Review Practice Exercise 3

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Practice Exercise 3

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Total Questions : 5

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Question 1:

A nurse on a medical-surgical unit admits a client. Two hours after admission, the client’s SaO2 is 91%, and he exhibits audible wheezes and uses accessory muscles. Which medication should the nurse expect to administer?

A. Antibiotic B. Beta-blocker C. Antiviral D. Beta-2 agonist

Answer and Explanation

Choice A:

Antibiotic. Antibiotics are used to treat bacterial infections and do not provide immediate relief of bronchoconstriction. The client’s presentation reflects acute airflow limitation rather than confirmed infection. Delaying bronchodilator therapy in favor of antibiotics would not address the urgent respiratory compromise.

Choice B:

Beta-blocker. Beta-blockers antagonize beta-adrenergic receptors and can worsen bronchoconstriction by inhibiting beta₂-mediated bronchodilation. Use of beta-blockers in a client with wheezing can precipitate severe bronchospasm. This medication class is contraindicated in acute obstructive airway conditions.

Choice C:

Antiviral. Antiviral medications treat viral replication but have no immediate effect on airway tone. They do not reverse bronchospasm or improve oxygenation during an acute respiratory event. The client’s symptoms require rapid bronchodilation rather than antiviral therapy.

Choice D:

Beta-2 agonist. Short-acting beta-2 adrenergic agonists, such as albuterol, directly stimulate beta₂ receptors in bronchial smooth muscle. This stimulation causes rapid muscle relaxation, bronchodilation, and decreased airway resistance. Administration of a beta₂ agonist is the first-line treatment for acute bronchospasm accompanied by wheezing and accessory muscle use.

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Question 2:

A nurse is teaching a client about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI). Which statement by the client shows the nurse that the client needs more teaching?

A. “I do not need to use the spacer like I used to.” B. “I will hold my breath for 10 seconds or longer if I can.” C. “I will not shake this inhaler like I did with my old inhaler.” D. “I will store it in the bathroom so I will be able to clean it when I need to.”

Answer and Explanation

Choice A:

“I do not need to use the spacer like I used to.” Spacers are used with metered-dose inhalers to improve coordination and medication delivery. DPIs are breath-actuated and do not require spacers for effective use. This statement correctly reflects the difference between MDI and DPI devices.

Choice B:

“I will hold my breath for 10 seconds or longer if I can.” Breath-holding after inhalation allows time for medication particles to deposit in the lower airways. This practice improves drug absorption and therapeutic effectiveness. The statement demonstrates correct inhaler technique.

Choice C:

“I will not shake this inhaler like I did with my old inhaler.” Shaking is required for MDIs to mix propellant and medication, but it is not required for DPIs. Shaking a DPI can disrupt the powdered medication dose. This statement correctly reflects appropriate DPI use.

Choice D:

“I will store it in the bathroom so I will be able to clean it when I need to.” DPIs must be kept dry because moisture can cause the powdered medication to clump and obstruct proper aerosolization. Bathrooms are humid environments that increase the risk of moisture exposure, leading to decreased medication delivery. This statement reflects a misunderstanding of proper DPI storage and indicates the need for further teaching.

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Question 3:

A nurse is evaluating a client’s understanding of asthma self-management before discharge. Which actions by the client demonstrate understanding? Select all that apply.

A. Checking peak flow readings daily and comparing them with personal best values. B. Increasing the frequency of the rescue inhaler without notifying the healthcare provider. C. Using a short-acting bronchodilator before planned exercise when exercise is a known trigger. D. Scheduling regular follow-up visits to reassess inhaler technique and symptom control. E. Initiating oral corticosteroids independently at the first sign of wheezing.

Answer and Explanation

Choice A:

Checking peak flow readings daily and comparing them with personal best values. Daily peak expiratory flow (PEF) monitoring allows clients to detect early airway obstruction before symptoms become severe. Comparing current readings to a personal best provides objective data to guide decisions outlined in the asthma action plan, such as adjusting medications or seeking care. This practice supports proactive management and reduces the risk of sudden, severe exacerbations.

Choice B:

Increasing the frequency of the rescue inhaler without notifying the healthcare provider. Frequent reliance on short-acting beta₂-agonists indicates poor asthma control and increased airway inflammation. Overuse can mask worsening disease and delay necessary adjustments to controller therapy, such as inhaled corticosteroids. Clients should report increased use to a healthcare provider rather than independently escalating treatment.

