The nurse is caring for a client diagnosed with pneumonia. Which medication will the nurse administer for treatment of client's problem of ineffective airway clearance?

dextromethorphan 10 mg PO q 4 r

cromolyn MDI 2 puffs daily

guaifenesin 200 mg PO q 4 hr

methylprednisone 30 mg IV BID

Answer and Explanation

The Correct Answer is C

A. Dextromethorphan 10 mg PO q 4 hr: Dextromethorphan is a cough suppressant, and while it may be useful for controlling a dry, non-productive cough, it is not appropriate for ineffective airway clearance in pneumonia. In fact, suppressing the cough in pneumonia could prevent the patient from clearing mucus from the airways, exacerbating the problem. It is more appropriate for a client who has a dry cough without significant mucus production.

B. Cromolyn MDI 2 puffs daily: Cromolyn is a mast cell stabilizer used for the prevention of asthma and allergy symptoms, and it is not typically used for treating pneumonia or ineffective airway clearance. It works by preventing the release of inflammatory mediators in response to allergens, but it does not address the issue of clearing mucus in the airways during a bacterial infection like pneumonia.

C. Guaifenesin 200 mg PO q 4 hr: Guaifenesin is an expectorant that helps loosen and thin mucus in the airways, making it easier for the client to cough up and clear secretions. This is the most appropriate medication for addressing ineffective airway clearance in a client with pneumonia, as the goal is to facilitate the removal of mucus and improve respiratory function. Guaifenesin does not suppress the cough reflex but instead promotes productive coughing, which is essential for clearing the airways during a respiratory infection like pneumonia.

D. Methylprednisolone 30 mg IV BID: Methylprednisolone is a corticosteroid used to reduce inflammation and control severe allergic or inflammatory conditions. While corticosteroids may be used in certain cases of pneumonia (e.g., in cases of significant inflammation or an underlying condition like COPD), they are not the first-line treatment for ineffective airway clearance. The priority in this case is to promote mucus clearance, which is better addressed by guaifenesin.

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Correct Answer is D

Explanation

A. Encourage the daily use of the incentive spirometer: While the use of an incentive spirometer is important for improving lung expansion and preventing atelectasis, it may not be effective unless the client’s pain is well-managed. If pain is not addressed first, the client may be unable or unwilling to use the incentive spirometer properly, thus delaying recovery and increasing the risk of respiratory complications.

B. Assisting the client with ambulation in the hallway: Ambulation is an important post-operative activity for improving circulation and preventing complications such as deep vein thrombosis (DVT) or pneumonia. However, the priority at this time should be addressing the client's pain and ensuring adequate breathing before attempting more strenuous activities like ambulation. If the client is in pain and not breathing effectively, ambulation could exacerbate respiratory difficulties..

C. Increasing the chest tube suction to 44 mmHg: Increasing chest tube suction is not indicated unless there is evidence of inadequate drainage or a specific complication, such as a pneumothorax or pleural effusion. In this case, the priority is to address the client’s respiratory function, which is more likely to improve with pain relief, deep breathing, and appropriate positioning. Suctioning should only be adjusted if there is a clinical reason such as signs of a pneumothorax or inadequate drainage, which is not indicated by the information provided.

D. Assessing for adequate pain relief: The most urgent intervention in this scenario is ensuring that the client has adequate pain relief. The client’s shallow respirations and guarding of the operative site suggest that pain is inhibiting effective breathing and deep inspiration, which is crucial for preventing atelectasis and improving ventilation. Pain control is essential in promoting optimal respiratory function, as uncontrolled pain can lead to shallow breathing, reduced lung expansion, and compromised gas exchange, all of which can increase the risk of acute respiratory failure. Once pain is managed, the client will be better able to engage in other respiratory interventions

A. there is continuous bubbling in the water-seal chamber. B. the water levels in the water-seal chamber and suction chambers are decreased. C. fluid in the water-seal chamber fluctuates with the client's breathing. D. there is constant bubbling in the suction-control chamber.

Correct Answer is A

Explanation

A. There is continuous bubbling in the water-seal chamber: Continuous bubbling in the water-seal chamber suggests a potential air leak in the system, which needs to be investigated. The water-seal chamber is designed to prevent backflow of air into the pleural space, and persistent bubbling typically indicates that air is escaping from the pleural cavity or there is a problem with the tubing or chest tube placement. This is the first sign that the system may not be sealed properly and should be checked for leaks.

B. The water levels in the water-seal chamber and suction chambers are decreased: Decreased water levels in both the water-seal and suction chambers may be indicative of fluid loss or evaporation, but it does not necessarily point to a leak. In the case of a chest tube, water levels may also drop due to suction pressure or gradual evaporation, which would need to be adjusted or monitored. While this should be addressed, it is not an immediate cause for suspicion of an air leak in the system.

C. Fluid in the water-seal chamber fluctuates with the client's breathing: The fluctuation (also known as "tidaling") in the water-seal chamber is a normal finding that occurs when the client breathes in and out. It reflects the pressure changes in the pleural cavity during respiration. The absence of tidaling might indicate that the lung has re-expanded or that there is a blockage in the tubing. While tidaling is a normal occurrence, the absence or abnormality of this fluctuation would require further assessment but not for an air leak.

D. There is constant bubbling in the suction-control chamber: Constant bubbling in the suction-control chamber generally indicates that suction is appropriately applied to the system. However, if there is continuous bubbling in this chamber, it is typically related to the level of suction being applied, not an air leak. This is a normal occurrence and does not require checking for leaks in the system unless suction pressure is too high or low for optimal functioning.

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The nurse is caring for a client diagnosed with pneumonia. Which medication will the nurse administer for treatment of client's problem of ineffective airway clearance?

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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