HESI MED SURG 1 FINAL EXAM TEST BANK LATEST
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2024 ACTUAL EXAM 350 QUESTIONS AND
gg gg gg gg gg gg
CORRECT DETAILED ANSWERS WITH RATIONALES
gg gg gg gg gg
(VERIFIED ANSWERS) |ALREADY GRADED A+
gg gg gg gg gg
The nurse assesses a patient with shortness of breath for evidence of long-standing hypoxemia by
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inspecting:
gg
A. Chest excursion gg
B. Spinal curvatures gg
C. The respiratory pattern
gg gg
D. The fingernail and its base
gg - answer-D. The fingernail and its base Clubbing, a sign of long-
gg gg gg g g ff gg gg gg gg gg gg gg gg gg gg
standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
and sponginess of the end of the finger.
gg gg gg gg gg gg gg gg
2. The nurse is caring for a patient with COPD and pneumonia who has an order for arterial blood
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
gases to be drawn. Which of the following is the minimum length of time the nurse should
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
plan to hold pressure on the puncture site?
gg gg gg gg gg gg gg gg
A. 2 minutes
gg
B. 5 minutes
gg
C. 10 minutes
gg
D. 15 minutes - answer-B. 5 minutes Following obtaining an arterial blood gas, the nurse should
gg gg ff gg gg gg gg gg gg gg gg gg gg gg
hold pressure on the puncture site for 5 minutes by the clock to be sure that bleeding has
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
stopped. An artery is an elastic vessel under higher pressure than veins, and significant blood
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
loss or hematoma formation could occur if the time is insufficient.
gg gg gg gg gg gg gg gg gg gg gg
3. The nurse notices clear nasal drainage in a patient newly admitted with facial trauma,
gg gg gg gg gg gg gg gg gg gg gg gg gg
including a nasal fracture. The nurse should:
gg gg gg gg gg gg gg
A. test the drainage for the presence of glucose.
gg gg gg gg gg gg gg
B. suction the nose to maintain airway clearance.
gg gg gg gg gg gg
C. document the findings and continue monitoring.
gg gg gg gg gg
D. apply a drip pad and reassure the patient this is normal. - answer-A. test the drainage for
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the presence of glucose. Clearnasal drainage suggests leakage of cerebrospinal fluid (CSF). The
gg gg gg gg gg gg gg gg gg gg gg gg gg
drainage should be tested for the presence of glucose, which would indicate the presence
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
of CSF.
gg gg
,4. When caring for a patient who is 3 hours postoperative laryngectomy, the nurse's highest
gg gg gg gg gg gg gg gg gg gg gg gg gg
priority assessment would be:
gg gg gg gg
A. Airway patency gg
B. Patient comfort gg
C. Incisional drainage gg
D. Blood pressure and heart rate - answer-A. Airway patency Remember ABCs with prioritization.
gg gg gg gg gg ff gg gg gg gg gg gg
Airway patency is always the highest priority and is essential for a patient undergoing surgery
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
surrounding the upper respiratory system.
gg gg gg gg gg
5. When initially teaching a patient the supraglottic swallow following a radical neck dissection,
gg gg gg gg gg gg gg gg gg gg gg gg
with which of the following foods should the nurse begin?
gg gg gg gg gg gg gg gg gg gg
A. Cola
B. Applesauce
C. French fries gg
D. White grape juice - answer-A. ColaWhen learning the supraglottic swallow, it may be helpful
gg gg gg gg gg gg gg gg gg gg gg gg gg
to start with carbonated beverages because the effervescence provides clues about the liquid's
gg gg gg gg gg gg gg gg gg gg gg gg gg
position. Thin, watery fluids should be avoided because they are difficult to swallow and increase
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the risk of aspiration. Nonpourable pureed foods, such as applesauce, would decrease the risk
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
of aspiration, but carbonated beverages are the better choice to start with.
