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Course
Nur 180
Institution
Nur 180
A nurse is monitoring a group of clients for increased risk for developing pneumonia. Which of the following clients should the nurse expect to be at risk? (Select all that apply)
a. Client who has dysphagia
b. Client who has AIDS
c. Client who was vaccinated for pneumococcus and influenza 6 m...
NUR 180 Exam 2 TEST
QUESTIONS AND ANSWERS
2024-2025(GUARANTEED
SUCCESS)
A nurse is monitoring a group of clients for increased risk for
developing pneumonia. Which of the following clients should the
nurse expect to be at risk? (Select all that apply)
a. Client who has dysphagia
b. Client who has AIDS
c. Client who was vaccinated for pneumococcus and influenza 6
months ago
d. Client who is postoperative and has received local anesthesia
e. Client who has a closed head injury receiving ventilation
f. Client who has myasthenia gravis - answer A. Client who has
dysphagia is at risk of aspiration pneumonia
b. The client with AIDS is at risk of pneumonia because they have a
weakened immune system
d. The client who is postoperative is at risk of aspiration pneumonia
if they drink fluid
e. This person is at risk of pneumonia because it's invasive and
increases the risk of pneumonia
f. Myasthenia gravis weakens the skeletal muscles and can make if
difficult to clear airway secretions, which increases the risk of
pneumonia.
, A nurse in a clinic is caring for a client whose partner states the
client woke up this morning, did not recognize him, and did not
know where she was. The client reports chills and chest pain that is
worse upon inspiration. Which of the following actions is the nursing
priority?
a. Obtain baseline vital signs and oxygen saturation
b. Obtain a sputum culture
c. Obtain a complete history from the client
d. Provide a pneumococcal vaccine - answer a. obtain baseline vital
signs and oxygen saturation - the first action the nurse should take
using the nursing process is to assess the client, which is essential
in planning client-centered care
A nurse is caring for a client who has pneumonia. Assessment
findings include temperature 37.8 C (100F), respirations 30/min,
blood pressure 130/76, heart rate 100/min, and SaO2 91 on room air.
Prioritize the following nursing interventions.
a. Administer antibiotics
b. Administer oxygen therapy
c. Perform a sputum culture
d. Administer an antipyretic medication to promote client comfort. -
answer b. Administer oxygen therapy - using ABC framework,
providing oxygen is the first intervention
c. Perform a sputum culture - this is the second nursing intervention
because it should be done prior to administering oral medications to
obtain an appropriate specimen.
a. administer antibiotics
d. administer an antipyretic medication
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