A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD). The nurse should prioritize which of the following interventions?

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Question 1 of 9

A nurse is caring for a patient with a history of chronic obstructive pulmonary disease (COPD). The nurse should prioritize which of the following interventions?

Correct Answer: A

Rationale: The correct answer is A: Administering bronchodilators as prescribed. Rationale: 1. Bronchodilators help dilate the airways, improving airflow in COPD patients. 2. Priority is to address the underlying respiratory issue. 3. Bronchodilators are a standard treatment for managing COPD symptoms. 4. Improving airway patency is crucial in COPD exacerbations. Summary: - B: Encouraging avoidance of physical activity is incorrect as it can lead to deconditioning. - C: Providing supplemental oxygen is important but not the priority in this case. - D: Monitoring for acute kidney injury is unrelated to COPD management.

Question 2 of 9

Which medication should be administered first for a client with acute asthma exacerbation?

Correct Answer: A

Rationale: Step-by-step rationale for choosing Albuterol as the correct answer: 1. Albuterol is a rapid-acting bronchodilator that provides immediate relief by relaxing the airway muscles during asthma exacerbation. 2. It is the first-line medication recommended by guidelines for acute asthma attacks due to its quick onset of action. 3. Albuterol helps in opening the airways, improving airflow, and relieving symptoms like shortness of breath and wheezing. 4. Epinephrine is not the first choice for asthma exacerbation as it can have more systemic side effects. 5. Levalbuterol is a similar medication to Albuterol but may not be as widely available or cost-effective. 6. IV corticosteroids are important for long-term control but take longer to show effects, making them less suitable as the initial treatment for acute exacerbation.

Question 3 of 9

What is the most appropriate action when a parent crosses their arms and legs during an interview?

Correct Answer: D

Rationale: The correct answer is D because crossing arms and legs can indicate defensiveness or discomfort, which may suggest the parent is uneasy discussing their son's treatment. This nonverbal cue could signal a need for empathy and sensitivity in communication. Choice A is incorrect as it overlooks the significance of body language. Choice B assumes comfort without considering the context. Choice C assumes tiredness without considering other possibilities. Understanding body language cues can help in building rapport and addressing concerns effectively.

Question 4 of 9

What does a focused assessment primarily address?

Correct Answer: B

Rationale: The correct answer is B: Specific client issues. A focused assessment is a targeted examination that addresses specific client concerns or issues. By focusing on a particular aspect of the client's health, healthcare providers can gather relevant information efficiently and effectively. This approach allows for a more in-depth evaluation of the specific problem at hand, leading to better treatment outcomes. Choice A (Comprehensive physical findings) is incorrect because a focused assessment does not aim to gather information on all physical findings, but rather on specific issues. Choice C (Multiple body systems) is incorrect because a focused assessment is more narrow in scope and typically focuses on one area or system of the body. Choice D (Long-term wellness goals) is incorrect as a focused assessment is more immediate and targeted towards addressing current issues rather than long-term goals.

Question 5 of 9

What should be the nurse's first action when caring for a client who has a suspected stroke?

Correct Answer: A

Rationale: The correct answer is A: Assess the client's airway. This is the first action because airway patency is the top priority in any emergency situation, including a suspected stroke. Ensuring the client can breathe effectively is crucial to prevent hypoxia and further complications. Administering oxygen (choice B) may be necessary after assessing the airway. Administering aspirin (choice C) should be done after a definitive diagnosis of an ischemic stroke. Performing a CT scan (choice D) is important for diagnosis but is not the first action to take in a suspected stroke scenario.

Question 6 of 9

What assessment framework provides additional modesty for clients, such as teenage girls?

Correct Answer: D

Rationale: The correct answer is D: Head to toe. This assessment framework allows for modesty by assessing one body part at a time, starting from the head down to the toe. This approach ensures clients, especially teenage girls, feel comfortable and respected during the assessment process. Other choices like A (Body systems) involve assessing multiple body parts simultaneously, potentially compromising modesty. Functional assessment (B) focuses on assessing specific functions rather than individual body parts, which may not address the modesty concern. Focused assessment (C) targets a specific area of concern, which may not provide a comprehensive evaluation while also potentially overlooking modesty concerns.

Question 7 of 9

What is the first intervention when a client develops symptoms of shock?

Correct Answer: A

Rationale: The correct answer is A: Administer oxygen. Oxygen administration is the first intervention for shock as it helps improve oxygenation to vital organs. Lack of oxygen can worsen shock. Administering IV fluids (choice B) could be the second step to improve perfusion. Monitoring respiratory rate (choice C) is important but not the first intervention. Administering pain medication (choice D) is not a priority in managing shock.

Question 8 of 9

The major electrolytes in the extracellular fluid are:

Correct Answer: C

Rationale: The correct answer is C: sodium and chloride. In the extracellular fluid, sodium and chloride are the major electrolytes due to their roles in maintaining fluid balance, nerve function, and muscle contraction. Potassium and phosphate (choice B) are primarily found in intracellular fluid, while potassium and chloride (choice A) are not the major electrolytes in extracellular fluid. Similarly, sodium and phosphate (choice D) are not major extracellular electrolytes. Thus, choice C is the correct answer based on the significant presence and functions of sodium and chloride in the extracellular fluid.

Question 9 of 9

Acyclovir is the drug of choice for which condition?

Correct Answer: B

Rationale: Acyclovir is a nucleoside analog antiviral drug that is specifically effective against herpes simplex virus (HSV) types 1 and 2, as well as varicella-zoster virus (VZV). The drug works by inhibiting viral DNA synthesis. HSV and VZV are both members of the herpes virus family, and acyclovir is most commonly prescribed for infections caused by these viruses. Therefore, the correct answer is B. Choice A (HIV) is incorrect because acyclovir is not effective against HIV. Choice C (CMV) is incorrect because acyclovir is less effective against cytomegalovirus (CMV) compared to HSV and VZV. Choice D (influenza A viruses) is incorrect because acyclovir is not indicated for the treatment of influenza viruses.

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