Unit 7 - Respiratory Dysfunction

The nurse is teaching nursing students about normal physiologic changes in the respiratory system of toddlers. Which best describes why toddlers have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

ANS: B Children have increased immunity after exposure to a virus. The amount of lymphoid tissue increases as children grow older. Viral organisms are not less prevalent, but older children have the ability to resist invading organisms. Secondary infections after viral illnesses include Mycoplasma pneumoniae and group A β-hemolytic streptococcal infections.

Which consideration is the most important in managing tuberculosis (TB) in children? a. Skin testing annually b. Pharmacotherapy c. Adequate nutrition d. Adequate hydration

ANS: B Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. Pharmacotherapy is the most important intervention for TB.

Which type of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

ANS: B Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. Laryngitis is a common viral illness in older children and adolescents, with hoarseness and URI symptoms. Spasmodic croup is treated with humidity. LTB may progress to a medical emergency in some children.

The nurse is assessing a child with acute epiglottitis. Examining the child's throat by using a tongue depressor might precipitate which symptom or condition? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

ANS: B If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place. Stridor is aggravated when a child with epiglottitis is supine. Sore throat and pain on swallowing are early signs of epiglottitis. Epiglottitis is caused by H. influenzae in the respiratory tract.

The nurse is assessing a child with croup and a sore throat in the ED. The child is drooling and agitated. The nurse knows that examining the child's throat using a tongue depressor might precipitate which of the following? A. Profuse coughing B. Inspiratory stridor C. Complete obstruction D. Increased agitation

ANS: C

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which disease or assessment findings may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

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

When is it generally recommended that a child with acute streptococcal pharyngitis may return to school? a. When sore throat is better. b. If no complications develop. c. After taking antibiotics for 24 hours. d. After taking antibiotics for 3 days.

ANS: C After children have taken antibiotics for 24 hours, they are no longer contagious to other children. Sore throat may persist longer than 24 hours after beginning antibiotic therapy, but the child is no longer considered contagious. Complications may take days to weeks to develop.

A nurse is caring for a child who is in the postoperative period following a tonsillectomy. Which of the following is a clinical finding of postoperative bleeding? a. Hgb 11.6 and Hct 37% b. inflamed ad reddened throat c. frequent swallowing and clearing of the throat d. blood-tingled mucus

ANS: C Frequent swalloing and clearing thrat indicates that there is an increase amount of fluid in the back of the throat, which is indicates bleeding

A nurse is teaching an adolescent how to use the peak expiratory flowmeter. The adolescent has understood the teaching if which statement is made? a. "I will record the average of the readings." b. "I should be sitting comfortably when I perform the readings." c. "I will record the readings at the same time every day." d. "I will repeat the routine two times."

ANS: C Instructions for use of a peak flowmeter include standing up straight before performing the reading, recording the highest of the three readings (not the average), measuring the peak expiratory flow rate (PEFR) close to the same time each day, and repeating the entire routine three times, waiting 30 seconds between each routine.

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

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

A nurse is teaching nursing students about clinical manifestations of cystic fibrosis (CF). Which is/are the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

ANS: A - The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. - History of malabsorption is a later sign that manifests as failure to thrive. - Foul-smelling stools are a later manifestation of CF. - Recurrent respiratory tract infections are a later sign of CF.

A child is being admitted to the hospital to be tested for cystic fibrosis (CF). Which tests should the nurse expect? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool test for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

ANS: A A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. - Gastric contents contain hydrochloride normally; it is not diagnostic. - Bronchoscopy and duodenal fluid are not diagnostic. - Stool test for trypsin and intestinal biopsy are not helpful in diagnosing CF.

A child with cystic fibrosis (CF) receives aerosolized bronchodilator medication. When should this medication be administered? a. Before chest physiotherapy (CPT) b. After CPT c. Before receiving 100% oxygen d. After receiving 100% oxygen

ANS: A Bronchodilators should be given before CPT to open bronchi and make expectoration easier. Aerosolized bronchodilator medications are not helpful when used after CPT. Oxygen administration is necessary only in acute episodes with caution because of chronic carbon dioxide retention.

Parents of a child with cystic fibrosis ask the nurse about genetic implications of the disorder. Which statement, made by the nurse, expresses accurately the genetic implications? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

ANS: A CF is an autosomal recessive gene inherited from both parents and is inherited as an autosomal recessive, not autosomal dominant, trait. CF is found primarily in Caucasian populations. An autosomal recessive inheritance pattern means that there is a 25% chance a sibling will be infected but a 50% chance a sibling will be a carrier.

In providing nourishment for a child with cystic fibrosis (CF), which factor should the nurse keep in mind? a. Diet should be high in carbohydrates and protein b. Diet should be high in easily digested carbohydrates and fats c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

ANS: A Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption. Enzyme supplementation helps digest foods; other modifications are not necessary. A well-balanced diet containing fruits and vegetables is important. Fats and proteins are a necessary part of a well-balanced diet.

