Reactive Airway Disease

Question 1

Determine the correct statement about asthma in the elderly.

Confusion in the diagnosis of asthma and chronic obstructive pulmonary disease influences the lack of timely treatment.

Asthma is a pathology that is chronic, irreversible, and progressive, and it encompasses different pathologies.

D-dimer concentrations have been shown as predictors of mortality and severity in patients with asthma admitted to the hospital.

This disease is characterized by exacerbation phases that usually motivate the hospitalization of the patient, with an average of twice a year, and in many cases, admission to the intensive care unit.

Answer 1

Confusion in the diagnosis of asthma and chronic obstructive pulmonary disease influences the lack of timely treatment.

Question 2

The advanced practice nurse plans teaching for the older adult patient about prevention of respiratory illnesses. Determine the most important strategy for the patient to use.

Reduce the use of inhaled tobacco.

Getting a flu vaccination annually is key to keeping the immune system healthy against diseases.

Use hand sanitizer after shopping.

Wear a mask when mowing the lawn.

Answer 2

Getting a flu vaccination annually is key to keeping the immune system healthy against diseases.

Question 3

An older patient is scheduled for diagnostic testing. Propose the best indication for the patient to undergo pulmonary function tests.

Abnormal arterial blood gas analysis results

Fever for 24 hours or more

Chronic wheezing with an undiagnosed cause

The presence of hemoptysis and fatigue

Answer 3

Chronic wheezing with an undiagnosed cause

Question 4

Determine the respiratory system assessment finding of an older patient that is most concerning.

Three episodes of diagnosed bronchitis in 12 months

Shortness of breath when walking around the house

Purposefully sitting up straighter to get a deep breath

Patient sharing a room with another elderly

Answer 4

Shortness of breath when walking around the house

Question 5

Determine the true statement regarding the respiratory process referred to as remodeling.

Remodeling results in a temporary change.

Pulmonary artery hypotension results.

Remodeling involves the pulmonary walls.

Remodeling involves the vascular walls.

Answer 5

Remodeling involves the vascular walls.

Question 6

A number of mediators that account for pathophysiological features of allergic diseases have been implicated in asthma. Identify inflammatory mediators that are produced in asthma.

Interleukins

Neutrophil proteases

B and T lymphocyte products

Histamine

Answer 6

Histamine

Question 7

Determine the most important teaching point from the advanced practice nurse to the older patient diagnosed with asthma.

Call 911 immediately if you have trouble walking or talking because of shortness of breath or blue lips or fingernails.

Take your asthma medicines exactly as your provider tells you.

Asthma is treated with the same types of medications in older patients as in younger patients.

Call 911 immediately if you have severe wheezing or if you experience shortness of breath that is not relieved by your quick-relief medicine.

Answer 7

Take your asthma medicines exactly as your provider tells you.

Question 8

Dyspnea can be triggered by specific causes. Identify a cause of dyspnea.

Controlled exercise

Decreased blood flow to the medulla oblongata

Presence of pain

Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2), and decreased partial pressure of arterial oxygen (PaO2)

Answer 8

Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2), and decreased partial pressure of arterial oxygen (PaO2)

Question 9

An older patient is scheduled for diagnostic testing. Propose the best indication for the patient to undergo pulmonary function tests.

The presence of hemoptysis and fatigue

Evaluation of respiratory complaints, such as cough and dyspnea

Fever for 24 hours or more

Abnormal arterial blood gas analysis results

Answer 9

Evaluation of respiratory complaints, such as cough and dyspnea

Question 10

Determine what the health care provider would observe during a mild episode of acute bronchospasm.

If you have the means to measure the PEF, this will be less than 50% of the personal value; otherwise, a clinical evaluation should be performed.

Respiratory difficulty appears when the patient is at rest and when pronouncing words. The position the patient adopts is hunched forward.

Respiratory difficulty appears when walking and speaking a few minutes. The patient tolerates the position of recumbency.

Oxygen saturation is less than 90%.

Answer 10

Respiratory difficulty appears when walking and speaking a few minutes. The patient tolerates the position of recumbency.

Question 11

The primary health care provider, while examining the test report of a patient, finds that the patient is producing foul-smelling sputum with a cough. This sign is accompanied by chills, fever, and chest pain. Propose an appropriate treatment.

Antibiotic therapy

Continue testing

Observation

Respiratory isolation until the patient is no longer infected

Answer 11

Antibiotic therapy

Question 12

Determine the true statement regarding the respiratory process referred to as remodeling.

