A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurses assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?

Correct Answer: A

Rationale: Encouraging the patient to increase oral fluids, unless contraindicated, is the most effective initial intervention to manage copious tracheobronchial secretions in pneumonia. Hydration thins mucus, making it easier to mobilize and clear from the airways, thus reducing the work of breathing. Oral suctioning is inadequate for tracheobronchial secretions as it only addresses the mouth and throat, not deeper airways. Lying in a low Fowler's or supine position worsens secretion pooling and impairs breathing, contradicting the goal of improving respiratory function. Increasing activity may be beneficial later but is impractical during acute respiratory distress due to fatigue and oxygen demand. Adequate hydration supports mucociliary clearance, a critical mechanism impaired in pneumonia, and aligns with evidence-based care to prevent further complications like atelectasis or worsening infection.

Correct Answer: B

Rationale: Monitoring pulse oximetry is the best bedside method to assess oxygenation status during thrombolytic therapy for pulmonary embolism (PE), providing real-time, noninvasive measurement of oxygen saturation (SpO2). It reflects how effectively oxygen reaches the blood despite PE-induced ventilation-perfusion mismatch, guiding adjustments in oxygen therapy (e.g., aiming for SpO2 >90%). Serial arterial blood gases (ABGs) are precise but invasive, time-consuming, and not practical for continuous bedside use. Pulmonary function tests assess airway obstruction or restriction, not acute oxygenation, and are irrelevant here. Incentive spirometry measures inspiratory effort, aiding atelectasis prevention, not oxygenation. Pulse oximetry's immediacy and simplicity enable the nurse to detect hypoxemia promptly, ensuring timely intervention (e.g., increasing FiO2) as thrombolytics dissolve the clot, critical in this dynamic, high-risk scenario.

Correct Answer: C

Rationale: Chronic hyperinflation, typical in COPD with emphysema, results from air trapping due to alveolar destruction and loss of elastic recoil, reshaping the thorax into a barrel chest expanded anteroposterior diameter from flattened diaphragm and elevated ribs. The nurse assesses this physical sign via inspection, noting a rounded chest contour, reflecting advanced disease. Oxygen toxicity occurs with prolonged high O2 therapy, not hyperinflation itself. Chronic chest pain isn't a COPD feature unless from comorbidities (e.g., pleurisy), as emphysema involves dyspnea over pain. Long, thin fingers (arachnodactyly) relate to Marfan syndrome, not lung disease. Barrel chest's presence informs the nurse of disease severity, guiding interventions like breathing techniques or oxygen titration to manage chronic respiratory compromise.

Correct Answer: D

Rationale: An FEV1/FVC ratio of 60% below the normal threshold of 70% indicates obstructive lung disease on spirometry, reflecting reduced airflow from narrowed airways, as in COPD or asthma. FEV1 (forced expiratory volume in 1 second) measures air expelled quickly, while FVC (forced vital capacity) is total air exhaled; a low ratio shows expiration is disproportionately impaired, typical of obstruction. Strong exercise tolerance contradicts this, requiring unimpeded airflow. Exhalation volume isn't ‘normal' the ratio signals restriction in speed, not capacity alone. Respiratory infection may worsen obstruction but isn't diagnosed by spirometry alone. The nurse's interpretation guides further assessment (e.g., bronchodilator response) and management (e.g., inhalers), aligning with pulmonary function standards for diagnosing obstructive pathology.

Correct Answer: C

Rationale: A patient's statement about using a long-acting beta2-agonist (LABA, e.g., salmeterol) ‘each time I feel an asthma attack coming on' signals a need for further education, as LABAs are for maintenance, not rescue. LABAs prevent bronchospasm over 12-24 hours, not acutely relieving symptoms that's the role of short-acting beta-agonists (e.g., albuterol). Misuse risks delaying effective treatment, worsening attacks. Tachycardia is a known side effect, correctly noted. LABAs do prevent exercise-induced asthma, a valid benefit. Tolerance (less effectiveness over time) can occur, a fair concern. The nurse must clarify LABA's prophylactic role twice-daily dosing versus rescue inhalers, ensuring the patient's action plan prevents severe exacerbations, per asthma management standards.