Nokea
Which assessment information will you need to communicate to the physician?
- A. The client says she has not been to the lab to have an aPTT done.
- B. The right calf is warm to touch and is larger than the left calf.
- C. The client is unable to remember her husband's name.
- D. There are multiple ecchymotic areas on the client's arms.
Correct Answer: B
Rationale: The correct answer is B. Swelling and warmth in the right calf suggest worsening DVT, warranting immediate physician notification. Missing lab tests (A), cognitive issues (C), and bruising (D) are less urgent.
You may also like to solve these questions
When the nurse reads the diagnosis of centrilobar emphysema, the nurse recognizes that this type of emphysema is characterized by:
- A. No significant smoking history in the patient.
- B. Enlarged and broken down bronchioles, with intact alveoli.
- C. Hypoelastic bronchi and bronchioles.
- D. Deficiency of the enzyme inhibitor alpha "“ antitrypsin.
Correct Answer: B
Rationale: The correct answer is B because centrilobar emphysema is characterized by enlarged and broken down bronchioles with intact alveoli. This type of emphysema primarily affects the respiratory bronchioles and alveolar ducts in the upper lung lobes. The other choices are incorrect because: A) Significant smoking history is usually present in patients with centrilobar emphysema. C) Hypoelastic bronchi and bronchioles are not characteristic of centrilobar emphysema. D) Deficiency of the enzyme inhibitor alpha-1 antitrypsin is associated with a different type of emphysema called panlobar emphysema, not centrilobar emphysema.
Which one is a Non-reversible pulmonary disease in which the bronchi are blocked with mucous and infection and rupture of alveoli
- A. Silicosis
- B. Asphyxia
- C. Emphysema
- D. Embolism
Correct Answer: C
Rationale: Emphysema is the correct answer because it is a non-reversible pulmonary disease characterized by the destruction of lung tissue, leading to the blockage of bronchioles and rupture of alveoli. This results in difficulty breathing and reduced oxygen exchange. Silicosis (A) is caused by inhaling silica dust, not related to bronchial blockage. Asphyxia (B) is a condition of suffocation, not related to pulmonary disease. Embolism (D) is the blockage of a blood vessel by a clot, not specific to the bronchi or alveoli.
An oxygen delivery system is prescribed for a male client with chronic obstructive pulmonary disease to deliver a precise oxygen concentration. Which of the following types of oxygen delivery systems would the nurse anticipate to be prescribed?
- A. Face tent
- B. Venturi mask
- C. Aerosol mask
- D. Tracheostomy collar
Correct Answer: B
Rationale: The correct answer is B: Venturi mask. This type of oxygen delivery system allows for precise oxygen concentration delivery by adjusting the oxygen flow rate and selecting the appropriate color-coded adaptor. Venturi masks are commonly used in clients with COPD to ensure accurate oxygen delivery and prevent oxygen toxicity.
A: Face tent provides high humidity but does not allow for precise oxygen concentration delivery.
C: Aerosol mask is used for humidification and medication delivery, not for precise oxygen concentration.
D: Tracheostomy collar is used for clients with a tracheostomy, not for precise oxygen concentration in COPD.
The lungs move easily within their protective sacs due to
- A. intrapleural fluid.
- B. leaking plasma.
- C. blood.
- D. mucus.
Correct Answer: A
Rationale: The correct answer is A: intrapleural fluid. Intrapleural fluid reduces friction between the lungs and the chest wall, allowing them to move easily during breathing. This fluid creates a lubricated surface that facilitates smooth movement. Leaking plasma (B) and mucus (D) do not provide the necessary lubrication for lung movement. Blood (C) plays a role in oxygen exchange but does not directly contribute to the ease of lung movement within the pleural sacs.
Which of the following are not present prior to birth?
- A. Pulmonary arterial resistance is high
- B. Pulmonary vessels are collapsed
- C. Rib cage is compressed
- D. Alveoli are expanded
Correct Answer: D
Rationale: The correct answer is D: Alveoli are expanded. Prior to birth, the alveoli in the lungs are collapsed, and they begin to expand and develop after birth when the baby starts breathing air. A: Pulmonary arterial resistance is high due to blood flow bypassing the lungs. B: Pulmonary vessels are collapsed to prevent blood flow in the fetal lungs. C: The rib cage is compressed in the womb due to the limited space, but it expands after birth to allow for lung expansion.