Loving
A client has been using a metaproterenol metered dose inhaler (MDI) for exercise-induced asthma. Montelukast has been added to the client's therapy. What would be important for the nurse to teach the client about the control of asthma with these medications?
1. Use the metaproterenol when the montelukast does not relieve acute symptoms.
2. The montelukast should be taken on a regular schedule whether there are symptoms or not.
3. At the first sign of wheezing or difficulty breathing, take the montelukast.
4. Use the metaproterenol three times a day, preferably before meals.
Correct Answer: 2
Rationale:
Montelukast is a leukotriene modifier used to decrease inflammation and decrease or prevent asthmatic attacks; it is not used for immediate relief of asthmatic symptoms. It should be taken on a regular schedule whether the client is experiencing symptoms or not. Metaproterenol is used for relief of acute symptoms or to prevent exercise-induced asthma; it should not be used on a regular schedule.
The nurse is reviewing medications with a client who is receiving multiple drugs for treatment of tuberculosis (TB). Considering the toxic effects of the medications, what will the nurse tell the client to report?
1. Yellow color in the sclera of the eyes
2. Ringing in the ears
3. Orange urine
4. Anxiety and insomnia
Correct Answer: 1
Rationale:
The standard medications used to treat TB are hepatotoxic. The client should report any signs of jaundice, including discoloration of the sclera. Orange urine is common with rifampin, but the nurse does not need to report it. The other options (ringing in the ears, anxiety, and insomnia) are not side effects of the antituberculin medications.
A woman has a positive tuberculosis (TB) test and is receiving isoniazid (INH) prophylactically. What will be important for the nurse to teach the client?
1.
Take pyridoxine (vitamin B6) daily to prevent nerve damage.
2.
Do not take any over-the-counter (OTC) decongestants.
3.
Return to the clinic weekly for sputum studies.
4.
Have vision checked for any changes.
Correct Answer: 1
Rationale:
INH may precipitate a deficiency in vitamin B6; therefore the client should take a supplemental pyridoxine (vitamin B6) to prevent the peripheral neuritis. The client will not require sputum studies; the medication is being given prophylactically. The other options are not associated with INH.
A client with pneumonia has been receiving intravenous (IV) antibiotics for 24 hours. What nursing assessment would indicate the treatment is effective?
1.
Temperature is 99° F (37.2° C) and he is breathing comfortably.
2.
Sputum is yellow and slightly blood tinged.
3.
Breath sounds are clear at the base of the left lung.
4.
White blood cell count is 20,000/μL (20 × 109/L).
Correct Answer: 1
Rationale:
The decrease in fever and the comfortable breathing is indicative of the treatment being effective. Yellow-tinged sputum and elevated white blood cell counts are common in clients with pneumonia. The breath sounds are clear in the base of only one lung; therefore the other lung may still contain consolidation.
The nurse is admitting a child with an acute asthma attack. What information would indicate to the nurse the need to review the child's medication use with the parents?
1.
Ipratropium is used with albuterol for severe asthma attack.
2.
The child has been taking albuterol before playing soccer.
3.
The child is taking beclomethasone via a metered dose inhaler (MDI) every 12 hours.
4.
When the child begins wheezing, the parents have administered cromolyn.
Correct Answer: 4
Rationale:
Cromolyn is to be administered on a scheduled basis to prevent attacks, not to treat an acute episode. Albuterol and ipratropium are used together in an acute asthmatic attack. Albuterol is administered to prevent exercise-induced asthma. Beclomethasone is a corticosteroid administered on a schedule to prevent acute asthmatic episodes.
A client has developed pulmonary edema secondary to many years of hypertension and congestive heart failure. He had been experiencing peripheral edema and paroxysmal nocturnal dyspnea before admission. The nurse has administered 40 mg of furosemide via an intravenous (IV) push. What would the nurse observe as the desired response to this medication?
1.
Decrease in respiratory rate and less difficulty breathing
2.
Blood pressure (BP) goes from 160/100 to 150/94 mm Hg
3.
Urine output increases to 100 mL/hr for 3 hours
4.
Peripheral edema begins to decrease in 24 hours
Correct Answer: 1
Rationale:
The decrease in respiratory rate and less difficulty breathing are secondary to a decrease in the fluid collecting in the lungs; this is the desired response to the diuretic. The decrease in BP is an expected response, but is not the desired response or primary objective in this client. The urine output increases, but if the output increases and the respiratory problem is not resolved, the desired response to the medication is not achieved. The peripheral edema may begin to decrease as a result of the diuretic, but the drug was given via IV push for the immediate action to decrease fluid precipitating respiratory distress.
The nurse is administering albuterol via a metered dose inhaler (MDI) to a client who has a history of coronary artery disease and is now in heart failure. For what side effects will be it particularly important to observe when the client takes the medication?
