Nokea
Which of the following instructions should the nurse give a client about his active tuberculosis (TB)?
- A. "It's okay to miss a dose every day or two."
- B. "If side effects occur, stop taking the medication."
- C. "Only take the medication until you feel better."
- D. "You must comply with the medication regimen to treat TB."
Correct Answer: D
Rationale: The correct answer is D because adherence to the medication regimen is crucial in treating active TB to prevent drug resistance and ensure successful treatment. Missing doses can lead to treatment failure and the spread of TB. Option A is incorrect because missing doses compromises treatment effectiveness. Option B is incorrect as stopping medication due to side effects can also result in treatment failure. Option C is incorrect because TB treatment must be completed as prescribed, regardless of symptom improvement.
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The 79-year-old patient with bacterial pneumonia becomes increasingly restless, confused,
and agitated. The patient’s temperature is 100° F, and his pulse, blood pressure, and
respirations are elevated since the last assessment 6 hours ago. What action should the nurse
take first?
- A. Auscultate the patient's lungs.
- B. Assess the patient's oxygen saturation.
- C. Administer the mild sedative as ordered.
- D. Administer an ordered analgesic for discomfort.
Correct Answer: B
Rationale: The correct answer is B: Assess the patient's oxygen saturation first. In a patient with bacterial pneumonia showing signs of restlessness, confusion, and agitation along with elevated vital signs, the priority is to assess oxygen saturation to rule out hypoxemia. Hypoxemia can lead to cognitive changes and increased agitation in older adults. Administering a sedative (choice C) or an analgesic (choice D) without addressing the underlying hypoxemia can worsen the patient's condition. Auscultating the lungs (choice A) is important but should come after assessing oxygen saturation to prioritize immediate interventions.
Which of the following signs may be revealed in a client with tonsillar infection by a visual examination if group A streptococci is the cause?
- A. White patches on the tonsils
- B. Hemorrhage in the tonsils
- C. Hypertrophied tonsils
- D. Bleeding in the tonsils
Correct Answer: A
Rationale: The correct answer is A. White patches on the tonsils are characteristic of streptococcal infections, such as strep throat. B (hemorrhage) and D (bleeding) are not typical findings in streptococcal infections. C (hypertrophied tonsils) may occur but is not specific to group A streptococci.
In Carbon monoxide poisoning, Hemoglobin shows about 250 times greater affinity with CO2 than oxygen and Carbonmonoxyheamoglobin (COHb). This causes Oxygen starvation and Asphyxia. The immediate remedy is
- A. Giving pure Oxygen
- B. Dialysis
- C. Giving pure Oxygen Carbon dioxide mixture
- D. Transfusing blood
Correct Answer: C
Rationale: The correct answer is C: Giving pure Oxygen Carbon dioxide mixture. When hemoglobin binds with carbon monoxide (CO) instead of oxygen, it forms carboxyhemoglobin (COHb), which decreases the oxygen-carrying capacity of blood. Administering pure oxygen helps to displace CO from hemoglobin, but giving pure oxygen alone may not be sufficient in severe cases. By providing a mixture of pure oxygen and carbon dioxide, the increased carbon dioxide levels can help stimulate breathing and aid in the elimination of CO from the body more rapidly. This approach can help restore oxygen levels in the blood more effectively compared to just giving pure oxygen. Dialysis and blood transfusion are not immediate remedies for carbon monoxide poisoning and are not as directly targeted at addressing the underlying issue of COHb formation.
A nurse assesses a client after an open lung biopsy. Which assessment finding is matched with the correct intervention?
- A. Client reports being dizzy—nurse calls the Rapid Response Team.
- B. Client's heart rate is 55 beats/min—nurse withholds pain medication.
- C. Client has reduced breath sounds—nurse calls primary health care provider immediately.
- D. Client's respiratory rate is 18 breaths/min—nurse decreases oxygen flow rate.
Correct Answer: C
Rationale: The correct answer is C. Reduced breath sounds after an open lung biopsy could indicate a potential complication such as pneumothorax, requiring immediate attention. Calling the primary health care provider allows for timely assessment and intervention.
Choice A is incorrect because dizziness alone may not warrant calling the Rapid Response Team without further assessment.
Choice B is incorrect as a heart rate of 55 beats/min may not necessarily indicate a need to withhold pain medication without considering other factors.
Choice D is incorrect as a respiratory rate of 18 breaths/min does not necessarily mean the oxygen flow rate should be decreased without further assessment.
Oxygen and carbon dioxide concentration in the alveolar air is respectively
- A. 16 % and 4%
- B. 19.8 % and 4.6 %
- C. 21 % and 4%
- D. 13.1 % and 5 %
Correct Answer: D
Rationale: The correct answer is D (13.1% oxygen and 5% carbon dioxide). In the alveolar air, the oxygen concentration is around 13.1%, which is lower than atmospheric air (21%) due to gas exchange in the lungs. The carbon dioxide concentration in alveolar air is around 5%, higher than atmospheric air (0.04%). Choices A, B, and C have oxygen concentrations higher than what is found in alveolar air, making them incorrect. Choice B also has a carbon dioxide concentration higher than what is typically found in alveolar air, making it incorrect.