Nokea
Before discharging a client with fractured ribs from the emergency department, which instruction is most important for the nurse to give the client?
- A. Avoid coughing to prevent further injury.
- B. Take deep breaths periodically.
- C. Apply heat to the chest daily.
- D. Sleep in a prone position.
Correct Answer: B
Rationale: Taking deep breaths periodically prevents atelectasis and pneumonia, which are risks with fractured ribs due to shallow breathing.
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A 52-year old female patient is receiving medical treatment for a possible tuberculosis infection. The patient is a U.S. resident but grew up in a foreign country. She reports that as a child she received the BCG vaccine (bacille Calmette-Guerin vaccine). Which physician's order below would require the nurse to ask the doctor for an order clarification?
- A. PPD (Mantoux test)
- B. Chest X-ray
- C. QuantiFERON-TB Gold (QFT)
- D. Sputum culture
Correct Answer: A
Rationale: The BCG vaccine can cause false-positive PPD (Mantoux) test results, making it unreliable in patients with a BCG history. The nurse should clarify this order, as an IGRA test (e.g., QuantiFERON-TB Gold) or other diagnostics are preferred.
The case manager is arranging a care planning meeting regarding the care of a 65-year-old client diagnosed with adult-onset asthma. Which health-care disciplines should participate in the meeting? Select all that apply.
- A. Nursing.
- B. Pharmacy.
- C. Social work.
- D. Occupational therapy.
- E. Speech therapy.
Correct Answer: A,B,C
Rationale: Nursing (A), pharmacy (B), and social work (C) address asthma management, medications, and social needs. Occupational (D) and speech (E) therapies are less relevant.
You are assessing your newly admitted patients who are all presenting with atypical signs and symptoms of a possible lung infection. The physician suspects tuberculosis. So, therefore, the patients are being monitored and tested for the disease. Select all the risk factors below that increases a patient's risk for developing tuberculosis:
- A. Diabetes
- B. Liver failure
- C. Long-term care resident
- D. Inmate
- E. IV drug user
- F. HIV
- G. U.S. resident
Correct Answer: C,D,E,F
Rationale: Remember from our lecture we discussed the risk factors for developing TB and to remember them I said remember the mnemonic "TB Risk". It stands for tight living quarters (LTC resident, prison, homeless shelter etc.), below or at the poverty line (homeless), refugee (especially in high risk countries), immune system issue such as HIV, substance abusers (IV drugs or alcohol), Kids less than the age of 5....all these are risk factors.
A patient with asthma is receiving a nebulizer of Cromolyn. The patient reports a burning sensation in the nose along with a horrible taste in their mouth. As the nurse you will?
- A. Immediately stop the nebulizer
- B. Re-adjust the nebulizer
- C. Call a rapid response because the patient is having a potential anaphylactic reaction to the medication.
- D. Reassure the patient this is a temporary side effect of this medication.
Correct Answer: D
Rationale: Burning sensation and bad taste are common temporary side effects of Cromolyn nebulizer treatment and do not indicate a severe reaction.
When performing the client's tracheostomy care, which nursing action is correct?
- A. Cut a gauze square to fit around the client's stoma.
- B. Secure the ties at the back of the client's neck.
- C. Attach new ties before removing old ones.
- D. Replace the cannula after changing the ties.
Correct Answer: C
Rationale: Attaching new ties before removing old ones ensures the tracheostomy tube remains secure, preventing accidental dislodgement.