A patient came to the walk-in clinic with extremely labored breathing and a history of asthma that is unresponsive to prescribed inhalers or medications. What would you do first?
Call 911 and report that the patient has probable status asthmaticus.
Obtain the equipment and prepare the patient for intubation.
Establish IV access to give emergency medication.
Place the patient in a high Fowler's position and start oxygen therapy.
The Correct Answer is D
A. While status asthmaticus is a severe, life-threatening asthma exacerbation, the first step is to stabilize the patient by improving oxygenation and relieving airway obstruction, not immediately calling 911 unless the situation worsens.
B. Intubation is not the first step unless the patient's respiratory status continues to deteriorate despite initial interventions. The focus should be on improving oxygenation and managing the airway.
C. Establishing IV access and administering emergency medications, such as corticosteroids or bronchodilators, may be necessary, but the first priority is to improve the patient's breathing and oxygenation.
D. Placing the patient in a high Fowler's position helps to open the airways and facilitate breathing. Starting oxygen therapy is essential to support oxygenation in a patient with labored breathing. This should be the first intervention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Drinking 400 ml every hour is not a typical recommendation for bowel preparation with PEG. The client is usually instructed to drink a specific volume, but it is typically more than 400 ml at once and spread over a specific time frame, often 1-2 liters over several hours.
B. Abdominal bloating is a common side effect of polyethylene glycol-electrolyte solutions. The solution works by drawing water into the intestines to induce bowel movements, and this can lead to temporary bloating or discomfort.
C. While it is important to stay hydrated during the bowel prep, the recommendation to drink an additional liter of fluid is not typically included in the instructions. The PEG solution itself is designed to maintain fluid balance, and additional water may be advised, but this is not the standard guideline.
D. Bowel movements typically begin shortly after starting the PEG solution, often within 1-2 hours, rather than waiting 3 hours. The exact timing can vary, but 3 hours is longer than usual for the first bowel movement to occur.
Correct Answer is B
Explanation
A. While sterile drapes are important for maintaining a sterile field during the procedure, they do not directly address the issue of privacy.
B. Pulling the curtains around the client's bed is the most appropriate action to ensure privacy during the procedure. It creates a physical barrier to maintain confidentiality and dignity for the client while they undergo the lumbar puncture.
C. Closing the door to the client's room can also help maintain privacy but may not be as effective in a shared space like a hospital ward. Curtains are a more immediate and effective means of providing privacy.
D. Asking family members to leave the room may be necessary for the procedure but does not directly relate to privacy during the procedure. The focus should be on ensuring the environment is private by pulling curtains and closing doors.
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