After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?

“I will notify the physician about this adverse effect."

"This is an expected adverse effect. Let me take your pulse."

"We will hold the treatment for 24 hours."

"The next scheduled nebulizer treatment will be skipped."

Answer and Explanation

The Correct Answer is B

A. “I will notify the physician about this adverse effect.” Although it is appropriate to report concerning or worsening symptoms, slight nervousness after a beta-agonist nebulizer is a transient and expected effect. Immediate notification isn't necessary unless symptoms escalate.

B. "This is an expected adverse effect. Let me take your pulse." Beta-agonists like albuterol can stimulate the sympathetic nervous system, leading to mild side effects such as nervousness, jitteriness, or increased heart rate. This response reassures the patient while also ensuring safety through pulse monitoring.

C. "We will hold the treatment for 24 hours." Holding treatment may deprive the patient of necessary bronchodilation during an acute phase of asthma. A slight nervous sensation does not warrant stopping treatment unless accompanied by more severe reactions.

D. "The next scheduled nebulizer treatment will be skipped." Skipping a dose without reassessing the patient or provider input may risk worsening asthma control. Minor side effects should be monitored, not cause immediate cancellation of scheduled therapy.

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Correct Answer is A

Explanation

A. A possible airway obstruction: The tripod positionis a classic sign of epiglottitis and indicates the child is attempting to maximize airway patency. This posture helps keep the airway open and suggests significant upper airway obstruction, requiring immediate intervention.

B. The presence of pain: While children with epiglottitis often experience throat pain, this posture is not primarily used to relieve pain. It is associated with efforts to ease breathing and maintain airflow in the face of an obstructed or narrowed airway.

C. Extreme fatigue: Fatigue may occur in respiratory illnesses, but the tripod position is an active posture that requires muscle engagement. It is not a typical sign of fatigue and more accurately reflects respiratory distress and airway compromise.

D. Dehydration: Dehydration may be present in epiglottitis due to poor oral intake, but it does not cause the child to assume the tripod position. The posture is a compensatory mechanism for airway obstruction, not a direct result of fluid imbalance.

A. lint-free pipe cleaner B. The inner cannula does not need to be dried before reinserting it into the outer cannula. C. Q-tip D. medical air

Correct Answer is A

Explanation

A. Lint-free pipe cleaner:A lint-free pipe cleaner is ideal for drying the inner cannula because it won’t introduce fibers or debris into the airway. It ensures that the cannula is thoroughly dried without increasing the risk of aspiration or airway irritation from lint.

B. The inner cannula does not need to be dried before reinserting it into the outer cannula:Moisture left inside the cannula can promote bacterial growth and lead to infection. Drying the cannula is an essential step to prevent microbial contamination and to maintain patency and safety.

C. Q-tip:Q-tips can shed fibers and are not suitable for internal tracheostomy components. Using them may lead to lint being introduced into the airway, increasing the risk of irritation or infection.

D. Medical air:Medical air is not used to dry tracheostomy components. It is not practical, and it may not fully dry narrow internal surfaces. Manual drying with a lint-free material is safer and more effective.

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After receiving a nebulizer treatment with a beta agonist, the patient complains of feeling slightly nervous and wonders if her asthma is getting worse. What is the nurse's best response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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