With Complete Solutions
****What intervention does the nurse identify as
the priority for the client with a nursing diagnosis
of ineffective airway clearance related to the flu?
A. Provide supplemental oxygen.
B. Keep the head of the bed flat.
C. Teach the client coughing, deep breathing, and
hydration.
D. Prepare the client for the possibility of a
tracheostomy tube. Correct Answers C
****What is one advantage of an electronic client
chart?
A. No other charting method is necessary.
B. Access is open to anyone.
C. Retrieval of information is more efficient.
D. It is less costly to maintain. Correct Answers C
***A 72-year-old client hospitalized with a second
recent episode of pneumonia expressed frustration
to the nurse, stating "In the past I never used to
get sick." Which response by the nurse is most
appropriate?
A. "As you grow older, there is a decrease in the
speed and strength of the immune system, which
puts you at greater risk for developing an
infection."
,B. "As you grow older, your immune system just
quits working."
C. "As you grow older, there is an increase in the
number of B cells in the circulation, which hinders
the immune response ."
D. "As you grow older, there is an overall increase
in the speed and strength of your immune
response." Correct Answers A
***A physician suggests that the nurse use the
computer terminal that is available at the point of
care or at the client's bedside. What is the
probable reason for the physician's suggestion?
A. It keeps the nurse close to the source of the
data.
B. It solves the space constraint in the hospital.
C. There are limited computer modules available.
D. The client needs to check the entry as well.
Correct Answers A
***The nurse is caring for a client who develops
pneumonia after having surgery. The nurse
anticipates that the physician will write which
orders?
A. Respiratory and contact isolation.
B. Sputum cultures and antibiotics.
C. Reverse isolation for the client.
D. Bronchial washing for culture. Correct Answers
B
, ***The nurse is caring for an elderly client with
influenza. Which lab/diagnostic result does the
nurse determine is consistent with influenza?
A. Increased red blood cell count.
B. Clear chest x-ray .
C. Increased BUN.
Decreased sodium level Correct Answers B
***The nurse is preparing to admit a client who has
been diagnosed with influenza in the emergency
department. The nurse prepares for this client best
by performing which action?
A. Placing a ventilator in the room.
B. Notifying other departments of the diagnosis.
C. Placing droplet precaution signs outside the
client room.
D. Placing the client in a negative airflow room.
Correct Answers C
***The nurse provides discharge instructions for a
client diagnosed with pneumonia. Which statement
made by the client would suggest that further
instruction is needed?
A. "I will get the pneumococcal vaccine every fall."
B. "I will get the pneumococcal vaccine as soon as I
recover from this pneumonia."
C. "I will get the influenza vaccine every year."
D. "I may not be able to get the influenza vaccine
due to my allergy to eggs." Correct Answers A