Nokea
A patient has just been diagnosed with lung cancer. After the physician discusses treatment options and leaves the room, the patient asks the nurse how the treatment is decided upon. What would be the nurses best response?
- A. The type of treatment depends on the patients age and health status
- B. The type of treatment depends on what the patient wants when given the options
- C. The type of treatment depends on the cell type of the cancer, the stage of the cancer, and the patients health status
- D. The type of treatment depends on the discussion between the patient and the physician of which treatment is best
Correct Answer: C
Rationale: Treatment of lung cancer depends on the cell type, the stage of the disease, and the patients physiologic status (particularly cardiac and pulmonary status). Treatment does not depend solely on the patients age or the patients preference between the different treatment modes. The decision about treatment does not primarily depend on a discussion between the patient and the physician of which treatment is best, though this discussion will take place.
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The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client?
- A. Coumadin will continue to break up the clot over a period of weeks
- B. Coumadin must be taken concurrent with ASA to achieve anticoagulation
- C. Anticoagulant therapy usually lasts between 3 and 6 months
- D. He should take a vitamin supplement containing vitamin K
Correct Answer: C
Rationale: Anticoagulant therapy prevents further clot formation, but cannot be used to dissolve a clot. The therapy continues for approximately 3 to 6 months and is not combined with ASA. Vitamin K reverses the effect of anticoagulant therapy and normally should not be taken.
A patient in the ICU is status post embolectomy after a pulmonary embolus. What assessment parameter does the nurse monitor most closely on a patient who is postoperative following an embolectomy?
- A. Pupillary response
- B. Pressure in the vena cava
- C. White blood cell differential
- D. Pulmonary arterial pressure
Correct Answer: D
Rationale: If the patient has undergone surgical embolectomy, the nurse measures the patients pulmonary arterial pressure and urinary output. Pressure is not monitored in a patients vena cava. White cell levels and pupillary responses would be monitored, but not to the extent of the patients pulmonary arterial pressure.
A patient is brought to the ED by ambulance after a motor vehicle accident in which the patient received blunt trauma to the chest. The patient is in acute respiratory failure, is intubated, and is transferred to the ICU. What parameters of care should the nurse monitor most closely? Select all that apply.
- A. Coping
- B. Level of consciousness
- C. Oral intake
- D. Arterial blood gases
- E. Vital signs
Correct Answer: B,D,E
Rationale: Patients are usually treated in the ICU. The nurse assesses the patients respiratory status by monitoring the level of responsiveness, ABGs, pulse oximetry, and vital signs. Oral intake and coping are not immediate priorities during the acute stage of treatment, but would become more important later during recovery.
An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patients plan of care?
- A. Nasogastric intubation
- B. Administration of probiotic supplements
- C. Bedrest
- D. Cautious hydration
Correct Answer: D
Rationale: Supportive treatment of pneumonia in the elderly includes hydration (with caution and with frequent assessment because of the risk of fluid overload in the elderly); supplemental oxygen therapy; and assistance with deep breathing, coughing, frequent position changes, and early ambulation. Mobility is not normally discouraged and an NG tube is not necessary in most cases. Probiotics may or may not be prescribed for the patient.
The nurse is caring for a patient suspected of having ARDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patients symptoms from those of a cardiac etiology?
- A. Carboxyhemoglobin level
- B. Brain natriuretic peptide (BNP) level
- C. C-reactive protein (CRP) level
- D. Complete blood count
Correct Answer: B
Rationale: Common diagnostic tests performed for patients with potential ARDS include plasma brain natriuretic peptide (BNP) levels, echocardiography, and pulmonary artery catheterization. The BNP level is helpful in distinguishing ARDS from cardiogenic pulmonary edema. The carboxyhemoglobin level will be increased in a client with an inhalation injury, which commonly progresses into ARDS. CRP and CBC levels do not help differentiate from a cardiac problem.