The nurse is preparing to assist the patient in using the incentive spirometer. Which nursing intervention should the nurse provide first?

Correct Answer: A

Rationale: The correct answer is A: Perform hand hygiene. This should be the first intervention because it ensures patient safety by preventing the spread of infection. Before any patient interaction, proper hand hygiene is essential. Choice B, explaining the use of the mouthpiece, can come after hand hygiene to ensure aseptic technique. Choice C, instructing the patient to inhale slowly, is important but should come after the initial hand hygiene step. Choice D, placing the patient in the reverse Trendelenburg position, is not necessary for using an incentive spirometer and is not the priority at this time.

Correct Answer: D

Rationale: The correct answer is D: Atropine. In a patient with symptomatic bradycardia due to complete third-degree AV block, atropine should be avoided if possible because it works by blocking the parasympathetic nervous system, potentially worsening the AV block. The first-line treatment for symptomatic bradycardia with hypotension in this scenario is transcutaneous pacing or external temporary pacing. If atropine is ineffective or contraindicated, other options like dopamine, dobutamine, or epinephrine may be considered to support blood pressure until more definitive treatment can be initiated. Dopamine and dobutamine can help increase heart rate and improve cardiac output, while epinephrine can provide inotropic and chronotropic support. However, these medications should be used cautiously and in consultation with a specialist due to the risk of exacerbating the AV block.

Correct Answer: C

Rationale: The correct answer is C: Hydrocortisone. When epinephrine fails to improve hypotension in anaphylaxis, corticosteroids like hydrocortisone are indicated. Corticosteroids help reduce inflammation and stabilize blood vessels, which can aid in increasing blood pressure. Cimetidine (A) is an H2 receptor antagonist used for acid reflux, not for anaphylaxis. Albuterol (B) is a bronchodilator used for respiratory symptoms in anaphylaxis. Ipratropium (D) is an anticholinergic bronchodilator and not indicated for hypotension in anaphylaxis.

Correct Answer: C

Rationale: The correct answer is C: Kussmaul respirations. In diabetic ketoacidosis, the body attempts to compensate for the metabolic acidosis by increasing the respiratory rate and depth, leading to Kussmaul respirations characterized by deep, rapid, and labored breathing. This pattern helps to blow off excess CO2 and decrease the acidity in the blood. Bradypnea (A) is slow breathing, which is not characteristic of the compensatory response in diabetic ketoacidosis. Central neurogenic hyperventilation (B) involves rapid and deep breathing due to neurological issues, not commonly seen in diabetic ketoacidosis. Cheyne-Stokes respirations (D) are characterized by periods of deep breathing followed by periods of apnea, which is not typically associated with diabetic ketoacidosis.

Correct Answer: B

Rationale: Step 1: Chest pain that is not changed or relieved by oxygen therapy alone is a key indicator of acute myocardial infarction (MI). Step 2: In a suspected MI, the lack of improvement with oxygen therapy suggests a cardiac origin for the chest pain. Step 3: Oxygen therapy may alleviate chest pain related to respiratory issues, but not typically in cases of cardiac origin. Step 4: This lack of response to oxygen therapy indicates the need for further evaluation and treatment for a suspected MI. Summary: Choices A, C, and D are incorrect because they do not specifically address the characteristic of chest pain in relation to oxygen therapy, which is a crucial differentiating factor in identifying a potential acute MI.