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Hesi med surg (resp, git, cvs) MCHPS University
Total Questions : 60
Showing 10 questions, Sign in for moreA client reports confusion and blurred vision after receiving a dose of glipizide. Which action should the nurse implement?
A client receives a new prescription for montelukast. Which information should the nurse include in the client's teaching?
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
Patient Data
Review history.
Which 2 drugs would be the most appropriate to give the client now?
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
0900
Wheezes heard throughout lung fields.
Vital signs
- Heart rate: 100 beats/minute
- Respirations: 36 breaths/minute
- Blood pressure: 116/68 mm Hg
- Oxygen saturation: 83% on room air
0900
Give albuterol 2.5 mg via nebulizer every 3 hours PRN for wheezing.
Patient Data
Review history, nurses notes, and prescriptions.
Choose the most likely options for the information missing from the statement by selecting from the lists of options provided.
Albuterol is a
Explanation
Rationale for correct choices:
- Beta adrenergic agonist: Albuterol is a short-acting beta-2 adrenergic agonist that stimulates receptors in the bronchial smooth muscle. This action leads to muscle relaxation and airway dilation, making it highly effective in relieving acute asthma symptoms such as wheezing and shortness of breath.
- Bronchospasm: The main therapeutic effect of albuterol is decreasing bronchospasm. By relaxing airway smooth muscle and opening narrowed bronchi, it improves airflow, oxygenation, and symptom relief during an asthma attack.
Rationale for incorrect choices:
- Cholinergic antagonist: This drug class, including medications like ipratropium, blocks muscarinic receptors to reduce bronchoconstriction. While used in respiratory conditions, it is not the mechanism of albuterol, which works through beta-2 receptor stimulation.
- Beta adrenergic blocker: These medications block beta receptors and can worsen bronchospasm, particularly in asthma. Nonselective beta-blockers are contraindicated for asthmatic patients because they may trigger severe bronchoconstriction.
- Inflammation: Although inflammation is central to asthma pathology, albuterol does not reduce it. Corticosteroids are the drugs of choice for anti-inflammatory action, whereas albuterol only provides rapid bronchodilation.
- Blood pressure: Albuterol may cause mild cardiovascular side effects such as tachycardia, but it is not prescribed to lower blood pressure. Its therapeutic focus is the respiratory system, specifically bronchodilation.
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler" but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
0900
Wheezes heard throughout lung fields.
Vital signs
- Heart rate: 100 beats/minute
- Respirations: 36 breaths/minute
- Blood pressure: 116/68 mm Hg
- Oxygen saturation: 83% on room air
0930
Albuterol given as prescribed via nebulizer. Following the treatment, decreased wheezes noted. The client's hands are trembling and is reporting a headache.
0900
Give albuterol 2.5 mg via nebulizer every 3 hours PRN for wheezing.
Patient Data.
Review history, nurses' notes, and prescriptions.
Click to specify which aspects of the 0930 focused assessment indicate adverse reactions to albuterol.
0930
Albuterol given as prescribed via nebulizer. Following the treatment, decreased wheezes noted. The client's hands are trembling and is reporting a headache. Heart rate 129 beats/minute, respirations 20 breaths/minute, blood pressure 125/72 mm Hg, oxygen saturation 99% on room air.
Explanation
Rationale for correct choices:
- Tremors: Albuterol stimulates beta-2 adrenergic receptors in skeletal muscle, which can cause fine tremors. This is a well-documented adverse effect and often appears after nebulizer or inhaler treatments.
- Headache: Increased beta-adrenergic activity and vasodilation in cerebral vessels can lead to headaches. This is another recognized side effect that commonly follows albuterol administration.
- Tachycardia (heart rate 129): Stimulation of beta-2 receptors can inadvertently activate beta-1 receptors in the heart, leading to an increased heart rate. This cardiovascular effect is considered an adverse reaction that requires monitoring.
Rationale for incorrect choices:
- Decreased wheezes: This is a desired therapeutic effect showing that the drug effectively relieved bronchospasm and improved airway airflow. It does not indicate an adverse reaction.
- Respiratory rate 20: A decreased respiratory rate from 36 to 20 indicates improved breathing efficiency. This is a positive response to albuterol, not an adverse effect.
- Blood pressure 125/72: The blood pressure remains within normal limits and does not reflect hypertension or hypotension. Albuterol can sometimes cause minor changes, but this value is stable and not adverse.
