A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department reporting shortness of breath on minimal exertion. Which assessment finding by the nurse would be most important to report to the health care provider?

The patient is sitting in the tripod position.

The patient’s pulse oximetry shows a 90% O2 saturation.

The patient has bibasilar lung crackles.

The patient’s respiratory rate is 9 breaths/min.

Answer and Explanation

The Correct Answer is D

Choice A reason: Tripod position aids breathing in COPD by stabilizing accessory muscles, a common adaptation. It signals distress but isn’t immediately life-threatening compared to respiratory rate, as it reflects chronic compensation rather than acute decompensation requiring urgent intervention.

Choice B reason: O2 saturation of 90% is low but typical in COPD due to ventilation-perfusion mismatch. It warrants monitoring, yet it’s less critical than respiratory rate, as supplemental oxygen can correct it, and it’s not an immediate danger sign.

Choice C reason: Bibasilar crackles suggest fluid or infection, uncommon in pure COPD exacerbations, which show wheezing. This finding needs attention but is less urgent than respiratory rate, as it may indicate pneumonia rather than immediate respiratory failure.

Choice D reason: Respiratory rate of 9 breaths/min is alarmingly low in COPD, where tachypnea (20-30 breaths/min) is expected during exacerbation. Bradypnea indicates potential respiratory depression or fatigue, risking CO2 retention and hypoxia, necessitating immediate reporting for intervention.

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Correct Answer is A

Explanation

Choice A reason: Community-acquired pneumonia (CAP) fits symptoms like cough or fever from pathogens outside hospitals. It’s the most likely without hospital exposure history, aligning with typical outpatient respiratory infection patterns.

Choice B reason: Cor pulmonale involves right heart failure from lung disease, not primary infection. Maria’s acute symptoms suggest pneumonia, not chronic pulmonary hypertension, making this less probable without supporting cardiac findings.

Choice C reason: Hospital-acquired pneumonia requires recent hospitalization, not indicated here. Maria’s presentation lacks nosocomial context, favoring community-acquired pneumonia as the diagnosis based on typical outpatient symptom onset.

A. Mantoux testing shows an induration of 10 mm. B. TB medications have been taken for 6 months. C. Sputum smears for acid-fast bacilli are negative. D. Chest x-ray shows no upper lobe infiltrates.

Correct Answer is C

Explanation

Choice A reason: Mantoux induration of 10 mm indicates TB exposure, not active infection status. It’s a diagnostic tool, not a marker for contagiousness, so it doesn’t guide discontinuation of airborne precautions in treatment.

Choice B reason: Six months of TB meds suggests treatment progress, but contagiousness persists until sputum clears. Duration alone isn’t enough; microbiologic evidence is required to lift precautions, per infection control standards.

Choice C reason: Negative sputum smears for acid-fast bacilli (three consecutive) confirm non-infectiousness in TB. This microbiological clearance allows discontinuation of airborne precautions, as the patient no longer spreads viable bacteria via droplets.

Choice D reason: Clear x-ray (no infiltrates) shows healing, but sputum can remain infectious. Radiologic improvement lags behind contagiousness, so negative smears, not imaging, determine when precautions can safely end.

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A patient with chronic obstructive pulmonary disease (COPD) arrives in the emergency department reporting shortness of breath on minimal exertion. Which assessment finding by the nurse would be most important to report to the health care provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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