PATHO PHARM- Respiratory

Factors affecting diffusion of gases

--Partial pressure gradient --Thickness of the respiratory membrane ------Fluid accumulation in alveoli or interstitial tissue impairs gas exchange. --Total surface area available for diffusion ------If part of alveolar wall is destroyed, surface area is reduced, so less exchange --Ventilation-perfusion ratio ------Ventilation (air flow) and perfusion (blood flow) need to match for maximum gas exchange.

The client with the flu is prescribed the over-the-counter cough suppressant dextromethorphan. Which information should the nurse teach regarding this medication? 1. Take the medication every 4-8 hours as needed for cough. 2. The medication can cause addiction if taken too long. 3. Do not drive or operate machinery while taking the drug. 4. Do not take a beta blocker while taking this medication.

Answer 3

A client, prescribed oxygen 4 liters per nasal cannula, has a respiratory rate of 8 per minute. Which health problem could be causing this change in the client's respiratory rate? A. Congestive heart failure B. Chronic obstructive pulmonary disease C. Asthma D. Pulmonary edema

Answer B Rationale: In chronic obstructive pulmonary disease, the drive to breathe is initiated by the level of carbon dioxide in the blood. If provided with oxygen at 4 liters, the amount of oxygen in the blood is higher than the concentration of carbon dioxide causing the respiratory rate to decrease. Choice A would not cause the respiratory rate to decrease. Choice C would most likely cause an increase in the respiratory rate. Choice D would cause the respiratory rate to increase.

A client is experiencing rapid respirations and difficulty swallowing. The nurse determines the client is having an alteration in which physiologic structure? A. Cerebral cortex B. Brain stem C. Cerebellum D. Diencephalon

Answer B Rationale: The brain stem is the physiologic structure that controls cardiac and respiratory function and the swallowing gag and cough reflexes. Choice A is the center responsible for processing information, motor function, communication, judgement, and abstract thought processes. Choice C is the structure responsible for regulation and coordination of movement, posture, coordination and balance. Choice D regulate autonomic nervous system function, regulates and produces hormones, and mediates emotional responses.

Clients with chronic COPD can develop acid-base imbalances. How does the body compensate for this shift in acid-base balance? A. The respiratory center increases the respiratory rate. B. The respiratory center decreases the respiratory rate C. The kidney increases the reabsorption of bicarbonate D. The kidney increases the excretion of acid

Answer C Rationale: Clients with COPD can develop respiratory acidosis due to CO2 retention. The kidney compensates for the increased acid (CO2) by increasing the reabsorption of bicarbonate, the body's main base in the intravascular space. Choice A is incorrect because an increase in the respiratory rate lowers the PaCO2, which is the compensatory mechanism for metabolic acidosis. Choice B is incorrect because a decreased in respiratory rate increases the PaCo2 which is the compensatory mechanism for metabolic alkalosis. Choice D is incorrect because an increase in acid excretion isi the compensatory mechanism for respiratory alkalosis.

What health problem can be caused by chronic bronchitis? A. Barrel shaped chest B. Hypoxic drive dependency C. Cor pulmonale (Right heart failure) D. Esophageal varices

Answer C: Chronic bronchitis causes a decrease in ventilation and a decrease in alveolar oxygen concentration. The lungs react by constricting the pulmonary arterioles. The increased resistance in the pulmonary circulation forces the right ventricle to work harder (increased afterload), resulting in ventricular hypertrophy. Eventually, clients with chronic bronchitis develop cor pulmonale. Choice A is incorrect because a barrel shaped chest is a manifestation of emphysema due to alveolar destruction and increased lung compliance. Choice B is seen in COPD. Chronic hypercapnea causes respiratory center to become insensitive to high PaCO2. As the respiratory center does not increase the respiratory rate in response to a high PaCO2, these patients are dependent on the hypoxic drive (low PaO2) to maintain their rate of breathing. Choice D is incorrect because esophageal varices are not associated with chronic bronchitis.

While observing a client's respirations, the nurse notes the thoracic region expands in size with inspiration and returns to the resting size with expiration. The nurse determines that which anatomic structure is functioning adequately? A. Lungs B. Nose C. Thorax D. Diaphragm

Answer D Rationale: For normal respiration to occur, the diaphragm needs to contract with inspiration and relax with expiration. When contracting the size of the thoracic cavity increases, lowering the pressure gradient and pulling air into the lungs during inspiration. When the diaphragm relaxes, the pressure gradient within the lungs increases which caused air to leave the lungs during expiration. Choices A, B, and C are incorrect because these structures do not control inspiration and expiration.

The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating "rusty-colored" sputum. Which medication should the nurse anticipate the HCP prescribing? A. Prednisone, a glucocorticoid. B. Habitrol, a transdermal nicotine system. C. Dextromethorphan (Robitussin), an antitussive. D. Ceftriaxone (Rocephin), a cephalosporin antibiotic.

Answer D. The client's "rusty-colored" sputum indicates an infection and an antibiotic should be ordered. Rocephin is a broad-spectrum antibiotic.

The client with seasonal allergic rhinitis is prescribed fluticasone (Flonase), an intranasal glucocorticosteroid. Which intervention should the nurse implement first? A. Instruct the client not to eat licorice B. Explain that this is for short-term use C. Instruct not to use other nasal decongestants D. Assess the nares for excoriation or bleeding

Answer D. The nurse must first assess the client's nares because broken mucous mem- branes allow direct access to the blood- stream, increasing the likelihood of systemic effects of the drug. Therefore, this is the first intervention the nurse should implement. The HCP may not prescribe the medication if nasal excoriation or bleeding is present.

The nurse on a medical unit is administering 0900 medications. Which medication should the nurse question administering? 1. Acetylcysteine (Mucomyst), a mucolytic, to a client who is coughing forcefully. 2. Cefazolin (Ancef), an antibiotic, IVPB to a client diagnosed with the flu. 3. Diphenhydramine (Benadryl), an antihistamine, to a client who is congested. 4. Dextromethorphan (Robitussin), an antitussive, to a client who has pneumonia.

Answer: 1 Rationale: 1. An adverse effect of Mucomyst is bronchospasm. This client should be assessed for bronchospasm before administering a dose of Mucomyst. 2. Antibiotics are frequently administered to clients with viral infections to prevent secondary bacterial infections. This client is considered at risk or the client would not be in a hospital receiving care. There Is no reason to question this medication. 3. Antihistamines are prescribed for congestion; there is no reason to question this medication. 4. A symptom of pneumonia is a cough. There is no reason to question this medication.

