✅ Pyrazinamide (PZA) is an antitubercular medication commonly used during the initial phase of tuberculosis treatment.

✅ A major adverse effect of pyrazinamide is hyperuricemia, because the drug can reduce renal excretion of uric acid.

✅ Increased uric acid levels may cause joint pain or gout-like symptoms in susceptible clients.

✅ Encouraging adequate fluid intake helps support renal excretion and reduces the risk of uric acid accumulation.

✅ Pyrazinamide can also cause hepatotoxicity, so liver function tests should be monitored during therapy.

✅ The client should report symptoms such as jaundice, dark urine, persistent nausea, severe fatigue, or right upper-quadrant pain.

✅ Alcohol should generally be avoided because it can increase the risk of liver injury.

✅ Therefore, among the options provided, instructing the client to increase fluid intake is the appropriate teaching.

Airway Obstruction — ✅ Correct

*️⃣ Airway obstruction can directly contribute to bronchiectasis because it interferes with the normal movement and clearance of respiratory secretions.

*️⃣ When a bronchus becomes partially or completely obstructed, mucus accumulates distal to the obstruction, creating an environment where bacteria can multiply.

*️⃣ Persistent mucus retention promotes recurrent respiratory infections and chronic inflammation within the affected bronchi.

*️⃣ Repeated inflammation damages the elastic tissue, smooth muscle, and structural components of the bronchial wall.

*️⃣ Progressive destruction causes the affected bronchi to become abnormally and permanently dilated, which is the hallmark of bronchiectasis.

*️⃣ Causes of obstruction can include foreign bodies, bronchial tumors, mucus plugs, airway stenosis, or external compression of a bronchus.

*️⃣ Obstruction commonly produces localized bronchiectasis, meaning the disease may be limited to the lung segment supplied by the obstructed bronchus.

*️⃣ Therefore, preventing or removing airway obstruction can help interrupt the cycle of mucus retention → infection → inflammation → permanent airway damage.

Pulmonary Infections — ✅ Correct

*️⃣ Severe or recurrent pulmonary infections are major causes of acquired bronchiectasis because they can permanently damage the bronchial walls.

*️⃣ Respiratory infections trigger an inflammatory response that can injure the bronchial epithelium and supporting tissues.

*️⃣ Once the airways are damaged, the normal mucociliary clearance mechanism becomes impaired, allowing mucus to remain in the bronchi.

*️⃣ Retained secretions then provide an ideal environment for additional bacterial growth, producing a destructive cycle of infection and inflammation.

*️⃣ Infections historically associated with bronchiectasis include severe pneumonia, tuberculosis, pertussis, measles-related pneumonia, and recurrent bacterial respiratory infections.

*️⃣ Clients with established bronchiectasis commonly develop chronic colonization with organisms such as Pseudomonas aeruginosa, which can further damage the airways.

*️⃣ Repeated infections gradually weaken the bronchial walls until they become irreversibly widened and distorted.

*️⃣ Therefore, preventing and promptly treating pulmonary infections is an important part of slowing the progression of bronchiectasis.

Genetic Disorders — ✅ Correct

*️⃣ Several inherited disorders predispose clients to bronchiectasis because they interfere with mucus clearance, immune defense, or normal ciliary function.

*️⃣ Cystic fibrosis is one of the most important genetic causes because abnormal chloride transport produces thick, sticky respiratory secretions.

*️⃣ Thick mucus obstructs the airways, traps microorganisms, and leads to repeated pulmonary infections and chronic inflammation.

*️⃣ Primary ciliary dyskinesia is another inherited disorder in which respiratory cilia cannot effectively move mucus out of the airways.

*️⃣ Poor ciliary movement causes persistent mucus retention and recurrent respiratory infections from early life.

*️⃣ Some inherited immunodeficiency disorders also increase susceptibility to repeated lung infections, which can progressively damage bronchial walls.

*️⃣ Over time, the combination of mucus retention, infection, and inflammation causes permanent bronchial dilation and structural destruction.

*️⃣ Therefore, identifying an underlying genetic disorder is important because treatment may require management of both the bronchiectasis and the underlying disease.

✅ The combination of sudden increased shortness of breath, oxygen saturation of 84%, asymmetrical chest movement, and decreased breath sounds on one side strongly suggests a pneumothorax.

✅ A pneumothorax occurs when air enters the pleural space, causing partial or complete collapse of the affected lung.

✅ Clients with COPD, especially emphysema, may have fragile pulmonary blebs or bullae that can rupture after forceful coughing and produce a secondary spontaneous pneumothorax.

