A nurse is caring for a number of patients on a medical unit. The patient of the highest priority is
1. A 22-year-old with pneumonia who is restless and confused.
2. A 41-year-old with a chest tube who has noted tidaling.
3. A 58-year-old with chronic obstructive pulmonary disease with a nonproductive cough.
4. A 72-year-old with pneumonia who has rusty-colored sputum.
Question 2
A nurse is caring for a patient with a chest tube who has notable crepitus at the chest tube site, extending across the chest about 3 inches. The best statement the nurse can make is:
1. Don't worry. That happens with a lot of chest tubes. We'll simply mark this and keep an eye on it.
2. That is a local swelling caused by the trauma of having the tube placed. It will go down a few days after the tube comes out.
3. There are some new, small pockets of air under your skin that I'd like to have the doctor examine.
4. You may be developing an infection. I'd like to check your temperature and change the chest tube dressing so that I can see the site.
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