A patient with bacterial pneumonia has coarse crackles and thick sputum. Which action should the nurse plan to promote airway clearance?

Correct Answer: C

Rationale: The correct answer is C) Assist the patient to splint the chest when coughing. This option is the most appropriate action to promote airway clearance in a patient with bacterial pneumonia presenting with coarse crackles and thick sputum. By splinting the chest during coughing, the patient can effectively mobilize and expel the thick sputum, which helps clear the airways and improve oxygenation. Option A) Restricting oral fluids during the day is incorrect as hydration is crucial in thinning the sputum, making it easier to cough up and clear the airways. Dehydration can lead to thicker secretions, exacerbating the problem. Option B) Teaching the pursed-lip breathing technique is beneficial for patients with chronic lung conditions like COPD to improve oxygen exchange. However, in a patient with bacterial pneumonia and thick sputum, the priority is to facilitate the removal of secretions through effective coughing rather than focusing solely on breathing techniques. Option D) Encouraging the patient to wear the nasal O₂ cannula may be necessary for supplemental oxygen therapy in some cases of pneumonia, but it does not directly address the issue of airway clearance. Oxygen therapy aims to improve oxygenation but does not specifically aid in mobilizing and clearing the sputum from the airways. In an educational context, understanding the rationale behind each option helps nurses make informed clinical decisions based on the patient's condition. By prioritizing interventions that directly address the underlying issue, such as promoting airway clearance in this scenario, nurses can provide optimal care and improve patient outcomes. Encouraging critical thinking and clinical reasoning skills through NCLEX-style questions helps reinforce the importance of evidence-based practice in nursing care.

Correct Answer: B

Rationale: The correct answer to this NCLEX question is option B: "The patient rapidly inhales the medication." This action indicates successful teaching about the administration of Advair Diskus. Rapid inhalation is crucial for this dry powder inhaler to ensure proper delivery of the medication into the lungs. Unlike metered-dose inhalers (MDIs) that require slow inhalation to coordinate with the release of the medication, dry powder inhalers like Advair Diskus require a quick, forceful inhalation to effectively disperse the medication for optimal absorption. Option A, shaking the device before use, is incorrect because Advair Diskus does not require shaking before administration. Shaking the device can actually disrupt the consistency of the medication inside. Option C, attaching a spacer to the Diskus, is also incorrect because spacers are not used with dry powder inhalers like Advair Diskus. Spacers are typically used with MDIs to help improve medication delivery and coordination. Option D, performing huff coughing after inhalation, is not a step associated with the administration of Advair Diskus and does not indicate successful teaching. In an educational context, it is essential for nurses to understand the proper administration techniques for different types of inhalers to effectively teach patients with respiratory conditions. By ensuring patients understand the correct inhalation techniques for medications like Advair Diskus, nurses can help improve patient outcomes and medication efficacy. Understanding these nuances can help nurses provide comprehensive education and support to patients managing chronic respiratory conditions like chronic bronchitis.

Correct Answer: C

Rationale: In this scenario, the most important question the nurse should ask the patient undergoing pulmonary spirometry for a possible COPD diagnosis is whether they have taken any bronchodilators that day (Option C). This is the correct choice because bronchodilators can affect the spirometry results by altering airway tone and potentially providing a false representation of the patient's baseline lung function. Option A, asking about claustrophobia, is incorrect because it is not directly related to the accuracy of the spirometry test. Option B, inquiring about shellfish allergies, is irrelevant to pulmonary function testing. Option D, asking about metal implants, is also not as crucial as ensuring the patient has not taken bronchodilators prior to spirometry. Educationally, understanding the impact of medications on diagnostic tests is crucial for nurses and healthcare providers. It highlights the need for thorough patient assessment and history-taking to ensure the accuracy of diagnostic procedures. By asking the right questions, healthcare professionals can guarantee reliable test results and provide appropriate care based on accurate assessments. This rationale emphasizes the importance of clinical knowledge and critical thinking skills in nursing practice.

Correct Answer: C

Rationale: The correct answer is option C, a 42-year-old patient with a 15 pack-year smoking history, should not receive the inactivated influenza vaccination. The rationale behind this is that individuals with a smoking history are not in the high-risk category for flu complications compared to elderly patients, pregnant individuals, and those who are immunocompromised due to corticosteroid use. Smoking history alone does not place a person at an increased risk of developing severe complications from the flu. Option A, a 76-year-old nursing home resident, should receive the influenza vaccination as the elderly are at a higher risk of flu-related complications. Option B, a pregnant 36-year-old female, should also receive the vaccine as pregnancy puts women at an increased risk for severe flu complications. Option D, a 30-year-old patient on corticosteroids for rheumatoid arthritis, should receive the vaccine because being immunocompromised increases the risk of flu-related complications. Educationally, understanding the rationale behind why certain populations are at higher risk for flu complications helps nursing students make informed decisions when administering vaccinations. It reinforces the importance of evidence-based practice and individualized care based on patient risk factors. By knowing which patients require specific interventions such as the influenza vaccine, nurses can contribute to better health outcomes and prevent unnecessary complications.

Correct Answer: A

Rationale: The correct answer is A) Place hands as shown in the illustration. Palpating chest excursion involves placing hands on the patient's chest as demonstrated in the illustration. This technique allows the healthcare provider to feel the movement of the chest during inspiration and expiration, assessing the symmetry and quality of chest expansion. It helps in identifying any restrictions in chest wall movement, which can be indicative of respiratory conditions like COPD. Option B) Percuss the chest is incorrect because percussion is used to assess the density of underlying tissues and detect abnormalities like fluid or air in the lungs, not for palpating chest excursion. Option C) Inspect for accessory muscle use is incorrect as this refers to observing if the patient is using additional muscles to aid in breathing, which is a different assessment than palpating chest excursion. Option D) Auscultate breath sounds is incorrect because auscultation is done to assess the quality of breath sounds in different lung fields, not to evaluate chest excursion through palpation. In an educational context, understanding the correct technique for palpating chest excursion is crucial for healthcare providers to accurately assess respiratory function in patients. This skill is essential in identifying respiratory conditions, monitoring disease progression, and evaluating the effectiveness of interventions. By mastering this technique, healthcare providers can provide more comprehensive care and support to patients with respiratory issues.