Which information should the nurse teach the client who is prescribed a glucocorticoid inhaler? 1. Advise the client to gargle after each administration. 2. Instruct the client to use the inhaler on a PRN basis. 3. Encourage the client not to use a spacer when using the inhaler. 4. Teach the client to check his or her forced expiratory volume daily.

Answer: 1 Rationale: 1. Gargling after each administration will help decrease the development of oropharyngeal yeast infections. 2. Glucocorticoids are intended for preventive therapy, not for aborting an ongoing asthma attack, and they should not be taken on a PRN basis. 3. A spacer, a device that attaches directly to the metered-dose inhaler, should be used because a spacer increases the delivery of the drug to the lungs and decreases deposition of the drug on the oropharyngeal mucosa. 4. Forced expiratory volume is the single most useful test of lung function, but the instrument required is a spirometer, which is expensive, cumbersome, and not suited for home use.

The client diagnosed with the flu is prescribed the cough medication hydrocodone. Which information should the nurse teach the client regarding this medication? 1. Teach the client to monitor the bowel movements for constipation. 2. Driving or operating machinery is all right while taking this medication. 3. This medication usually causes insomnia, so plan for rest periods. 4. This medication is more effective when taken with a mucolytic.

Answer: 1 Rationale: 1. Hydrocodone is an opioid and can slow the peristalsis of the bowel, resulting in constipation. The client should be aware of this and increase the fluid intake and use bulk laxatives and stool softeners, if needed. 2. Opioids can cause drowsiness, so driving or operating machinery should be discouraged. 3. Opioids usually cause the client to be drowsy, not have insomnia. 4. Hydrocodone is a cough suppressant and a mucolytic is an expectorant. These are opposite-acting medications.

The client with the flu has been taking acetylcysteine (Mucomyst), a mucolytic. Which adverse effect should the nurse assess for? 1. Bronchospasm. 2. Nausea. 3. Fever. 4. Drowsiness.

Answer: 1 Rationale: 1. Mucomyst can cause bronchospasm, which will impair the client's breathing, not improve it. An adverse reaction is a reason to immediately discontinue the medication. 2. Nausea is a side effect of many medications and can usually be managed by taking the medication with food. A side effect is not an adverse effect. 3. Fever would result from the cold, flu, or infection, not from the medication. 4. Drowsiness is caused by some cold and flu preparations, usually the antihistamines. Mucomyst causes the client to expectorate secretions, which will keep the client awake.

Which assessment data indicates the client with reactive airway disease has "good" control with the medication regimen? 1. The client's peak expiratory flow rate (PEFR) is greater than 80% of his or her personal best. 2. The client's lung sounds are clear bilaterally, both anterior and posterior. 3. The client has only had three acute exacerbations of asthma in the last month. 4. The client's monthly serum theophylline level is 18 fig/mL. 5. The client is taking the medication as directed by the health-care provider.

Answer: 1 Rationale: 1. The PEFR is defined as the maximal rate of airflow during expiration in a relatively inexpensive, handheld device. If the peak flow is less than 80% of personal best, more frequent monitoring should be done. The PEFR should be measured every morning. 2. A normal respiratory assessment does not indicate that the medication regimen is effective and has "good" control. 3. Three asthma attacks in the last month would not indicate the client has "good" control of the reactive airway disease. 4. A serum theophylline level between 10 and 20 fig/mL indicates the medication is within the therapeutic range, but it is not the best indicator of the client's control of the signs or symptoms. 5. Taking the medication as directed is appropriate for the client but it does not indicate the medication regimen is effective.

The client with reactive airway disease is taking the oral sympathomimetic bronchodilator metaproterenol (Alupent) three times a day. Which intervention should the nurse implement? 1. Instruct the client to take the last dose a few hours before bedtime. 2. Teach the client to decrease the fluid intake when taking this medication. 3. Have the client demonstrate the correct way to use the inhaler. 4. Encourage the client to take the medication with an antacid.

Answer: 1 Rationale: 1. The client should take the last dose a few hours before bedtime so that the medication does not produce insomnia. 2. The client should increase fluid intake, especially water, because it will make the mucus thinner and help the medication work more effectively. 3. This medication is taken orally; therefore, there is no reason for the client to demonstrate the correct way to use an inhaler. 4. Antacids decrease the absorption of medication; therefore, the medication should not be taken with or within 2 hours of taking an antacid.

Which statement indicates to the nurse that the 13-year-old child understands the zone system for monitoring the treatment of asthma? 1. "When I am in the green zone, it means good control and I do not need any medication." 2. "If I am in the black zone, it means I should go to the emergency department." 3. "If I am in the red zone, it means I should take my cromolyn and steroid inhaler." 4. "The yellow zone means I tell my mom so she can give me a nebulizer treatment."

Answer: 1 Rationale: 1. The zone system is used to help children monitor their treatment. The child uses a peak flow meter, which monitors breathing capacity and shows which zone—green, yellow, or red—the child's peak flow is in.Treatment, if needed, is then based on which zone the peak flow meter shows. Green zone means all clear; no asthma symptoms are present. 2. There is no such zone as the black zone. 3. The red zone indicates a medical alert—bronchodilator should be taken and the child should seek medical attention for acute severe asthma. The cromolyn and steroid inhaler are not used for an acute asthma attack. 4. The yellow zone indicates caution because an acute episode may be present. The control is insufficient. The child should inhale a short-acting beta2 agonist. If this fails to return the child to the green zone,a short course of oral glucocorticoids maybe needed.

The HCP prescribed amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement? 1. Discuss the prescription with the HCP because antibiotics do not help viral infections. 2. Teach the client to take all the antibiotics as ordered. 3. Encourage the client to seek a second opinion before taking the medication. 4. Ask the client if he or she is allergic to sulfa drugs or shellfish.

Answer: 2 Rationale: 1. Antibiotics do not treat viral infections, but HCPs will frequently prescribe prophylactic antibiotics for clients with comorbid conditions (such as COPD) to prevent secondary bacterial infection. 2. Clients prescribed antibiotics should always be taught to take all the medication as ordered to prevent resistant strains of bacteria from developing. 3. There is no reason for a second opinion; this is standard medical practice. 4. This is a penicillin preparation, not a sulfa medication or iodine.

The 8-year-old male child diagnosed with reactive airway disease is prescribed a cromolyn (Intal) inhaler. The child shares with the nurse that he wants to play baseball but can't because of his asthma. Which intervention should the nurse discuss with the child and parents? 1. Instruct the child to take the medication as soon as shortness of breath starts. 2. Teach the child to take a puff of the cromolyn inhaler 15 minutes before playing ball. 3. Encourage the child to play another sport that does not require running outside. 4. Inform the parents to notify the pediatrician if the child complains of a yellow haze.

