NU373 Week 3 EAQ: Oxygenation (Asthma, COPD, RSV)
Short-Acting Beta Agonists (bronchodilators) Action and Examples
SABAs work by relaxing the smooth muscles of the the airways leading to the lungs that become narrow (constrict) during an asthma attack—allowing air to flow more freely and alleviating spasms. They're used as needed to treat acute symptoms and are known as rescue medications Examples: Albuterol (Ventolin, Proair HFA, Proventil) bitolterol (Tornalate) Combivent levalbuterol (Xopenex) metaproterenol (Alupent) pirbuterol (Maxair)
Bronchiolitis vs Bronchitis
Both can be caused by a virus. Both affect the airways in the lungs. Bronchitis affects the larger airways (the bronchi),-upper respiratory- and more common in older children/adults. Bronchiolitis affects the smaller airways (bronchioles)-lower respiratory- and more common in children younger than 2 years.
When a client is newly diagnosed with chronic obstructive pulmonary disease (COPD), which action by the nurse has the highest priority? o Teach the client how to use the prescribed inhalers. o Discuss the normal progression of the disease process. o Ask whether the client is interested in quitting smoking. o Explain the purpose of a pulmonary rehabilitation program.
o Ask whether the client is interested in quitting smoking. Smoking cessation slows the progression of COPD and is the most important action that the client can take to help maintain lung function. Although many clients may not be ready to stop smoking, the nurse will assess the client's interest in smoking cessation at every encounter. Teaching correct inhaler use is important, but inhaled medications only treat the symptoms of COPD and do not slow disease progression. The client will be educated on the progression of COPD, but education alone does not change the progression of the disease. Pulmonary rehabilitation programs are helpful in improving ability to do activities of daily living and also will assist the client with tobacco cessation, but assessment of readiness to quit smoking is done before developing a plan to quit.
A client is receiving dexamethasone to treat acute exacerbation of asthma. For which side effect would the nurse monitor the client? o Hyperkalemia o Liver dysfunction o Orthostatic hypotension o Increased blood glucose
o Increased blood glucose Dexamethasone increases gluconeogenesis, which may cause hyperglycemia. Hypokalemia, not hyperkalemia, is a side effect. Liver dysfunction is not a side effect. Hypertension, not hypotension, is a side effect.
The nurse provides instructions about how to use a metered-dose inhaler (MDI) to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique? o Places the tip of the inhaler just past the lips o Holds the inspired breath for at least 3 seconds o Activates the inhaler during inspiration o Inhales rapidly with the lips sealed around the nebulizer opening
o Inhales rapidly with the lips sealed around the nebulizer opening The client should inhale slowly rather than rapidly when using a metered-dose inhaler (MDI) to optimize delivery of the nebulized medication into the lungs. If the client has a dry powder inhaler (DPI), then rapid inhaling would be an important action because the powder is not nebulized. The MDI should be gently held in the mouth just past the lips to deliver the medication into the airway. Holding the inspired breath for at least 3 seconds promotes contact of the medication with the bronchial mucosa. The inhaler should be activated during inspiration.
Which trigger would the nurse instruct a client to avoid to decrease the incidence of asthma attacks? Select all that apply. o Mold o Cold air o Pet dander o Air pollution o Cigarette smoke
o Mold o Cold air o Pet dander o Air pollution o Cigarette smoke Clients with asthma should be instructed to avoid asthma attack triggers such as mold, cold air, pet dander, air pollution, and cigarette smoke.
Which nursing intervention would the nurse provide for a 6-month-old infant with bronchiolitis? o Discouraging parental visits to conserve energy o Monitoring skin color, anterior fontanel, and vital signs o Wearing gown and gloves when providing care o Promoting stimulating activities to meet developmental needs
o Monitoring skin color, anterior fontanel, and vital signs Continuous assessments, including monitoring skin color and anterior fontanel as well as vital signs, are vital in determining the infant's oxygenation and hydration status and responses to the disease process. The infant needs the parents' presence to fulfill the developmental goal of infancy, the establishment of trust. Respiratory syncytial virus is the most common cause of bronchiolitis in an infant. Droplet precautions are recommended for an infant with bronchiolitis. The infant is too ill to be involved in stimulating activities; energy should be conserved and oxygen demands kept to a minimum.
A client with chronic obstructive pulmonary disease (COPD) has a blood pH of 7.25 and a partial pressure of carbon dioxide (PCO2) of 60 mm Hg. Which complication would the nurse suspect the client is experiencing? o Metabolic acidosis o Metabolic alkalosis o Respiratory acidosis o Respiratory alkalosis
o Respiratory acidosis The pH indicates acidosis; the PCO2 level is the parameter for respiratory function. The expected PCO2 is 40 mm Hg. These results do not indicate a metabolic disorder or indicate respiratory alkalosis.
