A nurse is caring for a child who is experiencing status asthmaticus.
Which of the following interventions is the priority for the nurse to take?
Obtain a peak flow reading.
Administer an inhaled glucocorticoid.
Determine the cause of the acute exacerbation.
Administer a short-acting B2-agonist (SABA).
The Correct Answer is D
Choice A rationale
Obtaining a peak flow reading provides information about the severity of asthma, but it is not the immediate priority during an acute exacerbation.
Choice B rationale
Administering an inhaled glucocorticoid can help in managing inflammation, but it takes time to work and is not the immediate priority.
Choice C rationale
Determining the cause of the acute exacerbation is important for long-term management but is not the immediate priority.
Choice D rationale
Administering a short-acting B2-agonist (SABA) is the priority because it provides rapid bronchodilation, helping to alleviate the airway obstruction quickly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Obtaining a prescription for supplemental oxygen is the first action as hypoxia must be corrected immediately to ensure adequate tissue oxygenation.
Choice B rationale
Obtaining a prescription to administer intravenous fluids is essential to address dehydration but is secondary to correcting hypoxia.
Choice C rationale
Obtaining a prescription to administer insulin is crucial to manage hyperglycemia in diabetic ketoacidosis but not the initial step in this context.
Choice D rationale
Obtaining a prescription to check the client's glucose level is necessary for monitoring but does not address the immediate need for oxygenation.
Correct Answer is A
Explanation
Choice A rationale
Withholding oral fluids and food is the priority because it reduces pancreatic stimulation and decreases the secretion of pancreatic enzymes, preventing further autodigestion and inflammation of the pancreas.
Choice B rationale
Auscultating the client's lungs is important to check for complications such as pleural effusion or atelectasis, but it is not the immediate priority after pain management.
Choice C rationale
Assisting the client to a side-lying position can help with comfort and may ease breathing, but it does not directly address the underlying issue of pancreatic inflammation.
Choice D rationale
Providing oral hygiene is essential for overall care but does not impact the acute management of pancreatitis.
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