The nurse would question an order for ipratropium bromide (Atrovent) ordered for a client with asthma if the client had which concurrent medical history?

Correct Answer: A

Rationale: Glaucoma (A) contraindicates ipratropium (Atrovent), per document (1). This anticholinergic dilates pupils (mydriasis), raising intraocular pressure (e.g., >21 mmHg) in narrow-angle glaucoma, risking vision loss. Cushing's (B) is unrelated steroid issue. Warfarin (C) or fluid retention (D) don't interact. A's risk 10% incidence demands caution, unlike B's metabolic focus, per pharmacology texts.

Correct Answer: C

Rationale: During inhalation, diaphragm and intercostal contraction expand the chest, increasing thoracic volume. This decreases alveolar (intrapulmonary) pressure below atmospheric (e.g., -1 mmHg), pulling air in, and intrapleural pressure drops (e.g., -6 mmHg from -4 mmHg), keeping lungs adherent to the chest wall. Both pressures decreasing aligns with ventilation mechanics pressure drops drive airflow and lung expansion. Other options misalign: increased intrapleural pressure would collapse lungs; increased alveolar pressure occurs in exhalation. This dual decrease ensures efficient inspiration, a core principle in breathing dynamics, critical for understanding lung function and disorders like restrictive diseases altering pressure gradients.

Correct Answer: B

Rationale: Beclomethasone (Beclovent), an inhaled corticosteroid, reduces inflammation in COPD airways, easing breathing by decreasing mucosal swelling and mucus production, which obstruct airflow. It doesn't prevent airway dilation (A) that's counterproductive; it enhances beta-agonist responsiveness, dilating airways indirectly. While it suppresses immunity (C), this isn't the primary therapeutic goal reducing inflammation is. It doesn't decrease responsiveness to bronchodilators (D); it may enhance it. The exact mechanism is unclear, but its anti-inflammatory action targets chronic airway irritation, a hallmark of COPD, distinct from bronchodilators' immediate relief. This explanation aligns with patient education, emphasizing improved airflow over side effects, critical for adherence and understanding treatment's role in managing COPD's progressive obstruction.

Correct Answer: D

Rationale: Knowing to call the physician if dyspnea on exertion increases (D) is an appropriate outcome for a COPD client post-discharge. Worsening dyspnea signals potential exacerbation or hypoxia, requiring medical review empowering self-monitoring enhances safety. Promises (A) aren't measurable outcomes; pursed-lip breathing is a means, not a goal. Pain (B) isn't typical in COPD unless complicated focus is respiratory. High-flow oxygen at 5 L/minute (C) risks CO2 retention in COPD; 1-2 L/minute is standard to avoid suppressing hypoxic drive. Option D reflects understanding of disease progression, critical for home management and preventing readmission, a key nursing education goal.

Correct Answer: B

Rationale: Giving an ordered bronchodilator by nebulizer (B) is the first action for this 19-year-old in acute asthma distress respiratory rate 44 breaths/minute signals severe bronchoconstriction needing immediate reversal. Nebulized albuterol opens airways fast, easing distress and preventing hypoxia, a life-saving priority. Medication history (A) delays critical intervention details can wait. Cardiac monitoring (C) assesses tachycardia but doesn't treat the cause. Emotional support (D) is secondary to airway management. In ED nursing, bronchodilators address the acute obstruction wheezing, dyspnea key to stabilizing the client before further steps.