An infant with cardiopulmonary disease displays signs and symptoms of bronchiolitis and pneumonia. Which condition would the nurse anticipate when planning care? o Poliomyelitis o Pneumococcal infection o Meningococcal infection o Respiratory syncytial virus infection
o Respiratory syncytial virus infection Respiratory syncytial virus infections are the most common cause for hospitalization of infants younger than 1 year of age; this disease especially affects premature infants and infants with cardiopulmonary disease. Poliomyelitis is caused by the poliovirus. Streptococcus pneumonia infections cause meningitis, sepsis, pneumonia, and otitis media. Neisseria meningitidis causes meningitis.
When assessing the breath sounds of a client with chronic obstructive pulmonary disease (COPD), the nurse hears moist rumbling sounds that improve after the client coughs. How will the nurse document the lung sounds? o Rhonchi o Wheezes o Fine crackles o Vesicular sounds
o Rhonchi Rhonchi are coarse and moist sounds caused by obstruction of the airway with thick mucus, and they usually clear or change with coughing as the mucus moves or is expectorated. Wheezes are high-pitched, continuous sounds. Fine crackles are high-pitched popping noises. Vesicular sounds are the normal breath sounds.
A client is prescribed albuterol to relieve severe asthma. Which adverse effects will the nurse instruct the client to anticipate? Select all that apply. o Tremors o Lethargy o Palpitations o Bronchoconstriction o Decreased pulse rate
o Tremors o Palpitations Albuterol's sympathomimetic effect causes central nervous system (CNS) stimulation, precipitating tremors, tachycardia, and palpitations. Lethargy is an adverse effect of medications that cause CNS depression, not CNS stimulation. Albuterol causes bronchodilation, not bronchoconstriction. Albuterol will cause tachycardia, not bradycardia.
A client with chronic obstructive pulmonary disease (COPD) reports chest congestion, especially upon awakening in the morning. To address the concern, the nurse would make which suggestion? o Use a humidifier in the bedroom. o Sleep with two or more pillows. o Cough regularly even if the cough does not produce sputum. o Cough and deep-breathe each night before going to sleep.
o Use a humidifier in the bedroom. A humidifier will help liquefy secretions and promote their expectoration. Sleeping on pillows facilitates breathing; it does not relieve chest congestion. Nonproductive coughing should be avoided because it is irritating and exhausting. Deep breathing and coughing at night will not help relieve early-morning congestion.
Which topic would the nurse plan to include in teaching a client with a new diagnosis of asthma? o Home oxygen therapy o Antibiotic treatment o Incentive spirometer use o Use of peak flow meter
o Use of peak flow meter Daily peak flow monitoring is recommended for clients with asthma because changes in peak flow frequently occur before the client notices any respiratory distress. Because asthma is an intermittent airway problem, home oxygen therapy is not needed. Asthma is not an infectious process and antibiotics are not prescribed. Incentive spirometers are prescribed to encourage clients to take deep breaths and prevent atelectasis, which is not a concern with asthma.
Which physiologic responses to bronchiolitis would the nurse expect to observe in the pediatric intensive care unit? Select all that apply. o Wheezing o Bradycardia o Sternal retractions o Nasal flaring o Prolonged expiratory phase
o Wheezing o Sternal retractions o Nasal flaring o Prolonged expiratory phase Bronchiolitis in most infants is caused by respiratory syncytial virus. Wheezing occurs as the air passages narrow, resulting in the typical whistling sound. As breathing becomes more difficult, the infant must expend more energy and use accessory muscles of respiration to breathe. Nasal flaring is a predominant characteristic of bronchiolitis. The infectious and inflammatory changes narrow the bronchial passage, making it difficult for air to leave the lungs. As a result of increased respiratory effort and decreased oxygen exchange, tachycardia, not bradycardia, develops. Breath sounds are diminished because of edema of the bronchiolar mucosa and filling of the lumina with mucus and exudate.
Incentive Spirometer vs Peak flow meter
Peak flow meter: Measures the ability to push air out of your lungs. An incentive spirometer measures how deeply you breath in.
Which recommendation from the school nurse to the parent of an older child reflects the safest plan for managing the child's asthma in the school setting? o "Your child's inhaler will be kept locked in the health center." o "I will provide all supervision when your child uses the inhaler." o "Your child's teacher will supervise your child's use of the inhaler." o "I need your permission for your child to carry the inhaler at all times."
o "I need your permission for your child to carry the inhaler at all times." With parental permission, older children with asthma can carry their inhalers with them at all times in case of an emergency. Locking the inhaler in the health center or telling a parent that a nurse or teacher will always be available to supervise the child may not be realistic, because they may not be immediately present if the child requires the inhaler, which would delay treatment and risk an asthma exacerbation.
