Asthma

Question 1

The nurse is caring for a client diagnosed with status asthmaticus who is currently not receiving any medical treatment. Which risk factor should the nurse consider for this​ client? (Select all that​ apply.)
A. Alkalosis
B. Hypercapnia
C. Anxiety
D. Hyperresonance
E. Hyporeflexia

Answer 1

B, C, D
​Rationale: The client who is not being treated for status asthmaticus is at risk for developing​ hypercapnia, hyperresonance, and anxiety. Acidosis occurs with status​ asthmaticus, not alkalosis. Hyporeflexia is not a condition that occurs if a client does not receive treatment for status asthmaticus.

Question 2

The nurse is preparing to teach a client who is newly diagnosed with asthma on how to prevent asthma triggers. Which trigger should the nurse include in the teaching​ plan? (Select all that​ apply.)
A. Cigarette smoke
B. Mattress covers
C. Indoor pets
D. Stuffed animals
E. Tile floors in the house

Answer 2

A, C, D
Rationale: Asthma triggers include cigarette​ smoke, indoor​ pets, and stuffed animals.​ Carpets, not tile​ floors, should be avoided as they can trigger asthma. Mattress covers should be used to decrease dust​ mites, which is a trigger for asthma.

Question 3

Which clinical manifestation should the nurse expect to observe in the client with​ asthma? (Select all that​ apply.)
A. Bradycardia
B. Wheezing
C. Dyspnea
D. Retractions
E. Cough

Answer 3

Answer: B, C, D, E
​Rationale: Clinical manifestations associated with asthma include​ dyspnea, wheezing,​ cough, and retractions.​ Tachycardia, not​ bradycardia, is a clinical manifestation of asthma.

Question 4

The nurse is examining a client newly diagnosed with asthma. Which pathological characteristic should the nurse expect in this client during physical​ examination?
A. Dead space
B. Air trapping
C. Expiratory wheezing
D. Increased lung volume

Answer 4

Answer: C
​Rationale: On physical​ examination, there is expiratory wheezing that is often described as high pitched and​ musical, and there is prolongation of the expiratory phase of the respiratory cycle. Lung volumes are decreased. Air trapping and dead space occur in​ emphysema, not asthma.

Question 5

The nurse is teaching a client who is newly diagnosed with asthma. Which manifestation of an asthma attack should the nurse​ include?
A. Bradycardia
B. Wheezing
C. Chest pain
D. Headache

Answer 5

B
​Rationale: Wheezing occurs in asthma due to narrowing of airways. Chest pain and headaches are not a part of an asthma attack. Clients might exhibit tachycardia with an asthma​ attack, not bradycardia.

Question 6

The nurse is discharging a client following a status asthmaticus episode. Which information should the nurse include in the​ asthma-teaching plan to prevent recurrence of​ episodes? (Select all that​ apply.)
A. Carrying a​ rapid-acting bronchodilator inhaler at all times
B. Getting a yearly influenza vaccination
C. Using the inhaled corticosteroid when shortness of breath occurs
D. Recommending that the client not be vaccinated for pneumonia
E. Avoiding breathing in strong odors and smoke

Answer 6

A, B, E
​Rationale: Clients should be instructed to get vaccinated for both influenza and pneumonia and avoid asthma triggers such as strong odors and smoke. Inhaled corticosteroids do not act rapidly to reduce dyspnea.​ Rapid-acting bronchodilators are used to quickly open airways in an asthma attack and should be carried with the client at all times.

Question 7

The nurse is teaching a client with asthma about peak flowmeter use. Which action by the client indicates that the teaching was​ successful?
A. The client anticipates using montelukast for readings in the red zone.
B. The client exhales slowly into the mouthpiece to obtain a reading.
C. The client uses the albuterol inhaler for peak flow readings in the yellow zone.
D. The client plans to contact the healthcare provider when the readings are in the green zone

Answer 7

C
​Rationale: Readings in the yellow zone indicate a decrease in peak flow that should be treated with a​ short-acting beta2​-adrenergic medication such as albuterol. Readings in the green zone indicate good asthma​ control, so there is no need to contact the healthcare provider. The client should be taught to exhale quickly and forcefully through the peak flowmeter mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak​ flow, and the client should take a​ fast-acting bronchodilator and call the healthcare provider for further instructions. Montelukast is not indicated for acute attacks but rather is used for maintenance therapy.

