Nokea
Which explanation to the client by the nurse regarding the use of antibiotics is best?
- A. Antibiotics are ineffective in treating viral infections.
- B. Antibiotics are ineffective after cold symptoms develop.
- C. Antibiotics only prevent the spread of colds to others.
- D. Antibiotics are used only for immunosuppressed individuals.
Correct Answer: A
Rationale: Head colds are typically caused by viruses, and antibiotics are effective against bacterial infections, not viral ones.
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A patient's D-dimer result is <500 ng/mL (FEU). The nurse knows that the D-dimer assesses and this result means?
- A. fibrin degradation fragment; positive for a blood clot
- B. platelet degradation protein; negative for a blood clot
- C. clotting factors; positive for a blood clot
- D. fibrin degradation fragment; negative for a blood clot
Correct Answer: D
Rationale: A d-dimer test assess fibrin degradation fragment. This test doesn't tell us where the clot may be (so it not specific) so it will need to be further investigated by the MD and a positive result doesn't necessarily mean the patient has a clot because some disease processes can cause a false positive. Also, a normal d-dimer is <500 ng/mL (FEU). However, it depends on how the lab reports the assay cut-off value for the d-dimer. Some labs have a cutoff <250 ng/mL (D-DU). However, <500 ng/mL (FEU) is equivalent to <250 ng/mL (D-DU).
The nurse is caring for a client on a ventilator and the alarm goes off. Which action should the nurse implement first?
- A. Notify the respiratory therapist immediately.
- B. Check the ventilator to determine the cause.
- C. Elevate the head of the client's bed.
- D. Assess the client's oxygen saturation.
Correct Answer: B
Rationale: Checking the ventilator (B) is the first action to identify the alarm’s cause (e.g., disconnection, obstruction), per the ABCs. Notifying the therapist (A) delays intervention. Elevating the bed (C) is irrelevant. Assessing oxygen saturation (D) is secondary to addressing the ventilator issue.
Which question is essential for the nurse to ask before administering the influenza vaccine?
- A. Have you had influenza in the last year?
- B. Did you receive pneumonia vaccine last year?
- C. Are you allergic to eggs or egg products?
- D. Do you have a history of respiratory disease?
Correct Answer: C
Rationale: Influenza vaccines are often produced using eggs, so an egg allergy must be assessed to prevent allergic reactions.
The nurse is applying oxygen via nasal cannula to a client diagnosed with chronic obstructive pulmonary disease (COPD). The client complains of extreme shortness of breath. At which rate should the nurse set the flowmeter?
- A. 2 LPM.
- B. 4 LPM.
- C. 6 LPM.
- D. 10 LPM.
Correct Answer: A
Rationale: COPD clients require low-flow oxygen (2 LPM, A) to avoid CO2 retention. Higher rates (B, C, D) risk respiratory drive suppression.
Which nursing explanation identifies the primary rationale for administering aminophylline?
- A. Aminophylline relieves persistent coughing.
- B. Aminophylline reduces mucosal edema.
- C. Aminophylline dilates the bronchial airways.
- D. Aminophylline thins respiratory secretions.
Correct Answer: C
Rationale: Aminophylline is a bronchodilator that dilates bronchial airways, improving airflow in COPD clients.