The nurse is caring for a client admitted with chronic obstructive pulmonary disease (COPD). Which laboratory test would the nurse monitor for hypoxia? o Red blood cell count o Sputum culture o Arterial blood gas o Total hemoglobin
o Arterial blood gas Red blood cell count, sputum culture, and total hemoglobin tests assist in the evaluation of a client with respiratory difficulties; however, arterial blood gas analysis is the only test that evaluates gas exchange in the lungs. This provides accurate information about the client's oxygenation status.
The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the health care provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? o One hour before or 2 hours after eating o At bedtime o At the specific time prescribed o Daily until symptoms are gone
o At the specific time prescribed For theophylline to be effective, therapeutic serum levels must be maintained by taking the medication at the prescribed time. If the medication is not taken at the prescribed time, the level may drop below the therapeutic range. The medication will not be effective if it drops below the therapeutic range. Theophylline should be given after a meal and with a full glass of water to decrease gastric irritability. Giving it 2 hours after a meal (on an empty stomach) can result in gastric discomfort. It should not be taken at night, because it can cause central nervous system stimulation resulting in insomnia, restlessness, irritability, etc. Theophylline is used for long-term medication therapy.
Which clinical finding of an 8-year-old child with a history of asthma requires immediate intervention? o Barrel chest o Audible wheezing o Heart rate of 105 beats per minute o Respiratory rate of 30 breaths per minute
o Audible wheezing Audible wheezing that is heard without a stethoscope is an indication that the airways are significantly compromised, and this requires immediate medical intervention. Barrel chest is a sign of chronic asthma. Repeated attacks result in a fixed hyperaerated thoracic cavity; this clinical finding does not require intervention. A heart rate of 105 beats per minute is expected in an 8-year-old child, as is a respiratory rate of 30 breaths per minute.
A client with asthma is pregnant. Which nursing intervention is advisable to ensure the safe delivery of the baby? o Have the client stop taking her medication. o Advise the client to abort the pregnancy. o Have the client continue the asthma treatment. o Have the client reduce the dose of the medication.
o Have the client continue the asthma treatment. Untreated maternal asthma poses a high risk to the fetus. The client should continue the medication. The medication should not be stopped because this action may have harmful effects on both the fetus and the mother. The pregnancy does not need to be aborted. A reduction in the dose may not give the desired therapeutic action.
In which position would the nurse place an 8-year-old child with asthma who is short of breath? o Supine o Left lateral o High-Fowler o Trendelenburg
o High-Fowler Clients find it easier to breathe while sitting up than lying down. Helping them get into a comfortable sitting position is crucial. The high-Fowler position gives the lungs more room to expand, thereby promoting respiration and affording more comfort. The supine, left lateral, and Trendelenburg positions will all increase dyspnea; they do not permit chest expansion.
Which treatment would the nurse anticipate for an infant admitted with bronchiolitis caused by respiratory syncytial virus (RSV)? o Humidified cool air and adequate hydration o Postural drainage and oxygen by hood o Bronchodilators and cough suppressants o Corticosteroids and broad-spectrum antibiotics
o Humidified cool air and adequate hydration Humidified cool air and hydration are essential to facilitating improvement in the child's physical status. Postural drainage is not effective with this disorder; oxygen is used only if the infant has severe dyspnea and hypoxia. Bronchodilators are not used, because the bronchial tree is not in spasm; cough suppressants are ineffective. Corticosteroids are ineffective; antibiotics are also ineffective, because the causative agent is viral.
An infant is admitted to the pediatric unit with bronchiolitis caused by respiratory syncytial virus (RSV). Which interventions would the nurse provide for the infant? Select all that apply. o Limiting fluid intake o Instilling saline nose drops o Maintaining droplet precautions o Nasal suctioning to remove mucus o Administering inhaled bronchodilators
o Instilling saline nose drops o Maintaining droplet precautions o Nasal suctioning to remove mucus Saline nose drops help clear the nasal passage, which improves breathing and aids the intake of fluids. RSV is contagious; infants with RSV should be isolated from other children, and the number of people visiting or caring for the infant should be limited. Infants with RSV produce copious amounts of mucus, which hinders breathing and feeding; suctioning before meals and at naptime and bedtime provides relief. Fluid intake should be increased; adequate hydration is essential to counter fluid loss. These infants have difficulty nursing and often vomit their feedings. If measures such as suctioning before feeding and instilling saline nose drops are ineffective, intravenous fluid replacement is instituted. Research has shown that bronchodilators are not effective in the treatment of bronchiolitis because the bronchial tree is not in spasm.