1.
Tremors and central nervous system stimulation
2.
Tachycardia and presence of chest pain
3.
Development of oral candidiasis
4.
An increase in blood pressure (BP)
Correct Answer: 2
Rationale:
The side effects of tachycardia and chest pain are particularly important to watch for in a client who is receiving the beta2 agonist and has a history of cardiac problems. They are less common when the medication is administered via inhalation. Tremors also occur, but the tachycardia is more important with this client considering his cardiac history. Oral candidiasis may occur with the inhalation of the corticosteroids.
A client with chronic bronchitis is receiving salmeterol, a beta2-adrenergic agonist. What is the best evidence that the drug is effective?
1.
Heart rate decreased from 120 beats/min to 90 beats/min
2.
Productive cough with increased amounts of clear sputum
3.
Diminished wheezing; decreased shortness of breath
4.
Decreased dyspnea for up to 4 hours after administration
Answer: 3
Rationale:
Beta2-adrenergic agonists cause relaxation of bronchial smooth muscle, relieving bronchospasm and reducing airway resistance. Treating a client with a beta2-adrenergic agonist should cause a decrease in wheezing and prevent bronchospasm. Beta2-adrenergic agonists do not act as expectorants, so productive cough is incorrect. Beta2-adrenegic agonists have cardiac stimulant effects, which can lead to palpitations and tachycardia. The medication should have an effect of about 12 hours; it is not used for short-term relief.
A client who was recently diagnosed with tuberculosis (TB) calls the clinic because her urine is reddish orange. She is taking isoniazid (INH), rifampin, and pyrazinamide. What would be the best nursing response?
1.
"These are symptoms of a urinary tract infection; drink plenty of fluids."
2.
"This is an expected response to the rifampin."
3.
"This may be an indication of liver toxicity; stop the medications."
4.
"There is something wrong with the medication; you should see a physician immediately."
Correct Answer: 2
Rationale:
This is a common side effect of rifampin. The client would not stop taking the medications. Contact lenses also may become discolored. No indication exists of a urinary tract infection.
A client at a long-term care facility is being treated for chronic bronchitis. When the nurse enters the room, the nurse hears the client wheezing. The client's pulse oximeter reads 85% saturation. The earlier reading was 88%. What should be the nurse's first action for the client?
1.
Auscultate breath sounds every 2 hours.
2.
Give two puffs of albuterol by a metered dose inhaler (MDI).
3.
Give two puffs of beclomethasone via an MDI.
4.
Increase oxygen to 5 L/min per rebreathing mask.
Correct answer: 2
Rationale:
The wheezing relates to constricted and swollen bronchioles from the chronic bronchitis. Albuterol is a short-term bronchodilator that relaxes bronchial smooth muscles, allowing for better oxygenation. Data already provided indicate that the client is respiratory compromised; quality of breath sounds would not affect the need to administer the albuterol. Beclomethasone is not a rescue inhaler. It is used to prevent acute airway problems secondary to the bronchitis. The albuterol must be administered before the oxygen; opening the airway will facilitate the oxygen.
A 10-year-old child is admitted with reactive airway disease. Assessment reveals that the child has decreased breath sounds bilaterally. A nebulizer treatment is administered with albuterol, and oral corticosteroids were started. Two hours later, the child's breath sounds are coarse bilaterally. What is the best interpretation of this information?
1.
The child's respiratory status has improved.
2.
The child needs another nebulizer treatment.
3.
The child's condition is deteriorating.
4.
The child is going to need to be suctioned.
Correct Answer: 1
Rationale:
The albuterol opened the airway and the airflow has improved, as indicated by the increase in the breath sounds. The coarse breath sounds are related to the opening of the airway and movement of the mucus in the main stem bronchi. The child does not need another treatment now, nor does the child need to be suctioned.
A nurse is preparing to administer 20 mg of prednisone via intravenous (IV) push to a client with chronic obstructive pulmonary disease (COPD). What intervention should the nurse be prepared to institute based on the medication given?
1.
Have the client use an incentive spirometer.
2.
Check the client's blood sugar.
3.
Have the client turn, cough, and deep breathe.
4.
Have the client ambulate in the hallway.
Correct Answer: 2
Rationale:
Check the client's blood sugar with a glucometer. A side effect of prednisone is it raises a client's blood sugar level, so this is routinely checked. An incentive spirometer is used to expand the lungs. Having the client turn, cough, and deep breathe also expands the lungs and clears the airway. Ambulation helps to strengthen a client and keeps the client from getting deep vein thrombosis and pneumonia.