Remodeling involves the pulmonary walls.

Pulmonary artery hypotension results.

Remodeling increases blood flow resistance.

Remodeling results in a temporary change.

Answer 12

Remodeling increases blood flow resistance.

Question 13

Older adults form a heterogeneous group in which, frequently, there are multiple diseases for which various drugs are indicated with the risk of adverse reactions to medications and pharmacological interactions. This risk increases with age because of the physiological changes of aging in relation to pharmacokinetics and pharmacodynamics and influence of diseases and functional and social problems. Identify the most accurate statement about asthma treatment in older adults.

Corticosteroids are the basis of chronic drug treatment and can be administered in any geriatric patient without the need of any monitoring.

Corticosteroids are the basis of chronic drug treatment and, in the geriatric patient, the performance of a bone densitometry before its onset and, if you have osteopenia or osteoporosis, assess treatment with calcium, vitamin D, and bisphosphonates.

Short-term betamimetics (e.g., salbutamol, terbutaline, and so on) should be indicated as regular management, added to the base medication (usually corticosteroids), not forgetting that they should be administered with care in patients with sarcopenia (caused by the higher percentage of free fraction as there is less protein).

The pharmacological treatment of asthma is based primarily on drugs that relieve symptoms in a short period.

Answer 13

Corticosteroids are the basis of chronic drug treatment and, in the geriatric patient, the performance of a bone densitometry before its onset and, if you have osteopenia or osteoporosis, assess treatment with calcium, vitamin D, and bisphosphonates.

Question 14

The nurse is preparing a care plan for an older patient with asthma. The patient is receiving oxygen and has a respiratory rate of 30 breaths per minute, heart rate of 87 beats per minute, and blood pressure of 106/51 mmHg. Propose a nursing diagnosis that would be the priority for this patient.

Risk for injury

Inadequate tissue oxygenation

Risk for fall

Risk for infection

Answer 14

Inadequate tissue oxygenation

Question 15

Dyspnea can be triggered by specific causes. Identify a cause of dyspnea.

Controlled exercise

Decreased blood flow to the medulla oblongata

Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2), and decreased partial pressure of arterial oxygen (PaO2)

Increased blood flow to the heart

Answer 15

Decreased pH, increased partial pressure of arterial carbon dioxide (PaCO2), and decreased partial pressure of arterial oxygen (PaO2)

Question 16

Determine the most important teaching point from the advanced practice nurse to the older patient diagnosed with asthma.

If respiratory infections, such as colds or flu, trigger your asthma, use your quick-relief medicines only when you feel you need them.

Place several rescue inhalers around the house and label them with brightly colored tape.

Call 911 immediately if you have severe wheezing or if you experience shortness of breath that is not relieved by your quick-relief medicine.

Call 911 immediately if you have trouble walking or talking because of shortness of breath or blue lips or fingernails.

Answer 16

Place several rescue inhalers around the house and label them with brightly colored tape.

Question 17

The advanced practice nurse plans teaching for the older adult patient about prevention of respiratory illnesses. Determine the most important strategy for the patient to use.

Visit the health care professional every 3 months.

Reduce the use of inhaled tobacco.

Wear a mask when mowing the lawn.

Getting a flu vaccination annually is key to keeping the immune system healthy against diseases.

Answer 17

Getting a flu vaccination annually is key to keeping the immune system healthy against diseases.

Question 18

Determine what the health care provider would observe during a severe episode of acute bronchospasm.

Respiratory rate is more than 30 breaths per minute. Heart rate is more than 120 beats per minute or equal proportion, depending on age.

Peak expiratory flow (PEF) is between 70 and 80% of personal value. The percentage will be calculated, taking into account the preset personal value.

Respiratory difficulty appears when walking and speaking a few minutes. The patient tolerates the position of recumbency.

Respiratory rate is between 20 and 25 breaths per minute. Heart rate is less than 100 beats per minute.

Answer 18

Respiratory rate is more than 30 breaths per minute. Heart rate is more than 120 beats per minute or equal proportion, depending on age.

Question 19

Identify which of the following statements about the pathogenesis of asthma is false.

Indomethacin can cause asthma attacks through an immune mechanism in patients with triad loop.

Among the psychological factors, the suggestion variable is the most studied.

Intrathoracic thermal changes are the main factor by which exercise can induce or worsen asthma.

