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After administering the first puff of medication, what client action demonstrates proper use of the inhaler?
- A. The client depresses the canister a second time before exhaling.
- B. The client holds his or her breath for up to 10 seconds before exhaling.
- C. The client cleans the mouthpiece with a clean paper tissue or cloth.
- D. The client bends from the waist to increase the exhaled volume.
Correct Answer: B
Rationale: Holding the breath for up to 10 seconds after inhaling allows the medication to deposit in the lungs effectively.
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The nurse is caring for a woman who is admitted with pneumonia. On admission, the client is anxious and short of breath but able to respond to questions. One hour later, the client becomes more dyspneic and less responsive, answering only yes and no questions. What is the best action for the nurse to take at this time?
- A. Stimulate the client until the client responds.
- B. Increase the oxygen from the ordered 6 L to 10 L.
- C. Assess the client again in 15 minutes.
- D. Notify the charge nurse of the change in the client's mental status.
Correct Answer: D
Rationale: A change in mental status with worsening dyspnea indicates potential deterioration, requiring immediate notification of the charge nurse.
The client is suspected of having a pulmonary embolus. Which diagnostic test suggests the presence of a pulmonary embolus and requires further investigation?
- A. Plasma D-dimer test.
- B. Arterial blood gases.
- C. Chest x-ray (CXR).
- D. Magnetic resonance imaging (MRI).
Correct Answer: A
Rationale: Elevated D-dimer (A) suggests clotting, warranting further PE investigation (e.g., CT). ABGs (B) show hypoxia, CXR (C) is nonspecific, and MRI (D) is not standard.
The client diagnosed with exercise-induced asthma (EIA) is being discharged. Which information should the nurse include in the discharge teaching?
- A. Take two (2) puffs on the rescue inhaler and wait five (5) minutes before exercise.
- B. Warm-up exercises will increase the potential for developing the asthma attacks.
- C. Use the bronchodilator inhaler immediately prior to beginning to exercise.
- D. Increase dietary intake of food high in monosodium glutamate (MSG).
Correct Answer: A
Rationale: Two puffs of a rescue inhaler 5 minutes before exercise (A) prevents EIA. Warm-ups (B) reduce attacks, immediate use (C) is less effective, and MSG (D) is a trigger.
A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
- A. 5 mm induration
- B. 15 mm induration
- C. 9 mm induration
- D. 10 mm induration
Correct Answer: D
Rationale: 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.
The nurse is preparing to administer the oral anticoagulant warfarin (Coumadin) to a client who has a PT/PTT of 22/39 and an INR of 2.8. What action should the nurse implement?
- A. Assess the client for abnormal bleeding.
- B. Prepare to administer vitamin K (AquaMephyton).
- C. Administer the medication as ordered.
- D. Notify the HCP to obtain an order to increase the dose.
Correct Answer: C
Rationale: INR 2.8 (C) is therapeutic for PE (2–3), so administer warfarin. Bleeding assessment (A) is routine, vitamin K (B) reverses overdose, and increasing dose (D) is unnecessary.