Nokea
Steve has developed pneumonia following intrathoracic surgery performed last week. He has no comorbidities and the hospital does not have a high rate of MRSA infections. Treatment for postoperative pneumonia would most likely include a:
- A. Cephalosporin, such as cefazolin.
- B. Penicillin, such as amoxicillin.
- C. Fluoroquinolone, such as levofloxacin.
- D. Tetracycline, such as doxycycline.
Correct Answer: C
Rationale: Fluoroquinolones like levofloxacin are effective against a broad spectrum of pathogens and are often used to treat postoperative pneumonia, especially in cases without MRSA concerns.
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Lack of bubbling in the suction control chamber indicates
- A. Excessive negative pressure (suction)
- B. A leak somewhere in the drainage system, as within the patient
- C. A kink or plug in the drainage tubing
- D. The patient’s lung has reexpanded
Correct Answer: D
Rationale: Reexpanded lungs stop air leakage into the drainage system.
A client is on intravenous heparin to treat a pulmonary embolism. The client's most recent partial thromboplastin time (PTT) was 25 seconds. What action should the nurse anticipate?
- A. Decrease the heparin rate.
- B. Increase the heparin rate.
- C. No change to the heparin rate.
- D. Stop the heparin; start warfarin (Coumadin).
Correct Answer: B
Rationale: The correct answer is B: Increase the heparin rate. A PTT of 25 seconds indicates that the client's blood is not adequately anticoagulated, as the therapeutic range for PTT is typically around 60-80 seconds for heparin therapy. Therefore, the nurse should anticipate increasing the heparin rate to achieve the desired anticoagulant effect and prevent further clot formation.
Incorrect choices:
A: Decreasing the heparin rate would further decrease the anticoagulant effect, potentially putting the client at risk for thrombus progression.
C: No change to the heparin rate would not address the subtherapeutic PTT level and could lead to inadequate anticoagulation.
D: Stopping heparin and starting warfarin is not appropriate at this time as warfarin takes time to reach therapeutic levels, whereas heparin provides immediate anticoagulation for acute situations like a pulmonary embolism.
Place the events below in the order they occur in the patient with obstructive sleep apnea (beginning with 1).
- A. Sleep just before going to work
- B. Narrowing of air passages with muscle relaxation during sleep
- C. Apnea lasting 10 to 90 seconds
- D. Brief arousal and airway opened
Correct Answer: C
Rationale: The correct order is E (narrowing), A (apnea), C (arousal). Muscle relaxation leads to airway narrowing, followed by apnea and then arousal.
Which factors place a client at risk for serotonin syndrome?
- A. Coprescription of antidepressants from different classes such as MAOIs and SSRIs
- B. Abnormal levels of cortisol in the body
- C. Adequate time between weaning from one antidepressant drug to initiating another
- D. Premenstrual syndrome
Correct Answer: A
Rationale: Combining certain classes of antidepressants increases serotonin levels excessively, leading to serotonin syndrome.
Which of the following would indicate that Mrs. Filbert understands what you have taught her about her condition?
- A. She delays asking for medication so that she will not become addicted
- B. She asks for medication upon the first indication of an attack
- C. She permits the nurse to perform all of her morning care
- D. She asks her family to assist her at mealtime
Correct Answer: B
Rationale: Promptly seeking medication at the onset of symptoms reflects understanding of how to manage acute attacks effectively.