Exhibits

A nurse is reviewing the medical record of a school-age child who has asthma. Which of the following prescriptions should the nurse anticipate administering? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Chest physiotherapy four times per day

Ice packs to the groin

A cough suppressant

Corticosteroid via intermittent IV bolus

Answer and Explanation

The Correct Answer is D

A. Chest physiotherapy four times per day: While chest physiotherapy can help with clearing mucus, it is not indicated as the first-line intervention for asthma exacerbation. The child’s primary issue is difficulty with airway constriction and inflammation, not just mucus buildup.

B. Ice packs to the groin: Ice packs are not appropriate for this child’s asthma exacerbation. Ice packs are generally used for managing inflammation or injury, not for asthma exacerbations.

C. A cough suppressant: The cough is a symptom of the underlying asthma exacerbation and needs to be managed with bronchodilators and anti-inflammatory medications to treat the underlying cause, not suppressed.

D. Corticosteroid via intermittent IV bolus: The child has signs of a moderate to severe asthma exacerbation, including wheezing, intercostal retractions, a decreased peak flow, and oxygen saturation of 88%, which indicates poor ventilation. Corticosteroids are used to reduce inflammation and improve airway function.

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Free Nursing Study Resources

Correct Answer is C

Explanation

A. "Tilt the spirometer toward yourself so you can see the balls rise.": The spirometer should be held upright for optimal use, not tilted. Tilting it could interfere with proper readings of airflow and volume.

B. "Inhale deeply and hold each breath for a minimum of 10 seconds.": Holding the breath for 10 seconds may be too long, especially in pneumonia. The goal is to take a deep, slow breath and try to hold it for about 3 to 5 seconds to ensure maximum lung expansion.

C. "Exhale before sealing your lips around the mouthpiece.": The client should exhale normally before sealing their lips around the mouthpiece and then inhale deeply to maximize lung expansion and help clear secretions.

D. "Use your incentive spirometer every 4 hours while you are awake.": The recommendation is to use the incentive spirometer every 1 to 2 hours while awake, not every 4 hours. This frequent use helps to prevent atelectasis and promote lung expansion.

A. "Gestational diabetes increases the risk of your baby having a cleft lip or palate." B. "Gestational diabetes increases the risk of your baby having a low birth weight." C. "Gestational diabetes increases the risk of your baby having hemorrhagic disease after birth." D. "Gestational diabetes increases the risk of your baby having hypoglycemia after birth."

Correct Answer is D

Explanation

A. "Gestational diabetes increases the risk of your baby having a cleft lip or palate.": Gestational diabetes is not associated with an increased risk of cleft lip or palate. These conditions are more commonly linked to genetic or environmental factors.

B. "Gestational diabetes increases the risk of your baby having a low birth weight.": Gestational diabetes usually increases the risk of a baby having a high birth weight (macrosomia) rather than a low birth weight.

C. "Gestational diabetes increases the risk of your baby having hemorrhagic disease after birth.": Hemorrhagic disease of the newborn is typically associated with vitamin K deficiency, not gestational diabetes. It is unrelated to gestational diabetes.

D. "Gestational diabetes increases the risk of your baby having hypoglycemia after birth.": Babies born to mothers with gestational diabetes are at increased risk of hypoglycemia after birth, the baby produces excess insulin in response to the high blood sugar levels during pregnancy. After birth, the baby's insulin levels may remain high leading to hypoglycemia.

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has pneumonia about the use of an incentive spirometer. Which of the following instructions should the nurse include?

Correct Answer is C

Explanation

A nurse is caring for a client who is at 31 weeks of gestation and has gestational diabetes mellitus. The client asks, "Can gestational diabetes affect my baby?" Which of the following responses should the nurse make?

Correct Answer is D

Explanation

A nurse is assessing a client who has hypocalcemia. Which of the following manifestations should the nurse expect?

A nurse is caring for a client who has musculoskeletal injuries to the left lower extremity. Which of the following assessments should the nurse perform to evaluate the neurovascular status of the client's extremity?

A nurse is teaching a client who has a prescription for alendronate 5 mg PO daily for osteoporosis. Which of the following client statements should the nurse identify as an understanding of the teaching?

A nurse is reviewing the laboratory results of a client who was an unrestrained passenger in a motor-vehicle crash. The ABG results are as follows: pH 7.32, HCO3 24 mEq/L, PaCO2 48 mm Hg. The nurse should identify the client is experiencing which of the following acid-base imbalances?

A nurse in an emergency department is caring for a preschooler who experienced a near drowning and has hypothermia. Which of the following actions should the nurse take?

A nurse in an emergency department is assessing a client who has gastroenteritis with dehydration and reports vomiting for the last 3 days. Which of the following manifestations should the nurse expect?

A nurse is caring for a client who has AIDS and is experiencing wasting syndrome. Which of the following actions should the nurse take to prevent malnutrition?

A nurse working in an emergency department is reviewing laboratory results of a client who is unconscious and has fruity odor to his breath. The nurse suspects diabetic ketoacidosis. Which of the following results should the nurse expect for this acid-base imbalance?