If a client continues to hypoventilate, the nurse will continually assess for a complication of:
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Solution
Respiratory acidosis
Respiratory acidosis represents an increase in the acid component, carbon dioxide, and an increase in the hydrogen ion concentration (decreased pH) of the arterial blood.
Immediately following a thoracentesis, which clinical manifestations indicate that a complication has occurred and the physician should be notified?
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Solution
Increased pulse and pallor
Increased pulse and pallor are symptoms associated with shock. A compromised venous return may occur if there is a mediastinal shift as a result of excessive fluid removal. Usually, no more than 1 L of fluid is removed at one time to prevent this from occurring.
A cyanotic client with an unknown diagnosis is admitted to the E.R. In relation to oxygen, the first nursing action would be to:
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Solution
Administer oxygen at 2 L flow per minute.
Administer oxygen at 2 L/minute and no more, for if the client if emphysemic and receives too high a level of oxygen, he will develop CO2 narcosis and the respiratory system will cease to function.
Basilar crackles are present in a client’s lungs on auscultation. The nurse knows that these are discrete, non continuous sounds that are:
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Solution
Caused by the sudden opening of alveoli
Basilar crackles are usually heard during inspiration and are caused by sudden opening of the alveoli.
A female client comes into the emergency room complaining of SOB and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her VS are: 140/80, P 110, R 40. The physician orders ABG’s, results are as follows: pH: 7.50; PaCO2 29 mm Hg; PaO2 60 mm Hg; HCO3- 24 mEq/L; SaO2 86%. Considering these results, the first intervention is to:
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Solution
Place the client on oxygen
The pH (7.50) reflects alkalosis, and the low PaCO2 indicated the lungs are involved. The client should immediately be placed on oxygen via mask so that the SaO2 is brought up to 95%. Encourage slow, regular breathing to decrease the amount of CO2 she is losing. This client may have pulmonary embolism, so she should be monitored for this condition (4), but it is not the first intervention. Sodium bicarbonate (3) would be given to reverse acidosis; mechanical ventilation (1) may be ordered for acute respiratory acidosis.
The client with asthma should be taught that which of the following is one of the most common precipitating factors of an acute asthma attack?
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Solution
Viral respiratory infections
The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.
Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma?
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Solution
Incorporate physical exercise as tolerated into the treatment plan.
Physical exercise is beneficial and should be incorporated as tolerated into the client’s schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the client’s life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.
A client has been taking flunisolide (Aerobid), two inhalations a day, for treatment of asthma. He tells the nurse that he has painful, white patches in his mouth. Which response by the nurse would be the most appropriate?
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Solution
“You have developed a fungal infection from your medication. It will need to be treated with an antibiotic.”
Use of oral inhalant corticosteroids, such as flunisolide, can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antibiotic therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the Corticosteroid inhaler. Although good oral hygiene can help prevent the development of a fungal infection, it cannot be used alone to treat the problem.
A client is prescribed metaproterenol (Alupent) via a metered dose inhaler (MDI), two puffs every 4 hours. The nurse instructs the client to report side effects. Which of the following are potential side effects of metaproterenol?
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Solution
Irregular heartbeat
Irregular heart rates should be reported promptly to the care provider. Metaproterenol may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on the beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, petal edema, or bradycardia.
The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.
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Solution
Answer: 1 and 4.