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What nursing action takes priority for Mr. Alexander intubated for pneumonia?
- A. Provide the patient with intermittent positive pressure
- B. Aspirate secretions from the airway, as needed
- C. Explain the need for frequent suctioning
- D. Order a room air humidifier
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A client with chronic obstructive pulmonary disease is being taught by a nurse. Which nutritional information should the nurse include in the teaching? (SATA)
- A. Avoid drinking fluids just before and during meals.
- B. Rest before meals if you have dyspnea.
- C. Have about six small meals a day.
- D. Eat high-fiber foods to promote gastric emptying.
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. High-fiber foods promote gastric emptying, reducing the risk of bloating and discomfort in COPD patients.
2. COPD patients may experience difficulty breathing, leading to decreased physical activity and slower digestion.
3. Consuming high-fiber foods helps regulate bowel movements and prevents constipation, common in COPD patients.
Summary of Incorrect Choices:
A: Avoiding fluids just before and during meals is not specific to COPD patients and may not directly address their nutritional needs.
B: Resting before meals if experiencing dyspnea may be helpful, but it does not address specific nutritional information.
C: Having six small meals a day may be beneficial for some COPD patients, but it does not directly address the importance of high-fiber foods for promoting gastric emptying.
What are four basic characteristics of culture?
- A. Ever-present,shared by all members expected by all members adapted to individuals
- B. Dynamic,not always shared by all members
- C. adapted to specific conditions
- D. learned by communication and imitation
Correct Answer: D
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and vomiting to the physician, you would anticipate which initial order for the treatment of this patient?
- A. A fluid bolus as ordered.
- B. Fluid restrictions as ordered.
- C. Urinalysis as ordered.
- D. Sodium-restricted diet as ordered.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
When assessing a client with pneumonia, which clinical manifestation should the nurse expect to find?
- A. Fremitus
- B. Hyperresonance
- C. Dullness on percussion
- D. Decreased tactile fremitus
Correct Answer: C
Rationale: The correct answer is C: Dullness on percussion. In pneumonia, the affected lung tissue becomes consolidated, leading to dullness on percussion due to decreased air movement. The rationale behind this is that consolidation causes the air-filled lung tissue to become filled with fluid and inflammatory cells, impairing normal sound transmission upon percussion.
Incorrect choices:
A: Fremitus - Increased tactile fremitus is typically found in pneumonia due to the denser lung tissue, making this choice incorrect.
B: Hyperresonance - Hyperresonance is commonly found in conditions like emphysema with increased lung air volume, not in pneumonia.
D: Decreased tactile fremitus - This is contradictory as pneumonia usually presents with increased tactile fremitus due to the consolidated lung tissue.
The nurse documents a client's surgical incision as having red granulated tissue. This indicates that the wound is:
- A. infected.
- B. not healing.
- C. necrotic.
- D. healing.
Correct Answer: D
Rationale: The wound is not infected. An infected wound would contain pus, debris, and exudate. A necrotic wound would appear black or brown. The wound is healing properly. It is filled with red granulated tissue and fragile capillaries. A necrotic wound would appear black or brown. The wound is healing properly. It is filled with red granulated tissue and fragile capillaries.