Nokea
The nurse is caring for a patient with stage I non-small cell lung cancer who is scheduled for a lobectomy. The patient tells the nurse, 'I would rather have radiation than surgery.' Which of the following responses by the nurse is best?
- A. Are you afraid that the surgery will be very painful?
- B. Did you have bad experiences with previous surgeries?
- C. Surgery is the treatment of choice for stage I lung cancer.
- D. Tell me what you know about the various treatments available.
Correct Answer: D
Rationale: More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, 'Surgery is the treatment of choice' is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery.
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The nurse is caring for a patient with right lower-lobe pneumonia who has been treated with intravenous (IV) antibiotics for 2 days. Which of the following assessment data obtained by the nurse indicates that the treatment has been effective?
- A. Bronchial breath sounds are heard at the right base.
- B. The patient coughs up small amounts of green mucus.
- C. The patient's white blood cell (WBC) count is 9 x 10^9/L.
- D. Increased tactile fremitus is palpable over the right chest.
Correct Answer: C
Rationale: The normal WBC count indicates that the antibiotics have been effective. All the other data suggest that a change in treatment is needed.
The nurse is caring for a patient who has just had a thoracentesis. Which of the following information is most important to communicate to the health care provider?
- A. BP is 150/90 mm Hg.
- B. Oxygen saturation is 89%.
- C. Pain level is 5/10 with a deep breath.
- D. Respiratory rate is 24 when lying flat.
Correct Answer: B
Rationale: Oxygen saturation would be expected to improve after a thoracentesis. A saturation of 89% indicates that a complication such as pneumothorax may be occurring. The other assessment data also indicate a need for ongoing assessment or intervention, but the low oxygen saturation is the priority.
Which of the following information obtained by the nurse about a patient who has human immunodeficiency virus (HIV) and active tuberculosis (TB) disease is most important to communicate to the health care provider?
- A. The Mantoux test had an induration of only 8 mm.
- B. The chest x-ray showed infiltrates in the upper lobes.
- C. The patient is being treated with antiretrovirals for HIV infection.
- D. The patient has a cough that is productive of blood-tinged mucus.
Correct Answer: C
Rationale: Drug interactions can occur between the antiretrovirals used to treat HIV infection and the medications used to treat tuberculosis. The other data are expected in a patient with HIV and TB disease.
The nurse notes new onset confusion in an older-adult patient in a long-term care facility. The patient is normally alert and oriented. In which order should the nurse take the following actions?
- A. Obtain the oxygen saturation.
- B. Check the patient's pulse rate.
- C. Document the change in status.
- D. Notify the health care provider.
Correct Answer: A,B,D,C
Rationale: Assessment for physiological causes of new onset confusion such as pneumonia, infection, or perfusion problems should be the first action by the nurse. Airway and oxygenation should be assessed first, then circulation. After assessing the patient, the nurse should notify the health care provider. Finally, documentation of the assessments and care should be done.
Which of the following information should the nurse include in the teaching plan for a patient who is receiving rifampin for treatment of tuberculosis?
- A. Your urine, sweat, and tears will be orange coloured.
- B. Read a newspaper daily to check for changes in vision.
- C. Take vitamin B6 daily to prevent peripheral nerve damage.
- D. Call the health care provider if you notice any hearing loss.
Correct Answer: A
Rationale: Orange-coloured body secretions are an adverse effect of rifampin. The other adverse effects are associated with other antituberculosis medications.