Nokea
To improve Mr. Puff’s breathing pattern, the nurse can
- A. Encourage coughing and deep breathing
- B. Provide nasal O₂ at 6 L/min
- C. Sit him in a chair
- D. Teach him pursed-lip breathing
Correct Answer: D
Rationale: Pursed-lip breathing improves oxygenation and reduces shortness of breath.
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In assigning patients with alterations related to gastrointestinal (GI) cancer, which would be the most appropriate nursing care tasks to assign to the LPN/LVN, under supervision of the team leader RN?
- A. A patient with severe anemia secondary to GI bleeding.
- B. A patient who needs enemas and antibiotics to control GI bacteria.
- C. A patient who needs pre-op teaching for bowel resection surgery.
- D. A patient who needs central line insertion for chemotherapy.
Correct Answer: B
Rationale: Administering enemas and antibiotics involves routine tasks that LPNs/LVNs are trained to perform, whereas the other options require advanced skills or supervision.
A male nurse would be providing culturally competent care by requesting that a female nurse provide the care for which patient?
- A. Arab male
- B. Latino male
- C. Arab female
- D. African American female
Correct Answer: C
Rationale: In Arab culture, modesty and gender roles dictate that female caregivers attend to women, especially regarding intimate care.
What is your priority intervention for this patient?
- A. Transportation arrangements to a safe house
- B. Referral to a counselor
- C. Advise about contacting the police
- D. Follow-up appointment for injuries
Correct Answer: A
Rationale: Ensuring the patient's safety by arranging transportation to a safe house is the top priority.
Symptoms of an ectopic pregnancy include:
- A. Hematuria, pelvic pain, and dizziness
- B. Amenorrhea, pelvic pain, and vaginal spotting
- C. Constipation, nausea, and fainting
- D. Fallopian pain, nausea, and breast enlargement
Correct Answer: B
Rationale: Ectopic pregnancies often present with amenorrhea, pelvic pain, and vaginal spotting due to the abnormal implantation site.
A 44-year-old female client had an emergency cholecystectomy three days ago for a ruptured gallbladder. The client has severe abdominal pain, abdominal rigidity, distension, increased temperature, tachycardia and an elevated white blood count (WBC). The client has probably developed:
- A. gastritis.
- B. evisceration.
- C. peritonitis.
- D. a pulmonary embolism.
Correct Answer: C
Rationale: Assessment findings of gastritis would reveal anorexia, nausea and vomiting, epigastric fullness and tenderness, and discomfort. Evisceration is the extrusion of abdominal viscera as a result of trauma or sutures failing in a surgical incision. Peritonitis, inflammation of the peritoneum, can occur when an abdominal organ, such as the gallbladder, perforates and leaks blood and fluid into the abdominal cavity, which causes infection and irritation. Assessment findings of a pulmonary embolism would reveal severe substernal chest pain, tachycardia, tachypnea, shortness of breath, anxiety or panic, and wheezing and coughing, often accompanied by blood-tinged sputum.