Nokea
An adult is admitted with probable pulmonary tuberculosis. Which findings would the nurse expect to be present in this client? Select all that apply.
- A. High fevers in the morning
- B. Cough
- C. Bloody sputum
- D. Night sweats
- E. Weight gain
- F. Malaise
Correct Answer: B,C,D,F
Rationale: Tuberculosis causes chronic cough, hemoptysis (bloody sputum), night sweats, and malaise due to systemic infection. Fevers are typically low-grade and nocturnal, and weight loss, not gain, is common.
You may also like to solve these questions
A client weighing 76 kg is admitted at 0600 with a TBSA burn of 40%. Using the Parkland formula, the client's 24-hour intravenous fluid replacement should be:
- A. 6,080 ml
- B. 9,120 ml
- C. 12,160 ml
- D. 15,180 ml
Correct Answer: C
Rationale: The Parkland formula is 4 ml × kg × TBSA = 24-hour fluid requirement, or 4 × 76 × 40 = 12,160 ml. Answer A is the fluid requirement for the first 8 hours after burn injury, so it's incorrect. Answer B is incorrect because it's the fluid requirement for 16 hours after burn injury. Answer D is an excessive amount given the client's weight and TBSA, so it's incorrect.
The nurse is assisting a client with deep breathing and coughing exercises following abdominal surgery. What instruction is most appropriate for the nurse to give the client?
- A. Hold your breath for several seconds and then breathe out forcefully.
- B. Splint your incision while taking in deep breaths and coughing.
- C. Take deep breaths when you are moving in bed.
- D. Deep breathing exercises should be done when you are out of bed.
Correct Answer: B
Rationale: Splinting the incision reduces pain and supports effective deep breathing and coughing, preventing postoperative complications.
A client has developed a low inTest inal obstruction. The nurse would anticipate which of the following findings?
- A. Nausea, vomiting, abdominal distention.
- B. Explosive, irritating diarrhea.
- C. Abdominal tenderness with rectal bleeding.
- D. Midepigastric discomfort, tarry stool.
Correct Answer: A
Rationale: there is distention above the level of obstruction and initially hyperactive bowel sounds; would be no stool, as motility distal to (below) the obstruction would cease
The nurse is caring for a client who was in a motor vehicle accident. His blood pressure is dropping rapidly. What should the nurse observe the client for before placing the client in shock position?
- A. Long bone fractures
- B. Air embolus
- C. Head injury
- D. Thrombophlebitis
Correct Answer: C
Rationale: Shock position (legs elevated) is contraindicated in head injury due to increased intracranial pressure risk. Observing for head injury ensures safety before positioning.
The nurse is performing hypertension screening at the local grocery store. It would be MOST important for the nurse to complete which of the following tasks?
- A. Use a blood pressure cuff that overlaps the arm at least four inches.
- B. Support the client's arm above the level of the heart.
- C. Take two readings at least five minutes apart.
- D. Take the blood pressure after the client has exercised for 10 minutes.
Correct Answer: C
Rationale: Two readings five minutes apart ensure accuracy in hypertension screening. Options A, B, and D are incorrect techniques.