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The nurse is caring for a patient in the emergency department who is experiencing an acute asthma attack. After listening to the patient's breath sounds, which of the following should the nurse take next?
- A. Start an intravenous with Ringer's Lactate.
- B. Ask about inhaled corticosteroid use.
- C. Determine when the dyspnea started.
- D. Obtain a peak expiratory flow rate (PEFR).
Correct Answer: D
Rationale: The examiner can assess the degree of severity by measuring FEV1 or PEFR, identifying the degree of change in objective measurements, and evaluating the baseline pulse oximetry value. The length of time the attack has persisted is not as important as determining the patient's status at present. It is important to know about the medications the patient is using but not as important as assessing the breath sounds. Initiating IV therapy is not a priority at this time.
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Which of the following diagnostic tests should the nurse plan to discuss with a patient who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)?
- A. Eosinophil count.
- B. Spirometry.
- C. Immunoglobin E (IgE) levels.
- D. Radioallergosorbent test (RAST).
Correct Answer: B
Rationale: The diagnosis of COPD is confirmed by spirometry regardless of whether the patient has chronic symptoms. The other tests would be used to test for an allergic component for asthma, but will not be used in the diagnosis of COPD.
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.
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.
Which of the following findings in a patient who has received omalizumab is considered an adverse effect?
- A. Pain at injection site.
- B. Flushing and dizziness.
- C. Respiratory rate 22 breaths/minute.
- D. Peak flow reading 75% of normal.
Correct Answer: A
Rationale: Reaction at injection site is the only adverse effect of omalizumab. The other information is not related to omalizumab therapy.
Which of the following topics should the nurse include in medication teaching for a patient with newly diagnosed persistent asthma?
- A. Use of long-acting β-adrenergic medications.
- B. Adverse effects of sustained-release theophylline.
- C. Self-administration of inhaled corticosteroids.
- D. Complications associated with oxygen therapy.
Correct Answer: C
Rationale: Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.