Asthma

A nurse is preparing a discharge teaching plan for a 6-year-old client with asthma who has several prescription medications using metered-dose inhalers (MDIs). Which of the following interventions should the nurse include in the plan? A. Add a spacer to each MDI B. Instruct the child to inhale more rapidly than usual when using an MDI C. Ask the provider to change the child's medications from inhaled to oral formulations D. Administer oxygen by facemask along with the MDI

A. Add a spacer to each MDI MDIs are difficult to use correctly; even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an MDI can make up for a lack of hand-lung coordination by increasing the amount of medication delivered to the lungs.

A nurse is caring for a client who has asthma and a prescription for zileuton. Which of the following laboratory values should the nurse monitor while the client is taking this medication? A. Alanine aminotransferase (ALT) B. WBC count C. Potassium D. Chloride

A. Alanine aminotransferase (ALT) The nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. The nurse should monitor this laboratory value closely while the client is taking the medication.

A nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2-agonist combination dry-powdered inhaler (DPI) for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this medication? A. Restricted dosage flexibility B. Complicated delivery device C. Serious systemic effects D. Limited efficacy over time

A. Restricted dosage flexibility The nurse should identify that a disadvantage of an inhaled glucocorticoid and a long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted.

A nurse is caring for a client who has asthma and requires long-term treatment. The nurse should identify that which of the following medications used for long-term treatment places the client at an increased risk of asthma-related death? A. Salmeterol B. Fluticasone C. Budesonide D. Theophylline

A. Salmeterol The nurse should identify that salmeterol is a long-acting beta2-agonist. When this medication is used alone for the long-term treatment of asthma, this class of medication increases the client's risk of asthma-related death. To decrease this risk, the client should be prescribed both a long-acting beta2-agonist along with an inhaled corticosteroid.

A nurse is teaching a client with chronic asthma who has a new prescription for cromolyn. Which of the following instructions should the nurse include in the teaching? A. "Use the inhaler just before exercise." B. "The medication's therapeutic effects can take up to several weeks to develop." C. "You will shake the medication container for 3 seconds." D. "You will need to exhale slowly after you inhale."

B. "The medication's therapeutic effects can take up to several weeks to develop." The nurse should include in the teaching that the therapeutic effects of cromolyn can take up to several weeks to develop.

A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change? A. Potentiative interaction B. Detrimental inhibitory interaction C. Increased adverse reaction D. Toxicity-reducing inhibitory interaction

B. Detrimental inhibitory interaction A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and albuterol together, propranolol can interfere with albuterol's therapeutic effects.

A nurse is caring for a toddler who has asthma. The parents are concerned about the toddler's reaction to the hospitalization. Which of the following actions should the nurse take to decrease the child's anxiety? A. Provide privacy B. Give the child a thorough explanation before providing care C. Encourage rooming-in D. Tell the child you will help fix her

C. Encourage rooming-in Rooming-in is the most effective means of providing emotional support for a toddler. The family's presence provides a sense of security that increases the child's ability to cope with an unfamiliar environment.

A nurse is providing teaching to the parents of a school-age child with asthma about medications for bronchospasm. Which of the following inhaled medications should the nurse instruct the parents to use to relieve an acute asthma attack? A. Salmeterol B. Cromolyn C. Fluticasone D. Albuterol

D. Albuterol Albuterol is a short-acting beta-2 adrenergic agonist that is used to provide immediate relief for an acute asthma attack. One or two puffs every 4 to 6 hours PRN is the usually prescribed dose for a school-age child. If higher or more frequent doses are needed, the provider should evaluate the client for worsening asthma.

A school nurse is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse plan to administer to the child? A. Zafirlukast B. Budesonide C. Montelukast D. Albuterol

D. Albuterol The nurse should plan to administer albuterol to a child who is experiencing an acute exacerbation of asthma. This is considered a rescue medication due to its rapid onset of action. Albuterol is a beta-adrenergic agonist that promotes bronchodilation and suppresses histamine release in the lungs.

A nurse is providing teaching to a client with asthma who has a new prescription for a short-acting beta-2 agonist (SABA) bronchodilator. Which of the following pieces of information should the nurse share? A. The SABA will provide prolonged control of asthma attacks. B. SABAs are also available in an oral form. C. The SABA will have to be taken with an inhaled glucocorticoid. D. Notify the provider if the SABA is needed more than twice per week.

