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Adult Health Final Exam/139 Questions and Answers
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Adult Health Final Exam/139Questions and Answers
The nurse suspects that a client is at risk for tuberculosis. Which risk factor
should the nurse assess in this client? (Select all that apply.)
A) Sharing clothes with an infected individual
B) Living in a poorly ventilated environment
C) Using injection drugs
D) Being an immigrant to the United States
E) Having a compromised immune system - -B, C, D, E
Other risk factors think "TB RISK":
T → tight living quarters
B → below poverty line
R → refugee
I → immunocompromised
S → substance abuse
K → kids < 5y/o
- The nurse instructs a client with tuberculosis on the medication rifampin.
Which client statement indicates teaching has been effective? (Select all that
apply.)
A) "I should take rifampin on an empty stomach."
B) "I need to monitor my vision daily by reading a newspaper."
C) "I should not take aspirin while I am taking rifampin."
D) "I should not be frightened if my urine changes to an orange-red color; it
is a normal side effect."
E) "I need to take pyridoxine (vitamin B6) along with the rifampin." - -A, C, D
Answer B is important education for pt's on ethambutol
Answer E is pertinent for izoniazid (INH) to avoid peripheral neuropathy
- During an assessment of a 45-year-old patient with asthma, the nurse
notes wheezing and dyspnea. The nurse interprets that these symptoms are
related to what pathophysiologic change?
A) laryngospasm
B) pulmonary edema
C) narrowing of the airway
D) over distention of the alveoli - -C. Narrowing of the airwayNarrowing of
the airway by persistent but variable inflammation leads to reduced airflow,
making it difficult for the patient to breathe and producing the characteristic
wheezing. Laryngospasm, pulmonary edema, and overdistention of the
alveoli do not produce wheezing.
- The patient has an order for each of the following inhalers. Which one
should the nurse offer to the patient at the onset of an asthma attack?
,A) Albuterol
B) Salterm-11meterol
C) Beclomethasone
D) Ipratropium bromide - -A. Albuterol
Albuterol is a short-acting bronchodilator that should be given initially when
the patient experiences an asthma attack. Salmeterol (Serevent) is a long-
acting β2-adrenergic agonist, which is not used for acute asthma attacks.
Beclomethasone (Qvar) is a corticosteroid inhaler and not recommended for
an acute asthma attack. Ipratropium bromide (Atrovent) is an anticholinergic
agent that is less effective than β2-adrenergic agonists. It may be used in an
emergency with a patient unable to tolerate short-acting β2-adrenergic
agonists (SABAs).
- When providing discharge teaching to a patient who is newly diagnosed
with asthma, which of these points should the healthcare provider
emphasize?
A) " eliminate or reduce exposure to known asthma triggers"
B) " measure and record your peak flow meter readings every month"
C) take a NSAID agent daily as part of your treatment "
D) " when you feel an attack is imminent, use your inhaled corticosteroid" - -
A) " eliminate or reduce exposure to known asthma triggers"
- The nurse teaches pursed lip breathing to a patient who is newly
diagnosed with chronic obstructive pulmonary disease (COPD). The nurse
reinforces that this technique will assist respiration by which mechanism?
A) Loosening secretions so that they may be coughed up more easily
B) Promoting maximal inhalation for better oxygenation of the lungs
C) Preventing bronchial collapse and air trapping in the lungs during
exhalation
D) Increasing the respiratory rate and giving the patient control of
respiratory patterns - -C. Preventing bronchial collapse and air trapping in
the lungs during exhalation.
The purpose of pursed lip breathing is to slow down the exhalation phase of
respiration, which decreases bronchial collapse and subsequent air trapping
in the lungs during exhalation. It does not affect secretions, inhalation, or
increase the rate of breathing.
- 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 6 LPM via nasal cannula.
C) Monitor vital signs with the client sitting upright.
D) Notify the HCP about pt's status. - -A. Assist the client into a sitting
position at 90 degrees.
The client should be assisted into a sitting position either on the side of the
bed or in the bed. This position decreases the work of breathing. Some
,clients find it easier to sitting on the side of the bed leaning over the bed
table. The nurse needs to maintain client's safety.
- The nurse is assessing the client diagnosed with COPD. Which data
requires immediate intervention by the nurse?
A) Large amounts of thick white sputum.
