A nurse in a pulmonology clinic is preparing a client for spirometry testing. Which question should the nurse ask the client during the preparation for this test?
"Are you allergic to shellfish?"
"Do you have any metal implants in your body?"
"Have you taken any bronchodilators today?"
"Are you claustrophobic?"
The Correct Answer is C
. Shellfish allergies are related to potential reactions to iodinated contrast media used in imaging studies, such as CT scans, rather than to spirometry. Spirometry does not involve contrast media or shellfish, so this question is not pertinent for this test.
B.A Metal implants are typically a concern for imaging tests like MRI, which involve strong magnetic fields. Spirometry, however, does not involve any imaging or use of magnetic fields, so metal implants do not affect spirometry results. Thus, this question is not relevant for spirometry preparation.
C. This is a relevant question for spirometry testing. Bronchodilators are medications used to open the airways and improve breathing. They can affect spirometry results if taken shortly before the test. For accurate assessment, the nurse needs to know if the client has used any bronchodilators, as they might need to adjust the testing protocol or account for the medication's effects on lung function.
D. Spirometry does not typically involve enclosed spaces that would trigger claustrophobia, as it is a breathing test usually performed with the client sitting comfortably in an open space. Claustrophobia is more relevant to imaging studies like MRIs or CT scans, where the client might be in a confined space.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. This is useful for preventing atelectasis in patients who are unable to take deep breaths, but it is not the most critical piece of equipment for this client at this time.
B. While a Hoyer lift may be needed for mobility assistance in the future, it is not the most immediate priority.
C. Guillain-Barre syndrome can rapidly progress, leading to respiratory muscle weakness and the need for mechanical ventilation. Having an intubation tray readily available is crucial to ensure a prompt response if the client's respiratory status deteriorates.
D. A nebulizer is used to deliver medication to the lungs, but it is not the most critical piece of equipment for this client at this time.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"B"}}
Explanation
1. Begin Broad Spectrum IV Antibiotics Anticipated
The client's symptoms, including right upper quadrant pain, nausea, vomiting, jaundice, fever, and elevated white blood cell count, suggest a potential infection or inflammation in the abdominal area, possibly related to the biliary system (e.g., cholecystitis or cholangitis). Broad-spectrum antibiotics are commonly used to treat infections that could be causing these symptoms, especially if the exact pathogen is not yet identified. The elevated white blood cell count further supports the likelihood of an infection.
2. Transfuse 1 Unit of Packed Red Blood Cells Contraindicated
There is no indication from the provided information that the client has anemia or a significant drop in hemoglobin that would necessitate a blood transfusion. The hemoglobin level is 15.1 g/dL, which is within normal limits. Blood transfusion would typically be considered if there was evidence of significant blood loss or anemia, neither of which is indicated by the client’s current lab results.
3. Prepare Client for Endoscopic Retrograde Cholangiopancreatography (ERCP) Anticipated
The symptoms described, including right upper quadrant pain radiating to the right shoulder, jaundice, and the dark amber urine, are suggestive of biliary tract involvement, such as gallstones causing obstruction or infection. ERCP is a diagnostic and therapeutic procedure used to visualize and treat conditions of the bile ducts and pancreatic ducts. Given the symptoms and clinical presentation, preparing the client for an ERCP to assess and potentially address issues in the biliary system is appropriate.
4. Administer Morphine Sulfate IV Push for Pain Contraindicated
The client has a documented allergy to morphine. Administering morphine could lead to an allergic reaction and is therefore contraindicated. Alternative pain management options should be considered, such as non-opioid analgesics or other opioid medications that the client is not allergic to.
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