Question

A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol n(ICS/LABA). For which of the following adverse effects should the nurse instruct the client to report to the provider?

Answer 1

Correct Answers:

White coating in the mouth

Rationale :

🔵Fluticasone/salmeterol is an inhaled corticosteroid (ICS) combined with a long-acting beta agonist (LABA), commonly prescribed for asthma management.

🔵ICS medications can cause local immunosuppression in the oropharyngeal area, leading to oral candidiasis (thrush), which appears as a white coating in the mouth.

🔵Clients should be instructed to rinse the mouth and gargle with water after each use to reduce the risk of fungal growth.

🔵If thrush develops, the client will need antifungal treatment such as nystatin or clotrimazole lozenges.

🔵Early reporting of this side effect is important to prevent worsening infection, pain, and difficulty swallowing.

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Answer 2

Correct Answers:

Tape the connections on the client's chest tube.

Rationale :

🔴Chest tube connections must be secured with tape to prevent accidental disconnection, which could cause air leaks or loss of negative pressure.

🔴Proper taping reduces the risk of infection and maintains an effective drainage system for removing air, blood, or fluid from the pleural space.

🔴A disconnected chest tube can lead to pneumothorax or tension pneumothorax, which are life-threatening complications.

🔴The drainage system should always remain below the level of the chest, and tubing should not be looped or dependent.

🔴Nursing management includes continuous monitoring for bubbling, tidaling, and secure placement of the tubing.

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Answer 3

Correct Answers:

Dyspnea
Clubbing of the fingers
Barrel chest

Rationale :

Dyspnea

🔷 Emphysema causes destruction of alveolar walls and loss of elastic recoil, which traps air and makes exhalation inefficient, producing persistent dyspnea even at rest.

🔷 Reduced surface area for gas exchange lowers diffusing capacity (DLCO), so patients feel breathless with minimal exertion.

🔷 Hyperinflation flattens the diaphragm, forcing greater work of breathing and recruitment of accessory muscles, intensifying the sensation of shortness of breath.

🔷 Prolonged expiratory phase and pursed‑lip breathing are compensatory patterns that reflect the struggle to expel trapped air.

🔷 Clinically, dyspnea is a hallmark sign of emphysema and helps differentiate chronic, progressive COPD physiology from acute conditions.

Clubbing of the fingers

🔷 Long‑standing emphysema can lead to chronic hypoxemia, which drives vascular and connective tissue changes in the distal digits, producing clubbing.

🔷 Increased capillary density and soft‑tissue hypertrophy at the nail bed create the characteristic loss of the nail angle and bulbous fingertips.

🔷 Clubbing signals prolonged oxygen deprivation, often paralleling disease severity and chronicity in advanced pulmonary disorders.

🔷 Its presence prompts vigilant monitoring for worsening gas exchange and evaluation of oxygen needs.

🔷 In a client with emphysema, clubbing is a supportive physical finding consistent with chronic hypoxia over time.

Barrel chest

🔷 Air trapping from alveolar collapse and narrowed small airways causes lung hyperinflation, increasing the anteroposterior (AP) diameter—the classic barrel chest.

🔷 Hyperinflation pushes the ribs outward and flattens the diaphragm, diminishing mechanical efficiency and raising the work of breathing.

🔷 The chest wall assumes a more fixed, expanded position, reflecting persistent overdistension from retained air.

🔷 Barrel chest often accompanies diminished breath sounds, hyperresonance to percussion, and a prolonged expiratory phase.

🔷 Recognizing this contour change confirms chronic obstructive physiology and helps track disease progression.

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Answer 4

Correct Answers:

Agitation

Rationale :

🟠Agitation is an early sign of hypoxemia, as low oxygen levels in the blood affect cerebral function.

🟠The brain is very sensitive to oxygen deprivation, leading to restlessness, anxiety, and irritability during asthma exacerbations.

🟠If untreated, hypoxemia can progress to confusion, lethargy, and eventually loss of consciousness.

🟠Identifying agitation promptly allows the nurse to initiate oxygen therapy and notify the provider to prevent deterioration.

🟠This sign is critical in asthma attacks, as it may precede respiratory failure.

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Answer 5

Correct Answers:

Nucleic acid amplification test (NAAT)

Rationale :

🟡The nucleic acid amplification test (NAAT) is the first-line diagnostic test for suspected tuberculosis due to its rapid detection ability.

🟡NAAT can confirm TB by identifying genetic material of Mycobacterium tuberculosis within a few hours.

🟡Early and accurate diagnosis allows for timely initiation of treatment, preventing disease progression and transmission.

🟡Compared to sputum culture, which can take weeks, NAAT provides faster results, which is vital in public health management.

🟡NAAT also helps in determining drug resistance patterns, guiding effective therapy choices.

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Answer 6

Correct Answers:

Tachycardia

Rationale :

🔵 Theophylline is a methylxanthine bronchodilator that can cause stimulation of the central nervous system and cardiovascular system.

🔵 One of the primary adverse effects is tachycardia, which may progress to arrhythmias if serum drug levels are too high.

