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A nurse is caring for a client who has COPD.

Medication

Indacaterol 75 mcg, one inhalation daily

Acetylcysteine 20% solution 3 to 5 ml nebulizer every 6 to 8 hr while awake

Select the 5 findings that require follow-up.

Disorientation

Barrel-shaped chest

Yellow sputum

Nebulizer use

Ankle edema

SaO2 92%

Clubbing of fingers

Answer and Explanation

Correct Answer : A,B,C,E,F

A. Disorientation:

This may indicate a neurological or cognitive issue and requires further assessment.

B. Barrel-shaped chest:

This is a characteristic finding in COPD, but any change or worsening may need evaluation.

C. Yellow sputum:

Yellow or greenish sputum may indicate an infection, and follow-up is needed.

D. Nebulizer use:

Nebulizer use is part of the prescribed treatment.

E. Ankle edema:

Edema can be a sign of heart failure or other cardiovascular issues and should be investigated.

F. SaO2 92%:

Oxygen saturation of 92% is below the normal range. It may indicate respiratory compromise and needs attention.

G. Clubbing of fingers:

While clubbing can be associated with chronic respiratory conditions, it is not an immediate concern.

H. Lives alone:

Living alone may impact the client's support system but does not require immediate medical attention.

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Correct Answer is B

Explanation

A. Providing immediate rest for the client: Rest is important, but in the context of an acute asthma exacerbation, addressing the underlying respiratory distress is the priority.

B. Administering a nebulized beta-adrenergic agonist: This is the correct answer. Beta-adrenergic agonists, such as albuterol, are bronchodilators that help relieve bronchoconstriction and improve airflow. Administering a nebulized beta-adrenergic agonist is a key intervention during an acute asthma exacerbation to alleviate symptoms and improve respiratory function.

C. Positioning the client in high-Fowler's: While positioning can assist with respiratory effort, administering a bronchodilator is a more direct and immediate intervention to relieve airway obstruction.

D. Initiating oxygen therapy: While oxygen therapy may be necessary, addressing bronchoconstriction with a beta-adrenergic agonist is the primary intervention during an acute asthma exacerbation.

A. "Increasing my intake of foods containing trans-fatty acids can lower my risk." B. "Adding foods containing omega-3 fatty acids to my diet can lower my risk." C. "A weight loss program can decrease my LDL cholesterol level." D. "Exercising regularly will increase HDL cholesterol levels."

Correct Answer is A

Explanation

A. "Increasing my intake of foods containing trans-fatty acids can lower my risk." - This statement is incorrect. Trans-fatty acids are associated with an increased risk of cardiovascular disease. The client should be advised to reduce or eliminate the consumption of foods containing trans fats.

B. "Adding foods containing omega-3 fatty acids to my diet can lower my risk." - This statement is correct. Omega-3 fatty acids, found in fish and certain plant sources, have been associated with a decreased risk of cardiovascular disease.

C. "A weight loss program can decrease my LDL cholesterol level." - This statement is correct. Weight loss, especially in the context of a healthy diet and regular exercise, can contribute to a decrease in LDL (low-density lipoprotein) cholesterol levels.

D. "Exercising regularly will increase HDL cholesterol levels." - This statement is correct. Regular exercise is associated with an increase in HDL (high-density lipoprotein) cholesterol, which is considered beneficial for heart health.

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A nurse is caring for a client who has COPD. Medication Indacaterol 75 mcg, one inhalation daily Acetylcysteine 20% solution 3 to 5 ml nebulizer every 6 to 8 hr while awake Select the 5 findings that require follow-up.

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Naxlex Comprehensive Predictor Exams

A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. Which of the following actions is the nurse's highest priority?

Correct Answer is B

Explanation

A nurse is providing teaching to a client about interventions to reduce the risk of developing cardiovascular disease. Which of the following statements by the client should indicate to the nurse the need for further teaching?

Correct Answer is A

Explanation

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A nurse is caring for a client who has COPD.

Medication

Indacaterol 75 mcg, one inhalation daily

Acetylcysteine 20% solution 3 to 5 ml nebulizer every 6 to 8 hr while awake

Select the 5 findings that require follow-up.