PNC 1 PrepU - Asthma
A 4-week-old infant is diagnosed with acute bronchiolitis. The parent states, "I do not know how the baby got this!" How should the nurse respond?
"Has your infant been around any crowds?" Explanation: Acute bronchiolitis is caused by a viral infection, most often, respiratory syncytial virus. Viruses are often spread between groups of people in close contact. Hereditary and environmental complications do not relate to this disorder.
A child with asthma has been monitoring his peak expiratory flow rate (PEFR) and has been maintaining it within 90% of his personal best. Today, the child is experiencing symptoms and his PEFR is at 40% of his personal best. The child's mother calls the office and asks the nurse what she should do. What would the nurse instruct the mother to do first?
"Have him use his short-acting bronchodilator right away." Explanation: The child's symptoms and drop in PEFR suggest a medical alert or "red" situation, indicating the need for the short-acting bronchodilator and then a trip to the office or emergency department. The child should use his short-acting bronchodilator first and then go to the physician's or nurse practitioner's office or emergency room. Waiting for a greater drop in his PEFR readings would be inappropriate because the child is experiencing an acute condition that warrants immediate attention. The child is experiencing an acute situation and requires immediate attention. A low-dose steroid inhaler would not be appropriate because it would not help his bronchospasm.
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 need to shake the inhaler well before taking the medication." Explanation: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
The nurse is auscultating the lungs of a lethargic, irritable 6-year-old boy and hears wheezing. The nurse will most likely include which teaching point if the child is suspected of having asthma?
"I'm going to have this hospital worker take a picture of your lungs." Explanation: The nurse should teach the child using terms a 6-year-old will understand. A chest x-ray is usually ordered for the assessment of asthma to check for hyperventilation. A sputum culture is indicated for pneumonia, cystic fibrosis, and tuberculosis; fluoroscopy is used to identify masses or abscesses as with pneumonia; and the sweat chloride test is indicated for cystic fibrosis.
The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine she takes for her rheumatoid arthritis when the child has a "flare-up" of asthma. "It's easier than going to the hospital or doctor every time a flare-up happens," the mother says. What is the best response by the nurse?
"I'm sure it must be difficult to cope with the flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child's asthma symptoms." Explanation: Showing empathy for the parent is important when explaining the possibility of the steroid's side effects and the importance of the physician monitoring the child's asthma. Just listing all of the side effects of the steroid is not therapeutic communication and doesn't address the need for the child to be seen by the physician. Scolding the parent by telling her that she should never give her child her medication does not encourage good rapport. Giving the child the mother's medication even "occasionally" is not advisable.
The nurse is providing education to a client newly diagnosed with asthma. Which statement by the parents indicates additional teaching is needed?
"It is okay for our child to do chores such as sweeping the floor." Explanation: Sweeping the floor can trigger a child's asthma by making environmental allergens and irritants airborne, causing upper respiratory infections. The nurse will intervene if the parents make this statement. An inhaler should be with the child at all times in case of an asthma attack. Smoke and pet allergens can trigger an attack and exposure should be avoided. Other triggers are exercise, weather changes, air pollution, foods, and certain medications.
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 -Cigarette smoke Explanation: Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.
Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.
-Montelukast -Zafirlukast -Zileuton Explanation: Montelukast (Singulair), Zafirlukast (Accolate), and Zileuton (Zyflo) are leukotriene modifiers. Ipratropium HFA (Atrovent) is a short-acting anticholinergic. Tiotropium (Spiriva) is a long-acting anticholinergic.
A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply.
-Take a slow, deep inhalation from the device. -Activate the MDI once. -The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.
The pediatric unit has multiple clients experiencing upper respiratory system complications. Which pediatric client is at the highest risk for respiratory distress?
2-year-old child with epiglottitis Explanation: Epiglottitis is a medical emergency due to the swelling of the epiglottis covering the larynx. This client needs frequent assessment for respiratory distress, especially since young children have smaller, more compliant airways. The 3-year-old child has more developed respiratory passages than a 2-year-old child, and although croup may cause respiratory distress, the likelihood of airway obstruction is lower when compared to epiglottitis. The 11-month-old infant has a common cold, typically from a virus. The 16-year-old adolescent with asthma has fully developed respiratory airways, which are less likely to be obstructed.
