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8 Cards in this Set

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A client with chronic bronchitis exacerbated by pneumonia is complaining of increased shortness of breath and has inspiratory and expiratory wheezes. All of the following medications are ordered. Which one should the nurse administer first?
A. Salmeterol (Serevent) 2 inhalations
B. Albuterol (Proventil) 2 inhalations
C. Ipratropium (Atrovent) 2 inhalations
D. Triamcinolone (Azmacort) 2 inhalations
B. Albuterol (Proventil) 2 inhalations

The client’s dyspnea and wheezing indicates a need for immediate bronchodilation. The rapidly acting beta2 agonists are the recommended treatment for acute airway narrowing.
The other medications are more appropriate for long-term prevention of bronchospasm or inflammation.
All of the following clients are being cared for on the intensive care (ICU) “stepdown” unit. Which client should the charge nurse assign to an RN who has "floated" from the pediatric unit?
A. A client with lung cancer who has just been transferred from the ICU after having a left lower lobectomy the previous day
B. A client with chronic pleural effusions who is scheduled for a pleurodesis during the shift
C. A client with emphysema who has an order to titrate oxygen saturation to keep SpO2 at 90% to 92%
D. A client admitted with status asthmaticus who is receiving oxygen at an FIO2 of 60% per non-rebreather mask
D. A client admitted with status asthmaticus who is receiving oxygen at an FIO2 of 60% per non-rebreather mask.
The other clients have medical diagnoses that are more common in adults and require nursing care that would not be familiar to a pediatric nurse. Because asthma is a common pediatric diagnosis, the pediatric nurse would be familiar with the assessments and care needed for a client with this diagnosis.
The change of shift report on the hospital medical surgical unit has just been completed. Which of these clients will the oncoming nurse need to assess first?
A. An asthmatic client who was admitted 1 hour ago with expiratory wheezes and a respiratory rate of 34 breaths/min
B. A client with lung cancer who needs an IV antibiotic administered before going to surgery
C. A hospice client with terminal pulmonary fibrosis and an oxygen saturation of 89%
D. A client with COPD who is ready for discharge, but is not able to pay for the prescribed home medications
A. An asthmatic client who was admitted 1 hour ago with expiratory wheezes and a respiratory rate of 34 breaths/min.

This client is having an acute asthma attack and should be assessed immediately. The other clients also require complex nursing care, but are more stable than the client admitted with asthma.
The registered nurse is caring for a client with lung cancer who has just been admitted to the ICU after having a pneumonectomy. The client is intubated and being ventilated with a positive pressure ventilator. All of the following orders are received. Which one will the nurse implement first?
A. Morphine sulfate 6 to 10 mg IV for pain
B. Continuous pulse oximetry to keep O2 saturation at 92% to 100%
C. Ceftriaxone (Rocephin) 500 mg IV every 6 hours
D. Infusion of one unit packed red blood cells over 2 hours
B. Continuous pulse oximetry to keep O2 saturation at 92% to 100%.

All of the listed interventions are important, but the priority concern after surgery is airway management and oxygenation.
The RN and nursing assistant are working together to provide care for a group of clients. Which of these nursing activities could the RN delegate to the nursing assistant?
A. Monitor the effectiveness of oxygen therapy for a client admitted with chronic bronchitis.
B. Reinforce the use of slow expiration through pursed lips to maximize gas exchange for a client with sarcoidosis.
C. Auscultate for improvement in breath sounds in a client who has had a right upper lobectomy.
D. Document discharge instructions for a client being discharged with new medication prescriptions.
B. Reinforce the use of slow expiration through pursed lips to maximize gas exchange for a client with sarcoidosis.

Reinforcing previously learned material is an essential intervention, but does not require RN level skills or licensure. The other skills are higher level and would need to be accomplished by the RN member of the team.
Situation: Your client is a 58-year-old woman with a 15–pack-year history of smoking. Chronic bronchitis was diagnosed 1 year ago and she has been taking albuterol (Proventil) metered dose inhaler (MDI). She has a cough and difficulty expectorating her secretions. You learn that it has become more difficult for her to breathe over the past 2 months. Her chronic obstructive pulmonary disease (COPD) classification has been raised from I to II.
This client will most likely have which medication(s) added to her therapy because of the increase in her COPD classification? Choose all that apply.
A. Prednisone (Prednisone).
B. Theophylline (Theo-Dur).
C. Salmeterol (Serevent).
D. Pirbuterol (Maxair).
C. Salmeterol (Serevent).
D. Pirbuterol (Maxair).

p. 601-602. Stepped therapy is recommended for clients with chronic bronchitis or emphysema (Table 33-3).
Situation: Your client is a 58-year-old woman with a 15–pack-year history of smoking. Chronic bronchitis was diagnosed 1 year ago and she has been taking albuterol (Proventil) metered dose inhaler (MDI). She has a cough and difficulty expectorating her secretions. You learn that it has become more difficult for her to breathe over the past 2 months. Her chronic obstructive pulmonary disease (COPD) classification has been raised from I to II.
What is the rationale for ordering a mucolytic for this client?
A. Mucolytics thin secretions, making them easier to expectorate.
B. Mucolytics decrease secretion production.
C. Mucolytics provide bronchodilation in clients with COPD.
D. Mucolytics increase gas exchange in the lower airways.
A. Mucolytics thin secretions, making them easier to expectorate.

p. 601-602. Mucolytics are prescribed for clients with thick, tenacious secretions.
Situation: Your client is a 58-year-old woman with a 15–pack-year history of smoking. Chronic bronchitis was diagnosed 1 year ago and she has been taking albuterol (Proventil) metered dose inhaler (MDI). She has a cough and difficulty expectorating her secretions. You learn that it has become more difficult for her to breathe over the past 2 months. Her chronic obstructive pulmonary disease (COPD) classification has been raised from I to II.
Which of the following is a systemic mucolytic?
A. Guaifenesin (Organidin).
B. Cromolyn sodium (Intal).
C. Montelukast (Singulair).
D. Flunisolide (AeroBid).
A. Guaifenesin (Organidin).

p. 601. Guaifenesin (Organidin) is a systemic mucolytic that is taken orally. Mucolytic agents are prescribed for the client with thick, tenacious mucus secretions.