Your patient is scheduled to undergo a bronchoscopy at the bedside.
Which of the following should the Registered Nurse anticipate?
Getting client signature on the consent.
Having Flumazenil available.
Ensuring client is NPO for 6 hours prior.
Placing the client on the bedside heart monitor and pulse oximeter.
Having Midazolam available.
Correct Answer : A,C,D,E
Choice A rationale
Obtaining informed consent is a fundamental ethical and legal requirement before any invasive medical procedure, including a bronchoscopy. This ensures patient autonomy, allowing them to make an educated decision based on understanding the procedure's risks, benefits, and alternatives. The patient's signature indicates their voluntary agreement after a thorough discussion with the healthcare provider, demonstrating adherence to patient rights.
Choice B rationale
Flumazenil is a benzodiazepine receptor antagonist used to reverse the sedative effects of benzodiazepines. While benzodiazepines like midazolam are commonly used for conscious sedation during bronchoscopy, flumazenil is generally not kept readily available for routine use. It is an emergency reversal agent reserved for severe respiratory depression or over-sedation.
Choice C rationale
Ensuring the client is NPO (nil per os) for at least 6 hours prior to a bronchoscopy is crucial to prevent aspiration. The procedure involves manipulating the airway, which can stimulate the gag reflex and potentially lead to regurgitation of gastric contents into the lungs, causing aspiration pneumonia or acute respiratory distress. Fasting significantly reduces this risk.
Choice D rationale
Continuous monitoring of heart rate and oxygen saturation via a bedside heart monitor and pulse oximeter is essential during and after a bronchoscopy. This allows for immediate detection of adverse events such as hypoxemia, arrhythmias, or respiratory depression, enabling prompt intervention. Constant vigilance ensures patient safety throughout the procedure.
Choice E rationale
Midazolam, a short-acting benzodiazepine, is commonly used for conscious sedation during bronchoscopy. Its anxiolytic, sedative, and amnestic properties help to reduce patient anxiety, promote comfort, and minimize recall of the procedure. Its rapid onset and short duration of action make it suitable for outpatient procedures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Given the patient's tachypnea (breathing rate 24), toxic appearance, and SpO2 of 90%, a Stat Arterial Blood Gas (ABG) is the most appropriate anticipated order. These findings suggest potential respiratory compromise and metabolic derangements. An ABG provides crucial information about the patient's oxygenation, ventilation (CO2 levels), and acid-base status, guiding immediate medical interventions to correct imbalances. Normal breathing rate is 12-20 breaths per minute.
Choice B rationale
Benzodiazepine administration would be indicated for anxiety or seizure activity, but the primary concern here is the physiological signs of respiratory distress and potential hypoxia. While anxiety can exacerbate dyspnea, the immediate diagnostic priority is to assess the severity of respiratory compromise before administering sedatives, which could further depress respiratory drive if not carefully titrated.
Choice C rationale
A KUB (Kidneys, Ureters, Bladder) X-ray is an imaging study of the abdomen, primarily used to evaluate the urinary tract or identify abdominal pathology. It would not provide any relevant information regarding the patient's respiratory status, SpO2, or "toxic appearance.”. Therefore, it is not an anticipated order in this clinical scenario focused on respiratory compromise.
Choice D rationale
Opioid administration is primarily for pain management. While pain can contribute to tachypnea, the combination of a toxic appearance and hypoxemia points more towards a respiratory or systemic illness rather than isolated pain. Administering opioids could potentially depress respiratory drive, which would be detrimental to a patient already experiencing respiratory distress.
Correct Answer is B
Explanation
Choice B rationale
Placing the patient in Trendelenburg position on their left side is the priority intervention for a suspected air embolism. This position traps the air in the apex of the right ventricle, preventing it from entering the pulmonary circulation and causing a pulmonary embolism, which can be fatal. The left lateral position further aids in keeping the air bubble within the right ventricle.
Choice A rationale
Ambulation would be contraindicated as it could facilitate the movement of the air embolism through the circulatory system, potentially leading to a more severe and widespread impact, including cerebral or pulmonary embolism. The goal is to isolate and prevent the air from progressing, not to mobilize it.
Choice C rationale
Reverse Trendelenburg position elevates the head of the bed, which would cause the air embolism to travel towards the brain, increasing the risk of a cerebral air embolism, a life-threatening complication. This position is actively harmful in the context of an air embolism.
Choice D rationale
McRoberts maneuver is used in obstetrics to aid in shoulder dystocia during childbirth by hyperflexing the mother's thighs toward her abdomen. This maneuver has no physiological relevance or benefit in the management of an air embolism and would not prevent or mitigate its effects.
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