Solutions manual for NR 603 Pulmonary Case Discussion Solutions
Manual: Questions and answers solutions with Rationales
1. Question: A patient presents with dyspnea, cough, and fever. Which initial diagnostic test
should the nurse anticipate?
Answer: Chest X-ray to identify pneumonia, atelectasis, or other pulmonary pathology.
Rationale: Chest imaging helps visualize lung parenchyma and pleural space abnormalities.
2. Question: Which symptom is most indicative of acute pulmonary embolism (PE)?
Answer: Sudden-onset dyspnea and pleuritic chest pain.
Rationale: PE often presents abruptly, and pleuritic pain occurs from infarcted lung tissue.
3. Question: A COPD patient has barrel chest and pursed-lip breathing. What pathophysiology
explains these findings?
Answer: Air trapping and hyperinflation of alveoli.
Rationale: Chronic airflow obstruction leads to overdistended lungs, causing barrel chest and
compensatory breathing techniques.
4. Question: Which ABG finding indicates respiratory acidosis?
Answer: pH < 7.35, PaCO2 > 45 mmHg.
Rationale: CO2 retention from hypoventilation increases hydrogen ion concentration, lowering
pH.
5. Question: What is the priority intervention for a patient with tension pneumothorax?
Answer: Immediate needle decompression followed by chest tube insertion.
Rationale: Tension pneumothorax causes cardiovascular compromise; urgent decompression
restores venous return.
6. Question: A patient with asthma has audible wheezing and oxygen saturation of 90%. Which
action is appropriate first?
Answer: Administer short-acting bronchodilator (albuterol) via nebulizer.
Rationale: Bronchodilation relieves airway obstruction and improves oxygenation.
7. Question: Which lab value is elevated in bacterial pneumonia?
Answer: White blood cell (WBC) count.
Rationale: Infection triggers leukocytosis as part of the inflammatory response.
8. Question: Which physical sign is most consistent with pulmonary edema?
Answer: Bilateral crackles, dyspnea, and pink frothy sputum.
, Rationale: Fluid accumulation in alveoli impairs gas exchange and produces characteristic
crackles and sputum.
9. Question: What is the primary cause of hypoxemia in V/Q mismatch?
Answer: Areas of the lung are ventilated but not perfused or perfused but not ventilated.
Rationale: Inadequate matching of ventilation to perfusion reduces oxygenation.
10. Question: Which intervention is most effective for preventing postoperative atelectasis?
Answer: Incentive spirometry and early ambulation.
Rationale: Deep breathing expands alveoli, improving oxygenation and preventing collapse.
11. Question: A patient with cystic fibrosis presents with thick mucus and recurrent infections.
What therapy is essential?
Answer: Chest physiotherapy and mucolytics.
Rationale: Clearing secretions improves airway patency and reduces infection risk.
12. Question: Which ABG finding indicates hypoxemic respiratory failure?
Answer: PaO2 < 60 mmHg with normal or low PaCO2.
Rationale: Oxygenation is impaired before CO2 retention occurs.
13. Question: What is the most common bacterial cause of community-acquired pneumonia in
adults?
Answer: Streptococcus pneumoniae.
Rationale: This organism is the predominant cause of bacterial pneumonia in otherwise
healthy adults.
14. Question: A patient has sudden unilateral pleuritic pain and dyspnea. Which condition is
suspected?
Answer: Pneumothorax or pulmonary embolism.
Rationale: Both can present acutely; imaging or D-dimer/CT helps confirm diagnosis.
15. Question: Which physical assessment finding is characteristic of emphysema?
Answer: Barrel chest and decreased breath sounds.
Rationale: Hyperinflated lungs and alveolar destruction reduce audible breath sounds.
16. Question: What is the priority nursing action for ARDS?
Answer: Maintain adequate oxygenation with low tidal volume ventilation.
Rationale: ARDS causes stiff lungs and hypoxemia; lung-protective strategies prevent
ventilator-induced injury.
17. Question: Which patient is at highest risk for hospital-acquired pneumonia?
Answer: Mechanically ventilated or immunocompromised patients.
Rationale: Reduced airway defenses increase susceptibility to infection.
18. Question: A patient with chronic bronchitis presents with productive cough for ≥3
months/year for 2 consecutive years. What does this indicate?
