A client newly diagnosed with asthma is being given discharge instructions. The nurse works collaboratively with the client, instructing the client to use a metered dose inhaler (MDI). What is the first priority and last priority step in the procedure?

Hold breath for 5 seconds and exhale / shake inhaler.

Place mouthpiece in mouth / exhale slowly and completely.

Press and hold the canister down while inhaling deeply and slowly / exhale slowly and completely.

Remove cap from inhaler and shake inhaler / rinse your mouth, gargle, spit out.

Answer and Explanation

The Correct Answer is D

Choice A reason:

Holding your breath for 5 seconds and exhaling is not the first step in using an MDI. Shaking the inhaler is necessary to ensure the medication is properly mixed, but it should be done after removing the cap.

Choice B reason:

Placing the mouthpiece in the mouth and exhaling slowly and completely is an important step, but it is not the first priority. Exhaling fully before inhaling the medication helps ensure that the medication reaches deep into the lungs.

Choice C reason:

Pressing and holding the canister down while inhaling deeply and slowly is a crucial step in using an MDI, but it is not the first step. This action releases the medication into the lungs.

Choice D reason:

Removing the cap from the inhaler and shaking it is the first priority step. This ensures the medication is ready for use. Rinsing your mouth, gargling, and spitting out after using the inhaler is the last priority step to prevent oral thrush and other side effects.

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Correct Answer is D

Explanation

Choice A reason:

Administering oxygen per the prescriber’s order to keep SpO2 greater than 96% is not typically recommended for clients with chronic bronchitis. High levels of oxygen can suppress the respiratory drive in clients with chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis. The target SpO2 for these clients is usually between 88% and 92%.

Choice B reason:

Placing the patient in the Sims position is not the most effective position for airway clearance. The Fowler’s or semi-Fowler’s position is generally preferred as it promotes better lung expansion and facilitates easier breathing.

Choice C reason:

Assessing the client’s use of a peak expiratory flow rate meter is important for monitoring the severity of bronchospasm and airflow obstruction. However, it is not a direct intervention for improving gas exchange.

Choice D reason:

Assisting with coughing and deep breathing at least every 2 hours while awake is an effective intervention for clients with chronic bronchitis. This helps to mobilize secretions, improve ventilation, and enhance gas exchange. Regular coughing and deep breathing exercises can prevent atelectasis and reduce the risk of respiratory infections.

A. 5% dextrose in water (D5W). B. 5% dextrose in 0.25% sodium chloride (D5 1/4 NS). C. 0.9% normal saline (0.9% NaCl). D. 3% sodium chloride (3% NaCl).

Correct Answer is C

Explanation

Choice A reason:

5% dextrose in water (D5W) is not typically used for fluid resuscitation in cases of hypovolemia due to severe bleeding. D5W is a hypotonic solution once the dextrose is metabolized, which means it does not remain in the intravascular space and is not effective in expanding blood volume. It is more commonly used for providing free water and calories.

Choice B reason:

5% dextrose in 0.25% sodium chloride (D5 1/4 NS) is also not suitable for fluid resuscitation in hypovolemia due to severe bleeding. This solution is hypotonic and will not adequately expand the intravascular volume. It is generally used for maintenance fluids rather than for resuscitation.

Choice C reason:

0.9% normal saline (0.9% NaCl) is the preferred choice for fluid resuscitation in hypovolemia due to severe bleeding. It is an isotonic solution, meaning it has the same osmolarity as blood and remains in the intravascular space, effectively expanding blood volume. This helps to restore circulating volume and improve tissue perfusion.

Choice D reason:

3% sodium chloride (3% NaCl) is a hypertonic solution and is not typically used for fluid resuscitation in hypovolemia due to severe bleeding. Hypertonic solutions can cause rapid shifts of fluid from the intracellular to the extracellular space, which can lead to complications such as hypernatremia and osmotic demyelination syndrome. It is generally reserved for specific situations such as severe hyponatremia.

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A client newly diagnosed with asthma is being given discharge instructions. The nurse works collaboratively with the client, instructing the client to use a metered dose inhaler (MDI). What is the first priority and last priority step in the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse has applied a client problem of ineffective gas exchange for a client diagnosed with chronic bronchitis. Which intervention would the nurse include in the plan of care?

Correct Answer is D

Explanation

A client is admitted with hypovolemia due to severe bleeding. Which IV fluid does the nurse anticipate using to replace fluid losses?

Correct Answer is C

Explanation

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