Patient Data
Place client on oxygen 2 10 4 liters and maintain oxygen saturation at or above, 959%.
Start the client on antibiotic therapy
STAT complete blood count (CBC), basic metabolic panel (BMP), and blood cultures
Stat ventilation/perfusion (V/Q) of chest
Send sputumn for culture & sensitivity
STAT 2 views chest x-ray
Correct Answer : B,C,E
B. Start the client on antibiotic therapy - Antibiotics are typically prescribed to treat bacterial pneumonia, which is a common cause of pneumonia.
C. STAT complete blood count (CBC), basic metabolic panel (BMP), and blood cultures - These tests help in assessing the severity of the infection, evaluating electrolyte balance, and identifying the causative organism respectively.
E. Send sputum for culture & sensitivity - This helps in identifying the specific organism causing the pneumonia and determining the most effective antibiotic for treatment.
A. At an oxygen saturation above 90%, the client does not necessarily require oxygen supplementation
D. A ventilation/ perfusion scan is needed in cases of suspected pulmonary embolism which is unlikely in this case.
F. Another chest X ray is not important as a recent one is present. No much changes is expected in the period of the few hours.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Since the client has reported only minimal reduction in symptoms after taking lansoprazole (a proton pump inhibitor used to treat GERD) for one full week, it suggests that the current dosage may not be sufficient for adequate symptom relief. Therefore, the nurse should notify the healthcare provider.
A. Auscultating the client's bowel sounds and measure the abdominal girth. This action is not directly related to the client's reported lack of symptom improvement with lansoprazole.
B. Lansoprazole is typically taken before meals to maximize its effectiveness in reducing gastric acid production.
C.While it is true that healing of erosive esophagitis may take several weeks with treatment, the client's report of minimal symptom reduction suggests that further evaluation and potentially a change in treatment approach are warranted.
Correct Answer is B
Explanation
B. Postural drainage involves placing the client in various positions to help drain secretions from different lobes of the lungs. There are typically five standard positions: head-down, head-up, on the side with the affected lung uppermost, on the side with the affected lung lowermost, and lying prone.
A. Performing postural drainage immediately after meals is not recommended because it can increase the risk of vomiting or aspiration, especially in individuals with chronic obstructive pulmonary disease (COPD) who may already have compromised lung function.
C. In postural drainage, the client is typically instructed to breathe deeply and slowly to maximize the effectiveness of the technique.
D. While ABGs may be necessary for monitoring respiratory status in clients with COPD, they are not specifically required prior to performing postural drainage.
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