Which client most likely faces the highest risk of developing secondary pulmonary hypertension?
A client with COPD and a 35 pack-year smoking history. Explanation: COPD is a major risk factor for secondary pulmonary hypertension. Pneumonia, bronchodilator use, and thermal injury are not noted to be among the more common causes of the disease.
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 Explanation: Cigarette smoking and drugs that stimulate drug-metabolizing enzymes in the liver (e.g., phenobarbital, phenytoin) increase the rate of metabolism and, therefore, the dosage requirements of aminophylline.
Which of the following is accurate regarding status asthmaticus?
A severe asthma episode that is refractory to initial therapy Explanation: Status asthmaticus is a severe asthma episode that is refractory to initial therapy. It is a medical emergency. Patients report rapid progressive chest tightness, wheezing, dry cough, and shortness of breath. It may occur with little or no warning.
A patient with acute respiratory symptoms is receiving a loading dose of theophylline. Which of the following signs of toxicity should alert the nurse to notify the primary health care provider immediately?
Abdominal cramps Explanation: It is important for the nurse to closely monitor the patient for signs of theophylline toxicity. The nurse should notify the primary health care provider immediately if any of the following signs of theophylline toxicity develop: anorexia, nausea, vomiting, diarrhea, confusion, abdominal cramping, headache, restlessness, insomnia, tachycardia, arrhythmias, or seizures. Constipation, bradycardia, or mental depression are not signs of theophylline toxicity.
Acute-onset bronchial asthma causes wheezing and breathlessness as a result of which of the following?
Airway inflammation Explanation: Bronchial asthma represents a reversible form of obstructive airway disease caused by narrowing of airways due to bronchospasms, inflammation, and increased airway secretions; this inflammatory process produces recurrent episodes of airway obstruction, characterized by wheezing, breathlessness, chest tightness, and cough. Vascular flow through the lungs is unaffected by the airway inflammation and bronchospasms. Hyperinflated alveoli are characteristic of the emphysema type of obstructive pulmonary disease. Compression atelectasis is associated with high external pressure that blocks lung expansion.
A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?
Albuterol Explanation: Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.
A client experiencing an asthmatic attack is prescribed methylprednisolone intravenously. What action should the nurse take?
Assesses fasting blood glucose levels Explanation: Adverse effects of methylprednisolone (Solu-Medrol) include abnormalities in glucose metabolism. The nurse monitors blood glucose levels. Methylprednisolone also increases the client's appetite and fluid retention, but the client will not decrease caloric or fluid intake as a result of these adverse effects. It is not necessary to aspirate for blood return prior to injecting the medication, because doing so would not support the intravenous line in the vein.
The parents of an infant bring the child to the emergency room 3 hours after they put the child to bed in apparent good health. The child is restless, the pulse is 140 beats/min, and lung sounds are diminished in all lung fields with intercostal retractions. What is the most likely cause of these symptoms?
Asthma Explanation: Acute asthma symptoms may develop in children when the airway patency decreases at night. There is sudden onset of symptoms such as a runny nose, irritability, a tight and nonproductive cough, wheezing, rapid respiratory rate, dyspnea, and use of accessory muscles to breathe. Pleuritis, pleural effusion, and bronchitis are commonly preceded by other symptoms of respiratory infection.
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 Explanation: Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options.
A client is experiencing an acute asthmatic attack. Which agent would be most effective?
Beta-2 selective adrenergic agonist Explanation: A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation. An inhaled steroid would require 2 to 3 weeks to reach effective levels. Leukotriene receptor antagonists and mast cell stabilizers do not have immediate effects.
A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid?
Chocolate Explanation: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.
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 Explanation: The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.
A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer?
Cromolyn Explanation Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.
A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?
Cromolyn sodium Explanation: Cromolyn sodium and nedocromil are mild to moderate anti-inflammatory agents and are considered alternative medications for treatment. These medications stabilize mast cells. Though also used in the treatment of asthma the following are NOT mast cell stabilizers: Albuterol is a beta2-antagonist. Budesonide is an inhaled corticosteroid. Theophylline is a mild to moderate bronchodilator.
