Nokea
A nurse is caring for a client who has a respiratory infection. The nurse should have the client sit in a high-Fowler's position to help mobilize secretions from which of the following lung segments?
- A. Apical segments
- B. Both upper lobes
- C. Anterior segments of both lower lobes
- D. Posterior segments of both lower lobes
Correct Answer: B
Rationale: High-Fowler's position enhances lung expansion and secretion clearance from the upper lobes.
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A nurse is preparing an older adult client for a physical examination the provider is about to perform. Which of the following actions should the nurse take?
- A. Explain to the client what is about to happen.
- B. Make sure the room temperature is cool.
- C. Provide music as an environmental distraction.
- D. Inform the client that the provider will examine sensitive areas first.
Correct Answer: A
Rationale: The correct answer is A. The nurse should explain to the client what is about to happen to ensure the client feels informed and comfortable throughout the physical examination. This helps establish trust and promote client autonomy. Choice B is incorrect because older adults may prefer a warmer room temperature for comfort. Choice C is incorrect as not all clients may find music distracting or helpful during the examination. Choice D is incorrect because informing the client about examining sensitive areas first may cause unnecessary anxiety.
A nurse is reinforcing teaching with a 40-year-old female client about preventive health screenings. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should have my skin checked every 5 years for cancer.
- B. I will need to have a mammogram every year now.
- C. I should have my first colonoscopy when I turn 65.
- D. I will be checked for uterine cancer every 2 years.
Correct Answer: B
Rationale: The correct answer is B: "I will need to have a mammogram every year now." Mammograms are recommended for women starting at age 40 to screen for breast cancer. Annual mammograms help detect any abnormalities early, improving the chances of successful treatment. Choice A is incorrect as skin checks should be done annually. Choice C is incorrect as the first colonoscopy is usually recommended at age 50. Choice D is incorrect as there is no standard screening for uterine cancer every 2 years.
A nurse is caring for a client who requires contact precautions. Which of the following actions should the nurse take?
- A. Wear a mask when entering the client's room.
- B. Remove potted plants from the room.
- C. Allow the client to leave the room every 2 hr.
- D. Dedicate equipment and supplies for use with the client.
Correct Answer: D
Rationale: The correct answer is D: Dedicate equipment and supplies for use with the client. This is essential for preventing the spread of infection. By dedicating equipment to the client, the nurse reduces the risk of contaminating other clients. Choice A is incorrect because wearing a mask is not necessary for contact precautions unless respiratory droplets are a concern. Choice B is irrelevant to contact precautions. Choice C is incorrect as allowing the client to leave the room frequently can increase the risk of spreading infection.
A nurse is caring for a client who is receiving oxygen at 2 L/min via a nasal cannula. From this information, the nurse should identify that the client is receiving which of the following oxygen concentrations?
- A. 0.28
- B. 0.36
- C. 0.5
- D. 0.7
Correct Answer: A
Rationale: A nasal cannula at 2 L/min delivers approximately 28% oxygen concentration. Higher values correspond to mask or higher flow rates.
A nurse is preparing an older adult client for a physical examination the provider is about to perform. Which of the following actions should the nurse take?
- A. Explain to the client what is about to happen.
- B. Make sure the room temperature is cool.
- C. Provide music as an environmental distraction.
- D. Inform the client that the provider will examine sensitive areas first.
Correct Answer: A
Rationale: The correct answer is A: Explain to the client what is about to happen. This is important to ensure the client's understanding and cooperation during the physical examination. By explaining the procedure, the nurse can reduce the client's anxiety and build trust. This communication also promotes client autonomy and respects their dignity. As for the other choices: B (Make sure the room temperature is cool) is not directly related to preparing the client for the physical examination. C (Provide music as an environmental distraction) may not be appropriate for all clients and may not address the client's emotional needs. D (Inform the client that the provider will examine sensitive areas first) may cause unnecessary anxiety without providing a clear understanding of the examination process.