- Oxygen saturation 99%: The improved oxygenation reflects effective bronchodilation and enhanced gas exchange. This is the intended therapeutic outcome, not a negative effect.
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
9000
Wheezes heard throughout lung fields.
Vital signs
- Heart rate: 100 beats/minute
- Respirations: 36 breaths/minute
- Blood pressure: 116/68 mm Hg
- Oxygen saturation: 83% on room air
0930
Albuterol given as prescribed via nebulizer. Following the treatment, decreased wheezes noted. The client's hands are trembling and is reporting a headache.
Orders
0900
Give albuterol 2.5 mg via nebulizer every 3 hours PRN for wheezing
Patient Data.
Review history, nurses' notes, and prescriptions.
Which other medications might be helpful for this client in his management of asthma? Select all that apply.
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
0900
Wheezes heard throughout lung fields.
Vital signs
- Heart rate: 100 beats/minute
- Respirations: 36 breaths/minute
- Blood pressure: 116/68 mm Hg
- Oxygen saturation: 83% on room air
0930
Albuterol given as prescribed via nebulizer. Following the treatment, decreased wheezes noted. The client's hands are trembling and is reporting a headache.
0900
Give albuterol 2.5 mg via nebulizer every 3 hours PRN for wheezing
1100
Discharge client.
Fluticasone 50 mcg metered dose inhaler one puff in the mornings.
Patient Data.
The nurse prepares the client for discharge and educates him on his new prescription.
Which possible side effect(s) of fluticasone should the nurse advise the client about? Select all that apply.
The client is a 34-year-old male with a history of seasonal allergies and asthma. He was jogging this morning and became short of breath. He took one puff of an "emergency inhaler but is unsure of the name of the medication. Upon exam, the client is anxious, tachypneic, tachycardic, and wheezing.
0900
Wheezes heard throughout lung fields.
Vital signs
- Heart rate: 100 beats/minute
- Respirations: 36 breaths/minute
- Blood pressure: 116/68 mm Hg
- Oxygen saturation: 83% on room air
0930
Albuterol given as prescribed via nebulizer. Following the treatment, decreased wheezes noted. The client's hands are trembling and is reporting a headache.
0900
Give albuterol 2.5 mg via nebulizer every 3 hours PRN for wheezing.
1100
Discharge client.
Fluticasone 50 mcg metered dose inhaler one puff in the mornings.
Patient Data.
Click to specify whether the client statements following asthma management education indicate understanding or no understanding. Each row must have one option selected.
Explanation
Rationale:
- Fluticasone has the same risk as oral steroids: Inhaled corticosteroids primarily target local airway inflammation with minimal systemic absorption. Oral corticosteroids, in contrast, carry higher risks such as adrenal suppression, osteoporosis, and glucose intolerance.
- Reduce allergen exposure: Environmental allergens such as dust, pollen, and mold are major asthma triggers that promote airway inflammation. Reducing exposure minimizes bronchospasm risk and helps prevent acute exacerbations, aligning with standard asthma self-management guidelines.
- Maintain normal activity levels: Well-controlled asthma should not limit a patient’s ability to exercise or engage in daily activities. The goal of therapy is to reduce symptoms, improve lung function, and maintain quality of life rather than impose long-term physical restrictions.
- Other drug options available: Asthma management follows a stepwise approach. If inhaled corticosteroids like fluticasone are insufficient, the provider may add long-acting beta-agonists, leukotriene modifiers, or biologics.
- Peak expiratory flow monitoring: Daily monitoring allows early detection of airflow limitation before symptoms appear. Declining values may indicate worsening control or an impending exacerbation, prompting early intervention to avoid hospitalization.
- Discontinue albuterol once fluticasone is prescribed: Fluticasone is a maintenance controller medication that reduces airway inflammation over time, but it does not provide immediate bronchodilation. Albuterol remains necessary as a rescue inhaler for acute symptoms and should never be discontinued unless otherwise directed.
The spouse of a client diagnosed with Parkinson's disease calls the clinic and tells the nurse the client is having involuntary jerky movements of the legs and arms and is confused. Which action should the clinic nurse implement first?
The nurse is preparing to administer the client's morning dose of digoxin. Which action should the nurse take prior to administering the digoxin?
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