Nursing Elites

1. During an acute asthma attack in a client with asthma, what medication should the nurse administer first?

• A. Oral corticosteroids
• B. Short-acting beta agonist
• C. Leukotriene receptor antagonist
• D. Long-acting beta agonist

Correct answer: B

Rationale: During an acute asthma attack, the priority is to quickly relieve bronchospasm and improve breathing. Short-acting beta agonists, like albuterol, are the first-line medications as they rapidly relax bronchial muscles, providing immediate relief. Oral corticosteroids are used as adjunct therapy to reduce airway inflammation over time, while leukotriene receptor antagonists and long-acting beta agonists are not appropriate for immediate relief during an acute attack.

2. A nurse cares for a client with chronic obstructive pulmonary disease who has been prescribed continuous oxygen therapy at home. Which statement indicates the client correctly understands the teaching?

• A. I plan to wear my oxygen when I exercise & feel short of breath.
• B. I will use my portable oxygen when grilling burgers in the backyard.
• C. I plan to use cotton balls to cushion the oxygen tubing on my ears.
• D. I will only smoke while I am wearing my oxygen via nasal cannula.

Correct answer: C

Rationale: Cotton balls can decrease pressure ulcers from the oxygen tubing. Continuous oxygen orders mean the client should wear the oxygen at all times. Oxygen fuels a fire. Wearing oxygen while grilling & smoking increases the risk for fire.

3. A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements should the nurse include in communications with the respiratory therapist prior to the tests? (Select all that apply)

• A. I held the client's morning bronchodilator medication.
• B. The client is ready to go down to radiology for this examination.
• C. Physical therapy states the client can run on a treadmill.
• D. I advised the client not to smoke for 6 hours prior to the test.

Correct answer: B

Rationale: Communication between the nurse and respiratory therapist is crucial before pulmonary function tests (PFTs). It is important to inform the respiratory therapist that the client is ready for the examination. The nurse should not administer bronchodilator medication before the test as it may affect the results, and the client should not smoke for 6 to 8 hours prior to the test to ensure accurate results. Additionally, PFTs do not involve running on a treadmill; instead, the client may be required to perform specific breathing maneuvers as instructed by the respiratory therapist.

4. A client has a three-chamber closed chest tube system, and the water seal chamber rises with client inspiration. What action should the nurse take?

• A. Continue to monitor the client.
• B. Immediately notify the healthcare provider.
• C. Reposition the client to the left side.
• D. Clamp the chest tube near the water seal.

Correct answer: A

Rationale: In a client with a three-chamber closed chest tube system, a rise in the water seal chamber with client inspiration is an expected finding. The nurse should continue to monitor the client as this indicates that the system is functioning correctly. There is no need to notify the healthcare provider, reposition the client, or clamp the chest tube as these actions are not indicated in response to a rise in the water seal chamber.

5. A client tests positive for alpha1-antitrypsin (AAT) deficiency and asks the nurse, What does this mean? How should the nurse respond?

• A. Your children may be at high risk for developing chronic obstructive pulmonary disease.
• B. I will arrange for a genetic counselor to discuss your condition.
• C. Your risk for chronic obstructive pulmonary disease is higher, particularly if you smoke.
• D. This is a recessive gene that should not affect your health.

Correct answer: C

Rationale: Alpha1-antitrypsin (AAT) deficiency is associated with a higher risk of chronic obstructive pulmonary disease (COPD), especially if the individual smokes. This condition is caused by a recessive gene. Individuals with one allele typically produce enough AAT to prevent COPD unless they smoke. However, those with two alleles are at high risk for COPD even without exposure to smoke or other irritants. Being a carrier of AAT deficiency does not guarantee that one's children will develop the disease; it depends on the AAT levels of the partner. While involving a genetic counselor may be beneficial in the long run, the immediate concern of the client's question should be addressed first.

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