A 74-year old female is admitted to the Emergency room with increasing dyspnea, productive cough, and fatigue.   Nurses’ Notes       1000: Client arrives in Emergency Department with worsening shortness of breath over the past week, strong productive cough with green-tinged sputum, and fatigue. Client has a history of  chronic obstructive pulmonary disease -emphysema; has been using their “relief” inhaler at home with no relief of symptoms. Client lives independently at home and states they smoke approximately 1 pack of cigarettes per day. Ambulatory, alert and oriented x 4. Has coarse crackles auscultated in bilateral lower lung fields with a barrel chest appearance, using accessory muscles, expiratory wheeze on auscultation. Client states they have “less room” to take a deep breath. Clubbing noted in all digits bilaterally.   1015: Client has increasing dyspnea, prefers to be sitting up in the chair. Requesting “rescue inhaler.” The provider has been notified. IV started. Ipratropium bromide and albuterol nebulizer treatment started.   Vital Signs       Time  1000 1015   Oral Temp  99.0 F (37.2 C 99.0 F (37.2 C   Pulse 104 108   Respiratory Rate 27 30   Blood Pressure 157/86 159/88   Pulse oximeter  91% room air 90% room air   Pain  0 0     Provider ordered Medications (ER):     Medication Dosage/Frequency/ Route   Ipratropium bromide and albuterol  3mL(0.5mg ipratropium bromide 2.5 mg albuterol) nebulizer treatment 4 x a day. First dose now.   Acetaminophen 500 mg x 1 PO  PRN for moderate to severe back pain   Methylprednisolone sodium succinate 40 mg IV push x 1 dose now   Amoxicillin/clavulanate  875 mg/ 125 mg PO every 12 hours   Albuterol sulfate 2.5 mg/3 ml nebulizer every 4 hours PRN Which medication do you anticipate that the nurse will give first?

After abdominal surgery, the client experiences a decrease in blood pressure, decreased level of consciousness, abdominal distention, and a decreased urinary output.  After calling the HCP (Health Care Provider), which order has the highest priority? 

The nurse is caring for a client with emphysema. Which of the following nursing interventions are appropriate? Select all that apply.

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mm Hg. Which condition does the ABG reflect?

The nurse is administering a purified protein derivative (PPD) test on a nursing home resident. Which statements about this test are correct? Select all that apply. 

The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission, and since that time the client has been on low intermittent suction. Upon review of the morning’s blood work, the nurse notices that the client’s potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance?

A client was stabbed in the anterior chest with a steak knife. The nurse observes that the client’s airway is patent, that there is a 2-cm laceration on his anterior chest; a sucking noise is coming from his chest wound. What is the priority action?

Harriet, 30 years old, has been admitted to the burn treatment center with full-thickness burns over 30% of her upper body. Her diagnosis is consistent with extracellular fluid volume deficit.  What symptoms would indicate to the nurse that the patient may be experiencing fluid volume deficit.  (Select all that apply)

An elderly client admitted with pneumonia and dementia has attempted several times to pull out the IV and Foley catheter. The nurse obtains a prescription for bilateral soft wrist restraints. Which nursing action is most appropriate?

The teaching plan for a client with acute sinusitis will need to include which of the following interventions? Select all that apply.