A nurse cares for a client who had a partial laryngectomy 10 days ago. The client states that all food tastes bland. How would the nurse respond?

Correct Answer: B

Rationale: Step 1: Acknowledge client's concern about bland taste. Step 2: Validate normalcy post-laryngectomy. Step 3: Assess client's food preferences for individualized care. Step 4: Encourage open communication for effective care plan. Step 5: Addressing the issue holistically promotes client-centered care. Summary: - A: Focuses on swallowing, not taste. - C: Addresses food consistency, not taste. - D: Important but not directly related to client's concern.

Correct Answer: C

Rationale: The correct answer is C. Frequent handwashing prevents the spread of infection, which is crucial in managing acute bronchitis. A (not coughing frequently) is impractical and counterproductive. B (consuming adequate calories) supports general health but is not specific. D (semi-Fowler’s position) may aid breathing but is not a primary teaching point.

Correct Answer: A

Rationale: The correct answer to the question is option A) Client was recently in a motor vehicle accident, which supports the diagnosis of pulmonary embolism (PE). PE occurs when a blood clot travels to the lungs, often originating from deep vein thrombosis (DVT), which can be triggered by trauma like a motor vehicle accident. Option B) Client participating in an aerobic exercise program is not directly linked to PE. While physical inactivity can be a risk factor for DVT/PE, engaging in aerobic exercise is typically a protective factor. Option C) Client giving birth to a child one year ago is not a direct indicator of PE. While pregnancy and postpartum period increase the risk of blood clots, it's not as immediate as a recent motor vehicle accident. Option D) Client being on bedrest after a diagnostic procedure does not directly point to PE. Bedrest can be a preventive measure for various conditions post-procedure but does not specifically indicate PE. In an educational context, understanding the risk factors and clinical presentation of PE is crucial for nurses, especially for those preparing for the NCLEX-RN exam. Recognizing the significance of a recent trauma, like a motor vehicle accident, in the context of respiratory symptoms can aid in prompt diagnosis and intervention for PE, a potentially life-threatening condition.

Correct Answer: B

Rationale: The correct answer is B) An abrupt onset of fever and chills. When a patient presents with suspected Community-Acquired Pneumonia (CAP), symptoms such as sudden fever and chills are commonly reported. This abrupt onset of symptoms is indicative of an acute infection affecting the respiratory system, leading to pneumonia. Option A) Confusion is a symptom commonly associated with severe pneumonia but is not typically the initial symptom reported in a patient with suspected CAP. Option C) A recent loss of consciousness is not a typical symptom of CAP. This symptom would be more concerning for a neurological event rather than a respiratory infection. Option D) A gradual onset of headache and sore throat are not typical symptoms of CAP. While sore throat can sometimes be present, it is usually accompanied by respiratory symptoms like cough and shortness of breath in the context of pneumonia. Educationally, understanding the typical signs and symptoms of CAP is crucial for nurses in assessing and managing patients with respiratory infections. Recognizing the key symptoms helps in early identification, prompt treatment, and prevention of complications associated with pneumonia. Nurses must be able to differentiate between various respiratory conditions based on the patient's history to provide appropriate care effectively.

Correct Answer: D

Rationale: The most effective treatment for cystic fibrosis is vigorous and consistent chest physiotherapy, which helps to mobilize and clear the thick, sticky mucus that accumulates in the lungs of individuals with this condition. This therapy is crucial in improving lung function, reducing the risk of infections, and enhancing overall respiratory health in cystic fibrosis patients. Heart-lung transplant (Option A) is not the first-line treatment for cystic fibrosis. It is typically considered as a last resort when conservative treatments have failed, and the patient's condition has significantly deteriorated. Administration of prophylactic antibiotics (Option B) is important in managing lung infections in cystic fibrosis patients but is not the most effective treatment for the underlying disease itself. Administration of nebulized bronchodilators (Option C) can help with airway clearance in certain respiratory conditions, but in cystic fibrosis, chest physiotherapy is a more targeted and effective intervention for mucus clearance. In an educational context, it is important for nursing students preparing for the NCLEX RN exam to understand the pathophysiology of cystic fibrosis and the appropriate management strategies. By knowing the rationale behind each treatment option, students can apply critical thinking skills to select the most appropriate intervention for patients with cystic fibrosis. This question reinforces the importance of personalized, evidence-based care in respiratory conditions.