A patient with severe chronic obstructive pulmonary disease (COPD) tells the nurse, "I wish I were dead! I'm just a burden on everybody." Based on this information, which nursing diagnosis is most appropriate?

Correct Answer: C

Rationale: The most appropriate nursing diagnosis is "Ineffective coping related to unknown outcome of illness" (Choice C). This is because the patient's expression of feeling like a burden and wishing to be dead indicates difficulty coping with the uncertainties and challenges of their COPD. The patient's emotional distress and sense of hopelessness suggest ineffective coping mechanisms in dealing with their illness. Choice A (Complicated grieving) is incorrect because the patient's statement does not indicate grief over an actual loss, but rather a sense of burden and hopelessness. Choice B (Chronic low self-esteem) is incorrect as the patient's statement is more related to the impact of the illness on others rather than self-esteem issues. Choice D (Deficient knowledge) is not the most appropriate as the patient's statement reflects emotional distress rather than a lack of knowledge about COPD.

Correct Answer: B

Rationale: The correct answer is B: Administer corticosteroids. In the scenario described, the priority intervention is to administer corticosteroids to reduce airway inflammation and improve breathing in an acute asthma exacerbation. This treatment addresses the underlying cause of the symptoms and helps to prevent further complications. Nebulized bronchodilators (choice A) and inhalers (choice C) are important treatments for asthma but are typically used after corticosteroids to provide immediate relief of symptoms. Administering subcutaneous insulin (choice D) is not relevant to the management of asthma and would not address the patient's respiratory distress.

Correct Answer: A

Rationale: The correct answer is A: Perform a neurological exam. This is the priority action because the patient's symptoms of slurred speech and weakness indicate a potential stroke recurrence. By performing a neurological exam, the nurse can assess the patient's current neurological status, determine the severity of the symptoms, and identify any signs of worsening condition or complications. This information is crucial for timely intervention and management of the patient's condition. Summary: B: Notifying the healthcare provider can be important but assessing the patient's neurological status is the immediate priority. C: Administering insulin therapy is not indicated for slurred speech and weakness in a patient with a history of stroke. D: Administering IV fluids and monitoring blood glucose is not the priority action in this situation; neurological assessment takes precedence.

Correct Answer: A

Rationale: The correct answer is A: Administer a bronchodilator. This is the priority intervention because the patient is experiencing difficulty breathing, indicating an asthma exacerbation. Administering a bronchodilator helps to open up the airways and improve breathing. It targets the underlying cause of the respiratory distress. Administering IV fluids (choices B and C) may be necessary for hydration but is not the priority in this situation. Administering pain relief (choice D) is not appropriate as the priority is addressing the breathing difficulty.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D, which is to obtain repeat arterial blood gases (ABGs). In metabolic alkalosis, it is crucial to assess the patient's arterial blood gases to determine the pH and carbon dioxide (CO₂) levels. ABGs provide vital information about the patient's acid-base balance, which guides appropriate treatment interventions. Option A, completing a head-to-toe assessment, is not the priority in this situation as the patient's metabolic alkalosis and oxygen saturation levels need immediate attention. Option B, administering an inhaled bronchodilator, is not indicated for metabolic alkalosis but might be considered for respiratory issues. Option C, placing the patient on high-flow oxygen, is not necessary solely based on the oxygen saturation level of 94% as the primary concern is the metabolic alkalosis rather than hypoxemia. Educationally, understanding the importance of ABGs in assessing acid-base imbalances like metabolic alkalosis is crucial for nurses and healthcare providers. It allows for accurate diagnosis and appropriate treatment planning. This case emphasizes the significance of clinical judgment based on comprehensive assessment data to provide safe and effective patient care. Nurses should be able to prioritize interventions based on the patient's condition and the underlying pathophysiology to promote optimal outcomes.