ATI n300 Med Surg Exam

Extract:

Question 1 of 5

The nurse is caring for a client in the burn unit with burns to the head, neck, chest back left arm and hand following an explosion in their garage. Upon admission, the nurse auscultates wheezes throughout all lung fields and applies oxygen via non-rebreather. One hour later, upon reassessment, the patient is visibly anxious and short of breath, wheezes cannot be heard, lung sounds are decreased, voice is hoarse, and the client is coughing up gray sputum. What is the most appropriate nursing action?

A. Notify the physician and anticipate the need for endotracheal intubation B. Place the client in semi-fowler's position and administer albuterol breathing treatment C. Encourage the client to cough, take deep breaths, and then auscultate again D. Recommend a medical prescription for guaifenesin and encourage use of incentive spirometry

Correct Answer: A

Rationale: The absence of wheezes, decreased lung sounds, hoarseness, and gray sputum indicate progressive airway obstruction from inhalation injury, requiring immediate intubation.

Question 2 of 5

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Question 3 of 5

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Question 4 of 5

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Question 5 of 5

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Similar Questions

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ATI n300 Med Surg Exam | Nurselytic

Nurselytic

ATI RN

ATI RN