PrepU Asthma

Question 1

Which drug is a selective, short-acting, inhaled beta2-adrenergic agonist (SABA) used as the initial rescue drug of choice for acute bronchospasm?

Answer 1

Albuterol
(subcutaneous epinephrine may be considered)

Question 2

A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route?

Answer 2

Inhalation

Question 3

A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on long term management of symptoms associated with which respiratory condition?
A. Asthma
B. Chronic bronchitis
C. Pneumonia
D. Emphysema

Answer 3

A: They block or antagonize receptors for production of leukotrienes D4 and E4, blocking many of the signs and symptoms of asthma. This class of medicaton is not typically associated with the long term management of any of the other options.

Question 4

3 long-acting beta-2 agonists (LABA)?

Answer 4

1. formoterol
2. salmeterol
3. arformoterol

Question 5

An asthmatic client on a beta blocker should be observed for which adverse reaction?
A. Pneumonia
B. Bronchospasm
C. Pleural effusion
D. Hypoglycemia

Answer 5

B. Can occur with beta blockade

Question 6

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

Answer 6

Respiratory acidosis: the PaCO2 increases and pH decreases. (?)

Question 7

Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication?
A. Albuterol blocks stimulation of the beta-2 receptors
B. Albuterol causes relaxation of the bronchial smooth muscles
C. Albuterol reduces inflammation

Answer 7

B: This is the main result of albuterol binding to beta-2 receptors in the lungs. This action relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity

Question 8

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?
A. Salmeterol
B. Albuterol

Answer 8

B

Question 9

A nurse caring for a client with asthma monitors respiratory function. Which level of asthma is seen by the following:
PEF 350 mL in AM, 200 mL at noon, symptoms occur continuously.

Answer 9

Severe persistent asthma: has frequent exacerbations and PEF is less than 60% of what is predicted with variability of 30%.

Question 10

4 levels of asthma:

Answer 10

1. mild intermittent
2. mild persistent
3. moderate persistent
4. severe persistent

Question 11

Which level of asthma is described as symptoms occurring more than 2 times per week (not daily). Exacerbations may affect activity with a PEF of (20%-30% variability?

Answer 11

Mild persistent asthma

Question 12

Which level of asthma is characterized by symptoms occurring 2 or less times per week. Client is asymptomatic between attacks and has a normal peak expiratory flow (PEF).

Answer 12

Mild intermittent asthma

Question 13

Which level of asthma has daily symptoms, exacerbations that affect activity, and PEF variability greater than 30%?

Answer 13

Moderate persistent asthma

Question 14

An asthma educator is teaching a client newly diagnosed with asthma and the family about the use of a peak flow meter. The educator should teach the client that a peak flow meter measures highest airflow during which type of breath?
A. normal expiration
B. forced expiration
C. normal inspiration
D. forced inspiration

Answer 14

B

Question 15

When treating status asthmaticus, which danger sign does the nurse observe for that would indicate respiratory failure?

Answer 15

Respiratory acidosis.

Question 16

Overuse of albuterol can lead to?

Answer 16

rebound bronchoconstriction.

Question 17

Within how much time should a SABA begin to work?

Answer 17

30 minutes.

Question 18

A client diagnosed with asthma has been prescribed a leukotriene receptor antagonist. What information should the nurse include when discussing medication instructions?
A. The effectiveness of the medication is enhanced when taken with food.
B. The medication should be taken on an empty stomach
C. Take this medication 30 minutes before a meal.
D. This medication is best delivered in the morning with breakfast.

Answer 18

B. Bioavailability is decreased markedly by presence of food. Take 1 - 2 hours before a meal.

Question 19

Which client most likely faces the HIGHEST risk of developing secondary pulmonary hypertension?
A. A client with asthma who uses her inhaled bronchodilator more often than prescribed
B. A client with COPD and a 35 pack-year smoking history.
C. A frail elderly woman who has pneumonia

Answer 19

B. COPD is a major risk factor for secondary pulmonary hypertension.

Question 20

Instruction for use of inhaler to reduce Candida infections:

Answer 20

Rinse mouth with water after each use

Question 21

A client being assessed by the home care nurse for the appropriate use of a metered-dose inhaler (MDI). Instructions concerning which intervention will assist a client in the proper use of the device?
A. Using a spacer
B. Exhale immediately after administration
C. Push fluids
D. Administer corticosteroid before administering inhaler

Answer 21

A: Spacers increase compliance and accuracy of admin. Eases admin of aerosolized medication from a MDI.
- corticosteroid should be administered after bronchodilator.

