A client is admitted to the emergency room with an asthma attack. To decrease the client's dyspnea and anxiety, which of the following interventions will the nurse perform?
Let the client rest alone in a quiet, calm environment.
Reassure the client that the doctor will arrive soon.
Place the client on a cardiac monitor and observe from the nurse's station.
Stay with the client and encourage pursed-lip breathing.
The Correct Answer is D
A. Letting the client rest alone is not an appropriate intervention for an asthma attack. The client needs reassurance and support during an asthma exacerbation, and isolation can increase anxiety and worsen symptoms.
B. Reassuring the client that the doctor will arrive soon may provide some comfort, but it does not directly address the acute symptoms of dyspnea and anxiety. Immediate interventions to manage the asthma attack should be prioritized.
C. Placing the client on a cardiac monitor and observing from the nurse's station may be appropriate for monitoring heart rate and rhythm, but it does not address the primary concern of managing the asthma attack or anxiety. The nurse should be present to provide direct support and interventions.
D. Staying with the client and encouraging pursed-lip breathing is an effective intervention for managing anxiety and dyspnea during an asthma attack. Pursed-lip breathing helps the client slow their breathing, improve ventilation, and reduce anxiety, which can alleviate dyspnea.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. A musty odor is not normal and may indicate the presence of infection or moisture inside the cast. The client should report any unusual odors to the healthcare provider.
B. Applying ice to the foot after walking is not typically recommended for a Plaster of Paris cast. The client should focus on elevating the leg to reduce swelling and avoid getting the cast wet.
C. The cast must be kept dry to maintain its integrity. The client should cover the cast with a waterproof covering when showering to prevent damage or weakening of the plaster.
D. Numbness or pain in the toes may indicate impaired circulation or nerve compression, which are serious complications that require immediate medical attention. The client should be instructed to report these symptoms promptly.
Correct Answer is B
Explanation
A. Checking the client’s PTT level is unnecessary in this situation because low molecular weight heparin (e.g., enoxaparin) does not typically require PTT monitoring. This test is more relevant for clients receiving unfractionated heparin.
B. Small purple hemorrhagic areas (ecchymosis) at the injection sites are a common and expected side effect of low molecular weight heparin. The nurse should explain to the client that this is a normal reaction to the medication and does not indicate a serious issue.
C. Notifying the healthcare provider immediately is not warranted unless the client shows signs of excessive bleeding, such as hematomas, significant bruising, or a drop in blood pressure. The described ecchymosis is a minor and expected side effect.
D. Assessing the client’s blood pressure and heart rate is a reasonable step if there are concerns about significant bleeding or hemodynamic instability. However, in this case, the described symptoms are localized and do not suggest systemic bleeding.
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