Nokea
A 17-year-old male is admitted following an automobile accident. He is very anxious, dyspneic, and in severe pain. The left chest wall moves in during inspiration and balloons out when he exhales. The nurse understands these symptoms are most suggestive of?
- A. Hemothorax
- B. Flail chest
- C. Atelectasis
- D. Pleural effusion
Correct Answer: B
Rationale: The correct answer is B: Flail chest. Flail chest is characterized by paradoxical movement of a segment of the chest wall due to multiple rib fractures. In this case, the left chest wall moving in during inspiration and out during expiration indicates this paradoxical movement. This leads to ineffective breathing, causing dyspnea and anxiety. Hemothorax (A) is accumulation of blood in the pleural cavity, not associated with chest wall movement. Atelectasis (C) is collapse of lung tissue, not associated with chest wall movement. Pleural effusion (D) is accumulation of fluid in the pleural space, also not associated with paradoxical chest wall movement.
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The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. Which reply is most accurate?
- A. Pneumovax protects you for your lifetime.
- B. Immunity afforded you by Pneumovax lasts only 2 years.
- C. Pneumovax protection varies according to your risk factors and living situation.
- D. After 6 years, you need a repeat dose of Pneumovax for full immunity.
Correct Answer: D
Rationale: Step 1: Pneumovax is recommended for adults aged 65 and older.
Step 2: Immunity from Pneumovax decreases over time.
Step 3: CDC recommends a second dose of Pneumovax after 5 years for those at highest risk.
Step 4: Answer D is correct as it aligns with CDC guidelines for revaccination.
Step 5: Other choices are incorrect as they do not reflect current recommendations or scientific evidence.
A sputum study has been ordered for a patient who has developed coarse chest crackles and a fever. At what time should the nurse best collect the sample?
- A. Immediately after a meal
- B. First thing in the morning
- C. At bedtime
- D. After a period of exercise
Correct Answer: B
Rationale: The correct answer is B: First thing in the morning. Sputum should be collected in the morning because it is usually more concentrated, making it easier to obtain a good sample. This is important for accurate analysis and identifying potential pathogens causing the patient's symptoms. Collecting sputum immediately after a meal may result in contamination with food particles. At bedtime, sputum may have accumulated overnight, but morning samples are still preferred due to concentration. Collecting sputum after a period of exercise may introduce respiratory secretions not reflective of the underlying condition.
Oxygen dissociation curve of myoglobin is
- A. Hypobolic
- B. Hyperbolic
- C. Linear
- D. Sigmoid
Correct Answer: B
Rationale: The correct answer is B: Hyperbolic. Myoglobin exhibits a hyperbolic oxygen dissociation curve due to its high affinity for oxygen, allowing it to bind oxygen quickly and efficiently at low partial pressures. This curve represents a simple one-to-one binding relationship between myoglobin and oxygen. The other choices are incorrect because A (Hypobolic) does not accurately describe myoglobin's binding characteristics, C (Linear) is not representative of the typical oxygen binding behavior of myoglobin, and D (Sigmoid) is more characteristic of hemoglobin, which exhibits cooperative binding of oxygen.
A male patient is admitted to the healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this patient?
- A. Activity intolerance related to fatigue.
- B. Anxiety related to actual threat to health status.
- C. Risk for infection related to retained secretions.
- D. Impaired gas exchange related to airflow obstruction.
Correct Answer: D
Rationale: The correct answer is D: Impaired gas exchange related to airflow obstruction. This is the most important nursing diagnosis for a patient with chronic obstructive pulmonary disease because impaired gas exchange directly impacts the patient's ability to breathe and obtain oxygen. Addressing this issue is crucial in managing the patient's condition and preventing further complications.
A: Activity intolerance related to fatigue may be a concern for the patient, but it is secondary to the primary issue of impaired gas exchange.
B: Anxiety related to actual threat to health status is important to address, but it is not the most critical nursing diagnosis for this patient.
C: Risk for infection related to retained secretions is a valid concern, but it is not as immediate and directly life-threatening as impaired gas exchange in a patient with chronic obstructive pulmonary disease.
Which of the following decreases respiratory efficiency?
- A. decreased blood flow
- B. increased surface area
- C. increased partial pressure gradients
- D. increased gas solubility
Correct Answer: A
Rationale: Step 1: Blood flow supplies oxygen and removes carbon dioxide in the lungs, essential for efficient gas exchange.
Step 2: Decreased blood flow means less oxygen delivery and carbon dioxide removal, leading to decreased respiratory efficiency.
Step 3: Choice A is correct as it directly impacts the gas exchange process.
Summary:
- Choice B (increased surface area) would enhance gas exchange efficiency.
- Choice C (increased partial pressure gradients) would improve gas exchange efficiency.
- Choice D (increased gas solubility) would not directly affect respiratory efficiency.