A client in the emergency room begins to experience an acute asthma attack. The nurse expects that which medication will be used as initial treatment?

A corticosteroid such as fluticasone

A long-acting beta 2 agonist such as salmeterol

A short-acting, beta 2 agonist such as albuterol

Methylxanthines such Theophylline

Answer and Explanation

The Correct Answer is C

A) A corticosteroid such as fluticasone:
While corticosteroids, such as fluticasone, are effective for managing chronic asthma and preventing inflammation over time, they are not the first-line treatment during an acute asthma attack. Corticosteroids are typically used for long-term control and maintenance therapy, not for rapid relief of symptoms in an acute exacerbation. Immediate relief is needed in acute situations, which corticosteroids alone do not provide.

B) A long-acting beta 2 agonist such as salmeterol:
Long-acting beta-2 agonists (LABAs), such as salmeterol, are used for maintenance therapy to prevent asthma attacks and should not be used for the immediate treatment of an acute asthma exacerbation. They take longer to start working, and their role is to provide prolonged bronchodilation over time, not to relieve sudden bronchoconstriction.

C) A short-acting beta 2 agonist such as albuterol:
During an acute asthma attack, the immediate goal is to relieve bronchoconstriction and improve airflow. Short-acting beta-2 agonists like albuterol are the first-line treatment because they quickly relax the smooth muscles of the airways, leading to bronchodilation. Albuterol works within minutes, providing rapid relief from the symptoms of wheezing, shortness of breath, and chest tightness.

D) Methylxanthines such as Theophylline:
Methylxanthines (e.g., theophylline) were once used for asthma management but are no longer considered the first-line treatment for acute exacerbations due to their narrow therapeutic range and the potential for toxicity. While theophylline can provide bronchodilation, its onset of action is slower than that of beta-agonists like albuterol, and it is generally reserved for more chronic management of asthma or severe cases where other medications are not effective.

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Correct Answer is D

Explanation

A) A normal finding:
A normal finding during an edrophonium (Tensilon) test is an improvement in muscle strength for clients with myasthenia gravis (MG). If the client becomes weaker after the dose, it indicates that the test results are not typical and suggest a different issue, not a normal response. This is not a normal finding.

B) A myasthenia gravis crisis due to drug undermedication:
In a myasthenic crisis, the client experiences severe weakness and respiratory difficulty, typically due to insufficient medication (e.g., pyridostigmine). While a myasthenic crisis could cause weakness and respiratory distress, the edrophonium test would typically show improvement in muscle strength if the crisis is due to undermedication. Since the client became weaker after receiving edrophonium, this is not indicative of a myasthenic crisis.

C) An allergic reaction:
An allergic reaction to the edrophonium test would typically result in symptoms such as rash, swelling, or difficulty breathing due to hypersensitivity, but it does not typically cause weakness as the primary response. The worsening of symptoms after the test is more likely related to drug overmedication rather than an allergic reaction.

D) A cholinergic crisis due to drug overmedication:
A cholinergic crisis occurs when there is an overdose of acetylcholinesterase inhibitors (e.g., pyridostigmine or neostigmine), which can lead to excessive acetylcholine at the neuromuscular junction, resulting in muscle weakness and respiratory failure. The edrophonium test helps differentiate between a myasthenic crisis and a cholinergic crisis. If the client becomes weaker after the administration of edrophonium, it suggests a cholinergic crisis due to drug overmedication.

A. Digoxin B. Diltiazem C. Propanolol D. Captopril

Correct Answer is A

Explanation

A) Digoxin:
The client’s symptoms of confusion, vision disturbances (such as yellow halos around lights), and anorexia are all classic signs of digoxin toxicity. Digoxin, a cardiac glycoside, is commonly used in the treatment of heart failure and atrial fibrillation. However, it has a narrow therapeutic index, meaning that even slightly elevated blood levels can lead to toxicity. Other common symptoms of digoxin toxicity include bradycardia (which the client is also experiencing with a pulse of 53 bpm), nausea, and vomiting.

B) Diltiazem:
Diltiazem is a calcium channel blocker used to treat hypertension, angina, and atrial fibrillation. While it can cause bradycardia (as evidenced by the client’s pulse of 53 bpm), vision disturbances and anorexia are not typical side effects of this medication. More common side effects include hypotension, edema, and constipation.

C) Propranolol:
Propranolol is a beta-blocker used to treat hypertension, arrhythmias, and angina, as well as to prevent migraines. Bradycardia is a known side effect of beta-blockers, but vision disturbances and anorexia are not typical of propranolol. Moreover, propranolol can cause hypotension and fatigue but would not be as likely to cause the specific symptoms of confusion and vision changes seen in this client.

D) Captopril:
Captopril is an ACE inhibitor commonly used to treat hypertension and heart failure. Common side effects include hypotension, dizziness, and hyperkalemia, but vision disturbances and anorexia are not typical side effects of captopril. The symptoms the client is experiencing are more specific to digoxin toxicity than to captopril's side effects.

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A client in the emergency room begins to experience an acute asthma attack. The nurse expects that which medication will be used as initial treatment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with history of myasthenia gravis is experiencing prolonged periods of weakness and difficulty breathing. The provider orders an edrophonium [Tensilon] test. Once the dose is administered, the client becomes weaker. The nurse interprets this test result as:

Correct Answer is D

Explanation

Correct Answer is A

Explanation

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