Answer: 2 Rationale: 1. Cromolyn is a safe and effective drug for prophylaxis of asthma, but it is not useful for aborting an ongoing attack. 2. Cromolyn can prevent bronchospasm in children subject to exercise-induced asthma. It should be administered 15 minutes prior to anticipated exertion. 3. The child with a chronic illness should be encouraged to live as normal a life as possible; therefore, encouraging the child not to play ball is not appropriate. 4. Cromolyn is devoid of significant adverse effects and drug interactions. A yellow haze is not an expected side effect or adverse effect of cromolyn.

The client who has been using oxymetazoline (Afrin) nasal spray for several weeks complains to the nurse that the spray no longer seems to work to clear the nasal passages. Which information should the nurse teach? 1. Increase the amount of sprays used until the desired effect has been reached. 2. This type of medication can cause rebound congestion if used too long. 3. Alternate the Afrin with a saline nasal spray every 2 hours. 4. Place the Afrin nasal spray in a vaporizer at night for the best results.

Answer: 2 Rationale: 1. Increasing the number of sprays will only increase the problem. This medication is for short-term use only (that is, a few days). Longer use can cause a rebound congestion that can be difficult to resolve. 2. Afrin is recommended for short-term relief of nasal congestion for clients older than the age of 6 years. Longer Use can cause a rebound congestion that can be difficult to resolve. 3. Afrin should be used every 10-12 hours only; using it more often increases the chance of developing a dependence on the medication and rebound congestion. 4. Afrin nasal spray is to be used intranasally; it is not an additive for a vaporizer.

The client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast (Singulair). Which statement by the client warrants intervention by the nurse? 1. "I have been having a lot of headaches lately." 2. "I have started taking an aspirin every day." 3. "I keep this medication up on a very high shelf." 4. "I must protect this medication from extreme temperatures."

Answer: 2 Rationale: 1. These drugs are generally safe and well-tolerated, with a headache being the most common side effect; therefore, this statement would not warrant intervention by the nurse. 2. This medication interacts with aspirin, warfarin, erythromycin, and theophylline; therefore, this statement warrants further intervention by the nurse. 3. All medications should be kept out of the reach of children, and keeping the medication on a high shelf would not warrant intervention by the nurse. 4. This medication does not need to be kept from extreme temperatures; it is the anti-asthmatic zafirlukast (Accolate) that must be protected from extremes of temperature, light, and humidity. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to medication, the nurse must intervene. The nurse must implement an independent action during intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

The child diagnosed with reactive airway disease is prescribed a cromolyn inhaler. The mother asks the nurse to explain how this medication helps control her child's asthma. Which statement is the best explanation to give to the mother? 1. This medication diminishes the mediator action of leukotrienes. 2. This medication blocks the release of mast cell mediators. 3. This medication causes relaxation of the bronchial smooth muscle. 4. This medication decreases bronchial airway inflammation.

Answer: 2 Rationale: 1. This is the explanation for administering leukotriene blockers. 2. This is the correct explanation for administering a cromolyn inhaler; it prevents the asthma attack by blocking the release of mast cell mediators. 3. This is the explanation for administering theophylline, a bronchodilator. 4. This is the explanation for administering glucocorticoids, such as prednisone.

The child with an acute asthma attack is prescribed a 7-day course of the systemic corticosteroid prednisolone. The mother asks the nurse, "Doesn't this medication cause serious side effects?" Which statement is the nurse's best response? 1."Yes, this medication does have serious side effects, but your child needs the medication." 2."The doctor would not have ordered a medication that has serious side effects." 3."A short-term course of steroids will not cause serious side effects." 4."There may be serious side effects if your child takes the medication for a long time."

Answer: 3 Rationale: 1. Prolonged glucocorticoid therapy can cause serious adverse effects such as adrenal suppression, osteoporosis, hyperglycemia, and peptic ulcer disease. Short-term use does not cause these adverse effects. 2. Doctors often order medications that have serious side effects, but it must be done to treat the client. This statement is false andis not appropriate. 3. This is a true statement and the nurse's best response. 4. This is not the best response to the mother's question about her son's use of the medication. Prolonged glucocorticoid therapy can cause serious adverse effects, but short-term use does not cause the adverse effects.

The nurse is teaching the mother of a 9-year-old child with severe reactive airway disease. The child is prescribed salmeterol (Serevent) by metered dose inhaler (MDI) every 12 hours. Which instruction should the nurse include when discussing the medication with the mother? 1. Instruct the mother to perform and record a daily salmeterol level. 2. Inform the mother to notify the HCP if the child vomits or becomes irritable. 3. Tell the mother to observe the child for a sore throat and respiratory infection. 4. Recommend that the medication be refrigerated at all times.

Answer: 3 Rationale: 1. Serum salmeterol levels are not obtained. 2. This would apply to theophylline, not salmeterol. 3. Salmeterol is used when the client has not been responsive to other medications; side effects include pharyngitis and upper respiratory tract infections. The parent should be aware of the side effects. 4. Salmeterol does not need to be refrigerated.

The client is prescribed albuterol (Ventolin), a sympathomimetic bronchodilator, metered-dose inhaler. Which behavior indicates the teaching concerning the inhaler is effective? 1. The client holds his or her breath for 5 seconds and then exhales forcefully. 2. The client states the canister is full when it is lying on top of the water. 3. The client exhales and then squeezes the canister as the next inspiration occurs. 4. The client connects the oxygen tubing to the inhaler before administering the dose.

Answer: 3 Rationale: 1. The client should hold his or her breath as long as possible before exhaling to allow the medication to settle before administering another dose; 5 seconds is not long enough. 2. The client can check how much medication is in a metered-dose canister by placing the canister in a glass of water; if the canister stays under water, the canister is full, and if it floats on top of the water, is empty. 3. This is the correct way to use an inhaler because it will carry the medication down into the lung. 4. Oxygen is not used when using an inhaler; oxygen is used to deliver the medication when using an aerosol.

Which information should the nurse discuss with the client diagnosed with reactive airway disease who is prescribed theophylline (Slo-Phyllin), a xanthine bronchodilator? 1. Instruct the client to take the medication on an empty stomach. 2. Explain that an increased heart rate and irritability are expected side effects. 3. Discuss the need to avoid large amounts of caffeine-containing drinks. 4. Tell the client to double the next dose if a dose is missed.