A child with status asthmaticus is admitted to the pediatric intensive care unit. Which would the nurse include in the plan of care as the child starts to recover from the episode? o Maintain the high-Fowler position. o Restrict fluids to two thirds of the usual intake. o Keep droplet precautions in place for 24 hours. o Administer the prescribed prophylactic antibiotic.
o Maintain the high-Fowler position. The high-Fowler position decreases pressure on the diaphragm and promotes lung expansion. Fluids should not be restricted. Adequate fluid intake should be maintained to promote hydration. Droplet precautions are not required. Asthma is not an infectious disease, and there are no data to indicate an accompanying infection. If the practitioner prescribes an antibiotic, it is to treat a concurrent infection; prophylactic antibiotic therapy is not required for children with status asthmaticus.
Which statement must the nurse emphasize to the family when preparing a school-aged child with persistent asthma for discharge? o A cold, dry environment is desirable. o Limits should not be placed on the child's behavior. o The health problem is gone when symptoms subside. o Medications must be continued even when the child is asymptomatic.
o Medications must be continued even when the child is asymptomatic. Children with persistent asthma must continue taking medications to keep them asymptomatic. Inhaled corticosteroids, long-acting β2-agonists, and leukotriene modifiers are used as controller medications. Some environmental moisture is necessary for these children. Consistent limits should be placed on any child's behavior, regardless of the disease; a chronic illness does not remove the need for setting limits. The child's symptoms are being controlled by medications that are necessary to keep the child asymptomatic.
A client with chronic obstructive pulmonary disease (COPD) is breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. Which action would the nurse take? o Encourage the client to take slow, deep breaths and administer 5 L/min oxygen per nasal cannula. o Place the client in a side-lying position and perform chest physiotherapy using clapping and vibration. o Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. o Assist the client in assuming a position of comfort and perform postural drainage.
o Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula. Sitting facilitates breathing by increasing lung expansion; 2 L of oxygen promotes respirations while preventing carbon dioxide narcosis. However, the results of one recent study of clients with stable COPD indicate that the hypercapnic drive is preserved with oxygen higher than 2 L. More research is needed before this theory is applied clinically. Five liters of oxygen may cause respiratory depression and carbon dioxide narcosis in a client with COPD. Chest physiotherapy (postural drainage) may be done later after the client's condition improves. Delaying intervention is likely to worsen the respiratory distress.
Which type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation? o Metabolic alkalosis caused by excessive production of acid metabolites o Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide o Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid o Metabolic acidosis caused by the kidneys' inability to compensate for increased carbonic acid formation
o Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid The restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. As carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid; the result is respiratory acidosis. The problem basic to asthma is respiratory, not metabolic. Respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide; asthma attacks cause carbon dioxide retention. Asthma is a respiratory problem, not a metabolic one; metabolic acidosis can result from an increase of nonvolatile acids or from a loss of base bicarbonate.
A client is admitted to the hospital with a diagnosis of chronic obstructive pulmonary disease (COPD). Which action would the nurse take to prevent client fatigue? o Provide small, frequent meals. o Encourage pursed-lip breathing. o Schedule nursing activities to allow for rest. o Encourage bed rest until energy level improves.
o Schedule nursing activities to allow for rest. Rest limits muscle contractions, which diminishes oxygen needs and decreases fatigue. Although small, frequent meals may decrease pressure on the diaphragm and facilitate breathing, this precaution does not address the client's fatigue. Although pursed-lip breathing facilitates gas exchange, it does not reduce the metabolic demand for oxygen. Bed rest promotes pooling of pulmonary secretions, which may aggravate the client's respiratory status.
Which instruction would the nurse include when teaching a client with asthma how to use a peak flow meter? o Sit up straight in a firm chair. o Check peak flow early in the morning. o Take the deepest breath you can, then blow out hard and fast. o Calculate the average of 3 readings to obtain your peak flow.
o Take the deepest breath you can, then blow out hard and fast. A peak flow meter measures the peak expiratory flow rate and is used by taking the deepest breath possible, then forcefully exhaling as quickly as possible. The client is taught to stand when measuring peak flows to assure accurate readings. Peak flow measurements should be done between noon and 2:00 PM when peak flows are highest. The peak flow reading is done 3 times, and the highest reading is recorded as the peak flow.
