Upon assessment, the nurse noted a temperature of 102.1, respirations of 30 breaths per minute, oxygen saturation of 90% on room air, decreased expansion and dullness over the right lung, and crackles heard on the right lower lobe. Which condition should the nurse suspect?

Atelectasis

Pulmonary obstruction

Pneumonia

Bronchitis

Answer and Explanation

The Correct Answer is C

A.   Atelectasis refers to the collapse or incomplete expansion of a lung or a portion of a lung. It can cause decreased breath sounds and dullness upon percussion, but it is less likely to present with a fever as high as 102.1°F. However, atelectasis can occur secondary to an obstructive pneumonia, making the distinction important in clinical settings.
B.   Pulmonary obstruction, such as from an obstruction of the airway or bronchus, might cause symptoms like difficulty breathing and decreased oxygen saturation. However, it would less commonly present with fever and localized crackles.
C.   Pneumonia often presents with symptoms such as fever (elevated temperature of 102.1°F), increased respiratory rate (30 breaths per minute), decreased oxygen saturation (90% on room air), and abnormal lung findings. The decreased expansion and dullness over the right lung, along with crackles (rales) heard in the right lower lobe, are indicative of fluid accumulation and inflammation in the lung, which are characteristic of pneumonia.
D.   Acute bronchitis involves inflammation of the bronchi and is often associated with a cough, sputum production, and sometimes fever. However, it typically presents with a productive cough and wheezing rather than localized dullness and crackles confined to one lobe.

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Correct Answer is A

Explanation

A. Wheezing is a high-pitched, musical sound produced by narrowed airways. It is a common and classic finding in asthma due to the bronchoconstriction that occurs during an asthma exacerbation. The presence of wheezing on auscultation is a strong indicator of asthma, as it reflects the turbulent airflow through constricted bronchi.
B. Normal breath sounds would generally not indicate asthma. In the absence of an asthma attack or during periods of remission, a person with asthma might have normal breath sounds. However, during an asthma exacerbation, the breath sounds are more likely to be abnormal, such as wheezing or decreased breath sounds if airflow is severely compromised.
C. Clear lung sounds on auscultation would typically indicate that there are no abnormal sounds such as wheezes, crackles, or rhonchi. In the context of asthma, clear lung sounds could be heard if the asthma is well-controlled or if the client is not currently experiencing an exacerbation.
D. A decreased respiratory rate (bradypnea) is not a typical finding in asthma. During an asthma exacerbation, clients often experience tachypnea (increased respiratory rate) due to difficulty breathing and the increased effort required to breathe.

A. Cyclic pain B. Noncyclic C. Fibrocystic breast D. Breast cancer

Correct Answer is B

Explanation

A. Cyclic breast pain is related to the menstrual cycle and typically follows a pattern in relation to hormonal changes. It often starts in the luteal phase of the cycle and resolves with the onset of menstruation. Since the described pain is not associated with the menstrual cycle, this term is not appropriate for the given scenario.
B. Noncyclic breast pain is pain that is not related to the menstrual cycle and does not have a specific, cyclical pattern. It is often described as occurring independently of hormonal changes and can be associated with a variety of other factors, including infections, injuries, or other conditions affecting the breast tissue.
C. Fibrocystic breast changes refer to a condition characterized by lumpy, tender breasts with pain often related to hormonal changes. The pain and lumps can vary with the menstrual cycle, so it does not fit the description of noncyclic pain that is independent of the menstrual cycle.
D. While breast cancer can present with pain, particularly in advanced stages or in the presence of a mass, the term "breast cancer" is not used to describe the nature of the pain itself. It is a diagnosis rather than a descriptive term for pain characteristics.

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Upon assessment, the nurse noted a temperature of 102.1, respirations of 30 breaths per minute, oxygen saturation of 90% on room air, decreased expansion and dullness over the right lung, and crackles heard on the right lower lobe. Which condition should the nurse suspect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which respiratory assessment finding will most likely indicate the client is exhibiting asthma?

Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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