Nokea
The nurse reviews the admission history of a 70-year-old client diagnosed with chronic obstructive pulmonary disease (COPD). Which of the following statements by the client does the nurse recognize as contributing to the development of COPD? Select all that apply.
- A. I have been drinking alcohol almost daily since age 20.'
- B. I have been overweight for as long as I can remember.'
- C. I have smoked about a pack of cigarettes a day since I was 16 years old but quit last year.'
- D. I know I eat too much fast food.'
- E. I was a car mechanic for about 40 years and had my own garage.'
Correct Answer: C, E
Rationale: Smoking (C) is a primary cause of COPD. Occupational exposure to chemicals as a mechanic (E) is also a risk factor. Alcohol (A), obesity (B), and fast food (D) are not directly linked to COPD.
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The nurse should consider which of the following client reports as an indication of an allergic reaction?
- A. I can't eat broccoli or cabbage when I take my warfarin.'
- B. I get a headache when using my nitroglycerine patch.'
- C. My feet swell when I take felodipine.'
- D. My lips swell when I eat bananas or avocados.'
Correct Answer: D
Rationale: Lip swelling (D) indicates an allergic reaction to food. Broccoli/cabbage (A) affects warfarin's efficacy, headaches (B) are a side effect of nitroglycerin, and swelling (C) is a side effect of felodipine.
Which finding by the nurse suggests that the mother is not giving the toddler iron supplements as ordered?
- A. The child has pale skin.
- B. There is light brown stool in the diaper.
- C. The child takes a nap every day.
- D. The child has ecchymotic areas on her legs.
Correct Answer: B
Rationale: Iron supplements typically cause dark or black stools; light brown stools suggest non-compliance with iron supplementation.
An adult client in an acute care facility says to the nurse, 'I hope this hospital doesn't have student doctors and nurses. I do not want a student taking care of me.' The nurse's response should be based on which of the following understandings?
- A. When a client signs permission for treatment in a hospital, this includes treatment by medical and nursing students.
- B. The client has the right to know if the hospital is affiliated with a medical school and to refuse care by students.
- C. The client may sign a special form that says he refuses to be cared for by medical or nursing students.
- D. The client should be informed if any caregivers are students, but the client does not have the right to refuse to be cared for by students.
Correct Answer: B
Rationale: Clients have the right to know about student involvement and refuse student care, respecting autonomy. Consent doesn't inherently include students, and special forms or mandatory acceptance are incorrect.
The home health nurse visits a 72-year-old client with pneumonia who was discharged from the hospital 3 days ago. The client has less of a productive cough at night but now reports sharp chest pain with inspiration. Which finding is most important for the nurse to report to the supervising registered nurse?
- A. Bronchial breath sounds
- B. Increased tactile fremitus
- C. Low-pitched wheezing (rhonchi)
- D. Pleural friction rub
Correct Answer: D
Rationale: Pleural friction rub (D) indicates pleuritis or pleural effusion, a serious complication requiring immediate reporting. Other findings (A, B, C) are less specific or urgent.
The nurse is evaluating a parent's understanding of home care management for a 2-week-old client after initial cast placement for treatment of congenital clubfoot. Which of the following statements by the parent indicate a correct understanding? Select all that apply.
- A. Cradling my baby in my arms may cause stress and damage to the cast.'
- B. I will check my baby's toes several times a day to ensure that they are pink and warm.'
- C. My baby should alternate between sleeping on the stomach and back'
- D. My baby will need to have a new cast applied weekly for 5-8 weeks.'
- E. When I bathe or diaper my baby, I will be sure to keep the cast dry.'
Correct Answer: B, D, E
Rationale: Checking toes (B), weekly casts (D), and keeping the cast dry (E) are correct. Cradling (A) is safe, and alternating sleep positions (C) is not cast-related.