Nokea
Which medication should the nurse anticipate the health-care provider ordering for the client diagnosed with ARDS?
- A. An aminoglycoside antibiotic.
- B. A synthetic surfactant.
- C. A potassium cation.
- D. A nonsteroidal anti-inflammatory drug.
Correct Answer: B
Rationale: Synthetic surfactant (B) improves lung compliance in ARDS. Antibiotics (A), potassium (C), and NSAIDs (D) are not standard treatments.
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A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order for this medication to have a therapeutic effect on the patient, the aPTT should be?
- A. 0.5-2.5 times the normal value range
- B. 2-3 times the normal value range
- C. 1.5-2.5 times the normal value range
- D. 1-3.5 times the normal value range
Correct Answer: C
Rationale: An aPTT should be 1.5-2.5 times the normal value range for Heparin to achieve a therapeutic effect in a patient to prevent blood clots. If the aPTT is too low, blood clots can form. If the aPTT is too high, bleeding can occur.
A 48-year old homeless man, who is living in a local homeless shelter and is an IV drug user, has arrived to the clinic to have his PPD skin test assessed. What is considered a positive result?
- A. 5 mm induration
- B. 15 mm induration
- C. 9 mm induration
- D. 10 mm induration
Correct Answer: A
Rationale: For high-risk individuals (e.g., homeless, IV drug users), a PPD induration of ≥5 mm is considered positive due to their increased risk of TB exposure and progression.
Because of this client's impaired speech, which nursing action facilitates communication?
- A. Discourage the client's attempts at communication.
- B. Inform the client to speak slowly when talking.
- C. Listen attentively to the client's vocalizations.
- D. Provide the client with paper and pencil.
Correct Answer: D
Rationale: Providing paper and pencil allows the client with impaired speech post-laryngectomy to communicate effectively through writing.
Which time of day is best for the nurse to obtain a sputum specimen from the client?
- A. Before bedtime
- B. After a meal
- C. Between meals
- D. On awakening
Correct Answer: D
Rationale: Sputum is most concentrated and easier to collect on awakening due to accumulation overnight.
The nurse and an unlicensed assistive personnel (UAP) are caring for a group of clients on a medical unit. Which information provided by the UAP warrants immediate intervention by the nurse?
- A. The client diagnosed with cancer of the lung has a small amount of blood in the sputum collection cup.
- B. The client diagnosed with chronic emphysema is sitting on the side of the bed and leaning over the bedside table.
- C. The client receiving Procrit, a biologic response modifier, has a T 99.2°F, P 68, R 24, and BP of 198/102.
- D. The client receiving prednisone, a steroid, is complaining of an upset stomach after eating breakfast.
Correct Answer: C
Rationale: Hypertension (198/102) with Procrit (C) suggests a serious side effect, requiring immediate intervention. Hemoptysis (A), tripod position (B), and stomach upset (D) are expected or less urgent.