Nokea
A client complaining of severe shortness of breath is diagnosed with congestive heart failure. The nurse observes a falling pulse oximetry. The client's color changes to gray and she expectorates large amounts of pink frothy sputum. The first action of the nurse would be which of the following?
- A. Call the health care provider.
- B. Check vital signs.
- C. Position in high Fowler's.
- D. Administer oxygen.
Correct Answer: D
Rationale: Oxygen administration is immediate to address hypoxemia.
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What is the best method of controlling exposure to illness in any occupational environment?
- A. Use of masks
- B. Developing prevention programs
- C. Early diagnosis of illness
- D. Developing rehabilitation programs
Correct Answer: B
Rationale: Prevention programs address root causes, minimizing exposure risks.
A client was exposed to anthrax. Which of the following antibiotics should the nurse plan to administer?
- A. Ciprofloxacin
- B. Fluconazole
- C. Tobramycin
- D. Vancomycin
Correct Answer: A
Rationale: The correct answer is A: Ciprofloxacin. Anthrax is caused by the bacterium Bacillus anthracis, and ciprofloxacin is the recommended antibiotic for treating anthrax due to its effectiveness against this specific bacterium. Ciprofloxacin works by inhibiting bacterial DNA replication, thus stopping the growth and spread of the anthrax bacteria.
The other choices are incorrect because:
B: Fluconazole is an antifungal medication and is not effective against bacterial infections like anthrax.
C: Tobramycin is an antibiotic primarily used to treat bacterial infections in the eyes, ears, and skin, but it is not the first-line treatment for anthrax.
D: Vancomycin is an antibiotic used to treat certain bacterial infections, but it is not the preferred choice for anthrax treatment.
While caring for a client receiving positive-pressure mechanical ventilation, which intervention should the nurse NOT implement to prevent complications?
- A. Elevate the head of the bed to at least 30°.
- B. Verify the prescribed ventilator settings daily.
- C. Administer pantoprazole as prescribed.
- D. Reposition the endotracheal tube to the opposite side of the mouth daily.
Correct Answer: D
Rationale: The correct answer is D. Repositioning the endotracheal tube to the opposite side of the mouth daily is not necessary and could potentially lead to complications such as accidental extubation or damage to the airway. A: Elevating the head of the bed helps prevent aspiration. B: Verifying ventilator settings daily ensures proper functioning. C: Administering pantoprazole helps prevent stress ulcers. In summary, D is incorrect because it is unnecessary and poses risks, while A, B, and C are important interventions to prevent complications associated with positive-pressure mechanical ventilation.
Expected age-related changes of the pulmonary system include:
- A. Significant airway obstruction
- B. Shortness of breath
- C. Development of emphysema
- D. A modest,gradual decline in pulmonary function
Correct Answer: D
Rationale: While lung capacity decreases with age, it typically results in a gradual decline rather than significant obstruction or diseases like emphysema unless other factors (e.g., smoking) are present.
The following data are organized according to Gordon’s functional health patterns.
- A. 78-year-old woman
- B. Married, three grown children who all live out of town
- C. Cares for invalid husband in home with help of daily homemaker
- D. Vision corrected with glasses; hearing normal
Correct Answer: A
Rationale: N/A