A client with chronic obstructive pulmonary disease (COPD) is to be discharged and sent home while receiving continuous oxygen at a rate of 2 L/min via cannula. What information does the nurse provide to the client and his wife regarding the use of oxygen at home?
1. Because of his need for oxygen, the client will have to limit activity at home.
2. The use of oxygen will eliminate the client's shortness of breath.
3. Precautions are necessary because oxygen can spontaneously ignite and explode.
4. Use oxygen during activity to relieve the strain on the client's heart.
Correct Answer: 4
Rationale:
The primary purpose of oxygen therapy is to decrease the workload of the heart in clients with COPD and to assist in preventing right-sided heart failure. Use of oxygen may help to relieve shortness of breath but will not eliminate it. Oxygen supports combustion but is not explosive; supplemental oxygen will allow more activity for the client, not less.
What finding on the nursing assessment would be associated with a diagnosis of pneumonia in the older adult?
1. Acute confusion
2. Hypertension
3. Hematemesis in the morning
4. Dry hacking cough at night
Correct Answer: 1
Rationale:
Confusion in the older adult is related to hypoxemia, which occurs with pneumonia. Vasodilation and dehydration cause hypotension and orthostatic changes. Crackles are typically heard when fluid is in the alveolar area. The cough is generally productive. The breathing is rapid and shallow without the use of accessory muscles. Hemoptysis may occur, but not hematemesis (blood from the gastrointestinal [GI] tract).
For a client with chronic obstructive pulmonary disease (COPD), what is the main risk factor for pulmonary infection?
1. Fluid imbalance with pitting edema
2. Pooling of respiratory secretions
3. Decreased fluid intake and loss of body weight
4. Decreased anteroposterior diameter of the chest
Correct Answer: 2
Rationale:
Ineffective clearing of secretions with resultant pooling can lead to an increased risk for infection. The client's appetite is usually decreased. The client has an increased anteroposterior diameter of the chest.
A client has a history of atherosclerotic heart disease with a sustained increase in his blood pressure (BP). What is important to discuss with this client before he uses an over-the-counter (OTC) decongestant?
1. Urinary frequency and diuresis
2. Bradycardia and diarrhea
3. Vasoconstriction and increased arterial pressure
4. Headache and dysrhythmias
Correct Answer: 3
Rationale:
Decongestants should be avoided by clients with hypertension because these medications often contain pseudoephedrine and phenylephrine, which cause central nervous system stimulation with vasoconstriction and increased BP. They also precipitate anxiety and insomnia. Decongestants do not cause urinary frequency, diuresis, or dysrhythmias.
The nurse is caring for a client in pulmonary edema. In what position should the nurse avoid placing this client?
1. Supine with legs elevated
2. Low Fowler's with legs dependent
3. Sitting at bedside
4. High Fowler's with legs straight in front
Correct Answer: 1
Rationale:
The problem with pulmonary edema is that the heart cannot handle the venous return. By elevating the client's legs, all of the venous blood is put back into the central system. The legs should remain straight or dependent to prevent overload. Low Fowler's, high Fowler's, and sitting positions enhance ventilation and decrease venous return.
The arterial blood gas (ABG) results for a client with chronic obstructive pulmonary disease (COPD) are PaO2 of 90 mm Hg, PCO2 of 40 mm Hg, and Hco3 of 24 mEq/L (24 mmol/L). The client is alert and is short of breath on exertion. What is the best nursing action based on this assessment data?
1. Administer oxygen at 4 L/min to prevent hypoxia.
2. No action is necessary; this is within the normal range for a client with COPD.
3. Anticipate the development of metabolic acidosis and perform pulmonary hygiene.
4. Place in high Fowler's position and anticipate the need for assisted ventilation.
Correct Answer: 2
Rationale:
These results are within the anticipated blood gas values for a client with COPD; therefore, no action is needed. The PCO2 of 40 mm Hg is within the high normal range and the PaO2 of 90 mm Hg is within normal range. The Hco3 of 24 mEq/L is normal.
The nurse anticipates the hemoglobin and hematocrit levels to be elevated for a client with chronic obstructive pulmonary disease (COPD). The nurse would recognize that this is caused by:
1.
Hypercapnia
2.
Chronic hypoxia
3.
Acute upper respiratory tract infections
4.
Chronic infections
Correct Answer: 2
Rationale:
When chronic hypoxia occurs, the body increases the hemoglobin and hematocrit levels to increase the oxygen-carrying capacity of the blood in an attempt to deliver increased oxygen to the tissues. Increased carbon dioxide and acute and chronic infections do not cause this characteristic increase.
A common complication in clients with chronic lung disease is pneumonia. To help determine the effectiveness of therapy, the nurse should refer to the results of which diagnostic test?