Answer: 3 Rationale: 1. The client should take the medication with a glass of water or with meals to avoid an upset stomach. 2. The client should notify the health-care provider of a rapid or irregular heart beat,v omiting, dizziness, or irritability because these are not expected side effects. 3. The client should avoid drinking large amounts of caffeine-containing drinks such as tea, coffee, cocoa, and cola. 4. If a dose is missed within an hour, the client should take the dose immediately, but if it is more than 1 hour, the client should skip the dose and stay on the original dosing schedule. The client should not double the dose.

The 10-year-old child is being prescribed a cromolyn inhaler. Which statement indicates the child needs more teaching concerning the cromolyn inhaler? 1. "If I cannot take a deep breath, I will not use my cromolyn inhaler." 2. "I should not exhale into my inhaler after I have finished taking a puff." 3. "I should wait at least 1 hour to rinse my mouth after taking my inhaler." 4. "I should not stop taking my inhaler because I might have an asthma attack."

Answer: 3 Rationale: 1. The cromolyn inhaler should be taken routinely and is not used for an acute asthma attack; therefore, the child understands the teaching. 2. Moisture (from exhaled air) will interfere with proper use of the inhaler; therefore, the child understands the teaching. 3. The child should rinse the mouth with water immediately after using the inhaler to help prevent throat irritation,dry mouth, and hoarseness. 4. Discontinuing the medication quickly can cause the child to have an acute attack of asthma. The child understands this.

The client admitted for an acute exacerbation of reactive airway disease is receiving intravenous aminophylline. The client's serum theophylline level is 28 fig/mL. Which intervention should the nurse implement first? 1. Continue to monitor the aminophylline drip. 2. Assess the client for nausea and restlessness. 3. Discontinue the aminophylline drip. 4. Notify the health-care provider immediately.

Answer: 3 Rationale: 1. The therapeutic level for theophylline is10-20 fig/mL; therefore, the nurse should take action. 2. As the serum theophylline level rises above 20 fig/mL, the client will experience nausea, vomiting, diarrhea, insomnia, and restlessness. This theophylline level may result in serious effects, such as convulsions and ventricular fibrillation. Therefore, the client should not be assessed first. 3. The client has the potential for having convulsions and ventricular fibrillation because the theophylline level is too high; therefore, the nurse should discontinue the aminophylline drip first. 4. After discontinuing the aminophylline drip and then assessing the client for potential life-threatening complications, the nurse should notify the health-care provider. MEDICATION MEMORY JOGGER: The Nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

The female client asks the nurse why her teenage child would have many boxes of Sudafed, an over-the-counter cold and allergy medication, in her room. Which statement is the nurse's best response? 1. "Has your child always had allergy problems?" 2. "Teenagers will try to take care of their own health problems." 3. "Has the teenager's behavior at school or at home changed recently?" 4. "Remove the medication and say nothing to the teenager about it."

Answer: 3 Rationale: 1. These may be allergy medications when used legally, but they are also the ingredients in illegal methamphetamine production. Quantities of any medication in a teenager's room should be investigated. 2. Teenagers do try to develop independence, but it is always the parent or guardian's responsibility to monitor the child's health. 3. This situation could indicate the teenager is involved with the drug culture, taking for manufacturing drugs. The nurse should assess for signs of drug involvement. 4. The parent is responsible for determining the teenager's activities; the situation should be discussed with the teenager.

The client with an acute exacerbation of reactive airway disease is prescribed a nebulizer treatment. Which statement best describes how a nebulizer works? 1. Nebulizers are small, handheld pressurized devices that deliver a measured dose of anti asthma drug with activation. 2. A nebulizer is an inhaler that delivers an antiasthma drug in the form of a dry, micronized power directly to the lungs. 3. A nebulizer is a small machine used to convert an antiasthma drug solution into a mist that is delivered through a mouthpiece. 4. Nebulizers are small devices that are used to crush glucocorticoids so that the client can place them under the tongue for better absorption.

Answer: 3 Rationale: 1. This is the description of how a metered-dose inhaler works. 2. This is the description of how a dry-powder inhaler works. 3. This is the description of how a nebulizer works. Nebulizers take several minutes to deliver the same amount of drug contained in one puff from inhaler. They are usually used at home but can be used in the hospital. 4. This is not the description of how a nebulizer works. Glucocorticoids are not used sublingually to treat acute or chronic asthma.

The clinic nurse is teaching the parent of a child with reactive airway disease about nebulizer treatments. Which statement indicates the teaching has been effective? 1. "I will use half the medication in the nebulizer at each treatment." 2. "The nebulizer treatment will take about 30 minutes or longer." 3. "I will use a disinfectant solution weekly when cleaning the nebulizer." 4. "I will rinse the nebulizer in clean water after each breathing treatment."

Answer: 4 Rationale: 1. All the medication in the nebulizer should be used during the treatment; medication should not be stored in the nebulizer for later use. 2. The length of treatment is usually 10-15 minutes. If it takes longer, the parent should check the nebulizer equipment compressor for defects or problems. 3. The nebulizer should be cleaned daily (not weekly) using a disinfecting solution or a solution containing one-part white vinegar and four parts water. 4. The nebulizer should be cleaned with water after each treatment and allowed to air dry after loosely covering it with a clean paper towel. Storing the equipment wet promotes the growth of mold and bacteria.

The 6-year-old child is experiencing an acute exacerbation of reactive airway disease. The child passed out, and the parents brought the child to the emergency department. Which intervention should the nurse implement first? 1. Administer subcutaneous epinephrine via a tuberculin syringe. 2. Administer a beta2-adrenergic agonist, albuterol (Ventolin), via nebulizer. 3. Administer intravenous methylprednisolone, a glucocorticoid. 4. Administer oxygen to maintain oxygen saturation above 95%.

Answer: 4 Rationale: 1. Because the child is unconscious the nurse should prepare to administer epinephrine, a beta 2-adrenergic agonist, but this is not the first action. 2. The client is unconscious; therefore, a nebulizer could not be administered to the child. It would be administered as soon as the child is conscious. 3. If there is no response to the nebulizer, the n the child should receive an intravenous glucocorticoid. 4. The first intervention should be administering oxygen to the child and then administering medication. Oxygen is considered a medication.

The client diagnosed with arterial hypertension develops a cold. Which information regarding over-the-counter medications should the nurse teach? 1. Try to find a medication that will not cause drowsiness. 2. Over-the-counter medications are not as effective as a prescription. 3. Over-the-counter medications are more expensive than prescriptions. 4. Do not take over-the-counter medication unless approved by the HCP.

