A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. Which of the following actions is the nurse's highest priority?
Administering a nebulized beta-adrenergic
Providing immediate rest for the client
Positioning the client in high-Fowler's
Initiating oxygen therapy
The Correct Answer is A
Answer: A
Rationale:
A) Administering a nebulized beta-adrenergic:
In the case of an acute asthma exacerbation, administering a nebulized beta-adrenergic agonist (such as albuterol) is the highest priority. These medications act quickly to relax bronchial smooth muscle, dilate airways, and improve airflow. This intervention directly addresses the underlying bronchospasm and helps to alleviate the acute symptoms of asthma.
B) Providing immediate rest for the client:
While rest is important in managing an acute asthma exacerbation, it is not the immediate priority. Addressing the airway obstruction with appropriate medications is crucial for stabilizing the client's condition before focusing on comfort measures such as rest.
C) Positioning the client in high-Fowler's:
Positioning the client in a high-Fowler's position can help improve lung expansion and facilitate breathing. However, this action is secondary to administering medication that can relieve the acute symptoms of bronchoconstriction. The medication should be administered first to rapidly address the exacerbation.
D) Initiating oxygen therapy:
Oxygen therapy might be necessary if the client shows signs of hypoxemia or severe respiratory distress. However, the immediate priority is to address the bronchospasm with a nebulized beta-adrenergic agonist to improve airflow. Once the acute bronchospasm is managed, oxygen therapy can be implemented if needed to support oxygen saturation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Hyperextended position, or backward bending of the neck, is the correct position for the client's neck during a bronchoscopy procedure with a rigid scope and general anesthesia. This position allows the provider to insert the scope through the mouth and into the trachea and bronchi, while avoiding injury to the teeth, tongue, or larynx. It also facilitates visualization of the airways and removal of foreign bodies or secretions.
b) Neutral position, or alignment of the head and neck with the spine, is not the correct position for the client's neck during a bronchoscopy procedure with a rigid scope and general anesthesia. This position may interfere with the insertion of the scope and cause damage to the oral structures or airways.
c) Extended position, or forward bending of the neck, is not the correct position for the client's neck during a bronchoscopy procedure with a rigid scope and general anesthesia. This position may obstruct the airway and make it difficult for the provider to insert the scope and access the bronchi.
d) Flexed position, or downward bending of the neck, is not the correct position for the client's neck during a bronchoscopy procedure with a rigid scope and general anesthesia. This position may compress the airway and prevent adequate ventilation and oxygenation of the client.
Correct Answer is B
Explanation
Answer: B
Rationale:
A) "Expect your sputum cultures to be negative after 6 months of therapy":
While sputum cultures may become negative after a period of effective therapy, it is not always guaranteed to happen within exactly 6 months. Tuberculosis (TB) treatment usually involves several months of medication, and sputum cultures are monitored periodically to assess treatment efficacy, not solely at the 6-month mark.
B) "Drink at least 8 ounces of water when you take the pyrazinamide tablet":
Drinking plenty of water with pyrazinamide is important to prevent dehydration and to help minimize potential side effects, such as hyperuricemia or gout. Adequate hydration can also aid in the effective elimination of the medication from the body, thus reducing the risk of adverse effects.
C) "Provide a sputum specimen every 2 weeks to the clinic for testing":
Sputum specimens are typically provided less frequently than every 2 weeks, usually monthly, to monitor the progress of TB treatment. Testing frequency may vary depending on the client's condition and the healthcare provider's recommendations.
D) "Take isoniazid with an antacid":
Isoniazid should not be taken with antacids, as antacids can interfere with the absorption of isoniazid. It is usually advised to take isoniazid on an empty stomach, and clients should be instructed to wait at least 1 hour after taking isoniazid before consuming antacids.
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