gg gg gg gg gg gg gg gg gg gg gg gg
6. The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum and a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
respiratory rate of
gg gg gg
20. Which of the following nursing diagnosis is most appropriate based upon this assessment? A.
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Hyperthermia related to infectious illness
gg gg gg gg gg
B. Ineffective thermoregulation related to chilling
gg gg gg gg gg
C. Ineffective breathing pattern related to pneumonia
gg gg gg gg gg gg
D. Ineffective airway clearance related to thick secretions - answer-A. Hyperthermia related to
gg gg gg gg gg gg gg gg ff gg gg gg
infectious illness Because the patient has spiked a temperature and has a diagnosis of
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is
gg gg gg gg gg gg gg gg gg gg gg gg gg
no evidence of a chill, and her breathing pattern is within normal limits at 20 breaths per
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
minute. There is no evidence of ineffective airway clearance from the information given
gg gg gg gg gg gg gg gg gg gg gg gg gg
because the patient is expectorating sputum.
gg gg gg gg gg gg
,7. Which of the following physical assessment findings in a patient with pneumonia best supports
gg gg gg gg gg gg gg gg gg gg gg gg gg
the nursing diagnosis of ineffective airway clearance? A. Oxygen saturation of 85%
gg gg gg gg gg gg gg gg gg gg gg gg
B. Respiratory rate of 28
gg gg gg gg
C. Presence of greenish sputum
gg gg gg gg
D. Basilar crackles - answer-D. Basilar crackles The presence of adventitious breath sounds indicates
gg gg gg ff gg gg gg gg gg gg gg gg gg
that there is accumulation of secretions in the lower airways. This would be consistent with a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
nursing diagnosis of ineffective airway clearance because the patient is retaining secretions.
gg gg gg gg gg gg gg gg gg gg gg gg
8. Which of the following clinical manifestations would the nurse expect to find during assessment
gg gg gg gg gg gg gg gg gg gg gg gg gg
of a patient admitted with pneumococcal pneumonia? A. Hyperresonance on percussion
gg gg gg gg gg gg gg gg gg gg gg
B. Fine crackles in all lobes on auscultation
gg gg gg gg gg gg gg
C. Increased vocal fremitus on palpation D. Vesicular breath sounds in all lobes - answer-C. Increased
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
vocal fremitus on palpation. A typical physical examination finding for a patient with
gg gg gg gg gg gg gg gg gg gg gg gg gg
pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation
gg gg gg gg gg gg gg gg gg gg gg gg
include dullness to percussion, bronchial breath sounds, and crackles in the affected area.
gg gg gg gg gg gg gg gg gg gg gg gg gg
9. Which of the following nursing interventions is of the highest priority in helping a patient
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
expectorate thick secretions related to pneumonia?
gg gg gg gg gg gg
A. Humidify the oxygen as able gg gg gg gg
B. Increase fluid intake to 3L/day if tolerated.
gg gg gg gg gg gg
C. Administer cough suppressant q4hr. gg gg gg
D. Teach patient to splint the affected area. - answer-B. Increase fluid intake to 3L/day if
gg gg gg gg gg gg gg ff gg gg gg gg gg gg
tolerated. Although several interventions may help the patient expectorate mucus, the highest
gg gg gg gg gg gg gg gg gg gg gg gg
priority should be on increasing fluid intake, which will liquefy the secretions so that the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
patient can expectorate them more easily. Humidifying the oxygen is also helpful, but is not
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the primary intervention. Teaching the patient to splint the affected area may also be helpful,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
but does not liquefy the secretions so that they can be removed.
gg gg gg gg gg gg gg gg gg gg gg gg
10. During discharge teaching for a 65-year-old patient with emphysema and pneumonia, which of
gg gg gg gg gg gg gg gg gg gg gg gg
the following vaccines should the nurse recommend the patient receive?
gg gg gg gg gg gg gg gg gg gg
A. S. aureus gg
B. H. influenzae
gg
C. Pneumococcal
, D. Bacille Calmette-Guérin (BCG) - answer-C. Pneumococcal The pneumococcal vaccine is
gg gg gg gg gg gg gg gg gg
important for patients with a history of heart or lung disease, recovering from a severe illness,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
age 65 or over, or living in a long-term care facility.
gg gg gg gg gg gg gg gg gg gg gg
11. The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has
gg gg gg gg gg gg gg gg gg gg gg gg
been most effective when the patient states which of the following measures to prevent a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
relapse?
gg
A. "I will increase my food intake to 2400 calories a day to keep my immune system well."
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
B. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to reevaluate."