✅ The decreased breath sounds on the right side indicate reduced ventilation of the right lung.

✅ Asymmetrical chest movement further supports unilateral lung collapse rather than a generalized COPD exacerbation.

✅ The oxygen saturation of 84% indicates significant hypoxemia, so supplemental oxygen should be administered immediately.

✅ The client requires close respiratory monitoring for worsening dyspnea, tachycardia, hypotension, tracheal deviation, or increasing respiratory distress, which could indicate progression to a tension pneumothorax.

✅ In actual clinical care, the nurse should also notify the healthcare provider immediately and prepare for interventions such as chest tube insertion if the pneumothorax is significant.

Level of consciousness — ✅ Correct

✅ Level of consciousness is a critical indicator of cerebral oxygenation in a client with acute respiratory failure.

✅ Hypoxemia can rapidly impair brain function, causing restlessness, confusion, agitation, lethargy, or decreased responsiveness.

✅ Changes in mental status may be one of the earliest signs that oxygen delivery to the brain is inadequate.

✅ Hypercapnia can also depress the central nervous system and lead to drowsiness, confusion, and eventually coma.

✅ Because the client is intubated, the nurse cannot rely on verbal reports of worsening dyspnea, making neurologic assessment especially important.

✅ Serial neurologic assessments help determine whether ventilatory support is improving oxygenation and carbon dioxide removal.

✅ A sudden decline in consciousness may indicate worsening respiratory failure, shock, intracranial injury, or another complication of the motor vehicle accident.

✅ Therefore, level of consciousness requires close and frequent monitoring.

Arterial blood gases — ✅ Correct

✅ Arterial blood gas (ABG) analysis is one of the most important assessments in acute respiratory failure because it directly evaluates oxygenation, ventilation, and acid-base status.

✅ The PaO₂ indicates how effectively oxygen is moving from the lungs into the bloodstream.

✅ The PaCO₂ reflects the client's ability to eliminate carbon dioxide through ventilation.

✅ An elevated PaCO₂ may indicate inadequate ventilation and can contribute to respiratory acidosis.

✅ A low PaO₂ indicates hypoxemia, which may require adjustment of oxygen concentration or ventilator settings.

✅ The pH and bicarbonate values help determine the severity and type of acid-base disturbance.

✅ Serial ABGs allow the healthcare team to evaluate the client's response to mechanical ventilation and oxygen therapy.

✅ Therefore, ABG results should be monitored closely in an intubated client with acute respiratory failure.

Vital signs — ✅ Correct

✅ Vital signs provide continuous information about the client's respiratory and cardiovascular stability.

✅ Respiratory rate and pattern can indicate increasing respiratory distress, ventilator problems, or deterioration in pulmonary function.

✅ Heart rate may increase in response to hypoxemia, pain, shock, or physiologic stress.

✅ Blood pressure must be monitored because chest trauma and respiratory failure can be associated with hemorrhage, shock, or tension pneumothorax.

✅ Oxygen saturation provides rapid information about the client's current oxygenation status.

✅ Temperature should also be monitored because infection may develop during ICU care, particularly in an intubated client.

✅ Sudden changes in blood pressure, heart rate, or oxygen saturation can signal a life-threatening complication requiring immediate intervention.

✅ Therefore, frequent vital-sign assessment is essential.

➡️ Teaching self-care and the prescribed therapeutic regimen has the greatest impact on preventing asthma-related readmissions because it directly affects how well the client manages the disease at home.

➡️ Clients need to know how and when to use controller medications, such as inhaled corticosteroids, and how to use rescue medications, such as albuterol.

➡️ Correct inhaler and spacer technique is essential because poor technique can significantly reduce medication delivery to the lungs.

➡️ Clients should be taught to recognize early signs of worsening asthma, including increased wheezing, coughing, chest tightness, nighttime symptoms, and increased rescue-inhaler use.

➡️ Following a written asthma action plan helps the client know when to increase treatment, contact the healthcare provider, or seek emergency care.

➡️ Avoiding or reducing exposure to known asthma triggers, such as smoke, allergens, respiratory irritants, and certain occupational exposures, can prevent exacerbations.

➡️ Adherence to the therapeutic regimen decreases the likelihood of uncontrolled airway inflammation, acute bronchospasm, emergency department visits, and hospital readmission.

➡️ Effective self-management gives the client the practical skills needed to maintain asthma control outside the hospital and respond promptly when symptoms begin to worsen.

