Patient Data

History and Physical

The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler" but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.

Review history.

Which 2 drugs would be the most appropriate to give the client now?

Salmeterol via nebulizer

Albuterol via nebulizer

Fexofenadine orally

Levalbuterol inhaler

Racemic epinephrine via nebulizer

Budesonide via metered dose inhaler

Answer and Explanation

Correct Answer : B,D

A. Salmeterol via nebulizer: Salmeterol is a long-acting beta-2 agonist (LABA) and is used for maintenance therapy, not for acute bronchospasm. It has a delayed onset of action and is not suitable for emergency relief.

B. Albuterol via nebulizer: Albuterol is a short-acting beta-2 agonist (SABA) that acts quickly to relax bronchial smooth muscle, relieving acute bronchospasm. It is one of the first-line treatments during an asthma exacerbation or acute respiratory distress.

C. Fexofenadine orally: Fexofenadine is an oral antihistamine used to treat allergic rhinitis, not acute bronchospasm. It would not provide the rapid airway dilation needed in an emergency asthma situation.

D. Levalbuterol inhaler: Levalbuterol is another short-acting beta-2 agonist similar to albuterol, used for quick relief of bronchospasm. It is appropriate for emergency use to improve airway obstruction rapidly.

E. Racemic epinephrine via nebulizer: Racemic epinephrine is typically used for upper airway obstruction, such as croup or severe airway swelling, not lower airway bronchospasm like in asthma. It is not first-line treatment for an asthma exacerbation.

F. Budesonide via metered dose inhaler: Budesonide is an inhaled corticosteroid intended for long-term asthma control, not immediate relief. Its onset is delayed, making it unsuitable for managing acute respiratory distress.

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Elective surgery is scheduled in two hours: Clopidogrel is an antiplatelet agent that significantly increases the risk of bleeding. It should be held prior to surgery to minimize intraoperative and postoperative bleeding risks. Surgeons often require clopidogrel to be discontinued several days in advance, making it critical to withhold the drug if surgery is imminent.

B. An abdominal sonogram is scheduled: An abdominal ultrasound is a noninvasive imaging test that does not carry bleeding risks. There is no need to hold clopidogrel prior to sonogram procedures because it does not impact the safety or accuracy of the imaging study.

C. Breakfast has not been eaten: Clopidogrel can be taken with or without food. Skipping a meal does not contraindicate administering the medication, although taking it with food can sometimes help reduce gastrointestinal discomfort.

D. The client's platelet level is high: Clopidogrel works by inhibiting platelet aggregation, not by lowering platelet count. A high platelet count alone is not a reason to withhold the medication unless there is a specific bleeding risk or another contraindication identified by the healthcare provider.

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D","dropdown-group-3":"A"}

Explanation

Increasing heart rate: Increasing heart rate is not the mechanism of thiazide diuretics or ACE inhibitors. It would raise blood pressure by increasing cardiac workload. Effective antihypertensives aim to lower or stabilize heart rate, not increase it.
Reducing stroke volume: Thiazide diuretics reduce stroke volume by lowering blood volume through sodium and water excretion. This decreases cardiac output and helps lower blood pressure, particularly in volume-sensitive hypertension.
Suppressing the appetite: Suppressing appetite is unrelated to the action of thiazide diuretics or ACE inhibitors. These drugs target fluid balance and vascular tone, not the central nervous system mechanisms that regulate hunger.
Decreasing serum sodium levels: Both thiazide diuretics and ACE inhibitors contribute to decreased serum sodium levels, which helps lower blood volume. This reduction supports blood pressure control but must be monitored to avoid hyponatremia.
Reducing systemic vascular resistance: ACE inhibitors lower blood pressure by reducing systemic vascular resistance through vasodilation. Blocking angiotensin II prevents arterial constriction, easing the workload on the heart and lowering afterload.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has a prescription for clopidogrel bisulfate 75 mg by mouth daily at 0900. In which situation should the nurse hold this medication?

Correct Answer is A

Explanation

Patient Data Select from Word Choices to complete the sentence. The thiazide diuretic works to decrease the client's blood pressure by ______, and the angiotensin converting enyzme (ACE) inhibitor works to decrease the client's blood pressure by ________ and _______

Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D","dropdown-group-3":"A"}

Explanation

A client who uses transdermal contraceptive, calls to the clinic because she forgot to apply a new patch three days ago. Which instruction should the nurse provide to the client?

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