Question 1

The nurse is teaching a client about the use of an albuterol rescue inhaler.Which nursing diagnosis is most appropriate to avoid the adverse effects of albuterol?

Accepted Answer

The most appropriate nursing diagnosis to avoid adverse effects of albuterol is Knowledge, Deficient related to proper use of albuterol inhaler. This diagnosis will help in educating the client about the proper technique of using the inhaler, including proper timing and administration of the medication, to avoid overdose or underdose of albuterol. It will also help in reducing the risk of adverse effects, such as palpitations, anxiety, tremors, and increased heart rate, which may occur due to improper use of the inhaler.

Question 2

Over the course of treatment for chronic asthma,a client develops an allergy to the propellants in rapid-acting metered-dose inhalers (MDI).What option would the nurse expect to be used to address this problem after discharge?

Accepted Answer

A dry powder inhaler (DPI) does not use propellants, making it a suitable alternative for patients with allergies to MDI propellants.

Question 3

A client in acute respiratory distress on a medical unit is receiving a nebulizer albuterol treatment.The client is annoyed because he already has an albuterol metered-dose inhaler (MDI).The nurse's response to the client's concern is based on the knowledge that:

Accepted Answer

Nebulized therapy delivers medication in a suspension of liquid over a longer period, which increases the bronchodilator's effectiveness. This is especially beneficial for clients in acute respiratory distress. While nebulized therapy may be more expensive than using an MDI in outpatient settings, it is generally considered more effective in the inpatient setting. However, there is no evidence to suggest that the nebulized form of albuterol has fewer negative effects on clients in respiratory distress, nor is there evidence to suggest that clients in respiratory distress are unable to use an MDI effectively.

Question 4

An adult is admitted to the emergency department with a respiratory rate of 32 breaths per minute and gasping.The nursing interview reveals the client witnessed a drive-by shooting.The nurse recognizes the client's rapid breathing is probably driven by:

Accepted Answer

The rapid breathing and gasping seen in this client are likely a result of an acute stress reaction, specifically the “fight or flight” response. This response is controlled by the brainstem and leads to increased respiratory and heart rates, as well as other physiologic changes, in order to prepare the body to respond to a perceived threat. Increased cerebral cortex perfusion and alveolar capillary bed perfusion are not likely to be driving factors in this scenario, and a sudden increase in blood pressure may be seen as a result of the stress response, but is not the primary cause of the rapid breathing.

Question 5

The nurse is teaching an asthmatic client about the use of a corticosteroid inhaler prior to discharge.The expected outcome of this therapy is:

Accepted Answer

Corticosteroid inhalers work by reducing inflammation and swelling in the airways, which then decreases mucus production and hyperresponsiveness to allergens. While inhalers can improve asthma symptoms, they may not necessarily resolve all symptoms. Choice A is incorrect because it only addresses the upper airway and not the smaller bronchial tubes affected by asthma. Choice D is somewhat correct, but it is more specific to the location of inflammation in the airways.

Question 6

The nurse is planning care for a client with chronic obstructive pulmonary disease (COPD).The client's symptoms are wheezing,tachycardia,increased respiratory rate,coughing up yellow mucus,and a low oxygen level.The highest-priority nursing diagnosis is:

Accepted Answer

The client's symptoms indicate impaired gas exchange, which is the inability to adequately oxygenate and/or eliminate carbon dioxide. This is a life-threatening condition and the priority nursing diagnosis that requires immediate attention. The nurse should implement interventions such as administering oxygen, encouraging deep breathing exercises, and monitoring the client's respiratory status closely. Falls, deficient knowledge, and anxiety are important nursing diagnoses but are of lower priority compared to the potential consequences of impaired gas exchange.

Question 7

A client is learning metered-dose inhaler technique.The client says,"I don't understand why I have to use this thing.Can't I just take pills?" The nurse responds that the inhalation route:

Accepted Answer

The inhalation route delivers medication directly to the site of action, resulting in lower doses and fewer systemic side effects. It also allows for targeted delivery to the lungs, making it a preferred route for respiratory conditions such as asthma and chronic obstructive pulmonary disease.

Question 8

A client with degenerative arthritis is provided with a spacer along with a corticosteroid metered-dose inhaler.The nurse recognizes that the spacer assists this client to:

Accepted Answer

The spacer helps compensate for decreased dexterity by allowing the client to easily inhale the medication even with limited maneuvering ability. It does not increase the dose of the steroid nor does it help with weaning from the drug or prevent thrush infections.

Question 9

A client with limited strength in the hands is being prepared for discharge with a dry powder inhaler (DPI).The discharge nurse teaches the client that an advantage of this inhaler is that:

Accepted Answer

The answer of A client with limited strength in the...

Question 10

A trauma client has experienced a ruptured diaphragm.The nurse would anticipate that this client will have difficulty:

Accepted Answer

A ruptured diaphragm can cause difficulty in carrying out the respiratory cycle, as the diaphragm is essential for the mechanics of breathing. The client may experience shortness of breath, difficulty taking deep breaths, and decreased lung function. The ruptured diaphragm can also cause other complications, such as abdominal contents entering the chest cavity and putting pressure on the lungs, which can exacerbate the difficulty with the respiratory cycle. The other choices (A, B, and C) do not accurately reflect the potential difficulties associated with a ruptured diaphragm.

