A nurse is planning care for a child who has asthma. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)
Administer dornase alfa daily.
Place the child in an upright position.
Administer bronchodilators.
Perform chest percussion.
Monitor oxygen saturation.
Correct Answer : B,C,E
Choice A reason: Dornase alfa is used to break down mucus and is beneficial for children with cystic fibrosis, not typically prescribed for asthma.
Choice B reason: Placing a child in an upright position can help ease breathing during an asthma attack by reducing pressure on the diaphragm.
Choice C reason: Bronchodilators are medications that help open the airways and are a mainstay in the treatment of asthma.
Choice D reason: Chest percussion can help loosen mucus in the lungs; however, it is not commonly used in the routine management of asthma.
Choice E reason: Monitoring oxygen saturation is crucial in assessing the severity of an asthma attack and determining the effectiveness of treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: While administering vitamins and minerals is important, it does not provide complete nutrition, especially for a client with such extensive burns and absent bowel sounds.
Choice B reason: This is the correct choice because total parenteral nutrition (TPN) provides complete nutrition intravenously, bypassing the gastrointestinal tract, which is necessary when bowel sounds are absent, indicating a non-functioning GI system.
Choice C reason: Enteral feedings require a functioning GI tract. With absent bowel sounds, this indicates a high risk for complications like aspiration or feeding intolerance.
Choice D reason: Encouraging oral intake is not feasible for a client with extensive burns and absent bowel sounds due to the high risk of inadequate intake and aspiration.
Correct Answer is A
Explanation
Choice A reason: A sweat chloride content of 85 mEq/L is indicative of cystic fibrosis, as normal values are below 30 mEq/L, and values above 60 mEq/L are diagnostic for cystic fibrosis.
Choice B reason: Hard, packed stools could be a sign of cystic fibrosis but are not as diagnostic as a sweat chloride test.
Choice C reason: Increased blood levels of fat-soluble vitamins are not typically associated with cystic fibrosis; patients often have deficiencies due to malabsorption.
Choice D reason: A chest x-ray negative for atelectasis does not indicate cystic fibrosis, as atelectasis can be present in many conditions.
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