Nokea
A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
- A. 5 mm induration
- B. 15 mm induration
- C. 9 mm induration
- D. 10 mm induration
Correct Answer: D
Rationale: 15 mm induration is positive in ALL people regardless of health history or risk factors. However, for patients who are homeless (living in homeless shelter) and are IV drug users, a 10 mm or more is considered positive.
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The client in the intensive care unit diagnosed with end-stage chronic obstructive pulmonary disease has a Swan-Ganz mean pulmonary artery pressure of 35 mm Hg. Which health-care provider order would the nurse question?
- A. Administer intravenous fluids of normal saline at 125 mL/hr.
- B. Provide supplemental oxygen per nasal cannula at 2 L/min.
- C. Continuous telemetry monitoring with strips every four (4) hours.
- D. Administer a loop diuretic intravenously every six (6) hours.
Correct Answer: A
Rationale: A mean pulmonary artery pressure of 35 mm Hg indicates pulmonary hypertension, common in end-stage COPD. IV fluids at 125 mL/hr (A) risk fluid overload and worsening right heart strain, so this order should be questioned. Oxygen (B), telemetry (C), and diuretics (D) are appropriate to manage hypoxia, monitor cardiac status, and reduce fluid overload.
Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
- A. Stridor
- B. Coarse crackles
- C. Oxygen saturation less than $90 \%$
- D. Non-productive, nagging cough
- E. Elevated white blood cells
- F. Low PCO2 of less than 35
- G. Tachypnea
Correct Answer: B,C,E,G
Rationale: Pneumonia typically presents with coarse crackles due to fluid in alveoli, low oxygen saturation from impaired gas exchange, elevated WBCs indicating infection, and tachypnea (G) as a compensatory mechanism. Stridor is associated with upper airway obstruction, non-productive cough is less common, and low PCO2 suggests hyperventilation, not typical.
The nurse is assessing the client with COPD. Which health promotion information is most important for the nurse to obtain?
- A. Number of years the client has smoked.
- B. Risk factors for complications.
- C. Ability to administer inhaled medication.
- D. Willingness to modify lifestyle.
Correct Answer: C
Rationale: Correct inhaler use (C) ensures effective COPD management, a priority for health promotion. Smoking history (A), risk factors (B), and lifestyle (D) are important but secondary.
The nurse observes the client sitting on the side of the bed with the arms propped on the over-bed table. The chest is barrel shaped and the client is breathing though lips spaced close together and is exhaling slowly. Which concept is priority for this client?
- A. Mobility.
- B. Nutrition.
- C. Activity intolerance.
- D. Oxygenation.
Correct Answer: D
Rationale: Tripod position, barrel chest, and pursed-lip breathing (D) indicate COPD with oxygenation as the priority. Mobility (A), nutrition (B), and activity (C) are secondary.
A patient is being discharged home on Doxycycline for treatment of pneumonia. Which statement by the patient indicates they understood your education material?
- A. I will wear sunscreen when outdoors.'
- B. I will avoid green leafy vegetables while taking this medication.'
- C. I will monitor my blood glucose regularly due to the side effects of hypoglycemia.'
- D. I will take this medication with a full glass of milk.'
Correct Answer: A
Rationale: Doxycycline causes photosensitivity, so wearing sunscreen is correct. Green leafy vegetables are relevant for warfarin, hypoglycemia is not a side effect, and milk can reduce doxycycline absorption.