MSN Exam for Asthma Part 2

Obesity is a risk factor for CVA. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, oral contraceptive use, emotional stress, family history of CVA, and advancing age. The client’s race, sex, and bronchial asthma aren’t risk factors for CVA.

Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed (COPD) and emphysema.

Bronchi normally expand and lengthen during inspiration and shorten during expiration. Asthma causes spasm of the smooth muscles in the bronchi and bronchioles, resulting in an even tighter airway on exhalation and prolonged exhalation. Inspirations increase in rate in an effort to relieve hypoxia. At the beginning of the attack, the cough is nonproductive and results from bronchial edema. Then the mucus becomes profuse and rattly, with a cough producing frothy, clear sputum. Gas trapping is the central feature of asthma. It is caused by allowing more air to enter alveoli than can escape from them through the narrowed airways. Gas trapping also causes an increased depth and rate of respirations. The wheeze starts during the expiratory phase because of the extreme narrowing of the bronchus on exhalation. As obstruction increases, wheezes become more high pitched and continuous.

A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.

COPD clients have low oxygen and high carbon dioxide levels. Therefore, hypoxia is the main stimulus for ventilation is persons with chronic hypercapnea. Increasing the level of oxygen would decrease the stimulus to breathe.

Acute and sever inflammation of the epiglottis can cause life threatening airway obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare tracheostomy set at bed side. LTB, can also cause airway obstruction but its not an emergency. Asthma is also not an emergency (ung status asthmaticus ang kaylangan ng prompt treatment). CF is a chronic disease, so its not a medical emergency.

The patient having an acute asthma attack needs more oxygen delivered to his lungs and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. The patient may not need cardiac monitoring because he’s only 19 years old, unless he has a medical history of cardiac problems.

Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.

Children who have a depressed immune system related to HIV or chemotherapy should not be given routine immunizations.

A significant correlation between nocturnal asthma and gastroesophageal reflux has been observed. The patient may not complain of epigastric burning or have reflux symptoms. Cough may be the only symptom.

Asthmatic children don’t have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don’t have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.

When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

Moderate persistent, great than one night per week of symptoms bumps him to Moderate persistent

During an acute attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can’t get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles do not replace wheezes during an acute asthma attack.

Grapes is inappropriate because of its “skin” that can cause choking. A glass of milk is not a good snack because it’s the most common cause of Iron-deficiency anemia in children (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar.

Bronchodilators are the first line of treatment for asthma because broncho-constriction is the cause of reduced airflow. Beta adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.

Bronchodilators can produce the side effects listed in answer choice for a short time after the patient begins using them.

Proteins in animal's skin flakes, urine, feces, saliva and hair can trigger asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other warm-blooded mammals can trigger Asthma in individuals with an allergy to animal dander. SO, load your class with the Asthma friendliest pets of all-FISH!

The higher pitched a sound is, the more narrow the airway. Therefore, the obstruction has increased or worsened. With no evidence of secretions no support exists to indicate the need for suctioning.

Reviewing the number of prescription refills the child has required over the last 6 months would be the best indicator of how well controlled and thus how effective the child’s asthma treatment is. Breakthrough wheezing, shortness of breath, and upper respiratory infections would require that the child take additional medication. This would be reflected in the number of prescription refills.

Try not to wear perfumes to school. Limit the use of scented aerosols in the center. Try to use non-aerosol cleaners while Asthmatic children are present.

Secondhand smoke can be present on your clothing therefore exposing children to it. Never smoke in clothing you wear to work.

Asthma is the presence of bronchiolar spasms. This spasm can be brought on by allergies or anxiety. Answer A is incorrect because the primary physiological alteration is not inflammation. Answer B is incorrect because there is the production of abnormally viscous mucus, not a primary alteration. Answer C is incorrect because infection is not primary to asthma.

The acute cough and/or wheeze caused by a foreign body in the lower respiratory tract may diminish over time only to recur later and present as chronic cough and/or persistent wheezing.

Moderate persistent, great than one night per week of symptoms bumps him to Moderate persistent

A significant correlation between nocturnal asthma and gastroesophageal reflux has been observed. The patient may not complain of epigastric burning or have reflux symptoms. Cough may be the only symptom.

Children who have a depressed immune system related to HIV or chemotherapy should not be given routine immunizations.

The acute cough and/or wheeze caused by a foreign body in the lower respiratory tract may diminish over time only to recur later and present as chronic cough and/or persistent wheezing.

The higher pitched a sound is, the more narrow the airway. Therefore, the obstruction has increased or worsened. With no evidence of secretions no support exists to indicate the need for suctioning.

