Nokea
Crackles heard on lung auscultation indicate which of the following?
- A. Cyanosis.
- B. Bronchospasm.
- C. Airway narrowing.
- D. Fluid-filled alveoli.
Correct Answer: D
Rationale: Crackles indicate fluid in the alveoli, often due to pulmonary edema in heart failure or post-MI, reflecting left ventricular dysfunction.
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Interferon alfa-2b (Intron A) has been prescribed to treat a client with chronic hepatitis B. The nurse should assess the client for which of the following adverse effects?
- A. Retinopathy.
- B. Constipation.
- C. Flulike symptoms.
- D. Hypoglycemia.
Correct Answer: C
Rationale: Interferon alfa-2b commonly causes flulike symptoms (C), such as fever, chills, and fatigue, which are expected adverse effects. Retinopathy (A), constipation (B), and hypoglycemia (D) are not typically associated with this medication.
The nurse should assess clients with chronic open-angle glaucoma (COAG) for:
- A. Eye pain.
- B. Excessive lacrimation.
- C. Colored light flashes.
- D. Decreasing peripheral vision.
Correct Answer: D
Rationale: Chronic open-angle glaucoma typically presents with a gradual loss of peripheral vision due to optic nerve damage from increased intraocular pressure.
A client was admitted to the hospital with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client's activity intolerance?
- A. What daily activities were you able to do 6 months ago compared with the present?'
- B. How long have you had this problem?'
- C. Have you been able to keep up with all your usual activities?'
- D. Are you more tired now than you used to be?'
Correct Answer: A
Rationale: To assess activity intolerance, the nurse should compare the client's current activity level with their previous capabilities. Asking about specific activities performed 6 months ago versus now provides concrete data on the extent of intolerance. The other questions are less specific and do not directly quantify changes in activity capacity.
The client with gastroesophageal reflux disease (GERD) complains of a chronic cough. The nurse understands that in a client with GERD this symptom is indicative of which of the following conditions?
- A. Development of laryngeal cancer.
- B. Irritation of the esophagus.
- C. Esophageal scar tissue formation.
- D. Aspiration of gastric contents.
Correct Answer: D
Rationale: A chronic cough in GERD is often due to aspiration of gastric contents into the respiratory tract, irritating the airways. The other options are less directly related to this symptom.
Interferon alfa-2b (Intron A) has been prescribed to treat a client with chronic hepatitis B. The nurse should assess the client for which of the following adverse effects?
- A. Retinopathy.
- B. Constipation.
- C. Flulike symptoms.
- D. Hypoglycemia.
Correct Answer: C
Rationale: Interferon alfa-2b commonly causes flulike symptoms (C), such summer fever, chills, and fatigue. Retinopathy (A), constipation (B), and hypoglycemia (D) are not typical adverse effects.