Nokea
A client who has chronic heart failure tells the nurse 'I was fine when I went to bed but I woke up in the middle of the night feeling like I was suffocating!' How should the nurse document this finding?
- A. Orthopnea
- B. Pulsus alternans
- C. Paroxysmal nocturnal dyspnea
- D. Acute bilateral pleural effusion
Correct Answer: C
Rationale: The correct answer is C: Paroxysmal nocturnal dyspnea. This finding describes the sudden onset of severe shortness of breath at night, commonly seen in patients with chronic heart failure due to fluid redistribution when lying down. Orthopnea (A) is difficulty breathing when lying flat, not specifically at night. Pulsus alternans (B) is a regular rhythm with alternating strong and weak pulses, not related to this patient's symptom. Acute bilateral pleural effusion (D) is a buildup of fluid in the lungs, not a sudden onset symptom like in this case.
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What is the least successful treatment for laryngeal cancer?
- A. Surgical treatment
- B. Radical neck dissection
- C. Radiation therapy with surgery
- D. Chemotherapy
Correct Answer: D
Rationale: The correct answer is D. Chemotherapy alone is generally less effective for laryngeal cancer compared to surgical treatment, radiation therapy, or combinations thereof. A (surgical treatment) and C (radiation therapy with surgery) are more successful. B (radical neck dissection) is a specific surgical approach but still more effective than chemotherapy alone.
Which pressure remains negative throughout the respiratory cycle?
- A. intrapulmonary
- B. intrapleural
- C. intra-alveolar
- D. atmospheric
Correct Answer: B
Rationale: The correct answer is B: intrapleural pressure. Intrapleural pressure remains negative throughout the respiratory cycle due to the opposing forces of the elastic recoil of the lungs and the chest wall. This negative pressure keeps the lungs inflated and facilitates breathing. In contrast, intrapulmonary (A) and intra-alveolar (C) pressures fluctuate during inhalation and exhalation, becoming positive and negative, respectively. Atmospheric pressure (D) remains relatively constant and serves as the reference point for pressure changes in the respiratory system.
A client has been taking isoniazid for tuberculosis for 3 weeks. What laboratory results need to be reported to the primary health care provider immediately?
- A. Albumin: 5.1 g/dL (7.4 mcmol/L)
- B. Alanine aminotransferase (ALT): 180 U/L
- C. Red blood cell (RBC) count: 5.2/million/µL (5.2  1012/L)
- D. White blood cell (WBC) count: 12,500/mm3 (12.5 ï‚´ 109/L)
Correct Answer: B
Rationale: The correct answer is B: Alanine aminotransferase (ALT): 180 U/L. Elevated ALT levels indicate liver damage, a potential side effect of isoniazid. This is crucial to report immediately to the primary health care provider to assess liver function and adjust medication if needed.
A: Albumin levels may fluctuate due to various factors but are not typically urgent in this context.
C: RBC count within normal range, not directly related to isoniazid therapy.
D: WBC count slightly elevated but not a priority unless there are other concerning symptoms.
A nurse teaches a client who had a supraglottic laryngectomy. Which technique would the nurse teach the client to prevent aspiration?
- A. Tilt the head back as far as possible when swallowing.
- B. Swallow twice while bearing down.
- C. Breathe slowly and deeply while swallowing.
- D. Keep the head very still and straight while swallowing.
Correct Answer: B
Rationale: The correct answer is B: Swallow twice while bearing down. This technique helps close the trachea during swallowing to prevent aspiration. Swallowing twice initiates a double swallow, which helps clear the throat and reduce the risk of food or liquid entering the airway. Tilt the head back (A), breathing slowly and deeply (C), and keeping the head still and straight (D) do not directly address the risk of aspiration in a client with a supraglottic laryngectomy.
The patient with asthma is prescribed a leukotriene modifier drug, montelukast (Singulair).
Which statement describes an advantage of this medication?
- A. Limited gastrointestinal (GI) side effects
- B. Bronchodilation and anti-inflammatory effects
- C. Stringent control of acute episodes of asthma
- D. Ability to replace all other asthma remedies
Correct Answer: B
Rationale: The correct answer is B because montelukast is a leukotriene modifier that works by reducing inflammation and promoting bronchodilation in asthma patients. This helps in managing asthma symptoms and improving lung function.
A is incorrect because montelukast can cause mild GI side effects such as nausea and diarrhea. C is incorrect because while montelukast helps in controlling asthma symptoms, it does not provide immediate relief during acute episodes. D is incorrect because montelukast is typically used as an add-on therapy and not as a replacement for all other asthma medications.