When assessing an individual during an acute (severe) asthma episode, you should expect to find (select all that apply)
use of accessory breathing muscles.
foul-smelling sputum.
feeling of chest tightness.
coughing.
expiratory wheezing.
Correct Answer : A,C,D,E
Choice A reason: Use of accessory breathing muscles is a sign of respiratory distress and increased work of breathing. Accessory muscles are the muscles of the neck, chest, and abdomen that assist the diaphragm and intercostal muscles in breathing. They are normally not used for breathing, but they are recruited when the airway is obstructed or the lung function is impaired.
Choice B reason: Foul-smelling sputum is not a sign of an acute asthma episode. It is a sign of a bacterial infection or a lung abscess. Sputum is the mucus that is coughed up from the lungs. It can have different colors, textures, and odors depending on the cause and severity of the condition.
Choice C reason: Feeling of chest tightness is a sign of an acute asthma episode. It is caused by the bronchoconstriction, or the narrowing of the airways, that occurs during an asthma attack. It can also be accompanied by pain or pressure in the chest.
Choice D reason: Coughing is a sign of an acute asthma episode. It is a reflex action that tries to clear the airways of mucus, irritants, or foreign particles. It can also be triggered by the inflammation and hypersensitivity of the airways that occur during an asthma attack.
Choice E reason: Expiratory wheezing is a sign of an acute asthma episode. It is a high-pitched whistling sound that is heard when the person exhales. It is caused by the turbulent flow of air through the narrowed airways. It can also be heard on inspiration, but it is more prominent on expiration.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Decrease in wheezing present on auscultation indicates that albuterol was effective. Albuterol is a bronchodilator that relaxes the smooth muscles of the airways and reduces the airway resistance. This improves the airflow and reduces the wheezing sound that is caused by the turbulent flow of air through the narrowed airways.
Choice B reason: Respiratory rate increased to 38 breaths/min does not indicate that albuterol was effective. It indicates that the patient is still experiencing respiratory distress and hypoxia. The normal respiratory rate for adults is 12 to 20 breaths/min. A high respiratory rate can also be a side effect of albuterol, as it can stimulate the sympathetic nervous system and increase the heart rate and blood pressure.
Choice C reason: Sputum production is clear and watery does not indicate that albuterol was effective. It indicates that the patient has a productive cough and is expelling mucus from the lungs. Sputum production is not directly affected by albuterol, as it does not have anti-inflammatory or mucolytic properties.
Choice D reason: Use of neck muscles does not indicate that albuterol was effective. It indicates that the patient is using accessory muscles to breathe and is exerting more effort to inhale. This is a sign of severe respiratory distress and airway obstruction. Albuterol should relieve the bronchospasm and reduce the need for accessory muscle use.
Correct Answer is B
Explanation
Choice A reason: Lipid-laden mast cells are not foam cells. Mast cells are immune cells that release histamine and other inflammatory mediators. They do not accumulate lipids or have a soap-like texture.
Choice B reason: Macrophages that engulf low-density lipoproteins (LDLs) are foam cells. They are part of the atherosclerotic process that leads to plaque formation in the blood vessels. They are called foam cells because they have a foamy appearance under the microscope.
Choice C reason: Injured neutrophil clots are not foam cells. Neutrophils are immune cells that fight infection and form pus. They do not engulf LDLs or contribute to atherosclerosis.
Choice D reason: Deposited adipose cells are not foam cells. Adipose cells are fat cells that store energy and secrete hormones. They do not phagocytose LDLs or form plaques in the blood vessels.
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