Question 8

A client has been taught how to use a peak flowmeter at home for asthma control. The daily peak flow is​ 75% of the baseline. Which action should the client take in this​ situation?
A. Go to the nearest emergency department for an evaluation.
B. Take her bronchodilator and recheck the peak flow.
C. Contact the healthcare provider.
D. Increase the dosage of daily corticosteroid and monitor her breathing.

Answer 8

B
​Rationale: The​ client’s peak flow reading indicates that the condition is​ worsening, so she should take her bronchodilator and recheck the peak flow. Depending on whether she returns to the green​ zone, indicating​ well-controlled symptoms, or worsening to the red​ zone, the next step will be decided. If the symptoms continue to​ worsen, she should contact the healthcare provider or go to the emergency department. Increasing the dose of prescribed oral corticosteroid is not an appropriate treatment at this time.

Question 9

The nurse is completing an admission history on a client with hypertension and possible asthma who is experiencing a new onset of wheezing and shortness of breath. Which information from the​ client’s health history may identify the cause of the asthma​ attack?
A. The client started a nonsteroidal​ anti-inflammatory drug​ (NSAID) 1 hour prior.
B. Two weeks​ ago, the client had an influenza vaccination.
C. The client took two acetaminophen​ (Tylenol) tablets for a headache that morning.
D. The client visited the zoo yesterday.

Answer 9

A
Rationale: Exposure to aspirin and nonsteroidal​ anti-inflammatory drugs can cause asthma. The other information in the health​ history, such as taking acetaminophen and getting an influenza​ vaccination, will not cause the asthma attack. If the trip to the zoo were going to trigger an​ attack, it would have happened yesterday while at the zoo or later in the evening following the trip.

Question 10

The nurse is discharging a client who is newly diagnosed with asthma. Which topic should the nurse include in the discharge​ teaching? (Select all that​ apply.)
A. Side effects of theophylline
B. Complications associated with oxygen therapy
C. Self-administration of inhaled corticosteroids
D. When to contact the healthcare provider
E. How to use a peak flowmeter

Answer 10

C, D, E
Rationale: The nurse should teach the client the use of the peak flowmeter and when to contact the healthcare provider. The use of inhaled corticosteroids is more effective in improving asthma than any other drug and is indicated for all clients with persistent asthma. The other​ therapies, such as oxygen and​ theophylline, are not expected treatments for asthma.

Question 11

A client is admitted in the emergency department for asthma. Which diagnostic and lab test should the nurse expect to be​ ordered? (Select all that​ apply.)
A. Allergy skin testing
B. Arterial blood gas
C. Spirometry
D. Pulse oximetry
E. Peak expiratory flow

Answer 11

A, B, D, E
​Rationale: Diagnostic tests that are appropriate for a client with asthma include peak expiratory​ flow, pulse​ oximetry, allergy skin​ testing, and arterial blood gas analysis. Spirometry can determine the extent of bronchospasm in clients with​ bronchitis, but not with asthma.

Question 12

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 12

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.

Question 13

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 13

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.

Question 14

A client calls the clinic nurse and reports the following​ readings: baseline peak flow of 600​ L/min and the current peak flow of 420​ L/min. Which instruction should the nurse give this​ client?
A. Notify the healthcare provider.
B. Use the albuterol​ (bronchodilator) inhaler.
C. Avoid any asthma triggers and repeat the peak flow testing.
D. Go to the closest emergency department.

