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For Mr. Jones’ persistent productive cough, what nursing action would be most appropriate?
- A. Increase intake of warm liquids
- B. Administer narcotic cough medication
- C. Monitor the amount of sputum produced each day
- D. Place the patient on strict bed rest
Correct Answer: A
Rationale: Warm liquids soothe the throat and thin mucus, facilitating expectoration.
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A client calls to report redness to the sclera, itching of the eyes, and increased lacrimation for several hours. What should you direct the caller to do first?
- A. Please call your doctor.'
- B. Apply a cool compress to your eyes.'
- C. If you are wearing contact lenses, remove them.'
- D. Take an over-the-counter antihistamine.'
Correct Answer: C
Rationale: Removing contact lenses is the first step to prevent further irritation and allow proper assessment of the eye condition.
Why are older adults more likely to develop hypovolemic shock?
- A. Low-activity lifestyle
- B. Altered cardiac function
- C. Decreased percentage of body water
- D. Decline in muscle strength and bone mass
Correct Answer: C
Rationale: Older adults have less total body water, making them more susceptible to fluid losses and hypovolemic shock.
When interviewing a client recently diagnosed with lung cancer and having a 60-pack-year smoking history, what is the most important action for the nurse to take?
- A. Educate the client about the importance of quitting smoking to halt cancer progression.
- B. Encourage the client to disclose both tobacco and marijuana use openly.
- C. Maintain a nonjudgmental attitude to promote honest communication with the client.
- D. Provide realistic information about cancer treatment and prognosis without giving false hope.
Correct Answer: C
Rationale: The correct answer is C because maintaining a nonjudgmental attitude promotes honest communication with the client. This is crucial in building trust and rapport, allowing the client to feel comfortable sharing important information about their health and lifestyle. It lays the foundation for effective care and support.
Choice A is not the most important action as quitting smoking, although important, may not be the immediate priority during the initial interview. Choice B, while valuable, is not as crucial as fostering an open and honest relationship with the client. Choice D, although important, may not be the primary focus during the initial meeting and may not promote the necessary trust between the client and nurse.
A healthcare professional assesses a client's respiratory status. Which information is of highest priority for the healthcare professional to obtain?
- A. Average daily fluid intake
- B. Neck circumference
- C. Height & weight
- D. Occupation & hobbies
Correct Answer: D
Rationale: The correct answer is D: Occupation & hobbies. This information is crucial as certain occupations or hobbies may expose the client to respiratory hazards, influencing their respiratory status. The healthcare professional needs to assess potential respiratory risks in the client's environment.
A: Average daily fluid intake is important for overall health but not directly related to respiratory status assessment.
B: Neck circumference is more relevant for assessing risk of obstructive sleep apnea rather than overall respiratory status.
C: Height & weight are important for assessing overall health and potential respiratory issues like obesity, but not as immediate as assessing respiratory hazards in the client's daily activities.
A newly graduated nurse in the hospital states that, since she is so new, she cannot participate in quality improvement (QI) projects. What response by the precepting nurse is best?
- A. All staff nurses are required to participate in quality improvement projects.
- B. Even as a new nurse, you can implement activities designed to improve care.
- C. It's easy to identify which indicators should be used to measure quality improvement.
- D. You should ask to be assigned to the research and quality committee.
Correct Answer: B
Rationale: The correct answer is B because even as a new nurse, one can contribute to improving care by implementing activities. This response encourages the new nurse to actively engage in the quality improvement process, fostering a sense of ownership and commitment to enhancing patient outcomes. Choice A is incorrect as participation in QI projects is not solely based on tenure. Choice C is incorrect as identifying indicators requires knowledge and experience. Choice D is incorrect as it suggests a specific assignment rather than empowering the new nurse to take initiative in improving care.