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. Applying soft restraints during a seizure could increase the risk of injury and is not recommended.
B. Administering lorazepam is often necessary in seizures, but the priority during a seizure is ensuring the airway is open and the patient is in a safe position.
C. Obtaining a seizure history is important but should be done after managing the acute situation.
D. The priority during a seizure is to ensure the patient's airway is open and to position them on their side to prevent aspiration and facilitate breathing.

A. Flush the NG tube with 60 mL of water before starting the feeding. B. Administer the feeding with the patient lying flat to ensure comfort. C. Increase the feeding rate to ensure the patient receives adequate nutrition. D. Position the patient in a semi-Fowler's position during and after feeding.

Correct Answer is D

Explanation

A. Flushing the NG tube with 60 mL of water before feeding is not sufficient to reduce aspiration risk.
B. Administering the feeding with the patient lying flat increases the risk of aspiration and should be avoided.
C. Increasing the feeding rate could cause discomfort and increase the risk of aspiration if the stomach becomes overdistended.
D. Positioning the patient in a semi-Fowler's position (head of the bed elevated 30 to 45 degrees) reduces the risk of aspiration during and after feeding.

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Naxlex Comprehensive Predictor Exams

A 25-year-old patient with a history of epilepsy is brought to the emergency department after experiencing a generalized tonic-clonic seizure. Which of the following is the most appropriate initial action by the nurse?

Correct Answer is D

Explanation

A nurse is caring for a patient receiving enteral nutrition through a nasogastric (NG) tube. Which of the following actions should the nurse take to reduce the risk of aspiration?

Correct Answer is D

Explanation

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