1. The client with COPD presents in the ER with complaints of worsening SOB since last night. His ABG results are below. How should these results be interpreted?

pH: 7.33

PaCO2: 60

HCO3-:31

PaO2: 75

SaO2: 91%

A. Schedule a chest x-ray to evaluate for active pulmonary tuberculosis: A positive Mantoux test with induration ≥10 mm in a client without prior TB exposure indicates possible latent TB infection. A chest x-ray is necessary to rule out active disease before initiating treatment and to guide further management.

B. Instruct the client to begin a full course of antitubercular medications immediately: Starting treatment without confirming whether the infection is latent or active could be inappropriate and may lead to unnecessary drug exposure and side effects. Confirmation through imaging and possibly further testing is required first.

C. Repeat the Mantoux test in 3 months to confirm the result: Repeating the test is not necessary because an induration of 12 mm already meets the criteria for a positive result in most adults. Delaying further evaluation could postpone appropriate diagnosis and management.

D. Document the result as negative since the client has no symptoms: Absence of symptoms does not rule out latent tuberculosis. Documenting the result as negative would be inaccurate and could delay treatment or preventive measures, increasing the risk of future disease activation.

A. Bloody drainage is observed in the collection chamber: Some bloody drainage is expected, especially in the initial postoperative or post-injury phase. It becomes concerning only if there is a sudden increase or massive blood loss, but in general, the presence of bloody drainage alone is not necessarily a complication.

B. Skin around tube is pink: Pink skin around the chest tube insertion site is generally a normal finding and may indicate mild irritation from dressing or tape.

C. Absence of bloody drainage in the anterior/upper tube: The anterior/upper chest tube is usually placed for air removal, not fluid. Therefore, it is normal for this tube to have little or no drainage, and absence of fluid does not indicate a complication.

D. The tissues around the tube give a crackling sensation when palpated: This finding indicates subcutaneous emphysema, where air has leaked into the subcutaneous tissue. It suggests a possible air leak or malfunction in the chest tube system, and requires further assessment and intervention.