Because of the client's pleural effusion and advanced lung disease, what would the nurse expect to hear when assessing the breath sounds?
- A. Wheezing in the upper lobes
- B. A friction rub posterior to the affected area
- C. Crackles over the affected area
- D. Decreased sounds over the involved area
Correct Answer: D
Rationale: Pleural effusion causes decreased breath sounds over the affected area due to fluid accumulation compressing the lung.
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Which of the following are typical signs and symptoms of pneumonia? Select-all-that-apply:
- A. Stridor
- B. Coarse crackles
- C. Oxygen saturation less than $90 \%$
- D. Non-productive, nagging cough
- E. Elevated white blood cells
- F. Low PCO2 of less than 35
- G. Tachypnea
Correct Answer: B,C,E,G
Rationale: Pneumonia typically presents with coarse crackles due to fluid in alveoli, low oxygen saturation from impaired gas exchange, elevated WBCs indicating infection, and tachypnea (G) as a compensatory mechanism. Stridor is associated with upper airway obstruction, non-productive cough is less common, and low PCO2 suggests hyperventilation, not typical.
The nurse is caring for the client diagnosed with bacterial pneumonia. Which priority intervention should the nurse implement?
- A. Assess respiratory rate and depth.
- B. Provide for adequate rest period.
- C. Administer oxygen as prescribed.
- D. Teach slow abdominal breathing.
Correct Answer: C
Rationale: Administering oxygen as prescribed (C) is the priority for bacterial pneumonia to address hypoxemia, a common issue due to impaired gas exchange. Assessing respiratory rate (A) is important but secondary to ensuring oxygenation. Rest (B) and breathing techniques (D) support recovery but are not the first priority.
A patient with COPD is reporting depression and thoughts of suicide. The patient states, 'I just feel like ending it all.' You assess the patient's health history and note that the patient was recently started on which medication that could cause this side effect:
- A. Atrovent
- B. Prednisone
- C. Roflumilast
- D. Theophylline
Correct Answer: C
Rationale: Roflumilast is associated with psychiatric side effects, including depression and suicidal thoughts. Other medications (A, B, D) are less commonly linked to these effects.
The client diagnosed with influenza A is being discharged from the emergency department with a prescription for antibiotics. Which statement by the client indicates an understanding of this prescription?
- A. These pills will make me feel better fast and I can return to work.
- B. The antibiotics will help prevent me from developing a bacterial pneumonia.
- C. If I had gotten this prescription sooner, I could have prevented this illness.
- D. I need to take these pills until I feel better; then I can stop taking the rest.
Correct Answer: B
Rationale: Antibiotics for influenza (B) prevent secondary bacterial pneumonia, not treat the virus. Quick recovery (A), prevention (C), and stopping early (D) are incorrect.
The client is suspected of having a pulmonary embolus. Which diagnostic test suggests the presence of a pulmonary embolus and requires further investigation?
- A. Plasma D-dimer test.
- B. Arterial blood gases.
- C. Chest x-ray (CXR).
- D. Magnetic resonance imaging (MRI).
Correct Answer: A
Rationale: Elevated D-dimer (A) suggests clotting, warranting further PE investigation (e.g., CT). ABGs (B) show hypoxia, CXR (C) is nonspecific, and MRI (D) is not standard.
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