✅ Beclomethasone is an intranasal corticosteroid commonly used to reduce inflammation in chronic rhinosinusitis and allergic rhinitis.

✅ Intranasal corticosteroids can cause dryness, irritation, and thinning of the nasal mucosa, which can make the tissue more fragile.

✅ Fragile nasal mucosa is more prone to epistaxis, especially when the spray is directed toward the nasal septum.

✅ Repeated exposure can increase local irritation and contribute to recurrent nosebleeds.

✅ Clients should be taught to aim the spray away from the nasal septum and toward the outer wall of the nostril.

✅ Gentle nasal hygiene and avoidance of excessive nose blowing can also help reduce irritation.

✅ Persistent or frequent epistaxis should be reported because the medication technique or treatment plan may need to be adjusted.

✅ Therefore, among the listed medications, beclomethasone places the client at the greatest risk for recurrent epistaxis.

➡️ Fluticasone propionate (Flovent) is an inhaled corticosteroid used as a controller medication for long-term asthma management.

➡️ It reduces airway inflammation, swelling, and mucus production, helping decrease the frequency and severity of asthma symptoms.

➡️ A portion of the inhaled corticosteroid can remain deposited in the mouth and throat after administration.

➡️ Residual corticosteroid can suppress local immune defenses and promote oral candidiasis (thrush).

➡️ Oral candidiasis can cause white patches, mouth soreness, burning, or difficulty swallowing.

➡️ The client should rinse the mouth thoroughly with water and spit it out after every dose of inhaled fluticasone.

➡️ Using a spacer device, when appropriate for the inhaler formulation, can also decrease medication deposition in the mouth and improve delivery to the lungs.

➡️ Fluticasone is intended for maintenance therapy and should not be used as the primary rescue medication during an acute asthma attack.

✅ Pulmonary function tests (PFTs) are a group of noninvasive tests used to evaluate how well the lungs are functioning.

✅ PFTs measure lung volumes and capacities, which show how much air the lungs can hold and how much air can be moved during breathing.

✅ They also assess ventilatory function, including how quickly and effectively a person can move air into and out of the lungs.

✅ Measurements such as forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁) are commonly obtained.

✅ The relationship between FEV₁ and FVC helps differentiate obstructive lung diseases, such as asthma and COPD, from restrictive patterns.

✅ PFTs can also evaluate the mechanics of breathing, including airflow resistance and the effectiveness of respiratory muscle function.

✅ Some PFTs include diffusing capacity testing (DLCO), which evaluates how effectively gases move from the alveoli into the blood.

✅ Therefore, describing PFTs as measuring lung volume, ventilatory function, and breathing mechanics provides the most complete explanation.

➡️ The client has signs of acute bronchospasm and respiratory distress, including wheezing, accessory-muscle use, and an SpO₂ of 91%.

➡️ A short-acting beta₂ agonist (SABA) such as albuterol is the preferred rescue medication for rapid bronchodilation.

➡️ SABAs stimulate beta₂ receptors in bronchial smooth muscle, causing the airways to relax and open.

➡️ Their onset is rapid, making them appropriate for acute wheezing and shortness of breath.

➡️ Improvement should include decreased wheezing, easier breathing, improved air movement, and rising oxygen saturation.

➡️ The nurse should continue to monitor respiratory rate, breath sounds, oxygen saturation, work of breathing, and heart rate after administration.

➡️ Common adverse effects include tachycardia, tremor, nervousness, and palpitations.

➡️ Because the client is showing immediate respiratory compromise, a rapid-acting bronchodilator is the priority medication class.

✅ A client with active pulmonary tuberculosis (TB) is considered potentially infectious while Mycobacterium tuberculosis organisms are being expelled in respiratory secretions.

✅ The best evidence that infectiousness has significantly decreased is repeated negative testing of sputum specimens for the organism.

✅ In clinical practice, discontinuation of airborne isolation commonly relies on three consecutive negative sputum AFB smears, collected appropriately, together with clinical improvement and effective therapy.

✅ Among the answer choices provided, three negative sputum cultures is the option that best reflects clearance of infectious organisms from respiratory secretions.

✅ A chest x-ray may remain abnormal even after the client is no longer infectious because radiographic changes can persist after successful treatment.

✅ Absence of symptoms does not guarantee that the client is no longer contagious because organisms may still be present in respiratory secretions.

✅ A TB skin test may remain positive for years or for life after infection and therefore is not used to determine whether a treated client remains infectious.

✅ The nurse should also reinforce adherence to the full antitubercular regimen to prevent relapse and drug-resistant TB.