Robert, a 52-year-old male, comes to the ED with difficulty swallowing, a muffled voice, and facial swelling. His temperature is 102°F, and his WBC count is elevated. Past medical history includes recurrent strep throat infections, for which he's been noncompliant with antibiotics. What are the immediate nursing interventions for Robert who is suspected to have a peritonsillar abscess?

Initiate IV antibiotics.

Prepare the patient for incision and drainage (I&D)

Administer acetaminophen for fever.

Monitor airway patency continuously.

Answer and Explanation

Correct Answer : A,B,D

A.   Initiation of IV antibiotics is appropriate to treat the infection.

B.   Preparation for incision and drainage (I&D) is the immediate nursing intervention to relieve pressure, decrease the risk of airway compromise, and promote resolution of the abscess.
C.   Administering acetaminophen for fever is appropriate for symptomatic relief but is not the most immediate intervention for a suspected peritonsillar abscess.
D.   Continuous monitoring of airway patency is crucial due to the risk of airway compromise from the abscess.
E.   While obtaining blood for culture and sensitivity is important for determining appropriate antibiotic

Nursing Test Bank

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Correct Answer is C

Explanation

A. Transversus thoracis is involved in expiration rather than inspiration.

B. Internal intercostals primarily aid in forced expiration.

C. The diaphragm contracts and moves downward during inspiration, increasing the vertical dimensions of the thoracic cavity and allowing air to enter the lungs.
D. External intercostals help elevate the ribs during inspiration but do not contribute significantly to increasing the vertical dimensions of the thoracic cavity.

A. Cough assist machine B. Orthopedic shoes C. A manually operated wheelchair D. High-frequency chest wall oscillation device

Correct Answer is A

Explanation

A. A cough assist machine can help Alice clear secretions from her airways, reducing the risk of respiratory complications associated with spinal muscular atrophy.

B. Orthopedic shoes may help with support and stability but do not directly address Alice's respiratory needs.
C. While a wheelchair may be necessary for mobility, it does not address Alice's respiratory needs.
D. High-frequency chest wall oscillation devices are used to help clear mucus from the airways but may not be as appropriate for Alice's age and condition as a cough assist machine.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Emma, a 25-year-old athlete, undergoes a physical exam. During deep inspiration, which muscle is primarily responsible for increasing the vertical dimensions of her thoracic cavity?

Correct Answer is C

Explanation

Alice, 4, shows delays in reaching milestones like sitting and walking. Chetic testing confirms the SMN1 gene deletion characteristic of Spinal Muscular Atrophy. A pulmonary function test shows reduced FVC. Which piece of equipment would most benefit Alice at this stage?

Correct Answer is A

Explanation

Thomas, 42, with a past history of kidney stones, has been prescribed ciprofloxacin for a UTI. Lab values indicate normal renal function. What should be included in the teaching plan?

Jack, a 60-year-old man with a history of smoking and alcohol consumption, has been diagnosed with squamous cell carcinoma of the larynx. He is scheduled for a partial laryngectomy. What are the preoperative nursing interventions? Select all that apply.

Linda, 50, has a history of rheumatoid arthritis and Raynaud's phenomenon. She presents with muscle pain, weakness, and a hellotrope rash. Her lab tests show elevated levels of aldolase and antinuclear antibodies (ANA). What medication would best help control Linda's inflammatory myositis symptoms?

John, a 35-year-old male involved in a motor vehicle accident, presents with a contusion across his chest from the seatbelt. Which two combined assessments should the nurse prioritize to detect potential complications?

George, 65, has a 10-year history of diabetes mellitus. He complains of tingling sensations and numbness in his feet. His HbA1c is 9%, and a monofilament test reveals a loss of sensation. Which of the following interventions should be prioritized?

Sarah, a 42 year old woman, complains of rectal pain that worsens during bowel movements. She has no history of rectal or colon problems but has been taking profen regularly for chronic back pain. What could be a potential reason for her symptoms?

Samantha, a nurse in the post-operative ward, is going over recent lab results of a patient, Jane, who underwent abdominal surgery two days ago. Samantha notes an elevated C- reactive protein level. What clinical concern should Samantha prioritize based on this finding?

Betty, 52, presents with unexplained lymphadenopathy. Her biopsy tissue is sent for T- cell receptor (TCR) Gene Rearrangement testing. What is the main purpose of the TCR Gene Rearrangement test in Betty's diagnosis?