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While assisting a patient with intermittent asthma to identify specific triggers of asthma, what should the nurse explain?
- A. a. Food and drug allergies do not manifest in respiratory symptoms.
- B. b. Exercise-induced asthma is seen only in individuals with sensitivity to cold air.
- C. c. Asthma attacks are psychogenic in origin and can be controlled with relaxation techniques.
- D. d. Viral upper respiratory infections are a common precipitating factor in acute asthma attacks.
Correct Answer: d
Rationale: The correct answer is D because viral upper respiratory infections are a common precipitating factor in acute asthma attacks. This is important information for the patient to understand in order to help identify triggers and manage their asthma effectively. Viral infections can exacerbate asthma symptoms, so recognizing this connection can aid in prevention and treatment.
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A client with acute asthma showing inspiratory and expiratory wheezes and a decreased forced expiratory volume should be treated with which of the following classes of medication right away?
- A. Beta-adrenergic blockers.
- B. Bronchodilators.
- C. Inhaled steroids.
- D. Oral steroids.
Correct Answer: B
Rationale: The correct answer is B: Bronchodilators. In acute asthma, bronchodilators are the first-line treatment to quickly relieve bronchoconstriction and improve airflow. Inspiratory and expiratory wheezes indicate airway obstruction, and decreased forced expiratory volume suggests reduced airflow. Beta-adrenergic blockers (A) can worsen asthma symptoms by blocking beta-2 receptors, leading to bronchoconstriction. Inhaled steroids (C) are used for long-term asthma control and not for acute exacerbations. Oral steroids (D) are typically used in severe asthma exacerbations requiring systemic anti-inflammatory effects and are not the immediate first-line treatment for acute asthma.
You are providing care for a client with recently diagnosed asthma. What key points will you be sure to include in your teaching plan for this client? (Choose all that apply.)
- A. Avoid potential environmental asthma triggers such as smoke.
- B. Use inhaler 30 minutes before exercising to prevent bronchospasm.
- C. Wash all bedding in cold water to reduce and destroy dust mites.
- D. Be sure to get at least 8 hours of rest and sleep every night.
Correct Answer: D
Rationale: The correct answer includes A, B, and D. Avoiding triggers (A), using inhalers before exercise (B), and ensuring adequate rest (D) are important for asthma management. Washing bedding in cold water (C) is ineffective for destroying dust mites; hot water is required.
When Bohr effect occurs due to increased CO2 tension, Oxygen affinity of Hb decreases. The reason for increased CO2 tension is
- A. Increase in P50
- B. Decrease in P50
- C. High CO2 content
- D. High O2 content
Correct Answer: A
Rationale: The correct answer is A because an increase in P50 indicates a decrease in oxygen affinity of hemoglobin (Hb), as seen in the Bohr effect. When CO2 tension rises, it forms carbonic acid in the blood, leading to a decrease in pH. This decrease in pH causes a right shift in the oxygen-hemoglobin dissociation curve, resulting in lower oxygen affinity of Hb. Decreasing P50 reflects this reduced affinity. Choices B, C, and D are incorrect because a decrease in P50, high CO2 content, and high O2 content would not lead to a decrease in oxygen affinity as observed in the Bohr effect.
A patient with a decreased level of consciousness is in a recumbent position. How should the nurse best assess the lung fields for a patient in this position?
- A. Inform that physician that the patient is in a recumbent position and anticipate an order for a portable chest x-ray.
- B. Turn the patient to enable assessment of all the patient's lung fields.
- C. Avoid turning the patient, and assess the accessible breath sounds from the anterior chest wall.
- D. Obtain a pulse oximetry reading, and, if the reading is low, reposition the patient and auscultate breath sounds.
Correct Answer: B
Rationale: The correct answer is B because turning the patient to enable assessment of all the lung fields is the best approach to assess lung sounds comprehensively. By turning the patient, the nurse can listen to breath sounds on both the anterior and posterior chest walls, ensuring a thorough assessment. Option A is incorrect as it assumes the need for a chest x-ray without first performing a physical assessment. Option C is incorrect as it limits assessment to only the anterior chest wall, potentially missing abnormalities in the posterior lung fields. Option D is incorrect as obtaining a pulse oximetry reading and repositioning the patient should not replace the need for a physical assessment of lung sounds.
A long-term COPD client is receiving oxygen at 1 L/minute. Her visiting cousin decides she "doesn't look too good" and increases her oxygen to 7 L/minute. What should the nurse's initial action be?
- A. Thank the client's cousin and continue to observe the client.
- B. Immediately decrease the oxygen.
- C. Notify the physician.
- D. Elevate the client's head and take vital signs.
Correct Answer: B
Rationale: The correct answer is B: Immediately decrease the oxygen. Increasing oxygen without physician's order can lead to oxygen toxicity in COPD patients. Step-by-step rationale: 1. Assess the client's condition. 2. Determine the client's baseline oxygen therapy. 3. Recognize that sudden increase in oxygen can suppress the respiratory drive in COPD patients. 4. Decrease oxygen to the prescribed level. Summary: A: Inadequate response, as oxygen adjustment is necessary. C: Not immediate action, physician notification can follow. D: Pertinent to assess, but not the initial action needed in this scenario.