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.
Computerized tomography (CT) scan of the chest
Albuterol treatments by nebulizer every 4 to 6 hours
Chest x-ray
Increase oral fluids
Arterial blood gas (ABG)
Correct Answer : B,C,D,E
Choice A rationale:
A computerized tomography (CT) scan of the chest is not typically required for routine pneumonia cases unless there are complications or the pneumonia is not responding to standard treatment. CT scans provide more detailed images but are usually reserved for more complex cases.
Choice B rationale:
Albuterol treatments by nebulizer every 4 to 6 hours are appropriate for managing wheezing and bronchospasm associated with pneumonia, especially in a patient with a history of COPD. Albuterol helps open the airways, making it easier for the patient to breathe.
Choice C rationale:
A chest x-ray is a standard diagnostic tool for pneumonia. It helps assess the extent of lung involvement and monitor the progression or resolution of the infection. Repeating the chest x-ray can help evaluate the effectiveness of the treatment.
Choice D rationale:
Increasing oral fluids is essential for patients with pneumonia to help thin mucus, making it easier to expectorate. Adequate hydration also supports overall health and recovery.
Choice E rationale:
Obtaining an arterial blood gas (ABG) is important for assessing the patient’s oxygenation and acid-base status. This information is crucial for managing respiratory distress and ensuring adequate oxygen delivery.
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View Related questions
Correct Answer is A
Explanation
Choice A rationale
Reported history of alcoholism is the most important assessment finding to address before administering terbinafine HCL. Terbinafine is metabolized by the liver, and clients with a history of alcoholism may have impaired liver function, increasing the risk of hepatotoxicity. Monitoring liver function and assessing for signs of liver damage are crucial before starting treatment.
Choice B rationale
Toenails appear thick and yellow is a common symptom of fungal toenail infection, but it is not the most critical assessment finding to address before administering terbinafine HCL. The focus should be on assessing liver function.
Choice C rationale
Employed as a construction worker is not the most critical assessment finding to address before administering terbinafine HCL. While occupational exposure to fungi may be relevant, the primary concern is liver function.
Choice D rationale
White blood cell count of 8,500/mm³ (8.5 x 10⁹/L) is within the normal range and is not the most critical assessment finding to address before administering terbinafine HCL. The primary concern is liver function.
Correct Answer is D
Explanation
Choice A rationale
Trouble sleeping is not directly relevant to the administration of pyridostigmine, which is used to improve muscle strength in myasthenia gravis.
Choice B rationale
Unexplained weight loss is not a primary concern when administering pyridostigmine. The focus should be on the patient’s ability to swallow and recent oral intake.
Choice C rationale
Difficulty with urination is not a primary concern for pyridostigmine administration. The medication’s effects on muscle strength and swallowing are more critical.
Choice D rationale
Recent oral intake is crucial to assess because pyridostigmine can cause gastrointestinal side effects, and food intake can affect its absorption and effectiveness.