NCLEX Practice Set 9 (Case Study #3)

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Question 1 of 6

1. Question

Case Study Question 1 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

>Select the answer below that correctly highlights all the findings that require immediate follow-up.

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Question 2 of 6

2. Question

Case Study Question 2 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

>For each client finding, click to indicate if the finding is consistent with asthma, pneumonia, or pulmonary embolism. Each finding may support more than one type of respiratory condition. Select the answer below.

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Question 3 of 6

3. Question

Case Study Question 3 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

Chest X-Ray:

Notes

Reveals pulmonary infiltrates bilaterally. Consolidation left lower lobe. No hilar lymphadenopathy.

Laboratory Report:

Lab	Results	Reference range
Hematocrit	45%	Males: 42-52% Females: 35-47%
Hemoglobin	14 g/dL	Males: 13-18 g/dL Females:12-16 g/dL
WBC	13,000 cell/mm3	4.5 – 10.5 x 10³cells/mm³
Potassium(serum)	4.5 mEq/L	3.5 to 5 mEq/L
Sodium (serum)	137 mEq/L	135 to 145 mEq/L

The chest x-ray report has been sent from radiology and labs are ready.

>Complete the sentence from the list of options below.

The nurse should recognize that the client is most likely experiencing (choose a, b, or c). As evidence by (choose d, e, f, or g) and (choose d, e, f, or g).

a. Pneumonia

b. Chronic obstructive pulmonary

c. Acute asthma

d. Fever and chills

e. Hemoglobin of 14g/dL

f. Infiltrates on chest x-ray

g. Oxygen saturation 90%

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Question 4 of 6

4. Question

Case Study Question 4 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

Chest X-Ray:

Notes

Reveals pulmonary infiltrates bilaterally. Consolidation left lower lobe. No hilar lymphadenopathy.

Laboratory Report:

Lab	Results	Reference range
Hematocrit	45%	Males: 42-52% Females: 35-47%
Hemoglobin	14 g/dL	Males: 13-18 g/dL Females:12-16 g/dL
WBC	13,000 cell/mm3	4.5 – 10.5 x 10³cells/mm³
Potassium(serum)	4.5 mEq/L	3.5 to 5 mEq/L
Sodium (serum)	137 mEq/L	135 to 145 mEq/L

The chest x-ray report has been sent from radiology and labs are ready.

>Select the orders from each of the categories the nurse should include in the plan of care at this time. Each category may have more than one order.

Categories	Orders
Nursing	a. Prepare to place client on airborne precautions
	b. Place client in a semi-fowlers position
	c. Encourage use of incentive spirometer
	d. Encourage PO fluids every 1-2 hours
Medications	e. Ceftriaxone 1gram IV q 24 hours and Azithromycin 500mg IV q 24 hours
	f. Tylenol 650mg PO q 4 hours PRN temperature greater than 101
	g. Dextromethorphan 20mg ever 4 hours

a. Prepare to place client on airborne precautions

b. Place client in a semi-fowlers position

c. Encourage use of incentive spirometer

d. Encourage PO fluids every 1-2 hours

e. Ceftriaxone 1gram IV q 24 hours and Azithromycin 500mg IV q 24 hours

f. Tylenol 650mg PO q 4 hours PRN temperature greater than 101

g. Dextromethorphan 20mg ever 4 hours

Correct

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Question 5 of 6

5. Question

Case Study Question 5 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

Chest X-Ray:

Notes

Reveals pulmonary infiltrates bilaterally. Consolidation left lower lobe. No hilar lymphadenopathy.

Most Recent Laboratory Report:

Lab	Results	Reference range
Hematocrit	42%	Males: 42-52% Females: 35-47%
Hemoglobin	13 g/dL	Males: 13-18 g/dL Females:12-16 g/dL
WBC	9,000 cell/mm3	4.5 – 10.5 x 10³cells/mm³
Potassium(serum)	4.5 mEq/L	3.5 to 5 mEq/L
Sodium (serum)	139 mEq/L	135 to 145 mEq/L

>Five days later, the nurse is assessing the client and reviewing labs. Select the word choices that complete the sentence (order does not matter).

a. Performs ADLs without dyspnea

b. Expectorates moderate amount of thick yellow-green sputum

c. Oxygen saturation 96% on room air

d. Afebrile for past 48 hours

e. WBC count is 9,000 cells/mm3

f. Repeat chest x-ray shows consolidation in left lower lobe

Correct

Incorrect

Question 6 of 6

6. Question

Case Study Question 6 of 6

The emergency room nurse is admitting a 55-year-old male who presents with dyspnea, chest pain, and a cough.

Nurse Notes:

Notes	Time 1000. Client reports symptoms started almost a week ago, and he was diagnosed with an upper respiratory infection by his primary care physician. Reports worsening dyspnea since yesterday. Has a productive cough sometimes tinged with blood. Complains of chills. Has intermittent chest pain when he breathes deeply. Pain 0/10 at present. Appears restless but can speak in full sentences. No known drug allergies.
Vital Signs	Blood pressure = 100/65 RR = 28 Pulse = 110bpm Temp= 100.8 degrees Fahrenheit
Neurologic	Awake alert and oriented x 3.
Cardio-respiratory	HR regular rhythm, rales and rhonchi heard on auscultation, productive cough. Oxygen saturation 90% on room air.
Gastrointestinal	Abdomen soft, nontender. Denies nausea, vomiting, diarrhea, constipation
Extremities	Warm to touch, no edema
Social Assessment	Smokes 1 pack a week. Denies alcohol use. Lives independently at home.

Chest X-Ray:

Notes

Reveals pulmonary infiltrates bilaterally. Consolidation left lower lobe. No hilar lymphadenopathy.

Most Recent Laboratory Report:

Lab	Results	Reference range
Hematocrit	42%	Males: 42-52% Females: 35-47%
Hemoglobin	13 g/dL	Males: 13-18 g/dL Females:12-16 g/dL
WBC	9,000 cell/mm3	4.5 – 10.5 x 10³cells/mm³
Potassium(serum)	4.5 mEq/L	3.5 to 5 mEq/L
Sodium (serum)	139 mEq/L	135 to 145 mEq/L

>The nurse is performing discharge teaching. Which of the following statements indicates that teaching has been successful? Select all that apply.

a. “I will continue my turn, cough, deep breathe exercises at home.”

b. “I will continue my antibiotics until my cough is gone.”

c. “I will continue to drink lots of fluids.”

d. “I can take Robitussin for my cough if needed.”

e. “If I can’t breathe well, have chest pain or fever, or I keep bringing up yellow, green, or bloody sputum, I will notify my doctor.”

f. “I will get a pneumonia vaccine after I am healed.”

Correct

Incorrect

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NCLEX Practice Set 9 (Case Study #3)

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