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
C. "I will seek immediate medical treatment for any upper respiratory infections."
gg gg gg gg gg gg gg gg gg gg
D. "I should continue to do deep-breathing and coughing exercises for at least 6 weeks." -
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
answer-D. "I should continue to do deep-breathing and coughing exercises for at least 6
ff gg gg gg gg gg gg gg gg gg gg gg gg gg
weeks." It is important for the patient to continue with coughing and deep breathing
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
exercises for 6 to 8 weeks until all of the infection has cleared from the lungs. A patient
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
should seek medical treatment for upper respiratory infections that persist for more than 7
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
days. Increased fluid intake, not caloric intake, is required to liquefy secretions. Home O2 is
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
not a requirement unless the patient's oxygenation saturation is below normal.
gg gg gg gg gg gg gg gg gg gg gg
12. After admitting a patient to the medical unit with a diagnosis of pneumonia, the nurse will verify
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
that which of the following physician orders have been completed before administering a dose
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of cefotetan (Cefotan) to the patient?
gg gg gg gg gg gg
A. Serum laboratory studies ordered for AM
gg gg gg gg gg
B. Pulmonary function evaluation gg gg
C. Orthostatic blood pressures gg gg
D. Sputum culture and sensitivity - answer-D. Sputum culture and sensitivityThe nurse should
gg gg gg gg gg gg gg gg gg gg gg
ensure that the sputum for culture and sensitivity was sent to the laboratory before
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
administering the cefotetan. It is important that the organisms are correctly identified (by the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
culture) before their numbers are affected by the antibiotic; the test will also determine
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic
gg gg gg gg gg gg gg gg gg gg gg
administration should not be unduly delayed while waiting for the patient to expectorate
gg gg gg gg gg gg gg gg gg gg gg gg gg
sputum, all of the other options will not be affected by the administration of antibiotics.
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
13. Which of the following nursing interventions is most appropriate to enhance oxygenation
gg gg gg gg gg gg gg gg gg gg gg
in a patient with unilateral malignant lung disease?
gg gg gg gg gg gg gg gg
A. Positioning patient on right side. gg gg gg gg
B. Maintaining adequate fluid intake gg gg gg
gg gg gg gg gg gg gg gg
2024 ACTUAL EXAM 350 QUESTIONS AND
gg gg gg gg gg gg
CORRECT DETAILED ANSWERS WITH RATIONALES
gg gg gg gg gg
(VERIFIED ANSWERS) |ALREADY GRADED A+
gg gg gg gg gg
The nurse assesses a patient with shortness of breath for evidence of long-standing hypoxemia by
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
inspecting:
gg
A. Chest excursion gg
B. Spinal curvatures gg
C. The respiratory pattern
gg gg
D. The fingernail and its base
gg - answer-D. The fingernail and its base Clubbing, a sign of long-
gg gg gg g g ff gg gg gg gg gg gg gg gg gg gg
standing hypoxemia, is evidenced by an increase in the angle between the base of the nail and
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the fingernail to 180 degrees or more, usually accompanied by an increase in the depth, bulk,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
and sponginess of the end of the finger.
gg gg gg gg gg gg gg gg
2. The nurse is caring for a patient with COPD and pneumonia who has an order for arterial blood
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
gases to be drawn. Which of the following is the minimum length of time the nurse should
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
plan to hold pressure on the puncture site?
gg gg gg gg gg gg gg gg
A. 2 minutes
gg
B. 5 minutes
gg
C. 10 minutes
gg
D. 15 minutes - answer-B. 5 minutes Following obtaining an arterial blood gas, the nurse should
gg gg ff gg gg gg gg gg gg gg gg gg gg gg
hold pressure on the puncture site for 5 minutes by the clock to be sure that bleeding has
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
stopped. An artery is an elastic vessel under higher pressure than veins, and significant blood
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
loss or hematoma formation could occur if the time is insufficient.
gg gg gg gg gg gg gg gg gg gg gg
3. The nurse notices clear nasal drainage in a patient newly admitted with facial trauma,
gg gg gg gg gg gg gg gg gg gg gg gg gg
including a nasal fracture. The nurse should:
gg gg gg gg gg gg gg
A. test the drainage for the presence of glucose.
gg gg gg gg gg gg gg
B. suction the nose to maintain airway clearance.
gg gg gg gg gg gg
C. document the findings and continue monitoring.
gg gg gg gg gg
D. apply a drip pad and reassure the patient this is normal. - answer-A. test the drainage for
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the presence of glucose. Clearnasal drainage suggests leakage of cerebrospinal fluid (CSF). The
gg gg gg gg gg gg gg gg gg gg gg gg gg
drainage should be tested for the presence of glucose, which would indicate the presence
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
of CSF.
