Nokea
A patient has a PPD skin test (Mantoux test). As the nurse you tell the patient to report back to the office in so the results can be interpreted?
- A. 24-48 hours
- B. 12-24 hours
- C. 48-72 hours
- D. 24-72 hours
Correct Answer: C
Rationale: The PPD skin test (Mantoux) is read 48-72 hours after administration to assess for induration, as this is the standard timeframe for an accurate immune response to be visible.
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Which side effect can the nurse expect when the client receives aminophylline (Truphylline)?
- A. Bronchospasm
- B. Hypotension
- C. Drowsiness
- D. Tachycardia
Correct Answer: D
Rationale: Aminophylline, a xanthine derivative, commonly causes tachycardia as a side effect due to its stimulatory effects.
Your patient is diagnosed with a latent tuberculosis infection. Select all the correct statements that reflect this condition:
- A. The patient will not need treatment unless it progresses to an active tuberculosis infection.
- B. The patient is not contagious and will have no signs and symptoms.
- C. The patient will have a positive tuberculin skin test or IGRA test.
- D. The patient will have an abnormal chest x-ray.
- E. The patient's sputum will test positive for mycobacterium tuberculosis.
Correct Answer: B,C
Rationale: Latent TB infection is characterized by no symptoms, no contagiousness , and a positive tuberculin skin test or IGRA . Treatment is often recommended to prevent progression (not A). Chest X-rays are typically normal (not D), and sputum tests are negative (not E).
The client is three (3) days post-partial laryngectomy. Which type of nutrition should the nurse offer the client?
- A. Total parenteral nutrition.
- B. Soft, regular diet.
- C. Partial parenteral nutrition.
- D. Clear liquid diet.
Correct Answer: D
Rationale: Clear liquids (D) are safest 3 days post-laryngectomy to prevent aspiration. TPN (A), soft diet (B), and partial PN (C) are premature or unnecessary.
Which of the following statements are incorrect about discharge teaching that you would provide to a patient with COPD? Select-all-that-apply:
- A. It is best to eat three large meals a day that are relatively low in calories.'
- B. Avoid going outside during extremely hot or cold days.'
- C. It is important to receive the Pneumovax vaccine annually.'
- D. Smoking cessation can help improve your symptoms.'
Correct Answer: A,C
Rationale: Eating small, frequent meals (not three large meals, A) prevents diaphragm compression, and Pneumovax is not annual but given once or as per guidelines. Avoiding extreme weather and smoking cessation are correct.
The client diagnosed with deep vein thrombosis (DVT) suddenly complains of severe chest pain and a feeling of impending doom. Which complication should the nurse suspect the client has experienced?
- A. Myocardial infarction.
- B. Pneumonia.
- C. Pulmonary embolus.
- D. Pneumothorax.
Correct Answer: C
Rationale: Sudden chest pain and impending doom in a DVT patient suggest pulmonary embolus (C), where a clot dislodges to the lungs, causing acute respiratory distress. Myocardial infarction (A) presents with cardiac symptoms. Pneumonia (B) has gradual onset. Pneumothorax (D) causes unilateral symptoms.