In planning for Jose's oxygen therapy, the nurse shall consider which of the following, EXCEPT

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Question 1 of 9

In planning for Jose's oxygen therapy, the nurse shall consider which of the following, EXCEPT

Correct Answer: C

Rationale: When planning for Jose's oxygen therapy, the nurse should consider the need for a humidifier to prevent drying of the mucous membranes, the appropriate length of tubing for mobility and safety reasons, and the manner of administering oxygen (continuous or intermittent) based on Jose's condition and oxygen requirements. However, determining Jose's age is not a relevant factor in planning for his oxygen therapy. The decision-making process should be based on his specific medical needs and condition rather than his age.

Question 2 of 9

Which of the following clinical features is most characteristic of acute respiratory distress syndrome (ARDS)?

Correct Answer: A

Rationale: Acute respiratory distress syndrome (ARDS) is a serious and life-threatening condition characterized by rapid onset of respiratory failure, severe hypoxemia (low oxygen levels in the blood), and non-cardiogenic pulmonary edema. The hallmark of ARDS is severe hypoxemia that is difficult to correct even with high levels of supplemental oxygen. Patients with ARDS often require mechanical ventilation to maintain adequate oxygen levels. Severe cough with purulent sputum production, chest pain exacerbated by deep breathing, and productive cough with hemoptysis are not typical features of ARDS.

Question 3 of 9

Patient Presley asks the nurse why such a diagnostic procedure is required. What is the MOST APPR0PRIATE answer can the nurse give?

Correct Answer: A

Rationale: Urinary tract infections are strongly associated with the occurrence of preterm labor. It is important to screen for and address any urinary tract infections during pregnancy to reduce the risk of complications like preterm labor. Diagnostic procedures, such as obtaining a urine sample for testing, help healthcare providers identify and treat any infections promptly to promote a healthy pregnancy. Therefore, the nurse can explain to Patient Presley that the diagnostic procedure is necessary to detect and address any potential urinary tract infections that could impact her pregnancy.

Question 4 of 9

The physician prescribes a treatment plan for patient Mila. Nurse Victor understands that the initial treatment goal is which of the following?

Correct Answer: A

Rationale: The initial treatment goal for a patient like Mila is often focused on preventing infection. Infection prevention is a basic and essential step in patient care, especially for someone who may be at risk due to their medical condition or treatment plan. By preventing infection, healthcare providers can help ensure the patient's safety and promote successful outcomes for the overall treatment plan. Correcting hypoxia, metabolic acidosis, and increasing myocardial oxygen supply may be important goals as well, but preventing infection is usually prioritized as it can have serious consequences if not addressed promptly.

Question 5 of 9

A patient with advanced cancer experiences dyspnea and anxiety during episodes of breathlessness. Which intervention should the palliative nurse prioritize to address the patient's symptoms?

Correct Answer: C

Rationale: Opioid medications are considered the first-line pharmacological treatment for dyspnea in palliative care patients with advanced cancer. Opioids help relieve dyspnea by reducing respiratory drive and the sensation of breathlessness, providing effective symptom management. In this case, addressing the patient's dyspnea with opioid medications would likely also help alleviate their anxiety related to breathlessness. Administering oxygen therapy (choice A) may not be effective at relieving dyspnea in this situation, as dyspnea in advanced cancer patients is often not primarily due to low oxygen levels. Teaching pursed-lip breathing techniques (choice B) and referring the patient to a respiratory therapist for breathing exercises (choice D) may be helpful complementary interventions, but opioid medications should be the priority for symptom management.

Question 6 of 9

A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed prednisone for an acute exacerbation. Which instruction is important for the nurse to include in patient education about prednisone therapy?

Correct Answer: B

Rationale: It is crucial for patients with COPD who are prescribed prednisone to be educated about the importance of not abruptly stopping the medication. Prednisone is a type of corticosteroid that should be tapered off gradually under the guidance of a healthcare provider to prevent potential withdrawal symptoms and adrenal insufficiency. Suddenly stopping prednisone can lead to serious adverse effects, including fatigue, weakness, joint pain, fever, dizziness, and potentially life-threatening complications. Therefore, adherence to the prescribed tapering schedule is essential to ensure the safe and effective management of COPD exacerbations with prednisone therapy.

Question 7 of 9

Amy, a multiparous patient, 28 hours after Ceasarian delivery (CS), who is breastfeeding, complains of severe abdominal cramps. Nurse Kayla explains that these are caused by which of the following?

Correct Answer: B

Rationale: The severe abdominal cramps experienced by the multiparous patient Amy, 28 hours after a Cesarean delivery (CS) and while breastfeeding, are likely caused by the release of Oxytocin during the breastfeeding session. Oxytocin is a hormone that is naturally produced during breastfeeding to stimulate the contraction of the uterus and help reduce postpartum bleeding. These contractions may result in cramping sensations in the abdomen, specifically at the site of the uterus. It is a normal physiological response and an indication that the body is working as it should to support the postpartum recovery process.

Question 8 of 9

Which of the following mechanisms is responsible for the phenomenon of immunological memory, wherein the immune system mounts a faster and more robust response upon re-exposure to a previously encountered pathogen?

Correct Answer: A

Rationale: Immunological memory is primarily maintained by the clonal expansion of memory B cells. Memory B cells are a type of long-lived immune cell that originates from previously activated B cells during an immune response to a pathogen. When the immune system encounters the same pathogen again, memory B cells can quickly recognize and respond to it by undergoing rapid clonal expansion and differentiation into plasma cells that produce specific antibodies. This quick and robust response leads to the more efficient elimination of the pathogen during secondary exposure, resulting in the faster and stronger immune response characteristic of immunological memory.

Question 9 of 9

A postpartum client who delivered twins expresses concerns about breastfeeding both infants simultaneously. What nursing intervention should be prioritized to address the client's concerns?

Correct Answer: A

Rationale: Demonstrating tandem breastfeeding positions and techniques should be prioritized as the nursing intervention to address the client's concerns about breastfeeding both infants simultaneously. Tandem breastfeeding involves nursing twins at the same time and can help enhance milk production, promote bonding with both infants, and save time for the mother. By showing the client the proper positions and techniques for tandem breastfeeding, the nurse can empower the client with the knowledge and skills needed to successfully breastfeed both infants together. This intervention can ultimately support the client in feeling more confident and competent in managing the challenges of breastfeeding twins.

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