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A nurse is teaching a client about using a continuous positive airway pressure (CPAP) device to treat obstructive sleep apnea. Which of the following information should the nurse include in the teaching?
- A. It delivers a preset amount of inspiratory pressure throughout the breathing cycle
- B. It has a continuous adjustment feature that changes the airway pressure throughout the cycle
- C. It delivers a preset amount of airway pressure throughout the breathing cycle
- D. It delivers positive pressure at the end of each breath
Correct Answer: C
Rationale: The correct answer is C because a CPAP device delivers a preset amount of positive airway pressure continuously throughout all inspiration and expiration cycles. Choice A is incorrect because CPAP does not deliver inspiratory pressure at the beginning of each breath; it provides continuous positive pressure. Choice B is incorrect because CPAP typically delivers a constant pressure rather than having a feature that changes pressure throughout the cycle. Choice D is incorrect as CPAP does not deliver positive pressure specifically at the end of each breath; it maintains a consistent pressure throughout the breathing cycle.
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A client with heart failure is prescribed furosemide 20 mg PO twice daily. Which of the following instructions should the nurse include during discharge teaching?
- A. Monitor for increased blood pressure
- B. Increase intake of high-potassium foods
- C. Expect an increase in swelling in the hands and feet
- D. Take the second dose at bedtime
Correct Answer: B
Rationale: The correct answer is to instruct the client to increase their intake of high-potassium foods. Furosemide can lead to hypokalemia, a condition of low potassium levels in the blood. Increasing the consumption of high-potassium foods helps prevent this adverse effect. Monitoring for increased blood pressure (choice A) is not directly related to furosemide use. Expecting an increase in swelling (choice C) is incorrect as furosemide is a diuretic that helps reduce swelling. Taking the second dose at bedtime (choice D) is not necessary unless prescribed by the healthcare provider.
A nurse is admitting a client who has suspected appendicitis. Which of the following findings should the nurse report to the provider immediately?
- A. Distended, board-like abdomen
- B. WBC count of 15,000/mm3
- C. Rebound tenderness over McBurney's point
- D. Temperature of 37.3°C (99.1°F)
Correct Answer: A
Rationale: A distended, board-like abdomen should be reported to the provider immediately because it indicates peritonitis, a serious complication of appendicitis resulting from a ruptured appendix. Option B, an elevated WBC count, may indicate infection but is not as urgent as a board-like abdomen. Option C, rebound tenderness over McBurney's point, is a classic sign of appendicitis but does not indicate immediate life-threatening complications. Option D, a slightly elevated temperature, is not as concerning as a distended, board-like abdomen.
A nurse is caring for a client who has a new diagnosis of tuberculosis. Which of the following precautions should the nurse initiate to prevent transmission of the disease?
- A. Contact precautions
- B. Airborne precautions
- C. Droplet precautions
- D. Protective environment
Correct Answer: B
Rationale: Tuberculosis is spread through small droplets measuring less than 5 microns, which can remain airborne for extended periods. The nurse should place a client who has TB under airborne precautions to prevent the spread of microbes. Choice A, contact precautions, are used for diseases spread by direct or indirect contact. Choice C, droplet precautions, are for diseases spread by larger droplets. Choice D, protective environment, is used for immunocompromised clients to protect them from environmental pathogens.
A nurse is providing teaching to a client who was newly diagnosed with nephrotic syndrome. Which of the following statements should indicate to the nurse that the client understands the teaching?
- A. I can expect swelling in my hands and on my face.
- B. The amount of protein in my blood is high.
- C. I might have some pain and gas in my stomach from this condition.
- D. I will use a soft bristle toothbrush to prevent bleeding gums.
Correct Answer: A
Rationale: The correct answer is A. Nephrotic syndrome leads to edema, especially of the face and dependent areas, due to the loss of protein in the urine. Choice B is incorrect because nephrotic syndrome leads to protein loss in the urine, not an increase in blood protein levels. Choice C is incorrect as stomach pain and gas are not typical symptoms of nephrotic syndrome. Choice D is incorrect as using a soft bristle toothbrush is not directly related to the manifestations of nephrotic syndrome.
A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching?
- A. Immunosuppressant medications need to be taken for up to 1 year
- B. Shortness of breath might be an indication of transplant rejection
- C. The surgical site will heal in 3 to 4 weeks after surgery
- D. Begin 45 minutes of moderate aerobic exercise per day following discharge
Correct Answer: B
Rationale: The correct answer is B. Shortness of breath is an important sign of transplant rejection. Other manifestations of rejection include fatigue, edema, bradycardia, and hypotension. Choices A, C, and D are incorrect because: A) Immunosuppressant medications are typically required for life, not just up to 1 year. C) The surgical site healing time can vary and may take longer than 3 to 4 weeks. D) Starting a specific exercise regimen should be individualized and guided by healthcare providers; a general recommendation like 45 minutes of exercise per day may not be suitable for all heart transplant recipients.