Sara is receiving a nebulized albuterol treatment for her asthma exacerbation. Which of the following should be the nurse’s first priority after administering the treatment?

Auscultate Sara’s lung sounds.

Measure Sara’s temperature.

Encourage Sara to ambulate

Document the treatment in her medical record.

Answer and Explanation

The Correct Answer is A

Choice A reason: Auscultating lung sounds post-albuterol assesses treatment efficacy in asthma exacerbation. Reduced wheezing or improved air entry indicates bronchodilation, guiding further care, making it the priority to evaluate respiratory response immediately.

Choice B reason: Measuring temperature monitors infection, a possible asthma trigger, but it’s not the priority post-treatment. Albuterol targets acute bronchospasm, so assessing respiratory effect trumps systemic checks like fever in this moment.

Choice C reason: Encouraging ambulation is premature post-albuterol; patients need rest during exacerbation. It risks worsening dyspnea before confirming treatment success, making it less urgent than evaluating lung response to the bronchodilator.

Choice D reason: Documentation is essential but secondary to patient assessment post-treatment. Auscultating lung sounds first ensures albuterol’s effect is evaluated, as clinical response guides care before recording in the record.

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Correct Answer is A

Explanation

Choice A reason: CF-related diabetes (CFRD) from pancreatic damage requires insulin, as glucose of 180-250 mg/dL indicates insulin deficiency. Teaching administration addresses this directly, aligning with standard CFRD management for glycemic control.

Choice B reason: Oral hypoglycemics aren’t effective in CFRD, which stems from insulin lack, not resistance. Glucose levels of 180-250 mg/dL need insulin, making this inappropriate for CF’s unique endocrine pathology.

Choice C reason: Diet impacts glucose, but CFRD requires insulin first, not just dietary control. Levels of 180-250 mg/dL exceed dietary management alone, so this is secondary to initiating insulin therapy in CF.

Choice D reason: Pancreatic enzymes aid digestion in CF, not glucose control directly. Evaluating use is routine, but hyperglycemia of 180-250 mg/dL points to CFRD, necessitating insulin over enzyme adjustment.

A. Community acquired pneumonia B. Cor pulmonale C. Hospital acquired pneumonia

Correct Answer is A

Explanation

Choice A reason: Community-acquired pneumonia (CAP) fits symptoms like cough or fever from pathogens outside hospitals. It’s the most likely without hospital exposure history, aligning with typical outpatient respiratory infection patterns.

Choice B reason: Cor pulmonale involves right heart failure from lung disease, not primary infection. Maria’s acute symptoms suggest pneumonia, not chronic pulmonary hypertension, making this less probable without supporting cardiac findings.

Choice C reason: Hospital-acquired pneumonia requires recent hospitalization, not indicated here. Maria’s presentation lacks nosocomial context, favoring community-acquired pneumonia as the diagnosis based on typical outpatient symptom onset.

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Sara is receiving a nebulized albuterol treatment for her asthma exacerbation. Which of the following should be the nurse’s first priority after administering the treatment?

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