The client, who has a history of asthma, is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, nasal flaring, and use of accessory muscles. Auscultation of breath sounds reveals greatly diminished breath sounds. What should the nurse do first?
Draw blood for an arterial blood gas
Initiate oxygen therapy as prescribed and reassess the client in 10 minutes
Encourage the client to relax and breathe slowly through the mouth
Administer bronchodilators as prescribed
The Correct Answer is D
A. Draw blood for an arterial blood gas — While ABG analysis is important in assessing respiratory function, it is not the priority in this emergency. The client is in severe respiratory distress and needs immediate intervention.
B. Initiate oxygen therapy as prescribed and reassess the client in 10 minutes — Although oxygen therapy is essential, waiting 10 minutes to reassess without addressing bronchoconstriction may delay critical treatment. Immediate bronchodilation is needed.
C. Encourage the client to relax and breathe slowly through the mouth — This may be helpful as a supportive measure but is not appropriate as the first intervention during acute respiratory distress.
D. Administer bronchodilators as prescribed — This is the priority action. The client is experiencing an acute asthma exacerbation, likely leading to airway constriction. Bronchodilators will help relieve bronchospasm and improve airflow, which is the most urgent need.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Fatigue is a common and expected finding in anemia due to reduced oxygen-carrying capacity of the blood, leading to decreased tissue oxygenation.
B. Bradycardia is not expected; anemia typically causes tachycardia as the heart compensates to deliver more oxygen to tissues.
C. Diarrhea is not directly associated with anemia caused by blood loss.
D. Hypertension is not expected; hypotension may occur due to decreased blood volume from excess blood loss.
Correct Answer is B
Explanation
A. The client should see improvement in condition in 2 days — Levothyroxine typically takes 1 to 3 weeks for therapeutic effects to be noticeable.
B. Take on an empty stomach — Levothyroxine should be taken on an empty stomach, ideally 30 to 60 minutes before breakfast, to enhance absorption.
C. It is ok to skip doses — Levothyroxine should be taken consistently every day to maintain stable hormone levels. Skipping doses can lead to symptom recurrence.
D. Notifying the health care provider is unnecessary if you experience a fast heartbeat — A fast heartbeat (tachycardia) may indicate overmedication and should be reported to the healthcare provider promptly.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.