A nurse is caring for a child who is to receive percussion, vibration, and postural drainage. Which of the following actions should the nurse take first?

Instruct the client to cough

Perform vibration while the client exhales slowly through the nose.

Percuss the upper posterior chest.

Administer albuterol by nebulizer.

Answer and Explanation

The Correct Answer is D

A. Instruct the client to cough. Coughing is generally encouraged after chest physiotherapy to help expel loosened secretions, but it is not the first action. The bronchodilator should be administered first to maximize the effectiveness of the chest physiotherapy.

B. Perform vibration while the client exhales slowly through the nose. Vibration is a component of chest physiotherapy used to help loosen secretions during exhalation, but it is performed after the bronchodilator is administered and once the client is positioned properly.

C. Percuss the upper posterior chest. Percussion helps to mobilize secretions but is typically done after the bronchodilator has been administered to allow for more effective airway clearance.

D. Administer albuterol by nebulizer. Administering albuterol first dilates the airways, making it easier to mobilize and clear secretions during percussion, vibration, and postural drainage.

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Correct Answer is B

Explanation

A. Methylprednisolone: Methylprednisolone is a corticosteroid used for long-term management and prevention of asthma exacerbations. It has anti-inflammatory effects and is not typically used for immediate relief during an acute asthma attack.

B. Albuterol: Albuterol is a short-acting beta-agonist bronchodilator, which is the first-line medication for relieving acute bronchoconstriction during an asthma attack. It works quickly to open the airways and improve breathing.

C. Fluticasone: Fluticasone is an inhaled corticosteroid used for long-term asthma control and prevention of symptoms. It has anti-inflammatory effects but is not used for immediate relief during an acute asthma attack.

D. Beclomethasone: Beclomethasone is also an inhaled corticosteroid used for long-term asthma control and prevention of symptoms. Like fluticasone, it is not used for immediate relief during an acute asthma attack.

A. “I will elevate the affected area if possible." B. “I will apply warm compresses over the site." C. “I will have my child rest.” D. “I will promptly immobilize the involved area to relieve pain & decrease bleeding."

Correct Answer is B

Explanation

A. "I will elevate the affected area if possible."

This statement is correct. Elevating the affected area can help reduce swelling and minimize bleeding by promoting venous return. Elevating the limb above the level of the heart can aid in controlling bleeding and is a recommended intervention.

B. "I will apply warm compresses over the site."

This statement is incorrect. Applying warm compresses is generally not recommended for controlling bleeding in hemophilia. Heat can increase blood flow to the area, potentially exacerbating bleeding. Cold compresses or ice packs are typically recommended to help constrict blood vessels and reduce bleeding.

C. "I will have my child rest."

This statement is correct. Resting is an essential component of managing bleeding episodes in children with hemophilia. Physical activity and exertion can increase the risk of injury and bleeding, so it's important for children with hemophilia to avoid strenuous activities during bleeding episodes.

D. "I will promptly mobilize the involved area to relieve pain & decrease bleeding."

Immobilizing the affected area can help control bleeding and reduce pain by minimizing movement. This is also an appropriate response.

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A nurse is caring for a child who is to receive percussion, vibration, and postural drainage. Which of the following actions should the nurse take first?

Nursing Test Bank

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