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 B
Explanation
Choice A rationale
Decreasing speaking speed may help with clarity, but it does not address the issue of hearing loss.
Choice B rationale
Over-enunciating word syllables can help the client understand speech better, especially if they have hearing difficulties. This technique makes it easier for the client to read lips and understand spoken words.
Choice C rationale
Raising voice volume to a shout can be uncomfortable and may not improve understanding. It can also be perceived as rude or aggressive.
Choice D rationale
Exaggerating nonverbal expressions may help with communication, but it is not as effective as over-enunciating word syllables for clients with hearing difficulties.
Correct Answer is ["A","D"]
Explanation
Choice A rationale:
Enalapril is an ACE inhibitor used to manage hypertension. While it is generally safe, in the context of pneumonia, it can potentially cause complications such as hypotension, especially if the patient becomes septic or dehydrated. Additionally, ACE inhibitors can cause a persistent cough, which might be confused with or exacerbate the symptoms of pneumonia.
Choice B rationale:
Admitting the patient to the medical floor is appropriate given the diagnosis of pneumonia and the patient’s symptoms. Hospitalization allows for close monitoring and administration of necessary treatments.
Choice C rationale:
Sending blood for a complete blood count and electrolytes is standard practice to assess the patient’s overall health and identify any potential complications such as electrolyte imbalances or infection severity.
Choice D rationale:
Supplemental oxygen at 10 L/min via nasal cannula is quite high and typically not the first choice for pneumonia patients. High-flow oxygen therapy or non-invasive ventilation might be more appropriate if the patient requires such high levels of oxygen. Generally, nasal cannulas are used for lower flow rates (up to 6 L/min), and higher flow rates can cause discomfort and nasal dryness.
Choice E rationale:
Ibuprofen is commonly used to manage fever and pain in pneumonia patients. It helps reduce fever and alleviate discomfort, which can improve the patient’s overall condition.
Choice F rationale:
Continuous pulse oximetry is appropriate for monitoring the patient’s oxygen saturation levels, especially given the initial low oxygen saturation on room air.
Choice G rationale:
Vital signs every 4 hours is a standard practice for monitoring patients with pneumonia to detect any changes in their condition promptly.
Choice H rationale:
A chest X-ray is essential for diagnosing and assessing the extent of pneumonia. It helps in identifying the presence of infiltrates, consolidation, or other complications.