HESI CASE STUDY - COPD with Pneumonia (2019 Update)

Study online at https://quizlet.com/_659brs

1. Which assessment is most important for the nurse to Auscultate breath

complete next? sounds

2. Which assessment finding supports Mr. Johnson's Pulse rate of 110

diagnosis of pneumonia?

3. Based on these ABG results, which acid base imabal- Respiratory acido-
ance is Mr. Johnson experiencing? sis

4. Which nursing diagnosis has the highest priority Ineffective airway

when planning care for Mr. Johnson? clearance

5. Which nursing action should be implemented before Obtain a sputum

administering the prescribed Unasyn? culture

6. The levofloxacin 500 mg IVPB is supplied in 100mL 33

of D5W to be delivered over 60min. There is no IV
pump available so the nurse will infuse the antibiotic
by gravity. The drop factor on the tubing is 20 gtts/mL.
The nurse should set the IVPB to infuse at how many
gtts per min?

7. Which assessment is most important for the nurse to Monitor pulse and
perform while Mr. Johnson is receiving Ventolin? BP

8. After observing Mr. Johnson, which instruction by the -Wait at least 5

nurse is most important for client teaching? (SATA) minutes between
each medication

-Wait at least 1 min

between each puff
of the same med-
ication

9. Which instruction should the nurse provide Mr. John- Use the albuterol
son for an acute episode of asthma? inhaler for acute
asthma attacks

10.

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 HESI CASE STUDY - COPD with Pneumonia (2019 Update)
Study online at https://quizlet.com/_659brs
After checking the sensor site to make sure the read- Assess the client's
ings are accurate, the nurse should then initiate which respiratory rate
intervention? and rhythm

11. Which action should the nurse implement to en- Assess adequacy
sure accurate oxygen saturation readings via a pulse of circulation pri-
oximeter? or to applying the
sensor

12. What is the best statement for the nurse to use to You seem pretty
promote effective communication with Mr. Johnson? upset this morning

13. What is the nurse's best response? Remain silent

14. What is the BEST nursing action? Instruct the UAP

involved regarding
the inappropriate
removal of the
nasal cannula

15. Which 1 of these rights was violated in that situation Right

Direction/Commu-
nication

16. Which intervention should the nurse initiate immedi- Place resuscita-
ately? tion equipment in
the room

17. What ethical principle is the most important for the Autonomy
nurse to consider when responding to the son?

18. Which outcome statement is the best indicator that Sputum culture is
Mr. Johnson's pneumonia is resolves and he is ready negative
to be discharged?

19. Which additional discharge instruction(s) should the -Avoid crowds and
nurse include in the teaching plan to promote optimal people with infec-
health for Mr. Johnson? tions
-Increase intake of
oral fluids
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HESI CASE STUDY - COPD with Pneumonia (2019 Update)
Study online at https://quizlet.com/_659brs
-Store prescribed
inhalers away from
extreme heat or
colds

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