The home care nurse visits a client with compromised lung function. The client has greenish yellow sputum with a musty odor. Which assessment is the priority for the
Auscultate bilateral breath sounds.
Obtain blood culture for tuberculosis.
Request pulmonary function studies.
Document the findings.
The Correct Answer is A
The client's greenish-yellow sputum with a musty odor may indicate an infection, such as pneumonia or bronchitis, which can affect the client's lung function. By auscultating bilateral breath sounds, the nurse can assess for the presence of abnormal lung sounds, such as crackles or wheezing, which may indicate further respiratory compromise.
While obtaining a blood culture for tuberculosis (option b) may be appropriate in certain circumstances, the client's sputum color and odor do not necessarily indicate tuberculosis as the cause of their respiratory symptoms.
Requesting pulmonary function studies (option c) may also be beneficial in assessing the client's lung function, but this is not the priority assessment in this situation.
Finally, while documenting the findings (option d) is an important aspect of nursing care, it is not the priority action when the client is presenting with signs of compromised lung function.
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Related Questions
Correct Answer is B
Explanation
During exercise, the heart has to work harder to pump blood and oxygen to the muscles. In patients with stable angina, there is a partial blockage of the coronary arteries, which reduces blood flow and oxygen delivery to the heart muscle. This lack of oxygen to the heart muscles causes chest pain or discomfort, which subsides when the patient stops exercising and is relaxed.
Therefore, it is important for the patient with stable angina to avoid activities that trigger chest pain, take prescribed medications, and make lifestyle modifications to manage their condition.
Correct Answer is D
Explanation
This outcome is the most appropriate because smoking can worsen COPD and lead to further respiratory complications, while oxygen is often used to help patients with COPD breathe more easily. Smoking while wearing oxygen can be very dangerous and increases the risk of fire and explosion. Therefore, the best expected outcome is for the patient to completely avoid smoking while wearing oxygen.
Option a is not a recommended solution since vaping may also worsen COPD symptoms and there is limited evidence of its safety in people with respiratory conditions. Option b is a good outcome, but it may not be achievable in such a short time frame. Option c is not an ideal outcome as even a few cigaretes can cause harm to the respiratory system, exacerbate symptoms, and slow down the healing process.
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