A male client with emphysema becomes restless and confused. What step should nurse Jasmine take next?

Correct Answer: A

Rationale: The correct answer is A: Encourage the client to perform pursed lip breathing. This is the appropriate step because the client with emphysema showing restlessness and confusion may be experiencing hypoxia. Pursed lip breathing helps improve oxygenation by slowing down breathing and facilitating better gas exchange. Checking the client's temperature (B) is not the priority in this situation. Assessing the client's potassium level (C) may be important but not the immediate step for a client showing signs of hypoxia. Increasing the client's oxygen flow rate (D) can be considered after assessing the client's response to pursed lip breathing.

Correct Answer: A

Rationale: The correct answer is A because the left kidney is typically positioned slightly higher than the right one due to the space occupied by the liver on the right side. This anatomical fact is crucial for accurate palpation. Choice B is incorrect because the kidneys are actually located above the waist, not just above the adrenal glands. Choice C is incorrect as the average kidney size is around 11-14 cm long and 5-7.5 cm wide. Choice D is incorrect as the kidneys are located lower, between the 12th thoracic and the 3rd lumbar vertebrae.

Correct Answer: B

Rationale: The correct answer is B because a urine output of 20 ml/hour indicates potential hypovolemia or inadequate perfusion, which can lead to poor tissue perfusion and compromised healing in burn patients. This finding suggests a need for intervention to optimize fluid balance and prevent complications. A: A PaO2 value of 80 mm Hg can be within normal limits and does not specifically indicate a problem related to burns. C: White pulmonary secretions may suggest pulmonary infection but may not directly relate to the burns. D: A rectal temperature of 100.6°F (38°C) is slightly elevated and may be a normal response to the body's inflammatory process after burns, not necessarily indicating a problem.

Correct Answer: C

Rationale: The correct answer is C: 95 mm Hg. Mean Arterial Pressure (MAP) is calculated using the formula MAP = ((2 x diastolic) + systolic) / 3. Plugging in the values from the blood pressure measurement (diastolic 80, systolic 126), we get MAP = ((2 x 80) + 126) / 3 = (160 + 126) / 3 = 286 / 3 = 95 mm Hg. This calculation provides an accurate representation of the average pressure in the arteries during one cardiac cycle. The other choices are incorrect because they do not align with the correct formula or calculation for determining MAP.

Correct Answer: C

Rationale: The correct answer is C: Decreases inflammation. Colchicine is used in the treatment of gout because it inhibits the inflammatory response that occurs during gout flare-ups. It works by disrupting the inflammatory process, particularly by inhibiting the migration of neutrophils to the affected area. This reduces the inflammation, pain, and swelling associated with gout attacks. Explanation of other choices: A: Replaces estrogen - This is incorrect because colchicine does not have any role in replacing estrogen in the body. B: Decreases infection - This is incorrect because colchicine does not have any direct effect on fighting infections. D: Decreases bone demineralization - This is incorrect because colchicine is not used to treat bone-related conditions such as osteoporosis.