The nurse is reviewing the medical records for five patients who are scheduled for their yearly physical examinations in September. Which patients should receive the inactivated influenza vaccination (select one that doesn't apply)?

Correct Answer: C

Rationale: The correct answer is option C, a 42-year-old patient with a 15 pack-year smoking history, should not receive the inactivated influenza vaccination. The rationale behind this is that individuals with a smoking history are not in the high-risk category for flu complications compared to elderly patients, pregnant individuals, and those who are immunocompromised due to corticosteroid use. Smoking history alone does not place a person at an increased risk of developing severe complications from the flu. Option A, a 76-year-old nursing home resident, should receive the influenza vaccination as the elderly are at a higher risk of flu-related complications. Option B, a pregnant 36-year-old female, should also receive the vaccine as pregnancy puts women at an increased risk for severe flu complications. Option D, a 30-year-old patient on corticosteroids for rheumatoid arthritis, should receive the vaccine because being immunocompromised increases the risk of flu-related complications. Educationally, understanding the rationale behind why certain populations are at higher risk for flu complications helps nursing students make informed decisions when administering vaccinations. It reinforces the importance of evidence-based practice and individualized care based on patient risk factors. By knowing which patients require specific interventions such as the influenza vaccine, nurses can contribute to better health outcomes and prevent unnecessary complications.

Correct Answer: A

Rationale: The patient's clinical manifestations are consistent with streptococcal pharyngitis, and the nurse will anticipate the need for a rapid strep antigen test or cultures (or both). Because patients with streptococcal pharyngitis usually do not have a cough, use of expectorants will not be anticipated. Rinsing out the mouth after inhaler use may prevent fungal oral infections, but the patient's assessment data are not consistent with a fungal infection. NSAIDs are frequently prescribed for pain and fever relief with pharyngitis.

Correct Answer: C

Rationale: The correct answer is C) Chest tube and drainage. Absent breath sounds on the right side suggest a potential pneumothorax or hemothorax, which necessitates intervention to remove air or blood from the pleural space. A chest tube allows for drainage and re-expansion of the affected lung, addressing the underlying issue causing the absent breath sounds. Option A) Bronchodilators would not be the appropriate treatment for absent breath sounds due to a pneumothorax or hemothorax. Bronchodilators are typically used to treat conditions like asthma or COPD where there is bronchoconstriction, not for resolving issues related to lung collapse or fluid accumulation. Option B) Mechanical ventilation would be necessary if the patient's respiratory status deteriorates to the point where they are unable to ventilate adequately on their own. However, it is not the primary treatment for resolving absent breath sounds in the context of a pneumothorax or hemothorax. Option D) Cardiac tamponade treatment is unrelated to the management of absent breath sounds on the right side. Cardiac tamponade involves fluid accumulation around the heart, leading to impaired cardiac function, and would present with different clinical manifestations than absent breath sounds due to lung pathology. In an educational context, understanding the significance of absent breath sounds and the appropriate interventions is crucial for nurses and healthcare professionals caring for patients with respiratory issues. This knowledge is especially relevant for nurses preparing for the NCLEX exam, as they need to be able to differentiate between various respiratory conditions and understand the appropriate nursing interventions for each. Mastering this content ensures safe and effective patient care in clinical practice.

Correct Answer: D

Rationale: Long-term antibiotic therapy is needed for effective eradication of the infecting organisms in lung abscess. Chest physiotherapy and postural drainage are not recommended for lung abscess because they may lead to spread of the infection. Foul-smelling and bloody sputum are common clinical manifestations in lung abscess. Expectorants may be used because the patient is encouraged to cough.

Correct Answer: D

Rationale: The correct answer, D) Walk 15-20 minutes 3 times a week, is the most appropriate exercise regimen recommended for a COPD patient due to its emphasis on regular, moderate aerobic activity. Walking helps strengthen respiratory muscles, improves cardiovascular health, and enhances overall endurance without placing excessive stress on the lungs. This regimen strikes a balance between promoting physical activity and managing the potential limitations posed by COPD. Option A) Rest when short of breath is incorrect as it promotes a sedentary lifestyle, which can lead to deconditioning and worsen COPD symptoms. Option B) Limit to ADLs may not provide adequate cardiovascular exercise needed to improve oxygenation. Option C) High-intensity daily is not suitable for COPD patients as it can trigger severe shortness of breath and exacerbate symptoms. Educationally, it is crucial for healthcare providers to understand the significance of tailored exercise regimens for patients with COPD. By promoting evidence-based recommendations like walking 15-20 minutes 3 times a week, providers can empower patients to actively engage in managing their condition and improve their quality of life. Encouraging regular, moderate exercise not only benefits physical health but also promotes mental well-being and independence for individuals with COPD.