Asthma
A 10-year-old child presents with coughing, chest tightness, and difficulty exhaling after playing outside during high pollen counts. What is happening physiologically in the airways?
Airway inflammation, mucosal edema, excess mucus production, and bronchospasm are narrowing the airways and limiting airflow.
Rationale:
Asthma is an inflammatory disorder. Exposure to triggers causes smooth muscle constriction and swelling of airway lining, leading to narrowed airways and airflow obstruction, especially during exhalation.
What is the earliest and most common symptom of COPD?
Exertional dyspnea
Rationale:
As alveoli are destroyed and airflow becomes limited, clients first notice shortness of breath with activity before symptoms occur at rest.
Why must antiviral medications for influenza be started early and what is the time period?
They are most effective before viral replication peaks.
48-72 hours of onset of symptoms
Rationale:
Early treatment reduces severity, duration, and complications, especially in high-risk populations.
How does obesity contribute to obstructive sleep apnea?
Excess tissue around the airway increases airway collapse during sleep.
Rationale:
Decreased muscle tone during sleep combined with airway narrowing causes repeated obstruction.
Why is adequate fluid intake essential when taking guaifenesin?
Fluids help thin respiratory secretions so they can be coughed up more easily.
Rationale:
Guaifenesin works by loosening and thinning mucus. Without adequate hydration, secretions remain thick and difficult to expectorate, reducing the medication’s effectiveness.
What does FEV1 mean?
It is the amount of air a person can forcefully blow out in the first second after taking a deep breath.
Rationale:
It tells us how well air moves out of the lungs. It helps diagnose and monitor obstructive lung diseases. It’s a key value in pulmonary function tests
You assess a client during an asthma exacerbation and hear high-pitched sounds primarily during expiration. Why does this sound occur, and what does it indicate about airway diameter?
Expiratory wheezing occurs because air is forced through narrowed airways during exhalation, indicating bronchoconstriction.
Rationale:
Expiration increases intrathoracic pressure, further narrowing already inflamed airways. Wheezing signals airflow through constricted bronchi.
Why must oxygen be administered cautiously in clients with COPD?
Excess oxygen can suppress respiratory drive and worsen CO₂ retention.
Rationale:
Some COPD clients rely on hypoxic drive to breathe. High oxygen levels may decrease respiratory stimulation and lead to hypercapnia.
How does bronchitis differ from pneumonia?
Bronchitis affects the bronchi without alveolar infection; pneumonia involves alveoli and shows infiltrates on x-ray.
Rationale:
Pneumonia directly impairs gas exchange because alveoli are filled with inflammatory fluid.
Why do clients with sleep apnea experience morning headaches and daytime sleepiness?
Repeated nighttime hypoxia and sleep fragmentation.
Rationale:
Intermittent oxygen desaturation and frequent awakenings impair restorative sleep and increase CO₂ levels.
A client using fluticasone daily for asthma reports hoarseness and white patches inside the mouth. What nursing intervention is required, and why is this complication occurring?
Instruct the client to rinse their mouth after each use and assess for oral candidiasis.
Rationale:
Fluticasone is an inhaled corticosteroid that suppresses local immune response in the oropharynx. This allows fungal overgrowth, leading to oral candidiasis and hoarseness. Rinsing the mouth after each dose removes residual medication and reduces the risk of infection.
What is a peak flow meter and what does it do?
Measures Peak Expiratory Flow Rate, PEFR, which is the maximum speed of expiration after a full deep breath.
Rationale:
It measures speed, not volume like FEV1, Monitors airway narrowing, Detect early signs of an asthma flare, Evaluate response to bronchodilators, Guide the asthma action plan
What is the difference between short-acting and long-acting inhalers in asthma management.
Short-acting inhalers are used for acute symptom relief. Long-acting inhalers are used daily for long-term control.
Rationale:
Short-acting beta agonists provide rapid bronchodilation. Long-acting agents and corticosteroids reduce inflammation and prevent exacerbations but do not treat acute attacks.
A COPD client has elevated CO₂ levels on ABG. What acid-base imbalance is present and why?
Respiratory acidosis due to CO₂ retention.
Rationale:
Hypoventilation leads to decreased CO₂ elimination, increasing carbonic acid and lowering blood pH.
A client states, “I got the flu shot last year and still got sick, so it doesn’t work.” How should the nurse respond?
The flu vaccine reduces the severity of illness and risk of complications. It also takes about 14 days after vaccination for the body to build protective antibodies, so exposure to the virus during that time can still result in infection.
Rationale:
After vaccination, the immune system requires approximately two weeks to develop sufficient antibodies for protection. If the client is exposed to influenza before antibodies are fully formed, they can still become infected. Additionally, vaccine strains are based on predicted circulating viruses, and while not always a perfect match, vaccination significantly decreases hospitalization, severe illness, and mortality.
What is the primary purpose of CPAP therapy in obstructive sleep apnea?
To maintain airway patency by providing continuous positive pressure during sleep.
Rationale:
Positive pressure prevents airway collapse and reduces apnea episodes and hypoxemia.
A parent reports their child taking montelukast has become withdrawn and irritable. What is the nurse’s priority action?
Assess for neuropsychiatric symptoms and notify the provider.
Rationale:
Montelukast carries a warning for mood changes and suicidal ideation.
How does spirometry help diagnose asthma or COPD?
It measures airflow limitation and lung volumes.
