lOMoAR cPSD| 63316909
Peak Expiratory Flow Measurement - CE
1. A patient with reactive airway disease reports a personal best PEFR of 480
L/min and a rate this morning of 360 L/min. What does this indicate?
A. These readings indicate the patient is experiencing a moderate
exacerbation.
B. These readings indicate the patient is within normal limits. C. These
readings indicate the patient is experiencing a
severe exacerbation.
D. These readings indicate the patient is experiencing a mild exacerbation.
Rationale: The 360 L/min PEFR represents 75% of this patient’s personal
best, and a PEFR between 50% and 80% of the patient’s personal best
represents a moderate exacerbation (level is in the yellow zone).
2. What should the patient do to make a peak flow measurement more
accurate?
A. Lie supine and keep relaxed during the attempt.
B. Stand during the attempt.
C. Exhale through both the mouth and nose to empty the lungs quickly.
D. Hold the mouthpiece loosely between the lips to prevent obstruction of
the scale.
Rationale: Standing maximizes diaphragmatic excursion and improves the
accuracy of the results. Pediatric patients should also be encouraged to
stand. Alternatively, any patient not capable of standing may sit up straight
with the shoulders thrust back. A supine position does not maximize
diaphragmatic excursion. Exhaling through the nostrils yields a falsely low
reading, and the patient may need to pinch the nose shut. The patient
should make a tight seal on the mouthpiece to prevent air leakage and
falsely low results.
3. The patient has completed three PEFR attempts with results of 550 L/min,
580 L/min, and 575 L/min. Which value should be documented on the
patient’s record?
A. 550 L/min
, lOMoAR cPSD| 63316909
B. 568 L/min
C. 575 L/min
D. 580 L/min
Rationale: The highest value (580 L/min) is the value recorded. The values
obtained should not be averaged.
4. For which patient should a peak flow measurement not be attempted?
A. A 6-year-old patient with expiratory wheezing after T-ball practice who
is speaking in complete sentences
B. A 19-year-old patient with a respiratory rate of 24 breaths per minute
who is warm, pink, and dry
C. A 24-year-old patient who is diaphoretic and speaking only one word
at a time
D. A 64-year-old patient with mild retractions, respiratory rate of 28
breaths per minute, and pale skin
Rationale: Peak flow measurement should not be attempted in patients who
are in significant respiratory distress, such as the 24-year-old patient. Most
pediatric patients can perform the procedure at 5 years old. The 6-, 19-, and
64-year-old patients are not in severe respiratory distress, and a peak flow
measurement may be attempted.
5. When attempting a peak flow measurement on an adult patient in
moderate respiratory distress, which signs and symptoms in the patient
should make the nurse abort the procedure after the first attempt?
A. Expectoration of green sputum
B. Complaints of feeling dizzy
C. Occasional bronchospasm
D. An increase in oxygen saturation to 94%
Rationale: Any complaint of faintness, dizziness, prolonged coughing, or
worsening dyspnea should stop attempts to measure peak flow to prevent
further deterioration. Many patients cough briefly after each attempt. Green
sputum may signal an underlying infection, but it is not a reason to stop
Peak Expiratory Flow Measurement - CE
1. A patient with reactive airway disease reports a personal best PEFR of 480
L/min and a rate this morning of 360 L/min. What does this indicate?
A. These readings indicate the patient is experiencing a moderate
exacerbation.
B. These readings indicate the patient is within normal limits. C. These
readings indicate the patient is experiencing a
severe exacerbation.
D. These readings indicate the patient is experiencing a mild exacerbation.
Rationale: The 360 L/min PEFR represents 75% of this patient’s personal
best, and a PEFR between 50% and 80% of the patient’s personal best
represents a moderate exacerbation (level is in the yellow zone).
2. What should the patient do to make a peak flow measurement more
accurate?
A. Lie supine and keep relaxed during the attempt.
B. Stand during the attempt.
C. Exhale through both the mouth and nose to empty the lungs quickly.
D. Hold the mouthpiece loosely between the lips to prevent obstruction of
the scale.
Rationale: Standing maximizes diaphragmatic excursion and improves the
accuracy of the results. Pediatric patients should also be encouraged to
stand. Alternatively, any patient not capable of standing may sit up straight
with the shoulders thrust back. A supine position does not maximize
diaphragmatic excursion. Exhaling through the nostrils yields a falsely low
reading, and the patient may need to pinch the nose shut. The patient
should make a tight seal on the mouthpiece to prevent air leakage and
falsely low results.
3. The patient has completed three PEFR attempts with results of 550 L/min,
580 L/min, and 575 L/min. Which value should be documented on the
patient’s record?
A. 550 L/min
, lOMoAR cPSD| 63316909
B. 568 L/min
C. 575 L/min
D. 580 L/min
Rationale: The highest value (580 L/min) is the value recorded. The values
obtained should not be averaged.
4. For which patient should a peak flow measurement not be attempted?
A. A 6-year-old patient with expiratory wheezing after T-ball practice who
is speaking in complete sentences
B. A 19-year-old patient with a respiratory rate of 24 breaths per minute
who is warm, pink, and dry
C. A 24-year-old patient who is diaphoretic and speaking only one word
at a time
D. A 64-year-old patient with mild retractions, respiratory rate of 28
breaths per minute, and pale skin
Rationale: Peak flow measurement should not be attempted in patients who
are in significant respiratory distress, such as the 24-year-old patient. Most
pediatric patients can perform the procedure at 5 years old. The 6-, 19-, and
64-year-old patients are not in severe respiratory distress, and a peak flow
measurement may be attempted.
5. When attempting a peak flow measurement on an adult patient in
moderate respiratory distress, which signs and symptoms in the patient
should make the nurse abort the procedure after the first attempt?
A. Expectoration of green sputum
B. Complaints of feeling dizzy
C. Occasional bronchospasm
D. An increase in oxygen saturation to 94%
Rationale: Any complaint of faintness, dizziness, prolonged coughing, or
worsening dyspnea should stop attempts to measure peak flow to prevent
further deterioration. Many patients cough briefly after each attempt. Green
sputum may signal an underlying infection, but it is not a reason to stop
