An older adult is brought to the emergency department by a family member, who reports a moderate change in mental status and mild cough.
The client is afebrile.
The primary healthcare provider orders a chest x-ray.
The family member asks why this is needed since the symptoms seem so vague.
What response by the nurse is best?
Chest x-rays are always ordered when we suspect pneumonia.
Older people often have vague symptoms, so an x-ray is essential.
The x-ray can be done and read before laboratory work is reported.
We are testing for any possible source of infection in the client.
The Correct Answer is B
Choice A rationale
While pneumonia is a consideration, stating "always ordered" oversimplifies the diagnostic process and may not be entirely accurate, as other less invasive assessments often precede imaging. The scientific basis for ordering a chest x-ray is to visualize the lung parenchyma for infiltrates, consolidation, or effusions, which are characteristic radiological findings of pneumonia. However, in older adults, these findings may be subtle or atypical due to diminished inflammatory responses, making the x-ray a crucial initial diagnostic tool.
Choice B rationale
Older adults frequently present with atypical or vague symptoms of infections, including pneumonia, due to alterations in their immune response and physiological reserves. This blunted inflammatory response means classic signs like fever or pronounced cough may be absent. Therefore, a chest x-ray becomes an essential diagnostic tool to identify pulmonary infiltrates or consolidation that may be indicative of pneumonia, even in the presence of non-specific symptoms like a change in mental status.
Choice C rationale
While rapid diagnosis is important, prioritizing imaging over laboratory work solely based on turnaround time is not the primary scientific rationale.
Laboratory tests, such as complete blood count and inflammatory markers, provide crucial physiological insights into the body's response to infection, complementing imaging findings for a comprehensive diagnostic picture. X-rays provide structural information, while lab work provides functional and systemic information.
Choice D rationale
While infection is suspected, this response is too broad and lacks specificity regarding the scientific utility of a chest x-ray. A chest x-ray specifically targets the respiratory system to identify pulmonary pathologies. While infections can originate from various body systems, a chest x-ray is a focused diagnostic tool for respiratory infections. Other imaging or laboratory studies would be employed to investigate non-pulmonary sources of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Taking bronchodilators after meals can reduce their effectiveness in bronchodilation during digestion, as blood flow is shunted to the gastrointestinal tract. Optimal bronchodilation is crucial before meals to improve breathing, reduce dyspnea, and enhance food intake. This timing ensures maximum therapeutic effect of the medication when respiratory demand might increase due to the physiological process of eating.
Choice B rationale
Eating five or six small meals daily helps reduce the volume of food in the stomach at any one time, minimizing pressure on the diaphragm. This prevents diaphragmatic splinting and allows for better lung expansion, reducing the feeling of fullness and breathlessness that can occur with large meals in individuals with chronic obstructive pulmonary disease.
Choice C rationale
Resting for at least 30 minutes before eating conserves energy and reduces oxygen demand, which is vital for clients with chronic obstructive pulmonary disease. Fatigue can exacerbate dyspnea, making it difficult to consume adequate nutrition. This rest period allows the respiratory muscles to recover, making the act of eating less strenuous.
Choice D rationale
Choosing foods that are not gas-forming helps prevent abdominal distension. A distended abdomen can elevate the diaphragm, restricting lung expansion and increasing respiratory effort. Avoiding gas-producing foods reduces intra-abdominal pressure, thereby facilitating more comfortable breathing during and after meals for individuals with chronic obstructive pulmonary disease.
Correct Answer is C
Explanation
Choice A rationale
A decrease in respiration rate from 40 to 32 breaths/min in an infant with RSV, while a reduction, does not necessarily indicate immediate deterioration requiring urgent reporting unless accompanied by other signs of respiratory distress. The normal respiratory rate for an infant typically ranges from 30 to 60 breaths/min. This change might reflect an improvement or a less acute phase.
Choice B rationale
A decrease in heart rate from 110 to 100 beats/min in an infant, while a slight reduction, still falls within the normal range for an infant's heart rate (typically 90-160 beats/min). This change alone is not usually indicative of immediate critical deterioration, especially without accompanying signs of hypoxemia or circulatory compromise.
Choice C rationale
A "quiet chest" following a previous assessment of wheezing in an infant with RSV is an ominous sign. Wheezing is caused by air moving through constricted airways. A sudden cessation of wheezing, despite persistent respiratory distress, suggests severe bronchoconstriction and impending respiratory failure, as airflow has become so minimal that it no longer produces audible sounds.
Choice D rationale
An oxygen saturation of 90% is below the acceptable normal range (typically 95-100%) and indicates hypoxemia, requiring attention and intervention. However, while concerning, it is not as immediately life-threatening as a "quiet chest" which signals impending respiratory arrest due to absent air movement.
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