A 25-year-old patient with a history of asthma presents to the emergency department with severe shortness of breath, wheezing, and accessory muscle use. Despite initial treatment with albuterol and oxygen, the patient's condition has not improved. Which of the following is the most appropriate next step in the management of this patient's asthma exacerbation?

Initiate broad-spectrum antibiotics

Increase the frequency of albuterol nebulizations

Administer intravenous magnesium sulfate

Administer subcutaneous epinephrine

Answer and Explanation

The Correct Answer is C

A.   Antibiotics are not indicated in the treatment of an asthma exacerbation unless there is a confirmed bacterial infection, which is not suggested here.

B.   Increasing the frequency of albuterol nebulizations may be appropriate, but more aggressive interventions are required, as the patient has not improved with initial treatment.
C.   Intravenous magnesium sulfate is often used in severe asthma exacerbations to help relax the muscles around the airways, making it a more appropriate next step for this patient.
D.   Subcutaneous epinephrine can be used for anaphylaxis but is not the first-line treatment for asthma exacerbations.

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Correct Answer is D

Explanation

A. Klebsiella pneumoniae is a Gram-negative bacterium and is typically associated with more severe pneumonia, particularly in patients with underlying lung disease, but it does not form clusters.
B. Streptococcus pneumoniae is a common cause of pneumonia but typically appears as Gram-positive cocci in pairs or chains, not clusters.
C. Escherichia coli is a Gram-negative bacterium that generally causes urinary tract infections and is not a common cause of pneumonia with Gram-positive cocci in clusters.
D. Staphylococcus aureus is a Gram-positive bacterium that forms clusters and is a common cause of pneumonia, particularly in young, otherwise healthy individuals, and can present with fever, chills, and productive cough. This fits the presentation and sputum findings in this patient.

A. Advise the patient to take antacids only when severe pain occurs. B. Instruct the patient to eat three large meals per day. C. Encourage the patient to smoke to reduce stress. D. Recommend increased intake of spicy foods to boost metabolism. E. Suggest the patient use NSAIDS for pain relief. F. Advise the patient to drink coffee to help with digestion. G. Administer proton pump inhibitors as prescribed. H. Encourage the patient to consume a bland diet.

Correct Answer is ["G","H"]

Explanation

A. Advising the patient to take antacids only when severe pain occurs may not be effective. Antacids should be used regularly or as prescribed for consistent symptom relief.
B. Instructing the patient to eat three large meals per day may exacerbate symptoms; smaller, more frequent meals are often better for managing gastritis.
C. Encouraging smoking to reduce stress is harmful, as smoking can exacerbate gastritis and increase stomach acid production.
D. Spicy foods should be avoided in gastritis, as they can irritate the stomach lining.
E. NSAIDs should be avoided in gastritis because they can irritate the gastric mucosa and worsen symptoms.
F. Coffee can stimulate acid production and may irritate the stomach lining, so it should be avoided.
G. Proton pump inhibitors (PPIs) help reduce gastric acid secretion and are a mainstay treatment for gastritis.
H. A bland diet is recommended, as it avoids irritating foods and allows the stomach lining to heal.

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Naxlex Comprehensive Predictor Exams

A 25-year-old female patient presents with fever, chills, and a productive cough. Sputum culture reveals Gram-positive cocci in clusters. Which of the following bacterial organisms is most likely responsible for this infection?

Correct Answer is D

Explanation

A patient is diagnosed with gastritis after presenting with abdominal discomfort and nausea. As a nurse, which interventions would be appropriate for managing this patient's condition? (Select All that Apply.)

Correct Answer is ["G","H"]

Explanation

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