A 34 year old woman with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic with an RR of 35 BPM, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings what action should the nurse take to initiate care of the client?

Correct Answer: D

Rationale: In this scenario, the correct action for the nurse to take to initiate care of the client is to administer bronchodilators (Option D). This choice is the most appropriate because the client is presenting with signs and symptoms of a severe asthma exacerbation, such as dyspnea, increased respiratory rate, use of accessory muscles, and diminished breath sounds. Bronchodilators, such as albuterol, are the first-line treatment for managing acute asthma attacks as they work to relax and dilate the airways, improving airflow and relieving symptoms. Option A is incorrect because simply initiating oxygen therapy without addressing the underlying bronchoconstriction would not effectively treat the asthma exacerbation. Oxygen therapy may be needed later depending on the client's oxygen saturation levels, but bronchodilators are the priority in this situation. Option B is incorrect because while obtaining ABG analysis and a chest x-ray may provide valuable information about the client's respiratory status, they are not the immediate interventions needed to manage a severe asthma exacerbation. Option C is incorrect as simply encouraging the client to relax and breathe slowly through the mouth does not address the physiological cause of the client's distress, which is bronchoconstriction requiring bronchodilator therapy. Educationally, this scenario highlights the importance of recognizing and promptly treating acute asthma exacerbations in clinical practice. Nurses need to be able to assess and intervene effectively in situations where clients present with respiratory distress to provide timely and appropriate care to improve outcomes. Understanding the appropriate use of bronchodilators in managing asthma exacerbations is a crucial aspect of nursing practice in emergency situations.

Correct Answer: A

Rationale: In the context of oxygen therapy, understanding Auto-PEEP (also known as intrinsic PEEP or breath stacking) is crucial for healthcare professionals. Auto-PEEP occurs when there is incomplete exhalation before the next breath starts, leading to an increase in end-expiratory lung volume. This can cause air trapping, hemodynamic compromise, and barotrauma in patients receiving mechanical ventilation. The correct answer is A) Increasing inspiratory flow. Increasing the inspiratory flow rate helps to match the patient's demand for air, allowing for more complete exhalation during the expiratory phase. By ensuring a faster flow rate, the patient has enough time to fully exhale before the next breath, reducing the risk of Auto-PEEP. Option B) Decreasing inspiratory flow would actually worsen Auto-PEEP as it would prolong the inspiratory phase, leading to insufficient time for exhalation. Option C) Increasing respiratory rates might exacerbate Auto-PEEP by reducing the expiratory time, further trapping air in the lungs. Option D) Increasing tidal volume could potentially worsen Auto-PEEP by increasing the amount of air left in the lungs at the end of expiration. Educationally, this question reinforces the importance of understanding the pathophysiology of Auto-PEEP and how different ventilator settings can impact patient outcomes. Healthcare providers must be able to identify and address Auto-PEEP promptly to prevent complications and ensure optimal oxygenation for their patients.

Correct Answer: A

Rationale: The correct answer is A) The influence of oxygen on hemoglobin's affinity for carbon dioxide. The Haldane effect describes how the oxygenation of hemoglobin affects its ability to carry carbon dioxide. When hemoglobin binds with oxygen, it has a reduced capacity to bind with carbon dioxide, leading to the release of carbon dioxide in tissues where oxygen is being delivered. Option B is incorrect because it describes the Bohr effect, which is the effect of carbon dioxide on hemoglobin's affinity for oxygen, not the Haldane effect. Option C is incorrect because it describes the effect of pH on hemoglobin's affinity for oxygen, known as the Bohr effect, not the Haldane effect. Option D is incorrect because it describes the influence of carbon dioxide on bicarbonate ion formation, which is related to the chloride shift and the transport of carbon dioxide in the blood, but not the Haldane effect. Educational context: Understanding the Haldane effect is crucial in the context of oxygen therapy as it explains the intricate relationship between oxygen and carbon dioxide transport in the blood. Healthcare professionals need to grasp these concepts to effectively manage patients requiring oxygen therapy and those with respiratory conditions.

Correct Answer: A

Rationale: The correct answer is A) Diagnose Myasthenia gravis. The Tensilon test involves administering the drug Edrophonium (Tensilon) to the patient and observing for a rapid improvement in muscle strength, which is characteristic of Myasthenia gravis. This test helps differentiate Myasthenia gravis from other conditions presenting with similar symptoms. Option B) Monitor disease progression of Guillain-Barré syndrome is incorrect because the Tensilon test is not used to monitor Guillain-Barré syndrome. Guillain-Barré syndrome is diagnosed based on clinical presentation, nerve conduction studies, and lumbar puncture findings. Option C) Assess lung function of COPD is incorrect because the Tensilon test is not used to assess lung function. Lung function tests such as spirometry and arterial blood gas analysis are more appropriate for assessing lung function in COPD. Option D) Evaluate a patient's response to treatment is incorrect because the Tensilon test is primarily used for diagnostic purposes rather than monitoring treatment response. Treatment efficacy is typically assessed through clinical improvement, laboratory tests, and imaging studies. In an educational context, understanding the specific diagnostic utility of the Tensilon test in Myasthenia gravis is essential for healthcare professionals, particularly neurologists and neuromuscular specialists. Differentiating between various neuromuscular disorders is crucial for accurate diagnosis and appropriate management. This question reinforces the importance of clinical knowledge and diagnostic tools in providing quality patient care.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Severe. An Apnea-Hypopnea Index (AHI) is used to classify the severity of sleep apnea based on the number of pauses in breathing (apnea) or shallow breathing (hypopnea) that occur per hour of sleep. A person with an AHI of 30 or more events per hour is classified as having severe sleep apnea. Choosing option A) Mild is incorrect because an AHI of 5-15 events per hour is typically classified as mild sleep apnea. Option B) Moderate is incorrect as moderate sleep apnea is usually defined by an AHI of 15-30 events per hour. Option D) Very Severe would only be accurate if the AHI was significantly higher than 30 events per hour. Educationally, understanding the classification of AHI levels is crucial for healthcare professionals involved in diagnosing and managing sleep disorders. Recognizing the severity of sleep apnea helps determine appropriate treatment strategies, such as the use of continuous positive airway pressure (CPAP) therapy or lifestyle modifications. Monitoring and addressing sleep apnea effectively can significantly improve a patient's quality of life and reduce associated health risks.