Nokea
During a preoperative physical examination, the nurse is alerted to the possibility of compromised respiratory function during or after surgery in a patient with which problem?
- A. Obesity
- B. Dehydration
- C. Enlarged liver
- D. Decreased peripheral pulses
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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What is the best example of documentation of patient teaching regarding wound care?
- A. The patient was instructed about care of wound and dressing changes.
- B. The patient demonstrated correct technique of wound care following instruction.
- C. The patient and caregiver verbalize that they understand the purposes of wound care.
- D. Written instructions regarding wound care and dressing changes were given to the patient.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Goals for patient safety in the OR include the Universal Protocol. What is included in this protocol?
- A. All surgical centers of any type must submit reports on patient safety infractions to the accreditation agencies.
- B. Members of the surgical team stop whatever they are doing to check that all sterile items have been prepared properly.
- C. Members of the surgical team pause right before surgery to meditate for 1 minute to decrease stress and possible errors.
- D. A surgical timeout is performed just before the procedure is started to verify patient identity, surgical procedure, and surgical site.
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
During an acute asthma attack, a healthcare provider assesses a client. Which assessment finding indicates that the client's condition is worsening?
- A. Loud wheezing
- B. Increased respiratory rate
- C. Decreased breath sounds
- D. Productive cough
Correct Answer: C
Rationale: The correct answer is C: Decreased breath sounds. This finding indicates worsening asthma as it signifies decreased airflow to the lungs, which can lead to inadequate oxygenation. Loud wheezing (A) is common in asthma but does not necessarily indicate worsening. Increased respiratory rate (B) is a compensatory mechanism to improve oxygenation. Productive cough (D) may indicate clearing of mucus and is not necessarily associated with worsening asthma.
A client has a mediastinal chest tube. Which symptom requires the nurse's immediate intervention?
- A. Production of pink sputum
- B. Tracheal deviation
- C. Drainage greater than 70 mL/hr
- D. Sudden onset of shortness of breath
Correct Answer: B
Rationale: The correct answer is B: Tracheal deviation. Tracheal deviation indicates a tension pneumothorax, a life-threatening emergency that requires immediate intervention to prevent respiratory compromise. The other choices are incorrect because:
A: Production of pink sputum may indicate bleeding but does not require immediate intervention unless severe.
C: Drainage greater than 70 mL/hr may indicate a potential issue with the chest tube, but it does not require immediate intervention unless accompanied by other symptoms.
D: Sudden onset of shortness of breath is concerning but not as immediately life-threatening as tracheal deviation in this context.
It is estimated that the population of people aged 65 or older in United States will increase to:
- A. 13%
- B. 20%
- C. 25%
- D. 38%
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.