Nokea
Which intervention should the emergency department nurse implement first for the client admitted for an acute asthma attack?
- A. Administer glucocorticoids intravenously.
- B. Administer oxygen 5 L per nasal cannula.
- C. Establish and maintain a 20-gauge saline lock.
- D. Assess breath sounds every 15 minutes.
Correct Answer: B
Rationale: In an acute asthma attack, the priority is to address hypoxia. Administering oxygen (B) ensures adequate oxygenation, which is critical in respiratory distress. IV glucocorticoids (A) reduce inflammation but act slowly and are not the first intervention. Establishing a saline lock (C) is preparatory but not immediate. Assessing breath sounds (D) is important but secondary to ensuring oxygenation.
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A patient is admitted with pneumonia. Sputum cultures show that the patient is infected with a gram positive bacterium. The patient is allergic to Penicillin. Which medication would the patient most likely be prescribed?
- A. Macrolide
- B. Cephalosporins
- C. Pencillin G
- D. Tamiflu
Correct Answer: A
Rationale: For gram-positive bacterial pneumonia in a penicillin-allergic patient, macrolides like azithromycin are commonly prescribed due to their efficacy and safety. Cephalosporins may cross-react with penicillin allergies, Penicillin G is contraindicated, and Tamiflu is for viral infections.
A patient is being discharged home on Doxycycline for treatment of pneumonia. Which statement by the patient indicates they understood your education material?
- A. I will wear sunscreen when outdoors.'
- B. I will avoid green leafy vegetables while taking this medication.'
- C. I will monitor my blood glucose regularly due to the side effects of hypoglycemia.'
- D. I will take this medication with a full glass of milk.'
Correct Answer: A
Rationale: Doxycycline causes photosensitivity, so wearing sunscreen is correct. Green leafy vegetables are relevant for warfarin, hypoglycemia is not a side effect, and milk can reduce doxycycline absorption.
A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses and this result means?
- A. fibrin degradation fragment; positive for a blood clot
- B. platelet degradation protein; negative for a blood clot
- C. clotting factors; positive for a blood clot
- D. fibrin degradation fragment; negative for a blood clot
Correct Answer: D
Rationale: A d-dimer test assess fibrin degradation fragment. This test doesn't tell us where the clot may be (so it not specific) so it will need to be further investigated by the MD and a positive result doesn't necessarily mean the patient has a clot because some disease processes can cause a false positive. Also, a normal d-dimer is <500 ng/mL (FEU). However, it depends on how the lab reports the assay cut-off value for the d-dimer. Some labs have a cutoff <250 ng/mL (D-DU). However, <500 ng/mL (FEU) is equivalent to <250 ng/mL (D-DU).
The term 'blue bloaters' is used to describe patients with?
- A. Pulmonary hypertension
- B. Left-sided heart failure
- C. Chronic Bronchitis
- D. Emphysema
Correct Answer: C
Rationale: Blue bloaters' describes chronic bronchitis patients, who present with cyanosis ('blue') and edema ('bloating') due to hypoxemia and right heart failure. Emphysema patients are often called 'pink puffers.'
The client is four (4) hours post-lobectomy for cancer of the lung. Which assessment data warrant immediate intervention by the nurse?
- A. The client has an intake of 1,500 mL IV and an output of 1,000 mL.
- B. The client has 450 mL of bright-red drainage in the chest tube.
- C. The client is complaining of pain at a '10' on a 1-to-10 scale.
- D. The client has absent lung sounds on the side of the surgery.
Correct Answer: B
Rationale: 450 mL bright-red drainage (B) suggests hemorrhage, requiring immediate action. Fluid balance (A), severe pain (C), and absent lung sounds (D) are expected or less urgent.