Chapter 33 Prep U
Which would the nurse identify as being involved with asthma? Acute infection Hyperactive airways Alveolar collapse Progressive loss of lung compliance
Hyperactive airways
The nurse prepares teaching for the parent of a child with cystic fibrosis. Which statement indicates that teaching was effective? "It is caused by an infection." "There is medication to cure this condition." "I have to make sure my child doesn't spread this infection." "We need to do chest physical therapy to prevent pooling of secretions."
"We need to do chest physical therapy to prevent pooling of secretions."
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? "When I am short of breath, I will increase the use of my fluticasone." "I will wash my sheets weekly." "When I can do some, but not all of my usual activities, I am in the yellow zone." "I need to inhale my medication and hold my breath for 10 seconds."
"When I am short of breath, I will increase the use of my fluticasone."
The client has been diagnosed with asthma and is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order? Flunisolide first, wait five minutes and then follow with albuterol Albuterol first, wait five minutes and then follow with flunisolide Flunisolide followed immediately by albuterol Albuterol followed immediately by flunisolide
Albuterol first, wait five minutes and then follow with flunisolide
The nursing instructor is discussing common respiratory disorders with the nursing class. Which of the following might the instructor identify as a common sign or symptom? Oxygen saturation of 95% Drowsiness Hallucinations Bronchospasm
Bronchospasm
A nurse is required to educate a patient prescribed albuterol on the adverse effects associated with the drug. Which of the following symptoms, if experienced, should the nurse instruct the patient to report to the health care provider? Fall in blood pressure Increased nighttime urination Hearing impairment or deficit Headache and flushing
Headache and flushing
Which statement demonstrate effective knowledge regarding the body's process of gas exchange? Select all that apply. Involves the exchange of carbon dioxide and oxygen It occurs at the alveoli level The gases diffuse through the respiratory membrane This process of gas exchange is called ventilation The gases are diffused into the capillary blood system.
Involves the exchange of carbon dioxide and oxygen It occurs at the alveoli level The gases diffuse through the respiratory membrane The gases are diffused into the capillary blood system.
A client with asthma has been prescribed an anti-inflammatory medication. The client asks the nurse, "How does an anti-inflammatory drug my bronchoconstriction?" Which information will the nurse include in the response? It increases the ability to metabolize medication. It decreases the formation of mucus secretions. It increases the uptake of corticosteroids to medication. It decreases airway hyperreactivity to stimuli.
It decreases airway hyperreactivity to stimuli.
An older adult client has been prescribed ipratropium by metered-dose inhaler and the nurse has provided education on using the device. When demonstrating the technique back to the nurse, the client is unable to coordinate pressing down on the inhaler and maintaining a seal with their lips. What is the nurse's best action? Obtain a spacer and educate the client on its use. Advocate for a change to a medication available by the oral route. Identify a trusted family member to be responsible for administration. Request an increased dose from the health care provider to offset the client's incorrect technique.
Obtain a spacer and educate the client on its use.
A client is experiencing symptoms of the common cold. Which information would the nurse provide when explaining the reason for the client's symptoms? The epithelial lining of the sinus cavities become inflamed, leading to swelling and pain. The upper airways respond to a specific pathogen, leading to nasal congestion and watery eyes. Inflammation of the pharynx, larynx, and bronchi causes fever, muscle aches, pain, and malaise. Pathogens initiate the release of histamine and prostaglandins, causing an inflammatory response and leading to the increased production of mucus.
Pathogens initiate the release of histamine and prostaglandins, causing an inflammatory response and leading to the increased production of mucus.
A client has experienced an atelectasis in the left lung. What explanation should the nurse provide the family regarding the cause of this condition? The alveoli collapsed as a result of a inflammation caused by a bacterial or viral infection. The collapse of some of the alveoli in the left lung occurred as a result of outside pressure pushing against them. A process caused the release of histamine and prostaglandins that resulted in an inflammation of the alveoli There is a large amount of thick secretions in the lung that caused the alveoli to collapse.
The collapse of some of the alveoli in the left lung occurred as a result of outside pressure pushing against them.
A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussion medication instructions with this client? The effectiveness of the medication is enhanced when taken with food The medication should be taken 30 minutes before a meal The medication is most effective when taken at breakfast The medication should be taken on an empty stomach.
The medication should be taken on an empty stomach.
