no air pathway exists to the alveoli. Increasing O₂ to 8 L is excessive.)

A nurse assesses wheezes in a patient with asthma. What should the nurse know is the cause of wheezes? a. Increased thickness of respiratory secretions b. Use of accessory muscles of respiration c. Tachypnea and tachycardia d. Movement of air through narrowed airways

d. Movement of air through narrowed airways (Wheezes are adventitious sounds made by air passing through narrowed passages.)

The nurse is planning to teach parents about preventing sudden infant death syndrome (SIDS). What significant information would the nurse include? a. Wrapping the infant snugly for rest periods b. Positioning the infant prone for sleep c. Sitting the infant up in an infant seat d. Placing infants on their backs or sides for sleep

d. Placing infants on their backs or sides for sleep (The American Academy of Pediatrics recommends that all healthy infants be placed in the supine or side-lying position on a firm mattress to prevent SIDS.)

The nurse instructs a client to administer montelukast (LTRA): in the morning. at noon. late in the afternoon. in the evening.

in the evening. (For maximum effectiveness, this drug should be taken in the evening.)

A 4-year-old boy needs to use a metered-dose inhaler to treat asthma. He cannot coordinate the breathing to use it effectively. The nurse should suggest that he use a: spacer. nebulizer. peak expiratory flowmeter. trial of chest physiotherapy.

spacer. (The medication in a metered-dose inhaler is sprayed into the spacer. The child can then inhale the medication without having to coordinate the spraying and breathing. A nebulizer is a mechanism used to administer medications, but it cannot be used with metered-dose inhalers. A peak expiratory flowmeter is a measure of pulmonary function not related to medication administration. Chest physiotherapy is unrelated to medication administration.)

The nurse is interviewing the parents of a 4-month-old male infant brought to the hospital emergency department. The infant is dead on arrival, and no attempt at resuscitation is made. The parents state that the baby was found in his crib with a blanket over his head, lying face down in bloody fluid from his nose and mouth. They say he was "just fine" when they put him in his crib already asleep. The nurse should suspect his death was caused by: suffocation. child abuse. infantile apnea. sudden infant death syndrome (SIDS).

sudden infant death syndrome (SIDS). (Although the child was found under the blanket, the bloody fluid is consistent with sudden infant death syndrome (SIDS), not suffocation. No other injuries are reported. No previous acute life-threatening events had been reported. The death is consistent with the characteristics of SIDS.)

Infants most at risk for sudden infant death syndrome (SIDS) are those: Select all that apply. who sleep supine. who sleep prone. who were premature. with prenatal drug exposure. with a cousin who died of SIDS.

who sleep prone. who were premature. (Infants at increased risk for sudden infant death syndrome (SIDS) are low birth weight, have low Apgar scores, sleep prone, cosleep, were premature, and have a mother who smokes. It is recommended that infants sleep supine to reduce the risk of SIDS. A cousin dying of SIDS does not present an increased risk for the infant.)