NCLEX : Respiratory Condition Follow-Up
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Example Question #72 : Conditions And Treatments
What population is most at risk during pertussis infection?
Elderly
Pregnant women
Adolescents
Infants
Infants
Due to their susceptibility to suffocation, infants are more at risk of mortality than older children, pregnant women, or the elderly during pertussis infection. Mortality in infants with this condition can be as high as 2%. There is also an increase in infant co-moridities such as pneumonia, encephalopathy, seizures, and failure to thrive.
Example Question #1 : Respiratory Condition Follow Up
You are the nurse taking care of a 78-year old man with a 60 pack-year smoking history who is hospitalized for shortness of breath. You review the x-ray and notice a 1-cm solitary pulmonary nodule within the middle lobe of the right lung. Which of the following is the most appropriate next step?
Administer radiotherapy to the pulmonary nodule
Arrange for biopsy of the nodule
Attempt to obtain and review a prior x-ray
Administer chemotherapy
Refer the patient for surgical excision of the nodule
Attempt to obtain and review a prior x-ray
The correct answer is "Attempt to obtain and review a prior x-ray." This is the correct answer because while the patient appears to have a very concerning story for a primary lung neoplasm given his age and smoking history, or a metastasis from another neoplasm, if this nodule was noted on a prior x-ray, especially a much older x-ray, and is unchanged, then the degree of concern about the nodule is much lower, given its stability over time. On the contrary, if you can obtain a recent prior x-ray and the nodule is not present on that scan, or has grown since that scan, then the level of concern about the nodule should be greater, and should guide clinical decision-making as such.
Measures such as biopsy, surgery, chemotherapy, or radiotherapy administration are all possible future steps if indeed this pulmonary nodule turns out to be a malignant neoplasm. That being said, there is no definite evidence at this time that the patient's nodule is of malignant origin, and should this nodule be something that has been stable on prior x-rays for multiple years, then the level of concern should be far lower, and the need for more invasive measures would be obviated.
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