Which inhaler should the nurse be prepared to administer to a client at the onset of an asthma attack?

1. 1.

The nurse is assessing a client with asthma and notes wheezing and dyspnea. Which of the following pathophysiological changes is attributable to these symptoms? A. Laryngospasm B. Pulmonary edema C. Narrowing of the airway Correct Narrowing of the airway leads to reduced airflow, making it difficult for the client to breathe and producing the characteristic wheezing. D. Overdistension of the alveoli 2. 2 nurse is assessing a client with asthma who is short of breath and appears frightened. Which of the following clinical manifestations is often present as an early symptom during an exacerbation of asthma? A. Anxiety Correct An early symptom during an asthma attack is anxiety because the client is acutely aware of the inability to get sufficient air to breathe. He will be hypoxic early on with decreased PaCO 2 and increased pH as he is hyperventilating. B. Cyanosis C. Bradycardia D. Hypercapnia

1. 1. The nurse is caring for a client who has anxiety and an exacerbation of asthma. For which of the following reasons should the nurse carefully inspect the chest wall of the client? A. Allow time to calm the client. B. Observe for signs of diaphoresis. C. Evaluate the use of intercostal muscles. Correct The nurse physically inspects the chest wall to evaluate the use of intercostal (accessory) muscles, which gives an indication of the degree of respiratory distress experienced by the client. D. Monitor the client for bilateral chest expansion. Awarded 0 points out of 1 possible points.
2. 4: 18709164625 Which of the following positions is best for the nurse to place a client who is experiencing an asthma exacerbation? A. Supine B. Lithotomy C. High Fowler’s Correct The client experiencing an asthma attack should be placed in high Fowler’s position to allow for optimal chest expansion and enlist the aid of gravity during inspiration. D. Reverse Trendelenburg
3. 5 nurse is caring for a client with an acute exacerbation of asthma. Following initial treatment, which of the following findings indicates to the nurse that the client’s respiratory status is improving?

A. Wheezing becomes louder. Correct The primary problem during an exacerbation of asthma is narrowing of the airway and subsequent diminished air exchange. As the airways begin to dilate, wheezing gets louder because of better air exchange. B. Vesicular breath sounds decrease. C. The cough remains nonproductive. D. Aerosol bronchodilators stimulate coughing. Awarded 0 points out of 1 possible points. 6. 6: 18709164617 The nurse identifies the nursing diagnosis of activity intolerance for a client with asthma. Which of the following etiological factors should the nurse assess in the client? A. Work of breathing Correct When the client does not have sufficient gas exchange to engage in activity, the etiological factor is often the work of breathing. When clients with asthma do not have effective respirations, they use all available energy to breathe and have little left over for purposeful activity. B. Fear of suffocation C. Effects of medications D. Anxiety and restlessness Awarded 0 points out of 1 possible points. 7. 7: 18709164623 The nurse is caring for a client in the emergency department admitted with an exacerbation of asthma. The client has received a β-adrenergic bronchodilator and supplemental oxygen with no improvement in symptoms. Which of the following actions should the nurse anticipate next? A. Intravenous fluids B. Biofeedback therapy C. Systemic corticosteroids Correct Systemic corticosteroids speed the resolution of asthma exacerbations and are indicated if the initial response to the β-adrenergic bronchodilator is insufficient.

D. Pulmonary function testing

1. 8 nurse is caring for a client with an acute exacerbation of c hronic o bstructive p ulmonary d isease (COPD) who needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use? A. Oxygen tent B. Venturi mask Correct The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. The other methods are less precise in terms of amount of oxygen delivered. C. Nasal cannula D. Partial non-rebreather mask Awarded 0 points out of 1 possible points.

strenuous activity, (d) do not assume a dominant position, and (e) do not prolong foreplay. 13. 13. The nurse is caring for a client who is prescribed salbutamol. Which of the following client vital signs indicates that the client is not experiencing any adverse effects from this medication? A. Pulse rate of 76 Correct Salbutamol is a β 2 -agonist that can sometimes cause adverse cardiovascular effects. These would include tachycardia and angina. A pulse rate of 76 indicates that the client did not experience tachycardia as an adverse effect. B. Respiratory rate of 18 C. Temperature of 36° C (98°C) D. Oxygen saturation of 96%

1. 14 nurse is caring for a client who has a prescription for each of the following inhalers. Which of the following medications should the nurse administer to the client at the onset of an asthma attack? A. Salbutamol Correct Salbutamol is a short-acting bronchodilator that should be given initially when the client experiences an asthma attack. B. Salmeterol C. Beclomethasone D. Ipratropium bromide

2. 15 nurse, who has administered a first dose of oral prednisone to a client with asthma, writes on the care plan to begin monitoring which of the following client parameters? A. Apical pulse B. Bowel sounds C. Intake and output Correct Corticosteroids such as prednisone can lead to fluid retention. For this reason, it is important to monitor the client’s intake and output. D. Deep tendon reflexes

3. 16 nurse is assisting a client to learn self-administration of beclomethasone. Which of the following actions should the nurse include in the teaching plan as the best way to prevent an oral infection while taking this medication? A. Chew a hard candy before the first puff of medication. B. Rinse the mouth with water before each puff of medication. C. Ask for a breath mint following the second puff of medication. D. Rinse the mouth with water following the second puff of medication. Correct The client should rinse the mouth with water following the second puff of medication to reduce the risk of fungal overgrowth and oral infection.

