Nokea
A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for:
- A. A mild but constant aching in the chest.
- B. Severe midsternal pain.
- C. Moderate pain that worsens on inspiration.
- D. Muscle spasm pain that accompanies coughing.
Correct Answer: C
Rationale: Pleuritic chest pain is sharp or moderate and worsens with inspiration due to inflamed pleura. Constant aching, midsternal pain, or muscle spasm pain are not characteristic of pleurisy.
You may also like to solve these questions
A 65-year-old client is admitted to the emergency department with a fractured hip. The client has chest pain and shortness of breath. The health care provider orders nitroglycerin tablets. Which should the nurse instruct the client to do?
- A. Put the tablet under the tongue until it is dissolved.
- B. Swallow the tablet with 120 mL of water.
- C. Chew the tablet until it is dissolved.
- D. Place the tablet between his cheek and gums.
Correct Answer: A
Rationale: Sublingual nitroglycerin is administered under the tongue for rapid absorption to relieve chest pain. Other methods (swallowing, chewing, or buccal placement) are incorrect for this medication.
The nurse is assessing a client with drooping of their left eyelid. The nurse documents this finding as
- A. mydriasis.
- B. ptosis.
- C. presbyopia.
- D. hyphema.
Correct Answer: B
Rationale: Ptosis is the medical term for drooping of the eyelid. Mydriasis refers to pupil dilation, presbyopia is age-related vision loss, and hyphema is blood in the anterior chamber of the eye.
What is a priority nursing intervention for a client with renal colic?
- A. Encourage fluid intake.
- B. Administer morphine as prescribed.
- C. Apply warm compresses.
- D. Insert a urinary catheter.
Correct Answer: B
Rationale: Morphine effectively manages severe renal colic pain, prioritizing client comfort.
A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which of the following risk factors should be necessary:
- A. Family history.
- B. Lifestyle choices.
- C. Age.
- D. Menopause or hormonal events.
Correct Answer: C
Rationale: Age is the most significant risk factor for cancer, as the incidence of most cancers increases with advancing age due to cumulative genetic and environmental damage.
One goal in caring for a client with arterial occlusive disease is to promote vasodilation in the affected extremity. To achieve this goal, the nurse encourages the client to:
- A. Apply heat to the extremity
- B. Elevate the legs above the heart
- C. Stop smoking
- D. Begin a jogging program
Correct Answer: C
Rationale: Stopping smoking promotes vasodilation by reducing nicotine-induced vasoconstriction and improving endothelial function, critical in arterial occlusive disease. Applying heat risks burns in ischemic tissue, elevating legs worsens arterial flow, and jogging may be contraindicated due to claudication.