Nokea
A client is admitted with a diagnosis of cancer of the larynx. Which statement made by the client is most likely related to the cause of his illness?
- A. I have always enjoyed hot Mexican-style food.'
- B. I have smoked three packs of cigarettes a day for the last 40 years.'
- C. I used to work in a factory that burned coal.'
- D. I sang in the church choir every Sunday until my voice got hoarse last year.'
Correct Answer: B
Rationale: Cigarette smoking is the greatest risk factor for laryngeal cancer due to chronic exposure to carcinogens.
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The nurse suspects the client admitted with a near-drowning is developing acute respiratory distress syndrome (ARDS). Which data support the nurse's suspicion?
- A. The client's arterial blood gases are within normal limits.
- B. The client appears anxious, has dyspnea, and is tachypneic.
- C. The client has intercostal retractions and is using accessory muscles.
- D. The client has bilateral lung sounds with crackles and rhonchi.
Correct Answer: C
Rationale: Intercostal retractions and accessory muscle use (C) indicate severe respiratory distress, consistent with ARDS due to increased work of breathing from reduced lung compliance. Normal ABGs (A) contradict ARDS, which involves hypoxia. Anxiety, dyspnea, and tachypnea (B) are non-specific. Crackles and rhonchi (D) may occur but are less specific than physical signs of distress.
A patient taking Isoniazid (INH) should be monitored for what deficiency?
- A. Vitamin C
- B. Calcium
- C. Vitamin B6
- D. Potassium
Correct Answer: C
Rationale: This medication can lead to low Vitamin B6 levels. Most patients will take a supplement of B6 while taking this medication.
A patient, who is receiving continuous IV Heparin for the treatment of a DVT, has an aPTT of 110 seconds. What is your next nursing action per protocol?
- A. Continue with the infusion because no change is needed based on this aPTT.
- B. Increase the drip rate per protocol because the aPTT is too low.
- C. Re-draw the aPTT STAT.
- D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too high.
Correct Answer: D
Rationale: The aPTT is 110 seconds, which is too high. Any aPTT value greater than 80 seconds places the patient at risk for bleeding. Most Heparin protocols dictate that the nurse would hold the infusion for 1 hour and to decrease the rate of infusion. If the aPTT is less than 60 seconds, the dose would need to be increased and a bolus may be needed. aPTT values should be around 60-80 seconds to achieve a therapeutic response for Heparin.
Select all the following that can trigger an asthma attack:
- A. Sulfites
- B. Smoke
- C. Caffeine
- D. GERD
- E. Cold, windy weather
- F. Beta agonist
- G. Cockroaches
Correct Answer: A,B,D,E,G
Rationale: Triggers include sulfites, smoke, GERD, cold weather, and cockroaches. Caffeine and beta agonists are not typical triggers; beta agonists are treatments.
Which of the following best indicates that the client's grief is beginning to resolve?
- A. The client wants only the spouse to visit.
- B. The client says the physician made an incorrect diagnosis.
- C. The client looks at the tracheostomy tube in a mirror.
- D. The client asks the nurse for help with bathing.
Correct Answer: C
Rationale: Looking at the tracheostomy tube in a mirror suggests acceptance of the body image change, indicating progress in resolving grief.