Nokea
The client states that he has smoked three-fourths of a pack per day over the last 10 years. The nurse calculates that the client has a smoking history of how many pack-years?
Correct Answer: 7.5
Rationale: The standard method for quantifying smoking history is to multiply the number of packs smoked per day by the number of years of smoking. The number is recorded as the number of pack-years. The calculation for the number of pack-years for the client who has smoked three-fourths of a pack per day for 10 years is 0.75 pack × 10 years = 7.5 pack-years.
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The nurse is caring for an obese client on a weight loss program. Which method should the nurse use to most accurately assess the program's effectiveness?
- A. Monitor the client's weight.
- B. Monitor the client's intake and output.
- C. Calculate the client's daily caloric intake.
- D. Frequently check the client's serum protein levels.
Correct Answer: A
Rationale: The most accurate measurement of weight loss is weighing of the client. This should be done at the same time of the day, in the same clothes, and using the same scale. Options 2, 3, and 4 measure nutrition and hydration status but are not associated with effectiveness of the weight loss program.
Which conditions place the client receiving enteral nutrition at increased risk for aspiration? Select all that apply.
- A. Sedation
- B. Coughing
- C. An artificial airway
- D. Head-elevated position
- E. Nasotracheal suctioning
- F. Decreased level of consciousness
Correct Answer: A,B,C,E,F
Rationale: A serious complication associated with enteral feedings is aspiration of formula into the tracheobronchial tree. Some common conditions that increase the risk of aspiration include sedation, coughing, an artificial airway, nasotracheal suctioning, decreased level of consciousness, and lying flat. A head-elevated position does not increase the risk of aspiration.
During a routine prenatal visit, a client in her third trimester of pregnancy reports having frequent calf pain when she walks. The nurse suspects superficial thrombophlebitis and checks for which sign associated with this condition?
- A. Severe chills
- B. Kernig's sign
- C. Brudzinski's sign
- D. Palpable hard thrombus
Correct Answer: D
Rationale: Pain in the calf during walking could indicate venous thrombosis or peripheral arterial disease. The manifestations of superficial thrombophlebitis include a palpable thrombus that feels bumpy and hard, tenderness and pain in the affected lower extremity, and a warm and pinkish red color over the thrombus area. Severe chills can occur in a variety of inflammatory or infectious conditions and are also a manifestation of pelvic thrombophlebitis. Brudzinski's sign and Kernig's sign test for meningeal irritability.
A client experiencing a severe major depressive episode is unable to address activities of daily living (ADL). Which nursing intervention best meets the client's current needs therapeutically?
- A. Have the client's peers approach the client about how noncompliance in addressing ADL affects the milieu.
- B. Structure the client's day so that adequate time can be devoted to the client's assuming responsibility for ADL.
- C. Offer the client choices and describe the consequences for the failure to comply with the expectation of maintaining her or his own ADL.
- D. Feed, bathe, and dress the client as needed until the client's condition improves so that she or he can perform these activities independently.
Correct Answer: D
Rationale: The symptoms of major depression include depressed mood, loss of interest or pleasure, changes in appetite and sleep patterns, psychomotor agitation or retardation, fatigue, feelings of worthlessness or guilt, diminished ability to think or concentrate, and recurrent thoughts of death. Often, the client does not have the energy or interest to complete activities of daily living. Option 1 will increase the client's feelings of poor self-esteem and of unworthiness. Option 2 is incorrect because the client still lacks the energy and motivation to do these independently. Option 3 may lead to increased feelings of worthlessness as the client fails to meet expectations.
The nurse assesses the water seal chamber of a closed chest drainage system and notes fluctuations in the chamber. What intervention should the nurse implement?
- A. Unkinking the tubing
- B. Assessing for an air leak
- C. Documenting that the lung has reexpanded
- D. Documenting that the lung has not yet reexpanded
Correct Answer: D
Rationale: Fluctuations (tidaling) in the water seal chamber are normal during inhalation and exhalation until the lung reexpands and the client no longer requires chest drainage. If fluctuations are absent, it could indicate occlusion of the tubing or that the lung has reexpanded. Excessive bubbling in the water seal chamber indicates that an air leak is present.