Answer: 4 Rationale: 1. The client should be informed about the dangers of self-medicating with over-the-counter (OTC) medications. Many OTC medications work by causing vasoconstriction, which will increase the client's hypertension. 2.Efficacy of medications depends on the medication and strength. Most OTC medications were at one time prescription medications. There are many variables, and this statement is too general to be true. 3. The expense of the medications is not the relevant point for this client. The problem is to inform the client about the actions of any OTC medications and the effect on the client's hypertension. 4.Many OTC medications work by causing vasoconstriction, which will increase the client's hypertension; the client should only take medications (approved by the HCP) that will not affect the client's hypertension.

The 28-year-old female client with chronic reactive airway disease is taking the leukotriene receptor inhibitor montelukast sodium (Singulair). Which statement by the client indicates the client teaching is effective? 1. "I will not drink coffee, tea, or any type of cola drinks." 2. "I will take this medication at the beginning of an asthma attack." 3. "It is all right to take this medication if I am trying to get pregnant." 4. "I should not decrease the dose or suddenly stop taking this medication."

Answer: 4 Rationale: 1. This medication does not stimulate the central nervous system; therefore, the client does not need to avoid caffeine-containing products. This statement indicates that the teaching is not effective. 2. These medications are not used to treat an acute exacerbation of reactive airway disease. They are adjunctive drugs given as part of the asthma regimen. This statement indicates the teaching is not effective. 3. The safety of these drugs has not been established in pregnancy and breastfeeding. This statement indicates that the teaching has not been effective. 4. The client should not suddenly stop taking the medication or decrease the dose. This statement indicates the teaching has been effective. Singulair is used with other types of asthma medications and should be continued if the client has an acute asthma attack.

Which medical treatment is recommended for the client who is diagnosed with mild intermittent asthma? 1. This classification of asthma requires a combination of long-term control medication plus a quick-relief medication. 2. Mild intermittent asthma needs a routine glucocorticoid inhaler and a sustained-relief theophylline. 3. This classification requires daily inhalation of an oral glucocorticoid and daily nebulizer treatments. 4. Mild intermittent asthma is treated on a PRN basis and no long-term control medication is needed.

Answer: 4 Rationale: 1. This type of medical treatment would be used for a client with mild persistent asthma. 2. This medical treatment would be prescribed for a client with moderate persistent asthma. 3. The most severe class, severe persistent asthma, is managed with daily inhalation of a glucocorticoid (high dose), plus salmeterol, a long-acting inhaled agent. 4. Mild intermittent asthma is treated on a PRN basis; long-term control medication is not needed. The occasional acute attack is managed by inhaling a short-acting beta2 agonist. If the client needs the beta2 agonist more than twice a week, moving to Step 2 (mild persistent asthma) may be indicated.

Which statement is the scientific theory for prescribing zinc preparations for a client with a cold? 1. Zinc binds with the viral particle and reduces the symptoms of a cold. 2. Zinc decreases the immune system's response to a virus. 3. Zinc activates viral receptors in the body's immune system. 4. Zinc blocks the virus from binding to the epithelial cells of the nose.

Answer: 4 Rationale: 1. Zinc does not bind the viral particle. Symptoms are diminished by blocking the ability of the virus to bind with the nasal lining. 2. Zinc is a micronutrient found in the body that helps to increase the body's immune system. 3. Activating viral receptors would increase the symptoms of a cold. 4 . Theoretically, zinc blocks viral binding to nasal epithelium. Observation has shown that increased amounts of zinc can prevent the binding and prevent the development of symptoms of the rhinovirus.

The health-care provider has ordered theophylline 5 mg/kg/q 6 hours for a child who weighs 35 lb. How much medication would the nurse administer in each dose?

Answer: 79.5 mg Rationale: 79.5 mg. First, convert the child's weight to kilograms: 35 ÷ 2.2 = 15.9 kg. Then, determine how many milligrams should be given with each dose: 15.9 kg ×5 mg = 79.5 mg per dose.

The pediatric nurse is caring for a 7-year-old child with chronic reactive airway disease who is being discharged. The nurse must evaluate the breathing capacity of the child to determine the effectiveness of the medication regimen. Which interventions should the nurse implement when using the peak flow meter? Select all that apply. 1. Instruct the child to lie down in the bed in the supine position. 2. Tell the child to seal the lips tightly around the mouthpiece. 3. Note the number on the scale after the client gives a sharp, short breath. 4. Blow into the peak flow meter one time and obtain the results. 5. Move the pointer on the peak flow meter to zero.

Answers: 2, 3, 5 Rationale: 1. The child should be standing up at the bedside, not lying down. 2. This is the correct way to obtain the peak flow meter results. 3. This is the correct way to take a reading from the peak flow meter. 4. The peak flow meter should be repeated three times, waiting at least 10 seconds between each attempt. The highest reading of the three attempts is recorded. 5. The pointer should be at zero everytime the child attempts to blow into the peak flow meter.

alveolar II cells

Cells in the lungs that produce surfactant, substance that reduces surface tension

What systems take part in respiratory system control?

Circulatory, Nervous, Musculoskeletal

The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? 1. "I must take the medication exactly as prescribed." 2. "Once I start the medication, I will no longer be contagious." 3. "I will not get any colds or infections while taking this medication." 4. "This medication has minimal side effects and I can return to normal activities."

Correct answer: 1 Rationale: Antiviral medications for influenza must be taken exactly as prescribed. These medications do not prevent the spread of influenza and clients are usually contagious for up to 2 days after the initiation of antiviral medications. Secondary bacterial infections may occur despite antiviral treatment. Side effects occur with these medications and may necessitate a change in activities, especially when driving or operating machinery if dizziness occurs.

The health care provider (HCP) has prescribed codeine sulfate for a client with a nonproductive cough to suppress the cough reflex. The nurse should teach the client to monitor for which side effect of the medication? 1. Constipation 2. Painful coughing 3. Increased urination 4. Difficulty swallowing

Correct answer: 1 Rationale: Codeine sulfate is an opioid analgesic, and a frequent side effect is constipation. Additional side effects include drowsiness, nausea, and vomiting. Urinary retention is also a concern, and urine output should be monitored. Painful coughing and difficulty swallowing are unrelated to the administration of this medication.

A client has begun using a methylxanthine bronchodilator. What beverage should the nurse plan to teach the client to avoid while taking this medication? 1. Coffee 2. Orange juice 3. Mineral water 4. Cranberry juice

Correct answer: 1 Rationale: Cola, coffee, and chocolate contain methylxanthine and should be avoided by the client taking a methylxanthine bronchodilator. The additional methylxanthine could lead to increased incidence of cardiovascular and central nervous system side effects. Orange juice, mineral water, and cranberry juice are fluids that are allowed.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1. "I will take the medication on an empty stomach." 2. "I won't drink alcohol while taking this medication." 3. "I won't do activities that require mental alertness while taking this medication." 4. "I will use sugarless gum, candy, or oral rinses to decrease dryness in my mouth."