gg gg
,4. When caring for a patient who is 3 hours postoperative laryngectomy, the nurse's highest
gg gg gg gg gg gg gg gg gg gg gg gg gg
priority assessment would be:
gg gg gg gg
A. Airway patency gg
B. Patient comfort gg
C. Incisional drainage gg
D. Blood pressure and heart rate - answer-A. Airway patency Remember ABCs with prioritization.
gg gg gg gg gg ff gg gg gg gg gg gg
Airway patency is always the highest priority and is essential for a patient undergoing surgery
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
surrounding the upper respiratory system.
gg gg gg gg gg
5. When initially teaching a patient the supraglottic swallow following a radical neck dissection,
gg gg gg gg gg gg gg gg gg gg gg gg
with which of the following foods should the nurse begin?
gg gg gg gg gg gg gg gg gg gg
A. Cola
B. Applesauce
C. French fries gg
D. White grape juice - answer-A. ColaWhen learning the supraglottic swallow, it may be helpful
gg gg gg gg gg gg gg gg gg gg gg gg gg
to start with carbonated beverages because the effervescence provides clues about the liquid's
gg gg gg gg gg gg gg gg gg gg gg gg gg
position. Thin, watery fluids should be avoided because they are difficult to swallow and increase
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the risk of aspiration. Nonpourable pureed foods, such as applesauce, would decrease the risk
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
of aspiration, but carbonated beverages are the better choice to start with.
gg gg gg gg gg gg gg gg gg gg gg gg
6. The nurse is caring for a patient admitted to the hospital with pneumonia. Upon assessment,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the nurse notes a temperature of 101.4° F, a productive cough with yellow sputum and a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
respiratory rate of
gg gg gg
20. Which of the following nursing diagnosis is most appropriate based upon this assessment? A.
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
Hyperthermia related to infectious illness
gg gg gg gg gg
B. Ineffective thermoregulation related to chilling
gg gg gg gg gg
C. Ineffective breathing pattern related to pneumonia
gg gg gg gg gg gg
D. Ineffective airway clearance related to thick secretions - answer-A. Hyperthermia related to
gg gg gg gg gg gg gg gg ff gg gg gg
infectious illness Because the patient has spiked a temperature and has a diagnosis of
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
pneumonia, the logical nursing diagnosis is hyperthermia related to infectious illness. There is
gg gg gg gg gg gg gg gg gg gg gg gg gg
no evidence of a chill, and her breathing pattern is within normal limits at 20 breaths per
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
minute. There is no evidence of ineffective airway clearance from the information given
gg gg gg gg gg gg gg gg gg gg gg gg gg
because the patient is expectorating sputum.
gg gg gg gg gg gg
,7. Which of the following physical assessment findings in a patient with pneumonia best supports
gg gg gg gg gg gg gg gg gg gg gg gg gg
the nursing diagnosis of ineffective airway clearance? A. Oxygen saturation of 85%
gg gg gg gg gg gg gg gg gg gg gg gg
B. Respiratory rate of 28
gg gg gg gg
C. Presence of greenish sputum
gg gg gg gg
D. Basilar crackles - answer-D. Basilar crackles The presence of adventitious breath sounds indicates
gg gg gg ff gg gg gg gg gg gg gg gg gg
that there is accumulation of secretions in the lower airways. This would be consistent with a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
nursing diagnosis of ineffective airway clearance because the patient is retaining secretions.
gg gg gg gg gg gg gg gg gg gg gg gg
8. Which of the following clinical manifestations would the nurse expect to find during assessment
gg gg gg gg gg gg gg gg gg gg gg gg gg
of a patient admitted with pneumococcal pneumonia? A. Hyperresonance on percussion
gg gg gg gg gg gg gg gg gg gg gg
B. Fine crackles in all lobes on auscultation
gg gg gg gg gg gg gg
C. Increased vocal fremitus on palpation D. Vesicular breath sounds in all lobes - answer-C. Increased
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
vocal fremitus on palpation. A typical physical examination finding for a patient with
gg gg gg gg gg gg gg gg gg gg gg gg gg
pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation
gg gg gg gg gg gg gg gg gg gg gg gg
include dullness to percussion, bronchial breath sounds, and crackles in the affected area.
