Pre-test Respiratory Assessment

Explanation
Based on the assessment data provided, the client is experiencing significant respiratory distress with symptoms such as nasal flaring, use of accessory muscles, a high respiratory rate, and low oxygen saturation. These symptoms indicate that the client's condition is deteriorating and requires immediate medical attention. Notifying the client's physician is the most appropriate intervention in this situation to ensure prompt medical assessment and intervention.

Explanation
A nebulizer treatment is appropriate based on the assessment data because it helps deliver medication directly to the lungs, which can help relieve symptoms of asthma such as high pitched, shrill breath sounds on expiration. Nebulizer treatments can help open up the airways and reduce inflammation, making it easier for the client to breathe. Chest physiotherapy and postural drainage may be helpful in other respiratory conditions but may not be as effective in treating asthma. Increasing the oxygen may not directly address the underlying cause of the high pitched, shrill breath sounds.

Explanation
The correct answer is Paco2. In a client with COPD receiving oxygen via a Bipap mask with external positive pressure ventilation, the therapy is effective if the Paco2 (partial pressure of carbon dioxide) decreases on an arterial blood gas. This is because the positive pressure ventilation helps to improve ventilation and remove excess carbon dioxide from the lungs, leading to a decrease in Paco2 levels.

Explanation
The client's statement of never feeling like they're getting enough air, along with their history of COPD, hospitalized with pneumonia, and shallow respiratory rate of 40 breaths per minute, indicates that they are experiencing difficulty in clearing their airway. The presence of bilateral coarse crackles in the upper lung lobes, dry cough, and restlessness further support the diagnosis of insufficient airway clearance. This nursing diagnosis would be chosen to plan care for the client, as it addresses the specific issue of inadequate airway clearance, which is essential for effective breathing and gas exchange.

Explanation
During the physical examination, the nurse palpates the chest from one side to the other while the client says "99." This technique is known as fremitis. Fremitis refers to the vibration felt on the chest wall when the patient speaks. Increased fremitis can indicate underlying lung consolidation or fluid in the lungs. Therefore, by palpating the chest and assessing for fremitis, the nurse can detect abnormal physical findings that may suggest a respiratory condition such as pneumonia.