An infant's parents ask the nurse about preventing OM. Which should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in a supine position.

ANS: A Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. Nasal decongestants are not useful in preventing OM. Children with uncomplicated OM are not contagious unless they show other upper respiratory tract infection (URI) symptoms. Children should be fed in an upright position to prevent OM.

An infant with a congenital heart defect is receiving palivizumab (Synagis). Based on the nurse's knowledge of medication, the purpose of this medication is to A. prevent respiratory syncytial virus (RSV) infection. B. make isolation of the infant with RSV unnecessary. C. prevent secondary bacterial infection. D .decrease toxicity of antiviral agents.

ANS: A Palivizumab is a monoclonal antibody specifically used in the prevention of RSV. Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. Palivizumab is specific to RSV, not bacterial infections. Palivizumab will have no effect on antiviral agents.

The parent of a child with cystic fibrosis calls the clinic nurse to report that the child has developed tachypnea, tachycardia, dyspnea, pallor, and cyanosis. The nurse should tell the parent to bring the child to the clinic because these symptoms are suggestive of: A. pneumothorax. B. bronchodilation. C. carbon dioxide retention. D. increased viscosity of sputum.

ANS: A The child is exhibiting signs of increasing respiratory distress suggestive of a pneumothorax. The child needs to be seen as soon as possible. Bronchodilation would not produce the described symptoms. Carbon dioxide retention would not produce the described symptoms. The increased viscosity of sputum is characteristic of cystic fibrosis. The change in respiratory status is potentially due to a pneumothorax.

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

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

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which action? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

ANS: A Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. Drops should be discarded after one illness because they may become contaminated with bacteria. Vasoconstrictive nose drops can have a rebound effect after 3 days of use. Drops administered before feedings are more helpful.

A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral infection c. Exposure to cold air d. Allergy to dust or dust mites

ANS: B - Viral illnesses cause inflammation that causes increased airway reactivity in asthma. - Medications such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics may aggravate asthma, but not frequently in infants. - Exposure to cold air may exacerbate already existing asthma. - Allergy is associated with asthma, but 20% to 40% of children with asthma have no evidence of allergic disease.

The mother of a 20-month-old tells the nurse that the child has a barking cough at night. The child's temperature is 37ºC (98.6ºF). The mother states the child is not having difficulty breathing. The nurse suspects croup and should recommend A. controlling the fever with acetaminophen (Tylenol) and call the primary care provider if the cough gets worse tonight. B. trying a cool-mist vaporizer at night and watching for signs of difficulty breathing. C. trying over-the-counter cough medicine a

ANS: B Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency department if they develop. Cool mist is recommended to provide relief because this therapy will assist in opening up the child's airways. The child does not have a temperature and, therefore, does not need management with acetaminophen. Cough suppressants are not indicated by symptoms, and the American Pediatrics Association no longer recommends over-the-counter cough medicines for children under the age of 2 years. A barking cough is characteristic of laryngotracheobronchitis, not epiglottitis.

Which is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

ANS: D Preventing dehydration by small frequent feedings is an important intervention in the febrile child. Tepid water baths may induce shivering, which raises temperature. Food should not be forced; it may result in the child vomiting. The febrile child should be dressed in light, loose clothing.

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

ANS: D Short-acting β2 agonists are the first treatment in an acute asthma exacerbation. Ephedrine is not helpful in acute asthma exacerbations. Theophylline is unnecessary for treating asthma exacerbations. Aminophylline is not helpful for acute asthma exacerbation.

A child with asthma is having pulmonary function tests. What explains the purpose of the peak expiratory flow rate (PEFR)? A. Confirms the diagnosis of asthma B. Determines the cause of asthma C. Identifies the "triggers" of asthma D. Assesses the severity of asthma

ANS: D The PEFR measures the maximum amount of air that can be forcefully exhaled in 1 minute. This can provide an objective measure of pulmonary function when compared with the child's baseline. The diagnosis of asthma is made on the basis of clinical manifestations, history, and physical examination, not pulmonary function tests such as the PEFR. The cause of asthma is inflammation, bronchospasm, and obstruction, which are not identified by the PEFR. Some of the triggers of asthma are identified with allergy testing, not with the PEFR.

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

ANS: D, E, F - Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. - Clustering of care promotes periods of rest. - The use of noninvasive oxygen monitoring is recommended. - Mist tents are no longer used. Antibiotics do not treat illnesses with viral causes. Cough syrup suppresses clearing of respiratory secretions and is not indicated for young children.