A 9-year-old boy has been diagnosed with bronchial asthma. Which factor is most likely contributing to his condition?A 9-year-old boy has been diagnosed with bronchial asthma. Which factor is most likely contributing to his condition?
House dust Explanation: Environmental allergens such as pet dander, dust mite antigens, and cockroach allergens have been shown to contribute to the development of asthma, with the strongest response occurring in response to house dust. Active participation in physical activities, exercise, and sports should be encouraged.
Asthma is cause by which type of response?
IgE-mediated Explanation: Atopy, the genetic predisposition for the development of an IgE-mediated response to allergens, is the most common identifiable predisposing factor for asthma. Chronic exposure to airway allergens may sensitize IgE antibodies and the cells of the airway.
The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action?
Inhaled corticosteroid agents reduce airway inflammation. Explanation: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system or reduce bronchodilation or respiratory rate.
What is histamine, a mediator that supports the inflammatory process in asthma, secreted by?
Mast cells Explanation: Mast cells, neutrophils, eosinophils, and lymphocytes play key roles in the inflammation associated with asthma. When activated, mast cells release several chemicals called mediators. One of these chemicals is called histamine.
An 8-year-old child with an acute asthmatic attack is receiving metaproterenol via nebulizer. Which of the following would be most appropriate?
Mix the drug with saline. Explanation: Metaproterenol is mixed with saline in the nebulizer chamber for administration. The child should sit upright or be in a semi-Fowler's position. He should breathe slowly and deeply during the treatment. The treatment is completed when all of the solution (liquid) is gone from the chamber.
A nurse caring for a client with asthma monitors respiratory function. Which data indicate the client has mild intermittent asthma?
PEF 400 mL in AM, 390 mL at noon, symptoms occur twice a week Explanation: Asthma can be rated at four levels: mild intermediate, mild persistent, moderate persistent, and severe persistent. In mild intermittent asthma the symptoms occur 2 or fewer times per week and the client is asymptomatic between attacks with a normal peak expiratory flow (PEF). In mild persistent asthma the symptoms occur more than 2 times per week, but not daily. Exacerbations may affect activity. The PEF has 20-30% variability. Moderate persistent asthma has daily symptoms, exacerbations affect activity, and the PEF variability is greater than 30%. In severe persistent asthma the symptoms are continual with frequent exacerbations and the PEF is less than 60% of what is predicted, with variability more than 30%.
Which factor is most likely to precipitate an asthmatic attack in a child with a diagnosis of extrinsic, or atopic, asthma?
Pet dander Explanation: Extrinsic or atopic asthma is typically initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen or allergen such as pet dander. Intrinsic or nonatopic asthma triggers include respiratory tract infections, exercise, hyperventilation, cold air, drugs and chemicals, hormonal changes and emotional upsets, airborne pollutants, and gastroesophageal reflux.
Pain is an expected assessment finding in clients who have which lung disease?
Pleuritis Explanation: The effects of asthma, PAH, and pleural effusion may be profound, but none is typically accompanied by acute pain. Pleuritis, in contrast, is associated with characteristic pleural pain.
The nurse is caring for a child who has been admitted with a diagnosis of asthma. What laboratory/diagnostic tool would likely have been used for this child?
Pulmonary functions test Explanation: Pulmonary function tests are valuable diagnostic tools for the child with asthma and indicate the amount of obstruction in the bronchial airways, especially in the smallest airways of the lungs. Purified protein derivative tests are used to detect TB. Sweat sodium chloride tests are used for determining the diagnosis of cystic fibrosis. Blood culture and sensitivity is done to determine the causative agent as well as the anti-infective needed to treat an infection.
A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy?
Relaxation of smooth muscle Explanation: Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation. None of the other options describe the bronchial dilation affected of the anticholinergic classification of medications.
In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason?
Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Bronchodilators are not effective for pain.
A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?