4. 1. The nurse is preparing to administer salmeterol to a client by m etered- d ose i nhaler (MDI). The nurse tells the client that which of the following time frames is the onset of action for this medication? A. 3–5 minutes

B. 10–20 minutes Correct The onset of action for salmeterol, an adrenergic bronchodilator, is 10–20 minutes. C. 30–60 minutes D. 2–4 hours

1. 1. The nurse is evaluating whether a client understands how to safely determine whether a m etered- d ose i nhaler (MDI) without a counter is empty. Which of the following methods to check the inhaler to prevent underdosing should the nurse teach the client? A. Place it in water to see if it floats. B. Keep track of the number of inhalations used. Correct It is no longer appropriate to determine whether a canister is empty by seeing if it floats in water since this is not accurate. The best method to determine when to replace an inhaler is by knowing the maximum number of puffs available per MDI and then replacing it when those inhalations have been used. C. Shake the canister while holding it next to the ear. D. Check the indicator line on the side of the canister.

2. 19 nurse is preparing to administer a dose of ipratropium bromide by metered-dose inhaler to a client. The nurse tells the client that which of the following time frames is the expected duration of action for this medication? A. 30 minutes to 1 hour B. 2–3 hours C. 4–6 hours Correct The duration of action for ipratropium bromide, an anticholinergic medication, is 4– hours. D. 8–12 hours

3. 20 client has an order for salbutamol 5 mg via nebulizer. Available is a solution containing 2 mg/mL. How many millilitres should the nurse use to prepare the client’s dose? A. 0 mL B. 2 mL Correct 5 mg ÷ 2 mg/mL = 2 mL. C. 3 mL D. 5 mL

4. 21 nurse is providing client teaching about c hronic o bstructive p ulmonary d isease (COPD) and the client asks the nurse what is the cause of COPD symptoms. Which of the following information is the basis for the nurse’s response? A. An overproduction of the antiprotease α 1 -antitrypsin B. Hyperinflation of alveoli and destruction of alveolar walls Correct In COPD, there are structural changes that include hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowing of small airways, and loss of lung elasticity.

The focus of pursed-lip breathing is to slow down the exhalation phase of respiration, which decreases bronchial collapse and subsequent air trapping in the lungs during exhalation. D. Increasing the respiratory rate and giving the client control of respiratory patterns

1. 26 nurse is caring for a client with emphysema and notes jugular vein distension and pedal edema. Which of the following possible complications of emphysema are these symptoms reflective of? A. Acute respiratory failure B. Secondary respiratory infection C. Pulmonary edema caused by left-sided heart failure D. Fluid volume excess resulting from cor pulmonale Correct Cor pulmonale is a right-sided heart failure caused by resistance to right ventricular outflow resulting from lung disease. With failure of the right ventricle, the blood emptying into the right atrium and ventricle would be slowed, leading to jugular venous distension and pedal edema.

2. 27 nurse is caring for a client who is receiving oxygen per nasal cannula while hospitalized for c hronic o bstructive p ulmonary d isease (COPD). The client asks the nurse whether oxygen use will be needed at home. Which of the following responses is best? A. “Long-term home oxygen therapy should be used to prevent respiratory failure.” B. “Oxygen will not be needed until or unless you are in the terminal stages of this disease.” C. “Long-term home oxygen therapy should be used to prevent heart problems related to COPD.” D. “Oxygen will be needed when your oxygen saturation drops to 88% and you have symptoms of hypoxia.” Correct Long-term oxygen therapy in the home should be considered when the oxygen saturation is 88% or less and the client has signs of tissue hypoxia, such as cor pulmonale, erythrocytosis, or impaired mental status.