Correct answer: 1 Rationale: Diphenhydramine has several uses, including as an antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Instructions for use include taking with food or milk to decrease gastrointestinal upset and using oral rinses, sugarless gum, or hard candy to minimize dry mouth. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities requiring mental awareness during use.

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instruction is needed when the client makes which statement? 1. "I use my corticosteroid inhaler each time I feel short of breath." 2. "I see my doctor if I have an upper respiratory infection and always get a flu shot." 3. "I use my bronchodilator inhaler before walking so I don't become short of breath." 4. "I use my bronchodilator inhaler before I visit places like the zoo because of my allergies."

Correct answer: 1 Rationale: Most asthma medications are administered via inhalation because of their fast action via this route. Inhaled corticosteroids are preferred for long-term control of persistent asthma. They decrease inflammation and reduce bronchial hyperresponsiveness. Bronchodilator medications are considered "rescue" types because their onset is faster. Clients would use this type of medication to provide rapid relief of symptoms such as bronchospasm, which can be caused by a variety of triggers. Clients need to be evaluated for understanding of their disease, identifying triggers, and the proper use of equipment and medications.

A client with a prescription to take theophylline daily has been given medication instructions by the nurse. What statement by the client indicates the need for further education regarding the prescription? 1. "I will take the daily dose at bedtime." 2. "I need to drink at least 2 liters of fluid per day." 3. "I know to avoid changing brands of the medication without my health care provider's approval." 4. "I'll avoid over-the-counter cough and cold medications unless approved by my health care provider."

Correct answer: 1 Rationale: The client taking a single daily dose of theophylline, a xanthine bronchodilator, should take the medication early in the morning. This enables the client to have maximal benefit from the medication during daytime activities. In addition, this medication causes insomnia. The client should take in at least 2 L of fluid per day to decrease viscosity of secretions. The client should check with the health care provider (HCP) before changing brands of the medication because levels of bioavailability may vary for different preparations. The client also should check with the HCP before taking over-the-counter cough, cold, or other respiratory preparations because they could have interactive effects, increasing the side and adverse effects of theophylline and causing dysrhythmias.

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving theophylline. The nurse monitors the serum theophylline level and concludes that the medication dosage may need to be increased if which value is noted? 1. 5 mg/mL (20 mcmol/L) 2. 10 mg/mL (40 mcmol/L) 3. 15 mg/mL (60 mcmol/L) 4. 20 mg/mL (79 mcmol/L)

Correct answer: 1 Rationale: Theophylline is a bronchodilator. The nurse monitors the theophylline blood serum level daily when a client is on this medication to ensure that a therapeutic range is present and monitor for the potential for toxicity. The therapeutic serum level range is 10 to 20 mg/mL (40 to 79 mcmol/L). If the laboratory result indicated a level of 5 mg/mL (20 mcmol/L), the dosage of the medication would need to be increased.

A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1. Coffee, cola, and chocolate 2. Oysters, lobster, and shrimp 3. Melons, oranges, and pineapple 4. Cottage cheese, cream cheese, and dairy creamers

Correct answer: 1 Rationale: Theophylline is a methylxanthine bronchodilator. The nurse teaches the client to limit the intake of xanthine-containing foods while taking this medication. These foods include coffee, cola, and chocolate.

A client receiving oral theophylline is due to have a theophylline level drawn. The nurse should question the client to ensure that the client has not ingested which substance before the blood sample is drawn? 1. Coffee 2. Oatmeal 3. Ginger ale 4. Bagel with cream cheese

Correct answer: 1 Rationale: Theophylline is a xanthine bronchodilator. Before a serum level of the medication is drawn, the client should avoid taking foods or beverages that contain xanthine, such as colas, coffee, or chocolate; therefore, the client is told to avoid coffee before the test. The items in the other options do not need to be avoided before this test.

The nurse should monitor the client receiving the first dose of albuterol for which side or adverse effect of this medication? 1. Drowsiness 2. Tachycardia 3. Hyperkalemia 4. Hyperglycemia

Correct answer: 2 Rationale: Albuterol is a bronchodilator. Side and adverse effects include tachycardia, hypertension, chest pain, dysrhythmias, nervousness, restlessness, and headache. The nurse monitors for these effects during therapy. The items in the other options are not side and adverse effects of this medication.

The nurse is teaching a client about the effects of diphenhydramine, an ingredient in the cough suppressant prescribed for the client. The nurse should plan to tell the client to take which measure while taking this medication? 1. Take it on an empty stomach. 2. Avoid activities requiring mental alertness. 3. Use alcohol for additional effect in reducing cough. 4. Avoid chewing sugarless gum or using oral rinses mouth.

Correct answer: 2 Rationale: Diphenhydramine has several uses, including antihistamine, antitussive, antidyskinetic, and sedative-hypnotic. Because the medication causes drowsiness, the client should avoid use of alcohol or central nervous system depressants, operating a car, or engaging in other activities that require mental acuity. It should be taken with food or milk to decrease gastrointestinal upset, and oral rinses, sugarless gum, or hard candy may be used to minimize dry mouth.

A client has a prescription to take guaifenesin. The nurse should conclude that the client understands the most effective use of this medication if the client states that they need to take which action? 1. Watch for irritability as a side effect. 2. Take the tablet with a full glass of water. 3. Take an extra dose if the cough is accompanied by fever. 4. Crush the sustained-release tablet if immediate relief is needed.

Correct answer: 2 Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. The medication occasionally may cause dizziness, headache, or drowsiness as side effects. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Sustained-release preparations should not be broken open, crushed, or chewed.

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? 1. Beclomethasone first and then the salmeterol 2. Salmeterol first and then the beclomethasone 3. Alternating a single puff of each, beginning with the salmeterol 4. Alternating a single puff of each, beginning with the beclomethasone

Correct answer: 2 Rationale: Salmeterol is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when both are to be given on the same time schedule. This allows for widening of the air passages by the bronchodilator, which then makes the glucocorticoid more effective.

The client questions the nurse as to why the health care provider switched the usual prescription from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). The nurse should respond correctly by providing which facts? Select all that apply. 1. Dry powder inhalers have fewer side effects. 2. Dry powder inhalers pose no environmental risks. 3. Dry powder inhalers can be administered more frequently. 4. Dry powder inhalers deliver more medication to the lungs. 5. Dry powder inhalers require less hand-to-lung coordination.

