A client with asthma is exposed to a trigger and has an asthma attack within 30 minutes of the exposure. The client uses their albuterol inhaler as prescribed and experiences relief of symptoms. Six hours later, the client's asthma symptoms return. Which of the following is true about the late-phase response of asthma?

The late-phase response occurs due to an influx of additional inflammatory cells

The symptoms of the late-phase response tend to respond better to a rescue inhaler than the symptoms of the early-phase response

The late-phase response occurs because the client did not use their rescue inhaler properly

The late-phase response only occurs if the client continues to be exposed to their trigger after the initial attack

Answer and Explanation

The Correct Answer is A

A.   The late-phase response in asthma is characterized by a delayed and prolonged inflammatory reaction that can occur 4 to 6 hours after exposure to a trigger. It involves the recruitment of additional inflammatory cells, such as eosinophils and T cells, which contribute to ongoing airway inflammation, increased mucus production, and bronchoconstriction. This phase often leads to a return of symptoms or worsening of symptoms after the initial relief provided by a rescue inhaler.
B.   The late-phase response does not typically respond as well to rescue inhalers (such as albuterol) as the early-phase response does. Rescue inhalers are primarily effective for the immediate, bronchospastic component of asthma (early-phase response).
C.   The late-phase response occurs as part of the natural progression of asthma inflammation and is not necessarily related to improper use of a rescue inhaler. Even with proper use of a rescue inhaler, the late-phase response can still occur due to the underlying inflammatory processes.
D.   The late-phase response can occur even if the trigger is no longer present. It is related to the ongoing inflammatory process rather than continued exposure to the trigger. Although continued exposure to triggers can exacerbate symptoms, the late-phase response can still occur independently of further exposure.

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Correct Answer is C

Explanation

A. Methylprednisolone is a corticosteroid used to reduce inflammation and suppress the immune system. While corticosteroids are sometimes used in critical care settings, they are not specifically used to prevent stress ulcers. In fact, corticosteroids can increase the risk of gastrointestinal bleeding and may require additional measures to protect the stomach lining.
B. Enoxaparin is a low molecular weight heparin (LMWH) used primarily for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). It works as an anticoagulant, preventing blood clots. While enoxaparin is important for preventing thromboembolic events in critically ill patients, it does not specifically address the prevention of stress ulcers.
C. Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production by inhibiting the proton pumps in the stomach lining. PPIs are commonly used to prevent and treat stress ulcers because they help decrease gastric acid secretion, thereby reducing the risk of ulcer formation and bleeding. This makes pantoprazole the appropriate medication to administer to prevent physiologic stress ulcers in a patient with sepsis on a ventilator.
D. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for pain relief and inflammation. NSAIDs can actually increase the risk of gastrointestinal bleeding and ulceration, especially in critically ill patients.

A. Hypernatremia B. Fluid volume overload C. Hypokalemia D. Hypoglycemia

Correct Answer is D

Explanation

A. Hypernatremia (elevated sodium levels) is not a common sign of Addisonian crisis. In Addisonian crisis, the lack of aldosterone leads to sodium loss, which often results in hyponatremia (low sodium levels) rather than hypernatremia. The patient might also experience dehydration and electrolyte imbalances, but hypernatremia is not typical in this scenario.
B. Fluid volume overload is not characteristic of Addisonian crisis. Instead, Addisonian crisis often leads to fluid volume deficit due to the loss of aldosterone, which impairs sodium and water retention. This can result in dehydration and low blood volume rather than fluid overload.
C. Hypokalemia (low potassium levels) is not typically associated with Addisonian crisis. In fact, the lack of aldosterone in Addisonian crisis leads to potassium retention, resulting in hyperkalemia (elevated potassium levels). Therefore, monitoring for hypokalemia is not relevant in the context of Addisonian crisis following a bilateral adrenalectomy.
D. Hypoglycemia (low blood glucose levels) is a key sign of Addisonian crisis. Cortisol plays a crucial role in glucose metabolism and maintaining blood glucose levels. With the loss of cortisol production after a bilateral adrenalectomy, patients may experience hypoglycemia, which can be a critical indicator of Addisonian crisis.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with a diagnosis of sepsis who is on a ventilator in the intensive care unit. To reduce the risk of developing a physiologic stress ulcer, the nurse should anticipate an order to administer which medication?

Correct Answer is C

Explanation

A nurse is caring for a client who has undergone a bilateral adrenalectomy. The nurse monitors for which of the following signs of Addisonian crisis?

Correct Answer is D

Explanation

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