Answer 14

B
Rationale: The​ client’s peak flow is​ 70% of​ normal, which is the yellow zone. This indicates a need for immediate use of​ short-acting beta-adrenergic medications. Advising the client to avoid exposure to allergens is important but would not address the current decrease in peak flow. Because the client is currently in the yellow​ zone, notifying the healthcare provider and hospitalization are not immediately needed.

Question 15

The nurse is evaluating the oxygenation status of a client during an asthma attack. Which diagnostic tool should be most useful for gathering this​ information?
A. Cardiac monitor
B. Chest​ x-ray
C. Pulse oximetry
D. Peak flowmeter

Answer 15

C
​Rationale: The nurse should use pulse oximetry to determine the​ client’s oxygen saturation. The goal for treatment of an asthma attack is to keep the oxygen saturation greater than​ 90%. Viewing the heart rate and​ rhythm, chest​ x-ray, and knowing the measurements for the peak flow reading do not indicate if the client has good oxygenation status.

Question 16

A pediatric client who has asthma is unable to​ speak, has shortness of​ breath, and has diminished breath sounds. Which type of asthma exacerbation is the client experiencing based on the assessment​ findings?
A. Minimal
B. Severe
C. Moderate
D. Mild

Answer 16

B
​Rationale: This client is experiencing a severe asthma exacerbation with the assessment findings of shortness of​ breath, being unable to​ speak, and diminished breath sounds. A moderate exacerbation is manifested by shortness of breath at​ rest, the ability to speak in single​ words, and biphasic wheezing. A mild exacerbation is manifested by shortness of breath with mild​ exertion, the ability to speak in​ phrases, and audible expiratory wheezing. A minimal asthma attack is manifested by shortness of breath on​ exertion, the ability to speak in​ sentences, and wheezing being noted on auscultation.

Question 17

Which intervention is appropriate for the nurse to implement for a client who is short of​ breath? (Select all that​ apply.)
A. Monitor skin color and temperature.
B. Place the client in the prone position.
C. Monitor level of consciousness.
D. Provide endotracheal suctioning as needed.
E. Administer oxygen as prescribed.

Answer 17

A, C, D, E
​Rationale: Interventions to address the problem of shortness of breath in clients who have asthma include monitoring skin color and​ temperature, monitoring level of​ consciousness, administering oxygen as​ prescribed, and providing endotracheal suctioning as needed. Other interventions include placing the client in high Fowler​ position, or the orthopneic​ position, but not the prone position.

Question 18

The nurse is evaluating the effectiveness of therapy for a client following treatment for an asthma attack. Which assessment finding is the best indicator that the therapy has been​ effective?
A. No wheezing.
B. Capillary refill is 2 seconds.
C. Respiratory rate is 18​ breaths/min.
D. Oxygen saturation is​ 96%.

Answer 18

D
Rationale: The goal for treatment of an asthma attack is to keep the oxygen saturation greater than​ 90%, so the reading of​ 96% indicates that the therapy has been effective. No wheezing heard on auscultation does not indicate good ventilation or oxygenation. The respiratory rate and capillary refill time appear within normal​ limits; however, these data can also occur when the client is too fatigued to continue with the increased work of breathing that is required in an asthma attack.

Question 19

The nurse is auscultating the lungs of an asthmatic client during an acute attack. Which is the correct technique that the nurse should use during this​ assessment?
A. Listen as the client​ inhales, and then move to the next site on the thorax during exhalation.
B. Auscultate for at least one full respiration in each location on the thorax.
C. Auscultate the anterior and posterior thorax over the​ client’s hospital gown.
D. Ask the client to breathe in and out rapidly through the mouth while auscultating each location.

Answer 19

B
Rationale: During auscultation of the thorax with a​ stethoscope, it is important to listen to one full respiration in each location. The stethoscope should be placed on the​ client’s skin, not over the​ gown, and the client should be asked to take​ slow, deep breaths in and out while offering times for the client to breathe normally to prevent possible dizziness.

