Nokea
A patient with asthma is prescribed to take inhaled Salmeterol and Fluticasone for long-term management of asthma. You observe the patient taking these medications. Which option below best describes the correct order in how to take these medications?
- A. The patient inhales the Salmeterol first and then waits 5 minutes before inhaling the Fluticasone.
- B. The patient inhales the Fluticasone first and then waits 5 minutes before inhaling the Salmeterol.
- C. The patient inhales the Salmeterol first and then waits 1 minute before inhaling the Fluticasone.
- D. The patient inhales the Fluticasone and immediately inhales the Salmeterol.
Correct Answer: A
Rationale: Salmeterol, a long-acting bronchodilator, should be inhaled first to open the airways, followed by Fluticasone, a corticosteroid, after a 5-minute wait to ensure optimal delivery and reduce inflammation.
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The physician orders the patient to start taking Omalizumab. How will you administer this medication as the nurse?
- A. Intravenous
- B. Intramuscular
- C. Orally
- D. Subcutaneously
Correct Answer: D
Rationale: Omalizumab is administered subcutaneously for asthma treatment.
A patient, who is receiving continuous IV Heparin for the treatment of a DVT, has an aPTT of 110 seconds. What is your next nursing action per protocol?
- A. Continue with the infusion because no change is needed based on this aPTT.
- B. Increase the drip rate per protocol because the aPTT is too low.
- C. Re-draw the aPTT STAT.
- D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.
Correct Answer: D
Rationale: The aPTT is 110 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.
Which nursing observation provides the best evidence that postural drainage is effective?
- A. The client's respiratory rate is increased.
- B. The client's heart rate is much improved.
- C. The client's sputum culture is negative.
- D. The client raises a large volume of sputum.
Correct Answer: D
Rationale: Raising a large volume of sputum indicates that postural drainage is effectively clearing secretions from the airways.
You're providing discharge teaching to a patient who was admitted for pneumonia. You are discussing measures the patient can take to prevent pneumonia. Which of the following statements by the patient indicates they did NOT understand your education material?
- A. I'll use hand sanitizer regularly while I'm out in public.'
- B. It is important I don't receive the Pneumovax vaccine since I'm already immune to pneumonia.'
- C. I will try to avoid large crowds of people during the peak of flu season.'
- D. It is important I try to quit smoking.'
Correct Answer: B
Rationale: The statement about not receiving the Pneumovax vaccine is incorrect, as vaccination is recommended to prevent pneumococcal pneumonia, and prior infection doesn't confer immunity. Other options reflect correct preventive measures.
As the nurse you know that one of the reasons for an increase in multidrug-resistant tuberculosis is:
- A. Incorrect medication ordered
- B. Increase in tuberculosis cases nationwide
- C. Incorrect route of drug ordered
- D. Noncompliance due to duration of medication treatment needed
Correct Answer: D
Rationale: Patients must be on medication treatment for about 6-12 months (depending on the type of TB the patient has). This leads to noncompliant issues. DOT (directly observed therapy) is now being instituted so compliance is increased. This is where a public health nurse or a trained DOT worker will deliver the medication and watch the patient swallow the pill until treatment is complete.