Nokea
How many gtts per mL is delivered with microdrip tubing?
- A. 20 gtts per mL
- B. 10 gtts per mL
- C. 15 gtts per mL
- D. 60 gtts per mL
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A client with a pleural effusion is being assessed by a nurse. Which clinical manifestation does the nurse expect to find?
- A. Decreased breath sounds on the affected side
- B. Hyperresonance on percussion of the affected side
- C. Increased tactile fremitus on the affected side
- D. Tracheal deviation toward the affected side
Correct Answer: A
Rationale: The correct answer is A: Decreased breath sounds on the affected side. In a pleural effusion, fluid accumulates in the pleural space, leading to decreased air entry and diminished breath sounds on auscultation. This occurs because the fluid dampens the transmission of sound through the lungs.
B: Hyperresonance on percussion of the affected side is not expected in pleural effusion, as it is typically associated with conditions like pneumothorax.
C: Increased tactile fremitus on the affected side is not a typical finding in pleural effusion. Tactile fremitus may be decreased due to the presence of fluid.
D: Tracheal deviation toward the affected side is more commonly seen in conditions like tension pneumothorax, not pleural effusion.
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the physician, you would anticipate which initial order for the treatment of this patient?
- A. A fluid bolus as ordered.
- B. Fluid restrictions as ordered.
- C. Urinalysis as ordered.
- D. Sodium-restricted diet as ordered.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which emotional reaction does the client go through when facing mortality in an attempt to postpone death?
- A. Denial
- B. Bargaining
- C. Acceptance
- D. Depression
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with chronic obstructive pulmonary disease is being taught by a nurse. Which nutritional information should the nurse include in the teaching? (SATA)
- A. Avoid drinking fluids just before and during meals.
- B. Rest before meals if you have dyspnea.
- C. Have about six small meals a day.
- D. Eat high-fiber foods to promote gastric emptying.
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. High-fiber foods promote gastric emptying, reducing the risk of bloating and discomfort in COPD patients.
2. COPD patients may experience difficulty breathing, leading to decreased physical activity and slower digestion.
3. Consuming high-fiber foods helps regulate bowel movements and prevents constipation, common in COPD patients.
Summary of Incorrect Choices:
A: Avoiding fluids just before and during meals is not specific to COPD patients and may not directly address their nutritional needs.
B: Resting before meals if experiencing dyspnea may be helpful, but it does not address specific nutritional information.
C: Having six small meals a day may be beneficial for some COPD patients, but it does not directly address the importance of high-fiber foods for promoting gastric emptying.
A client with a tracheostomy experienced a coughing spell during a meal that was being fed by an unlicensed assistive personnel (UAP). What action by the nurse takes priority?
- A. Assess the client's lung sounds.
- B. Assign a different UAP to the client.
- C. Report the UAP to the manager.
- D. Request thicker liquids for meals.
Correct Answer: A
Rationale: The correct answer is A: Assess the client's lung sounds. This action takes priority because the client experienced a coughing spell, indicating a potential aspiration risk. Assessing lung sounds can help determine if there is any respiratory distress or compromised airway.
B: Assigning a different UAP does not address the immediate concern of the client's respiratory status.
C: Reporting the UAP to the manager may be necessary but is not the immediate priority when the client's health is at risk.
D: Requesting thicker liquids for meals does not address the client's current condition and may not be appropriate without proper assessment.