The patient is a 49-year-old male who has been experiencing flu-like symptoms, including fever and chest congestion, for 4 days. He came to the emergency department (ED) last night when his breathing difficulties increased. He has a history of smoking half a pack of cigarettes a day for 20 years. He has no significant medical or surgical history. Which two orders should the nurse prioritize?

Choice A rationale A chest x-ray is a critical diagnostic tool for a patient presenting with flu-like symptoms, fever, chest congestion, and increased breathing difficulties. It can help identify conditions such as pneumonia or other lung diseases, which could be causing the patient’s symptoms. Choice B rationale While hydration is important, running a 0.9% sodium chloride IV infusion at 150 mL/hour is not the most immediate need for this patient. The patient’s symptoms are primarily respiratory, and there is no indication of dehydration. Choice C rationale A sputum culture could be useful for diagnosing bacterial infections of the respiratory tract. However, it is not the most immediate need for this patient, as the results of a culture test can take time to come back. Choice D rationale This is the correct answer. Given the patient’s increased breathing difficulties, starting oxygen therapy can help improve the patient’s oxygen levels and ease their breathing. Choice E rationale Starting a peripheral IV might be necessary for administering medications or fluids, but it is not the most immediate need in this scenario. Choice F rationale While controlling the patient’s fever is important, it is not as immediate a need as performing a chest x-ray and starting oxygen therapy.