A nurse is reinforcing discharge teaching with a client following an episode of status asthmaticus. The client has a prescription for two inhalations from an albuterol metered-dose inhaler. Which of the following statements by the client indicates an understanding of the teaching?
"I will hold the inhaler with my non-dominant hand."
"I will tilt my head forward while inhaling the medication."
"I will hold my breath at least 10 seconds after inhaling the medication."
"I will wait 10 min between each inhalation.
The Correct Answer is C
A. "I will hold the inhaler with my non-dominant hand.": The hand used to hold the inhaler is not as important as the technique for inhaling the medication.
B. "I will tilt my head forward while inhaling the medication.": The head should be in a neutral or slightly tilted back position to ensure proper inhalation of the medication.
C. "I will hold my breath at least 10 seconds after inhaling the medication." Holding the breath for at least 10 seconds allows the medication to be deposited more effectively in the airways, increasing its therapeutic effect.
D. "I will wait 10 min between each inhalation.": The correct time to wait between puffs is usually about 1-2 minutes, not 10 minutes.
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Correct Answer is A
Explanation
A. Maintain the drainage container below the level of the client's chest. Keeping the drainage container below the level of the client's chest allows gravity to assist in draining fluid or air from the pleural space and prevents backflow into the chest.
B. Add tap water as needed to the suction control chamber: This is incorrect; sterile water should be used, not tap water, to prevent contamination.
C. Clamp the chest tubes if it becomes disconnected: This is not recommended as clamping can create a tension pneumothorax. Instead, the nurse should use a sterile gauze to cover the site and notify the provider.
D. Empty the collection container every shift: The collection container should be emptied as needed, not on a set schedule, to ensure proper function and accurate measurement of drainage.
Correct Answer is C
Explanation
A. "It delivers the highest concentration of oxygen possible." This is inaccurate; other methods (like non-rebreather masks) deliver higher concentrations.
B. "It delivers a specific concentration of oxygen constantly." While it does provide a specific concentration, it is not as constant as other devices because it can vary based on the client's breathing patterns.
C. "It delivers the low concentration of oxygen you need." A nasal cannula typically delivers a low concentration of oxygen (approximately 24-44% oxygen depending on the flow rate), which is appropriate for clients who need supplemental oxygen but do not require a high concentration.
D. "It allows you to remove it for a while when it gets uncomfortable." This is misleading; while the client can remove it temporarily, it is essential to maintain oxygen therapy as prescribed for adequate oxygenation.