Practice Question
A client is being treated in the ED for respiratory distress coupled with bacterial pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs?
Answer Choices:
Correct Answer:
Administration of corticosteroids and bronchodilators
Rationale:
🟢 The client is in respiratory distress with a background of coal exposure and smoking, suggesting possible underlying reactive airway or obstructive lung disease on top of pneumonia.
🟢 Bronchodilators help open narrowed airways, reduce wheezing and airflow limitation, and rapidly improve ventilation.
🟢 Corticosteroids decrease airway inflammation and edema, which can also worsen respiratory distress in the setting of infection and irritant exposure.
🟢 In an acute situation, improving airway patency and gas exchange is the immediate priority before or alongside other treatments.
🟢 Therefore, these medications address the client’s most urgent need: impaired breathing.
Completion of a 12-lead ECG.
🟢 A 12-lead ECG is helpful to evaluate cardiac function and exclude cardiac causes of dyspnea, such as ischemia.
🟢 However, this client’s primary problem is respiratory distress with pneumonia and known inhalation exposures.
🟢 An ECG does not directly treat or rapidly improve oxygenation or ventilation.
🟢 While it may be ordered, it is not the highest priority in the immediate stabilization of breathing.
🟢 The ABCs prioritize airway and breathing before detailed cardiac diagnostic testing.
Administration of antibiotics.
🟢 Antibiotics are essential in treating bacterial pneumonia and should be started promptly.
🟢 However, they do not provide immediate relief of respiratory distress because they take time to reduce bacterial load and inflammation.
🟢 In the acute phase, the greatest threat is impaired gas exchange, not the slow-acting bacterial process itself.
🟢 The nurse must first focus on immediate stabilization with respiratory support.
🟢 Therefore, while antibiotics are critical, they are not the single most urgent “immediate needs” intervention in this list.
Client education; avoidance of irritants.
🟢 Education about avoiding smoke and pollutants is important for long-term management and prevention of further lung damage.
🟢 However, this is clearly a health promotion and chronic care measure, not an acute stabilization intervention.
🟢 In respiratory distress, teaching is not the priority; maintaining airway and breathing is.
🟢 Client education can be done after the client’s condition has stabilized.
🟢 Therefore, this intervention is low priority compared with medications that improve airway function.
Want to practice more questions like this?
This question is from Custom Concept Quiz 2 which contains 40 questions.
More Questions from This Exam
A nurse is planning care for a client who has quadriplegia. Which of the following actions should the nurse take to prevent a pulmonary embolism (PE)?(Select all that apply.)
Answer Choices:
A nurse is performing chest physiotherapy on a client who has a respiratory infection. To help with the removal of the secretions of the respiratory system, which of the following techniques should the nurse use?
Answer Choices:
A nurse in the post-anesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to?
Answer Choices:
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.)
Answer Choices:
A nurse is assessing a client who has a long history of smoking and is suspected of having laryngeal cancer. The nurse should anticipate that the client will report that her earliest manifestation was
Answer Choices:
Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Custom Exam(s)
- Answer Choices: 4