During an acute attack, wheezing may stop and breath sounds become inaudible because the airways are so swollen that air can’t get through. If the attack is over and swelling has decreased, there would be no more wheezing and less emergent concern. Crackles do not replace wheezes during an acute asthma attack.

Bronchodilators are the first line of treatment for asthma because broncho-constriction is the cause of reduced airflow. Beta adrenergic blockers aren’t used to treat asthma and can cause bronchoconstriction. Inhaled oral steroids may be given to reduce the inflammation but aren’t used for emergency relief.

Proteins in animal's skin flakes, urine, feces, saliva and hair can trigger asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other warm-blooded mammals can trigger Asthma in individuals with an allergy to animal dander. SO, load your class with the Asthma friendliest pets of all-FISH!

Reviewing the number of prescription refills the child has required over the last 6 months would be the best indicator of how well controlled and thus how effective the child’s asthma treatment is. Breakthrough wheezing, shortness of breath, and upper respiratory infections would require that the child take additional medication. This would be reflected in the number of prescription refills.

Try not to wear perfumes to school. Limit the use of scented aerosols in the center. Try to use non-aerosol cleaners while Asthmatic children are present.

The patient having an acute asthma attack needs more oxygen delivered to his lungs and body. Nebulized bronchodilators open airways and increase the amount of oxygen delivered. The patient may not need cardiac monitoring because he’s only 19 years old, unless he has a medical history of cardiac problems.

COPD clients have low oxygen and high carbon dioxide levels. Therefore, hypoxia is the main stimulus for ventilation is persons with chronic hypercapnea. Increasing the level of oxygen would decrease the stimulus to breathe.

When percussing the chest wall, the nurse expects to elicit resonant sounds — low-pitched, hollow sounds heard over normal lung tissue. Hyperresonant sounds indicate increased air in the lungs or pleural space; they’re louder and lower pitched than resonant sounds. Although hyperresonant sounds occur in such disorders as emphysema and pneumothorax, they may be normal in children and very thin adults. Dull sounds, normally heard only over the liver and heart, may occur over dense lung tissue, such as from consolidation or a tumor. Dull sounds are thudlike and of medium pitch. Flat sounds, soft and high-pitched, are heard over airless tissue and can be replicated by percussing the thigh or a bony structure.

Acute and sever inflammation of the epiglottis can cause life threatening airway obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare tracheostomy set at bed side. LTB, can also cause airway obstruction but its not an emergency. Asthma is also not an emergency (ung status asthmaticus ang kaylangan ng prompt treatment). CF is a chronic disease, so its not a medical emergency.

Asthma is the presence of bronchiolar spasms. This spasm can be brought on by allergies or anxiety. Answer A is incorrect because the primary physiological alteration is not inflammation. Answer B is incorrect because there is the production of abnormally viscous mucus, not a primary alteration. Answer C is incorrect because infection is not primary to asthma.

A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.

Bronchodilators can produce the side effects listed in answer choice for a short time after the patient begins using them.

Secondhand smoke can be present on your clothing therefore exposing children to it. Never smoke in clothing you wear to work.

Based on the client’s history and symptoms, acute asthma is the most likely diagnosis. He’s unlikely to have bronchial pneumonia without a productive cough and fever and he’s too young to have developed (COPD) and emphysema.

Grapes is inappropriate because of its “skin” that can cause choking. A glass of milk is not a good snack because it’s the most common cause of Iron-deficiency anemia in children (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar.

Bronchi normally expand and lengthen during inspiration and shorten during expiration. Asthma causes spasm of the smooth muscles in the bronchi and bronchioles, resulting in an even tighter airway on exhalation and prolonged exhalation. Inspirations increase in rate in an effort to relieve hypoxia. At the beginning of the attack, the cough is nonproductive and results from bronchial edema. Then the mucus becomes profuse and rattly, with a cough producing frothy, clear sputum. Gas trapping is the central feature of asthma. It is caused by allowing more air to enter alveoli than can escape from them through the narrowed airways. Gas trapping also causes an increased depth and rate of respirations. The wheeze starts during the expiratory phase because of the extreme narrowing of the bronchus on exhalation. As obstruction increases, wheezes become more high pitched and continuous.

Obesity is a risk factor for CVA. Other risk factors include a history of ischemic episodes, cardiovascular disease, diabetes mellitus, atherosclerosis of the cranial vessels, hypertension, polycythemia, smoking, hypercholesterolemia, oral contraceptive use, emotional stress, family history of CVA, and advancing age. The client’s race, sex, and bronchial asthma aren’t risk factors for CVA.

Skin color doesn’t affect the mucous membranes. The lips, nail beds, and earlobes are less reliable indicators of cyanosis because they’re affected by skin color.

Asthmatic children don’t have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don’t have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.