Nokea
You're teaching a group of long-term care health givers about the signs and symptoms of tuberculosis. What signs and symptoms will you include in your education?
- A. Cough for a minimum of 6 weeks
- B. Night sweats
- C. Weight gain
- D. Hemoptysis
- E. Chills
- F. Fever
- G. Chest pain
Correct Answer: B,D,E,F,G
Rationale: Option A is wrong because a cough should be present for 3 weeks or more (NOT 6 weeks). Option C is wrong because the patient will experience weight LOSS (not gain).
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Which clinical manifestation should the nurse expect to assess in the client recently diagnosed with COPD?
- A. Clubbing of the client's fingers.
- B. Infrequent respiratory infections.
- C. Chronic sputum production.
- D. Nonproductive hacking cough.
Correct Answer: C
Rationale: Chronic sputum production (C) is a hallmark of COPD (chronic bronchitis). Clubbing (A) is late-stage, infections (B) are frequent, and nonproductive cough (D) is atypical.
The client is three (3) days post-partial laryngectomy. Which type of nutrition should the nurse offer the client?
- A. Total parenteral nutrition.
- B. Soft, regular diet.
- C. Partial parenteral nutrition.
- D. Clear liquid diet.
Correct Answer: D
Rationale: Clear liquids (D) are safest 3 days post-laryngectomy to prevent aspiration. TPN (A), soft diet (B), and partial PN (C) are premature or unnecessary.
When caring for a client with allergies, which nursing assessment finding is an early indication that the client is developing anaphylaxis?
- A. Breathing difficulty
- B. Headache
- C. Sore throat
- D. Cool, pale skin
Correct Answer: A
Rationale: Breathing difficulty is an early sign of anaphylaxis, indicating airway constriction or swelling, which requires immediate intervention.
The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein thrombosis is present?
- A. Cool extremity
- B. Decreases pulses
- C. Redness
- D. Pain
- E. Warm extremity
- F. Swelling
- G. Cyanosis
Correct Answer: C,D,E,F
Rationale: Signs and symptoms of a DVT include: redness, swelling, warm extremity, pain, positive Homan's Sign, and swelling (which can be unilateral...meaning there is more swelling in one extremity compared to the other).
The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first?
- A. Assist the client into a sitting position at 90 degrees.
- B. Administer oxygen at six (6) LPM via nasal cannula.
- C. Monitor vital signs with the client sitting upright.
- D. Notify the health-care provider about the client's status.
Correct Answer: A
Rationale: Sitting upright (A) improves lung expansion in COPD distress, a priority. Oxygen (B), vitals (C), and notification (D) follow to support oxygenation and communication.