A nurse is assessing a client with a history of chronic obstructive pulmonary disease (COPD). Which of the following findings is most concerning?

The client has a respiratory rate of 22 breaths per minute.

The client has a temperature of 38°C (100.4°F).

The client has a pulse oximetry reading of 88%.

The client has a blood pressure of 140/90 mmHg.

Answer and Explanation

The Correct Answer is C

Choice A rationale
A respiratory rate of 22 breaths per minute is slightly elevated but not necessarily concerning for a client with COPD. COPD patients often have higher respiratory rates due to their chronic lung condition.
Choice B rationale
A temperature of 38°C (100.4°F) indicates a fever, which could be a sign of infection. However, it is not the most concerning finding in a COPD patient.
Choice C rationale
A pulse oximetry reading of 88% is concerning because it indicates hypoxemia. COPD patients often have lower oxygen levels, but a reading below 90% is worrisome and may require supplemental oxygen or other interventions.
Choice D rationale
A blood pressure of 140/90 mmHg is elevated but not immediately concerning in the context of COPD. It is important to monitor, but it is not the most critical finding.

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Correct Answer is A

Explanation

Choice A rationale
Meningococcal meningitis can present with a high fever (39°C or 102.2°F) and a rash, indicating a severe bacterial infection.
Choice B rationale
Urinary tract infections typically present with urinary symptoms, not a rash.
Choice C rationale
Gastroenteritis presents with gastrointestinal symptoms, not a rash.
Choice D rationale
Osteoarthritis is a degenerative joint disease and does not cause fever or rash.

A. Sepsis. B. Hypovolemic shock. C. Myocardial infarction. D. Pulmonary embolism.

Correct Answer is A

Explanation

Choice A rationale
Sepsis is a systemic inflammatory response to infection, often characterized by fever (temperature of 38°C or higher) and tachycardia (heart rate of 120 beats per minute or higher). These symptoms indicate the body’s response to a severe infection.
Choice B rationale
Hypovolemic shock is caused by significant fluid loss, leading to decreased blood volume and perfusion. It typically presents with hypotension and tachycardia, but not necessarily fever.
Choice C rationale
Myocardial infarction (heart attack) is characterized by chest pain, shortness of breath, and other symptoms, but fever and tachycardia are not primary indicators.
Choice D rationale
Pulmonary embolism involves a blockage in the pulmonary arteries, leading to symptoms such as sudden shortness of breath, chest pain, and rapid heart rate, but not typically fever.

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A nurse is assessing a client with a history of chronic obstructive pulmonary disease (COPD). Which of the following findings is most concerning?

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Naxlex Comprehensive Predictor Exams

A client with a temperature of 39°C (102.2°F) and a rash is being evaluated. Which condition should the nurse consider?

Correct Answer is A

Explanation

A nurse is caring for a client with a temperature of 38°C (100.4°F) and a heart rate of 120 beats per minute. Which condition is the client most likely experiencing?

Correct Answer is A

Explanation

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