A patient with asthma presents with daily peak flow rates consistently at 45% of their personal best. What is the most appropriate action the nurse should take?
Instruct the patient to increase fluid intake.
Schedule a routine follow-up appointment in two weeks.
Advise the patient to avoid all physical activity.
Initiate an asthma action plan and provide oral corticosteroids.
The Correct Answer is D
A. Increasing fluid intake may help with hydration, but it is not the most appropriate intervention for a patient whose peak flow rates are significantly low. The priority is to address the asthma exacerbation.
B. Scheduling a follow-up appointment in two weeks is not appropriate in this situation. The patient is experiencing significant symptoms, and immediate action is required to manage the exacerbation.
C. Advising the patient to avoid all physical activity may not be necessary. Physical activity can be adjusted based on the patient's condition, but the priority is to treat the asthma exacerbation and improve the patient's respiratory status.
D. Initiating an asthma action plan and providing oral corticosteroids is the correct approach. A peak flow rate consistently at 45% of the personal best indicates poor asthma control, and the patient likely requires additional treatment, such as oral corticosteroids, to manage the exacerbation. The asthma action plan should guide further management based on the patient's peak flow rate and symptoms.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. A musty odor is not normal and may indicate the presence of infection or moisture inside the cast. The client should report any unusual odors to the healthcare provider.
B. Applying ice to the foot after walking is not typically recommended for a Plaster of Paris cast. The client should focus on elevating the leg to reduce swelling and avoid getting the cast wet.
C. The cast must be kept dry to maintain its integrity. The client should cover the cast with a waterproof covering when showering to prevent damage or weakening of the plaster.
D. Numbness or pain in the toes may indicate impaired circulation or nerve compression, which are serious complications that require immediate medical attention. The client should be instructed to report these symptoms promptly.
Correct Answer is D
Explanation
A. Notifying the client's family may be appropriate after assessing the client and identifying the cause of the confusion. However, it is not the first action, as the priority is to determine if the confusion is due to a medical condition requiring immediate attention.
B. Instructing the client to return to their room addresses the wandering behavior but does not address the underlying cause of the new onset confusion. Without further assessment, this action may delay necessary interventions.
C. Asking the UAP to push fluids assumes that dehydration is the cause of the confusion without evidence. While encouraging hydration may be beneficial later, it is essential first to assess for other potential causes, such as infection or hypoxia.
D. Assessing the client's lung fields and temperature is the first priority because new onset confusion in an older adult is often a symptom of an underlying medical issue, such as infection (e.g., pneumonia or urinary tract infection) or hypoxia. Early assessment helps identify the cause and guide appropriate interventions.
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