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A 59-year-old client is brought into the emergency room with complaints of chest pain. The client states that the pain is a crushing, constrictive pressure that is not relieved with position change. He states that the pain started 3 hours ago in the middle of his chest and radiates down his left arm. The client has a history of diabetes, asthma, and hypertension.

T: 99

BP: 138/72

HR: 106

RR: 19

ECG-ST segment depression

Troponin - Negative

The client is given medication for his unstable angina. Soon after, the client states that he is having difficulty breathing with audible wheezing heard on auscultation. Which of the following is most likely responsible for the symptoms experienced by this client?

Heparin

Morphine

Propranolol

Nitroglycerin

Answer: C

Answer and Explanation

The Correct Answer is C

A. Heparin is an anticoagulant and does not typically cause bronchospasm or wheezing.

B. Morphine can cause respiratory depression but not bronchospasm.

C. Propranolol, a non-selective beta-blocker, can cause bronchospasm, particularly in clients with asthma.

D. Nitroglycerin primarily causes vasodilation and does not typically lead to bronchospasm or wheezing.

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Correct Answer is D

Explanation

A. Administering multiple vitamins and minerals via IV alone would not be sufficient for adequate nutrition in this patient, especially given the large burn surface area.

B. Total parenteral nutrition (TPN) may be used if enteral feeding is not possible, but enteral feeding is usually preferred when feasible.

C. Encouraging oral intake is not appropriate for a client with a 60% TBSA burn, as they would likely require more significant nutritional support than oral intake can provide.

D. Enteral feeding is the preferred method for nutrition in burn patients as it maintains gut integrity and prevents the complications associated with parenteral nutrition. Although the client has absent bowel sounds and a distended abdomen, this can be common early in burn care, and enteral feedings should be started as soon as feasible to prevent malnutrition and promote recovery.

A. Encourage the client to sit up at the bedside in a chair and lean forward. B. Have the client rest in bed with the head elevated 15 to 20 degrees. C. Place the client in the Trendelenburg position with pillows behind the head. D. Ask the client to rest in bed in a high- Fowlers position with the knees flexed.

Correct Answer is A

Explanation

A. Sitting up and leaning forward helps improve lung expansion and ventilation, which is beneficial for clients with COPD.

B. Elevating the head is helpful but not as effective as sitting upright for COPD clients who need to improve their ventilation.

C. The Trendelenburg position is not appropriate for improving ventilation in COPD patients.

D. While high-Fowler's may help in some situations, having the knees flexed can restrict the diaphragm and limit breathing capacity.

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Test Name	Results	Reference Range
WBC	12, 000	4, 000- 11, 000
Na+	149 mEq/L	135-145 mEq/L
K+	5.0 mEq/L	3.5- 5.0 mEq/L
Cl-	110 mEq/L	96-106 mEq/L
pH	7.34	7.35-7.45
PaCO2	34 mmHg	35- 45 mmHg
PaO2	78 mm Hg	80-100 mmHg
HCO3	21 mEq/L	22- 26 mEq/L

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Naxlex Comprehensive Predictor Exams

A client has just been admitted with a 60% total body surface area (TBSA) burn injury. The nurse notes a distended abdomen with absent bowel sounds in all quadrants. To maintain adequate nutrition, the nurse should plan to take which action?

Correct Answer is D

Explanation

A client with chronic obstructive pulmonary disease (COPD) has poor gas exchange. Which action by the nurse would support the client's ventilation?

Correct Answer is A

Explanation

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