What should the nurse explain to the parent of a child with exercise-induced asthma about when to inhale Cromolyn?
Before exercise to prevent attacks.
At the initial onset of the attack.
During the attack to relieve symptoms.
As often as 4 times a day.
The Correct Answer is A
Choice A rationale
Cromolyn is a mast cell stabilizer that works by inhibiting the release of inflammatory mediators (e.g., histamine, leukotrienes) from mast cells. Its mechanism of action is prophylactic, meaning it prevents the cellular cascade leading to bronchospasm when administered before exposure to a trigger, such as exercise. It has no bronchodilatory effect.
Choice B rationale
Administering cromolyn at the initial onset of an attack is ineffective because it does not have acute bronchodilatory properties. Once the inflammatory cascade is initiated and bronchoconstriction has begun, cromolyn cannot reverse the symptoms. Rescue inhalers like albuterol are needed for acute symptom relief.
Choice C rationale
Cromolyn is a prophylactic medication and does not provide symptomatic relief during an acute asthma attack. Its role is to stabilize mast cells to prevent the release of inflammatory mediators that cause bronchoconstriction and inflammation. Therefore, it is not used to alleviate symptoms once an attack is in progress.
Choice D rationale
While cromolyn can be prescribed for regular daily use, the specific instruction for exercise-induced asthma is to take it before exercise. Taking it as often as 4 times a day without considering the timing relative to triggers may not be optimal for preventing exercise-induced symptoms, as its effect is primarily preventive.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Offering plenty of fluids is important for hydration and thinning secretions in asthma, but carbonated beverages can cause gastric distension and worsen respiratory distress by pressing on the diaphragm, making them unsuitable. Furthermore, this intervention does not directly address the acute bronchoconstriction that defines an asthma attack.
Choice B rationale
While humidified oxygen might be indicated for hypoxemia, a cool mist tent is not the primary intervention for acute asthma. The core problem is bronchoconstriction, which requires bronchodilators to open the airways. A cool mist tent offers general comfort but does not provide specific therapeutic relief for the underlying pathophysiology.
Choice C rationale
Administering sedatives to a child experiencing an acute asthma attack is generally contraindicated. Sedation can depress respiratory drive, worsen hypoventilation, and mask signs of worsening respiratory distress, potentially leading to respiratory arrest, especially when the child's respiratory effort is already compromised.
Choice D rationale
Positioning the child with arms resting on the overbed table, often referred to as the "tripod position," allows for the use of accessory respiratory muscles (e.g., sternocleidomastoid, scalenes) to facilitate breathing. This position optimizes lung expansion and reduces the work of breathing by providing a stable base for shoulder girdle muscles to pull up the chest cage.
Correct Answer is B
Explanation
Choice A rationale
A peak flow meter measures the maximum speed of exhalation, providing information about airflow obstruction and lung function. While useful for monitoring asthma control, it does not address the patient's difficulty coordinating MDI activation with breathing. It's a diagnostic tool, not a coordination aid.
Choice B rationale
A spacer device is a valved holding chamber that attaches to the MDI. It simplifies inhalation by holding the aerosolized medication, allowing the patient to inhale it slowly and deeply without requiring precise coordination between activation and inspiration. This significantly improves drug delivery to the lungs.
Choice C rationale
Notifying the prescriber that the patient is unable to use the MDI without suggesting solutions is premature. The nurse should first attempt an intervention to resolve the coordination issue, such as suggesting a spacer, as this is a common problem with a well-established solution.
Choice D rationale
While some respiratory medications can be given orally, switching the route of administration should not be the initial intervention for MDI coordination issues. Oral administration can have different pharmacokinetic profiles, systemic side effects, and may not provide the same targeted drug delivery to the airways as inhaled therapy.
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