A pulmonary nurse cares for clients who have chronic obstructive pulmonary disease (COPD). Which client would the nurse assess first?
A 46 year old with a 30-pack-year history of smoking.
A 52 year old in a tripod position using accessory muscles to breathe.
A 68 year old who has dependent edema and clubbed fingers.
A 74 year old with a chronic cough and thick, tenacious secretions.
The Correct Answer is B
Choice A rationale
A 30-pack-year smoking history indicates significant cumulative exposure to respiratory irritants, predisposing the client to COPD development. However, this historical factor does not indicate acute respiratory distress requiring immediate intervention. While a strong risk factor, it doesn't present as an emergent physiological alteration demanding first assessment in this scenario. Current physiological stability takes precedence over historical risk.
Choice B rationale
A client in a tripod position utilizing accessory muscles to breathe indicates significant respiratory distress and increased work of breathing. This compensatory mechanism suggests impending respiratory failure or severe hypoxemia. This is an acute, life-threatening physiological manifestation demanding immediate nursing assessment and intervention to prevent respiratory arrest and optimize oxygenation.
Choice C rationale
Dependent edema and clubbed fingers are chronic manifestations of long-standing respiratory and/or cardiovascular compromise, often seen in advanced COPD or cor pulmonale. While indicative of significant disease progression, they do not represent an acute, life-threatening emergency demanding immediate assessment over active respiratory distress. These are chronic adaptations, not acute decompensation.
Choice D rationale
A chronic cough with thick, tenacious secretions is a common symptom in COPD, indicating impaired mucociliary clearance and chronic inflammation. While these symptoms can exacerbate acute respiratory issues, they do not inherently suggest the acute, life-threatening respiratory distress seen in a client using accessory muscles, thus not requiring the absolute first assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
A negative chest x-ray, while indicative of resolving lung pathology, does not definitively confirm the absence of viable Mycobacterium tuberculosis. Radiographic resolution can lag behind bacteriologic clearance, meaning granulomas might still be present even if the active infection has been eliminated, and thus transmissibility cannot be excluded solely based on imaging.
Choice B rationale
The absence of clinical symptoms, such as cough, fever, or weight loss, suggests clinical improvement but does not guarantee bacteriologic cure or non-infectiousness. A patient can be asymptomatic yet still shed viable mycobacteria, posing a risk of transmission to others. Bacteriological confirmation is essential.
Choice C rationale
Three negative sputum cultures, typically collected on separate days, are the gold standard for confirming that a patient with tuberculosis is no longer infectious. This indicates the absence of viable Mycobacterium tuberculosis in respiratory secretions, significantly reducing the risk of transmission to others due to the inability to aerosolize infectious particles.
Choice D rationale
A negative skin test, or tuberculin skin test (TST), indicates the absence of a delayed-type hypersensitivity reaction to M. tuberculosis antigens. It primarily reflects exposure and immune response, not active infection or infectiousness. A previously positive TST usually remains positive even after successful treatment, so a negative result in a treated patient is not a measure of non-infectiousness.
Correct Answer is ["3.5"]
Explanation
Step 1: Convert pounds to kilograms. 55 lb ÷ (2.2 lb/1 kg) = 25 kg.
Step 2: Calculate the total milligrams per 24 hours. 7 mg/kg/24 h × 25 kg = 175 mg/24 h.
Step 3: Calculate the milligrams per dose (q h implies 2 doses per 24 hours). 175 mg/24 h ÷ 2 doses = 87.5 mg/dose.
Step 4: Calculate the volume in milliliters per dose. 87.5 mg ÷ (125 mg/5 mL) = 3.5 mL. 3.5 mL will be administered for each dose.
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