Mr. James Carter is a 67-year-old male with a history of COPD, hypertension, and type 2 diabetes. He was admitted 2 hours ago for SOB, increased sputum production, and a productive cough

Question

The questions asks the nurse to read the case study and answer the following:

Answer 1

On assessment, you find:

RR: 30/min

SpO₂: 84% on room air

HR: 110 bpm

BP: 148/92 mmHg

Temp: 101.2°F (38.4°C)

Lung sounds: Crackles and wheezes bilaterally

Sputum: Yellow-green

He is using accessory muscles to breathe and appears anxious

Question #1: Which provider order should the nurse implement first?

A. Start IV ceftriaxone 1g every 12 hours

B. Obtain a sputum culture and sensitivity

C. Administer albuterol-ipratropium nebulizer treatment

D. Draw blood cultures x2 from different sites

Answer: C

Rationale: The client is in respiratory distress and hypoxic. The bronchodilator is the most immediate, life-saving intervention. Cultures and antibiotics are essential but not as urgent.

Question #2: Which of the following findings would indicate clinical deterioration requiring immediate intervention?

Select all that apply:

A. SpO₂ drops to 78% despite oxygen therapy

B. The client becomes drowsy and confused

C. Respiratory rate decreases to 20/min

D. Heart rate drops to 56 bpm

E. The client refuses a sputum culture

Correct Answers: A, B, D

Rationale:

A: O₂ sat worsening = critical hypoxemia

B: Neuro changes = possible CO₂ retention or hypoxia

D: Bradycardia in this context may signal fatigue or respiratory failure

C is not alarming on its own unless other signs of hypoventilation are present

E is not life-threatening

Question #3: Which of the following interventions are appropriate for managing this client’s respiratory status?

Select all that apply:

A. Position the client in high Fowler’s

B. Administer oxygen via nasal cannula at 6 L/min

C. Encourage effective coughing and deep breathing

D. Limit fluid intake to avoid fluid overload

E. Monitor for signs of hypercapnia

Answers: A, C, E

Rationale:

A: Maximizes lung expansion

C: Helps clear secretions

E: COPD clients are at risk for CO₂ retention

B: High-flow oxygen (>2–3 L/min) can suppress respiratory drive in CO₂ retainers

D: Hydration is key to thinning secretions unless contraindicated

Question #4: You are calling the provider with an SBAR. Which information is most important to report?

A. “The client has been anxious since admission.”

B. “SpO₂ remains at 84% despite oxygen and nebulizers.”

C. “His last dose of insulin was yesterday.”

D. “The client is refusing labs due to needle anxiety.”

Answer: B

Rationale: This reflects worsening hypoxia despite intervention — urgent clinical concern.