The client has right lower lobe pneumonia with a non-productive cough. Which intervention is the nurse’s priority?

Suction the client at least every two hours.

Encourage fluids up to 3000 mL/day unless contraindicated.

Encourage a right side-lying position.

Administer codeine elixir PRN following prescription.

Answer and Explanation

The Correct Answer is B

Choice A reason: Suctioning the client at least every two hours is not typically necessary for a non-productive cough. Suctioning is more appropriate for patients with excessive secretions that they cannot clear on their own. Overuse of suctioning can cause irritation and discomfort.

Choice B reason: Encouraging fluids up to 3000 mL/day unless contraindicated is crucial for a client with pneumonia. Adequate hydration helps to thin mucus, making it easier to expectorate and clear from the lungs. This can improve the client’s ability to cough effectively and reduce the risk of complications such as atelectasis. Hydration also supports overall bodily functions and helps in maintaining electrolyte balance.

Choice C reason: Encouraging a right side-lying position is not the best intervention for a client with right lower lobe pneumonia. This position may not promote optimal lung expansion and drainage. Instead, positioning the client to maximize lung expansion and facilitate drainage, such as sitting up or lying on the unaffected side, is more beneficial.

Choice D reason: Administering codeine elixir PRN following prescription is not the priority intervention. While codeine can help suppress a cough, it is generally not recommended for a non-productive cough in pneumonia because it can suppress the cough reflex needed to clear secretions. Additionally, codeine can cause respiratory depression and other side effects.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is D

Explanation

Choice A reason:

A 36-year-old male who had a minimally invasive appendectomy and a history of community-acquired pneumonia a year ago is at relatively low risk for postoperative respiratory complications. Minimally invasive surgeries typically have fewer complications, and a past episode of pneumonia does not significantly increase the risk unless there are ongoing respiratory issues.

Choice B reason:

A 58-year-old female with type 1 diabetes who had an incision and drainage of an abscess with procedural sedation has some risk factors for complications, such as diabetes, which can impair healing and immune response. However, the procedure was minor and performed under sedation, which poses less risk compared to general anesthesia.

Choice C reason:

A 19-year-old male undergoing arthroscopic knee surgery under regional anesthesia with a history of exercise-induced asthma has a low risk of respiratory complications. Regional anesthesia does not affect the respiratory system as much as general anesthesia, and exercise-induced asthma is generally well-controlled and less likely to cause complications in this context.

Choice D reason:

A 65-year-old female with a BMI of 32 and a long history of tobacco use who underwent upper abdominal surgery under general anesthesia is at the greatest risk for respiratory complications. Factors such as advanced age, obesity, smoking history, and the type of surgery (upper abdominal) significantly increase the risk of postoperative pulmonary complications. General anesthesia further exacerbates this risk due to its effects on respiratory function.

A. Decreased anteroposterior diameter of the chest B. Oxygen saturation level below 95% C. Petechiae on chest D. Respiratory alkalosis

Correct Answer is B

Explanation

Choice A reason: A decreased anteroposterior diameter of the chest is not typically associated with COPD and emphysema. In fact, patients with COPD often have an increased anteroposterior diameter, known as a “barrel chest,” due to hyperinflation of the lungs. This change in chest shape is a compensatory mechanism to accommodate the increased lung volume and is a common physical finding in advanced COPD.

Choice B reason: Oxygen saturation level below 95% is a common finding in patients with COPD and emphysema. These conditions impair the lungs’ ability to oxygenate the blood effectively, leading to lower oxygen levels. Chronic hypoxemia is a hallmark of COPD, and monitoring oxygen saturation is crucial in managing these patients. Normal oxygen saturation levels typically range from 95% to 100%, so levels below 95% indicate a need for supplemental oxygen or other interventions.

Choice C reason: Petechiae on the chest are not a typical finding in COPD or emphysema. Petechiae are small, red or purple spots caused by bleeding into the skin and are usually associated with conditions affecting blood clotting or platelet function. They are not related to the respiratory pathology seen in COPD and emphysema.

Choice D reason: Respiratory alkalosis is not commonly associated with COPD and emphysema. These conditions are more likely to cause respiratory acidosis due to chronic retention of carbon dioxide (CO2). In COPD, the damaged alveoli and airways lead to impaired gas exchange, resulting in elevated CO2 levels and a decrease in blood pH. Respiratory alkalosis, characterized by low CO2 levels and increased pH, is more often seen in conditions causing hyperventilation, such as anxiety or acute asthma attacks.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

The client has right lower lobe pneumonia with a non-productive cough. Which intervention is the nurse’s priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following postoperative patients is at greatest risk for respiratory complications?

Correct Answer is D

Explanation

A nurse on a medical-surgical unit is performing an admission assessment of a client who has COPD with emphysema. The client reports that they have a frequent productive cough and shortness of breath. The nurse should anticipate which of the following assessment findings for this client?

Correct Answer is B

Explanation

The nurse is aware that a common adverse effect of anesthetic agents experienced by the client is:

A nurse is assessing a newly admitted client whose chief complaint is “coughing up blood” and whose recent history includes a productive cough and night sweats. What is the nurse’s priority intervention?

The nurse recognizes which of the following tests will confirm the diagnosis of tuberculosis for a client?

The priority nursing intervention for a client who has a serum sodium level of 154 mEq/L would be:

The nurse has applied a client problem of ineffective gas exchange for a client diagnosed with chronic bronchitis. Which intervention would the nurse include in the plan of care?

An older adult client with chronic respiratory disease tells the nurse it is unnecessary to receive the pneumococcal pneumonia vaccine because the influenza vaccine was just received two months ago. Which response by the nurse is most appropriate?

Which of the following is a characteristic of a Venturi mask?

A nurse is caring for a client who is hospitalized with active pulmonary tuberculosis and is started on ethambutol therapy. The nurse should understand that which of the following should be monitored?