D. Notify the provider if the SABA is needed more than twice per week. SABA bronchodilators are used as a PRN rescue medication to stop an ongoing asthma attack. If the client requires the SABA more than twice per week, the provider should be notified because a prescription for a long-acting beta-2 agonist (LABA) might be required. Using a SABA more than twice per week can lead to serious adverse effects.

A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this client? A. Dextromethorphan B. Montelukast C. Ciprofloxacin D. Propranolol

D. Propranolol The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm and relax the client's airway. Therefore, propranolol is contraindicated for this client. Propranolol is a beta-blocker that is used to treat cardiac conditions, including hypertension. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol.

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methylprednisolone

C. Zafirlukast The nurse should identify that zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast along with theophylline suppresses the metabolism of theophylline, which can lead to toxicity. Therefore, another medication should be used.

A nurse is teaching a client who has asthma and a prescription for a fluticasone dry powder inhaler (DPI). Which of the following instructions should the nurse include in the teaching? A. "This medication should be taken at the start of your symptoms." B. "Rinse your mouth after administering this medication." C. "Shake the canister prior to administering this medication." D. "This medication relaxes your airways to decrease your symptoms."

B. "Rinse your mouth after administering this medication." The nurse should include in the teaching that this medication is an oral corticosteroid. Oral corticosteroids increase the risk of the development of oral candidiasis, also known as thrush. In order to prevent this effect, the nurse should advise the client to rinse the mouth after the administration of this medication

A nurse is reviewing the medication history of a client who has asthma. Which of the following medication combinations should the nurse identify as incompatible? A. Albuterol and montelukast B. Theophylline and zileuton C. Aminophylline and fluticasone D. Salmeterol and levalbuterol

B. Theophylline and zileuton The nurse should identify that zileuton, a leukotriene modifier, impairs the metabolism of certain medications. Concurrent use of zileuton with theophylline can cause toxicity due to elevated theophylline, which is a systemic methylxanthine used to relax the smooth muscles of the airway. Therefore, these medications are incompatible when used together.

A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered-dose inhaler. Which of the following statements by the parent indicates the need for further teaching? A. "I will give my child a dose as soon as wheezing starts." B. "My child should rinse out his mouth after using the inhaler." C. "My child should exhale completely before placing the inhaler in his mouth." D. "If my child has difficulty breathing in the dose, a spacer can be used."

A. "I will give my child a dose as soon as wheezing starts." Cromolyn is a mast cell inhibitor that has a slow onset and is given for prophylactic treatment of asthma. It is not a rescue medication.

A nurse is reviewing the medication history of a client who has mild intermittent asthma. The nurse should anticipate a prescription for which of the following inhalers for the client? A. Ipratropium B. Albuterol sulfate C. Tiotropium D. Budesonide

B. Albuterol sulfate The nurse should anticipate a client who has mild intermittent asthma to be prescribed albuterol sulfate. Albuterol sulfate is a short-acting beta2-agonist that activates beta2-receptors in the smooth muscle of the lung, allowing the client's airway and lungs to dilate, thereby relieving bronchospasm and allowing the client to breathe.

A nurse is teaching an adolescent who has asthma about how to use a peak expiratory flow meter (PEFM). Which of the following responses by the adolescent indicates an understanding of the teaching? A. "I will breathe in through the mouthpiece, hold my breath for 5 sec, and then exhale." B. "If I get a reading in the green zone, I will tell my parents immediately so they can call the doctor." C. "I will slowly exhale through the mouthpiece over a 10 sec interval." D. "I will record the highest reading of three attempts."

D. "I will record the highest reading of three attempts." After establishing a personal best, the client should routinely check the PEFM by performing 3 attempts and recording the highest reading of the 3.

A nurse is teaching a client who has asthma about the proper use of an albuterol inhaler. Which of the following client statements indicates an understanding of the teaching? A. "I should rinse my mouth out right before I use the inhaler." B. "After the first puff, I will wait 10 seconds before taking the second puff." C. "I will shake the inhaler well right before I use it." D. "I will tilt my head forward while inhaling the medication."