Correct answer: 2, 4, 5 Rationale: DPIs are used to deliver medications in the form of a dry, micronized powder directly to the lungs. DPIs do not require the hand-to-lung coordination needed with MDIs; thus, DPIs are much easier to use. Compared with MDIs, DPIs deliver more medication to the lungs (20% of the total released versus 10%) and less to the oropharynx. Because DPIs do not require propellant, they are not a risk to the environment. Both types of inhalers have side effects. Frequency of use is prescribed by the health care provider.

A client has begun therapy with a xanthine bronchodilator. The nurse determines that the client understands dietary alterations if the client states to limit which items while taking this medication? Select all that apply. 1. Milk 2. Coffee 3. Oysters 4. Oranges 5. Pineapple 6. Chocolate

Correct answer: 2, 6 Rationale: The nurse teaches the client to limit the intake of xanthine-containing foods while taking a xanthine bronchodilator. These include coffee and chocolate. The other food items are acceptable to consume.

A client taking albuterol by inhalation cannot cough up secretions. What should the nurse suggest that the client do to assist in expectoration of secretions? 1. Get more exercise each day. 2. Use a dehumidifier in the home. 3. Drink increased amounts of fluids every day. 4. Take an extra dose of albuterol before bedtime.

Correct answer: 3 Rationale: A client should drink increased fluids (2000 to 3000 mL/day) to decrease viscosity and increase expectoration of secretions. This is standard advice for clients receiving any of the adrenergic bronchodilators, unless the client has another health problem that contraindicates an increased fluid intake. Additional exercise will not effectively clear bronchial secretions. A dehumidifier will dry secretions, making the situation worse. The client should not take additional medication.

The nurse is preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? 1. Nausea and vomiting 2. Headache and level of consciousness 3. Lung sounds and presence of dyspnea 4. Urine output and blood urea nitrogen level

Correct answer: 3 Rationale: Albuterol is an adrenergic bronchodilator. The nurse assesses respiratory pattern, lung sounds, pulse, and blood pressure before and during therapy. The nurse also notes the color, character, and amount of sputum.

The health care provider prescribes cromolyn for the client with asthma. The nurse identifies that the client correctly understands the purpose of this medication when the client states that the medication will produce which effect? 1. Promote bronchodilation 2. Decrease the risk of infection 3. Suppress an allergic response 4. Eliminate the need for a rescue inhaler

Correct answer: 3 Rationale: Cromolyn is a first-line therapy for prophylactic treatment of asthma; it is a mast cell stabilizer, antiasthmatic, and antiallergic. The medication acts in part by stabilizing the cytoplasmic membrane of mast cells, thereby preventing release of histamine and other mediators. It is not a bronchodilator. It does not decrease the risk of infection. It does not eliminate the need for the rescue inhaler.

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? 1. Take an extra dose if fever develops. 2. Take the medication with meals only. 3. Take the tablet with a full glass of water. 4. Decrease the amount of daily fluid intake.

Correct answer: 3 Rationale: Guaifenesin is an expectorant and should be taken with a full glass of water to decrease the viscosity of secretions. Extra doses should not be taken. The client should contact the health care provider if the cough lasts longer than 1 week or is accompanied by fever, rash, sore throat, or persistent headache. Fluids are needed to decrease the viscosity of secretions. The medication does not have to be taken with meals.

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? 1. Nasogastric tube 2. Paracentesis tray 3. Resuscitation equipment 4. Central line insertion tray

Correct answer: 3 Rationale: The nurse administering Naloxone {Narcan = antidote of Narcotic drugs} for suspected opioid overdose should have resuscitation equipment readily available to support naloxone therapy if it is needed. Other adjuncts that may be needed include oxygen, a mechanical ventilator, and vasopressors.

Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1. Platelet count 2. Neutrophil count 3. Liver function tests 4. Complete blood count

Correct answer: 3 Rationale: Zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma {Leukotriene cause bronchoconstriction; leukotriene modifiers/antagonists cause bronchodilation}. Zafirlukast is used with caution in clients with impaired hepatic function. Liver function laboratory tests should be performed to obtain a baseline, and the levels should be monitored during administration of the medication. It is not necessary to perform the other laboratory tests before administration of the medication.

A client is scheduled to receive acetylcysteine 20% solution diluted in 0.9% normal saline by nebulizer. Which outcome would the nurse expect as a result of the administration of this medication? 1. Bronchodilation 2. Decreased coughing 3. Absence of wheezing 4. Thinning of respiratory secretions

Correct answer: 4 Rationale: Acetylcysteine is administered to thin bronchial secretions and is considered a mucolytic. The remaining options are the outcomes of respiratory medication therapy, but not of acetylcysteine.

Cromolyn sodium is prescribed for the client with allergic asthma. What goal does the nurse expect to achieve by administration of this medication? 1. Dilation of the bronchi 2. Increase in the number of eosinophils 3. Promotion of the migration of eosinophils into the inflammatory site 4. Inhibition of the release of mediators from mast cells after exposure to an antigen

Correct answer: 4 Rationale: Cromolyn sodium is an antiasthmatic, antiallergic, and mast cell stabilizer that inhibits the release of mediators from mast cells after exposure to an antigen. It can also interrupt the migration of eosinophils into the inflammatory site and decrease the number of eosinophils. These actions decrease airway hyperresponsiveness in some clients with asthma. It has no bronchodilating action.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1. Insomnia 2. Constipation 3. Hypotension 4. Bronchospasm

Correct answer: 4 Rationale: Cromolyn sodium is an inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. Undesirable effects associated with inhalation therapy of cromolyn sodium are bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Clients receiving this medication orally may experience pruritus, nausea, diarrhea, and myalgia.

A client who experiences allergic rhinitis asks the nurse about a nasal corticosteroid. How should the nurse reply? 1. "Clear the nasal passages after use." 2. "Take the medication only as needed." 3. "The medication should start to work immediately." 4. "The medication works locally and decreases inflammation."

Correct answer: 4 Rationale: Intranasal corticosteroids may be used to treat allergic rhinitis. The medication works locally and decreases inflammation. The client should be instructed to clear the nasal passages before use for best medication effectiveness. The client should take the medication regularly as prescribed in order for the effect to be achieved. The medication may take several days to achieve maximal effect because it works by decreasing inflammation.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? 1. "I have a severe headache." 2. "My feet are quite swollen." 3. "I am nauseated and may vomit." 4. "My lips and tongue are swollen."