Long Acting Beta2 Agonists (LABA)
Onset 20 minutes so NOT for ACUTE attacks. *Never used alone in ASTHMA, always with inhaled corticosteroids* different with COPD. Studies showed that LABA alone for asthma can cause death. They relax the smooth muscle lining the airways of your lungs and causes your airways to open up- inhibit mast cell mediator release, plasma exudation and may reduce sensory nerve activation. Thus these two classes of drug address complementary aspects of the pathophysiology of asthma that neither drug class is able to achieve alone. Examples: Fluticasone and salmeterol (Advair Diskus, Wixela Inhub, others) Budesonide and formoterol (Symbicort) Mometasone and formoterol (Dulera) Fluticasone and vilanterol (Breo Ellipta)
Inhaled Corticosteroids (glucocorticosteroids, corticosteroids, steroids) Action and Examples
Suppress airway inflammation by activating anti-inflammatory genes, switching off inflammatory gene expression, and inhibiting inflammatory cells - reduce the mucus secretion by inhibiting the release of secretagogin from macrophages. (Inhibit the late phase reaction by inhibiting the inflammatory response and interfering with chemotaxis. This action may be due to the inhibition of LTB4 release.) Examples: Fluticasone (Flovent HFA) Mometasone (Asmanex Twisthaler) Ciclesonide (Alvesco) Beclomethasone dipropionate (Qvar) Budesonide (Pulmicort) Budesonide/Formoterol (Symbicort)
After the home health nurse has taught a client with asthma how to use a peak flow meter, which statement by the client needs correction? o "I will record the highest reading of 3." o "I will use the peak flow meter while standing." o "I will take a deep breath before blowing into the peak flow meter." o "I will repeat the test in 15 minutes if the reading is in the red zone."
o "I will repeat the test in 15 minutes if the reading is in the red zone." A red zone reading is a serious situation; the client should be instructed to use airway reliever medications and seek immediate medical care. Clients need to conduct a peak flow test 3 times and record the highest reading. Clients should use the peak flow meter while standing independently without leaning. Correct use of the peak flow meter begins with the client taking a deep breath before blowing into the meter.
A 6-year-old child with asthma is prescribed an inhaled corticosteroid. The nurse would conclude the mother understands teaching about the medication side effects when the mother makes which statement? o "I'll watch for frequent urination." o "I'll check for white patches in the mouth." o "I'll be alert for short episodes of not breathing." o "I'll monitor for an increased blood glucose level."
o "I'll check for white patches in the mouth." Oral candidiasis is a potential side effect of inhaled steroids because of steroids' anti-inflammatory effect; the child should be taught to rinse the mouth after each inhalation. Frequent urination is not a side effect of steroid therapy. Apneic episodes are not a side effect of steroid therapy. Hyperglycemia is not a side effect of inhaled steroid therapy; it may occur when steroids are administered for a systemic effect.
The school nurse recommends suitable physical activity for a child with exercise-induced asthma. Which statement by a parent indicates the need for additional teaching? o "I'll sign him up for swimming lessons." o "She'd really enjoy being on a bowling team." o "I'll encourage him to join a youth running club." o "I know she'd enjoy going to the gym and lifting weights."
o "I'll encourage him to join a youth running club." Exercise-induced asthma is triggered by rapid mouth breathing of large volumes of dry, cool air, so running increases the risk for an attack. Recommended exercises for people with asthma include swimming, weight lifting, and similar activities that do not necessitate rapid breathing through the mouth.
After the nurse has taught a client with asthma about use of a peak flow meter, which client statements indicate that the teaching has been effective? Select all that apply. o "Readings in the green zone mean that my asthma is under control." o "If I get a reading in the yellow zone, I need to stop what I'm doing and rest for a while." o "If I get a reading in the red zone, then I need to use the quick relief inhaler and have my family take me to the hospital." o "I should check the peak flow readings at least twice a day until my baseline is established." o "I don't need to check my peak flow readings if I use the quick relief medication."
o "Readings in the green zone mean that my asthma is under control." o "If I get a reading in the red zone, then I need to use the quick relief inhaler and have my family take me to the hospital." o "I should check the peak flow readings at least twice a day until my baseline is established." Peak flow meters are used to measure how well the client's asthma is controlled. Readings in the green zone mean the asthma is under control. Peak flows in the red zone indicate serious airflow problems; the client should use the quick relief inhaler and plan to see the health care provider or go the emergency department. Peak flow readings should be done 2 to 4 times a day for the first few weeks to establish a baseline. With yellow zone peak flow readings, the client should use the quick relief inhaler and then recheck peak flows in an hour. Clients who need the quick relief medication should continue to check peak flows to assure that peak flows improve.
