Nokea
What is the best way to determine whether a client with a tracheostomy is becoming hypoxemic during suctioning?
- A. Monitoring level of consciousness
- B. Assessing skin color and temperature
- C. Auscultating the respiratory rate
- D. Counting the respiratory rate
Correct Answer: C
Rationale: Auscultating the respiratory rate detects changes in breathing patterns, indicating potential hypoxemia during suctioning.
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Which statement by the client indicates an accurate understanding of the purpose of aerosol therapy?
- A. Aerosol therapy relieves tissue irritation.
- B. Aerosol therapy delivers medication directly to the lungs.
- C. Aerosolization dries respiratory passages.
- D. Aerosol therapy helps to slow breathing.
Correct Answer: B
Rationale: Aerosol therapy delivers medication directly to the lungs, targeting the respiratory tract for effective treatment of bronchitis.
As the nurse you know that one of the reasons for an increase in multi-drug-resistant tuberculosis is:
- A. Incorrect medication ordered
- B. Increase in tuberculosis cases nationwide
- C. Incorrect route of drug ordered
- D. Noncompliance due to duration of medication treatment needed
Correct Answer: D
Rationale: Noncompliance with TB treatment, often due to the long duration (6-9 months or more), is a major cause of multi-drug-resistant TB, as incomplete treatment allows bacteria to develop resistance.
A 25 year-old female patient with pneumonia is prescribed Doxycycline. What question is important to ask the patient prior to administration of this medication?
- A. Do you take birth control pills?'
- B. Are you allergic to Penicillin?'
- C. Are you allergic to eggs?'
- D. Do you have a history of diabetes?'
Correct Answer: A
Rationale: Doxycycline can reduce the effectiveness of oral contraceptives, so asking about birth control use is critical. Penicillin allergy is unrelated, egg allergy is relevant for vaccines, and diabetes is not a primary concern.
Which nursing assessment data support that the client has experienced a pulmonary embolism?
- A. Calf pain with dorsiflexion of the foot.
- B. Sudden onset of chest pain and dyspnea.
- C. Left-sided chest pain and diaphoresis.
- D. Bilateral crackles and low-grade fever.
Correct Answer: B
Rationale: Sudden chest pain and dyspnea (B) are classic PE symptoms from hypoxia. Calf pain (A) suggests DVT, left-sided pain (C) suggests MI, and crackles/fever (D) suggest pneumonia.
During suctioning of a tracheostomy tube, the catheter appears to attach to the tracheal wall and creates a pulling sensation. What is the best action for the nurse to take?
- A. Release the suction by opening the vent
- B. Continue suctioning to remove the obstruction
- C. Increase the pressure
- D. Suction deeper
Correct Answer: A
Rationale: Releasing suction by opening the vent prevents trauma to the tracheal mucosa when the catheter adheres to the wall.