Case Study 2 (Dyspnea and Shortness of
Breath) - Prioritization, Delegation, and
Assignment Questions and Answers Grade
A+ 2023
Mr. W is an 83-year-old man who was brought to the hospital from a long-term care facility by
emergency medical services after reporting severe dyspnea and shortness of breath. He has been
experiencing coldlike symptoms for the past 2 days. He has a productive cough with thick
yellowish sputum. When Mr. W awoke in the nursing home, it was found that he was having
difficulty breathing even after using his albuterol metered-dose inhaler (MDI). He appears very
anxious and is in respiratory distress. His history includes chronic obstructive pulmonary disease
(COPD) related to smoking 2 packs of cigarettes per day since he was 15 years old; he quit
smoking 2 years ago when he was admitted to the long-term facility. Mr. W has been incontinent
of urine and stool for the past 2 years.
In the emergency department, Mr. W undergoes chest radiography, and admission laboratory
tests are performed, including serum electrolyte levels and a complete blood count. A sputum
sample is sent to the laboratory for culture and sensitivity testing and Gram staining.
Mr. W's *vital sign values* are as follows:
-Blood pressure: 154/92 mm Hg
-Heart rate: 118 beats/min
-O2 saturation: 88% on 1 L/min oxygen by nasal cannula
-Respiratory rate: 38 breaths/min
-Temperature: 100.9° F (38.3° C) (oral) - -
-Which *priority* actions will the nurse take when the patient is initially admitted to the
emergency department (ED)? *Select all that apply.*
•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Change the patient's adult pad
•Send the patient for a chest x-ray
•Order the patient a lunch tray - -•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Send the patient for a chest x-ray
•Baseline data that are essential to decisions for the care of this patient take priority at this time
including vital signs, cardiac rhythm, lab values, and chest x-ray findings. Placement of a saline
lock is essential for administration of fluids and emergency drugs. Changing the patient's
, incontinence pad is important to protect his skin but is not urgent. Ordering a lunch tray may be
premature because the interventions for this patient's care are undecided when he is first admitted
to the ED.
-What is the *priority* nursing concern for this patient?
•Skin care due to incontinence
•Clearance of thick secretions
•Rapid heart rate
•Elevated temperature - -•Clearance of thick secretions
•The patient's major problems at this time relate to airway and breathing including thick sputum,
difficulty breathing, and respiratory distress. The patient's skin care, blood pressure, and elevated
temperature will need to be followed up on soon but are not as urgent at this time as his
respiratory status.
-The RN assesses Mr. W in the emergency department. Which assessment findings are consistent
with a diagnosis of COPD? *Select all that apply.*
•Enlarged neck muscles
•Forward bent posture
•Respiratory rate 15 to 25 breaths/min
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•Symmetrical lung expansion - -•Enlarged neck muscles
•Forward bent posture
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•The presence of wheezes, enlarged neck muscles, bluish dusky appearance, and forward bent
posture are all classic manifestations in a patient with COPD. The respiratory rate is usually
higher than normal and during an exacerbation can be as high as 30 to 40 breaths/min. Lung
expansion in patients with COPD is usually asymmetrical.
-The health care provider's (HCP's) prescribed actions for this patient include all of the
following. Which intervention should the nurse complete *first*?
•Send an arterial blood gas (ABG) sample to the laboratory
•Schedule pulmonary function tests
•Repeat chest radiography each morning
•Administer albuterol via MDI 2 puffs every 4 hours - -•Send an arterial blood gas (ABG)
sample to the laboratory
•Baseline ABG results are important in planning the care of this patient. The unit clerk can
schedule the pulmonary function tests and chest radiography. The albuterol therapy is a routine
order.
Breath) - Prioritization, Delegation, and
Assignment Questions and Answers Grade
A+ 2023
Mr. W is an 83-year-old man who was brought to the hospital from a long-term care facility by
emergency medical services after reporting severe dyspnea and shortness of breath. He has been
experiencing coldlike symptoms for the past 2 days. He has a productive cough with thick
yellowish sputum. When Mr. W awoke in the nursing home, it was found that he was having
difficulty breathing even after using his albuterol metered-dose inhaler (MDI). He appears very
anxious and is in respiratory distress. His history includes chronic obstructive pulmonary disease
(COPD) related to smoking 2 packs of cigarettes per day since he was 15 years old; he quit
smoking 2 years ago when he was admitted to the long-term facility. Mr. W has been incontinent
of urine and stool for the past 2 years.
In the emergency department, Mr. W undergoes chest radiography, and admission laboratory
tests are performed, including serum electrolyte levels and a complete blood count. A sputum
sample is sent to the laboratory for culture and sensitivity testing and Gram staining.
Mr. W's *vital sign values* are as follows:
-Blood pressure: 154/92 mm Hg
-Heart rate: 118 beats/min
-O2 saturation: 88% on 1 L/min oxygen by nasal cannula
-Respiratory rate: 38 breaths/min
-Temperature: 100.9° F (38.3° C) (oral) - -
-Which *priority* actions will the nurse take when the patient is initially admitted to the
emergency department (ED)? *Select all that apply.*
•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Change the patient's adult pad
•Send the patient for a chest x-ray
•Order the patient a lunch tray - -•Place the patient on a cardiac monitor
•Get a baseline set of vital signs
•Draw admission labs and place a saline lock
•Send the patient for a chest x-ray
•Baseline data that are essential to decisions for the care of this patient take priority at this time
including vital signs, cardiac rhythm, lab values, and chest x-ray findings. Placement of a saline
lock is essential for administration of fluids and emergency drugs. Changing the patient's
, incontinence pad is important to protect his skin but is not urgent. Ordering a lunch tray may be
premature because the interventions for this patient's care are undecided when he is first admitted
to the ED.
-What is the *priority* nursing concern for this patient?
•Skin care due to incontinence
•Clearance of thick secretions
•Rapid heart rate
•Elevated temperature - -•Clearance of thick secretions
•The patient's major problems at this time relate to airway and breathing including thick sputum,
difficulty breathing, and respiratory distress. The patient's skin care, blood pressure, and elevated
temperature will need to be followed up on soon but are not as urgent at this time as his
respiratory status.
-The RN assesses Mr. W in the emergency department. Which assessment findings are consistent
with a diagnosis of COPD? *Select all that apply.*
•Enlarged neck muscles
•Forward bent posture
•Respiratory rate 15 to 25 breaths/min
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•Symmetrical lung expansion - -•Enlarged neck muscles
•Forward bent posture
•Inspiratory and expiratory wheezes
•Blue-tinged dusky appearance
•The presence of wheezes, enlarged neck muscles, bluish dusky appearance, and forward bent
posture are all classic manifestations in a patient with COPD. The respiratory rate is usually
higher than normal and during an exacerbation can be as high as 30 to 40 breaths/min. Lung
expansion in patients with COPD is usually asymmetrical.
-The health care provider's (HCP's) prescribed actions for this patient include all of the
following. Which intervention should the nurse complete *first*?
•Send an arterial blood gas (ABG) sample to the laboratory
•Schedule pulmonary function tests
•Repeat chest radiography each morning
•Administer albuterol via MDI 2 puffs every 4 hours - -•Send an arterial blood gas (ABG)
sample to the laboratory
•Baseline ABG results are important in planning the care of this patient. The unit clerk can
schedule the pulmonary function tests and chest radiography. The albuterol therapy is a routine
order.
