Nokea
Which of the following instructions should the nurse include?
- A. Perform chest percussion and postural drainage at least twice daily.
- B. Restrict intake of foods that contain gluten.
- C. Administer pancreatic enzymes on an empty stomach.
- D. Use a nebulizer to administer a bronchodilator fallowing airway clearance therapy.
Correct Answer: A
Rationale: The correct answer is A: Perform chest percussion and postural drainage at least twice daily. Chest percussion and postural drainage are essential airway clearance techniques for patients with cystic fibrosis to help mobilize and clear mucus from the lungs. Performing these techniques at least twice daily helps to prevent mucus buildup, reduce the risk of infections, and improve lung function. Restricting gluten intake (B) is not specific to cystic fibrosis management. Administering pancreatic enzymes on an empty stomach (C) is important for patients with cystic fibrosis to aid in digestion, but it is not directly related to chest physiotherapy. Using a nebulizer after airway clearance therapy (D) may be beneficial, but the primary focus should be on chest physiotherapy as the initial intervention for mucus clearance.
You may also like to solve these questions
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing.
- A. Instruct the client to avoid live vaccines, Instruct the client to use mild soaps for cleansing skin, Instruct the client to avoid foods high in purities, Instruct the client to apply tropical analgesics, Instruct the client to apply heat
- B. Systemic lupus erythematous, Osteoarithritis, Gout, Rheumatoid arthritis(RA)
- C. Uric acid level, ESH, Joint deformities, lymphadenopathy, ANA
Correct Answer:
Rationale: Gout presents with elevated uric acid levels.
Which of the following actions should the nurse take?
- A. Monitor for the development of Koplik spots.
- B. Isolate the client from staff who are pregnant.
- C. Administer aspirin to the client
- D. Initiate airborne precautions
Correct Answer: B
Rationale: Pregnant women should avoid contact with individuals who have rubella due to the risk of congenital defects.
The nurse should first address the client's.... followed by the client's....
- A. lung, sounds
- B. pain level
- C. bowel sounds
- D. blood glucose level
- E. blood pressure
- F. temperature
Correct Answer: E,F
Rationale: The correct answer is E,F. Firstly, addressing the client's blood pressure (E) is crucial as it assesses cardiovascular health and can indicate potential immediate risks. Secondly, addressing the client's temperature (F) is important as it can indicate infection or other health issues. Choices A, B, C, and D are not the priority as they do not directly relate to immediate cardiovascular or infection risks like blood pressure and temperature do.
Which of the following laboratory findings should the nurse expect following the transfusion?
- A. Increased platelets
- B. Increased Hct
- C. Decreased Hgb
- D. Decreased WBC count
Correct Answer: B
Rationale: The correct answer is B: Increased Hct. Following a transfusion, the nurse should expect an increase in hematocrit (Hct) levels due to the addition of packed red blood cells. This will result in an increase in the concentration of red blood cells in the blood, leading to a higher Hct value. The other choices are incorrect as: A) Increased platelets are not typically affected by a red blood cell transfusion, C) Decreased Hgb would not be expected as the purpose of the transfusion is to increase hemoglobin levels, and D) Decreased WBC count is unrelated to a red blood cell transfusion.
A nurse is receiving change-of-shift report for a group of clients. Which of the following clients should the nurse plan to assess first?
- A. A client who has epidural analgesia and weakness in the lower extremities
- B. A client who has a hip fracture and a new onset of tachypnea
- C. A client who has sinus arrhythmia and is receiving cardiac monitoring
- D. A client who has diabetes mellitus and an HbA1c of 6.8%
Correct Answer: B
Rationale: The correct answer is B. The nurse should assess the client with a hip fracture and new onset of tachypnea first. Tachypnea in this client could indicate a potential complication such as a pulmonary embolism, which is a life-threatening condition requiring immediate intervention. Assessing this client first allows for prompt identification and management of any emergent issues. Clients with epidural analgesia and lower extremity weakness (choice A) may indicate a neurological concern but are not as urgent as tachypnea in a client with a hip fracture. Sinus arrhythmia with cardiac monitoring (choice C) and diabetes mellitus with an HbA1c of 6.8% (choice D) do not present immediate life-threatening situations that require immediate assessment compared to the client with a hip fracture and tachypnea.