Respiratory System

1. In day medicine, a patient is receiving instructions for the home care of the tracheostomy he underwent for laryngeal neoplasia. The instructions session is going well, but the patient says that, since the previous night, he’s been feeling a pain rated 5/10 at the site of the tracheostomy and has noticed increased secretions. The LPN notices a yellowish discharge around the periphery of the tracheostomy. While taking the patient’s vital signs, she notes an onset of hyperthermia at a buccal temperature of 37.9. The patient is scheduled to return home today. The LPN immediately informs the informs the physician of the observed changes in the patient’s condition. Given the patient’s condition, which of the following interventions should be done? *
2. Mr. Henri Paquette, a 68-year-old man with a history of type 2 diabetes and mild COPD, arrives on the medical floor after being diagnosed with left lower lobe pneumonia. He tells the LPN that his breathing “feels heavier today,” and he has been coughing up thick yellow sputum since the morning. As the LPN leans in to assess him, she notices that he is slightly disoriented and struggling for breath. His vital signs are: respiratory rate 32/min, SpO₂ 86% on room air, heart rate 118 bpm, and blood pressure 148/92. Crackles are audible on inspiration, and he is using intercostal muscles to breathe.
The physician has written the following orders: oxygen 3–5 L/min via nasal cannula, IV ceftriaxone, sputum culture, chest physiotherapy twice daily, and continuous pulse oximetry. Which intervention should the LPN perform first? *
3. Ms. Olivia Martel, 22 years old, arrives in the emergency observation room after experiencing sudden shortness of breath during a family dinner. She explains between gasps that her rescue inhaler “did nothing this time,” and her chest feels extremely tight. The LPN notes visible anxiety, nasal flaring, and generalized wheezing audible without a stethoscope. Her vital signs are: RR 38/min, SpO₂ 89%, pulse 132 bpm, and BP 142/84. She is sitting upright and refusing to lie down, saying she “cannot breathe at all” when reclining.

The physician’s orders include: salbutamol nebulization STAT, oxygen 2–4 L/min, keep patient sitting upright, and prepare oral prednisone.

Which intervention should the LPN prioritize? *
4. Mr. Raymond Gauthier, 74 years old, known for severe COPD, arrives at his usual follow-up unit but appears significantly more lethargic today. He tells the LPN he has been coughing “all night long” and feels too weak to eat breakfast. His skin is slightly cyanotic around the lips, and he appears confused when responding to questions. His vital signs show RR 28/min, SpO₂ 88% on his usual 2 L/min, pulse 104 bpm, and BP 130/78. The LPN hears diminished breath sounds with scattered wheezes.
The physician’s updated orders include: oxygen 1–2 L/min to maintain SpO₂ 88–92%, IV steroids, sputum culture, nebulized ipratropium-salbutamol, and no high-flow oxygen due to CO₂ retention risk. What should the LPN do first? *
5. Mrs. Joanna El-Khoury, a 72-year-old woman with metastatic breast cancer, has been increasingly short of breath over the past two days. She tells the LPN she “can’t lie flat anymore,” and becomes breathless even while speaking. On auscultation, breath sounds are absent over the lower left lung field, and she displays noticeable use of accessory muscles. Her vital signs show RR 30/min, SpO₂ 89% on 2 L/min, HR 110 bpm, and BP 150/86. The physician orders: oxygen 2–3 L/min, prepare for thoracentesis, keep patient upright, and monitor respiratory status closely. Which intervention should the LPN prioritize? *
6. Mr. Jean-Claude Mercier, a 79-year-old man with advanced COPD, reports feeling unusually weak, with increased sputum production over the past 24 hours. He tells the LPN that his sputum turned green “overnight” and that he can hardly walk from bed to bathroom. His vital signs show RR 26/min, SpO₂ 89% on 2 L, HR 96 bpm, and BP 138/82. Upon auscultation, the LPN hears low-pitched wheezes and diminished breath sounds. The physician orders: sputum culture, IV antibiotics, O₂ 1–2 L/min, and bronchodilator nebulizers. What should the LPN do first? *
7. Mrs. Sylvie Robitaille, 59 years old, is in the surgical recovery unit 12 hours after abdominal surgery. She reports feeling “very tired” and hasn’t taken many deep breaths due to incisional pain. Her breathing sounds shallow, and crackles are heard at the lung bases. Her vital signs are RR 24/min, SpO₂ 92%, HR 100 bpm, and BP 132/76. The physician orders include: incentive spirometry hourly, analgesics, oxygen 2 L/min PRN, and early ambulation. Which intervention should the LPN perform first? *
8. Mr. Ahmed Saadi, 52 years old, presents with a persistent cough, night sweats, and weight loss. During assessment, the LPN notices he becomes breathless after coughing fits. His vital signs show RR 20/min, SpO₂ 94%, HR 88 bpm, and BP 128/80. A chest x-ray suggests possible tuberculosis. The physician orders: airborne isolation, sputum sample for AFB, and N95 mask for all staff. What should the LPN do first? *
9. Nine-month-old Léa Tremblay has been admitted with suspected RSV. She has nasal flaring, retractions, and intermittent coughing. Her oxygen saturation is 89%, respiratory rate 48/min, and she appears tired and irritable. Her mother reports difficulty feeding her. The doctor orders: humidified O₂ 1–2 L/min, nasal suction PRN, small frequent feeds, and droplet/contact precautions. Which intervention comes first? *
10. Mrs. Flora Mendes, 63 years old, arrives with worsening shortness of breath after five days of fever and cough. The LPN notes she is fatigued, sweating, and struggling to speak full sentences. Her vital signs are RR 30/min, SpO₂ 88%, HR 110, BP 140/82. The physician orders: oxygen 4 L/min, droplet/contact precautions, bloodwork, and prepare for dexamethasone. What should the LPN do first? *
11. Mr. Simon Fraser, 35 years old, arrives with sudden swelling of the lips and difficulty breathing after eating shellfish. His voice sounds muffled, and his neck appears swollen. His vitals show RR 32/min, SpO₂ 87%, HR 128, BP 98/60. The doctor orders epinephrine IM, O₂ 5 L/min, and prepare for advanced airway support. What should the LPN do first? *