EXAM: ATI learning system Respiratory Exam with
Complete Solutions
A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of
the following findings indicates that the nurse should suction the client's airway secretion?
A. The client is unable to speak
B....
EXAM: ATI learning system Respiratory Exam with
Complete Solutions
A nurse is caring for a client who has a tracheostomy with an inflated cuff in place. Which of
the following findings indicates that the nurse should suction the client's airway secretion?
A. The client is unable to speak
B. The client's airway secretions were last suctioned 2 hr ago
C. The client coughs and expectorates a large mucous plug
D. The nurse auscultate coarse crackles in the lung fields Correct Answer-D. The nurse
auscultates coarse crackles in the lung fields
should auscultate coarse crackles or rhonchi, identify a moist cough, hear or see secretions in
the tracheostomy tube and then suction the client's airway secretions
- who has tracheostomy with inflated cuff in place is unable to speak
- should assess the need for suctioning every 2 hr and then suction as necessary
- should assess the client's airway after coughing and only suction client's secretions if client is
not able to cough and expectorate secretions
, EXAM: ATI learning system Respiratory Exam with
Complete Solutions
A nurse in a clinic is providing teaching for a client who is to have a tuberculin skin test. Which
of the following information should the nurse include?
A. If the test is positive, it means you have an active case of TB
B. If the test is positive, you should have another tuberculin test in 3 weeks
C. You must return to the clinic to have the test read in 2 or 3 days
D. A nurse will use a small lancet to scratch the skin of your forearm before applying the
tuberculin substance Correct Answer-C. You must return to the clinic to have the test read
2 or 3 days
should have skin test read in 2-3 ays. Area of induration after 48-72 hr indicates exposure to
the tubercle bacillus. If the client does not return to have test read within 72 hr, another
tuberculin test is necessary
- positive test means client has exposed TB but doesn't mean that the client has an active case
of TB, should have chest x-ray to rule out active TB
- Who have positive skin test should have x-ray to rule out active TB. -subsequent test will be
always positive
, EXAM: ATI learning system Respiratory Exam with
Complete Solutions
- will inject 0.1mL of purified protein derivates intradermally to dorsal aspect of the forearm
A nurse is providing discharge teaching to a client who is postoperative following a
rhinoplasty. Which of the following instructions should the nurse include?
A. Apply warm compress to the face
B. Take aspirin 650 mg by mouth for mild pain
C. Close your mouth when sneezing
D. Lie on your back with your head elevated 30 degree when resting Correct Answer-D. Lie
on your back with your head elevated 30 degree when resting
the nurse should instruct client to rest in semi-Fowler position to prevent aspiration of nasal
secretions
- should apply cold compresses to his face to decrease swelling
- should avoid taking aspirin, because it increases the risk of bleeding by decreasing platelet
aggregation
- should open her mouth when sneezing to reduce straining on the incisional site
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