Question 11

The nurse is collaboratively setting goals for the inpatient management of new-onset asthma in a child.The nurse prioritizes the client's nursing diagnoses and gives which goal the highest priority?

Accepted Answer

The highest priority goal should be related to improving the client's respiratory status and easing their breathing, as this is the primary concern in the management of new-onset asthma. Sleeping patterns and medication education are important, but they are secondary to ensuring adequate oxygenation and breathing comfort for the client. Demonstrating the use of an inhaler with a spacer is also important, but it should be prioritized after ensuring that the client's breathing is adequately managed.

Question 12

The nurse is admitting a client with a history of asthma attacks every other day and three episodes at night in the last month.The client reports activity is somewhat limited.The nurse anticipates that the health care provider will determine the client's level of asthma to be:

Accepted Answer

The answer of The nurse is admitting a client with...

Question 13

A client with chronic obstructive pulmonary disease (COPD)is experiencing difficulty with copious amounts of tenacious sputum.A mucolytic drug is prescribed.The outcome the nurse would track is:

Accepted Answer

A mucolytic drug is prescribed to liquefy and loosen thick, tenacious sputum, thereby increasing its clearance. The other options are not directly related to the expected outcome of a mucolytic drug.

Question 14

A client with moderate and persistent asthma has obtained control with a formoterol inhaler qid for bronchospasm for several years.In the past couple of weeks,however,the client has been reporting more chest tightness and wheezing during the day.The nurse recognizes that the most likely problem is that the client:

Accepted Answer

The client has likely developed a tolerance to the formoterol inhaler, which is why they are experiencing increased symptoms despite regular use.

Question 15

A nurse is caring for several clients receiving bronchodilator therapy for asthma.The nurse has noted that some clients develop hyperglycemia during therapy.Which bronchodilator would the nurse consider problematic?

Accepted Answer

The answer of A nurse is caring for several clients...

Question 16

The nurse is assisting a client to master the use of a steroid inhaler.The client says,"I don't think I should be using steroids.I see steroids labeled as bad in the news at least once a week." The nurse's response is based on the fact that:

Accepted Answer

Inhaled steroids are very useful in managing reactive airways, with a fairly good safety profile. The steroids abused by people reported in the news media are different from the steroid preparations used to treat airway problems. It is important to educate the client that inhaled steroid use can be very beneficial for their specific condition, and the risk is relatively low when used as directed.

Question 17

A nurse in an intensive care unit is planning care for a client with severe bronchospasms triggered by a known allergy to peanuts.The nurse recognizes that constriction is related to inflammatory mediators that trigger:

Accepted Answer

Constriction of the muscles in the walls of the large bronchiole tubes is a common response in bronchospasms triggered by allergy-induced inflammation. This narrowing of the airways causes difficulty breathing and can be life-threatening, which is why it is important to identify and avoid allergens that can trigger this response. Options A, B, and D may occur in other respiratory conditions, but are not typically associated with bronchospasms caused by allergies.

Question 18

The nurse is admitting a client with an exacerbation of asthma.The medication list includes albuterol,salmeterol,budesonide,cromolyn,and zafirlukast.The client takes these medicines every day,except for the albuterol.When planning the client's care,the nurse recognizes that:

Accepted Answer

The client's combination of medications including albuterol, salmeterol, budesonide, cromolyn, and zafirlukast is appropriate according to current practice guidelines for asthma management. This combination provides both quick relief and long-term control of asthma symptoms. It is important for the client to continue taking these medications as prescribed by the healthcare provider to manage asthma exacerbation and prevent future attacks.

Question 19

The nurse is caring for an orthopedic surgical client with mild intermittent asthma.During the second postoperative day,the client has an asthma attack while eating lunch.The nurse expects the health care provider to give an order for:

Accepted Answer

The client's mild intermittent asthma suggests that a short-acting selective beta-agonist inhaler, such as albuterol, would be appropriate for the treatment of an acute asthma attack. Subcutaneous epinephrine is not typically used as the first-line treatment for asthma, and theophylline is not commonly used for acute asthma exacerbations. While oral corticosteroids may be ordered to prevent future asthma attacks, they are not typically given for immediate relief during an acute attack.

Question 20

A mother is struggling to manage her child's moderate persistent asthma at home.The mother asks the nurse if there are any nonpharmacologic measures she can use.Which strategies are most likely to be effective?

Accepted Answer

Avoiding stimuli such as secondhand smoke, pollutants, and cold air is an effective nonpharmacologic measure for managing moderate persistent asthma. Keeping the child's immunizations up-to-date and wearing a face mask in public can prevent asthma exacerbations caused by infections, but they do not directly manage asthma symptoms. Limiting intake of protein and foods with red and yellow dyes and homeschooling the child and limiting his contact with other children who might have upper respiratory infections are not effective nonpharmacologic measures for managing moderate persistent asthma.

Quiz 44: Pharmacotherapy of Asthma and Other Pulmonary Disorders