Extrinsic asthma can be perennial.

Answer 19

Indomethacin can cause asthma attacks through an immune mechanism in patients with triad loop.

Question 20

Determine which age-related changes in the respiratory system are responsible for an increased susceptibility to pneumonia in older patients.

Diminished gag reflux

Accumulation of toxins

Osteopenia in the vertebrae

Increased pulmonary compliance

Answer 20

Diminished gag reflux

Question 21

Dyspnea can be triggered by specific causes. Identify a cause of dyspnea.

Controlled exercise

Increased blood flow to the heart

Presence of pulmonary disease

Decreased blood flow to the medulla oblongata

Answer 21

Presence of pulmonary disease

Question 22

Determine the most important teaching point from the advanced practice nurse to the older patient diagnosed with asthma.

It is essential to rinse out the mouth after use of inhaled medications, especially steroids.

If a metered-dose inhaler is too difficult to use, a nebulizer can be used for treatments.

If respiratory infections, such as colds or flu, trigger your asthma, use your quick-relief medicines only when you feel you need them.

Dust or dust mites are common asthma triggers. Avoid dust mites.

Answer 22

Dust or dust mites are common asthma triggers. Avoid dust mites.

Question 23

The primary health care provider, while examining the test report of a patient, finds that the patient is producing foul-smelling sputum with a cough. This sign is accompanied by chills, fever, and chest pain. Propose an appropriate treatment.

Respiratory isolation until the patient is no longer infected

Antimicrobial medications, such as isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin

Observation

Surgical intervention

Answer 23

Surgical intervention

Question 24

Determine which of the following clinical criteria would lead to a diagnosis of acute bronchitis.

Cough that produces bloody or moldy mucus

Night sweats or unexplained weight loss

Respiratory symptoms that are getting worse

Acute respiratory infection manifested mainly by cough, with or without sputum production for at least 3 weeks

Answer 24

Acute respiratory infection manifested mainly by cough, with or without sputum production for at least 3 weeks

Question 25

A number of mediators that account for pathophysiological features of allergic diseases have been implicated in asthma. Identify inflammatory mediators that are produced in asthma.

Prostaglandins

B and T lymphocyte products

Macrophage enzymes

Interleukins

Answer 25

Prostaglandins

Question 26

An older patient with asthma is prescribed a rescue inhaler of albuterol. Determine what the advanced practice nurse should instruct the patient about using this medication.

Keep inhalers in multiple areas in the home.

Do not obtain a prescription for extra canisters.

Refrigerate unused canisters until needed.

Do a mouthwash after inhaling

Answer 26

Keep inhalers in multiple areas in the home.

Question 27

Determine the respiratory system assessment finding of an older patient that is most concerning.

Coughing during the night while sleeping because it can be a sign of a respiratory condition

Purposefully sitting up straighter to get a deep breath

Three episodes of diagnosed bronchitis in 12 months

Shortness of breath when crossing a large parking lot

Answer 27

Coughing during the night while sleeping because it can be a sign of a respiratory condition

Question 28

The APRN instructs an older patient with asthma about the use of a peak flow meter. Determine instructions to the patient on when to use the meter.

After eating dinner in the evening

If feeling like cold symptoms are occurring

Five times a day during the first 2 weeks when medication or treatments are changed

When ready to go to sleep at night

Answer 28

if feeling like cold symptoms are occurring

Question 29

An older patient is scheduled for diagnostic testing. Propose the best indication for the patient to undergo pulmonary function tests.

Chest x-ray demonstrating bilateral infiltrates

The presence of hemoptysis and fatigue

Assessment and monitoring of disease severity and progression

Fever for 24 hours or more

Answer 29

Assessment and monitoring of disease severity and progression

Question 30

The advanced practice nurse plans teaching for the older adult patient about prevention of respiratory illnesses. Determine the most important strategy for the patient to use.

Visit the health care professional every 3 months.

Reduce the use of inhaled tobacco.

Wear a mask when mowing the lawn.

Review the immunization record and update as appropriate.

Answer 30

Review the immunization record and update as appropriate.

Question 31

Determine what the health care provider would observe during a severe episode of acute bronchospasm.

Peak expiratory flow (PEF) is between 70 and 80% of personal value. The percentage will be calculated, taking into account the preset personal value.

Oxygen saturation is less than 90%.

Respiratory difficulty appears when walking and speaking a few minutes. The patient tolerates the position of recumbency.

