Situation: Mr. Tan, a 40 year old with asthmatic attack is admitted in the medical ward.
21. Mr. Tan admits to the nurse that he takes the following medications. Which medication may cause asthma attack?
a) milk of magnesia
b) pepcid ( famotidine)
c) acetylsalicylic ( aspirin)
d) benadryl ( diphenhydramine)
22. Your finding in your assessment would include the following except:
a) ability to speak words without taking deep breath
b) tachycardia, cool and moist skin
c) air hunger and presence of wheezing sound
d) tachycardia, warm and moist skin
23. With your assessment which of these symptoms would you expect to develop late?
a) nasal flaring
b) lips pursed in an effort exhale
c) cyanosis
d) use of accessory muscles for breathing
24. Which has the least tendency to precipitate or trigger asthmatic attack?
a) air pollution
b) cold climate
c) sudden changes in climate
d) molds, house dust
25. The most comfortable position for him to assume during asthmatic attack is:
a) sitting
b) orthopneic
c) fowlers
d) supine
26. Which of the following breathing patterns shows that the patient with chronic asthma has improved respiratory status?
a) a rate of exhalation twice that of inhalation
b) a rate of inhalation twice that of exhalation
c) slow, shallow inhalation
d) slow, deep exhalation
27. Which finding below would indicate the most effective response to asthma medications?
a) the ability to participate in active sports for longer periods
b) cyanosis subsides
c) peak expiratory flow rate (PEFR) within normal limits
d) patient can breathe on his own without oxygen
28. The child with asthma, has elevated WBC and eosinophils. Which of the following should be included in the nursing care plan of the client?
a) provide a private room
b) room-in the child with another child with asthma
c) room-in the child with another child with chicken pox
d) room-in the child with another child with glomerulonephritis
ANSWERS AND RATIONALE
21) C
- Common Factors Triggering an Asthmatic Attack
1. Medications:
- Aspirin and NSAID - can trigger allergic reaction, its anti-inflammatory effect decreases histamine secretion and mucus secretion causing pooling of thick mucus that obstructs the airway and triggers an asthmatic attack
- beta blockers
- cholinergic drugs - eye drops used in glaucoma (pilocarpine) and bladder contraction
- chemicals - paint, solvents, rubber, plastic - avoid engaging in tasks that involves the use of these chemicals, avoid powder detergents
2. Air pollutants - instruct to close car window and use airconditioner
3. Sudden changes in temperature
4. Cold air - exercising in cold air
5. Allergens - feather, pollen, dust, molds, animal dander - keep away from pets, remove carpets and curtains, damp dusting, stay indoor when grass cutting and when pollen count is high, close window at night, avoid garage and basements, avoid feather pillow
6. Exercise - irregular exercise schedules and excessive physical exertion
7. stress
8. Strong odors
22) A
- common assessment findings in asthma include: wheezing, chest tightness, breathlessness, coughing, anxiety, apprehension, tachypnea and tachycardia.
Patients experiencing asthmatic attack can usually speak only one or two words between breaths because of severe dyspnea, anxiety, fatigue and apprehension.
23) C
- Signs and Symptoms of Asthma
Asthma is caused by inflammatory response in the lungs triggered by any of the above mentioned allergens. When a patient comes in contact with allergens. IgE is produced which stimulate the mast cells in the lungs to release inflammatory mediators in the lungs such as histamine, prostaglandins and leokotrienes. These substances cause the following pathologic changes in the lungs that cause the signs and symptoms of asthma:
- bronchospasms which narrows airways causing wheezing, shortness of breath
- increased mucus production which blocks airways and causes nonproductive cough
- increased capillary permeability which causes edema of the airways decreasing area for gas exchange.
24) B
- cold climate does not trigger asthmatic attack but it is the sudden changes in environmental temperature or sudden weather changes that does. However, exercising in cold weather usually trigger asthma.
25) B
- the ideal position for a patient with asthma is the orthopneic position in which the patient is in high fowler's position with the head and arms resting on the over bed table. This position promotes lung expansion and facilitates breathing
26) A
27) C
- PERF and Drugs used in Asthma
PERF refers to amount of air inspired. If the PERF is below the amount of air inspired, it means that air is trapped in the alveoli and bronchioles because of bronchial spasms and blockage by accumulated secretions, this prevents proper exchange of oxygen and carbon dioxide and leads to hypoxia and acidosis. Peak flow meters measures PERF. If medication used to relax and dilate bronchioles is effective, effective gas exchange will be manifested by an improved PERF because air will be able to freely enter and leave the lungs and normal gas exchange will be able to take place.
Drugs used in asthma include:
1. Bronchodilators - relieve bronchospasms
- epinephrine/ephedrine/terbutaline
- theophylline
- albuterol (ventalin and proventil)
- isoproterenol (isuprel)/metaproterenol (metaprel and alupent)
- give the inhaled bronchodilator before the ant-inflammatory steroids
- hydrocortisone/dexamethasone/beclomethasone
- cromolyn sodium (intal)
- elevated WBC indicates that the child is experiencing infection. Therefore, the child should not be roomed-in with another child. Provide a private room for this child.
Related Topics:
- Online Nursing Practice Test about Respiratory Diseases (29-35)
- Go back to Online Nursing Practice Test about Respiratory Diseases (1-6) to start the test from the beginning.
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