A child with asthma states "I want to play sports like my friends. What can I do?" The nurse should respond to the child based on the understanding of which information? a. most children with asthma can participate in sports if the asthma is controlled b. children with asthma must be excluded from sport teams c. vigorous physical exercise frequently precipitates an asthmatic episode d. physical activities are inappropriate for children with asthma

a. most children with asthma can participate in sports if the asthma is controlledasthmass

The nurse is assessing a child with asthma. Which of the following findings should the nurse report immidiately to the healthcare provider? a. a dry, hacking cough b. pulsus paradoxus c. breath sounds that are clear bilaterally d. respiratory rate of 24 breaths per minute

b. pulsus paradoxus Abnormally large decrease in blood pressure during inspiration. The rest of the options are within normal limits

A child who uses an inhaled bronchodilator only when needed for asthma has a best peak expiratory rate of 270 L/min. The child's current peak flow reading is 180 L/min. How does the nurse interpret this reading? a. the child's asthma is under good control, so the routine treatment plan should continue b. the child needs to use short-acting, inhaled beta-2 agonist medication c. this is a medical emergency requiring a trip to the emergency department for treatment d. the child needs to use inh

b. the child needs to use short-acting, inhaled beta-2 agonist medication The child is in the yellow zone, 50 - 80 %. therefore, the need for a beta-2 agonist is essential to control asthma

A 5 year old child with a known history of asthma presents to the clinic with wheezing and a persistent cough. What is the most appropriate initial action for the nurse? a. initiate chest compressions b. administer high-flow oxygen c. assess the child's peak expiratory rate d. start an IV

c. assess the child's peak expiratory rate The most appropriate initial peak expiratory rate. The nurse should first assess according to the nursing process

While providing care for a child diagnosed with pertussis, the registered nurse (RN) will be alert for what priority complication? a. atelectis b. OM c. seizures d. airway obstruction

d. airway obstruction Airway obstruction is the priority complication the RN will be alert for in the child diagnosed with pertussis. After 1 to 2 weeks of the initial upper respiratory infection clinical manifestations, the cough will progress into a high-pitched cough that sounds like a barking seal, referred to as a whooping cough.

What action performed by the new graduate nurse (GN), requires the registered nurse (RN) in charge to intervene as the two are performing an initial assessment for a 4 year old male diagnosed with epiglottitis? a. monitoring oxygen saturation continuously b. allow the child to remain in his mother's lap c. moving quietly in attempt not to wake the child up d. taking an oral temperature

d. taking an oral temperature This answer is correct because assessing the temperature using an oral thermometer is not an action the GN should implement. Examination of the throat or inserting anything in the mouth is contradicted.

Cystic fibrosis must often affects multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is which of the following? A. Hyperactivity of the sweat glands B. Hyperactivity of parasympathetic nervous system C. Sweat chloride test >60 mEq/L D. Increased viscosity of mucous gland secretions

ANS: D

Which of the following statements best represents infectious mononucleosis? A. Herpes simplex type 2 B. Leukopenia is often paired with the diagnosis C. Amoxicillin is used to treat the pharyngitis D. Physical assessment and blood tests are used as test results to establish the diagnosis

ANS: D

Cystic fibrosis (CF) is suspected in a toddler. Which test is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

ANS: D A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. Bronchoscopy, although helpful for identifying bacterial infection in children with CF, is not diagnostic. Serum calcium is normal in children with CF. Urine creatinine is not diagnostic of CF.

What assessment finding alerts the registered nurse (RN) that a 7 year old male experiencing an asthma exacerbation is progressing into status asthmaticus? a. oxygen saturation increases from 86% to 90% b. resting quietly in a side-lying position c. equal inspiratory and expiratory signs of breathing d. absence of wheezing and increase respiratory efforts

ANS: D Absence of wheezing and decreased respiratory effort is an assessment that alerts the RN to the development of status asthmaticus. All patients with bronchial asthma are at risk of developing an acute episode with a progressive severity that is poorly responsive to standard therapeutic measures, regardless of disease severity or phenotypic variant.

Cystic fibrosis may affect one system or multiple systems of the body. What is the primary factor responsible for possible multiple clinical manifestations? A. Atrophic changes in the mucosal wall of the intestines B. Hypoactivity of the autonomic nervous system C. Hyperactivity of the apocrine glands D. Mechanical obstruction caused by increased viscosity of exocrine gland secretions

ANS: D Children with cystic fibrosis have thick exocrine gland secretions. The viscous secretions obstruct small passages in organs such as the lungs and pancreas. Thick mucous secretions are the probable cause of the multiple-body system involvement, not atrophic changes in the intestinal mucosal walls. There is an identified autonomic nervous system anomaly, but it is not hypoactivity. The apocrine, or sweat, glands are not hyperactive. The child loses a greater amount of salt due to abnormal chloride movement.