A male client is concerned because ever since he began his antiasthma medication, his GERD symptoms are worse. The nurse explains that his symptoms are worse because his asthma medications have what effect? They cause acid indigestion. They tighten the gastresophageal sphincter. They relax the gastresophageal sphincter. They stimulate peristalsis.
They relax the gastresophageal sphincter.
A 34-year-old client has recently started taking theophylline. The nurse knows medication teaching has been successful when the client agrees to what activity? avoiding beverages that contain caffeine eating foods high in potassium limiting my fluid intake to 1,000 mL a day taking the medication on an empty stomach
avoiding beverages that contain caffeine
A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication? inhaled corticosteroids intravenous theophylline high doses of montelukast beta2 agonists in high doses
beta2 agonists in high doses
The nurse is providing education to the parents of a child who has been newly diagnosed with asthma. During teaching, the nurse should explain that asthma attacks occur when mast cells release substances that cause what reaction? inflammation. smooth muscle dilation. decreased capillary permeability. Decreased fluid leakage.
inflammation
The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching? "I should take a deep breath, hold it while I administer the medication, and then exhale." "I need to shake the inhaler well before taking the medication." "I need to take three short, quick breaths to inhale the medication." "I need to wait at least 30 minutes after the first inhalation before taking a second."
"I need to shake the inhaler well before taking the medication."
A client newly diagnosed with chronic obstructive pulmonary disease (COPD) asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? "The medications that have been prescribed for you are what the primary health care provider thinks will help your breathing the most." "The medications that have been prescribed for you are to help you breathe with less resistance from your diaphragm." "The medications that have been prescribed for you are designed to work together to reduce your oxygen requirements." "The medications that have been prescribed for you are to help relieve the inflammation and open your airways."
"The medications that have been prescribed for you are to help relieve the inflammation and open your airways."
A male client presents to the emergency department in bronchospasm. He has a history of smoking two packs per day for 20 years and is prescribed phenytoin to control a seizure disorder that developed after a head injury 3 years ago. Based on the client's history, what would the nurse expect the health care provider to order? A modified dose of aminophylline The standard dose of aminophylline A drug other than aminophylline Phenytoin intravenously
A modified dose of aminophylline
A female client is prescribed systemic corticosteroids for her asthma. The nurse knows that the client is at risk for what problem? Pituitary insufficiency Pancreatic insufficiency Adrenal insufficiency Renal insufficiency
Adrenal insufficiency
During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? Epinephrine Omalizumab Salmeterol Albuterol
Albuterol
Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? Albuterol causes stimulation of the bronchial tissue. Albuterol blocks the stimulation of the beta-2 receptors. Albuterol decreases vital capacity. Albuterol causes relaxation of the bronchial smooth muscles.
Albuterol causes relaxation of the bronchial smooth muscles.
The nurse is providing education to a client diagnosed with a respiratory disorder. During teaching, which structure would the nurse identify as being directly involved in gas exchange during respiration? Alveoli Arteriole Venule Lymphatic vessel
Alveoli
A patient is prescribed Ventolin (albuterol) for bronchospasm in chronic bronchial asthma. Which of the following nursing diagnoses would the nurse expect to see on the care plan as a result of the adverse effect of albuterol? Anxiety Risk of impaired oral mucous membranes Ineffective tissue perfusion Risk of injury
Anxiety
A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? Asthma Emphysema Chronic bronchitis Pneumonia
Asthma
A client is experiencing an acute asthmatic attack. Which agent would be most effective? Inhaled steroid Leukotriene receptor antagonist Mast cell stabilizer Beta-2 selective adrenergic agonist
Beta-2 selective adrenergic agonist
A patient has an acute inflammation of the bronchi. The nurse identifies this as: Bronchitis Bronchiectasis Pneumonia Emphysema
Bronchitis
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? Hyperthyroidism Cigarette smoking Gastrointestinal upset Alcohol intake
Cigarette smoking
A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following? Coffee Alcohol Salt Vitamin C
Coffee
Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He reports that his symptoms persist in spite of using albuterol MDI as prescribed. What advice should the nurse give the client? Contact the health care provider to obtain an increased dosage of albuterol. Contact the health care provider to obtain adjunctive medications. Use the MDI more often. Clean the MDI thoroughly on a regular basis
Contact the health care provider to obtain adjunctive medications.
