PNR 309 Midterm EXAM PREP
QUESTIONS AND ANSWERS (2025)
GUARANTEED PASS.
The nurse is preparing to interview an older-adult client. Which of the following actions is most
appropriate?
a)Ensure all assistive devices are in place.
b)Interview the client and caregiver together.
c)Perform the interview before administering analgesics.
d)Move on to the next question if the client does not respond quickly. - Answer a)Ensure all
assistive devices are in place.
All assistive devices, such as glasses and hearing aids, should be in place when interviewing an
older-adult client. It is best to interview the client and caregiver separately to ensure a reliable
assessment related to elder mistreatment. The client should be free from pain during the
assessment and may need extra time to respond to questions.
A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD).
At what point should the nurse begin to include the client's wife in the teaching around the
management of the disease?
a)As soon as possible
b)When the client requests assistance from his spouse and family
c)When the client becomes unable to manage his symptoms independently
d)After the client has had the opportunity to adjust to his treatment regimen - Answer a)As
soon as possible
In the management of chronic illness, it is desirable to include family caregivers in client
education and symptom-management efforts as early in the diagnosis as possible.
A nurse who is providing care for an 81-year-old female client recognizes the need to maximize
the client's mobility during her recovery from surgery. Which of the following statements
provides the best rationale for the nurse's actions?
a)Lack of stimulation contributes to the development of cognitive deficits in older adults.
b)Pharmacokinetics are improved by client mobility.
,Older adults are highly susceptible to deconditioning, a process that can be slowed or prevented
by regular physical activity. This consideration supersedes any possible effect on
pharmacokinetics, prevention of cognitive deficits, or the client's sense of purpose.
The nurse is assessing an elderly client who has arrived to the emergency department via
ambulance from home where she lives with her adult daughter. The client has a large pressure
ulcer on the sacrum, three large bruises on the upper back, appears depressed and withdrawn.
Which of the following would the nurse suscept related to this client?
a)Elder mistreatment
b)Social isolation
c)A stroke
d)Hypoglycemia - Answer a)Elder mistreatment
There are several types of elder mistreatment. In this scenario, the nurse would suspect elder
mistreatment related to physical neglect (pressure ulcers), physical abuse (bruises), or
psychological or emotional abuse (withdrawn and depressed).
Which of the following are symptoms of an overwhelmed caregiver? (Select all that apply.)
a)Powerlessness
b)Depression
c)Resentment
d)Inadequacy
e)Fatigue - Answer ALL ANSWERS ARE CORRECT
Caregivers may develop a sense of being overwhelmed and have feelings of inadequacy,
powerlessness, and depression. The stress of caregiving may result in emotional problems such
as depression, anger, and resentment. The burden of caregiving may lead to social isolation,
which can be characterized by increased time commitments and fatigue.
The nurse is caring for a client admitted to the hospital with pneumonia. Upon assessment, the
nurse notes a temperature of 38.6°C (101.5°F), a productive cough with yellow sputum, and a
respiratory rate of 20 breaths/minute. Which of the following nursing diagnoses is most
appropriate based upon this assessment?
a)Hyperthermia related to infectious illness
b)Ineffective thermoregulation related to chilling
,Because the client has spiked a temperature and has a diagnosis of pneumonia, the logical
nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill,
and the client's breathing pattern is within normal limits at 20 breaths/minute. There is no
evidence of ineffective airway clearance from the information given because the client is
expectorating sputum.
Which of the following physical assessment findings in a client with a lower respiratory problem
best supports the nursing diagnosis of ineffective airway clearance?
a)Basilar crackles
b)Respiratory rate of 28
c)Oxygen saturation of 85%
d)Presence of greenish sputum - Answer a)Basilar crackles
The presence of adventitious breath sounds indicates that there is accumulation of secretions in
the lower airways. This would be consistent with a nursing diagnosis of ineffective airway
clearance because the client is retaining secretions.
Which of the following clinical manifestations should the nurse expect to find during assessment
of a client admitted with pneumococcal pneumonia?
a)Hyper-resonance on percussion
b)Vesicular breath sounds in all lobes
c)Increased tactile fremitus on palpation
d)Fine crackles in all lobes on auscultation - Answer c)Increased tactile fremitus on palpation
A typical physical examination finding for a client with pneumonia is increased tactile fremitus
on palpation. Other signs of pulmonary consolidation include dullness to percussion, bronchial
breath sounds, and crackles in the affected area.
