Respiratory Case Study

What underlying diagnosis puts this patient at increased risk for pneumonia?

• COPD

• Hypercholesterolemia

• HTN

• GERD

What, in this patient's history, may be contributing factors to his SOB? (SELECT ALL THAT APPLY)

• Hypertension

• Left sided heart failure

• right sided heart failure

• COPD

• NKDA

Using the patient's past medical history and presenting illness, what physical assessment findings would the nurse expect to find? (SELECT ALL THAT APPLY)

• Pursed-lip breathing

• Jugular venous distention

• AP diameter equal to transverse

• Rhonchi and wheezing upon auscultation

• Hepatomegaly and peripheral edema

What interventions would promote the clearing of pulmonary secretions? (SELECT ALL THAT APPLY)

• Use of incentive spirometer

• Supine positioning

• Chest physiotherapy

• Encouraging coughing and deep breathing

• Fluid Restriction

Where would the nurse expect to auscultate adventitious breath sounds?

• Above the right clavicle.

• Anteriorly between the 2nd and 3rd rib on the right side of the chest.

• Posteriorly between C7 and T1 on the right side of the chest.

• Anteriorly between the 5th and 6th rib on the right side of the chest.

Which of the following admission orders would the nurse question? (SELECT ALL THAT APPLY).

• Strict I & O

• Regular diet, no restrictions

• Ambulate four times per day

• Remove oxygen when ambulating

• Maintain O2 sats above 90%

AB experiences a sudden hypoxic episode when ambulating. His O2sat drops to 82% on 2 L NC and his respiratory rate increases to 40 bpm.

During the hypoxic episode, what would be the priority nursing intervention?

• Administer pain medication and call the pharmacist.

• Start another IV and call the nurse manager.

• Administer additional oxygen via a non-rebreather mask and call the physician.

• Reassure the patient and family.

The physician orders furosemide 40 mg IV daily. Available is a vial containing 20mg/ml. How many ml will the nurse administer?

• 4ml

• 2ml

• 1ml

• 0.5 ml

What is the likely underlying cause of AB’s continued wheezing?

• Bronchodilation

• Bronchial inflammation

• Fluid overload

• Pulmonary consolidation

Prior to discharge, the nurse needs to administer AB's digoxin. The order requires the nurse to assess the apical impulse pulse prior to giving the medication. Based on AB's

history of chronic heart failure, where would the nurse expect to auscultate the apical impulse?

• 6th to 7th intercostal space, slightly lateral to the left midclavicular line

• 5th to 6th intercostal space, left midaxillary line.

• 4th to 5th intercostal space, left midclavicular line

• 3rd to 4th intercostal space, slightly lateral to the left midclavicular line