Exhibits

Which other treatment(s) might be helpful for this client? Select all that apply.

Phototherapy

Administration of lithium

Consciousness raising

Cognitive behavioral therapy

Electroconvulsive therapy

Animal therapy

Answer and Explanation

Correct Answer : A,C,D,F

A.   Phototherapy involves exposure to specific wavelengths of light to help regulate mood and alleviate symptoms of depression, anxiety, or sleep disorders. It can be particularly beneficial in a hospital setting where natural light exposure may be limited, potentially aiding in mood stabilization and improving sleep patterns.
B.   Lithium is a mood stabilizer commonly used to treat bipolar disorder. While the client's symptoms and presentation do not immediately suggest bipolar disorder, lithium could be considered if there are indications of mood instability or severe emotional dysregulation that are not adequately controlled by other medications.
C.   Consciousness raising refers to increasing awareness and understanding of one's thoughts, emotions, and behaviors. In the context of therapy, it can help the client process traumatic experiences, gain insight into their reactions, and develop coping strategies. This approach can be integrated into various forms of psychotherapy.
D.   CBT is a structured form of psychotherapy that focuses on identifying and modifying dysfunctional thought patterns and behaviors. It has been shown to be effective in treating anxiety, depression, PTSD, and other trauma-related disorders by helping individuals challenge negative thoughts and develop healthier coping mechanisms.
E.   ECT involves passing electrical currents through the brain to intentionally trigger a brief seizure. It is primarily used for severe depression or other mental illnesses that have not responded to other treatments. Given the client's presentation and the availability of less invasive treatments, ECT would generally not be considered unless her condition worsens significantly and other therapies are ineffective or contraindicated.
F.   Animal therapy involves interacting with animals, such as therapy dogs or horses, to improve mood, reduce stress, and provide emotional support. This type of therapy can be beneficial for individuals experiencing trauma or emotional distress, offering comfort and companionship.

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Correct Answer is ["A","B","D","G","H"]

Explanation

A. Assessing temperature is important to monitor for any signs of infection or inflammation, which could exacerbate the asthma condition or indicate a concurrent illness.
B. Evaluating breath sounds helps determine the effectiveness of the albuterol treatment in relieving bronchospasm. Clearer breath sounds suggest improved air entry and reduced wheezing.
C. While CBC can provide valuable information, it is not typically immediately necessary after an albuterol treatment unless there are specific concerns about infection or other systemic issues.
D. Monitoring the heart rate is crucial as albuterol can cause tachycardia (elevated heart rate) as a side effect. It's important to ensure that the heart rate does not become excessively elevated, which may indicate a need to adjust treatment or monitor more closely.
E. Peak inspiratory flow is less commonly used in asthma management compared to peak expiratory flow. It's the maximum flow rate during inhalation and is not typically assessed routinely in the immediate post-treatment period.
F. Assessing serum sodium is not directly related to monitoring asthma exacerbation or response to bronchodilator therapy.
G. PEF measures the maximum speed at which a person can exhale air after a deep breath. It is a direct indicator of lung function and the severity of airway obstruction in asthma. Assessing PEF post-albuterol treatment helps gauge how well the airways have responded to the bronchodilator therapy.
H. Checking oxygen saturation ensures that the patient's oxygen levels have improved following the administration of albuterol. The goal is to maintain oxygen saturation above 94%, as per the treatment plan.

A. Perform pulmonary function test B. Measure vital signs C. Provide a regular diet tray D. Give albuterol as ordered E. Apply oxygen 1 L/minute

Correct Answer is ["D","E"]

Explanation

A. Perform pulmonary function test
This is important for assessing lung function, but it is not an immediate priority during an acute exacerbation when the patient's oxygen saturation is low and they are experiencing respiratory distress.
Pulmonary function testing can be done once the patient's acute symptoms are stabilized.
B. Measure vital signs
While vital signs are important for ongoing assessment, the patient's vital signs were already assessed at admission and are being monitored every 4 hours as per orders.
Administering oxygen and albuterol to stabilize the patient's condition takes precedence over routine vital sign checks immediately after the initial assessment.
C. Provide a regular diet tray
This is a routine aspect of care and does not address the acute respiratory distress or hypoxemia that require immediate attention.
It can be done once the patient's respiratory status has stabilized.
D. Give albuterol as ordered
The patient is experiencing an asthma exacerbation with wheezing and subcostal retractions. Albuterol is a bronchodilator that helps relieve bronchospasm and improve airflow.
It was ordered for nebulization now and every 4 hours PRN (as needed) for wheezing.
Administering albuterol promptly is crucial to help alleviate respiratory distress and improve lung function.
E. Apply oxygen 1 L/minute
The patient's oxygen saturation is 91% on room air, which is below the target of greater than 94%. Oxygen therapy is indicated to correct hypoxemia and improve oxygen saturation.
The order specifies to titrate oxygen to keep saturation greater than 94%, starting at 1 L/minute via nasal cannula.

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Exhibits Which other treatment(s) might be helpful for this client? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits The nurse starts the albuterol nebulizer as prescribed. Which should the nurse assess after the albuterol nebulizer treatment is complete? Select all that apply.

Correct Answer is ["A","B","D","G","H"]

Explanation

Exhibits After the nurse assesses the client, the healthcare provider writes prescriptions. The nurse reviews the prescriptions. Which 2 prescriptions should the nurse complete first?

Correct Answer is ["D","E"]

Explanation

A client with septic shock develops disseminated intravascular coagulation (DIC). Which pathophysiologic process should the nurse recognize as the cause of the coagulation problem?

A client with metastatic cancer who was taking hydromorphone PO at home is now receiving the medication IV while in the hospital. To evaluate if the client is receiving an equianalgesic dose of the hydromorphone, which assessment should the nurse complete?

The nurse assesses the client after the dose of albuterol and documents the findings in the chart. Exhibits Which action(s) should the nurse plan for the rest of the shift? Select all that apply.

After a scheduled downtime, the computer documentation system fails to restart. Which action should the nurse take first?

A young adult is brought to the emergency department after taking a handful of drugs. The client is unresponsive, so an endotracheal tube (ETT) is inserted. How should the nurse determine if the ETT is correctly placed? Select all that apply.

Exhibits

Which other treatment(s) might be helpful for this client? Select all that apply.