A client with chronic obstructive pulmonary disease prepares to take a medication that is delivered via a nebulizer. Which instruction would the nurse provide when teaching about use of the nebulizer? o "Hold your breath, spray the medication into your mouth, then inhale deeply." o "Depress the canister as you inhale deeply, then hold your breath for at least 10 seconds." o "Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths." o "Inhale the medication from the nebulizer, remove the mouthpiece to exhale and then repeat."
o "Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths." Sealing the lips around the mouthpiece ensures that medication is delivered on inspiration; slow, deep breaths promote better deposition and efficacy of medication deep into the lungs. The breath should not be held during administration. A nebulizer treatment delivers medication by inhaling it into the mouth through a mouthpiece, not a canister. Removing the mouthpiece from the mouth to exhale allows valuable aerosolized medication to be deposited into the air; therefore the client will not receive the full dose of aerosolized medication.
A client has chronic obstructive pulmonary disease (COPD). To decrease the risk of CO2 intoxication (CO2 narcosis), which would the nurse do? o Initiate pulmonary hygiene to clear air passages of trapped mucus. o Instruct to deep-breathe slowly with inhalation longer than exhalation. o Encourage continuous rapid panting to promote respiratory exchange. o Administer oxygen at a low concentration to maintain respiratory drive.
o Administer oxygen at a low concentration to maintain respiratory drive. With chronically high levels of carbon dioxide, it is believed that decreased oxygen levels become the stimulus to breathe; high oxygen administration negates (makes ineffective) this mechanism. Initiating pulmonary hygiene to clear air passages of trapped mucus is an appropriate intervention but is not directly related to CO2 intoxication (CO2 narcosis). Encouraging continuous rapid panting to promote respiratory exchange will not bring oxygen into the alveoli for exchange, nor will it adequately remove carbon dioxide because it will increase bronchiolar obstruction. Inhalation should be of regular depth, and expiration should be prolonged to prevent carbon dioxide trapping (air trapping).
The nurse reviews the laboratory reports of four clients. Which client would the nurse suspect as having type I-mediated asthma? o Client A o Client B o Client C o Client D
o Client A Asthma is a type I or IgE-mediated hypersensitivity reaction. Client A, with IgE antibodies in the blood, has type 1-mediated asthma. Client B, with no antibodies, may not have humoral allergy or may have a humoral deficiency. Client C and client D may have either type II or type III hypersensitivity reactions.
When a client with chronic obstructive pulmonary disease (COPD) reports a 5-lb (2.3-kg) weight gain in 1 week, the nurse will assess for other signs and symptoms of which complication? o Polycythemia o Cor pulmonale o Compensated acidosis o Left ventricular failure
o Cor pulmonale Fluid retention and weight gain caused by right ventricular failure is a clinical manifestation of cor pulmonale, or right ventricular failure caused by pulmonary hypertension associated with COPD. Polycythemia may be caused by COPD, but it does not cause weight gain. Compensated respiratory acidosis is caused by COPD, but it would not lead to weight gain. Left ventricular failure may lead to weight gain, but it is not a complication of COPD.
Which rationale would the nurse use when teaching a client with chronic obstructive pulmonary disease (COPD) to use pursed-lip breathing? o Decrease air trapping o Prevent bronchial dilation o Strengthen intercostal muscles o Reduce diaphragmatic excursion
o Decrease air trapping Pursed-lip breathing prolongs the expiratory phase and increases airway positive pressure, leading to more complete expiration and reduced air trapping. Bronchi and bronchioles stay open longer and are expanded during pursed-lip breathing. Pursed-lip breathing does not strengthen the intercostal muscles or reduce diaphragmatic excursion.
Which goal is the priority for a client with asthma who has a prescription for an inhaled bronchodilator? o Is able to obtain pulse oximeter readings o Demonstrates use of a metered-dose inhaler o Knows the health care provider's office hours o Can identify triggers that may cause wheezing
o Demonstrates use of a metered-dose inhaler Clients with asthma use metered-dose inhalers to administer medications prophylactically or during times of an asthma attack; this is an important skill to have. Home management typically includes self-monitoring of the peak expiratory flow rate rather than pulse oximetry. Although knowing the health care provider's office hours is important, it is not the priority; during a persistent asthma attack that does not respond to planned interventions, the client should go to the emergency department of the local hospital or call 911 for assistance. Although it is important to be able to identify triggers that may cause wheezing, knowing these cannot prevent all wheezing; therefore, being able to abort wheezing with a bronchodilator is the greater priority.
