After the nurse has received a change-of-shift report, which patient should the nurse assess first?

Correct Answer: C

Rationale: The nurse should assess the patient with possible lung cancer who has just returned after bronchoscopy first because this patient may be at risk for complications such as bleeding, respiratory distress, or infection post-procedure. Assessing this patient promptly allows for early identification and intervention if any issues arise. The other choices present conditions that may require assessment but do not have the immediate post-procedure risk associated with bronchoscopy. The patient with pneumonia (choice A) may need assessment for respiratory status, but the urgency is lower than the post-bronchoscopy patient. The patient with chronic bronchitis (choice B) may require monitoring, but the low forced vital capacity does not indicate an acute issue. The patient with hemoptysis and a positive tuberculin skin test (choice D) may need further evaluation for tuberculosis, but the immediate risk is lower than the post-bronchoscopy patient.

Correct Answer: C

Rationale: The correct answer is C: Position the patient sitting upright and leaning forward on a table. This position allows for easier access to the thoracic cavity and helps prevent potential complications such as pneumothorax. Prone position (A) makes access difficult, NPO for 8 hours (B) is unnecessary for this procedure, and Trendelenburg position (D) can increase the risk of aspiration.

Correct Answer: A

Rationale: The correct answer is A: Pulmonary embolism. Sudden chest pain and dyspnea are classic symptoms of a pulmonary embolism, which is a blockage in one of the pulmonary arteries. This condition requires immediate medical attention due to the risk of serious complications like pulmonary infarction. Pneumothorax (B) presents with sharp chest pain and shortness of breath but is more commonly associated with trauma or underlying lung disease. Pneumonia (C) typically presents with gradual onset of symptoms such as fever and productive cough. Asthma attack (D) presents with wheezing and coughing, usually triggered by allergens or exercise.

Correct Answer: B

Rationale: The correct answer is B: Oxygen saturation of 89%. A low oxygen saturation level of 89% indicates hypoxemia and requires immediate intervention to prevent complications like tissue damage or organ failure. Oxygen is essential for cellular function, and a saturation below 90% is concerning. Coughing with blood-tinged sputum (A) is common post-bronchoscopy. Hoarseness and sore throat (C) are expected due to the procedure. Mild chest discomfort (D) is also common post-bronchoscopy and may not require immediate intervention.

Correct Answer: C

Rationale: The correct next action is to assess the system for an air leak. This is because continuous bubbling in the water-seal chamber indicates air is escaping from the patient's chest cavity through the tube. By assessing the system for an air leak, the nurse can identify and address the source of the problem. Clamping the chest tube (choice A) can lead to a tension pneumothorax and is not appropriate. Adding more water (choice B) is incorrect as it will not address the underlying issue. Replacing the entire system (choice D) is unnecessary without first identifying the specific problem.