Which of the following individuals would the nurse consider to have the highest priority for receiving an influenza vaccination? A. A 60-year-old man with a hiatal hernia. B. A 36-year-old woman with 3 children. C. A 50-year-old woman caring for a spouse with cancer. D. A 60-year-old woman with osteoarthritis. … Read More »
Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the: A. Contralateral side in a simple pneumothorax. B. Affected side in a hemothorax. C. Affected side in a tension pneumothorax. D. Contralateral side in hemothorax. Correct Answer: D. Contralateral side… Read More »
A client with allergic rhinitis asks the nurse what he should do to decrease his symptoms. Which of the following instructions would be appropriate for the nurse to give the client? A. “Use your nasal decongestant spray regularly to help clear your nasal passages.” B. “Ask the doctor for antibiotics. Antibiotics will help… Read More »
After undergoing a left pneumonectomy, a female patient has a chest tube in place for drainage. When caring for this patient, the nurse must: A. Monitor fluctuations in the water-seal chamber. B. Clamp the chest tube once every shift. C. Encourage coughing and deep breathing. D. Milk the chest tube every… Read More »
An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she developed a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings? A. It is likely that the client is developing a secondary bacterial pneumonia.… Read More »
When caring for a male patient who has just had a total laryngectomy, the nurse should plan to: A. Encourage oral feeding as soon as possible. B. Develop an alternative communication method. C. Keep the tracheostomy cuff fully inflated. D. Keep the patient flat in bed. Correct… Read More »
A male patient has a sucking stab wound to the chest. Which action should the nurse take first? A. Drawing blood for a hematocrit and hemoglobin level. B. Applying a dressing over the wound and taping it on three sides. C. Preparing a chest tube insertion tray. D. Preparing to start an… Read More »
Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug? A. Constipation B. Bradycardia C. Diplopia D. Restlessness Correct Answer: D. Restlessness Side effects of pseudoephedrine are experienced primarily in the cardiovascular system and through sympathetic… Read More »
For a patient with advanced chronic obstructive pulmonary disease (COPD), which nursing action best promotes adequate gas exchange? A. Encouraging the patient to drink three glasses of fluid daily. B. Keeping the patient in semi-Fowler’s position. C. Using a high-flow venturi mask to deliver oxygen as prescribed. D. Administering a sedative,… Read More »
A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? A. Altered nutrition: Less than body requirements related to fatigue. B. Activity intolerance related to dyspnea. C. Weight loss related… Read More »