Correct answer: 4 Rationale: Omalizumab is an antiinflammatory used for long-term control of asthma. Anaphylactic reactions can occur with the administration of omalizumab. The nurse administering the medication should monitor for adverse reactions of the medication. Swelling of the lips and tongue are an indication of an anaphylaxis. The client statements in options 1, 2, and 3 are not indicative of an adverse reaction.

A client with an exacerbation of chronic obstructive pulmonary disease (COPD) has been on oral glucocorticoids and is currently being weaned to triamcinolone by inhalation. The nurse determines that the client understands the potential adverse effects to watch for during this medication change when the client states the need to report which signs and symptoms? 1. Chills, fever, and generalized rash 2. Vomiting, diarrhea, and increased thirst 3. Blurred vision, headache, and insomnia 4. Anorexia, nausea, weakness, and fatigue

Correct answer: 4 Rationale: The client being changed from oral to inhalation glucocorticoids could experience signs of adrenal insufficiency. The nurse teaches the client to report anorexia, nausea, weakness, and fatigue. Other signs that can be detected and are objective include hypotension and hypoglycemia.

A home care nurse has observed a client self-administer a dose of an adrenergic bronchodilator via metered-dose inhaler. Within a short time, the client begins to wheeze loudly. The nurse understands that this is the result of which occurrence? 1. Insufficient dosage of the medication, which needs to be increased 2. Probable interaction of this medication with an over-the-counter cold remedy 3. Tolerance to the medication, indicating a need for a stronger type of bronchodilator 4. Paradoxical bronchospasm, which must be reported to the health care provider (HCP)

Correct answer: 4 Rationale: The client taking adrenergic bronchodilators may experience paradoxical bronchospasm, which is evidenced by the client's wheezing. This can occur with excessive use of inhalers. Further medication should be withheld and the HCP should be notified. The remaining options are incorrect interpretations.

A client taking theophylline has a serum theophylline level of 15 mcg/mL (60 mcmol/L). How does the nurse interpret this laboratory value? 1. Below therapeutic range 2. In excess of the therapeutic range 3. Near the top of the therapeutic range 4.In the middle of the therapeutic range

Correct answer: 4 Rationale: The normal therapeutic range for the theophylline level is 10 to 20 mcg/mL (40 to 79 mcmol/L). A level above 20 mcg/mL (79 mcmol/L) is considered toxic. The value of 15 mcg/mL places the client in the middle of the therapeutic range.

A client with chronic obstructive pulmonary disease (COPD) is being changed from an oral glucocorticoid to triamcinolone by inhalation. The client asks why this change is necessary. Which statement by the nurse to the client is accurate? 1. "Inhaled glucocorticoids cure the condition." 2. "Inhaled glucocorticoids treat this condition more effectively." 3. "Inhaled glucocorticoids decrease the symptoms more quickly." 4."Inhaled glucocorticoids are preferred because of decreased adverse effects."

Correct answer: 4 Rationale: Triamcinolone is an adrenocorticosteroid. Inhaled glucocorticoids are preferable for long-term management because there is a decreased incidence of adverse effects since the medication is not absorbed systemically. COPD is a progressive condition and cannot be cured. Options 2 and 3 are incorrect.

Which statement made by a client taking Montelukast indicates the need for further teaching? 1. "I will need to have my liver function checked." 2. "I can take the medication with food or without." 3. "I may be able to decrease the use of my metered-dose inhaler." 4. "I will take the medication when I first notice I am having trouble breathing."

Correct answer: 4 Rationale: cannot be used for quick relief of an asthma attack because effects of the medication develop too slowly. For prophylaxis and maintenance therapy of asthma, maximal effects develop within 24 hours of the first dose and are maintained with once-daily dosing in the evening. The remaining options are correct statements.

Pulm. artery: what type of blood flow?

Deoxygenated blood (low PaO2)

What are the functions of the upper respiratory tract?

Is first line of immunological defense• Warms, humidifies, & cleans incoming air

opiod overdose treatment

Naloxone (Narcan)- opioid antagonist, increase in pain level can occur after administering

Pulmonary Vein: what type of blood flow

Oxygenated Blood (high PO2

SOB: what do we evaluate?

PASTE P:provoking factors? What were you doing when this started? A: associated chest pain S: sputum production? coughing up sputum? What color & how much? T: Tiredness/Time? When did symptoms begin? E: exercise tolerance

Brain stem damage can lead to?

Respiratory arrest

What is hypoxic drive?

a form of respiratory drive in which the body uses oxygen chemoreceptors instead of carbon dioxide receptors to regulate the respiratory cycle Accounts for 10% of total drive to breathe. This increases as PaO2 decreases Normal resp. is driven by the levels of CO2 in the arteries, which are detected indirectly by central chemoreceptors.• An ↑ in CO2 will cause chemoreceptor reflexes to trigger an increase in ventilation.• So, the levels of CO2 dictate how fast we will breathe

Is inspiration a passive or active process?

active

Where is the site of gas exchange in the lungs?

alveoli

Where are peripheral chemoreceptors located?

carotid and aortic bodies

s/s of hypoxia

confusion, cyanosis is a late sign

What is hypocapnia?

decreased PCO2 in the blood, caused by hyperventilation and excessive amounts of CO2 expired, causes respiratory alkalosis

Alveolar 1 cells

diffusion

What structure protects opening into larynx. & Closes over glottis at swallowing to prevent aspiration

epiglottis

What is hypercapnia?

excess carbon dioxide in the blood

What drives COPD patients to breath?

hypoxic drive -give them a little O2

What is hypoxemia

low oxygen in the blood

What is hypoxia? What does it lead to?

low oxygen in tissues, leads to ischemia, necrosis, and cell death

Where are central chemoreceptors located?

medulla oblongata (brain stem)

How does the musculoskeletal system participate in respirations?

participates in chest expansions and contraction

Is expiration active or passive?

passive

What does quiet expiration consist of?

passive process allows the diaphragm and muscles relax and the elastic lungs and thoracic wall coil inwards

What does the Nervous System regulate?

rate & depth of respiration primary resp center located in the medulla oblongata and pons

RRED assessment

rate, rhythm, effort, depth

What does hypercapnia cause?

respiratory acidosis, lowers pH and stimulates resp center, body compensates by increasing RR (hyperventilation)

What is an early sign of hypoxemia?

restlessness

what causes respiratory depression

severe hypoxemia and hypercapnia

What exists when there is no ventilation to an alveolar unit but perfusion continues?

shunt

What does quiet inspiration consist of?

the diaphragm and external intercostal muscles contract and pull downward, enlarging the thoracic cavity

What is dead space?

the volume of air which is inhaled that does not take part in the gas exchange