The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present? (Select all that apply.) Cough Increased temperature Increased secretions Mucosal congestion
Cough Increased secretions Mucosal congestion
The nursing instructor is teaching a session explaining mast cell stabilizers. The instructor determines the session is successful when the students correctly choose which drug as an example? Beclomethasone Cromolyn Albuterol Montelukast
Cromolyn
A patient tells you that a friend of theirs has recommended the use of caffeine to treat the patient's asthma. What would be the most important reason a nurse should counsel this patient not to delay prescribed treatment for the use of natural health products? Caffeine can aggravate the drugs used to treat asthma Most natural products are less toxic or more potent than traditional asthma medications Natural products decrease the adverse effects associated with adrenergic bronchodilators Delays in appropriate treatment can have serious, even fatal, consequences
Delays in appropriate treatment can have serious, even fatal, consequences
A client who has been admitted to the healthcare center has been diagnosed with emphysema. The arterial blood gas results reveal respiratory acidosis. Based on this information, what should the nurse explain to the client that is the cause of the respiratory acidosis? Too little carbon dioxide in the blood Presence of food in the respiratory passage Excess carbon dioxide in the blood Inflammation of the pleura
Excess carbon dioxide in the blood
An adult client with newly diagnosed asthma presents for client education regarding situations that could precipitate an asthma attack. In this teaching, which precipitants would the nurse state may trigger an attack? Select all that apply. Exercise Allergens Mold Warm weather Cigarette smoke
Exercise Allergens Mold Cigarette smoke
A nurse is teaching a client diagnosed with asthma about the disease. Which should the nurse instruct the client to avoid because it may cause bronchoconstriction? Fatigue Direct sunlight Extremely cold temperatures Food high in sodium
Extremely cold temperatures
Where should the nurse initially direct a client who is interested in learning more about the management of asthma? Global Initiative for Asthma (GINA) Journal of Allergy and Clinical Immunology Centers for Disease Control Education Center National Association of Educational Pulmonologists
Global Initiative for Asthma (GINA)
A male client is experiencing dysphasia secondary to a mild stroke that he had 3 weeks ago. He states that his asthma medications are not working as well or as long as they did in the past. What does the nurse suspect is the reason for this? He is crushing the medication. He is administering the wrong medication. He is experiencing confusion. He is experiencing postural hypotension.
He is crushing the medication.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse? "I'll try to make sure that I drink plenty of fluids each day." I'll keep taking my medications until I'm not experiencing any more symptoms." "I'll make sure I don't take my inhalers more often than they've been prescribed." "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this."
I'll keep taking my medications until I'm not experiencing any more symptoms."
The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take? Withhold the scheduled dose of theophylline pending the next day's blood work results. Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. Inform the health care provider that an increase in the client's dose of theophylline may be necessary. Inform the health care provider that the client has toxic theophylline levels.
Inform the health care provider that the client has toxic theophylline levels. TR is 5-15 mcg/mL (~27-83umol/l)
A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? Inhalation Oral Subcutaneous Intravenous
Inhalation
A client with recently diagnosed exercise-induced bronchospasms is to be prescribed an inhalant. The nurse anticipates the client will be prescribed which medication(s)? Select all that apply Beclomethasone Levalbuterol Theophylline Mometasone Terbutaline
Levalbuterol Terbutaline
A newborn, experiencing ineffective alveolar expansion, is receiving treatment. What intervention should the nurse implement to assure the administration of the prescribed medication has been effective? Suctioning the infant every 30 minutes for 2 hours after the treatment has been initiated Monitoring respirations for bilateral chest movement Changing the newborn's position frequently to assure effective distribution of medication Supply supplemental oxygen as prescribed
Monitoring respirations for bilateral chest movement
After teaching a group of students about zafirlukast, the students demonstrate understanding when they identify which as possible adverse effects? (Select all that apply.) Myalgia Dizziness Vomiting Constipation Chills
Myalgia Dizziness Vomiting
The nurse teaches a client receiving an inhaled corticosteroid about the possibility of developing oral thrush. Which action(s) would the nurse include in the teaching plan as a way to reduce this risk? Select all that apply. Need to avoid eating after administration Performing strict oral hygiene Cleaning the inhaler per package instructions Using proper technique when administering dose Administering a dose only every other day
Need to avoid eating after administration Performing strict oral hygiene Cleaning the inhaler per package instructions Using proper technique when administering dose
The health care provider has prescribed a monoclonal antibody for a client with asthma. The nurse will prepare a teaching plan for which medication? Zafirlukast Zileuton Omalizumab Salmeterol
Omalizumab
What is the most effective method used to monitor clients with asthma that they can use at home? Incentive spirometer Manometer Peak-flow monitor Trough-flow monitor
Peak-flow monitor
A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy? Reduction of the inflammatory response Decrease in the production of leukotrienes D4 and E4 Relaxation of smooth muscle Enhancement of alveolar expansion
Relaxation of smooth muscle
A client is being evaluated for a possible diagnosis of emphysema. What client characteristic should the nurse monitor to provide evidence of the disorder? Respiratory expiration Respiratory inspiration Presence of a fever Evidence of underlying trauma
Respiratory expiration
The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication? LABA SABA Antiasthma Leukotriene modifier
SABA
A female client presents to the emergency department with acutely deteriorating asthma. Her husband tells the nurse that his wife takes salmeterol. He then tells the nurse that he gave her three extra puffs when she became ill. What statement is correct in this situation? The husband made the correct decision in giving the extra doses. The extra doses facilitated bronchodilation and probably saved her life. Salmeterol is contraindicated based on his wife's condition. The health care provider will most likely order continuation of the salmeterol with increased dosage.