C. "I will shake the inhaler well right before I use it." The nurse should instruct the client to shake the inhaler vigorously for 3 to 5 seconds, which will mix the medication within the inhaler evenly.

A nurse is developing a teaching plan for a client about preventing acute asthma attacks. Which of the following points should the nurse plan to discuss first? A. Eliminating environmental triggers that precipitate attacks B. Addressing the client's perception of the disease process and what might have triggered past attacks C. Overviewing the client's medication regimen D. Explaining manifestations of respiratory infections

B. Addressing the client's perception of the disease process and what might have triggered past attacks The nurse should apply the nursing process priority-setting framework to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing the client will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first assess the client's current knowledge.

A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs. B. Take the medication on an empty stomach to enhance absorption. C. Schedule the medication on alternate days to decrease adverse effects. D. Treat shortness of breath with an extra dose of the medication.

C. Schedule the medication on alternate days to decrease adverse effects. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy.

A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer

A. Dry-powder inhaler (DPI) The nurse should identify that DPIs do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs.

A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. B. It stabilizes the cellular membrane of mast cells. C. It decreases the synthesis and release of inflammatory mediators. D. It relaxes the smooth muscles by blocking adenosine receptors.

A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. The charge nurse should include in the teaching that the mechanism of action of omalizumab reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm.

A nurse is performing an admission assessment for a client who has asthma and reports several food allergies. Which of the following actions should the nurse take first? A. Document the client's food allergies in the medical record B. Ask the client to identify the specific food allergies C. Monitor the client for indications of anaphylaxis D. Have epinephrine available for administration

B. Ask the client to identify the specific food allergies The nurse should apply the nursing process priority-setting framework in order to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first assess the client's allergies and identify the specific allergens to ensure the specific foods are not offered to the client during meals.

A nurse is caring for a client who has asthma and is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of this medication? A. Reduces the frequency of attacks B. Reverses bronchospasm C. Prevents inflammation D. Decreases chronic manifestations

B. Reverses bronchospasm The nurse should identify that the expected outcome of a short-acting beta2-agonist is reversal of bronchospasm. Short-acting beta2-agonists bind to beta2-adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth muscles.

A nurse is teaching an adolescent about managing asthma and using a peak expiratory flow meter. Which of the following statements by the client demonstrates an understanding of the teaching? A. "I will use my peak flow meter whenever I feel short of breath." B. "I will continue to take my medication when my peak flow rate is in the green zone." C. "I need to use the average of 3 readings when I measure my flow rate." D. "My asthma is being controlled if my flow rate is in the yellow zone."

B. "I will continue to take my medication when my peak flow rate is in the green zone." This statement by the adolescent indicates an understanding of the teaching. A peak flow rate in the green zone indicates the current treatment has been effective; therefore, the adolescent should continue with their current medication regimen.

A nurse is providing teaching about disease management to the parent of a preschooler who has a new diagnosis of asthma. Which of the following parent statements indicates an understanding of the teaching? A. "My child should not receive live virus vaccines." B. "I will encourage my child to participate in sports." C. "I will give my child aspirin when she has a fever." D. "My child will outgrow asthma by adulthood."

B. "I will encourage my child to participate in sports." The parent should encourage the child to remain physically active because this promotes lung expansion and air exchange.

A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the following sounds should the nurse expect to hear? A. Soft blowing B. Loud bubbling C. Dry grating D. Noisy wheezing

D. Noisy wheezing Asthma causes the bronchioles of the lungs to constrict, creating a wheezing sound.

A nurse in an emergency department is assessing a school-aged child who is experiencing an acute asthma exacerbation. Which of the following findings is the priority for the nurse to report to the provider? A. Excessively prolonged expiration B. Increased diaphoresis C. Increased production of frothy sputum D. Sudden decrease in wheezing

D. Sudden decrease in wheezing When applying the urgent versus nonurgent priority-setting framework, the nurse should consider urgent needs to be the priority because they pose a larger risk to the client. A sudden decrease in wheezing can indicate that the child is experiencing decreased air movement and should be reported to the provider. The nurse might also need to use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which finding is the most urgent. A sudden decrease in wheezing (silent chest) indicates ventilatory failure and imminent respiratory arrest.