🔵 The therapeutic range of theophylline is 5–15 mcg/mL, and toxicity often occurs above 20 mcg/mL.

🔵 Clients should be taught to monitor for symptoms such as palpitations, chest pain, or rapid heartbeat.

🔵 Nurses must stress the importance of regular blood level monitoring to avoid toxicity and serious cardiac complications.

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Answer 7

Correct Answers:

Place the client in a private room with a special ventilation system.

Rationale :

🟤Clients with active TB require airborne precautions, including placement in a negative pressure room with special ventilation.

🟤This system ensures that air from the room is filtered and not recirculated, preventing airborne spread of TB bacteria.

🟤Staff and visitors must use N95 respirators rather than standard masks for adequate protection.

🟤The private room prevents exposure of other clients, especially immunocompromised individuals, to airborne pathogens.

🟤Adhering to airborne precautions is a critical infection control measure to reduce community transmission.

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Answer 8

Correct Answers:

Assess the client's airway.

Rationale :

🟢The first priority after accidental extubation is to assess the client’s airway patency to determine if spontaneous breathing is adequate.

🟢Without airway assessment, interventions like reintubation or suctioning may be delayed, leading to hypoxemia and respiratory failure.

🟢Immediate assessment includes observing chest rise, auscultating breath sounds, and checking oxygen saturation.

🟢This approach follows the ABC (Airway, Breathing, Circulation) framework of emergency care.

🟢Once the airway status is known, the nurse can prepare for reintubation or provide supplemental oxygen as needed.

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Answer 9

Correct Answers:

Respiratory acidosis

Rationale :

🟠After unplanned extubation, the client may have impaired ventilation and inadequate CO₂ elimination, leading to respiratory acidosis.

🟠CO₂ retention increases carbonic acid levels, lowering blood pH.

🟠Clinical signs may include confusion, drowsiness, and hypoventilation as the imbalance worsens.

🟠Arterial blood gases (ABGs) would typically show elevated PaCO₂ and decreased pH, confirming the diagnosis.

🟠Rapid intervention, such as reintubation and assisted ventilation, is necessary to restore acid-base balance.

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Answer 10

Correct Answers:

Stridor

Rationale :

🔴Stridor is a high-pitched, harsh sound caused by upper airway obstruction, commonly heard after accidental extubation.

🔴It reflects narrowing or swelling of the trachea or larynx, which is a medical emergency.

🔴The presence of stridor indicates impaired airflow and risk for complete obstruction.

🔴This finding requires rapid provider notification and preparation for reintubation.

🔴Recognizing stridor early allows for timely airway management before hypoxemia worsens.

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RN Custom Exam 1 2025

No.

1 :
A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol n(ICS/LABA). For which of the following adverse effects should the nurse instruct the client to report to the provider?

2 :
A nurse is caring for a client who has a chest tube. Which of the following actions should the nurse take?

3 :
A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select All that Apply.)

4 :
A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

5 :
A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe which of the following diagnostic tests first?

6 :
A nurse is providing discharge instructions to a client who has asthma and is about to start taking a methylxanthine drug theophylline (Theo-2-The nurse should tell the client that this medication might cause which of the following adverse effects?

7 :
A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?

8 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. Which of the following actions should the nurse take first?

9 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube experiencing which of the following acid-base imbalances?

10 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. The nurse should document that the client has which of the following respiratory alterations?

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RN Custom Exam 1 2025

No.

1 : A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol n(ICS/LABA). For which of the following adverse effects should the nurse instruct the client to report to the provider?

2 : A nurse is caring for a client who has a chest tube. Which of the following actions should the nurse take?

3 : A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select All that Apply.)

4 : A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

5 : A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe which of the following diagnostic tests first?

6 : A nurse is providing discharge instructions to a client who has asthma and is about to start taking a methylxanthine drug theophylline (Theo-2-The nurse should tell the client that this medication might cause which of the following adverse effects?

7 : A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?

8 : A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. Which of the following actions should the nurse take first?

9 : A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube experiencing which of the following acid-base imbalances?

10 : A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. The nurse should document that the client has which of the following respiratory alterations?

1 :
A nurse is providing discharge teaching to a client who has asthma and a new prescription for fluticasone/salmeterol n(ICS/LABA). For which of the following adverse effects should the nurse instruct the client to report to the provider?

2 :
A nurse is caring for a client who has a chest tube. Which of the following actions should the nurse take?

3 :
A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (Select All that Apply.)

4 :
A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect?

5 :
A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe which of the following diagnostic tests first?

6 :
A nurse is providing discharge instructions to a client who has asthma and is about to start taking a methylxanthine drug theophylline (Theo-2-The nurse should tell the client that this medication might cause which of the following adverse effects?

7 :
A nurse is preparing for the admission of client who has suspected active tuberculosis. Which of the following precautions should the nurse plan to implement to safely care for this client?

8 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. Which of the following actions should the nurse take first?

9 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube experiencing which of the following acid-base imbalances?

10 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. The client pulls out his endotracheal tube. The nurse should document that the client has which of the following respiratory alterations?