Salmeterol is contraindicated based on his wife's condition.
A client diagnosed with chronic obstructive pulmonary disease (COPD) has been prescribed bronchodilators by nebulizer for home use. What should the nurse teach the client to do to best assure effective use of the nebulizer? Keep an extra oxygen tank on hand for propelling the medication. Sit in a fully upright position when administering the medication. Take the exact number of puffs that have been prescribed. Gargle with an alcohol-based mouthwash after each dose.
Sit in a fully upright position when administering the medication.
The nurse is caring for a 38-year-old client who is beginning treatment with albuterol. Which should the nurse identify as a potential adverse effect of the drug? Polydipsia Tachycardia Hypotension Diarrhea
Tachycardia
What action by the client would indicate to the nurse that the client understands how to use an inhaler? The client inhales as soon as the inhaler enters the mouth. The client holds their breath as long as possible after depressing the canister. The client uses a spacer to administer a powdered medication. The client exhales as soon as the inhaler is depressed.
The client holds their breath as long as possible after depressing the canister.
The nurse is caring for a 38-year-old client who has been diagnosed with asthma and is prescribed albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? The client reports excessive thirst. The client's heart rate is 99 beats/min. The client's oral temperature is 100°F (37.8°C). The client had diarrhea this morning.
The client's heart rate is 99 beats/min.
Why are inhaled steroids used to treat asthma and COPD? They act locally to decrease release of inflammatory mediators They act locally to improve mobilization of edema They act locally to increase histamine release They act locally to decrease histamine release
They act locally to decrease release of inflammatory mediators
Respiratory symptoms are treated with many types of drugs, including anti-inflammatory agents. analgesics. bronchoconstrictors. histamines.
anti-inflammatory agents.
The nurse is caring for a client who is experiencing an attack of acute bronchiectasis. What is the principal pathologic finding in the diagnosis of bronchiectasis? increase in the red blood cell concentration in the blood leakage of fluid into the alveolar interstitial spaces chronic, irreversible dilation of the bronchi and bronchioles obstruction of the pulmonary vasculature by a clot
chronic, irreversible dilation of the bronchi and bronchioles
The nurse notes that a client begins coughing after taking a deep breath through an opened mouth. Which physiologic mechanism would the nurse suspect is occurring in the client? cough reflex paralysis of the cilia macrophage activation irritation of the nasal passages
cough reflex
A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition? gastroesophageal reflux disease urinary retention dermatitis cataracts
gastroesophageal reflux disease
A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient is a 56-year-old man. has a history of pneumonia. prefers a high-calorie diet. has a high coffee intake.
has a high coffee intake.
The nurse is caring for a client with a neurologic condition. Which assessment finding indicates to the nurse that the client's sympathetic nervous system is affecting ventilation? shallow respirations reduced breath sounds increased respiratory rate reduced oxygen saturation
increased respiratory rate
The nurse is caring for a client who reports having a "hoarse voice." On which structure will the nurse focus when assessing this client? larynx sinuses trachea pharynx
larynx
A client recovering from surgery has reduced lung sounds and hypoxia from atelectasis. Which treatment will the nurse expect to be prescribed for this client? antibiotics ambulation decongestants oxygen therapy
oxygen therapy
A nurse is caring for a client who has been diagnosed with chronic bronchiectasis. The nurse should assess the patient for which clinical manifestation? purulent cough angina pigeon chest pulmonary hypertension
purulent cough
A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse? intake of fatty foods weight activity level use of nicotine
use of nicotine