Nokea
When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:
- A. Encourage oral feeding as soon as possible.
- B. Develop an alternative communication method.
- C. Keep the tracheostomy cuff fully inflated.
- D. Keep the patient flat in bed.
Correct Answer: B
Rationale: The correct answer is B: Develop an alternative communication method. After a total laryngectomy, the patient loses the ability to speak. Developing an alternative communication method such as using a communication board or electronic device is crucial for effective communication. Encouraging oral feeding (A) is not appropriate initially due to the risk of aspiration. Keeping the tracheostomy cuff fully inflated (C) can obstruct airflow, and keeping the patient flat in bed (D) can lead to respiratory complications. Developing an alternative communication method is essential for the patient's emotional well-being and quality of life.
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When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse instruct the patient to do?
- A. a. Carry the flow meter with the patient at all times in case an asthma attack occurs
- B. b. Use the flow meter to check the status of the patient’s asthma every time the patient takes quick-relief medication
- C. c. Follow the written asthma action plan (e.g., take quick-relief medication) if the expiratory flow rate is in the yellow zone
- D. Use the flow meter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible
Correct Answer: C
Rationale: The nurse should instruct the patient to follow the written asthma action plan if the expiratory flow rate is in the yellow zone. This helps the patient know when to take quick-relief medication based on their peak flow meter readings.
A 68-year-old male is being admitted to the hospital for an exacerbation of his COPD. The nurse is developing his plan of care. The nurse can expect that this client will?
- A. Be placed on 10 L of oxygen per nasal cannula.
- B. Be placed in respiratory isolation.
- C. Require frequent rest periods throughout the day.
- D. Be placed on fluid restriction.
Correct Answer: C
Rationale: The correct answer is C: Require frequent rest periods throughout the day. This is because patients with COPD often experience shortness of breath and fatigue, necessitating frequent rest periods to conserve energy and manage symptoms. Oxygen therapy is typically started at a lower flow rate (2-4 L/min) to avoid suppressing the patient's respiratory drive, so option A is not appropriate. Respiratory isolation is unnecessary for COPD exacerbation, as it is not a contagious condition, making option B incorrect. Fluid restriction is not typically indicated for COPD exacerbation unless the patient has comorbid conditions like heart failure, so option D is not the priority.
A client is found to be allergic to Chinese food, which causes acute asthma. Which of the following instructions should the nurse give the client?
- A. "Only eat Chinese food once a month."
- B. "Use your inhalers before eating Chinese food."
- C. "Avoid Chinese food because this is a trigger for you."
- D. "Determine other causes, because Chinese food wouldn't cause such a violent reaction."
Correct Answer: C
Rationale: Rationale: Choice C is correct because avoiding Chinese food, a known trigger for the client's acute asthma, is crucial to prevent future asthma attacks. By eliminating the trigger, the client can reduce the risk of allergic reactions and asthma exacerbations.
Summary:
A: Incorrect. Eating Chinese food once a month still exposes the client to the trigger, increasing the risk of asthma attacks.
B: Incorrect. Using inhalers before eating Chinese food may help manage symptoms temporarily but does not address the root cause of the allergic reaction.
D: Incorrect. Dismissing the client's known trigger without further investigation can lead to serious health consequences.
A male client who weighs 175 lb (79.4 kg) is receiving aminophylline (Aminophylline) (400 mg in 500 ml) at 50 ml/hour. The theophylline level is reported as 6 mcg/ml. The nurse calls the physician who instructs the nurse to change the dosage to 0.45 mg/kg/hour. The nurse should:
- A. Question the order because it's too low.
- B. Question the order because it's too high.
- C. Set the pump at 45 ml/hour.
- D. Stop the infusion and have the laboratory repeat the theophylline measurement.
Correct Answer: A
Rationale: The correct answer is A: Question the order because it's too low. To determine the correct dosage, calculate the current dosage the client is receiving (400 mg in 500 ml at 50 ml/hour). Then calculate the new dosage using the client's weight (79.4 kg). Comparing the two dosages, if the new order is significantly lower than the current dosage, it may not be appropriate for the client's condition. Therefore, the nurse should question the physician's order to ensure the client is receiving an adequate dose. Choices B, C, and D are incorrect because they do not address the discrepancy in dosage and the need to verify the appropriateness of the new order based on the client's weight and current medication regimen.
Regarding ventilation
- A. Normal FEV1 is 70% of FVC
- B. FEV1 is decreased much more than FVC in patients with lung fibrosis
- C. FEV1 is dependent on expiratory effort
- D. FEV1 is about 42% of FVC in a patient with obstructive lung disease
Correct Answer: D
Rationale: The correct answer is D because in obstructive lung diseases like COPD, FEV1 is reduced compared to FVC due to air trapping. This is a characteristic feature of obstruction. A: Incorrect, normal FEV1/FVC ratio is around 80-85%. B: Incorrect, in lung fibrosis, both FEV1 and FVC are reduced but the reduction in FVC is typically more prominent. C: Incorrect, while expiratory effort affects FEV1 maneuver, it is not the sole determinant.