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A patient with acute dyspnea is scheduled for a spiral computed tomography (CT) scan. Which information obtained by the nurse is a priority to communicate to the health care provider before the CT?
- A. Allergy to shellfish
- B. Apical pulse of 104
- C. Respiratory rate of 30
- D. Oxygen saturation of 90%
Correct Answer: A
Rationale: Because iodine-based contrast media is used during a spiral CT, the patient may need to have the CT scan without contrast or be premedicated before injection of the contrast media. The increased pulse, low oxygen saturation, and tachypnea all indicate a need for further assessment or intervention but do not indicate a need to modify the CT procedure.
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The nurse assesses a patient with chronic obstructive pulmonary disease (COPD) who has been admitted with increasing dyspnea over the last 3 days. Which finding is most important for the nurse to report to the healthcare provider?
- A. Respirations are 36 breaths/minute.
- B. Anterior-posterior chest ratio is 1:1.
- C. Lung expansion is decreased bilaterally.
- D. Hyperresonance to percussion is present.
Correct Answer: A
Rationale: The correct answer is 'Respirations are 36 breaths/minute.' An increased respiratory rate is a crucial sign of respiratory distress in patients with COPD, necessitating immediate interventions like oxygen therapy or medications. The other options are common chronic changes seen in COPD patients. Option B, the 'Anterior-posterior chest ratio is 1:1,' is related to the barrel chest commonly seen in COPD due to hyperinflation. Option C, 'Lung expansion is decreased bilaterally,' is expected in COPD due to air trapping. Option D, 'Hyperresonance to percussion is present,' is typical in COPD patients with increased lung volume and air trapping.
The nurse is performing tuberculosis (TB) skin tests in a clinic that has many patients who have immigrated to the United States. Which question is most important for the nurse to ask before the skin test?
- A. Is there any family history of TB?
- B. How long have you lived in the United States?
- C. Do you take any over-the-counter (OTC) medications?
- D. Have you received the bacille Calmette-Guerin (BCG) vaccine for TB?
Correct Answer: D
Rationale: It is crucial for the nurse to inquire about whether the patient has received the bacille Calmette-Guerin (BCG) vaccine for TB before performing the skin test. Patients who have received the BCG vaccine can have a positive Mantoux test, leading to the need for alternative screening methods, such as a chest x-ray, to determine TB infection. While family history of TB and length of time in the United States are relevant factors, they do not directly impact the decision to perform the TB skin test. Asking about over-the-counter medications, unless relevant to TB treatment, is not as critical as assessing BCG vaccination status.
While auscultating a patient's lungs, the nurse hears low-pitched, bubbling sounds during inhalation in the lower third of both lungs. How should the nurse document this finding?
- A. Inspiratory crackles at the bases
- B. Expiratory wheezes in both lungs
- C. Abnormal lung sounds in the apices of both lungs
- D. Pleural friction rub in the right and left lower lobes
Correct Answer: A
Rationale: The correct answer is 'Inspiratory crackles at the bases.' Crackles are low-pitched, bubbling sounds typically heard during inspiration, which aligns with the nurse's finding. Expiratory wheezes are high-pitched sounds and are not consistent with the described auscultation findings. The lower third of both lungs refers to the bases, not the apices, so option C is incorrect. Pleural friction rubs are grating sounds heard during both inspiration and expiration, unlike the described finding of only hearing the sounds during inhalation in the lower third of both lungs.
Which information about a 60-year-old patient with MS indicates that the nurse should consult with the healthcare provider before giving the prescribed dose of dalfampridine (Ampyra)?
- A. The patient has relapsing-remitting MS
- B. The patient walks a mile a day for exercise
- C. The patient complains of pain with neck flexion
- D. The patient has an increased serum creatinine level
Correct Answer: D
Rationale: The correct answer is that the patient has an increased serum creatinine level. Dalfampridine should not be given to patients with impaired renal function as it can worsen their condition. Options A, B, and C are unrelated to the administration of dalfampridine. The fact that the patient has relapsing-remitting MS, walks for exercise, or experiences neck pain does not directly impact the decision to administer dalfampridine. However, an increased serum creatinine level is a contraindication for this medication and requires consultation with the healthcare provider to determine the appropriate course of action.
A patient who has a history of chronic obstructive pulmonary disease (COPD) was hospitalized for increasing shortness of breath and chronic hypoxemia (SaO2 levels of 89% to 90%). In planning for discharge, which action by the nurse will be most effective in improving compliance with discharge teaching?
- A. Start giving the patient discharge teaching on the day of discharge
- B. Have the patient repeat the instructions immediately after teaching
- C. Accomplish the patient teaching just before the scheduled discharge
- D. Arrange for the patient's caregiver to be present during the teaching
Correct Answer: D
Rationale: Hypoxemia interferes with the patient's ability to learn and retain information, so having the patient's caregiver present will increase the likelihood that discharge instructions will be followed. Having the patient repeat the instructions will indicate that the information is understood at the time, but it does not guarantee retention of the information. Giving discharge instructions just before discharge is not ideal as the patient is likely to be distracted and anxious at that time. Teaching the patient about discharge on the day of admission is not recommended because the patient may be more hypoxemic and anxious than usual, making it difficult for them to absorb and retain the information effectively. Therefore, arranging for the patient's caregiver to be present during the teaching session is the best option to ensure proper compliance and understanding of the discharge instructions.