A healthcare professional is assessing a client who has a fracture of the femur. Vital signs are obtained on admission and again in 2 hours. Which of the following changes in assessment should indicate to the healthcare professional that the client could be developing a serious complication?

Correct Answer: A

Rationale: Step 1: Increased respiratory rate from 18 to 44/min indicates potential respiratory distress, a serious complication post-fracture. Step 2: Rapid breathing can signify hypoxemia, pulmonary embolism, or infection, requiring immediate intervention. Step 3: Increased oral temperature and blood pressure within normal range are not as critical as respiratory distress. Step 4: A slight increase in heart rate is common after a fracture and not indicative of a serious complication.

Correct Answer: D

Rationale: The correct answer is D: Need for suctioning. After a laryngectomy, maintaining a clear airway is crucial to prevent aspiration and ensure proper oxygenation. Suctioning helps remove secretions and maintain airway patency. Monitoring for signs of respiratory distress is essential. A: Patency of the intravenous line is important but not the priority over airway management. B: Level of pain is important but not as critical as ensuring a clear airway. C: Integrity of the dressing is important for wound healing but does not directly impact airway patency.

Correct Answer: B

Rationale: The correct answer is B: Inspect the mouth for signs of inhalation injuries. This is the priority action because inhalation injuries can be life-threatening due to airway compromise. The nurse should assess for soot in the mouth, facial burns, hoarseness, and difficulty breathing. This allows for prompt intervention if respiratory distress is present. A: Inserting an indwelling urinary catheter is not the priority as it does not address the immediate life-threatening issue. C: Administering pain medication is important but not the priority over assessing for inhalation injuries which could lead to respiratory distress. D: Drawing blood for a CBC count is not the priority as it does not address the immediate threat to the client's airway.

Correct Answer: B

Rationale: The correct answer is B: Continuous bubbling in the water-seal chamber. Continuous bubbling in the water-seal chamber indicates an air leak in the system, which can lead to lung collapse. The water-seal chamber should have intermittent bubbling during exhalation but should not bubble continuously. Constant bubbling in the suction-control chamber (A) is expected and indicates proper suction is being applied. Bloody drainage in the collection chamber (C) is common in the immediate postoperative period. Fluid-level fluctuations in the water-seal chamber (D) can be normal due to changes in intrathoracic pressure.

Correct Answer: C

Rationale: The correct answer is C: Tuberculosis. Healthcare workers should wear an N95 respirator mask when caring for clients with airborne infectious diseases like tuberculosis. The N95 mask is designed to filter out at least 95% of airborne particles, including those that may carry the tuberculosis bacteria. This level of protection is necessary to prevent the healthcare worker from inhaling the infectious agent. Pertussis (A), Mycoplasma pneumonia (B), and Respiratory syncytial virus (D) are not typically transmitted through the air and therefore do not require the use of an N95 respirator mask for standard care. These diseases are usually spread through respiratory droplets or direct contact, so standard precautions such as wearing a surgical mask and gloves are sufficient.