A nurse is caring for a client following a bronchoscopy with moderate sedation. Which of the following actions should the nurse take? (Select all that apply.)
Assess the client’s gag reflex before offering oral intake.
Listen to the client’s breath sounds.
Monitor the client’s oxygen saturation.
Monitor the client for manifestations of bleeding.
Assess the client’s puncture site.
Observe the client for manifestations of a pneumothorax.
Correct Answer : A,B,C,D,F
Choice A rationale
Assessing the client’s gag reflex before offering oral intake is essential to prevent aspiration. The gag reflex may be diminished after moderate sedation and the use of local anesthetics during bronchoscopy.
Choice B rationale
Listening to the client’s breath sounds is important to detect any abnormalities, such as wheezing, crackles, or decreased breath sounds, which could indicate complications like bronchospasm or pneumothorax.
Choice C rationale
Monitoring the client’s oxygen saturation is crucial to ensure adequate oxygenation and detect any signs of respiratory distress or hypoxemia following the procedure.
Choice D rationale
Monitoring the client for manifestations of bleeding is necessary because bronchoscopy can cause trauma to the airways, leading to bleeding. Signs of bleeding may include hemoptysis or a drop in hemoglobin levels.
Choice E rationale
Assessing the client’s puncture site is not applicable in this context, as bronchoscopy does not involve a puncture site. This option is incorrect.
Choice F rationale
Observing the client for manifestations of a pneumothorax is important because bronchoscopy can occasionally cause a pneumothorax, especially if a biopsy is performed. Signs of pneumothorax include sudden chest pain, dyspnea, and decreased breath sounds on the affected side. .
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Correct Answer is ["A","B","C"]
Explanation
Choice A rationale
Peripheral edema is a common adverse effect of verapamil. It occurs due to the vasodilatory effects of the medication, which can cause fluid retention in the extremities.
Choice B rationale
Bradycardia is an adverse effect of verapamil. It occurs because verapamil slows down the heart rate by blocking calcium channels in the heart.
Choice C rationale
Constipation is a common adverse effect of verapamil. It occurs due to the medication’s effect on smooth muscle relaxation, which can slow down gastrointestinal motility.
Choice D rationale
Reports of blurred vision are not a common adverse effect of verapamil. Blurred vision is not typically associated with this medication.
Choice E rationale
Reports of insomnia are not a common adverse effect of verapamil. Insomnia is not typically associated with this medication.
Correct Answer is A
Explanation
Choice A rationale
Benzonatate is a non-narcotic cough suppressant that works by numbing the throat and lungs, making the cough reflex less active. It can cause drowsiness and dizziness, so patients are advised not to drive or operate heavy machinery while taking this medication.
Choice B rationale
Benzonatate does not help in coughing up mucus. It suppresses the cough reflex, which can be beneficial for dry, irritating coughs but is not suitable for productive coughs where mucus needs to be expelled.
Choice C rationale
There is no need to decrease dietary fiber intake while taking benzonatate. Dietary fiber does not interact with the medication or its effectiveness.
Choice D rationale
Benzonatate capsules should not be chewed or crushed, as this can cause numbness of the mouth and throat, leading to potential choking hazards.