Question 22

The nurse is auscultating the lungs of a lethargic, irritable 6-y.o. boy and hears wheezing. The nurse will MOST likely include which teaching point if the child is suspected of having asthma?
A. “I’m going to have the hospital worker take a picture of your lungs”
B. We are going to collect some mucus from your lungs
C. We need to take an X-ray to see if their are any sores on your lungs

Answer 22

A. x-ray usually ordered for assessment of asthma to check for hyperventilation.

Question 23

Which 3 conditions require sputum culture?

Answer 23

1.. pneumonia
2. cystic fibrosis
3. tuberculosis

Question 24

What procedure is used to identify masses or abscesses in the case of pneumonia?

Answer 24

Fluoroscopy

Question 25

When is the sweat chloride test indicated (for what condition?)

Answer 25

cystic fibrosis

Question 26

The pediatric unit has multiple clients experiencing upper resp. system complication. Which pediatric client is at the HIGHEST risk for resp. distress?
A. 11-month-old infant with nasopharyngitis
B. 3-year-old with croup
C. 16-year-old adolescent with asthma
D. 2-year-old child with epiglottitis

Answer 26

D. = medical emergency due to swelling of epiglottis covering the larynx. Pt. needs frequent assessment for resp. distress, especially if a child= smaller, more compliant airways. Obstruction is most associated with D.

Question 27

Which factor is most likely to precipitate an asthmatic attack in a child with extrinsic, or atopic, asthma?
A. Resp. tract infections
B. Cold weather
C. Stress
D. Pet dander

Answer 27

D. = type 1 hypersensitivity reaction induced by exposure to extrinsic antigen/allergen.
-Intrinsic or nonatopic asthma triggers = resp. tract infection; exercise; hyperventilation; cold air; drugs; chemicals; hormonal changes/emotional upsets; airborne pollutants; and gastroesophageal reflux.

Question 28

What does the black box warning for Salmeterol say?

Answer 28

Contraindicated for people with significantly worsening or acutely deteriorating asthma attacks = may be life threatening.

Question 29

Beclomethasone use, care, and considerations.

Answer 29

• Inhaled steroid
  -may cause oral candidiasis if mouth is not rinsed after each use.
  -Not a rescue inhaler or bronchodilator: must be taken regularly for it to be useful.

Question 30

The mother of a child with asthma tells the nurse that she occasionally gives her child the steroid medicine that 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?
A: I understand that appointments can be annoying but steroid use can cause your child to have high blood sugar, peptic ulcers, slowed growth rate, and various other problems.
B. I’m sure giving your child some of your steroid would be fine if it’s for times of “flare-ups”.
C. I’m sure it must be difficult to cope with flare-ups, but there are many side effects from steroid use and the physician needs to monitor your child’s asthma symptoms
D. You should never give a child adult medication because dosage may differ.

Answer 30

C. Always show empathy and focus on positive action.
-Listing all of the side effects of the steroid is NOT therapeutic communication and does not address the child’s need to be seen by a physician.

Question 31

The school nurse if reviewing the records of students in an elementary school. Based on current child morbidity rates, which child is the nurse MOST careful to monitor for days missed from school?
A. One with food allergies
B. “” asthma
C. “” has atopic dermatitis
D. “” hay fever

Answer 31

B.
Morbidity = illness present in a specific population at a given time.
Asthma = leading chronic disease in children (14%); 13% suffer from skin allergies; 9% have hay fever; 6% have food allergies

Question 32

The nurse is providing discharge planning for a 45-year-old woman who has a prescription of oral albuterol. The nurse will question the patient about her intake of:
A. alcohol
B. coffee
C. vitamin C
D. salt

Answer 32

B. caffeine has sympathomimetic effects that may increase risk for adverse effects.

Question 33

A client is being admitted from the emergency room reporting shortness of breath, wheezing, and coughing. What nursing concern with the nurse formulate for planning the client’s care?
A. Asthma attack
B. insufficient airway clearance
C. Acute dyspnea
D. bronchial pneumonia

Answer 33

B.
A nurse cannot plan care for a client for a diagnosis that has not been given by a doctor, which means that insufficient airway clearance is a summary of client condition, whereas acute dyspnea is a symptom of the condition. IE: wheezing, shortness of breath, and coughing are signs of a constricted airway.

Question 34

When describing the events of an asthma attack to a client, the nurse incorporates into her teaching the understanding that stimulation of alpha-adrenergic receptors results in which of these?
A. bronchoconstriction
B. cough
C. bronchodilation
D. sputum production

Answer 34

A: Stimulation of alpha-adrenergic receptors = bronchoconstriction.
When leukotriene production is inhibited, bronchodilation is facilitated.
-cough is stimulated from the sensory nerves in the airways
-inflammation of mucosa = sputum production from increased mucus

Question 35

Which is an underlying feature of asthma?
A. shortness of breath
B. inflammation
C. chest tightness
D. wheeze

Answer 35

B: inflammation is the cause of all other symptoms.