A client with chronic obstructive pulmonary disease receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

Primes the inhaler with 7 pumps

Attaches spacer device to the inhaler

Stores the medication at room temperature

Rinses the mouth after each use

Answer and Explanation

The Correct Answer is A

Choice A reason: Priming an ipratropium inhaler typically requires 2 pumps, not 7, to ensure proper dosing. Excessive priming wastes medication and may reduce the inhaler’s lifespan. This action indicates misunderstanding of device preparation, necessitating further teaching to ensure effective administration and therapeutic outcomes.

Choice B reason: Attaching a spacer device enhances ipratropium delivery by improving aerosol deposition in the lungs, especially in COPD patients with poor inhalation technique. This is correct, as spacers reduce oropharyngeal deposition, minimizing side effects and maximizing bronchodilation, requiring no additional teaching.

Choice C reason: Storing ipratropium at room temperature is correct, as extreme temperatures can degrade the medication’s efficacy. This action aligns with manufacturer guidelines, ensuring the inhaler’s stability and effectiveness, indicating proper understanding and eliminating the need for further teaching on storage.

Choice D reason: Rinsing the mouth after ipratropium use is appropriate, as it reduces local side effects like dry mouth or throat irritation from residual medication. This correct action prevents complications, showing proper technique and understanding, so no additional teaching is required for this step.

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Correct Answer is C

Explanation

Choice A reason: Chest x-ray may show nonspecific findings in pulmonary embolism but is not diagnostic. D-dimer, a fibrin degradation product, is highly sensitive for detecting thrombosis, guiding further imaging like CT pulmonary angiography, making it the priority test in suspected cases.

Choice B reason: Electrocardiogram may show tachycardia or right heart strain in pulmonary embolism but is nonspecific. D-dimer is a sensitive screening test, indicating clot presence, which prompts definitive imaging, making it the preferred initial diagnostic step in suspected pulmonary embolism.

Choice C reason: D-dimer blood test is the most sensitive screening tool for pulmonary embolism, detecting fibrin degradation from clots. Elevated levels prompt CT pulmonary angiography for confirmation, guiding urgent treatment to prevent further embolization, making it the critical test to anticipate.

Choice D reason: Arterial blood gas may reveal hypoxemia in pulmonary embolism but is nonspecific, as other conditions cause similar findings. D-dimer is more diagnostic, identifying clot presence, guiding imaging, and ensuring timely intervention, making it the priority test in suspected cases.

A. Assist with personal care but leave oral care for the nurse to complete B. Provide a soft-bristled toothbrush for the client to use during oral care C. Wear sterile gloves when cleansing any areas of infected mucosa D. Offer the client mouthwash after brushing teeth

Correct Answer is B

Explanation

Choice A reason: Delegating oral care to UAP is appropriate for routine hygiene in AIDS patients with candidiasis. Leaving oral care solely to the nurse is unnecessary unless complex treatments are required. A soft-bristled toothbrush ensures safe, effective cleaning, supporting UAP involvement in standard oral hygiene.

Choice B reason: A soft-bristled toothbrush is ideal for oral care in candidiasis, as it gently cleans without traumatizing painful ulcers. In AIDS, oral hygiene reduces fungal load and discomfort. This instruction ensures safe, effective care by UAP, aligning with standard hygiene practices for mucosal infections.

Choice C reason: Sterile gloves are unnecessary for routine oral care, as candidiasis is not highly contagious in this context. Standard precautions, including clean gloves, suffice for UAP performing hygiene. Requiring sterile gloves is excessive, complicating care without added benefit compared to using a soft toothbrush.

Choice D reason: Mouthwash may irritate candidiasis ulcers, especially if alcohol-based, and is not the priority. Brushing with a soft-bristled toothbrush effectively cleans the mouth without causing trauma. Mouthwash is secondary and requires nurse oversight to ensure compatibility with the client’s condition, unlike brushing.

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A client with chronic obstructive pulmonary disease receives a new prescription for an ipratropium inhaler. Which action indicates to the nurse that additional teaching is needed?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is B

Explanation

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