3. 1. The nurse is providing discharge information related to activity levels to a 61-year-old client with c hronic o bstructive p ulmonary d isease (COPD) and pneumonia. Which of the following exercise goals is most appropriate once the client is fully recovered from this episode of illness? A. Slightly increase activity over the current level. B. Swim for 10 minutes/day, gradually increasing to 30 minutes/day. C. Limit exercise to activities of daily living to conserve energy. D. Walk for 20 minutes/day, keeping the pulse rate less than 130 beats/min. Correct The client will benefit from mild aerobic exercise that does not stress the cardiorespiratory system. The client should be encouraged to walk for 15– minutes/day, keeping the pulse rate <75% to 80% of maximum heart rate (220—client’s age). With this client, the maximum heart rate is 162(220 – 58) × 80% = 129 beats/min.
4. 1. The nurse is evaluating a client who taking opium. Which of the following assessment findings indicates that the medication is beneficial?

A. Decreased respiratory rate B. Increased respiratory rate C. Increased peak flow readings Correct Ipratropium is a bronchodilator that should lead to increased p eak e xpiratory f low r ates (PEFRs). D. Decreased sputum production

1. 1. The nurse is teaching a client how to self-administer ipratropium via a metered-dose inhaler. Which of the following instructions should the nurse provide to the client about proper inhalation technique? A. “Avoid shaking the inhaler before use.” B. “Breathe out slowly before positioning the inhaler.” Correct It is important to breathe out slowly before positioning the inhaler. This allows the client to take a deeper breath while inhaling the medication, thus enhancing the effectiveness of the dose. C. “After taking a puff, hold the breath for 30 seconds before exhaling.” D. “Using a spacer should be avoided for this type of medication.”
2. 1. Which of the following statements made by a client with c hronic o bstructive p ulmonary d isease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler? A. “I should rinse my mouth following the two puffs to get rid of the bad taste.” B. “I should wait at least one to two minutes between each puff of the inhaler.” C. “Because this medication is not fast acting, I cannot use it in an emergency if my breathing gets worse.” D. “If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily.” Correct The client should not take extra puffs of the inhaler at will to make breathing easier. Excessive treatment could trigger paradoxical bronchospasm, which would worsen the client’s respiratory status.

3. 32 nurse is admitting a client with a diagnosis of asthma exacerbation. Which of the following potential triggers should the nurse assess in the client? ( Select all that apply. ) A. Exercise Correct B. Allergies Correct C. Emotional stress Correct D. Decreased humidity E. Upper respiratory infections Correct Although the exact mechanism of asthma is unknown, there are several triggers that may precipitate an attack. These include allergens, exercise, air pollutants, upper respiratory infections, drug and food additives, psychological factors, and g astro- e sophageal r eflux d isease (GERD).

STROKE

positioning. T issue p lasminogen a ctivator (tPA) is contraindicated in hemorrhagic stroke. B. Positioning to promote cerebral perfusion C. Control of fluid and electrolyte imbalances D. Administration of t issue p lasminogen a ctivator (tPA)

1. 5 nurse is caring for a client who has left-sided hemiplegia following an ischemic stroke that she experienced two weeks earlier. Which of the following actions should the nurse implement to best promote the health of the client’s integumentary system? A. Position the client on her weak side the majority of the time. B. Alternate the client’s positioning between supine and side- lying. Correct A position change schedule should be established for stroke clients. An example is side-back-side, with a maximum duration of two hours for any position. The client should be positioned on the weak or paralyzed side for only 30 minutes. Pillows may be used to facilitate positioning. Areas of skin breakdown should never be massaged. C. Avoid the use of pillows in order to promote independence in positioning. D. Establish a schedule for the massage of areas where skin breakdown emerges.
2. 1. Which of the following sensory-perceptual deficits is associated with left-brain stroke (right hemiplegia)? A. Overestimation of physical abilities B. Difficulty judging position and distance C. Slow and possibly fearful performance of tasks Correct Clients with a left-brain stroke (right hemiplegia) commonly are slower in organization and performance of tasks and may have a fearful, anxious response to a stroke. Overconfidence, spatial disorientation, and impulsivity are more commonly associated with a right-brain stroke. D. Impulsivity and impatience at performing tasks E.
3. 1. The nurse is discharging a client admitted with a t ransient i schemic a ttack (TIA). Which of the following medications should the nurse expect to provide discharge instructions to the client? ( Select all that apply. ) A. Clopidogrel Correct B. Enoxaparin (Lovenox) C. Apixiban Correct D. Enteric-coated Aspirin Correct E. Tissue plasminogen activator (tPA)

Aspirin is the most frequently used antiplatelet agent. Other drugs to prevent clot formation include clopidogrel (Plavix), Oral anticoagulation using apixiban (Eliquis), dabigatran (Pradaxa), or rivaroxaban (Xarelto). Enoxaparin (Lovenox) is used to treat d eep v enous t hrombosis (DVT). T issue p lasminogen a ctivator (tPA) is a fibrinolytic medication used to treat ischemic stroke, not prevent TIAs.

Which inhaler should be used first?

What bronchodilators can be used to treat an asthma attack?

What comes first Flovent or Ventolin?

What medication is used in fast acting inhalers?