Which of the following is the priority nursing intervention in helping a client expectorate thick
lung secretions?
a)Humidify the oxygen as able
b)Administer cough suppressant q4hr
c)Teach client to splint the affected area
d)Increase fluid intake to 3 L/day if tolerated - Answer d)Increase fluid intake to 3 L/day if
tolerated
, intervention. Teaching the client to splint the affected area may also be helpful, but does not
liquefy the secretions so that they can be removed.
The nurse is providing discharge teaching to an older-adult client with COPD and pneumonia.
Which of the following vaccines should the nurse recommend that this client receive?
a)Staphylococcus aureus
b)Haemophilus influenzae
c)Pneumococcal
d)Bacille Calmette-Guérin (BCG) - Answer c)Pneumococcal
The pneumococcal vaccine is important for clients with a history of heart or lung disease,
recovering from a severe illness, age 65 or over, or living in a long-term care facility.
The nurse is providing discharge teaching to a client that was hospitalized with pneumonia.
Which of the following client statements about measures to prevent a relapse indicates that the
teaching has been effective?
a)"I will seek immediate medical treatment for any upper respiratory infections."
b)"I will increase my food intake to 2 400 calories a day to keep my immune system well."
c)"I should continue to do deep-breathing and coughing exercises for at least 6 weeks."
d)"I must use home oxygen therapy for three months and then will have a chest x-ray to re-
evaluate." - Answer c)"I should continue to do deep-breathing and coughing exercises for at
least 6 weeks."
It is important for the client to continue with coughing and deep-breathing exercises for 6-8
weeks until all of the infection has cleared from the lungs. A client should seek medical
treatment for upper respiratory infections that persist for more than 7 days. Increased fluid
intake, not caloric intake, is required to liquefy secretions. Home O2 is not a requirement unless
the client's oxygenation saturation is below normal.
The nurse is admitting a client to the medical unit with a diagnosis of pneumonia. Which of the
following prescriptions should the nurse verify has been completed before administering a dose
of trimethoprim-sulfamethoxazole to the client?
a)Orthostatic blood pressures
b)Sputum culture and sensitivity
c)Pulmonary function evaluation
QUESTIONS AND ANSWERS (2025)
GUARANTEED PASS.
The nurse is preparing to interview an older-adult client. Which of the following actions is most
appropriate?
a)Ensure all assistive devices are in place.
b)Interview the client and caregiver together.
c)Perform the interview before administering analgesics.
d)Move on to the next question if the client does not respond quickly. - Answer a)Ensure all
assistive devices are in place.
All assistive devices, such as glasses and hearing aids, should be in place when interviewing an
older-adult client. It is best to interview the client and caregiver separately to ensure a reliable
assessment related to elder mistreatment. The client should be free from pain during the
assessment and may need extra time to respond to questions.
A 70-year-old man has just been diagnosed with chronic obstructive pulmonary disease (COPD).
At what point should the nurse begin to include the client's wife in the teaching around the
management of the disease?
a)As soon as possible
b)When the client requests assistance from his spouse and family
c)When the client becomes unable to manage his symptoms independently
d)After the client has had the opportunity to adjust to his treatment regimen - Answer a)As
soon as possible
In the management of chronic illness, it is desirable to include family caregivers in client
education and symptom-management efforts as early in the diagnosis as possible.
A nurse who is providing care for an 81-year-old female client recognizes the need to maximize
the client's mobility during her recovery from surgery. Which of the following statements
provides the best rationale for the nurse's actions?
a)Lack of stimulation contributes to the development of cognitive deficits in older adults.
b)Pharmacokinetics are improved by client mobility.
,Older adults are highly susceptible to deconditioning, a process that can be slowed or prevented
by regular physical activity. This consideration supersedes any possible effect on
pharmacokinetics, prevention of cognitive deficits, or the client's sense of purpose.
The nurse is assessing an elderly client who has arrived to the emergency department via
ambulance from home where she lives with her adult daughter. The client has a large pressure
ulcer on the sacrum, three large bruises on the upper back, appears depressed and withdrawn.
Which of the following would the nurse suscept related to this client?
a)Elder mistreatment
b)Social isolation
c)A stroke
d)Hypoglycemia - Answer a)Elder mistreatment
There are several types of elder mistreatment. In this scenario, the nurse would suspect elder
mistreatment related to physical neglect (pressure ulcers), physical abuse (bruises), or
psychological or emotional abuse (withdrawn and depressed).
