Correct Detailed Answers With Complete
Solutions | Graded A+ | New Update 2025
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?
SATA
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 and is receiving mechanical ventilation
F.) Client who has myasthenia gravis - ANSWER A.) Client who has dysphagia
B.) Client who has AIDS
E.) Client who has a closed head injury and is receiving mechanical ventilation
F.) Client who has myasthenia gravis
A nurse is assessing a client who, upon awakening, was disoriented to person,
place, and time. The client reports chills and chest pain that is worse upon
inspiration. Which of the following actions is the nursing priorities?
A.) Obtain baseline vital signs and oxygen saturation
B.) Obtain a sputum culture
C.) Obtain a complete history from the client
, D.) Inform client about recommended 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 to determine the next nursing action and provide safe and effective client
care.
A nurse is caring for a client who has pneumonia. Assessment findings include
temperature (100°F), respirations 30/min, blood pressure 130/76, heart rate
100/min, and SpO2 91% on room air. Prioritize the following nursing interventions:
-Administer antibiotics
-Administer oxygen therapy
-Perform a sputum culture
-Instruct the client to obtain a yearly influenza vaccination - ANSWER -
Administer oxygen therapy
-Perform a sputum culture
-Administer antibiotics
-Instruct the client to obtain a yearly influenza vaccination
Using the ABC priority framework, providing oxygen is the first intervention.
Obtaining a sputum culture should be done prior to administering oral antibiotics
to obtain an accurate specimen.
A nurse is assessing a client who has a history of asthma. Which of the following
factors should the nurse identify y as a risk for asthma?