Question

A nurse caring for a patient with pneumonia sits the patient up in bed and suctions his airway. After suctioning, the patient describes some discomfort in his abdomen. The nurse auscultates the patient's lung sounds and gives him a glass of water. Which of the following is an evaluative measure used by the nurse? [20]

1. Suctioning the airway
2. Sitting the patient up in bed
3. Auscultating lungs sounds
4. Patient describing type of discomfort

Answer 1

The evaluative measure used by the nurse is auscultating lung sounds. This method assesses the patient's lungs after suctioning and is critical for checking the respiratory status.

Step-by-step explanation:

The question is focused on identifying which of the listed actions by the nurse is considered an evaluative measure during the care of a pneumonia patient. An evaluative measure is a method used to assess the effectiveness of a medical intervention or to understand the patient's condition after treatment. In this case, the answer is auscultating lung sounds. By using a stethoscope, the nurse is evaluating the patient's lung sounds to check for improvements or deterioration in the respiratory condition following the suctioning procedure. This evaluation is crucial as it provides feedback on the patient's respiratory status and the effectiveness of suctioning. Auscultation is a common diagnostic technique that allows healthcare providers to listen to the internal sounds of the body. It is often used to assess the heart and lungs and can reveal abnormalities such as the crepitations commonly found in patients with pneumonia. The nurse's actions, like sitting the patient up and providing water, are parts of the treatment and care, while the patient's description of discomfort is a subjective report that can guide further evaluation or intervention.