NRG 301 RLE Week 3

In triage, an adult arrives upright, talking in short phrases with visible accessory muscle use. Orders aren’t in yet. What is the nurse’s initial independent action?

• Position in high Fowler’s and coach pursed-lip breathing

• Start an IV and draw labs

• Call respiratory therapy to arrange treatments

• Apply a non-rebreather at 15 L/min without orders

You plan chest physiotherapy (CPT) for copious secretions and weak cough. Which sequence reflects safe practice?

• Position → percussion → vibration → cough/suction

• Vibration → percussion → position → cough/suction

• Percussion → cough/suction → position → vibration

• Cough/suction → position → vibration → percussion

A client scheduled for CPT after lunch reports nausea. What is the best nursing action?

• Reschedule CPT to a time not soon after meals

• Proceed to keep the daily schedule

• Lower the head of bed and continue

• Offer strong mouthwash and proceed

On a busy unit, which task can be delegated to a nursing assistant for a patient receiving CPT?

• Assist with positioning and provide tissues/emesis basin

• Perform chest percussion over target segments

• Teach the huff-cough technique

• Assess breath sounds pre-/post-treatment

Four clients need attention. Who should the nurse see first?

• Client scheduled for CPT with ribs tender after a fall

• Client who expectorated thick sputum after CPT and feels relieved

• Client asking about home care instructions for CPT

• Client requesting help into side-lying for drainage

While preparing for percussion, which safety check is the priority?

• Avoid percussing over the spine, sternum, or upper abdomen

• Ensure the room temperature is cool

• Remove all clothing so the chest is bare

• Use fingertips to tap firmly over bony prominences

During vibration, the patient asks how to breathe. The nurse should coach:

• Exhale slowly through pursed lips during the vibration

• Take rapid breaths in and out during the vibration

• Hold breath during the vibration

• Inhale forcefully through the nose during the vibration

A patient with ineffective cough after CPT remains congested. What is the collaborative next step?

• Prepare for suctioning using sterile technique per protocol

• Repeat a full CPT session immediately

• Encourage bed rest for the remainder of the day

• Place in Trendelenburg and wait

You’re precepting a new nurse on percussion technique. Which coaching point is most important?

• Use cupped hands to produce a hollow sound without pain

• Use the ulnar edge of the hand for a sharper impact

• Percuss directly over zippers to localize vibration

• Keep the hand flat to spread the impact

The provider requests 'drain right lower lobe.' Which positioning plan supports this goal?

• Trendelenburg-assisted side-lying to drain dependent lower segments

• High Fowler’s leaning forward on over-bed table

• Supine with pillows under the knees

• Prone with head of bed elevated