gg gg gg gg gg gg gg gg gg gg gg gg gg
9. Which of the following nursing interventions is of the highest priority in helping a patient
gg gg gg gg gg gg gg gg gg gg gg gg gg gg
expectorate thick secretions related to pneumonia?
gg gg gg gg gg gg
A. Humidify the oxygen as able gg gg gg gg
B. Increase fluid intake to 3L/day if tolerated.
gg gg gg gg gg gg
C. Administer cough suppressant q4hr. gg gg gg
D. Teach patient to splint the affected area. - answer-B. Increase fluid intake to 3L/day if
gg gg gg gg gg gg gg ff gg gg gg gg gg gg
tolerated. Although several interventions may help the patient expectorate mucus, the highest
gg gg gg gg gg gg gg gg gg gg gg gg
priority should be on increasing fluid intake, which will liquefy the secretions so that the
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
patient can expectorate them more easily. Humidifying the oxygen is also helpful, but is not
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
the primary intervention. Teaching the patient to splint the affected area may also be helpful,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
but does not liquefy the secretions so that they can be removed.
gg gg gg gg gg gg gg gg gg gg gg gg
10. During discharge teaching for a 65-year-old patient with emphysema and pneumonia, which of
gg gg gg gg gg gg gg gg gg gg gg gg
the following vaccines should the nurse recommend the patient receive?
gg gg gg gg gg gg gg gg gg gg
A. S. aureus gg
B. H. influenzae
gg
C. Pneumococcal
, D. Bacille Calmette-Guérin (BCG) - answer-C. Pneumococcal The pneumococcal vaccine is
gg gg gg gg gg gg gg gg gg
important for patients with a history of heart or lung disease, recovering from a severe illness,
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
age 65 or over, or living in a long-term care facility.
gg gg gg gg gg gg gg gg gg gg gg
11. The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has
gg gg gg gg gg gg gg gg gg gg gg gg
been most effective when the patient states which of the following measures to prevent a
gg gg gg gg gg gg gg gg gg gg gg gg gg gg gg
relapse?
gg
A. "I will increase my food intake to 2400 calories a day to keep my immune system well."
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B. "I must use home oxygen therapy for 3 months and then will have a chest x-ray to reevaluate."
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C. "I will seek immediate medical treatment for any upper respiratory infections."
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D. "I should continue to do deep-breathing and coughing exercises for at least 6 weeks." -
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answer-D. "I should continue to do deep-breathing and coughing exercises for at least 6
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weeks." It is important for the patient to continue with coughing and deep breathing
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exercises for 6 to 8 weeks until all of the infection has cleared from the lungs. A patient
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should seek medical treatment for upper respiratory infections that persist for more than 7
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days. Increased fluid intake, not caloric intake, is required to liquefy secretions. Home O2 is
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not a requirement unless the patient's oxygenation saturation is below normal.
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12. After admitting a patient to the medical unit with a diagnosis of pneumonia, the nurse will verify
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that which of the following physician orders have been completed before administering a dose
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of cefotetan (Cefotan) to the patient?
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A. Serum laboratory studies ordered for AM
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B. Pulmonary function evaluation gg gg
C. Orthostatic blood pressures gg gg
D. Sputum culture and sensitivity - answer-D. Sputum culture and sensitivityThe nurse should
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ensure that the sputum for culture and sensitivity was sent to the laboratory before
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administering the cefotetan. It is important that the organisms are correctly identified (by the
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culture) before their numbers are affected by the antibiotic; the test will also determine
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whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic
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administration should not be unduly delayed while waiting for the patient to expectorate
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sputum, all of the other options will not be affected by the administration of antibiotics.
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13. Which of the following nursing interventions is most appropriate to enhance oxygenation
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in a patient with unilateral malignant lung disease?
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A. Positioning patient on right side. gg gg gg gg
B. Maintaining adequate fluid intake gg gg gg