Manual: Questions and answers solutions with Rationales
1. Question: A patient presents with dyspnea, cough, and fever. Which initial diagnostic test
should the nurse anticipate?
Answer: Chest X-ray to identify pneumonia, atelectasis, or other pulmonary pathology.
Rationale: Chest imaging helps visualize lung parenchyma and pleural space abnormalities.
2. Question: Which symptom is most indicative of acute pulmonary embolism (PE)?
Answer: Sudden-onset dyspnea and pleuritic chest pain.
Rationale: PE often presents abruptly, and pleuritic pain occurs from infarcted lung tissue.
3. Question: A COPD patient has barrel chest and pursed-lip breathing. What pathophysiology
explains these findings?
Answer: Air trapping and hyperinflation of alveoli.
Rationale: Chronic airflow obstruction leads to overdistended lungs, causing barrel chest and
compensatory breathing techniques.
4. Question: Which ABG finding indicates respiratory acidosis?
Answer: pH < 7.35, PaCO2 > 45 mmHg.
Rationale: CO2 retention from hypoventilation increases hydrogen ion concentration, lowering
pH.
5. Question: What is the priority intervention for a patient with tension pneumothorax?
Answer: Immediate needle decompression followed by chest tube insertion.
Rationale: Tension pneumothorax causes cardiovascular compromise; urgent decompression
restores venous return.
6. Question: A patient with asthma has audible wheezing and oxygen saturation of 90%. Which
action is appropriate first?
Answer: Administer short-acting bronchodilator (albuterol) via nebulizer.
Rationale: Bronchodilation relieves airway obstruction and improves oxygenation.
7. Question: Which lab value is elevated in bacterial pneumonia?
Answer: White blood cell (WBC) count.
Rationale: Infection triggers leukocytosis as part of the inflammatory response.
8. Question: Which physical sign is most consistent with pulmonary edema?
Answer: Bilateral crackles, dyspnea, and pink frothy sputum.
, Rationale: Fluid accumulation in alveoli impairs gas exchange and produces characteristic
crackles and sputum.
9. Question: What is the primary cause of hypoxemia in V/Q mismatch?
Answer: Areas of the lung are ventilated but not perfused or perfused but not ventilated.
Rationale: Inadequate matching of ventilation to perfusion reduces oxygenation.
10. Question: Which intervention is most effective for preventing postoperative atelectasis?
Answer: Incentive spirometry and early ambulation.
Rationale: Deep breathing expands alveoli, improving oxygenation and preventing collapse.
11. Question: A patient with cystic fibrosis presents with thick mucus and recurrent infections.
What therapy is essential?
Answer: Chest physiotherapy and mucolytics.
Rationale: Clearing secretions improves airway patency and reduces infection risk.
12. Question: Which ABG finding indicates hypoxemic respiratory failure?
Answer: PaO2 < 60 mmHg with normal or low PaCO2.
Rationale: Oxygenation is impaired before CO2 retention occurs.
13. Question: What is the most common bacterial cause of community-acquired pneumonia in
adults?
Answer: Streptococcus pneumoniae.
Rationale: This organism is the predominant cause of bacterial pneumonia in otherwise
healthy adults.
14. Question: A patient has sudden unilateral pleuritic pain and dyspnea. Which condition is
suspected?
Answer: Pneumothorax or pulmonary embolism.
Rationale: Both can present acutely; imaging or D-dimer/CT helps confirm diagnosis.
15. Question: Which physical assessment finding is characteristic of emphysema?
Answer: Barrel chest and decreased breath sounds.
Rationale: Hyperinflated lungs and alveolar destruction reduce audible breath sounds.
16. Question: What is the priority nursing action for ARDS?
Answer: Maintain adequate oxygenation with low tidal volume ventilation.
Rationale: ARDS causes stiff lungs and hypoxemia; lung-protective strategies prevent
ventilator-induced injury.
17. Question: Which patient is at highest risk for hospital-acquired pneumonia?
Answer: Mechanically ventilated or immunocompromised patients.
Rationale: Reduced airway defenses increase susceptibility to infection.
18. Question: A patient with chronic bronchitis presents with productive cough for ≥3
months/year for 2 consecutive years. What does this indicate?
