NCLEX Case Study: Nursing Care of the Patient With a Pulmonary Disorder

By March 17, 2018 No Comments

Pulmonary Disorder

Jeannette is a new nurse on a medical–surgical care unit. Mark, her preceptor, asks her to assess the patient’s lungs.

Hot spot:

Indicate where the nurse should place the stethoscope in order to auscultate for the following:
A. Bronchial breath sounds
B. Vesicular breath sounds
C. Bronchovesicular breath sounds

Patient Lungs

Hot spot: Locate patient lungs

It is important for Jeannette to understand why different masks are used.


Match the reason for oxygen delivery in Column A to the method of oxygenation in Column B:

Jeanette and Mark complete an admission assessment for a 22-year-old patient named Max. Max has possible tuberculosis (TB). He is homeless and has been living in a shelter since he lost his job last year.

Select all that apply:

Which clinical manifestations are consistent with active tuberculosis (TB)?
A. Dyspnea
B. Nightsweats
C. Fatigue
D. Low-gradefevers
E. Productive bloody sputum
F. Unexplained weight loss
G. Anorexia
H. Wheezing

The health care provider orders a Mantoux skin test (tuberculin test) to be performed intradermally.


Which statement is accurate regarding the Mantoux skin test?
A. A positive Mantoux test confirms active tuberculosis (TB)
B. The test is read within 24 hours of placement
C. An induration of 10 mm or greater indicates a positive skin test
D. An induration of 15 mm in immunocompromised patients is considered a positive test

Max had a positive skin test and, therefore, precautions are indicated. Jeannette collects a sputum specimen to test for acid-fast bacilli (AFB).


Which statement by a student nurse needs follow-up regarding precautions for a patient with possible tuberculosis (TB)?
A. “The patient will be isolated in a negative pressure room.”
B. “The nurse will wear a high-efficiency particulate air (HEPA) mask.”
C. “The airborne isolation sign will be placed at the entrance to the patient’s room.”
D. “The patient will wear a N95 mask when leaving the room.”

Max is diagnosed with TB and placed on a multimedication regimen.


Which instruction will the nurse give the patient in regard to rifampin (Rifadin)?
A. The medication may turn your urine red-orange.
B. The medication may cause short-term memory loss.
C. The medication should be taken with food.
D. The medication may increase your appetite.

Later that day, Max tells the nurse that he would like to go back to the shelter as soon as possible because he does not like being in the hospital. He has been taking his medica- tion for 2 weeks and is feeling better.


Which statement by the nurse is correct?
A. “You will be discharged when you stop coughing up secretions.”
B. “Discharge will depend on the results of the chest x-ray.”
C. “Most patients are discharged after taking their medication for 48 hours.”
D. “Patients are discharged after three negative acid-fast bacilli (AFB) smears.”

Max is ready to be discharged. Jeannette and Mark complete the discharge teaching.


Which of the following statements indicate that the patient understands appropriate care measures?
A. “One medication can be substituted for another because they all fight infection.”
B. “A sputum specimen will need to be collected every 2 to 4 weeks indefinitely.”
C. “Medication will need to be taken for a 6- to 12-month duration.”
D. “A standardized mask will need to be worn until medication therapy is completed.”

Tanya, a nurse working in the ED, assesses Dean, a 19-year-old who was hurt while playing football with his friends. Dean began to complain of dyspnea and pain in the left rib area after being tackled.

Fill in the blanks:

Name four causes of a closed pneumothorax.

1. ____________________________________________________________________________
2. ____________________________________________________________________________
3. ____________________________________________________________________________
4. ____________________________________________________________________________

Fill in the blanks:

Name two causes of an open pneumothorax.

1. ____________________________________________________________________________
2. ____________________________________________________________________________

The assessment findings are as follows—BP: 137/84 mmHg, pulse: 106, respiration rate (RR): 36, and pulse oximeter: 94%. Dean is sent to radiology for a chest x-ray.

Tanya understands that various complications can arise from a thoracic injury.


Match the manifestation in Column A to the complication in Column B:

Thoracic Injury

Thoracic Injury

The x-ray confirms that Dean has a fractured left rib, but no pneumothorax is noted.

Select all that apply:

Which findings will the nurse anticipate in a patient suffering from a fractured rib?
A. Pain during inspiration
B. Shallow, rapid respirations
C. Crackles to bilateral lower lobes
D. Splinting or guarding the chest

Dean is advised to take analgesics as ordered to provide relief and facilitate adequate respirations.

Jeannette is assessing Mr. Williams, who was recently diagnosed with chronic obstructive pulmonary disease (COPD). Mr.Williams states that he has smoked for 20 years and is employed by a chemical company. He also says that there were no safety regulations at the plant until 5 years ago.

Fill in the blanks:

What are the differences between chronic bronchitis and emphysema?

Chronic bronchitis:_____________________________________________________________________________________________________________________________________________________________________________________________________



Identify which clinical manifestations are related to chronic obstructive pulmonary disease (COPD) and which are related to asthma.
A. Onset is at 40 to 50 years of age
B. Dyspnea is always experienced during exercise
C. Clinical symptoms are intermittent from day to day
D. There is frequent sputum production
E. Weight loss is characteristic
F. There is a history of allergies, rhinitis, and eczema
G. Disability worsens progressively

COPD: ________________________________________________________________________________________________________________________________________________________________________________________________________________


Jeannette notes that the patient is orthopneic, has a nonproductive cough, and has an increased anteroposterior (AP) diameter.


The nurse’s findings are most consistent with which diagnosis?
A. Tuberculosis(TB)
B. Chronic obstructive pulmonary disease (COPD)
C. Pneumonia
D. Congestive heart failure (CHF)

Jeannette observes that the patient is on aVenturi mask.The patient’s wife asks Jeannette, “Why does my husband have this mask instead of a nasal cannula like he does at home?”


Which statement by the nurse demonstrates understanding of oxygen delivery via Venturi mask?
A. “Using a Venturi mask will prevent the nasal mucosa from drying and reduce coughing.”
B. “The Venturi mask provides a low-flow oxygen delivery system.”
C. “TheVenturimaskprovidesaconsistent,preciseconcentrationofoxygentomaintainrespiratorydrive.”
D. “The Venturi mask is a high-flow system that flushes the expired carbon dioxide out of the mask
preventing further retention.”

Mr.Williams is at increased risk of complications from COPD.


Match the associated factors in Column A to the complication in Column B:

complications from COPD

complications from COPD


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