Question 20

A client with acute shortness of breath is brought to the emergency department. Which action should the nurse take during the initial ​assessment?
A. Briefly ask specific questions about the​ client’s current respiratory status.
B. Assess for allergies before treatment.
C. Place the client supine to complete a full physical assessment.
D. Complete pulmonary function testing.

Answer 20

A
Rationale: Since the client has severe respiratory​ distress, only information that is pertinent to the current respiratory status is​ obtained, and a more thorough assessment is deferred until later. Brief questioning and a focused physical assessment should be done rapidly to help determine the cause of the distress and suggest treatment. Having the client lie down is contraindicated due to the respiratory distress. Obtaining a full physical examination is unnecessary until the acute distress has resolved. Checking for allergies is​ important, but it is not appropriate to complete the entire admission database at this time. The initial respiratory assessment must be completed before any diagnostic tests or interventions can be ordered.

Question 21

When admitting a patient with the diagnosis of asthma exacerbation, the nurse will assess for which of the following potential triggers? (Select all that apply.)
A. Exercise
B. Allergies 
C. Emotional stress 
D. Decreased humidity

Answer 21

A,B,C
Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, respiratory infections, drug and food additives, psychologic factors, and GERD.

Question 22

A nurse is working on a respiratory care unit where many of the patients are affected by asthma. Which of the following actions by the nurse would most likely increase respiratory difficulty for the patients?
A. Wearing perfume to work
B. Encouraging patients to ambulate daily
C. Allowing the patients to eat green leafy vegetables
D. Withholding antibiotic therapy until cultures are obtained

Answer 22

A.
Wearing perfume to work People with asthma should avoid extrinsic allergens and irritants (e.g., dust, pollen, smoke, certain foods, colognes and perfumes, certain types of medications) because their airways become inflamed, producing shortness of breath, chest tightness, and wheezing. Many green leafy vegetables are rich in vitamins, minerals, and proteins, which incorporate healthy lifestyle patterns into the patients’ daily living routines. Routine exercise is a part of a prudent lifestyle, and for patients with asthma the physical and psychosocial effects of ambulation can incorporate feelings of well-being, strength, and enhancement of physical endurance. Antibiotic therapy is always initiated after cultures are obtained so that the sensitivity to the organism can be readily identified.

Question 23

The nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority?

a) Avoid contact with fur-bearing animals.
b) Change filters on heating and air conditioning units frequently.
c) Take prescribed medications as scheduled.
d) Avoid goose down pillows.

Answer 23

C.

Question 24

A client is admitted to the emergency department with an acute asthma attack. The physician prescribes ephedrine sulfate, 25 mg subcutaneously (S.C.). How soon should the ephedrine take effect?

a) Rapidly
b) In 3 minutes
c) In 1 hour
d) In 2 hours

Answer 24

A.

Question 25

A slightly obese client with a history of allergy-induced asthma, hypertension, and mitral valve prolapse is admitted to an acute care facility for elective surgery. The nurse obtains a complete history and performs a thorough physical examination, paying special attention to the cardiovascular and respiratory systems. When percussing the client’s chest wall, the nurse expects to elicit:

a) resonant sounds.
b) hyperresonant sounds.
c) dull sounds.
d) flat sounds.

Answer 25

A.

Question 26

The physician prescribes triamcinolone (Azmacort) and salmeterol (Serevent) for a client with a history of asthma. What action should the nurse take when administering these drugs?
a) Administer the triamcinolone and then administer
the salmeterol.
b) Administer the salmeterol and then administer the triamcinolone.
c) Allow the client to choose the order in which the drugs are administered.
d) Monitor the client’s theophylline level before administering the medications.

Answer 26

b) Administer the salmeterol and then administer the triamcinolone.

Question 27

The 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:

a) the attack is over.
b) the airways are so swollen that no air can get through.
c) the swelling has decreased.
d) crackles have replaced wheezes.

Answer 27

b) the airways are so swollen that no air can get through.