Rationale:
Reduced FEV1 and abnormal FEV1/FVC ratios indicate obstructive disease.
A client with asthma presents to the emergency department with severe dyspnea, inability to speak, use of accessory muscles, and an oxygen saturation of 86% despite using multiple doses of a rescue inhaler at home. What condition should the nurse suspect?
Status asthmaticus.
Rationale:
Status asthmaticus is a life-threatening asthma exacerbation that does not respond to initial bronchodilator therapy. Persistent hypoxemia and severe respiratory distress indicate impending respiratory failure.
A COPD client reports fatigue during meals and weight loss. What nursing interventions should be implemented?
Small frequent high-protein meals, rest before eating, upright positioning, and pursed-lip breathing.
Rationale:
Eating increases oxygen demand. Energy conservation and improved ventilation techniques reduce dyspnea and prevent malnutrition.
Differentiate between community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP), including when each occurs.
CAP occurs outside healthcare settings. HAP develops 48 hours after hospital admission. VAP occurs in clients receiving mechanical ventilation.
Rationale:
Classification helps identify likely pathogens and appropriate antibiotic treatment strategies.
What lifestyle modifications should be included in teaching for a client with obstructive sleep apnea?
Weight loss, avoiding alcohol and sedatives, smoking cessation, and positional therapy.
Rationale:
Alcohol and sedatives relax airway muscles, worsening obstruction. Weight loss reduces mechanical airway narrowing.
Why does tiotropium improves daily symptoms in COPD but does not provide rapid relief during acute dyspnea?
It provides long-acting bronchodilation but has a slow onset of action.
Rationale:
Tiotropium is a maintenance anticholinergic medication, not a rescue bronchodilator.
Why might a COPD client require BiPAP instead of CPAP?
BiPAP provides separate inspiratory and expiratory pressures to assist ventilation.
Rationale:
BiPAP reduces work of breathing and improves ventilation in clients with CO₂ retention.
A client consistently reports yellow-zone peak flow readings for the past week despite using rescue inhaler as directed. What does this suggest about asthma control, and what change is likely needed in the action plan?
The client’s asthma is not well controlled and likely requires adjustment of long-term controller medications.
Rationale:
Frequent yellow-zone readings indicate inadequate baseline control. Rescue inhalers treat symptoms but do not address chronic inflammation. Maintenance therapy may need to be intensified.
A nurse teaches a client with COPD to use pursed-lip breathing during episodes of dyspnea. How does this technique improve ventilation?
It increases airway pressure during exhalation and prevents airway collapse.
Rationale:
Pursed-lip breathing prolongs exhalation and creates back pressure in the airways, helping keep small airways open and improving CO₂ elimination.
Why are crackles heard in pneumonia and what they indicate about alveolar function?
Fluid or exudate fills alveoli, causing popping sounds during inspiration.
Rationale:
Fluid accumulation interferes with normal gas exchange and produces characteristic adventitious lung sounds.
A client reports consistent CPAP use but continues to experience daytime fatigue. What should the nurse assess first?
Proper CPAP fit and adherence to therapy.
Rationale:
Mask leaks, improper pressure settings, or inconsistent use reduce effectiveness and may allow continued apnea episodes.
Why is diphenhydramine not recommended as a sleep aid in older adults?
It increases risk of delirium, urinary retention, and falls.
Rationale:
Beers Criteria recommend avoiding first-generation antihistamines in elderly clients.
A client with worsening dyspnea has spirometry results showing a progressive decline in FEV1 over the past year. What does this trend indicate about disease progression?
Worsening airflow limitation and advancing obstructive lung disease.
Rationale:
Declining FEV1 reflects progressive airway narrowing or alveolar damage, indicating disease progression and need for treatment adjustment.
A client with status asthmaticus is restless, tachycardic, and has diminished breath sounds with minimal wheezing. Why is the absence of wheezing a concerning finding?
It may indicate severely decreased airflow and impending respiratory failure.
Rationale:
In severe obstruction, airflow may be so limited that wheezing disappears. “Silent chest” is a critical red flag for respiratory collapse.
A client with COPD reports increased sputum production, thicker yellow mucus, and worsening shortness of breath over the past two days. What does this likely indicate?
A COPD exacerbation, possibly due to infection.
Rationale:
Increased sputum volume, color change, and worsening dyspnea are classic signs of acute exacerbation, often triggered by respiratory infection and requiring prompt intervention.
A hospitalized client with pneumonia suddenly becomes confused and restless. What does this indicate, and why is it an emergency?
It indicates hypoxia. Acute mental status changes can signal worsening oxygenation and require immediate intervention.
Why are clients with chronic hypoxemia at increased risk for myocardial infarction?
Increased myocardial oxygen demand combined with vascular damage increases risk of coronary artery occlusion.
Rationale:
Sympathetic surges increase heart workload. Chronic inflammation and hypertension promote atherosclerosis and plaque instability.
A client arrives in acute respiratory distress and states they only use fluticasone daily. What is the immediate nursing intervention?
Administer albuterol.
Rationale:
Fluticasone is maintenance therapy; albuterol provides rapid bronchodilation.
Why might hemoglobin and hematocrit levels be elevated in a client with chronic untreated OSA?
Chronic hypoxemia stimulates increased red blood cell production.
Rationale:
The body compensates for low oxygen levels by producing more erythropoietin, leading to secondary polycythemia(makes too many red blood cells).