The nurse teaches a client with chronic obstructive pulmonary disease (COPD) and cor pulmonale about nutrition. Which instruction would the nurse include? o Eat small meals six times a day to limit oxygen needs. o Drink large amounts of fluid to help liquefy secretions. o Lie down after eating to conserve energy needed for digestion. o Increase the intake of protein to decrease intravascular hydrostatic pressure.
o Eat small meals six times a day to limit oxygen needs. Eating small meals will decrease the amount of oxygen necessary for ingestion and digestion at any one time; a small volume of food in the stomach will not impede the downward movement of the diaphragm during inhalation. Although fluids can help liquefy secretions, they should not be encouraged for a client with heart failure. Lying down increases intra-abdominal pressure, pushing a full stomach against the diaphragm and limiting respiratory excursion. Protein maintains or increases hydrostatic pressure; it does not decrease it.
A child admitted to the hospital with a diagnosis of status asthmaticus appears to be improving. Which is the most objective way for the nurse to evaluate the child's response to therapy? o Auscultating breath sounds o Monitoring the respiratory pattern o Assessing the lips for decreased cyanosis o Evaluating the child's peak expiratory flow rate
o Evaluating the child's peak expiratory flow rate A peak expiratory flow meter (PEFM) is used to obtain the peak expiratory flow rate (PEFR). The PEFM provides an objective measure of the maximal flow of air that can be forcefully exhaled in 1 second. The PEFM individualizes data for the child because after a personal best value is established, this baseline can be compared with current values to determine progress or lack of progress regarding the child's respiratory status. Although breath sounds may be auscultated, the child's respiratory pattern may be monitored, and the color of the lips may be assessed, none is as objective a measure as a PEFR result.
The nurse in the health clinic is counseling a college student who recently was diagnosed with asthma. Which aspect of counseling would the nurse focus on? o Teaching how to make a room allergy-free o Referring to a support group for individuals with asthma o Arranging with the college to ensure a speedy return to classes o Evaluating whether the necessary lifestyle changes are understood
o Evaluating whether the necessary lifestyle changes are understood Understanding the disorder and the details of care are essential for the client to be self-sufficient. Although teaching is important, a perceived understanding of the need for specific interventions must be expressed before there is a readiness for learning. Referring to a support group is premature; this may be done eventually. Although ensuring a speedy return to classes is important, involving the college should be the client's decision.
Which intervention would the nurse implement for a client admitted for an exacerbation of asthma? o Determine the client's emotional state. o Give prescribed medications to promote bronchiolar dilation. o Provide education about the effect of a family history. o Encourage the client to use an incentive spirometer routinely.
o Give prescribed medications to promote bronchiolar dilation. Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to the development of asthma, exploring this issue is not the priority. The use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.
A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute pneumonia. The client is in moderate respiratory distress. The nurse would place the client in which position to enhance comfort? o Side-lying with head elevated 45 degrees o Sims with head elevated 90 degrees o Semi-Fowler with legs elevated o High Fowler using the bedside table to rest the arms
o High Fowler using the bedside table to rest the arms The high-Fowler position elevates the clavicles and helps the lungs expand, thus easing respirations. The side-lying, Sims, and semi-Fowler positions do not promote more comfortable breathing.
When the nurse is evaluating a client with an acute asthma attack who has just received a nebulized bronchodilator treatment, which finding requires the most rapid action? o Labored breathing and absent breath sounds o Continued high-pitched expiratory wheezes o Use of pursed-lip breathing during expiration o Hyperresonance to percussion of posterior chest
o Labored breathing and absent breath sounds Absent breath sounds and labored appearing respirations indicate that the client has extremely limited airflow and is at risk for respiratory arrest. The nurse would notify the health care provider immediately and anticipate interventions such as intubation, systemic bronchodilators, and mechanical ventilation. Continued high-pitched respiratory wheezes indicate that further treatment is needed, but the client would not be at risk for respiratory arrest. Pursed-lip breathing is frequently used by clients with obstructive airway disease to help improve expiratory effort. Hyperresonance to percussion indicates air trapping in the lungs, but is not an uncommon finding in clients with asthma.
Which finding in a client with asthma exacerbation requires the most rapid action by the nurse? o Report of chest tightness o Heart rate of 112 beats per minute o Expiratory wheezes in both lungs o Markedly decreased breath sounds
o Markedly decreased breath sounds Markedly decreased breath sounds may indicate very limited airflow and life-threatening asthma exacerbation. The nurse would immediately check oxygen saturation and anticipate possible need for mechanical ventilation. Clients with asthma exacerbation frequently report chest tightness, but this finding does not indicate possible impending respiratory arrest. Tachycardia is common with asthma exacerbation because of stress and increased work of breathing, but a heart rate of 110 beats per minute is not life-threatening. Expiratory wheezes are heard early in asthma exacerbation; inspiratory wheezes are a more ominous finding and indicate further progression of airway obstruction.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The client's arterial blood gases deteriorate, and respiratory failure is impending. Which clinical indicator is consistent with the client's condition? o Cyanosis o Bradycardia o Mental confusion o Distended neck veins
o Mental confusion Decreased oxygen to the vital centers in the brain results in restlessness and confusion. Cyanosis is a late sign of respiratory failure. Tachycardia, not bradycardia, will occur as a compensatory mechanism to help increase oxygen to body cells. Distended neck veins occur with fluid volume excess (e.g., pulmonary edema).
