The nurse receives change-of-shift report on the following four patients. Which patient should the nurse assess first?

Correct Answer: B

Rationale: The correct answer is B because a sudden onset of shortness of breath in a patient on bed rest may indicate a life-threatening condition like a pulmonary embolism or cardiac event. Assessing this patient first is crucial for prompt intervention. Choice A can wait as pulmonary function testing is a scheduled procedure. Choice C, the TB patient, can wait briefly as medications can be administered a bit later without immediate harm. Choice D, the patient with pneumonia and a low-grade fever, is stable and can be assessed after the patient with sudden shortness of breath.

Correct Answer: B

Rationale: The correct answer is B: Administer soft foods and fluids. This is the priority action because the patient is experiencing difficulty swallowing, which can lead to aspiration and further complications. Soft foods and fluids are easier for the patient to swallow safely. Administering thickened liquids (choice A) can still pose a risk of aspiration. Administering antihypertensive medications (choice C) is not the priority in this situation. Administering IV fluids (choice D) may not address the immediate issue of difficulty swallowing.

Correct Answer: C

Rationale: The correct answer is C: Perform chest physiotherapy. Shortness of breath in a ventilated patient may be due to secretion accumulation in the airways. Performing chest physiotherapy helps to mobilize and clear secretions, improving ventilation. Checking ventilator settings (A) is important but not the priority when the patient is experiencing distress. Administering IV fluids (B and D) is not directly related to the respiratory distress and should not take precedence over addressing the immediate breathing issue.

Correct Answer: A

Rationale: The correct answer is A: Administer aspirin. Aspirin is the priority intervention for a patient with a history of MI as it helps prevent further clot formation and reduces the risk of another cardiac event. Administering IV fluids (choices B and C) may be necessary depending on the patient's condition, but aspirin takes precedence to address the immediate cardiac issue. Administering morphine (choice D) is not the priority as it may mask symptoms and delay definitive treatment. Overall, the main goal in a patient with a history of MI is to prevent further clot formation and reduce the risk of complications, making aspirin the most appropriate intervention.

Correct Answer: B

Rationale: In this scenario, option B is the correct answer because listening only during the inspiratory phase and then moving the stethoscope misses out on important expiratory sounds, which are crucial for a comprehensive respiratory assessment. This indicates a need for the student to review their respiratory assessment skills to ensure a thorough examination. Option A is incorrect because comparing breath sounds from side to side at each level is a good practice in respiratory assessment to identify any asymmetry or abnormal findings. Option C is also incorrect as starting at the apices of the lungs and moving down towards the lung bases is a systematic and recommended approach for listening to lung sounds. Option D is incorrect because instructing the patient to breathe slowly and deeply through the mouth is a standard technique to ensure optimal lung sound auscultation and is not indicative of a need for review. In an educational context, understanding the importance of listening to both inspiratory and expiratory sounds during a respiratory assessment is vital for accurate diagnosis and monitoring of respiratory conditions. Students must be proficient in their assessment skills to provide high-quality care to patients with respiratory issues. Regular practice and feedback can help students refine their auscultation techniques and enhance their overall respiratory assessment competency.