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 7.25-7.45 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. 

A nurse is reviewing a client’s medication orders and notes a prescription for a beta blocker. The nurse should identify that beta blockers are contraindicated in which of the following client conditions? 

A client has a tracheostomy placed due to chronic respiratory failure. Upon return to the unit, the nurse notes that the outer cannula has been dislodged from the trachea. What is the priority nursing action?  

A client at the clinic is diagnosed with tuberculosis. When developing this client’s plan of care, which medications will the nurse anticipate as being prescribed as first-line agents? 

A nurse is caring for a client with manifestations of status asthmaticus. Which of the following factors play a role in creating circulatory surge of inflammatory cells and cytokines in this condition?

A client sustains a nasal fracture during a wrestling match. The fracture requires surgical intervention and an overnight hospitalization for observation. What is the priority nursing assessment?

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 7.25-7.45 PCO2 50 mmHg 35-45 mmHg HCO3 24 mEq/L 22-26 mEq/L 1045 – CXR: hyperinflation of lungs with flattened diaphragm Which of the following findings require immediate action? (Select All That Apply)

A nurse is preparing a client for discharge. Which action by the nurse is essential for medication reconciliation?

A patient arrives at the emergency department with crushing substernal chest pain that started 45 minutes ago while they were watching television. The pain is described as “pressure-like,” radiating to their left arm and jaw. They are diaphoretic, pale, and anxious. They have a past medical history of hypertension, hyperlipidemia, and type 2 diabetes. Vital Signs on Admission: BP: 150/90 mmHg HR: 110 bpm, irregular RR: 32 breaths/min SpO2: 88% on room air Current Medications: Lisinopril 10 mg daily Metformin 500 mg BID Simvastatin 20 mg daily Diagnostic Findings: ST-segment elevation noted on ECG Troponin level pending The healthcare provider orders the following: Oxygen at 2 L/min via nasal cannula Nitroglycerin sublingual, every 5 minutes PRN for chest pain Aspirin 325 mg, chewable Morphine sulfate 2 mg IV PRN for pain Metoprolol 5 mg IV Prepare for percutaneous coronary intervention (PCI) The nurse prepares to administer Metoprolol (lopressor) 5 mg IV. What is the priority assessment before giving this medication?

A nurse is assessing a client who has peripheral venous disease. Which of the following findings should the nurse recognize as a manifestation of peripheral venous disease?