Nokea
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.
You may also like to solve these questions
The nurse is preparing to take a toddler's blood pressure for the first time. Which of the following actions should the nurse perform first?
- A. Explain that the procedure will help him to get well
- B. Show a cartoon character with a blood pressure cuff
- C. Explain that the blood pressure checks the heart pump
- D. Permit handling the equipment before putting the cuff in place
Correct Answer: D
Rationale: Permit handling the equipment before putting the cuff in place. The best way to gain the toddler's cooperation is to encourage handling the equipment. Detailed explanations are not helpful.
The nurse is caring for assigned clients. The nurse should first check the client with
- A. liver cirrhosis who has a decreased RBC count and is reporting pruritis
- B. pneumonia who has an elevated WBC count and coarse crackles bilaterally
- C. atrial fibrillation who has an irregular heart rate of 122/min and is reporting palpitations
- D. pericarditis who has muffled heart sounds and a decrease in systolic blood pressure of 20 mm Hg with inspiration
Correct Answer: D
Rationale: Pericarditis with paradoxical pulse (D) suggests tamponade, requiring immediate assessment. Atrial fibrillation (C), pneumonia (B), and cirrhosis (A) are less urgent.
The pediatric nurse cares for a 16-year-old client who is scheduled for an appendectomy in the morning. Which of the following interventions are appropriate to support the client's psychosocial needs?
- A. Create a strict daily schedule for the client while hospitalized
- B. Encourage the client to have peers visit while hospitalized
- C. Ensure parental presence during any client procedure
- D. Include the client as an active participant when planning care
- E. Support the client in discussing concerns about body image changes
Correct Answer: B,D,E
Rationale: Peer visits (B), active participation (D), and addressing body image (E) support a teen's psychosocial needs. Strict schedules (A) reduce autonomy, and parental presence (C) may not align with the teen's preferences.
The client with a colostomy does not feel that the irrigating solution has drained completely. The nurse can enhance the effectiveness of the colostomy irrigation by telling the client to:
- A. Massage the abdomen gently.
- B. Reduce the amount of irrigation solution.
- C. Increase his oral intake.
- D. Place a heating pad on the abdomen.
Correct Answer: A
Rationale: Gentle abdominal massage can stimulate peristalsis and help the irrigation solution drain completely from the colostomy. Reducing solution or using a heating pad is not standard, and increasing oral intake is unrelated.
A client using a diaphragm should be instructed to:
- A. Refrain from keeping the diaphragm in longer than 8 hours.
- B. Keep the diaphragm in a warm location.
- C. Have the diaphragm resized if she gains 5 pounds.
- D. Have the diaphragm resized if she has any surgery.
Correct Answer: A
Rationale: Leaving a diaphragm in place longer than 8 hours increases infection risk. Resizing is needed for significant weight changes (e.g., 10+ pounds) or post-surgery, not minor changes.