A patient with asthma is admitted to an emergency department with a respiratory rate of 22 breaths per minute, a prolonged expiratory phase, tight wheezes, and an oxygen saturation of 90% on room air. The patient reports using fluticasone [Flovent HFA] 110 mcg twice daily and has used 2 puffs of albuterol [Proventil HFA], 90 mcg/puff, every 4 hours for 2 days. The nurse will expect to administer which drug?

Intravenous theophylline, oxygen, and fluticasone [Flovent HFA] 220 mcg

Four puffs of albuterol, oxygen, and intravenous theophylline

Intravenous glucocorticoids, nebulized albuterol and ipratropium, and oxygen

Intramuscular glucocorticoids and salmeterol by metered-dose inhaler

Answer and Explanation

The Correct Answer is C

Choice A reason: Theophylline is rarely used due to toxicity risks and less efficacy compared to beta-agonists. Increasing fluticasone dose doesn’t address acute exacerbations, as inhaled corticosteroids act slowly. Oxygen is appropriate, but this regimen lacks rapid-acting bronchodilators, making it inadequate for acute asthma management.

Choice B reason: Four puffs of albuterol via inhaler may be insufficient for severe asthma (90% saturation, wheezes). Theophylline is outdated, and nebulized treatments are more effective in emergencies. Oxygen is needed, but this combination lacks systemic steroids for inflammation, making it less optimal.

Choice C reason: Intravenous glucocorticoids reduce airway inflammation rapidly, nebulized albuterol and ipratropium provide synergistic bronchodilation, and oxygen corrects hypoxia (90% saturation). This aligns with guidelines for acute asthma exacerbations, addressing inflammation, bronchoconstriction, and oxygenation, making it the correct and comprehensive treatment choice.

Choice D reason: Intramuscular glucocorticoids are slower than intravenous for acute asthma. Salmeterol, a long-acting beta-agonist, is inappropriate for acute exacerbations, as it lacks rapid onset. Oxygen is needed, but this regimen doesn’t address immediate bronchoconstriction effectively, making it incorrect for emergency management.

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Correct Answer is D

Explanation

Choice A reason: Allergic reactions typically present with symptoms like rash, itching, or anaphylaxis, not jaundice, dark urine, or light stools. These symptoms indicate hepatobiliary dysfunction, not an immune-mediated response. Allergic reactions don’t typically affect liver function or bile excretion, making this choice inconsistent with the patient’s clinical presentation.

Choice B reason: Idiosyncratic drug effects on bone marrow cause hematologic issues like anemia or leukopenia, not jaundice or light stools. These symptoms suggest liver dysfunction, as bile pigment changes cause dark urine and pale stools. Bone marrow effects don’t explain the hepatobiliary symptoms, making this choice incorrect.

Choice C reason: Iatrogenic skin disease might involve rashes or lesions, but jaundice, dark urine, and light stools point to liver or bile duct issues. These symptoms result from impaired bilirubin metabolism, not cutaneous pathology. This choice doesn’t align with the systemic hepatobiliary symptoms described, making it incorrect.

Choice D reason: Drug-induced liver toxicity, such as from acetaminophen or statins, impairs bilirubin metabolism, causing jaundice, dark urine (bilirubinuria), and light stools (reduced bile). Malaise, nausea, and vomiting reflect systemic effects of liver dysfunction. This matches the patient’s symptoms, making it the most likely diagnosis and correct choice.

A. Fully Compensated Metabolic Acidosis B. Fully Compensated Respiratory Acidosis C. Fully Compensated Respiratory Alkalosis D. Fully Compensated Metabolic Alkalosis

Correct Answer is D

Explanation

Choice A reason: Metabolic acidosis has low pH and HCO3-. Normal pH (7.41) and high HCO3- (30) suggest alkalosis, not acidosis, so this is incorrect for the ABG values.

Choice B reason: Respiratory acidosis has high PaCO2 and low pH. Normal pH and high HCO3- indicate metabolic alkalosis, not respiratory acidosis, so this is incorrect.

Choice C reason: Respiratory alkalosis has low PaCO2 and high pH. High PaCO2 (46) and HCO3- rule this out, pointing to metabolic alkalosis, so this is incorrect.

Choice D reason: Normal pH (7.41), high PaCO2 (46), and high HCO3- (30) indicate metabolic alkalosis fully compensated by respiratory CO2 retention. This is correct.

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Naxlex Comprehensive Predictor Exams

The nurse is caring for a patient who has jaundice, dark urine, malaise, light-colored stools, nausea, and vomiting. What is this patient most likely experiencing?

Correct Answer is D

Explanation

Name the pulmonary imbalance using the following Arterial blood Gas (ABG) values: pH 7.41, PaCO2 46, HCO3- 30

Correct Answer is D

Explanation

Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug?

A nurse is reviewing a patient’s medications before administration. Which drug-to-drug interactions will most concern the nurse in a patient with a history of heart failure and a potassium level of 5.5 mEq/L?

Which are effective ways to help prevent medication errors? (Select all that apply)

Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 that their albuterol MDI (Proventil) is used:

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A cancer patient asks the nurse what can be given to alleviate severe, chronic pain of several months’ duration. The patient has been taking oxycodone (OxyContin) and states it is no longer effective. The nurse will suggest discussing which medication with the provider?

Name the imbalance using the following Arterial Blood Gas (ABG) values: pH 7.32, PaCO2 <37, HCO3- <24

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