RN Nursing · Bronchodilator and Anti-Inflammatory Respiratory Medications · Practice question
A nurse is caring for a client who is postoperative following an appendectomy. Select words from the choices below to fill in each blank in the following sentence. The nurse should plan to administer ____ and ____ to the client
Nurses' Notes
Day 1:
Bilateral breath sounds are clear and present throughout. Client reports pain as 2 on a scale of 0 to 10. Abdomen soft, nondistended, bowel sounds hypoactive. Client has a history of asthma.
Day 2:
Respirations rapid and shallow. Bilateral breath sounds with scattered wheezing. Client reports pain as 8 on a scale of 0 to 10. Client denies nausea and constipation. Abdomen soft, nondistended, bowel sounds audible.
Vital Signs
Day 1:
Temperature 37.2°C (99°F)
Heart rate 66/min
Respiratory rate 16/min
Blood pressure 124/56 mm Hg
Oxygen saturation 95% on room air
Day 2:
Temperature 37.2°C (99°F)
Heart rate 112/min
Respiratory rate 28/min
Blood pressure 148/86 mm Hg
Oxygen saturation 90% on room air
Medication Administration Record
Albuterol 2 inhalations every 4 to 6 hr PRN wheezing Bisacodyl 10 mg suppository daily PRN constipation Prochlorperazine 10 mg PO 3 to 4 times per day PRN nausea Morphine 4 mg IV bolus every 4 hr PRN severe pain Acetaminophen 325 to 650 mg every 4 to 6 hr PRN pain or temperature greater than 38.4° C (101.1°F)
Answer & explanation
Correct:
On Day 2, the client presents with two major problems that drive medication selection: an acute asthma exacerbation and severe pain. The client has a history of asthma, and today's assessment reveals rapid, shallow respirations, bilateral scattered wheezing, a respiratory rate of 28/min, heart rate of 112/min, and oxygen saturation of 90% — all signs of bronchospasm and respiratory distress. The MAR includes albuterol 2 inhalations every 4–6 hours PRN wheezing, which is the appropriate bronchodilator to address the wheezing and hypoxia immediately. The client also reports pain rated 8 out of 10, qualifying as severe pain. The MAR includes morphine 4 mg IV PRN severe pain, which is the appropriate analgesic for this level of pain. Bisacodyl is not indicated because the client denies constipation. Prochlorperazine is not indicated because the client denies nausea. Acetaminophen is used for mild-to-moderate pain or fever, and is not indicated here given the pain score of 8 and absence of fever. Therefore, albuterol addresses the acute bronchospasm, and morphine addresses the severe postoperative pain — both are clinically justified by the current assessment findings and the PRN criteria in the MAR.
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