A 92-year-old female patient is being admitted to the emergency department with severe shortness of breath. Being aware of the patient’s condition, what approach should the nurse use to assess the patient’s lungs?

Correct Answer: D

Rationale: In assessing the lungs of a 92-year-old female patient with severe shortness of breath, the nurse should use the approach of assessing the anterior (front) of the chest first, followed by the posterior (back) of the chest. This approach is correct (option D) because it allows the nurse to systematically evaluate different lung fields and identify any abnormalities such as reduced breath sounds, wheezing, or crackles effectively. Option A (apex to base) is incorrect as it focuses on assessing the lungs from top to bottom. This approach may miss important findings in the lower lung fields, which are commonly affected in conditions like pneumonia or heart failure. Option B (base to apex) is also incorrect as it is the reverse of the correct approach. Starting from the base may lead to missing critical findings in the upper lung fields. Option C (lateral sequence) is not the recommended approach for assessing the lungs in this scenario. Lateral assessment is important in specific situations like identifying pleural effusion but is not the primary method for initial lung assessment. In an educational context, it is crucial to teach nursing students the proper technique for assessing the lungs, which involves a systematic and thorough approach to ensure all lung fields are adequately evaluated. Understanding the rationale behind the correct assessment technique is essential for providing comprehensive care to patients presenting with respiratory distress.

Correct Answer: A

Rationale: The correct answer is A: Document the findings. The nurse should first document the assessment findings to establish a baseline and communicate the abnormal sound to the healthcare team for further evaluation. This is crucial for accurate diagnosis and treatment planning. Administering oxygen therapy (B) may be needed depending on the client's oxygen saturation but is not the priority in this situation. Positioning the client in high-Fowlers position (C) may help with breathing but does not address the underlying cause of the abnormal sound. Administering albuterol (D) may be indicated for bronchospasm but should not be done without understanding the cause of the harsh hollow sound first.

Correct Answer: A

Rationale: The correct answer is A because an increase in P50 indicates a decrease in oxygen affinity of hemoglobin (Hb), as seen in the Bohr effect. When CO2 tension rises, it forms carbonic acid in the blood, leading to a decrease in pH. This decrease in pH causes a right shift in the oxygen-hemoglobin dissociation curve, resulting in lower oxygen affinity of Hb. Decreasing P50 reflects this reduced affinity. Choices B, C, and D are incorrect because a decrease in P50, high CO2 content, and high O2 content would not lead to a decrease in oxygen affinity as observed in the Bohr effect.

Correct Answer: A

Rationale: Step-by-step rationale for choice A being correct: 1. Myoglobin is composed of a single polypeptide chain with 153 amino acids, making it monomeric. 2. Being monomeric, myoglobin does not exhibit cooperative binding, leading to a hyperbolic oxygen dissociation curve. 3. The lack of multiple subunits in myoglobin results in non-cooperative binding and a hyperbolic curve. 4. The monomeric nature allows myoglobin to have a simple structure, enhancing its affinity for oxygen. Summary of why other choices are incorrect: B: High concentration in the muscle does not directly explain the hyperbolic curve. C: Being a muscle protein does not inherently determine the hyperbolic nature of the oxygen dissociation curve. D: Quaternary structure would involve multiple subunits, leading to cooperative binding and a sigmoidal oxygen dissociation curve.

Correct Answer: B

Rationale: The correct answer is B because turning the patient to enable assessment of all the lung fields is the best approach to assess lung sounds comprehensively. By turning the patient, the nurse can listen to breath sounds on both the anterior and posterior chest walls, ensuring a thorough assessment. Option A is incorrect as it assumes the need for a chest x-ray without first performing a physical assessment. Option C is incorrect as it limits assessment to only the anterior chest wall, potentially missing abnormalities in the posterior lung fields. Option D is incorrect as obtaining a pulse oximetry reading and repositioning the patient should not replace the need for a physical assessment of lung sounds.