A nurse in an urgent care center is caring for a client who is having an acute asthma exacerbation. Which of the following actions is the nurse's highest priority?

Correct Answer: D

Rationale: The correct answer is D: Administering a nebulized beta-adrenergic. This is the highest priority because it directly addresses the acute asthma exacerbation by helping to open up the airways and improve breathing. Step 1: Assess the client's respiratory status Step 2: Administering the nebulized beta-adrenergic medication to relieve bronchospasm and improve airflow Step 3: Monitor the client's response to the medication and adjust care accordingly. Other choices are incorrect because A: Oxygen therapy may be needed but addressing the bronchospasm is the priority. B: Rest is important but not the priority in managing an acute asthma exacerbation. C: Positioning is helpful but not the priority over administering the medication to improve breathing.

Correct Answer: B

Rationale: The correct answer is B: Fluticasone. Fluticasone is an inhaled corticosteroid used to treat asthma, which can worsen heart failure symptoms. The healthcare provider needs to clarify this medication due to the client's history of asthma and heart failure. Carvedilol (A) is a beta-blocker used to treat heart failure. Captopril (C) is an ACE inhibitor also used in heart failure. Isosorbide dinitrate (D) is a vasodilator used for heart failure and angina, not contraindicated in asthma.

Correct Answer: B

Rationale: The correct answer is B: Administer oxygen via face mask. Given the client's symptoms and ABG results showing respiratory alkalosis and hypoxemia, the priority is to improve oxygenation. Administering oxygen via face mask will help increase the oxygenation levels and alleviate the hypoxemia. Mechanical ventilation (A) is not indicated as the client is able to maintain their own ventilation. Administering a sedative (C) is not appropriate without addressing the underlying respiratory issue. Assessing for pulmonary embolism (D) may be important but not the immediate priority in this case.

Correct Answer: D

Rationale: The correct answer is D: A hyperextended position. During bronchoscopy with a rigid scope, the client's neck needs to be hyperextended to facilitate optimal insertion of the scope into the trachea. Hyperextension straightens and opens up the airway, providing better visualization and access to the bronchial tree. Choice A (flexed position) would obstruct the airway and make insertion difficult. Choice B (extended position) would not provide the necessary alignment for scope insertion. Choice C (neutral position) may not offer sufficient airway visibility and access. In summary, a hyperextended position is crucial for successful bronchoscopy with a rigid scope, as it ensures proper alignment, airway visibility, and scope insertion.

Correct Answer: A

Rationale: The correct answer is A: Withhold food and liquids until the client's gag reflex returns. After a flexible bronchoscopy, the client may have a decreased gag reflex due to topical anesthesia used during the procedure, which increases the risk of aspiration. Withholding food and liquids helps prevent aspiration until the gag reflex returns, usually within 1-2 hours. B: Irrigating the client's throat every 4 hours is unnecessary and may not be indicated post-bronchoscopy. C: Having the client refrain from talking for 24 hours is not necessary after a flexible bronchoscopy unless specifically instructed by the healthcare provider. D: Suctioning the client's oropharynx frequently is not indicated unless there is a clinical indication for it, such as excessive secretions or respiratory distress. Frequent suctioning can increase the risk of trauma to the airway.