A patient is admitted to a respiratory unit with a diagnosis of bacterial pneumonia. Findings include a fever and a weak, congested-sounding cough with moist crackles throughout the lung fields. How should the nurse prioritize care?

Difficulty with breathing

Inability to clear the airway

Confusion from fever

Inadequate oxygen level

Answer and Explanation

The Correct Answer is B

B. The inability to clear the airway is a critical issue. This patient has a weak, congested-sounding cough and moist crackles, indicating that secretions are present and not being effectively cleared. This can lead to airway obstruction, decreased oxygenation, and further respiratory complications. Clearing the airway is a top priority to ensure the patient can breathe properly and prevent further deterioration.
A. Difficulty breathing (dyspnea) is a serious concern as it can indicate respiratory distress or failure. However, it is often a symptom rather than a primary issue, and its underlying causes (such as an inability to clear the airway or inadequate oxygen levels) must be addressed first.
C. Confusion can result from high fever, infection, or hypoxia. While it is important to address the fever and its underlying cause, confusion itself is usually a secondary issue. Addressing the primary respiratory issues will often improve the patient's mental status as well.
D. Hypoxia can result from severe pneumonia, and resolving it involves ensuring the patient has a clear airway and adequate ventilation. Measuring and correcting oxygen levels (e.g., with supplemental oxygen) is crucial, but the underlying cause (such as airway obstruction) must also be managed.

Nursing Test Bank

Test Bank #1: RN Pharmacology Exams Test Bank #2: RN Medical-Surgical Exams Test Bank #3: RN Fundamentals Exams Test Bank #4: RN Maternal-Newborn Exams Test Bank #5: RN Anatomy and Physiology Exams Test Bank #6: RN Obstetrics and Pediatrics Exams Test Bank #7: RN Fluid and Electrolytes Exams Test Bank #9: RN Adult Health Test Bank #10: RN Dosage Calculation Test Bank #11: RN Community Health Exams Test Bank #12: RN Psychology Exams Test Bank #13: RN Nursing Care Of Children Test Bank #14: RN Foundations of Nursing Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Exam #1: RN Comprehensive predictor 2023 proctored exam Exam #2: Ati rn vati comprehensive predictor proctored exam Exam #3: Ati Rn Comprehensive Predictor Proctored Exam 2023 Exam #4: Rn Comprehensive Predictor 2023 Proctored Exam - St. Joseph Exam #5: RN Comprehensive Predictor Proctored Exam (National U CA San Diego) Exam #6: Ati rn comprehensive predictor 2023 retake proctored exam Exam #7: RN Hesi Exit Proctored Exam Exam #8: Hesi RN Exit proctored exam Exam #9: Hesi rn exit proctored exam Exam #10: Hesi Rn compass exit B proctored exam

Free Nursing Study Resources

Correct Answer is A

Explanation

A. This range is generally considered acceptable for most patients with COPD. It provides a balance between ensuring adequate oxygenation while avoiding the risk of oxygen toxicity. Oxygen saturation levels within this range can help alleviate symptoms of hypoxemia without causing hyperoxia.
B. Oxygen saturation levels below 90% can lead to significant hypoxemia and exacerbate respiratory distress in individuals with COPD. Maintaining oxygen saturation levels above 90% is typically recommended to prevent complications associated with hypoxemia.
C. This range is appropriate for some patients but it may not be ideal for all patients with COPD. Oxygen saturation levels at the higher end of this range (e.g., 100%) can increase the risk of oxygen toxicity in patients with COPD who retain carbon dioxide (CO2) due to their chronic respiratory condition.
D. Oxygen saturation levels within this range help to balance the need for oxygen supplementation with the risk of hyperoxia and oxygen toxicity. However, individual patient factors, such as the severity of COPD, baseline oxygen saturation levels, and comorbidities, should be considered when determining the target range for oxygen saturation.

A. Pleural friction rub B. Expiratory wheeze C. Rhonchi D. Fine rales

Correct Answer is B

Explanation

B. Expiratory wheezes are high-pitched, musical sounds produced by air passing through narrowed or obstructed airways. Wheezing is a hallmark sign of asthma, particularly during an exacerbation, and is usually more pronounced during expiration due to the increased effort required to expel air through the narrowed airways.
A. A pleural friction rub is a grating sound produced by the movement of inflamed pleural surfaces rubbing together. It is typically heard in conditions such as pleuritis (inflammation of the pleura) or pleurisy. This sound is not commonly associated with asthma exacerbations.
C. Rhonchi are low-pitched, snoring-like sounds that occur due to the presence of mucus or other secretions in the larger airways. While rhonchi can be heard in conditions with increased mucus production, such as bronchitis, they are not typically the primary sound associated with asthma exacerbations.
D. Fine rales, also known as crackles, are high-pitched, popping sounds heard during inspiration. They are usually associated with conditions involving fluid in the alveoli, such as pulmonary edema or interstitial lung disease. Crackles are not characteristic of asthma.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A patient is admitted to a respiratory unit with a diagnosis of bacterial pneumonia. Findings include a fever and a weak, congested-sounding cough with moist crackles throughout the lung fields. How should the nurse prioritize care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is the desired peripheral capillary oxygen saturation (Spo2) level in the patient with chronic obstructive pulmonary disease?

Correct Answer is A

Explanation

A nurse is collecting data from a client who is having an acute asthma exacerbation. When auscultating the client's chest, the nurse should expect to hear which of the following sounds?

Correct Answer is B

Explanation

The nurse is preparing to teach about the long-term complications for patients diagnosed with diabetes. Which finding is accurate?

The nurse is teaching a patient recently diagnosed with type 1 diabetes mellitus (DM) about the disease. What information should the nurse include?

A patient with newly diagnosed diabetes asks the nurse what to take for low blood sugar. Which of the following would be most appropriate for the nurse to suggest?

A patient is admitted to the hospital with hyperosmolar hyperglycemia. The patient has a BG value of 987 mg/dL. Which is the priority focus while providing care?

The nurse is caring for a patient admitted with COPD, who is having difficulty breathing. Which actions can the nurse take to provide support? Select all that apply

A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of reflux during sleep. Which of the following client statements indicates an understanding of the teaching?

A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the following findings should the nurse identify as a risk factor for this condition?

A nurse is reinforcing dietary teaching with a client who has GERD. Which of the following food choices by the client indicates an understanding of the teaching?