Which diagnostic testing is most useful in evaluating the effectiveness of treatment for asthma? o Chest x-ray o Pulmonary function tests o Serum eosinophil counts o Immunoglobulin E levels
o Pulmonary function tests The most useful test when evaluating the effectiveness of asthma treatment is pulmonary function testing, which measures airflow. A chest x-ray might be used to check for complications of asthma such as respiratory infection, but is not used to evaluate the effectiveness of asthma treatment. Serum eosinophil counts might be used to determine whether a client's asthma was caused by allergies, but eosinophil counts will not be commonly used to check for effectiveness of treatment. Immunoglobulin E levels might be checked to determine if a client had allergic asthma, but would not be used to check for whether treatment was effective.
The nurse is providing hygiene care to a immobile client who was admitted for exacerbation of chronic obstructive pulmonary disease (COPD). Which nursing intervention is correct when the client becomes short of breath during the care? o Obtain a pulse oximeter to determine the client's oxygen saturation level. o Put the client in a high Fowler position. o Darken the lights and provide a rest period of at least 15 minutes. o Continue the hygiene activities while reassuring the client.
o Put the client in a high Fowler position. Putting the client in the high Fowler position will help expand the lungs and decrease the severity of shortness of breath. Leaving the client to obtain a pulse oximeter while the client is experiencing shortness of breath places the client in danger. Providing a rest period of at least 15 minutes may be appropriate but is not the priority. The nurse needs to acknowledge the change in the client's condition, such as shortness of breath, and take care of this immediate client need before continuing the hygiene activities.
A registered nurse (RN) is performing a physical examination of a client with chronic obstructive pulmonary disease. Which abnormal nail bed patterns would be expected in this client? o Spoon-shaped nails o Transverse depressions in nails o Softening of nail beds and flat nails o Red or brown linear streaks in nail bed
o Softening of nail beds and flat nails Softening of the nail bed and enlarged finger tips with flattened nails are signs of clubbing of the nails. Clubbing results in a change of the angle between the nail and nail base and is seen in conditions of oxygen deficiency, such as in heart or pulmonary diseases. Conditions such as iron-deficiency anemia and syphilis cause curvature of nails, which is called koilonychia. Transverse depressions in nails indicate a temporary disturbance of nail growth called Beau lines. Red or brown linear streaks in the nail bed are caused by minor trauma to nails, subacute endocarditis, and trichinosis. They are called splinter hemorrhages.
A 4-month-old infant with severe tachypnea, flaring of the nares, wheezing, and irritability is admitted to the pediatric unit with bronchiolitis. Which clinical finding is associated with possible respiratory failure? o Expiratory wheezing o Intercostal retractions o Fine crackles on deep inspiration o Sudden absence of breath sounds
o Sudden absence of breath sounds A sudden absence of breath sounds occurs when bronchioles become obstructed and respiratory failure is imminent. Expiratory wheezing is a common manifestation of bronchiolitis and is caused by the passage of air through the airways narrowed by inflammation and mucus; it does not herald (a sign of) respiratory failure. Intercostal retractions occur with mild and moderate respiratory distress in infants. Fine crackles are a routine occurrence with bronchiolitis, not a sign of respiratory failure.
The nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for in the child? o Flushing o Dyspnea o Tachycardia o Hypotension
o Tachycardia Albuterol produces sympathetic nervous system side effects such as tachycardia and hypertension. Pallor, not flushing, is a common side effect. Dyspnea is not a common side effect; this medication is given to decrease respiratory difficulty. Hypertension, not hypotension, is a common side effect.
Which type of hypersensitivity may have occurred in the client with elevated histamine and prostaglandin levels, allergic rhinitis, and asthma? o Type I o Type II o Type III o Type IV
o Type I Type I hypersensitivity reactions (immediate hypersensitivity reactions) involve the immunoglobulin E (IgE)-mediated release of histamines and other mediators from mast cells and basophils. Allergic rhinitis and asthma may occur when mediators such as histamine and prostaglandins are involved as mediators of injury. Type II hypersensitivity reaction is cytotoxic mediated; it occurs in transfusion reactions. Type III reactions are immune complex-mediated hypersensitivity reactions such as rheumatoid arthritis. Type IV hypersensitivity reactions are delayed hypersensitivity reactions; an example is contact dermatitis.
