A patient with Chronic Obstructive Pulmonary Disease (COPD), who smokes two packs of cigarettes daily and is hospitalized due to a respiratory infection, reports difficulty managing respiratory distress at home when using the rescue inhaler.
Which statement from the patient suggests to the nurse that the inhaler is not being used correctly?

“I never use the inhaler unless I am really short of breath.”.

“I have a hard time inhaling and holding my breath after I squeeze the inhaler, but I do my best.”.

“After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, but it goes away.”.

“I always shake the inhaler several times before I start.”.

Answer and Explanation

The Correct Answer is C

Choice A rationale

Using the inhaler only when the patient is really short of breath is not an incorrect use of the inhaler. However, it might indicate that the patient is not managing their COPD effectively, as rescue inhalers like albuterol are meant to be used for quick relief of acute symptoms.

Choice B rationale

Having a hard time inhaling and holding the breath after squeezing the inhaler might suggest that the patient is not using the inhaler correctly. However, the patient’s statement that they “do their best” suggests that they are aware of the correct technique and are trying to follow it.

Choice C rationale

Swallowing after squeezing the inhaler is a clear indication of incorrect use. The medication from the inhaler is meant to be inhaled into the lungs, not swallowed. Swallowing the medication would lead to less of it reaching the lungs, reducing its effectiveness. The wave of nausea the patient experiences could be a side effect of swallowing the medication.

Choice D rationale

Shaking the inhaler several times before starting is actually part of the correct technique for using many types of inhalers.

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Correct Answer is D

Explanation

Choice A rationale

Applying ice, then a warm compress to the IV site may help with pain or inflammation, but it does not address the potential problem with the IV site itself. If the client is experiencing pain and refuses a flush to assess the site, it could indicate that the IV site is compromised.

Choice B rationale

Checking the medical record for the date of IV insertion could provide useful information about how long the IV has been in place, but it does not directly address the client’s current complaint of pain at the IV site.

Choice C rationale

Redressing the IV site while checking for redness could help identify signs of infection or inflammation, but it does not address the client’s complaint of pain or their refusal to have the site flushed.

Choice D rationale

Discontinuing the current IV site and inserting a new one is the most appropriate action in this situation. If the client is experiencing pain at the IV site and refuses a flush to assess the site, it suggests that the current IV site may be compromised. Inserting a new IV ensures that the client can continue to receive their scheduled IV medication safely.

A. gravida 5 para 5 B. delivery of a 9 lb 1 oz (4.1 kg) female C. labor for 25 hours and forceps were used to assist with the delivery D. client had a 4th degree laceration E. Estimated blood loss was 600 mL after delivery F. Lochia rubra moderate with small clots G. Episiotomy edges well approximated H. A 1,000 mL bag of lactated Ringer’s solution containing 10 units of oxytocin is infusing I. The IV is patent, without redness or swelling J. given an epidural for anesthesia that was effective K. vital signs were stable

Correct Answer is ["A","B","C","D","E","F"]

Explanation

Based on the client’s history and physical, the following areas increase the risk for postpartum hemorrhage:

Gravida 5 Para 5 (G5P5): Multiparity (having given birth 5 times) can increase the risk of postpartum hemorrhage due to uterine atony (lack of muscle tone) resulting from repeated stretching of the uterus.
Delivery of a 9 lb 1 oz (4.1 kg) baby: Macrosomia (large baby) can overstretch the uterus, increasing the risk of uterine atony and postpartum hemorrhage.
Labor for 25 hours and use of forceps for delivery: Prolonged labor and instrumental delivery can lead to uterine fatigue and atony, increasing the risk of postpartum hemorrhage.
4th degree laceration: Severe lacerations can lead to significant blood loss.
Estimated blood loss was 600 mL after delivery: This is a significant amount of blood loss and could indicate a risk for further hemorrhage.
Lochia rubra moderate with small clots: This could indicate ongoing blood loss.

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Naxlex Comprehensive Predictor Exams

While preparing to administer a scheduled IV medication, a client complains of pain at the IV site and refuses a flush to assess the site.What should the nurse do next?

Correct Answer is D

Explanation

Correct Answer is ["A","B","C","D","E","F"]

Explanation

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The nurse has reviewed the patient’s chart.The nurse recognizes that this patient is hemorrhaging due to which condition?