Nokea
A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?
- A. Pigeon
- B. Funnel
- C. Kyphotic
- D. Barrel
Correct Answer: D
Rationale: When assessing a client with COPD, the nurse should expect the client's chest to be barrel-shaped. This shape is a classic characteristic of COPD due to hyperinflation of the lungs. A 'Pigeon' chest shape is associated with pectus carinatum, a deformity of the chest wall. A 'Funnel' chest shape is seen in conditions like pectus excavatum. 'Kyphotic' refers to an exaggerated outward curvature of the thoracic spine. Therefore, the correct answer is 'Barrel' as it is the expected chest shape in clients with COPD.
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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 client with angina pectoris is being taught about starting therapy with nitroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication
- A. after each meal and at bedtime.
- B. every 15 minutes during an acute attack.
- C. at the first indication of chest pain.
- D. with 8 oz of water.
Correct Answer: C
Rationale: Nitroglycerin (Nitrostat) tablets are used to relieve chest pain associated with angina. The client should take the medication at the first indication of chest pain to help dilate blood vessels and improve blood flow to the heart muscle. Choice A is incorrect because nitroglycerin should not be scheduled after each meal or at bedtime. Choice B is incorrect as taking the medication every 15 minutes during an acute attack is excessive and not recommended. Choice D is incorrect because while it is important to take nitroglycerin with water, the timing of water intake is not as critical as taking the medication at the first sign of chest pain.
A provider is discharging a client with a prescription for home oxygen therapy. Client and family teaching by the nurse should include all of the following instructions except?
- A. Cleanse the mask or collar with soapy water every other day.
- B. Ensure that the straps on the mask are secure but not too tight.
- C. Apply petroleum jelly around and inside the nares.
- D. Post 'no smoking' warning signs at home in a prominent location.
Correct Answer: C
Rationale: When providing instructions for home oxygen therapy, it is important to ensure safety and proper care. Choices A, B, and D are all essential instructions for the client and family. Choice C, 'Apply petroleum jelly around and inside the nares,' is incorrect. Petroleum jelly should not be used near oxygen sources as it is flammable and can increase the risk of fire hazard. Therefore, this instruction should not be included in the teaching.
A client hospitalized with deep vein thrombosis has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?
- A. The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.
- B. I will call the provider to get a prescription for discontinuing the IV heparin today
- C. Both heparin and Coumadin work together to dissolve the clots.
- D. The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay.
Correct Answer: A
Rationale: The correct answer is, 'The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.' Warfarin (Coumadin) is an oral anticoagulant that takes time to reach its full effect, typically a few days. In the meantime, IV heparin is used to provide immediate anticoagulation until the Coumadin levels become therapeutic. Option B is incorrect because discontinuing the IV heparin abruptly without reaching a therapeutic level with Coumadin can increase the risk of clot formation. Option C is incorrect because heparin and Coumadin do not work together to dissolve clots; they both have anticoagulant effects but work differently. Option D is incorrect because IV heparin does not directly increase the effects of Coumadin; they have different mechanisms of action.
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.