Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 6-year-old child with asthma is prescribed albuterol as a rescue inhaler for acute exacerbations. The nurse is educating the parents about the proper use of the inhaler. Which of the following instructions is most important for the nurse to provide?
A. Use the inhaler as needed during an asthma attack, but avoid overuse
Use the inhaler as needed during an asthma attack, but avoid overuse is correct. Albuterol is a short-acting beta-agonist (SABA) used as a rescue inhaler to relieve acute bronchospasm. It should be used during episodes of wheezing, coughing, or shortness of breath, but parents should be instructed not to overuse it, as excessive use can cause tachycardia, tremors, and decreased effectiveness. Monitoring frequency helps identify poorly controlled asthma that may require a review of the maintenance regimen.
B. Use the inhaler only when the child has difficulty breathing during physical activity
Use the inhaler only when the child has difficulty breathing during physical activity is partially correct, but limiting it to activity-induced symptoms alone ignores other potential triggers, such as allergens or infections, which can also precipitate asthma attacks. Rescue inhalers are intended for all acute exacerbations, not just activity-induced ones.
C. Use the inhaler every 4 hours as a preventative measure
Use the inhaler every 4 hours as a preventative measure is incorrect. Albuterol is not a maintenance or preventive medication; daily scheduled use is not recommended unless prescribed for specific short-term prophylaxis (e.g., before exercise). Long-term control requires inhaled corticosteroids or other controller medications, not a SABA.
D. Limit the use of the inhaler to prevent dependency on the medication
Limit the use of the inhaler to prevent dependency on the medication is incorrect. Albuterol does not cause drug dependency, but overuse can indicate poor asthma control. The focus should be on appropriate use for symptom relief rather than fear of dependency.
This question is an excerpt from Nurse Dive's nursing test bank - Ati dmmsn 650 OB/Pediatrics Proctored Exams. Take the full exam now
Full Explanation
A. Use the inhaler as needed during an asthma attack, but avoid overuse is correct. Albuterol is a short-acting beta-agonist (SABA) used as a rescue inhaler to relieve acute bronchospasm. It should be used during episodes of wheezing, coughing, or shortness of breath, but parents should be instructed not to overuse it, as excessive use can cause tachycardia, tremors, and decreased effectiveness. Monitoring frequency helps identify poorly controlled asthma that may require a review of the maintenance regimen.
B. Use the inhaler only when the child has difficulty breathing during physical activity is partially correct, but limiting it to activity-induced symptoms alone ignores other potential triggers, such as allergens or infections, which can also precipitate asthma attacks. Rescue inhalers are intended for all acute exacerbations, not just activity-induced ones.
C. Use the inhaler every 4 hours as a preventative measure is incorrect. Albuterol is not a maintenance or preventive medication; daily scheduled use is not recommended unless prescribed for specific short-term prophylaxis (e.g., before exercise). Long-term control requires inhaled corticosteroids or other controller medications, not a SABA.
D. Limit the use of the inhaler to prevent dependency on the medication is incorrect. Albuterol does not cause drug dependency, but overuse can indicate poor asthma control. The focus should be on appropriate use for symptom relief rather than fear of dependency.
Similar Questions
A nurse is discussing growth with the parents of a 6-month-old infant who weighed 7 lbs at birth. Which statement best reflects the expected weight at this age?
A. "Your baby should weigh about 15 lbs by now."
"Your baby should weigh about 15 lbs by now" is correct. When discussing infant growth, nurses refer to standard pediatric growth milestones, which indicate that a healthy, full-term infant typically doubles their birth weight by 4–6 months and triples it by 12 months. Since this infant weighed 7 lbs at birth, the expected weight at 6 months would be approximately 14 lbs, making “about 15 lbs” an accurate and reassuring estimate. This reflects adequate nutrition and normal metabolic development.
B. "Your baby should weigh about 25 lbs by now."
"Your baby should weigh about 25 lbs by now" is incorrect because this weight is significantly above the expected range for a 6-month-old. A 25-lb infant at this age would be unusual and could suggest measurement error or a rare growth disorder.
C. "Your baby should weigh about 20 lbs by now."
"Your baby should weigh about 20 lbs by now" is incorrect because 20 lbs corresponds to an older infant, likely 12–15 months old, and is too high for a 6-month-old who weighed 7 lbs at birth.
D. "Your baby should weigh about 10 lbs by now."
"Your baby should weigh about 10 lbs by now" is incorrect because 10 lbs is less than double the birth weight. If a 6-month-old weighed only 10 lbs, it could indicate growth delay, malnutrition, or other underlying health concerns, requiring further assessment.
Full Explanation
A. "Your baby should weigh about 15 lbs by now" is correct. When discussing infant growth, nurses refer to standard pediatric growth milestones, which indicate that a healthy, full-term infant typically doubles their birth weight by 4–6 months and triples it by 12 months. Since this infant weighed 7 lbs at birth, the expected weight at 6 months would be approximately 14 lbs, making “about 15 lbs” an accurate and reassuring estimate. This reflects adequate nutrition and normal metabolic development.
B. "Your baby should weigh about 25 lbs by now" is incorrect because this weight is significantly above the expected range for a 6-month-old. A 25-lb infant at this age would be unusual and could suggest measurement error or a rare growth disorder.
C. "Your baby should weigh about 20 lbs by now" is incorrect because 20 lbs corresponds to an older infant, likely 12–15 months old, and is too high for a 6-month-old who weighed 7 lbs at birth.