Respiratory acidosis Explanation: In status asthmaticus, increasing PaCO2 (to normal levels or levels indicating respiratory acidosis) is a danger sign signifying impending respiratory failure. Understanding the sequence of the pathophysiologic processes in status asthmaticus is important for understanding assessment findings. Respiratory alkalosis occurs initially because the patient hyperventilates and PaCO2 decreases. As the condition continues, air becomes trapped in the narrowed airways and carbon dioxide is retained, leading to respiratory acidosis.
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?
SABA Explanation: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.
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?
Salmeterol is contraindicated based on his wife's condition. Explanation: The FDA has issued a black box warning that initiating salmeterol in people with significantly worsening or acutely deteriorating asthma may be life threatening.
A child struggling to breathe is brought to the emergency department with a prolonged bronchospasm and severe hypoxemia. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. What is the most likely diagnosis?
Severe asthma attack Explanation: Severe asthma attacks are accompanied by use of the accessory muscles, distant breath sounds due to air trapping, and loud wheezing. As the condition progresses, fatigue develops, the skin becomes moist, and anxiety and apprehension are obvious. Sensations of shortness of breath may be severe, and often the person is able to speak only one or two words before taking a breath. At the point at which airflow is markedly decreased, breath sounds become inaudible with diminished wheezing, and the cough becomes ineffective despite being repetitive and hacking. This point often marks the onset of respiratory failure.
A child is brought to the emergency department with an asthma attack. Assessment revealed the use of accessory muscles, a weak cough, audible wheezing sound, moist skin, and tachycardia. Which drug will the nurse anticipate administering first?
Short-acting beta 2-adrenergic agonists such as albuterol (SABA) Explanation: The quick-relief medications such as SABA (e.g., albuterol, levalbuterol, pirbuterol) relax bronchial smooth muscle and provide prompt relief of symptoms, usually within 30 minutes. They are administered by inhalation (i.e., metered-dose inhaler or nebulizer), and their recommended use is in alleviating acute attacks of asthma.
Which medication helps treat the inflammatory reaction of clients with asthma who are diagnosed with an acute flare of their asthma response?
Systemic corticosteroids Explanation: A short course of systemic corticosteroids, administered orally or parenterally, may be used for treating the inflammatory reaction associated with the late-phase response. The anticholinergic agents block cholinergic receptors and reduce intrinsic vagal tone that causes bronchoconstriction. The long-acting β2 agonists, available for administration by the inhaled or oral routes, act by relaxing bronchial smooth muscle. Theophylline, a phosphodiesterase inhibitor, is a bronchodilator that acts by relaxing bronchial smooth muscle.
The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching?
Tachycardia Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.
The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method?
Using a nebulizer Explanation: Many of these drugs used in the treatment of asthma can be given either by a nebulizer (tube attached to a wall unit or cylinder that delivers moist air via a face mask) or a metered-dose inhaler ([MDI], which is a hand-held plastic device that delivers a premeasured dose). Emergency medications are given intravenously. Most children do not have a gastrostomy tube, and medications sprinkled on foods are given with cystic fibrosis.
The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with:
a bronchodilator and mast cell stabilizers. Explanation: Mast cell stabilizers are used to help decrease wheezing and exercise-induced asthma attacks. A bronchodilator often is given to open up the airways just before the mast cell stabilizer is used. Corticosteroids are anti-inflammatory drugs used to control severe or chronic cases of asthma. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma.
A client is admitted for a relapse for sarcoidosis. Knowing this is usually caused by an inflammatory process, the nurse can anticipate administering:
a corticosteroid. Explanation: Treatment is directed at interrupting the granulomatous inflammatory process that is characteristic of the disease and managing the associated complications. When treatment is indicated, corticosteroid drugs are used. Bronchodilators may be used if there is wheezing, but this is not a normal medication for this disease. Aspirin is a blood thinner. Albuterol is a short-term bronchodilator for acute asthma.
The nurse is collecting data on a child admitted with a respiratory concern. The nurse notes that the child is anxious and sitting forward with the neck extended to breathe. The signs the nurse noted indicate the child likely has:
epiglottitis. Explanation: The child with epiglottitis is very anxious and prefers to breathe by sitting forward with the neck extended. Immediate emergency attention is necessary. The child with asthma would have wheezing and distress trying to breathe. The child with cystic fibrosis would not have respiratory distress unless ill with respiratory infection. The drooling, leaning forward, and appearing distressed are not manifestations of TB.
