The nurse recognizes that the primary physiologic problem affecting clients with emphysema is:

Increase in cellular size of the bronchi and bronchioles.

Overexpansion of the diaphragm.

A decreased ability to inhale.

Destruction of alveolar walls and loss of lung elasticity.

Answer and Explanation

The Correct Answer is D

Choice A reason:

An increase in cellular size of the bronchi and bronchioles is not the primary issue in emphysema. Emphysema primarily affects the alveoli, the tiny air sacs in the lungs, rather than the bronchi and bronchioles.

Choice B reason:

Overexpansion of the diaphragm is not a primary problem in emphysema. While the diaphragm may become flattened due to hyperinflation of the lungs, this is a secondary effect rather than the primary issue.

Choice C reason:

A decreased ability to inhale is not the main problem in emphysema. The primary issue is difficulty exhaling due to the loss of elasticity in the alveolar walls, which leads to air trapping and hyperinflation

Choice D reason:

Destruction of alveolar walls and loss of lung elasticity is the primary physiologic problem in emphysema. This destruction leads to reduced surface area for gas exchange and impaired lung function. The loss of elasticity makes it difficult for the lungs to expel air, leading to air trapping and hyperinflation.

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Correct Answer is B

Explanation

Choice A reason: Suctioning the client at least every two hours is not typically necessary for a non-productive cough. Suctioning is more appropriate for patients with excessive secretions that they cannot clear on their own. Overuse of suctioning can cause irritation and discomfort.

Choice B reason: Encouraging fluids up to 3000 mL/day unless contraindicated is crucial for a client with pneumonia. Adequate hydration helps to thin mucus, making it easier to expectorate and clear from the lungs. This can improve the client’s ability to cough effectively and reduce the risk of complications such as atelectasis. Hydration also supports overall bodily functions and helps in maintaining electrolyte balance.

Choice C reason: Encouraging a right side-lying position is not the best intervention for a client with right lower lobe pneumonia. This position may not promote optimal lung expansion and drainage. Instead, positioning the client to maximize lung expansion and facilitate drainage, such as sitting up or lying on the unaffected side, is more beneficial.

Choice D reason: Administering codeine elixir PRN following prescription is not the priority intervention. While codeine can help suppress a cough, it is generally not recommended for a non-productive cough in pneumonia because it can suppress the cough reflex needed to clear secretions. Additionally, codeine can cause respiratory depression and other side effects.

A. Covers the mouth and nose when coughing. B. Reports daily to the public health department. C. Demonstrates correct use of the N95 mask. D. Washes dishes and personal items after use.

Correct Answer is A

Explanation

Choice A reason: Covering the mouth and nose when coughing is a critical measure to prevent the spread of tuberculosis (TB). TB is primarily transmitted through airborne particles when an infected person coughs, sneezes, or talks. By covering the mouth and nose, the client reduces the risk of spreading the bacteria to others, which is a fundamental goal of TB transmission education.

Choice B reason: Reporting daily to the public health department is important for monitoring and managing TB treatment, but it does not directly relate to preventing the transmission of TB. This action is more about ensuring adherence to treatment protocols and monitoring the client’s health status.

Choice C reason: Demonstrating correct use of the N95 mask is also crucial in preventing the spread of TB, especially in healthcare settings or when the client is in close contact with others. The N95 mask filters out airborne particles, including TB bacteria, thereby reducing the risk of transmission. However, this measure is typically emphasized in specific situations rather than as a general practice for all clients with TB.

Choice D reason: Washing dishes and personal items after use is good hygiene practice but is not specifically related to the transmission of TB. TB is not spread through contact with dishes or personal items but through airborne particles.

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The nurse recognizes that the primary physiologic problem affecting clients with emphysema is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The client has right lower lobe pneumonia with a non-productive cough. Which intervention is the nurse’s priority?

Correct Answer is B

Explanation

The nurse recognizes that the goals of teaching about the transmission of tuberculosis have been met when the client with tuberculosis:

Correct Answer is A

Explanation

The client diagnosed with pneumonia develops pleuritic chest pain. Which nursing action should the nurse implement at this time?

The nurse recognizes that the client is manifesting early signs of hypoxia with findings of:

The nurse is assisting the client with arm and shoulder exercises on the first post-op day following a right-sided thoracotomy. The client reports pain with the exercise and wants to know why they must be performed. What explanation should the nurse provide? The exercises:

The nurse recognizes which of the following tests will confirm the diagnosis of tuberculosis for a client?

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The nurse is reviewing newly written prescriptions for a client diagnosed with acute bronchitis. The client has a productive cough with green sputum and shortness of breath. The nurse would question the primary care provider regarding which medication order?