A patient who is experiencing an acute asthma attack is admitted to the emergency department.
Which action should the nurse complete first?
Administer a prescribed bronchodilator medication.
Check the patient's vital signs.
Collect a sputum sample for analysis.
Obtain a detailed health history.
The Correct Answer is A
Choice A rationale
Administering a prescribed bronchodilator medication is the priority action for a patient experiencing an acute asthma attack. This helps to open the airways and improve breathing.
Choice B rationale
While checking the patient's vital signs is important, it is not the first action in the acute management of an asthma attack. The immediate priority is to relieve bronchospasm.
Choice C rationale
Collecting a sputum sample for analysis is not the first priority in an acute asthma attack. Stabilizing the patient's breathing is more urgent.
Choice D rationale
Obtaining a detailed health history is essential for comprehensive care but is not the first action during an acute asthma attack. Rapid intervention to improve breathing is the priority.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
A terminal ileostomy involves creating an opening in the right lower quadrant of the abdomen where the ileum is brought to the surface to form a stoma for waste elimination.
Choice B rationale
The left lower quadrant is not used for a terminal ileostomy, as it is not anatomically appropriate for the ileum.
Choice C rationale
The right upper quadrant is not relevant to a terminal ileostomy because the ileum is located in the lower part of the abdomen.
Choice D rationale
The left upper quadrant is also inappropriate for a terminal ileostomy due to the anatomical position of the ileum.
Correct Answer is C
Explanation
Choice A rationale
Hypokalemia is a potential concern with diuretic therapy, but not with hypertonic saline solution (3% NaCl) administration for hyponatremia.
Choice B rationale
Hypovolemia is less likely to occur with hypertonic saline infusion. The main concern is overcorrection leading to fluid overload.
Choice C rationale
Fluid overload is a significant risk when administering hypertonic saline (3% NaCl). Nurses should closely monitor for signs of fluid overload, such as edema, crackles in the lungs, and increased blood pressure.
Choice D rationale
Hypernatremia is a possible complication of hypertonic saline administration, but it is not as immediate a concern as fluid overload. Monitoring for fluid overload should take precedence.
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