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
has a high coffee intake. Explanation: Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.
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. Explanation: When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation, increased capillary permeability and fluid leakage, and changes in the mucus-secreting properties of the airway epithelium.
After teaching the parents of an 8-year-old girl with asthma about common allergens their child should avoid, the nurse determines that the parents need additional teaching when they identify what as a common allergen for asthma?
shellfish Explanation: Eating shellfish is not a typical asthma trigger. Allergic reactions can occur with shellfish, but usually not an exacerbation of asthma. Indoor molds, pet dander, and dust mites are common asthma triggers.
A nurse is teaching a newly diagnosed client with asthma how to manage the disease. What should the nurse encourage this client to do?
stop smoking cigarettes Explanation: Since bronchoconstriction can be triggered by smoke, clients with asthma should be encouraged to quit smoking and to avoid secondhand smoke. Instead of instructing a client to abandon exercise, healthcare providers should consider prescribing bronchodilators as pre-exercise prophylaxis. nonsteroidal anti-inflammatory drugs can cause trigger an asthmatic attack in some clients; however, not all anti-inflammatory drugs cause this reaction.
A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:
the airways are so swollen that no air can get through. Explanation: During an acute asthma attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can't get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles don't replace wheezes during an acute asthma attack.
After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?
Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
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 relaxation of the bronchial smooth muscles. Explanation: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.
Which is the strongest predisposing factor for asthma?
Allergy Explanation: Allergy is the strongest predisposing factor for asthma.
A client in the emergency department reports sudden onset of coughing with a feeling of chest tightness. Lung sounds are diminished with wheezing in all lung fields, skin is moist, and the client appears anxious. What is the first intervention the nurse should implement?
Administer a beta-2 agonist. Explanation: During an acute asthma attack, bronchospasm prolongs expiration, trapping air and decreasing inspiratory capacity. A beta-2 agonist, such as albuterol, will relieve the bronchospasm within 30 minutes. A corticosteroid can prevent inflammation, but will not stop an attack in progress. The influenza vaccine and avoiding environmental triggers are measures to prevent asthma attacks.
During a teaching session, a parent asks the nurse which inhaler to use for quick relief if the child has an asthma attack. What teaching should the nurse review with the parent?
Albuterol is a short-acting inhalant and will relax muscles quickly. Explanation: Short-acting beta2-adrenergic agonists, such as albuterol (AccuNeb, Proventil, Ventolin), levalbuterol (Xopenex HFA), and pirbuterol (Maxair), are the inhalant medications of choice for relief of acute symptoms and prevention of exercise-induced asthma. Cromolyn sodium (Crolom, NasalCrom) and nedocromil (Alocril, Tilade) are mild to moderate anti-inflammatory agents that stabilize mast cells, and are contraindicated in acute asthma exacerbations. Long-acting beta2-adrenergic agonists, such as theophylline (Slo-Bid, Theo- Dur) and salmeterol (Serevent Diskus), are not indicated for immediate relief of symptoms.
What is the most common first-line therapy for relief of an acute asthma attack?
Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.
A client with asthma comes to the emergency department very anxious due to increasing shortness of breath. Physical assessment reveals tachypnea, and an arterial blood gas shows decreased carbon dioxide levels and hypoxemia. What is the most likely cause of the decreased carbon dioxide levels?
hyperventilation Explanation: Nonpharmacologic management of asthma includes relaxation techniques and controlled breathing, which often help to allay the panic and anxiety that aggravate breathing difficulties. The hyperventilation that often accompanies anxiety and panic is known to act as an asthmatic trigger. Hyperventilation by definition results in the excess exhalation of carbon dioxide, leading to respiratory alkalosis. Cyanosis develops if there is a high level of deoxygenated hemoglobin in the arterial circulation but does not cause changes in carbon dioxide levels. Apnea is a lack of respirations which would lead to an elevation of carbon dioxide levels. Heart rate does not influence carbon dioxide levels.