B) Oxygen flowmeter set at 8lpm.
C) Use of accessory muscles during inspiration.
D) Presence of a barrel chest and dyspnea. - -B. Oxygen flowmeter set at
8lpm.
The nurse should decrease the oxygen rate to 2-3lpm. Hypoxemia is the
stimulus for breathing in the client with COPD. If the hypoxemia improves
and the oxygen level increases, the drive to breathe may be eliminated.
- A patient has just been diagnosed with hypertension and has a new
prescription for captopril (Capoten). Which information is important to
include when teaching the patient?
A) Check BP daily before taking the medication.
B) Increase fluid intake if dryness of the mouth is a problem.
C) Include high-potassium foods such as bananas in the diet.
D) Change position slowly to help prevent dizziness and falls. - -D) Change
position slowly to help prevent dizziness and falls.
The angiotensin-converting enzyme (ACE) inhibitors frequently cause
orthostatic hypotension, and patients should be taught to change position
slowly to allow the vascular system time to compensate for the position
change. Increasing fluid intake may counteract the effect of the medication,
and the patient is taught to use gum or hard candy to relieve dry mouth. The
BP does not need to be checked at home by the patient before taking the
medication. Because ACE inhibitors cause potassium retention, increased
intake of high-potassium foods is inappropriate.
- A client with newly diagnosed hypertension asks what she can do to
decrease the risk for related cardiovascular problems. Which of the following
risk factors is modifiable by the client?
A) Impaired renal function
B) Dyslipidemia
C) Age
D) Family history - -B) Dyslipidemia
Age, family history, and impaired renal function are risk factors for
cardiovascular disease related to hypertension that the client cannot change.
Obesity, inactivity, and dyslipidemia are risk factors that the client can
improve through diet, exercise, and other healthy lifestyle changes.
- A patient is being treated for hypertensive emergency. When treating this
patient, the priority goal is to lower the mean blood pressure (BP) by which
percentage in the first hour?
, A) 45%
B) 35%
C) 40%
D) Up to 25% - -D) Up to 25%
The therapeutic goals are reduction of the mean BP by up to 25% within the
first hour of treatment, a further reduction to a goal pressure of about
160/100 mm Hg over a period of 2 to 6 hours, and then a more gradual
reduction in pressure to the target goal over a period of days.
- Which action will be included in the plan of care when the nurse is caring
for a patient who is receiving sodium nitroprusside (Nipride) to treat a
hypertensive emergency?
A) Organize nursing activities so that the patient has undisturbed sleep for 6
to 8 hours at night.
B) Assist the patient up in the chair for meals to avoid complications
associated with immobility.
C) Use an automated noninvasive blood pressure machine to obtain frequent
BP measurements.
D) Place the patient on NPO status to prevent aspiration caused by nausea
and the associated vomiting. - -ANS: C
Frequent monitoring of BP is needed when the patient is receiving rapid-
acting IV antihypertensive medications. This can be most easily
accomplished with an automated BP machine or arterial line. The patient will
require frequent assessments, so allowing 6 to 8 hours of undisturbed sleep
is not appropriate. When patients are receiving IV vasodilators, bed rest is
maintained to prevent decreased cerebral perfusion and fainting. There is no
indication that this patient is nauseated or at risk for aspiration, so an NPO
status is unnecessary.
- During change-of-shift report, the nurse obtains this information about a
hypertensive patient who received the first dose of propranolol (Inderal)
during the previous shift. Which information indicates that the patient needs
immediate intervention?
A) The patient's most recent BP reading is 156/94 mm Hg.
B) The patient's pulse has dropped from 64 to 58 beats/minute.
C) The patient has developed wheezes throughout the lung fields.
D) The patient complains that the fingers and toes feel quite cold. - -ANS: C
The most urgent concern for this patient is the wheezes, which indicate that
bronchospasm (a common adverse effect of the noncardioselective β-
blockers) is occurring. The nurse should immediately obtain an oxygen
saturation measurement, apply supplemental oxygen, and notify the health
care provider. The mild decrease in heart rate and complaint of cold fingers
and toes are associated with β-receptor blockade but do not require any
change in therapy. The BP reading may indicate that a change in medication
type or dose may be indicated; however, this is not as urgently needed as
addressing the bronchospasm.
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