The 75-year-old patient asks the nurse if the Pneumovax immunization he took when he was 65 is still protecting him. Which reply is most accurate?

Correct Answer: D

Rationale: Step 1: Pneumovax is recommended for adults aged 65 and older. Step 2: Immunity from Pneumovax decreases over time. Step 3: CDC recommends a second dose of Pneumovax after 5 years for those at highest risk. Step 4: Answer D is correct as it aligns with CDC guidelines for revaccination. Step 5: Other choices are incorrect as they do not reflect current recommendations or scientific evidence.

Correct Answer: A

Rationale: The correct answer is A because it demonstrates active listening and empathy, allowing the patient to express their feelings. By asking for clarification, it shows interest in the patient's concerns and opens up a dialogue for further exploration. This approach can help the patient feel heard and supported, leading to better understanding and communication. Choices B, C, and D are incorrect because they do not directly address the patient's statement or feelings. B dismisses the patient's concerns, C invalidates their emotions, and D offers a general statement without acknowledging the patient's specific worries. These responses may lead to the patient feeling unheard or misunderstood, hindering effective communication and rapport building.

Correct Answer: C

Rationale: Spirometry measures lung volumes and capacities. Functional Residual Capacity (FRC) is the volume of air left in the lungs after a normal exhalation, which cannot be directly measured by spirometry. Therefore, C is correct. IC (Inspiratory Capacity) is the maximum volume of air that can be inhaled after a normal exhalation, ERV (Expiratory Reserve Volume) is the additional volume of air that can be exhaled after a normal exhalation, and Vital Capacity is the total volume of air that can be exhaled after a maximum inhalation, all of which can be measured using spirometry.

Correct Answer: D

Rationale: The correct answer is D: 4500ml. Alveolar ventilation is calculated by multiplying tidal volume by respiratory rate. In this case, 600ml (tidal volume) x 10/min (respiratory rate) = 6000ml/min. However, we need to consider dead space ventilation, which is about 150ml. Therefore, the final alveolar ventilation is 6000ml/min - 150ml = 5850ml/min. Since the question asks for alveolar ventilation per minute, the correct answer is the closest option, which is D: 4500ml. Choices A, B, and C are incorrect because they do not accurately reflect the calculation of alveolar ventilation based on the provided respiratory rate, tidal volume, and dead space ventilation.

Correct Answer: D

Rationale: The correct answer is D: Impaired gas exchange related to airflow obstruction. This is the most important nursing diagnosis for a patient with chronic obstructive pulmonary disease because impaired gas exchange directly impacts the patient's ability to breathe and obtain oxygen. Addressing this issue is crucial in managing the patient's condition and preventing further complications. A: Activity intolerance related to fatigue may be a concern for the patient, but it is secondary to the primary issue of impaired gas exchange. B: Anxiety related to actual threat to health status is important to address, but it is not the most critical nursing diagnosis for this patient. C: Risk for infection related to retained secretions is a valid concern, but it is not as immediate and directly life-threatening as impaired gas exchange in a patient with chronic obstructive pulmonary disease.