Which of the following are symptoms of an overwhelmed caregiver? (Select all that apply.)
a)Powerlessness
b)Depression
c)Resentment
d)Inadequacy
e)Fatigue - Answer ALL ANSWERS ARE CORRECT
Caregivers may develop a sense of being overwhelmed and have feelings of inadequacy,
powerlessness, and depression. The stress of caregiving may result in emotional problems such
as depression, anger, and resentment. The burden of caregiving may lead to social isolation,
which can be characterized by increased time commitments and fatigue.
The nurse is caring for a client admitted to the hospital with pneumonia. Upon assessment, the
nurse notes a temperature of 38.6°C (101.5°F), a productive cough with yellow sputum, and a
respiratory rate of 20 breaths/minute. Which of the following nursing diagnoses is most
appropriate based upon this assessment?
a)Hyperthermia related to infectious illness
b)Ineffective thermoregulation related to chilling
,Because the client has spiked a temperature and has a diagnosis of pneumonia, the logical
nursing diagnosis is hyperthermia related to infectious illness. There is no evidence of a chill,
and the client's breathing pattern is within normal limits at 20 breaths/minute. There is no
evidence of ineffective airway clearance from the information given because the client is
expectorating sputum.
Which of the following physical assessment findings in a client with a lower respiratory problem
best supports the nursing diagnosis of ineffective airway clearance?
a)Basilar crackles
b)Respiratory rate of 28
c)Oxygen saturation of 85%
d)Presence of greenish sputum - Answer a)Basilar crackles
The presence of adventitious breath sounds indicates that there is accumulation of secretions in
the lower airways. This would be consistent with a nursing diagnosis of ineffective airway
clearance because the client is retaining secretions.
Which of the following clinical manifestations should the nurse expect to find during assessment
of a client admitted with pneumococcal pneumonia?
a)Hyper-resonance on percussion
b)Vesicular breath sounds in all lobes
c)Increased tactile fremitus on palpation
d)Fine crackles in all lobes on auscultation - Answer c)Increased tactile fremitus on palpation
A typical physical examination finding for a client with pneumonia is increased tactile fremitus
on palpation. Other signs of pulmonary consolidation include dullness to percussion, bronchial
breath sounds, and crackles in the affected area.
Which of the following is the priority nursing intervention in helping a client expectorate thick
lung secretions?
a)Humidify the oxygen as able
b)Administer cough suppressant q4hr
c)Teach client to splint the affected area
d)Increase fluid intake to 3 L/day if tolerated - Answer d)Increase fluid intake to 3 L/day if
tolerated
, intervention. Teaching the client to splint the affected area may also be helpful, but does not
liquefy the secretions so that they can be removed.
The nurse is providing discharge teaching to an older-adult client with COPD and pneumonia.
Which of the following vaccines should the nurse recommend that this client receive?
a)Staphylococcus aureus
b)Haemophilus influenzae
c)Pneumococcal
d)Bacille Calmette-Guérin (BCG) - Answer c)Pneumococcal
The pneumococcal vaccine is important for clients with a history of heart or lung disease,
recovering from a severe illness, age 65 or over, or living in a long-term care facility.
The nurse is providing discharge teaching to a client that was hospitalized with pneumonia.
Which of the following client statements about measures to prevent a relapse indicates that the
teaching has been effective?
a)"I will seek immediate medical treatment for any upper respiratory infections."
b)"I will increase my food intake to 2 400 calories a day to keep my immune system well."
c)"I should continue to do deep-breathing and coughing exercises for at least 6 weeks."
d)"I must use home oxygen therapy for three months and then will have a chest x-ray to re-
evaluate." - Answer c)"I should continue to do deep-breathing and coughing exercises for at
least 6 weeks."
It is important for the client to continue with coughing and deep-breathing exercises for 6-8
weeks until all of the infection has cleared from the lungs. A client should seek medical
treatment for upper respiratory infections that persist for more than 7 days. Increased fluid
intake, not caloric intake, is required to liquefy secretions. Home O2 is not a requirement unless
the client's oxygenation saturation is below normal.
The nurse is admitting a client to the medical unit with a diagnosis of pneumonia. Which of the
following prescriptions should the nurse verify has been completed before administering a dose
of trimethoprim-sulfamethoxazole to the client?
a)Orthostatic blood pressures
b)Sputum culture and sensitivity
c)Pulmonary function evaluation