D. "Your baby should weigh about 10 lbs by now" is incorrect because 10 lbs is less than double the birth weight. If a 6-month-old weighed only 10 lbs, it could indicate growth delay, malnutrition, or other underlying health concerns, requiring further assessment.
A school-age child with sickle cell anemia is admitted with a vaso-occlusive crisis. Which nursing action should the nurse prioritize to effectively manage this acute complication and prevent further morbidity?
A. Promote bed rest without additional pain interventions to allow natural resolution of the crisis.
Promote bed rest without additional pain interventions to allow natural resolution of the crisis is incorrect. While rest can help conserve energy, pain management is a priority in vaso-occlusive crises. Unmanaged pain can lead to stress-induced complications, prolonged hospital stays, and decreased oxygenation, which may worsen sickling.
B. Limit fluid intake to prevent fluid overload and minimize risk of pulmonary edema during the crisis.
Limit fluid intake to prevent fluid overload and minimize risk of pulmonary edema during the crisis is incorrect. Hydration is critical during a vaso-occlusive crisis because dehydration increases blood viscosity and promotes further sickling. Limiting fluids can exacerbate the crisis rather than help it.
C. Administer prescribed opioids promptly and encourage oral hydration as tolerated to manage pain and reduce sickling episodes.
Administer prescribed opioids promptly and encourage oral hydration as tolerated to manage pain and reduce sickling episodes is correct. Prompt administration of opioids (e.g., morphine or hydromorphone) addresses the severe pain associated with vaso-occlusive crises, while hydration helps maintain blood volume and decreases the likelihood of additional sickling. These interventions are central to reducing morbidity and preventing complications such as organ damage or prolonged hypoxia.
D. Delay opioid administration to assess the child's pain threshold and avoid potential opioid dependence.
Delay opioid administration to assess the child's pain threshold and avoid potential opioid dependence is incorrect. Pain should be treated promptly in vaso-occlusive crises. Delaying analgesia increases suffering, can worsen hypoxia, and may lead to more severe complications. Concerns about long-term opioid dependence are secondary to immediate pain control and patient safety.
Full Explanation
A. Promote bed rest without additional pain interventions to allow natural resolution of the crisis is incorrect. While rest can help conserve energy, pain management is a priority in vaso-occlusive crises. Unmanaged pain can lead to stress-induced complications, prolonged hospital stays, and decreased oxygenation, which may worsen sickling.
B. Limit fluid intake to prevent fluid overload and minimize risk of pulmonary edema during the crisis is incorrect. Hydration is critical during a vaso-occlusive crisis because dehydration increases blood viscosity and promotes further sickling. Limiting fluids can exacerbate the crisis rather than help it.
C. Administer prescribed opioids promptly and encourage oral hydration as tolerated to manage pain and reduce sickling episodes is correct. Prompt administration of opioids (e.g., morphine or hydromorphone) addresses the severe pain associated with vaso-occlusive crises, while hydration helps maintain blood volume and decreases the likelihood of additional sickling. These interventions are central to reducing morbidity and preventing complications such as organ damage or prolonged hypoxia.
D. Delay opioid administration to assess the child's pain threshold and avoid potential opioid dependence is incorrect. Pain should be treated promptly in vaso-occlusive crises. Delaying analgesia increases suffering, can worsen hypoxia, and may lead to more severe complications. Concerns about long-term opioid dependence are secondary to immediate pain control and patient safety.
A newborn is suspected of having esophageal atresia with tracheoesophageal fistula (TEF). Which clinical finding would most strongly support this diagnosis?
A. Excessive oral secretions, coughing, and cyanosis during feeding
Excessive oral secretions, coughing, and cyanosis during feeding is correct. These are classic signs of esophageal atresia with tracheoesophageal fistula (TEF). TEF results in an abnormal connection between the trachea and esophagus, causing ingested fluids to enter the airway. This leads to choking, coughing, cyanosis, and excessive drooling, especially during feeding. Early recognition is critical to prevent aspiration and respiratory complications.
B. Poor suck reflex and hypotonia
Poor suck reflex and hypotonia is incorrect because these findings are associated with neurologic or metabolic disorders, not TEF. While feeding difficulties may occur, they do not specifically indicate a fistula between the trachea and esophagus.
C. Projectile vomiting with blood-tinged emesis
Projectile vomiting with blood-tinged emesis is incorrect because this is more characteristic of pyloric stenosis or upper gastrointestinal bleeding, not TEF. TEF primarily affects swallowing and airway protection, not gastric emptying.
D. Bilious vomiting with abdominal distension
Bilious vomiting with abdominal distension is incorrect because these signs suggest intestinal obstruction, such as malrotation or intestinal atresia, rather than TEF.
Full Explanation
A. Excessive oral secretions, coughing, and cyanosis during feeding is correct. These are classic signs of esophageal atresia with tracheoesophageal fistula (TEF). TEF results in an abnormal connection between the trachea and esophagus, causing ingested fluids to enter the airway. This leads to choking, coughing, cyanosis, and excessive drooling, especially during feeding. Early recognition is critical to prevent aspiration and respiratory complications.
B. Poor suck reflex and hypotonia is incorrect because these findings are associated with neurologic or metabolic disorders, not TEF. While feeding difficulties may occur, they do not specifically indicate a fistula between the trachea and esophagus.
C. Projectile vomiting with blood-tinged emesis is incorrect because this is more characteristic of pyloric stenosis or upper gastrointestinal bleeding, not TEF. TEF primarily affects swallowing and airway protection, not gastric emptying.
D. Bilious vomiting with abdominal distension is incorrect because these signs suggest intestinal obstruction, such as malrotation or intestinal atresia, rather than TEF.