Nokea
A nurse is preparing to obtain a sputum specimen from a male client. Which of the following nursing actions will facilitate obtaining the specimen?
- A. Limiting fluid.
- B. Having the client take deep breaths.
- C. Asking the client to spit into the collection container.
- D. Asking the client to obtain the specimen after eating.
Correct Answer: B
Rationale: The correct answer is B: Having the client take deep breaths. This action facilitates obtaining a sputum specimen by helping the client to cough and expectorate sputum effectively. Deep breaths help to mobilize secretions, making it easier for the client to produce a quality specimen. Limiting fluid intake (choice A) can lead to dehydration and thickening of secretions, making it harder to obtain a specimen. Asking the client to spit into the container (choice C) may result in contamination with saliva. Asking the client to obtain the specimen after eating (choice D) can introduce food particles into the specimen, affecting the accuracy of the test.
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pharynx is a muscular tube with a length of
- A. 13cm
- B. 12cm
- C. Sinches
- D. both a and c
Correct Answer: A
Rationale: The correct answer is A: 13cm. The human pharynx is typically around 13cm in length. This length allows for the proper passage of food and liquids from the mouth to the esophagus. Choice B (12cm) is incorrect as it is slightly shorter than the average length of the pharynx. Choice C (5 inches) is also incorrect as it does not correspond to the standard unit of measurement for medical lengths. Choice D (both a and c) is incorrect as 12cm and 5 inches are not equivalent lengths for the pharynx.
The charge nurse on a medical unit is preparing to admit several "clients" who have possible pandemic flu during a preparedness drill. What action by the nurse is best?
- A. Admit the "clients" on Contact Precautions.
- B. Inquire as to recent travel outside the United States.
- C. Do not allow pregnant caregivers to care for these "clients."
- D. Place the "clients" on enhanced Droplet Precautions.
Correct Answer: B
Rationale: The correct answer is B because in a pandemic flu scenario, it is crucial to inquire about recent travel history to identify potential exposure risks. This information can help determine if the "clients" have been in high-risk areas or in contact with infected individuals. This step is essential for implementing appropriate infection control measures and preventing the spread of the virus.
Choice A is incorrect because Contact Precautions are not typically used for airborne infections like the flu. Choice C is incorrect as it discriminates against pregnant caregivers without any evidence-based rationale. Choice D is incorrect because enhanced Droplet Precautions are more suitable for diseases spread through respiratory droplets, not necessarily for pandemic flu with potential airborne transmission.
Following an asthmatic attack, a mother asks the physician how to prevent another asthmatic attack. The physician should:
- A. Tell her that asthmatic attacks cannot be prevented.
- B. Help the mother identify triggers that cause asthmatic attacks and show her how to avoid them.
- C. Change her medication.
- D. Immediately move her family to a dry climate.
Correct Answer: B
Rationale: The correct answer is B. Identifying and avoiding triggers is key to preventing asthma attacks. A is incorrect because prevention is possible. C (changing medication) may help but is secondary. D (moving to a dry climate) is impractical and unnecessary.
Which of the following structures most is responsible for determining pulmonary resistance?
- A. visceral and parietal pleura
- B. Trachea
- C. Bronchi
- D. Bronchioles
Correct Answer: D
Rationale: The correct answer is D: Bronchioles. Bronchioles are the smallest airways in the lungs and play a crucial role in determining pulmonary resistance. They have smooth muscle surrounding them, which can contract or relax to regulate airflow and resistance. Constriction of bronchioles increases resistance, while dilation decreases it. Visceral and parietal pleura (A) are membranes that cover the lungs and chest wall, not directly involved in determining pulmonary resistance. The trachea (B) and bronchi (C) are larger airways that mainly serve as conduits for air passage and do not have as significant an impact on resistance as the bronchioles do.
The COPD patient delightedly tells the nurse that he has quit smoking and is using chewing tobacco. The nurse's best intervention would be to:
- A. Congratulate him on his quitting smoking.
- B. Warn him of the dangers of oral cancer.
- C. Suggest that he add nicotine patches in addition to the chewing tobacco.
- D. Point out that he is still addicted and is using tobacco.
Correct Answer: D
Rationale: The correct answer is D. The nurse should point out that the patient is still addicted and using tobacco. This is important because quitting smoking is a positive step, but using chewing tobacco still poses health risks. By highlighting the addiction and continued use of tobacco, the nurse can provide necessary education and support for the patient's overall health.
Choice A is incorrect because it fails to address the continued tobacco use. Choice B is also incorrect as it focuses on a specific risk (oral cancer) rather than the broader issue of tobacco addiction. Choice C is incorrect as adding nicotine patches would not address the fact that the patient is still using tobacco in another form.