Respiratory rate is between 20 and 25 breaths per minute. Heart rate is less than 100 beats per minute.

Answer 31

Oxygen saturation is less than 90%.

Question 32

Determine the true statement regarding the respiratory process referred to as remodeling.

Remodeling involves the vascular walls.

Remodeling involves the pulmonary walls.

Remodeling decreases blood flow resistance.

Pulmonary artery hypotension results

Answer 32

Remodeling involves the vascular walls.

Question 33

A number of mediators that account for pathophysiological features of allergic diseases have been implicated in asthma. Identify inflammatory mediators that are produced in asthma.

Interleukins

Bradykinin

B and T lymphocyte products

Macrophage enzymes

Answer 33

Bradykinin

Question 34

An older patient is scheduled for diagnostic testing. Propose the best indication for the patient to undergo pulmonary function tests.

Fever for 24 hours or more

Evaluation of the effects of occupational or hazardous exposures

The presence of hemoptysis and fatigue

Chest x-ray demonstrating bilateral infiltrates

Answer 34

Evaluation of the effects of occupational or hazardous exposures

Question 35

The APRN instructs an older patient with asthma about the use of a peak flow meter. Determine instructions to the patient on when to use the meter.

Every day regardless of symptomatology

In the morning after awakening and in the early afternoon

Five times a day during the first 2 weeks when medication or treatments are changed

When ready to go to sleep at night

Answer 35

In the morning after awakening and in the early afternoon

Question 36

Propose what the APRN should instruct an older patient with asthma to do to control exposure to household allergens.

Remove carpets from the bedroom.

Eliminate surfaces that collect dust.

Monitor air quality.

Learn about nutrition.

Answer 36

Remove carpets from the bedroom.

Question 37

Determine the correct statement about asthma in the elderly.

This disease is characterized by exacerbation phases that usually motivate the hospitalization of the patient, with an average of twice a year, and in many cases, admission to the intensive care unit.

Asthma is a pathology that is chronic, irreversible, and progressive, and it encompasses different pathologies.

Asthma in older adults is one of the diseases that progressively increase in episodes and severity, circumstance that is related to the increase of the geriatric population in the world as a consequence of scientific advances that allow the achievement of greater longevity.

The elevation of the C-reactive protein is very sensitive in asthma although not very specific. When the levels remain high despite treatment, it suggests that the treatment is ineffective or that complications develop.

Answer 37

Asthma in older adults is one of the diseases that progressively increase in episodes and severity, circumstance that is related to the increase of the geriatric population in the world as a consequence of scientific advances that allow the achievement of greater longevity.

Question 38

Auscultation is the most important component of the physical exam. All fields of the thorax, including the lateral and anterior, should be auscultated to detect alterations associated with each lobe of the lung. Identify the characteristics that must be auscultated.

Friction

Wheezing

Heart murmurs

Borborygmus

Answer 38

Friction

Question 39

Auscultation is the most important component of the physical exam. All fields of the thorax, including the lateral and anterior, should be auscultated to detect alterations associated with each lobe of the lung. Identify the characteristics that must be auscultated.

Resonance

Heart murmurs

Inspiration-to-expiration ratio

Borborygmus

Answer 39

Inspiration-to-expiration ratio

Question 40

Older adults form a heterogeneous group in which, frequently, there are multiple diseases for which various drugs are indicated with the risk of adverse reactions to medications and pharmacological interactions. This risk increases with age because of the physiological changes of aging in relation to pharmacokinetics and pharmacodynamics and influence of diseases and functional and social problems. Identify the most accurate statement about asthma treatment in older adults.

Corticosteroids are the basis of chronic drug treatment and can be administered in any geriatric patient without the need of any monitoring.

For chronic treatment, betamimetics of long duration (e.g., formoterol, salmeterol) are not preferable to those of short duration because they have events that are more adverse.

Short-term betamimetics (e.g., salbutamol, terbutaline, and so on) should be indicated as regular management, added to the base medication (usually corticosteroids), not forgetting that they should be administered with care in patients with sarcopenia (caused by the higher percentage of free fraction as there is less protein).

The pharmacological treatment of asthma is based primarily on drugs from three different families, as follows: betamimetics, anticholinergics, and inhaled corticosteroids.

Answer 40

The pharmacological treatment of asthma is based primarily on drugs from three different families, as follows: betamimetics, anticholinergics, and inhaled corticosteroids.