Nokea
The nurse is caring for a client who is prescribed a long-acting beta2 agonist. The client states, 'The medication is too expensive to use every day. I only use my inhaler when I have an attack.' How should the nurse respond?
- A. You are using the inhaler incorrectly. This medication should be taken daily.
- B. If you avoid environmental stimuli, it will be okay to use the inhaler only for asthma attacks.
- C. Tell me more about your fears related to feelings of breathlessness.
- D. It is important to use this type of inhaler every day. Let's identify potential community services to help you.
Correct Answer: D
Rationale: Long-acting beta2 agonists are maintenance medications to prevent asthma attacks and should be used daily. Addressing the client's financial concerns by identifying community resources is the most effective response. Simply stating the inhaler is used incorrectly or exploring fears does not address the financial barrier.
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A nurse cares for a client who has developed esophagitis after undergoing radiation therapy for lung cancer. Which diet selection should the nurse provide for this client?
- A. Spaghetti with meat sauce, ice cream
- B. Grilled cheese sandwich with whole wheat bread
- C. Oatmeal with skim milk, custard
- D. Pasta salad, custard, orange juice
Correct Answer: C
Rationale: Side effects of radiation therapy may include esophagitis. Oatmeal with skim milk and custard are soft, non-irritating foods suitable for a client with esophagitis. Spaghetti with meat sauce may be too spicy, grilled cheese sandwiches are too difficult to swallow, and orange juice is too caustic due to its citric acid content.
A nurse cares for a client who is infected with Burkholderia cepacia. Which action should the nurse take first when admitting this client to a pulmonary care unit?
- A. Instruct the client to wash their hands after contact with other people.
- B. Implement Droplet Precautions and don a surgical mask.
- C. Isolate the client from other clients with cystic fibrosis.
- D. Obtain blood, sputum, and urine culture specimens.
Correct Answer: C
Rationale: Burkholderia cepacia is spread through casual contact among cystic fibrosis clients, necessitating isolation from other CF clients. Hand washing is important but not the priority. Droplet precautions are not required, and cultures are secondary to preventing transmission.
The nurse instructs a client on how to correctly use an inhaler with a spacer. In which order should these steps occur? 1. Press down firmly on the canister to release one dose of medication. 2. Breathe in slowly and deeply. 3. Shake the whole unit vigorously three or four times. 4. Insert the mouthpiece of the inhaler into the nonmouthpiece end of the spacer. 5. Place the mouthpiece into the mouth, over the tongue, and seal the lips tightly around it. 6. Remove the mouthpiece from your mouth, keep your lips closed, and hold your breath for at least 10 seconds.
- A. 2,3,5,1,6,2
- B. 3,4,5,1,2,6
- C. 4,3,5,1,2,6
- D. 1,3,2,5,6,7,4
Correct Answer: C
Rationale: The correct order is: insert the inhaler into the spacer (4), shake the unit (3), place the mouthpiece in the mouth (5), release the medication (1), breathe in slowly and deeply (2), and hold the breath for 10 seconds (6).
A nurse assesses a client who has a chest tube. For which manifestations should the nurse immediately intervene? (Select all that apply.)
- A. Production of pink sputum
- B. Tracheal deviation
- C. Sudden onset of shortness of breath
- D. Pain at insertion site
- E. Drainage of 75 ml/hr
Correct Answer: C,E
Rationale: Sudden shortness of breath and tracheal deviation indicate a pneumothorax, requiring immediate intervention. Pink sputum, pain at the insertion site, and drainage of 75 ml/hr are not immediately life-threatening.
A nurse cares for a client who tests positive for alpha1-antitrypsin (AAT) deficiency. The client asks, 'What does this mean?' How should the nurse respond?
- A. Your children will be at high risk for the development of chronic obstructive pulmonary disease.
- B. I will contact a genetic counselor to discuss your condition.
- C. Your risk for chronic obstructive pulmonary disease is higher, especially if you smoke.
- D. This is a recessive gene and should have no impact on your health.
Correct Answer: C
Rationale: AAT deficiency increases the risk of COPD, particularly in smokers. Clients with one allele produce enough AAT to prevent COPD unless exposed to irritants like smoke. The risk to children depends on the partner's AAT status, and contacting a genetic counselor is not the priority response.