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A client with active tuberculosis is prescribed isoniazid, rifampin, pyrazinamide, and ethambutol. Which statement by the client indicates an understanding of the teaching?
- A. I can substitute one medication for another if I run out because they all fight infection.
- B. I will wash my hands each time I cough.
- C. I am glad I don't have to have any more sputum specimens.
- D. I don't need to worry about where I go once I start taking my medications.
Correct Answer: B
Rationale: The correct statement indicating understanding of tuberculosis medication regimen is 'I will wash my hands each time I cough.' This statement shows knowledge of infection control practices to prevent the spread of tuberculosis. Washing hands after coughing helps in reducing the transmission of the disease to others. The other options are incorrect. Option A is incorrect as each medication in the regimen has a specific role, and substituting one for another can compromise the effectiveness of treatment. Option C is incorrect as obtaining sputum specimens is essential for monitoring treatment response. Option D is incorrect as the client should still adhere to infection control measures and avoid exposing others to tuberculosis.
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A client is to receive thrombolytic therapy. Which of the following factors should be recognized as a contraindication to the therapy?
- A. Hip arthroplasty 2 weeks ago
- B. Elevated sedimentation rate
- C. Incident of exercise-induced asthma 1 week ago
- D. Elevated platelet count
Correct Answer: A
Rationale: Thrombolytic therapy involves the use of medications to dissolve blood clots. Hip arthroplasty (joint replacement surgery) performed recently is a contraindication to thrombolytic therapy due to the risk of bleeding. Elevated sedimentation rate, exercise-induced asthma, and elevated platelet count are not contraindications to thrombolytic therapy.
When planning care for a client with severe acute respiratory distress syndrome (SARS), which of the following actions should not be included in the care plan?
- A. Administer antibiotics
- B. Provide supplemental oxygen
- C. Administer antiviral medications
- D. Administer bronchodilators
Correct Answer: A
Rationale: Severe acute respiratory distress syndrome (SARS) is caused by a virus, not bacteria, and antibiotics are ineffective against viral infections. Therefore, administering antibiotics would not be appropriate in the care plan for a client with SARS. The priority interventions for SARS include providing supplemental oxygen to improve oxygenation, administering antiviral medications to target the viral infection, and using bronchodilators to help with bronchospasm or airway constriction. Antibiotics are not indicated unless there is a secondary bacterial infection present.
In the emergency department, a nurse is assessing a client involved in a motor vehicle crash. Findings include absent breath sounds in the left lower lobe with dyspnea, blood pressure 118/68 mm Hg, heart rate 124/min, respirations 38/min, temperature 38.6 C (101.4 F), and SaO2 92% on room air. What action should the nurse take first?
- A. Obtain a chest X-ray.
- B. Prepare for chest tube insertion.
- C. Administer oxygen via high-flow mask.
- D. Initiate IV access.
Correct Answer: C
Rationale: In this scenario, the client is presenting with signs of respiratory distress, including absent breath sounds, dyspnea, and a low SaO2 level. The priority action should be to improve oxygenation by administering oxygen via a high-flow mask. This intervention aims to increase the oxygen supply to the client's lungs, helping to address the hypoxemia. Once oxygenation is optimized, further interventions, such as obtaining a chest X-ray, preparing for chest tube insertion, or initiating IV access, can be considered based on the client's condition and healthcare provider's orders.
When teaching a client with tuberculosis, which statement should the nurse include?
- A. You will need to continue taking the multi-medication regimen for 4 months.
- B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication.
- C. You will need to remain hospitalized for treatment.
- D. You will need to wear a mask at all times.
Correct Answer: B
Rationale: Monitoring the effectiveness of tuberculosis medication is crucial to ensure the treatment is working properly. Regular sputum samples help in assessing the response to the medication. This monitoring can guide adjustments in the treatment plan if needed. Options A and C are incorrect as they do not reflect essential aspects of tuberculosis treatment. Option D is not a standard recommendation for tuberculosis treatment and may lead to misconceptions.
When reviewing the prescriptions for a client with a pneumothorax, which of the following actions should the nurse perform first?
- A. Assess the client's pain.
- B. Obtain a large-bore IV needle for decompression.
- C. Administer lorazepam.
- D. Prepare for chest tube insertion.
Correct Answer: B
Rationale: In a client with a pneumothorax, the priority action for the nurse is to obtain a large-bore IV needle for decompression. This intervention helps to relieve the pressure in the pleural space, allowing the lung to re-expand. Prompt decompression is crucial in managing a tension pneumothorax, which can be life-threatening. Assessing pain, administering medication, and preparing for chest tube insertion are important, but they should follow the immediate intervention of decompression in a critical situation like a tension pneumothorax.