The nurse palpates the posterior chest while the patient says 99 ...

[jake]

The nurse palpates the posterior chest while the patient says 99 and notes absent fremitus. Which action should the nurse take next?
 
  a. Palpate the anterior chest and observe for barrel chest.
  b. Encourage the patient to turn, cough, and deep breathe.
  c. Review the chest x-ray report for evidence of pneumonia.
  d. Auscultate anterior and posterior breath sounds bilaterally.

Question 2

A patient with a chronic cough has a bronchoscopy. After the procedure, which intervention by the nurse is most appropriate?
 
  a. Elevate the head of the bed to 80 to 90 degrees.
  b. Keep the patient NPO until the gag reflex returns.
  c. Place on bed rest for at least 4 hours after bronchoscopy.
  d. Notify the health care provider about blood-tinged mucus.

[jsm54321]

Answer to Question 1

ANS: D
To assess for tactile fremitus, the nurse should use the palms of the hands to assess for vibration when the patient repeats a word or phrase such as 99. After noting absent fremitus, the nurse should then auscultate the lungs to assess for the presence or absence of breath sounds. Absent fremitus may be noted with pneumothorax or atelectasis. The vibration is increased in conditions such as pneumonia, lung tumors, thick bronchial secretions, and pleural effusion. Turning, coughing, and deep breathing is an appropriate intervention for atelectasis, but the nurse needs to first assess breath sounds. Fremitus is decreased if the hand is farther from the lung or the lung is hyperinflated (barrel chest).The anterior of the chest is more difficult to palpate for fremitus because of the presence of large muscles and breast tissue.

Answer to Question 2

ANS: B
Risk for aspiration and maintaining an open airway is the priority. Because a local anesthetic is used to suppress the gag/cough reflexes during bronchoscopy, the nurse should monitor for the return of these reflexes before allowing the patient to take oral fluids or food. Blood-tinged mucus is not uncommon after bronchoscopy. The patient does not need to be on bed rest, and the head of the bed does not need to be in the high-Fowler's position.

[jake]

Gracias!

[Alyson.hiatt@yahoo.com]

Excellent