1. Pulmonary function study
2. Culture and sensitivity (C & S) of sputum
3. Bronchoscopy
4. Lung scan
Correct Answer: 2
Rationale:
In any client with pneumonia, the C & S of sputum are critical in selecting the most effective antibiotic and tracking the effectiveness of the antibiotic. The other options do not identify the infecting organism.
What would the nurse expect to be present on the admission assessment of a client with chronic bronchitis?
1. Peripheral edema, chest pain, and hemoptysis
2. Dyspnea, productive cough, and wheezing
3. Wheezing, dry cough, and peripheral edema
4. Tachycardia, cyanosis, and nonproductive cough
Correct Answer: 2
Rationale:
A common assessment finding for a client with a chronic bronchitis is dyspnea, productive cough, and wheezing. Peripheral edema may be present if the client goes into heart failure, but not hemoptysis (usually associated with pulmonary edema). Eliminate the options that have nonproductive or dry cough. Cyanosis may or may not be present depending on the severity of the hypoxia.
What assessment findings would indicate the development of a critical complication in a client who is experiencing an increasing problem with asthma?
1. Arterial pH of 7.35, PO2 of 90 mm Hg, PCO2 of 35 mm Hg, Hco3 of 26 mEq/L (26 mmol/L)
2. Blood pressure (BP) of 200/110 mm Hg, pulse of 120 beats/min
3. Extremely labored breathing with decreased breath sounds
4. Increased wet breath sounds; hemoptysis
Correct Answer: 3
Rationale:
Severe dyspnea and decreased breath sounds indicate an increasing problem in the asthma client. This can quickly become a medical emergency (status asthmaticus) that can rapidly develop into a respiratory arrest. Client may also have respiratory acidosis; pulse and BP would go up, but these are nonspecific. Wet breath sounds and hemoptysis are not characteristic.
The nurse is caring for a client who had a stroke and subsequently aspirated gastric contents. His PaO2 at 10:00 am was 85 mm Hg and PCO2 was 30 mm Hg, at which time his inspired oxygen level was increased from 40% to 60%. It is noon; his PaO2 is 70 mm Hg and his PCO2 is 30 mm Hg. His pulse oximetry is slowly decreasing from 98% to 90%. After calling for assistance, what would be important nursing actions?
1. Assess for development of profuse purulent respiratory secretions.
2. Monitor progression of hypoxia and anticipate intubation and mechanical ventilation.
3. Encourage coughing and deep breathing; encourage ambulation, as tolerated.
4. Initiate endotracheal suctioning and prepare for insertion of a chest tube.
Correct Answer: 2
Rationale:
The client is at high risk (history of aspiration) for development of acute respiratory distress syndrome (ARDS). His oxygen levels are dropping even with an increase in his inspired oxygen concentration. The nurse should anticipate that his respiratory status will continue to deteriorate. No indication exists of an infection or that purulent respiratory secretions will be problem. Endotracheal suctioning will increase the hypoxia. No indication exists for chest tube insertion.
A client had a chest tube inserted to treat a spontaneous pneumothorax. Several hours after the insertion, the client complains of shortness of breath. The client's pulse has increased from 74 to 96 beats/min, and the respirations have increased from 18 to 28 breaths/min. The client is in semi-Fowler's position. What would be the first nursing action?
1.
Change the client's position and begin administration of oxygen.
2.
Check the chest tube for proper functioning.
3.
Evaluate breath sounds and pulse oximetry.
4.
Administer a pain medication.
Correct Answer: 3
Rationale:
Evaluate the client's breath sounds and pulse oximetry. The client may need to cough and deep breathe to remove secretions and to increase pulmonary expansion. After determining the respiratory status, the nurse focuses on the equipment and checks the chest tube to see if the fluid in the tube is fluctuating and the system is intact. This client should have minimal drainage. Semi-Fowler's position is probably the most comfortable and therapeutic for the client at this time. Administering pain medication does not address the cause of the respiratory problems.
A client diagnosed with tuberculosis (TB) is being cared for at home. What information should be included in a teaching plan for the client's home care?
1. The client must take medications at the prescribed time; the client should not skip doses or allow the supply to run out.
2. Respiratory isolation procedures need to be carried out at home; the client should avoid contact with immediate family members.
3. It will be necessary for the client to return to the clinic every week to have sputum checked for viable bacteria.
4. The client may experience a rash along with nausea and vomiting from the medications and should decrease the dose if this occurs.
Correct Answer: 1
Rationale:
A client with TB must understand the importance of taking medications as prescribed. If doses are missed, this will increase the mutation of the tubercle bacillus and decrease the effectiveness of the medication. Respiratory isolation at home is not necessary, and if the client experiences problems of rash, nausea, and vomiting, the doctor should be contacted. Weekly sputum checks are not necessary.