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When completing a focused respiratory assessment, which intervention should the practical nurse (PN) implement to assess for hemoptysis?

A.

Observe the appearance of sputum.

B.

Watch chest expansion on inspiration.

C.

Determine how often the cough occurs.

D.

Auscultate bilateral breath sounds.

Answer and Explanation

The Correct Answer is A

A. Observe the appearance of sputum:
Hemoptysis is coughing up blood. The primary method of identifying it is by directly observing sputum color and content.

B. Watch chest expansion on inspiration:
Assesses ventilation and symmetry, but not presence of blood in sputum.

C. Determine how often the cough occurs:
Evaluates frequency but not the nature of sputum production.

D. Auscultate bilateral breath sounds:
Assesses air movement and adventitious sounds, but not the presence of blood.


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Related Questions

Correct Answer is A

Explanation

A. Use normal saline to rinse the client's mouth: Normal saline is safe, non-irritating, and helps maintain oral mucosa integrity.
B. Avoid contact with the roof of the mouth: Unnecessary; oral care includes cleaning all oral surfaces gently.
C. Lower the head of the bed to 30 degrees: This increases aspiration risk; the head should be elevated or the client positioned side-lying.
D. Don sterile gloves prior to performing oral care: Clean gloves are sufficient; sterile gloves are not required.

Correct Answer is A

Explanation

A. Drinks more liquids than previously: Polydipsia is a classic symptom due to osmotic diuresis from hyperglycemia.
B. Gained 10 pounds within one month: Unlikely; children with type 1 DM often lose weight before diagnosis.
C. Voids only one or two times per day: Inaccurate; polyuria is common.
D. Refuses to eat favorite meals at home: Not a hallmark sign of type 1 DM.

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