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A client who has had a laryngectomy and tracheostomy frequently expectorates copious amounts of purulent secretions. When changing the ties of the tracheostomy tube, which action is most important for the nurse to take?

The antitubercular drug isoniazid is prescribed for a client with active tuberculosis. To evaluate the effectiveness of this medication, which outcome can the nurse expect this client to exhibit?

A client diagnosed with chronic obstructive pulmonary disease (COPD) is given a new prescription for tiotropium via an inhalation device. Which statement indicates the client understands the instructions for using this medication?

A nurse is caring for a 76-year-old male client in the medical unit

History and Physical

The client is a 76-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension. He presented to the emergency department with a 3-day history of productive cough, fever, and shortness of breath. He has a 40-pack-year smoking history and lives alone. He denies recent travel or sick contacts.

Nurses’ Notes

Day 1, 1800: The client was admitted to the medical unit with suspected pneumonia. Crackles were auscultated bilaterally in the lower lung fields, and breath sounds were diminished. A saline infusion was initiated at 50 mL/hour. Vancomycin IV piggyback (IVPB) was started. Sputum and blood cultures were obtained and sent to the lab.

Diagnostic Results

Day 2: Sputum culture positive for pneumococcus. Chest x-ray showed focal consolidation in the bilateral lower lobes, suggestive of pneumonia.

Vital Signs

• Temperature: 38.5°C
• Heart Rate: 110 bpm
• Respiratory Rate: 24 breaths/min
• Blood Pressure: 150/90 mmHg
• Oxygen Saturation: 88% on room air

Physical Examination Results

On physical examination, the client appeared in moderate respiratory distress. He had crackles bilaterally in the lower lung fields and diminished breath sounds throughout. His skin was warm and diaphoretic. He was using accessory muscles to breathe and had a productive cough with greenish sputum.

Provider’s Prescriptions

• Continue saline infusion at 50 mL/hour
• Discontinue vancomycin
• Start ceftriaxone 1g IV every 24 hours
• Albuterol treatments by nebulizer every 4 to 6 hours
• Increase oral fluids
• Obtain arterial blood gas (ABG)

Imaging Studies

Chest x-ray showed focal consolidation in the bilateral lower lobes, suggestive of pneumonia.

Question: Which of the following does the nurse anticipate the healthcare provider to prescribe during morning rounds? Select 4 findings.

A client who is experiencing respiratory distress is admitted with respiratory acidosis. Which pathophysiological process supports the client’s respiratory acidosis?

The client with Clostridium difficile in the stool receives a prescription for vancomycin PO. Which action should the nurse take before administering the first dose?

The nurse is caring for a client who is taking diclofenac for rheumatoid arthritis. During a clinic visit, the client appears pale and reports increasing fatigue. Which of the client’s serum laboratory values is most important for the nurse to review?

Exhibit 1: History and Physical

The client is a 51-year-old male admitted to the medical floor with a diagnosis of pneumonia. He reports a 3-day history of productive cough, shortness of breath, and fever. He also mentions increased fatigue and weakness over the last week. The client has a history of hypertension, which is controlled with enalapril 10 mg daily. His surgical history includes adenoidectomy at age 5 and surgical repair of a fractured femur at age 20. The client takes a multivitamin daily and has no known allergies. He is a non-smoker and reports occasional alcohol use.

Exhibit 2: Nurse's Notes (0800)

At 0800, the client was alert but appeared fatigued and short of breath. His oxygen saturation was 89% on room air, and he was placed on supplemental oxygen at 10 L/min via nasal cannula, which improved his saturation to 94%. The client stated, “I feel tired and weak, and it’s hard to breathe.” His skin was warm to the touch, and he had a productive cough with thick, yellow sputum. He reported a headache and body aches, rating his pain as 4/10. The client denied chest pain but reported feeling feverish throughout the night. His capillary refill was less than 3 seconds, and lung sounds were diminished with crackles heard bilaterally.

Exhibit 3: Vital Signs

• Time: 0800
• Temperature: 101.2°F (38.4°C)
• Pulse: 112 beats per minute
• Respiratory Rate: 28 breaths per minute
• Blood Pressure: 150/92 mmHg
• Oxygen Saturation: 89% on room air, 94% on 10 L/min nasal cannula

Exhibit 4: Physical Examination Results

Upon physical examination, the client appeared ill and was in mild respiratory distress, with shallow and rapid breathing. His skin was warm and flushed, and he was diaphoretic. Lung auscultation revealed bilateral crackles in the lower lobes, more pronounced on the right side. There were no wheezes or rhonchi noted. His heart sounds were regular, but tachycardia was present. The client’s abdomen was soft and non-tender with normal bowel sounds. No edema was noted in the extremities, and there were no visible rashes or skin abnormalities. The client’s capillary refill was normal, and neurological assessment showed no focal deficits.

Exhibit 5: Provider's Prescriptions

1. Admit to the medical floor
2. Vital signs every 4 hours
3. Continuous pulse oximetry
4. Supplemental oxygen 10 L/min via nasal cannula
5. Enalapril 10 mg PO every morning
6. Ibuprofen 400 mg PO every 4 to 6 hours PRN for temperature greater than 100.5°F (38.0°C)
7. Send blood for complete blood count and electrolytes
8. Chest X-ray now

Question: Which of the following provider's prescriptions would the nurse question? Select all that apply.

The nurse is preparing a teaching plan for a group of well-educated clients who were found to be HIV positive within the last year. The nurse should explain that the human immunodeficiency virus (HIV) acts in which way to suppress the immune system?

To assess the quality of an adult client’s pain, which approach should the nurse use?

An adult client is admitted with AIDS and oral Candida albicans manifested by several painful mouth ulcers. The nurse delegates to the assistive personnel (AP) and discusses how to assist the client. Which instruction should the nurse provide?