A patient recovering from a thoracotomy reports incisional pain and decreased breath sounds. What is the nurse's best action?

Correct Answer: A

Rationale: The correct answer is A: Administer prescribed pain medication. Pain can inhibit deep breathing post-thoracotomy, leading to decreased breath sounds and potential complications. Addressing pain first allows the patient to take deep breaths with the incentive spirometer effectively. Encouraging shallow breathing (Choice C) may worsen atelectasis. Assisting with an incentive spirometer (Choice B) should follow pain management. Repositioning (Choice D) may not directly address the primary issue of incisional pain.

Correct Answer: B

Rationale: The correct answer is B: Standard four-drug therapy for TB. In this scenario, the nurse has a positive TB skin test but no symptoms or chest x-ray findings. This suggests latent TB infection. The standard treatment for latent TB infection is a four-drug therapy regimen to prevent the progression to active TB. It is essential for the occupational health nurse to educate the staff nurse about this treatment to prevent the development of active TB disease. Choice A (Use and side effects of isoniazid) is incorrect because while isoniazid is part of the treatment regimen for latent TB infection, the nurse needs to be educated about the full four-drug therapy regimen, not just one drug. Choice C (Need for annual repeat TB skin testing) is incorrect as the positive TB skin test already indicates latent TB infection, so repeat skin testing annually is not necessary. Choice D (Reasons for annual sputum cytology testing) is incorrect because sputum cytology testing is not

Correct Answer: C

Rationale: The correct answer is C: Monitor the patient's respiratory rate. This is the priority nursing intervention because anticoagulant therapy can lead to potential bleeding complications, such as pulmonary embolism. Monitoring the patient's respiratory rate helps assess for signs of bleeding or clot formation in the lungs, which are critical to address promptly. A: Monitoring INR levels is important but not the priority over assessing for immediate complications. B: Increasing fluid intake may be beneficial for some conditions but is not the priority in this case. D: Administering an antifungal medication is unrelated to anticoagulant therapy and not a priority intervention.

Correct Answer: A

Rationale: The correct answer is A: Administer a bronchodilator. This is the priority intervention because wheezing indicates airway constriction in asthma, requiring immediate relief to improve breathing. Bronchodilators help dilate the airways, providing quick relief. Administering an inhaled corticosteroid (B) is important for long-term control, not immediate relief. Administering an IV analgesic (C) is not necessary for wheezing in asthma. Performing a neurological assessment (D) is not relevant and does not address the immediate respiratory issue.

Correct Answer: B

Rationale: The correct answer is B: Encourage the patient to sit up at the bedside in a chair and lean forward. This position, known as the orthopneic position, helps improve ventilation in COPD patients by reducing the pressure on the diaphragm and allowing for better expansion of the lungs. By sitting up and leaning forward, the patient can maximize their lung capacity and facilitate better gas exchange. A: Having the patient rest in bed with the head elevated to 15 to 20 degrees may help with breathing comfort but does not provide the same level of lung expansion as the orthopneic position. C: Resting in bed in a high-Fowler's position with the knees flexed may help with respiratory effort but does not promote optimal ventilation like sitting up in a chair and leaning forward. D: This is a duplicate of option C. In summary, option B is the best choice as it directly supports improved ventilation and gas exchange in COPD patients compared to the other options.