It is important that a child with acute streptococcal pharyngitis be treated with antibiotics to prevent A. otitis media. B. diabetes insipidus. C. nephrotic syndrome. D. acute rheumatic fever

ANS: D Children with group A β-hemolytic streptococci (GABHS) infection are at risk for acute rheumatic fever and acute glomerulonephritis. Otitis media is not a complication of acute streptococcal pharyngitis. Diabetes insipidus is not a complication of acute streptococcal pharyngitis. Children who have had acute streptococcal pharyngitis are at risk for acute glomerulonephritis, not nephrotic syndrome.

Pancreatic enzymes are administered to the child with cystic fibrosis (CF). What nursing considerations should be included? a. Do not administer pancreatic enzymes if the child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if the child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

ANS: D Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. - Pancreatic enzymes are not a contraindication for antibiotics. - The dosage of enzymes should be increased if the child is having frequent, bulky stools. - Enzymes should be given just before meals and snacks.

A humidified atmosphere is recommended for a young child with an upper respiratory tract infection because it: A. liquefies secretions. B. improves oxygenation. C. promotes ventilation. D. soothes inflamed mucous membranes.

ANS: D Humidified inspired air smoothes the membranes inflamed by the infection and dry air. The size of the droplets in humidified air is too large to liquefy secretions. No additional oxygen is provided with humidified air. The humidity has no effect on ventilation.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant displays which clinical manifestation? a. Fussiness b. Coughing c. A fever over 99° F d. Signs of an earache

ANS: D If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and the infant should be referred to a practitioner for evaluation. Irritability is common in an infant with a viral illness. Cough can be a sign of nasopharyngitis. Fever is common in viral illnesses.

The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease the child's respiratory efforts. c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's re

ANS: B The family's presence will decrease the child's distress. It is true that mothers of hospitalized toddlers often experience guilt but this is not the best answer. The main reason to keep parents at the child's bedside is to ease anxiety and therefore respiratory effort. The child should have constant monitoring by cardiorespiratory monitor and noninvasive oxygen saturation monitoring, but the parent should not play this role in the hospital. Ladrar = laryngotracheobronchitis ePi

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

ANS: B β-Adrenergic agonists and methylxanthines work to dilate the bronchioles in acute exacerbations. These medications do not liquefy secretions or reduce infection. Corticosteroids and mast cell stabilizers reduce inflammation in the lungs.

While providing care for a 4 year old male admitted to the emergency department, the registered nurse (RN) is alert to which clinical observation that is predictive of epiglottitis? Select all that apply. a. sinus congestion b. maintaining the tripod position c. presence of drooling d. absent cough e. restless and agitation

ANS: B, C, D, E

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate? a. Level of parents' education b. Presence of two parents in the home c. Preparation and training of family d. Family's ability to assume all health care costs

ANS: C One of the essential elements is the family's training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

Parents of two school-age children with asthma ask the nurse, "What sports can our children participate in?" The nurse should recommend which sport? a. Soccer b. Running c. Swimming d. Basketball

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

The registered nurse (RN) anticipates which infant will be prescribed palivizumab (an antiviral) as a prophylaxis to prevent respiratory syncytial virus (RSV) during the fall and winter outbreak of the infection? Select all that apply. a. infants in the 90 percentile of weight b. infants breastfeeding only c. infants born at 29 week gestation d. infants with congenital heart defects e. infats with chronic lung disease

ANS: C, D, E

While providing care for the infant admitted with a diagnosis of respiratory syncytial virus (RSV), which early clinical manifestation does the registered nurse (RN) monitor for? Select all that apply. a. fluid filled blisters on lips b. conjutivitis c. fever d. rhinorrhea e. pharyngitis

ANS: C, D, E

A client with a history of asthma presents with bradycardia and severe wheezing. Which action should be the​ nurse's priority​? A. Preparing to assist with intubation and mechanical ventilation B. Auscultating the lungs C. Encouraging the client to cough and breathe deeply D. Administering an intravenous​ (IV) corticosteroid

ANSWER: A Rationale: The​ client's clinical manifestation indicates impending respiratory failure and immediate action is​ required, so the nurse should notify the healthcare provider. The nurse should prepare to assist with intubation and mechanical ventilation after notifying the healthcare provider. IV corticosteroids require several hours before having any effect on respiratory status.​ Auscultation, coughing, and deep breathing will not help this client.

A client who is experiencing an acute asthma attack is brought to the emergency department. Which action should the nurse take first​? A. Administer an inhaled corticosteroid. B. Obtain a peak flowmeter reading. C. Auscultate the​ client's lungs. D. Determine when the shortness of breath began

ANSWER: C Rationale: Assessment of the​ client's lungs will help determine how effectively the client is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the current status. During an acute​ attack, most clients are unable to use a peak flowmeter. Medication administration should be done following the assessment.