A nurse is caring for a client who just had a flexible bronchoscopy. Which of the following nursing actions is appropriate?
Have the client refrain from talking for 24 hr.
Withhold food and liquids until the client's gag reflex returns.
Irrigate the client's throat every 4 hr.
Suction the client's oropharynx frequently.
The Correct Answer is B
A. Have the client refrain from talking for 24 hr.: This is unnecessary; the client may talk once the effects of the local anesthetic wear off, typically within an hour or two after the procedure.
B. Withhold food and liquids until the client's gag reflex returns: This is the most important action to prevent aspiration. After a bronchoscopy, the throat is anesthetized, and eating or drinking before the gag reflex returns increases the risk of aspiration.
C. Irrigate the client's throat every 4 hr.: This is not a routine post-procedure intervention and could be uncomfortable for the client.
D. Suction the client's oropharynx frequently: Suctioning should only be performed if the client has difficulty clearing secretions. There is no routine need for frequent suctioning after a bronchoscopy unless clinically indicated.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Formoterol is a long-acting beta agonist (LABA) used for maintenance therapy, not for aborting acute asthma attacks. LABAs help prevent asthma symptoms but are not effective for immediate relief during an acute attack.
B. Albuterol is a short-acting beta agonist (SABA), which is the medication of choice for relieving acute asthma symptoms. It acts quickly to relax the muscles of the airways and relieve bronchospasm.
C. Beclomethasone is an inhaled corticosteroid used for long-term asthma control, reducing inflammation, but it is not used to treat acute attacks.
D. Salmeterol is another LABA, similar to formoterol, and is not used for aborting acute asthma attacks but rather for long-term control.
Correct Answer is B
Explanation
A. HCO3 (bicarbonate) levels above 26 mEq/L indicate alkalosis, not acidosis. In metabolic acidosis, the HCO3 levels would be low as the body attempts to neutralize excess acid.
B. In metabolic acidosis, the pH is expected to be below 7.35 because metabolic acidosis indicates an accumulation of acid or loss of bicarbonate, which lowers the blood pH.
C. PaO2 (partial pressure of oxygen) below 70 mm Hg typically indicates hypoxemia, not necessarily metabolic acidosis. The primary concern with metabolic acidosis is the balance of acid-base status, not oxygenation.
D. PaCO2 above 45 mm Hg would suggest respiratory acidosis rather than metabolic acidosis. In metabolic acidosis, the body compensates by hyperventilating to blow off CO2 and raise the pH, resulting in a normal or low PaCO2.
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