CASE STUDY Nurse’s Note: 1015 – 68-year-old male client brought to the emergency department by significant other. Client reports waking up this morning and being “unable to breathe.” The client was treated for bronchitis 3 weeks ago by their primary care provider. Client reports no pain, nausea, vomiting, or difficulty urinating. Last bowel movement was yesterday. Skin is cyanotic and client is diaphoretic. Clubbing of nail beds present. Lungs are diminished in bilateral bases. Client has a productive cough. Sputum is thick, whitish-yellow color. Pedal pulses 2+ bilaterally. Skin turgor greater than 2 seconds. Labs, chest x-ray (CXR), and arterial blood gas (ABG) obtained. History and Physical: 1015 – Hypertension, Hyperlipidemia, Hypothyroidism; Bronchitis 3 weeks ago was treated with antibiotics; Smoker for past 40 years, smokes 2 packs per day; Denies daily alcohol use. Vital Signs @ 1015  Temperature 37.1° C (98.8° F)Heart rate 100/minRespiratory rate 26/minBlood pressure 164/90 mm HgOxygen saturation 84% on room air  Diagnostic Results: 1030  Lab Client Result Normal Value Range Sodium 142 mEq/L 136-145 mEq/L Potassium 4.8 mEq/L 3.5-5 mEq/L Calcium 9.5 mg/dL 7.6-10.4 mg/dL Hemoglobin 16 g/dL 14-18 g/dL Hematocrit 46% 40%-52% WBC 7000 mm³ 5000-10000 mm³ ABG: pH 7.25 7.35-7.45 PCO2 50 mmHg 35-45 mmHg HCO3 24 mEq/L 22-26 mEq/L 1045 – CXR: hyperinflation of lungs with flattened diaphragm Provider Prescriptions @ 1130: Admit client to telemetry unit. Place client on a high-calorie diet. Oxygen at 3 L/min via nasal cannula Albuterol 5 mg via nebulizer every 4 hr  Prednisolone 60 mg PO daily Obtain 12-lead ECG. Metoprolol 50 mg PO twice daily  Place on fall precautions. Collect sputum culture. Azithromycin 500 mg PO daily for 3 days Nurse’s Note: 1145 – Client admitted to telemetry unit with diagnosis of Chronic Obstructive Pulmonary Disorder (COPD) due to emphysema. Client states they have been “breathing better” since oxygen applied, but that they “feel weak.” Lungs sounds are diminished in bilateral bases. Cough is productive. Vital Signs @ 1145 Temperature 37.1° C (99.7° F)Heart rate 94/minRespiratory rate 22/minBlood pressure 158/88 mm HgOxygen saturation 90% on 3 L/min via nasal cannula For each potential prescription, specify whether it would be indicated or contraindicated for this client. 

The nurse is providing discharge education to a client who had hypophosphatemia (normal level 2.5-4.5 mg/dL). Which foods should the nurse teach this client to include in the diet? Select all that apply.

The teaching plan for a client with acute rhinosinusitis (runny nose) will need to include which of the following interventions? 

Which of the following electrolytes is most important for maintaining fluid balance in the body?

What is the recommended frequency for changing intravenous tubing for continuous infusions according to Centers for Disease Control guidelines?

When caring for a client’s peripheral intravenous site during fluid replacement, which action should the nurse take?

Which of the following nursing interventions is correct for clients receiving intravenous (IV) therapy?

A client who has a history of chronic obstructive pulmonary disease (COPD) is admitted to the hospital with possible pneumonia. Respirations are shallow and breath sounds are diminished. Blood gases reveal: pH – 7.25 (normal level 7.35- 7.45), PCO2 – 70 (normal level 35-45), HCO3- 24 (normal level 22-26).  What acid-base imbalance is this client experiencing?

While assessing a client’s peripheral intravenous site, the nurse observes edema and coolness around the insertion site. How should the nurse document this observation?

The nurse is caring for a client with acute kidney injury and hypermagnesemia (normal level 1.7-2.2 mg/dL). Which assessment finding is typically associated with hypermagnesemia?