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An elderly client is admitted with an acute exacerbation of chronic obstructive pulmonary disease. Pulse oximetry is 84% on room air. The client is restless, has expiratory wheezing and a productive cough, and is using the accessory muscles to breathe. Which prescription should the nurse question?
- A. Albuterol 2.5 mg by nebulizer
- B. IV methylprednisolone 125 mg now and every 6 hours
- C. IV morphine 2 mg now, may repeat every 2 hours
- D. Oxygen at 2 L/min by nasal cannula
Correct Answer: C
Rationale: Morphine (C) can depress respiration in COPD, worsening hypoxia, and should be questioned. Albuterol (A) relieves bronchospasm, methylprednisolone (B) reduces inflammation, and oxygen (D) addresses hypoxia, all appropriate for COPD exacerbation.
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The nurse has performed the initial assessments of 4 clients admitted with an acute episode of asthma. Which assessment finding would cause the nurse to call the provider immediately?
- A. prolonged inspiration with each breath
- B. expiratory wheezes that are suddenly absent in 1 lobe
- C. expectoration of large amounts of purulent mucous
- D. appearance of the use of abdominal muscles for breathing
Correct Answer: B
Rationale: Acute asthma is characterized by expiratory wheezes caused by obstruction of the airways. Sudden cessation of wheezing is an ominous sign that indicates an emergency -- the small airways are now collapsed.
The nurse is assisting with the care of a client who sustained a cervical spinal cord injury 1 hour ago and has paralysis in all four extremities. Which of the following actions would be a priority for the nurse to take?
- A. Reposition the client every 2 hours.
- B. Monitor the client for autonomic dysreflexia.
- C. Check the client's respiratory status frequently
- D. Perform passive range-of-motion exercises every 4 hours.
Correct Answer: C
Rationale: Respiratory status (C) is the priority in acute cervical spinal cord injury due to risk of respiratory failure. Repositioning (A), dysreflexia monitoring (B), and exercises (D) are secondary.
The nurse is caring for a newborn with patent ductus arteriosus. Which finding would be consistent with the condition?
- A. Blowing diastolic murmur
- B. Harsh systolic murmur
- C. Loud machine-like murmur
- D. Systolic ejection murmur
Correct Answer: C
Rationale: Patent ductus arteriosus causes a loud, machine-like murmur (C) due to continuous blood flow. Other murmurs (A, B, D) are associated with different cardiac conditions.
A pediatric client has been receiving Amoxil (amoxicillin) for acute otitis media. It is important the child receive all the medication. Which secondary disorder is associated with improper management of acute otitis media?
- A. Cholesteatoma
- B. Mastoiditis
- C. Acoustic neuroma
- D. Presbycusis
Correct Answer: B
Rationale: Improper management of acute otitis media can lead to mastoiditis, an infection of the mastoid bone that can result from untreated or inadequately treated ear infections. Answer A (cholesteatoma) is a possible complication but less directly associated with improper antibiotic management. Answer C (acoustic neuroma) is unrelated to otitis media. Answer D (presbycusis) is age-related hearing loss, not a complication of otitis media.
The intensive care nurse is caring for a client who has just been extubated. Which interventions are appropriate at this time?
- A. Administer prescribed oral narcotics for throat pain
- B. Administer warmed, humidified oxygen via facemask
- C. Give the client ice chips to moisten the mouth
- D. Provide mouth care with oral sponges
- E. Start the client on incentive spirometer
Correct Answer: B,C,D,E
Rationale: Post-extubation, warmed, humidified oxygen (B) prevents mucosal drying, ice chips (C) moisten the mouth, oral sponges (D) maintain hygiene, and incentive spirometry (E) promotes lung expansion. Oral narcotics (A) are risky due to potential airway compromise.