A nurse is caring for a client who has acute respiratory distress syndrome (ARDS) and requires mechanical ventilation. The client receives a prescription for pancuronium. The nurse recognizes that this medication is for which of the following purposes?

Choice A reason: History of hypertension is not a nonmodifiable risk factor for developing a stroke, but a modifiable risk factor. Hypertension is a high blood pressure, defined as 140/90 mm Hg or higher. Hypertension can damage the blood vessels and increase the risk of stroke by causing atherosclerosis, aneurysm, or hemorrhage. The nurse should teach the clients to monitor their blood pressure and take medications as prescribed to lower their blood pressure and reduce their stroke risk.

Choice B reason: Genetics is a nonmodifiable risk factor for developing a stroke. Genetics refers to the inherited traits that are passed down from parents to children. Genetics can influence the risk of stroke by affecting the susceptibility to certain conditions, such as sickle cell disease, clotting disorders, or familial hypercholesterolemia, that can increase the risk of stroke. The nurse should teach the clients to know their family history and discuss their genetic risk factors with their provider.

Choice C reason: Obesity is not a nonmodifiable risk factor for developing a stroke, but a modifiable risk factor. Obesity is a condition of having excess body fat, defined as a body mass index (BMI) of 30 or higher. Obesity can increase the risk of stroke by contributing to other risk factors, such as hypertension, diabetes, or high cholesterol. The nurse should teach the clients to maintain a healthy weight and follow a balanced diet and exercise regimen to lower their stroke risk.

Choice D reason: History of smoking is not a nonmodifiable risk factor for developing a stroke, but a modifiable risk factor. Smoking is the inhalation of tobacco or other substances that contain nicotine or other harmful chemicals. Smoking can increase the risk of stroke by damaging the blood vessels, increasing the blood pressure, reducing the oxygen in the blood, and promoting blood clotting. The nurse should teach the clients to quit smoking and avoid exposure to secondhand smoke to lower their stroke risk.

Choice A reason: This is incorrect. Taking the albuterol before taking the cromolyn is not necessary. Albuterol and cromolyn are both used to treat asthma, but they have different mechanisms of action. Albuterol is a bronchodilator that relaxes the muscles around the airways and opens them up, making it easier to breathe. Cromolyn is a mast cell stabilizer that prevents the release of substances that cause inflammation and allergy symptoms in the airways. Albuterol is used to relieve acute asthma attacks, while cromolyn is used to prevent chronic asthma symptoms. The nurse should advise the client to use albuterol as needed for quick relief, and to use cromolyn regularly as prescribed to prevent asthma flareups.

Choice B reason: This is incorrect. Using both medications immediately after exercising is not recommended. Exercise can trigger asthma symptoms in some people, such as wheezing, coughing, or shortness of breath. This is called exercise induced bronchoconstriction (EIB) or exercise induced asthma (EIA). The nurse should advise the client to use albuterol 15 to 30 minutes before exercising to prevent EIB or EIA, and to avoid exercising in cold, dry, or polluted air. The nurse should also instruct the client to use cromolyn at least 15 minutes before exercising, as it takes time to work and does not provide immediate relief. The nurse should also tell the client to stop exercising and use albuterol if asthma symptoms occur during or after exercising.

Choice C reason: This is incorrect. Using cromolyn immediately if the breathing begins to feel tight is not effective. Cromolyn is not a rescue medication that can provide quick relief of asthma symptoms. It is a preventive medication that works by reducing the inflammation and sensitivity of the airways over time. The nurse should advise the client to use albuterol instead of cromolyn if the breathing begins to feel tight, as albuterol can rapidly open up the airways and ease the breathing. The nurse should also instruct the client to seek medical attention if the albuterol does not work or if the symptoms get worse.

Choice D reason: This is correct. Administering the medications 10 minutes apart is good practice. Cromolyn and albuterol can be used together to treat asthma, but they should not be mixed in the same nebulizer, as they may not be compatible and may lose their effectiveness. The nurse should instruct the client to use separate nebulizers for each medication, and to wait at least 10 minutes between each nebulization to allow the medication to reach the lungs and avoid irritation of the airways. The nurse should also teach the client how to use the nebulizer properly, and how to clean and store it after each use.