Nokea
A client presents to the walk-in clinic complaining of a dry, irritating cough and production of a minute amount of mucus-like sputum. The patient complains of soreness in her chest in the sternal area. The nurse should suspect that the primary care provider will assess the patient for what health problem?
- A. Pleural effusion
- B. Pulmonary embolism
- C. Tracheobronchitis
- D. Tuberculosis
Correct Answer: C
Rationale: Initially, the patient with tracheobronchitis has a dry, irritating cough and expectorates a scant amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise. Pleural effusion and pulmonary embolism do not normally cause sputum production and would likely cause acute shortness of breath. Hemoptysis is characteristic of TB.
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The school nurse is presenting a class on smoking cessation at the local high school. A participant in the class asks the nurse about the risk of lung cancer in those who smoke. What response related to risk for lung cancer in smokers is most accurate?
- A. The younger you are when you start smoking, the higher your risk of lung cancer
- B. The risk for lung cancer never decreases once you have smoked, which is why smokers need annual chest x-rays
- C. The risk for lung cancer is determined mostly by what type of cigarettes you smoke
- D. The risk for lung cancer depends primarily on the other risk factors for cancer that you have
Correct Answer: A
Rationale: Risk is determined by the pack-year history (number of packs of cigarettes used each day, multiplied by the number of years smoked), the age of initiation of smoking, the depth of inhalation, and the tar and nicotine levels in the cigarettes smoked. The younger a person is when he or she starts smoking, the greater the risk of developing lung cancer. Risk declines after smoking cessation. The type of cigarettes is a significant variable, but this is not the most important factor.
A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?
- A. Older adults have less compliant lung tissue than younger adults
- B. Older adults are not normally candidates for pneumococcal vaccination
- C. Older adults often lack the classic signs and symptoms of pneumonia
- D. Older adults often cannot tolerate the most common antibiotics used to treat pneumonia
Correct Answer: C
Rationale: The diagnosis of pneumonia may be missed because the classic symptoms of cough, chest pain, sputum production, and fever may be absent or masked in older adult patients. Mortality from pneumonia in the elderly is not a result of limited antibiotic options or lower lung compliance. The pneumococcal vaccine is appropriate for older adults.
A patient presents to the ED stating she was in a boating accident about 3 hours ago. Now the patient has complaints of headache, fatigue, and the feeling that he just cant breathe enough. The nurse notes that the patient is restless and tachycardic with an elevated blood pressure. This patient may be in the early stages of what respiratory problem?
- A. Pneumoconiosis
- B. Pleural effusion
- C. Acute respiratory failure
- D. Pneumonia
Correct Answer: C
Rationale: Early signs of acute respiratory failure are those associated with impaired oxygenation and may include restlessness, fatigue, headache, dyspnea, air hunger, tachycardia, and increased blood pressure. As the hypoxemia progresses, more obvious signs may be present, including confusion, lethargy, tachycardia, tachypnea, central cyanosis, diaphoresis, and, finally, respiratory arrest. Pneumonia is infectious and would not result from trauma. Pneumoconiosis results from exposure to occupational toxins. A pleural effusion does not cause this constellation of symptoms.
The nurse is caring for a patient who has been in a motor vehicle accident and the care team suspects that the patient has developed pleurisy. Which of the nurses assessment findings would best corroborate this diagnosis?
- A. The patient is experiencing painless hemoptysis
- B. The patients arterial blood gases (ABGs) are normal, but he demonstrates increased work of breathing
- C. The patients oxygen saturation level is below 88%, but he denies shortness of breath
- D. The patients pain intensifies when he coughs or takes a deep breath
Correct Answer: D
Rationale: The key characteristic of pleuritic pain is its relationship to respiratory movement. Taking a deep breath, coughing, or sneezing worsens the pain. The patients ABGs would most likely be abnormal and shortness of breath would be expected.
The public health nurse is administering Mantoux tests to children who are being registered for kindergarten in the community. How should the nurse administer this test?
- A. Administer intradermal injections into the childrens inner forearms
- B. Administer intramuscular injections into each childs vastus lateralis
- C. Administer a subcutaneous injection into each childs umbilical area
- D. Administer a subcutaneous injection at a 45-degree angle into each childs deltoid
Correct Answer: A
Rationale: The purified protein derivative (PPD) is always injected into the intradermal layer of the inner aspect of the forearm. The subcutaneous and intramuscular routes are not utilized.