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A client is receiving oxygen therapy via a nasal cannula. The nurse should explain that this method of oxygen delivery does which of the following?
- A. Delivers a specific concentration of oxygen constantly
- B. Delivers a high concentration of oxygen
- C. Delivers a low concentration of oxygen
- D. Restricts the client's ability to eat, speak, or drink
Correct Answer: A
Rationale: A nasal cannula is a device used for delivering supplemental oxygen to patients. It delivers a specific concentration of oxygen constantly, typically ranging from 1-6 liters per minute. This method is effective for patients who require low to moderate levels of oxygen. Choices B and C are incorrect because a nasal cannula does not deliver a high concentration of oxygen and is not considered a low concentration delivery method. Choice D is incorrect because a nasal cannula does not restrict the client's ability to eat, speak, or drink; it allows them to perform these activities while receiving oxygen therapy.
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A client is telling the nurse in the clinic that he gets a headache after taking sublingual nitroglycerin (Nitrostat) for his angina pain. Which of the following should the nurse instruct the client to do?
- A. Reduce the nitroglycerin dose
- B. Ask the provider to prescribe a strong analgesic
- C. Lie down in a cool environment and rest
- D. Ask the provider to prescribe a different medication
Correct Answer: C
Rationale: The correct answer is to instruct the client to lie down in a cool environment and rest after taking sublingual nitroglycerin for angina pain. Headaches are a common side effect of nitroglycerin due to its vasodilatory effects, and resting in a cool environment can help alleviate the headache. Reducing the nitroglycerin dose is not recommended without consulting the healthcare provider as it may compromise the effectiveness of the medication in managing angina. Asking for a strong analgesic is not appropriate since the headache is likely related to the nitroglycerin and not a separate issue requiring a pain reliever. Requesting a different medication should also involve consulting the healthcare provider to ensure an appropriate alternative is prescribed for angina management.
A nurse in a clinic is caring for a client who came to be tested for tuberculosis (TB) after a close family member tested positive. The nurse should know that which of the following is a diagnostic tool used to screen for TB?
- A. Sputum culture for acid-fast bacillus (AFB)
- B. Mantoux skin test
- C. BCG vaccine
- D. Chest X-ray
Correct Answer: B
Rationale: The Mantoux skin test, also known as the tuberculin skin test, is a diagnostic tool used to screen for tuberculosis (TB). It involves injecting a small amount of tuberculin under the top layer of the skin on the forearm and then checking for a reaction within 48-72 hours. This test helps identify individuals who have been exposed to the TB bacteria. Sputum culture for acid-fast bacillus (AFB) is used to confirm TB diagnosis in individuals suspected of having active TB. The BCG vaccine is used to prevent severe forms of tuberculosis in high-risk individuals but is not a diagnostic tool. While a chest X-ray can show signs of active TB disease, it is not a primary diagnostic tool for screening purposes.
A client comes to the emergency department reporting chest pain that is sharp, knife-like, and localized to an area he points to with one finger. The nurse should document this chest pain as which of the following?
- A. Angina pectoris
- B. Cardiogenic pain
- C. Myocardial infarction
- D. Pleuritic pain
Correct Answer: D
Rationale: The correct answer is 'Pleuritic pain.' Pleuritic pain is characterized by sharp, knife-like pain that worsens with deep breathing or coughing and is localized to a specific area. This type of pain is often associated with inflammation of the pleura. Choices A, B, and C are incorrect. Angina pectoris is a type of chest pain caused by reduced blood flow to the heart muscle. Cardiogenic pain refers to pain originating from the heart itself. Myocardial infarction is the medical term for a heart attack.
A nurse at a provider's office receives a phone call from a client who reports unrelieved chest pain after taking a nitroglycerin (Nitrostat) tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?
- A. Tell the client to take an aspirin.
- B. Instruct the client to call 911.
- C. Have the client take another nitroglycerin tablet in 15 minutes.
- D. Advise the client to come to the office.
Correct Answer: B
Rationale: In this scenario, the client reporting unrelieved chest pain after taking a nitroglycerin tablet could be indicative of a serious cardiac event. Instructing the client to call 911 is the most appropriate response because immediate medical attention is necessary for chest pain that is not relieved by nitroglycerin. Telling the client to take an aspirin (Choice A) may not address the urgency of the situation, and aspirin might not be appropriate depending on the client's medical history. Having the client take another nitroglycerin tablet (Choice C) without relief could lead to overdosage. Advising the client to come to the office (Choice D) is not the best course of action when dealing with a potential cardiac emergency that requires immediate intervention.
A nurse is caring for a client who has active pulmonary tuberculosis (TB). The client is on airborne precautions and is being treated with multidrug therapy. A chest x-ray is scheduled for the client. Which of the following is not a precaution the nurse should take to safely transport the client to x-ray?
- A. Ask the x-ray technician to come to the client's room to perform a portable x-ray.
- B. Have the client wear a mask.
- C. Notify the x-ray department that the client is on airborne precautions.
- D. Wear a filtration mask and gloves for protection against the client's microorganisms.
Correct Answer: A
Rationale: The correct answer is to ask the x-ray technician to come to the client's room to perform a portable x-ray. This option minimizes the risk of exposing other individuals to the client's infectious microorganisms during transport. Having the client wear a mask (Choice B) and notifying the x-ray department about airborne precautions (Choice C) are crucial precautions to prevent the spread of infection. Additionally, wearing a filtration mask and gloves (Choice D) is essential for the nurse's protection when in direct contact with the client, but it is not directly related to transporting the client to the x-ray department.