A nurse in an emergency department is caring for a client.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Asthma: The client’s symptoms of wheezing, chest tightness, and persistent dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading of 90% indicate that the client is experiencing bronchoconstriction and reduced airflow, which are hallmark features of an asthma exacerbation.
Plan to administer bronchodilator: Administering a bronchodilator is essential in treating asthma as it helps relax the bronchial muscles, leading to bronchodilation and improved airflow. This intervention is crucial for alleviating wheezing and shortness of breath associated with an asthma attack.
Measure the client's peak airflow: Measuring peak airflow using a peak flow meter helps assess the severity of the asthma and the effectiveness of the bronchodilator therapy. It provides objective data on the client’s lung function, allowing the nurse to evaluate changes in the client’s condition over time and make necessary adjustments to the treatment plan.
Prepare to administer an antibiotic: This action is not appropriate for asthma since antibiotics are ineffective against viral conditions and are typically used for bacterial infections such as pneumonia. Since the client is experiencing asthma symptoms rather than an infection, this intervention does not address the underlying problem.
Request a prescription for a diuretic: This action is also not appropriate in this scenario. Diuretics are used to manage fluid overload conditions, such as pulmonary edema or heart failure, and would not be indicated for a client with asthma experiencing wheezing and shortness of breath.
Teach the client pursed lip breathing: This technique is more commonly used in COPD to prevent airway collapse rather than in asthma, where bronchodilators provide more immediate relief.
Oxygen saturation: Monitoring oxygen saturation is critical for assessing the effectiveness of treatment in clients with asthma. A low oxygen saturation level indicates inadequate oxygenation, which necessitates immediate intervention. Tracking this parameter helps ensure the client is receiving adequate oxygen during their treatment.
Pulmonary function tests: While pulmonary function tests are useful for assessing long-term lung function, they provide valuable information on how well the lungs are functioning. Pulmonary function tests (PFTs), including forced expiratory volume in one second (FEV1) and peak expiratory flow rate (PEFR), help evaluate the degree of airway obstruction and response to treatment. Monitoring PFTs over time provides insight into asthma control and treatment effectiveness.
Weight: Monitoring weight is not a primary concern in managing asthma exacerbations. While it can be relevant in certain chronic conditions or for assessing fluid retention, it is not directly related to monitoring respiratory status or the effectiveness of asthma treatment.
Temperature: While it is important to monitor temperature in general to identify potential infections, it is not specifically relevant to assessing asthma status unless there are other indications of an underlying infection contributing to the respiratory symptoms. In the context of asthma management, oxygen saturation and peak airflow are more critical parameters.
Urine output: Monitoring urine output is not a direct indicator of asthma status. It is more relevant in assessing kidney function and fluid balance, which are not primary concerns in the acute management of asthma exacerbations.
COPD typically presents with a long history of smoking, chronic cough, and progressive respiratory symptoms. In this scenario, the client is a nonsmoker, and the acute nature of the symptoms is more indicative of asthma rather than COPD.
Pulmonary edema often presents with symptoms such as cough with frothy sputum, severe shortness of breath, and hypoxia, typically related to heart failure. The client’s symptoms are more consistent with asthma rather than fluid overload.
Pneumonia: Pneumonia usually presents with symptoms such as productive cough, fever, chills, and localized lung findings. While wheezing can occur, the lack of fever and the specific nighttime worsening of symptoms align more closely with asthma than with pneumonia.
Asthma: The client’s symptoms of wheezing, chest tightness, and dry cough, especially worsening at night, are characteristic of asthma. The presence of bilateral wheezing and a low pulse oximetry reading indicate bronchoconstriction and reduced airflow, consistent with an asthma exacerbation.

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Correct Answer is B

Explanation

A. Standard: While a standard resume format includes basic information about education and experience, it may not effectively address the nurse's multiple moves and varied positions, potentially raising concerns about stability and commitment.
B. Functional: This resume type is most appropriate for the nurse in this situation as it focuses on skills and experiences rather than a chronological work history. This format allows the nurse to highlight relevant skills gained in different positions without emphasizing the frequent changes in employment, which could be beneficial in presenting a cohesive professional narrative.
C. Sequence: This term is less commonly used in resume types and may not provide clarity in presenting qualifications or experiences.
D. Chronological: While this format lists experiences in reverse chronological order, it may draw attention to the frequent changes in positions and locations, which could raise red flags for potential employers regarding the nurse's commitment and stability in a job.

A. Advocacy. B. Quality improvement. C. Case Management. D. Collaboration.

Correct Answer is B

Explanation

A. Advocacy: Advocacy involves representing the interests and needs of individual patients or groups within the healthcare system. While the nurse's actions may indirectly benefit patients by improving care standards, the focus here is on systemic changes rather than individual patient representation. Advocacy often involves lobbying for resources, policy changes, or addressing ethical concerns on behalf of patients, which is not the primary goal of the actions taken in this scenario.
B. Quality improvement: This term best describes the nurse's actions as it focuses on enhancing healthcare practices and patient outcomes through systematic efforts. By identifying the increase in pressure injuries and collaborating with management to implement a new policy, the nurse is actively participating in a quality improvement initiative aimed at reducing risks and improving care protocols in the ICU. This approach reflects a commitment to continuous improvement in patient safety and care standards, aligning with best practices in healthcare.
C. Case Management: Case management primarily involves coordinating care for individual patients, ensuring they receive appropriate services, and managing their healthcare journey. While the nurse may address pressure injuries at the unit level, the actions taken are broader and not confined to individual patient care. Case management emphasizes individualized care plans and resource allocation rather than addressing systemic issues affecting a group of patients in the ICU.
D. Collaboration: Collaboration refers to working together with others, such as colleagues and management, to achieve common goals in patient care. While the nurse did collaborate with the manager to develop and implement the new policy, collaboration alone does not capture the proactive approach taken to address the increase in pressure injuries. It emphasizes teamwork but lacks the focus on systematic quality enhancement that characterizes quality improvement efforts, which aim to implement lasting changes in practices and outcomes.

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Naxlex Comprehensive Predictor Exams

An experienced nurse has moved to a new state and is applying for a nursing position. The nurse has moved several times in the past few years and held several different positions. Which of the following resume types most appropriate?

Correct Answer is B

Explanation

Correct Answer is B

Explanation

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