Choice C:

Using a short-acting bronchodilator before planned exercise when exercise is a known trigger. Exercise-induced bronchoconstriction occurs due to airway cooling and drying, leading to smooth muscle contraction. Pre-treatment with a short-acting beta₂-agonist relaxes bronchial smooth muscle and prevents airflow limitation during physical activity. This demonstrates appropriate anticipatory management based on known personal triggers.

Choice D:

Scheduling regular follow-up visits to reassess inhaler technique and symptom control. Regular follow-up visits allow healthcare providers to evaluate asthma control, adjust therapy, and correct inhaler technique, which is a common cause of poor medication delivery. Asthma severity and control can change over time, requiring reassessment to prevent under- or overtreatment. This action reflects an understanding that asthma management is ongoing rather than episodic.

Choice E:

Initiating oral corticosteroids independently at the first sign of wheezing. Oral corticosteroids are reserved for moderate to severe exacerbations and are typically initiated under provider guidance due to systemic side effects. Unsupervised use increases the risk of immunosuppression, hyperglycemia, hypertension, and adrenal suppression. Proper self-management involves following a prescribed action plan, not independent initiation of systemic therapy unless explicitly instructed.

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Question 4:

A client newly diagnosed with asthma is preparing for discharge. Which point should a nurse emphasize during the client’s teaching?

A. Contact the care provider only if nighttime wheezing becomes a concern. B. Limit exposure to sources that trigger an attack. C. Use a peak flow meter only if symptoms are worsening. D. Use inhaled steroid medication as a rescue inhaler.

Answer and Explanation

Choice A:

Contact the care provider only if nighttime wheezing becomes a concern. Nighttime wheezing is a sign of poor asthma control and should prompt timely evaluation. Delaying communication until nocturnal symptoms occur can allow airway inflammation to progress. Clients should be taught to report worsening symptoms earlier to avoid life-threatening events.

Choice B:

Limit exposure to sources that trigger an attack. Asthma exacerbations are commonly precipitated by identifiable triggers such as allergens, smoke, respiratory infections, and environmental irritants. Avoidance of these triggers reduces airway inflammation and decreases the likelihood of bronchoconstriction. Emphasizing trigger identification and avoidance is a cornerstone of effective asthma self-management.

Choice C:

Use a peak flow meter only if symptoms are worsening. Peak flow monitoring is most effective when used regularly to detect early declines in airflow before symptoms appear. Relying on symptoms alone delays intervention and increases the risk of severe exacerbations. Routine peak flow measurements support proactive asthma management.

Choice D:

Use inhaled steroid medication as a rescue inhaler. Inhaled corticosteroids reduce airway inflammation but do not provide rapid bronchodilation. Rescue therapy requires short-acting beta₂ agonists for quick symptom relief. Misusing inhaled steroids as rescue medication can delay effective treatment during acute attacks.

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Question 5:

A nurse is teaching a client with moderate persistent asthma about the use of inhaled corticosteroids (ICS). Which statement by the client indicates a need for further teaching?

A. “I should rinse my mouth after using my inhaler to prevent thrush.” B. “I will use my ICS inhaler every day even if I feel fine.” C. “I can use this inhaler as a rescue when I suddenly wheeze.” D. “This medication helps reduce inflammation in my airways.”

Answer and Explanation

Choice A:

“I should rinse my mouth after using my inhaler to prevent thrush.” Rinsing the mouth after ICS use is recommended to prevent oral candidiasis, a common side effect of corticosteroid inhalation. This statement reflects correct understanding of safe inhaler technique. No further teaching is needed for this point.

Choice B:

“I will use my ICS inhaler every day even if I feel fine.” Daily use of ICS is necessary to maintain airway anti-inflammatory effects and prevent exacerbations. Asthma control depends on consistent use, not symptom presence. This statement demonstrates correct comprehension of the medication regimen.

Choice C:

“I can use this inhaler as a rescue when I suddenly wheeze.” ICS have a delayed onset of action and do not provide immediate bronchodilation. Using an ICS for acute symptoms is ineffective and can delay proper treatment with a short-acting beta₂ agonist. This misunderstanding indicates the client requires further teaching about correct inhaler use.

Choice D:

“This medication helps reduce inflammation in my airways.” ICS reduce mucosal edema, airway hyperresponsiveness, and inflammatory cell activity. Understanding this mechanism is essential for adherence and proper asthma management. The client’s statement correctly describes the purpose of the inhaler.

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