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The following medications are prescribed by the health care provider for a patient having an acute asthma attack. Which medication should the nurse administer first?
- A. Salmeterol 50 mcg per dry-powder inhaler (DPI).
- B. Salbutamol 2.5 mg per nebulizer.
- C. Triamcinolone 2 puffs per metered-dose inhaler (MDI).
- D. Methylprednisolone 60 mg IV.
Correct Answer: B
Rationale: Salbutamol is a rapidly acting bronchodilator and is the first-line medication to reverse airway narrowing in acute asthma attacks. It is known as an asthma rescue medication. The other medications work more slowly.
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The nurse is caring for a patient with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
- A. Tell the patient to go to the hospital emergency department.
- B. Instruct the patient to use the prescribed salbutamol.
- C. Ask about recent exposure to any new allergens or asthma triggers.
- D. Question the patient about use of the prescribed inhaled corticosteroids.
Correct Answer: B
Rationale: The patient's peak flow is 70% of normal, in the yellow zone, indicating a need for immediate use of short-acting β-adrenergic (SABA) medications. Assessing for correct use of medications or exposure to allergens also is appropriate, but would not address the current decrease in peak flow. Because the patient is currently in the yellow zone, hospitalization is not needed.
Which of the following information should the nurse include when teaching the patient with asthma about the prescribed medications?
- A. Utilize the inhaled corticosteroid when shortness of breath occurs.
- B. Inhale slowly and deeply when using the dry-powder inhaler (DPI).
- C. Hold your breath for 5 seconds after using the bronchodilator inhaler.
- D. Tremors are an expected adverse effect of rapidly acting bronchodilators.
Correct Answer: D
Rationale: Tremors are a common adverse effect of short-acting β2-adrenergic (SABA) medications and not a reason to avoid using the SABA inhaler. Inhaled corticosteroids do not act rapidly to reduce dyspnea. Rapid inhalation is needed when using a DPI. The patient should hold the breath for 10 seconds after using inhalers.
The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) who is receiving oxygen through a Venturi mask. Which of the following actions should the nurse take?
- A. Ensure that the oxygen flow is at least 10 L/min.
- B. Keep the air entrainment ports free of obstruction.
- C. Attach a humidifier to the oxygen delivery system.
- D. Drain condensation from the oxygen tubing every hour.
Correct Answer: B
Rationale: The air entrainment ports regulate the oxygen percentage delivered to the patient, so they must be unobstructed. A high oxygen flow rate is needed when giving oxygen by partial rebreather or nonrebreather masks. The use of an adaptor can improve humidification but not oxygen delivery. Draining oxygen tubing is necessary when caring for a patient receiving mechanical ventilation.
The nurse has completed patient teaching about the administration of salmeterol using a metered-dose inhaler (MDI). Which of the following actions by the patient indicates good understanding of the teaching?
- A. The patient attaches a spacer (aerochamber) before using the MDI.
- B. The patient coughs vigorously after using the inhaler.
- C. The patient floats the MDI in water to see if it is empty.
- D. The patient activates the inhaler at the onset of expiration.
Correct Answer: A
Rationale: Spacers can improve the delivery of medication to the lower airways. The other patient actions indicate a need for further teaching.
Which of the following actions by a patient who has asthma indicates a good understanding of the nurse's teaching about peak flow meter use?
- A. The patient records an average of three peak flow readings every day.
- B. The patient inhales rapidly through the peak flow meter mouthpiece.
- C. The patient uses the salbutamol metered-dose inhaler (MDI) for peak flows in the yellow zone.
- D. The patient calls the health care provider when the peak flow is in the green zone.
Correct Answer: C
Rationale: Readings in the yellow zone indicate a decrease in peak flow; the patient should use short-acting β-adrenergic (SABA) medications. The best of three peak flow readings should be recorded. Readings in the green zone indicate good asthma control. The patient should exhale quickly and forcefully through the peak flow meter mouthpiece to obtain the readings.