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The nurse has calculated a low PaO2/FIO2 (P/F) ratio <150 for a client with acute respiratory distress syndrome (ARDS). The nurse should place the client in which position to improve oxygenation, ventilation distribution, and drainage of secretions?
- A. Supine.
- B. Semi-Fowler's.
- C. Lateral side.
- D. Prone.
Correct Answer: D
Rationale: Prone positioning in ARDS with a low P/F ratio (<150) improves oxygenation, ventilation distribution, and secretion drainage by recruiting dependent lung regions. Other positions are less effective.
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A 58-year-old male has just had a sclerosing agent instilled after chest tube drainage of a pleural effusion. The nurse should instruct the client to:
- A. Lie still to prevent a pneumothorax.
- B. Sit upright with arms on an overhead table to promote lung expansion.
- C. Change position frequently to distribute the agent.
- D. Lie on the side where the thoracentesis was done to hold pressure on the chest tube site.
Correct Answer: C
Rationale: Changing position frequently distributes the sclerosing agent evenly, promoting effective pleurodesis to prevent recurrent pleural effusion.
A 42-year-old husband and father of a 7-year-old girl and a 10-year-old boy is concerned about what he should tell his children regarding his wife's impending death from aggressive breast cancer. The nurse should:
- A. Refer the family to pastoral care services.
- B. Encourage the husband to come to terms with his own grief first.
- C. Suggest that the children be told nothing until after death occurs.
- D. Begin education about strategies for communication with his children.
Correct Answer: D
Rationale: Educating the husband on communication strategies helps him prepare his children for their mother's death, fostering understanding and emotional support.
The nurse reviews prescriptions for packed red blood cell (PRBC) transfusions. Which PRBC transfusion should the nurse question with the primary healthcare provider (PHCP)? A client
- A. with a febrile illness.
- B. with pulmonary edema.
- C. receiving mechanical ventilation.
- D. with a chest tube for a hemothorax.
Correct Answer: B
Rationale: PRBC transfusions in pulmonary edema can worsen fluid overload, risking transfusion-associated circulatory overload (TACO). Febrile illness, mechanical ventilation, and hemothorax are not absolute contraindications, as transfusions may be indicated with appropriate monitoring.
Immediately after a lumbar laminectomy, the nurse administers ondansetron hydrochloride (Zofran) to the client as ordered. The nurse determines that the drug is effective when which of the following is controlled?
- A. Muscle spasms.
- B. Nausea.
- C. Shivering.
- D. Dry mouth.
Correct Answer: B
Rationale: Ondansetron is an antiemetic, effective when nausea is controlled.
During the first 24 hours after thrombolytic treatment for an ischemic stroke, the primary goal is to control the client's:
- A. Pulse.
- B. Respirations.
- C. Blood pressure.
- D. Temperature.
Correct Answer: C
Rationale: Controlling blood pressure is the primary goal post-thrombolytic therapy to prevent hemorrhagic transformation. Pulse, respirations, and temperature are monitored but are secondary.