A patient presents with a diagnosis of chronic obstructive pulmonary disease (COPD). The ABG results are as follows: pH 7.32. pCO2 68, p02 78, HCO3 23. What action should the nurse take first?

Remove the client's 02 mask.

Notify the physician

Have the client breath into a paper bag

Place the patient in left side-lying position

Answer and Explanation

The Correct Answer is B

A. Remove the client's O₂ mask: Removing supplemental oxygen is unsafe and may worsen hypoxia. Even though oxygen must be carefully titrated in COPD, abrupt removal is never appropriate without medical direction, especially when the client is already hypoxemic.

B. Notify the physician: The ABG shows respiratory acidosis (low pH, elevated pCO₂) with insufficient compensation and potential respiratory failure. Immediate provider notification is warranted to adjust oxygen delivery, initiate or escalate respiratory support, or evaluate for further interventions.

C. Have the client breathe into a paper bag: Paper bag breathing is used for respiratory alkalosis caused by hyperventilation, not for respiratory acidosis. This action would further elevate CO₂ and worsen the client's acid-base status.

D. Place the patient in left side-lying position: Side-lying positioning does not address the critical issue of respiratory acidosis. Instead, placing the client in high Fowler’s position might help improve ventilation, but first the provider must be notified to address the urgent ABG findings.

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Correct Answer is C

Explanation

A. Have the client lean over an over-the-bed table:This position is sometimes used during posterior thoracic examination or for percussing lung fields, but it is not standard for routine chest auscultation. Most chest sounds can be assessed with the client sitting upright or lying down.

B. Use the bell of the stethoscope held lightly against the chest:The bell is best for detecting low-pitched sounds like some heart murmurs, not respiratory sounds. Lung sounds are higher-pitched and require use of the diaphragm for accurate auscultation.

C. Use the diaphragm of the stethoscope held firmly against the chest:This is the correct technique for auscultating lung sounds, which are typically high-pitched. Holding the diaphragm firmly ensures clear transmission of breath sounds such as crackles, wheezes, or rhonchi.

D. Instruct the client to take deep, rapid breaths through their nose:Deep breathing is appropriate during auscultation, but it should be done through the mouth. Breathing through the nose may reduce air entry and obscure abnormal sounds, making it harder to detect lung pathology.

A. A 16-year old female high school student B. A 54 year old businessman C. A 54 year old businessman D. A 43-year old homeless man with a history of alcoholism

Correct Answer is D

Explanation

A. A 16-year-old female high school student:While TB can affect people of any age, high school students are generally not considered a high-risk group unless they have known exposure or immunosuppression. Routine exposure in school settings is relatively low.

B. A 54-year-old businessman:This client may be at risk depending on travel history or comorbidities, but business professionals typically have better access to healthcare and housing, reducing their baseline risk compared to other populations.

C. A 54-year-old businessman:Unless other risk factors are specified (e.g., foreign travel, immunocompromise), this demographic does not represent a high-risk group for TB in an outbreak situation.

D. A 43-year-old homeless man with a history of alcoholism:This client falls into a high-risk category for TB due to poor living conditions, potential malnutrition, and compromised immunity related to alcoholism. Homelessness and substance use are well-established risk factors for tuberculosis, especially during outbreaks.

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A patient presents with a diagnosis of chronic obstructive pulmonary disease (COPD). The ABG results are as follows: pH 7.32. pCO2 68, p02 78, HCO3 23. What action should the nurse take first?

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