NR-324 Adult Health I - Set 2 - Part 1

Correct Answer: "Routine pneumococcal vaccination now begins at age fifty."

Current recommendations lowered the routine pneumococcal vaccination age to fifty for all adults who have not been vaccinated, with risk-based vaccination from nineteen for chronic disease or immunocompromise. This client qualifies by age alone. Option a is incorrect because sixty-five was the old threshold and has been superseded. Repeating the outdated age would leave this client unprotected for more than a decade against the most common cause of community-acquired pneumonia. Option b is incorrect because healthy adults are exactly who the routine age-based recommendation targets. Being free of chronic illness does not exempt anyone from vaccination once the fiftieth birthday has passed. Option d is incorrect because chronic conditions such as diabetes lower the recommended starting age to nineteen rather than raising it. Waiting for a disease to appear delays protection that is already indicated.

Correct Answer: Add a barrier method of contraception

Rifampin induces hepatic enzymes and reduces the effectiveness of oral contraceptives, so an additional barrier or alternative method is needed throughout therapy. The orange discoloration of body fluids is harmless and expected. Option b is incorrect because orange-red urine, sweat and tears are an expected, harmless effect of rifampin. Stopping the drug for this reason interrupts a six month regimen and invites drug resistance. Option c is incorrect because the timing of lens wear does not protect them. Rifampin stains soft lenses permanently, so the client should switch to disposable lenses or to glasses while taking the drug. Option d is incorrect because nurses do not adjust prescribed doses, and no reliable dose increase overcomes enzyme induction. Adding a second, non-hormonal method is the recommended approach during rifampin therapy.

Correct Answer: Assisting the client into an upright position

Positioning a client for comfort and easier breathing is a standard task within the scope of assistive personnel. Assessment, teaching and titration of a prescribed therapy stay with the registered nurse, who evaluates the response. Option a is incorrect because client education requires nursing knowledge and evaluation of understanding. The nurse teaches this breathing skill while the client is calm, then checks that it is performed correctly before relying on it. Option b is incorrect because titrating oxygen involves judgment about a target saturation of eighty eight to ninety two percent and about level of consciousness. That decision belongs to the nurse, not to unlicensed staff. Option d is incorrect because judging a change in sputum volume and purulence is assessment, and those are two of the three cardinal exacerbation symptoms. Interpreting them guides antibiotic and steroid decisions, so the nurse performs it.

Correct Answer: Positive, since ten millimetres applies to residents

Residents and employees of congregate settings such as long term care, and people with diabetes, are positive at ten millimetres or more. This resident falls into that group twice over, so eleven millimetres is positive. Option a is incorrect because fifteen millimetres is reserved for people with no identified risk factors at all. Both congregate living and diabetes move this resident to the lower ten millimetre cut-off. Option b is incorrect because no threshold is set at any induration whatsoever. The lowest cut-off in use is five millimetres, and it applies to HIV, recent close contacts and severely immunosuppressed clients. Option c is incorrect because diabetes raises the risk of progression to disease rather than producing spurious reactions. False positive skin tests come from prior BCG vaccination and from non-tuberculous mycobacteria.

Correct Answer: Directly observed therapy for every dose

Directly observed therapy, in which a health worker watches every dose swallowed, is the standard of care and is the answer whenever homelessness, substance use or prior non-adherence makes self-administration unreliable. Incomplete treatment breeds resistant disease. Option a is incorrect because a pill organiser still depends on the client remembering to open it every day. It is a useful adjunct but cannot verify that six months of doses were actually swallowed. Option b is incorrect because printed material addresses understanding, and this client's barrier is circumstance rather than knowledge. Written instructions are also easily lost by someone without stable housing or storage. Option d is incorrect because a reminder call requires a reachable telephone and proves nothing about ingestion. Public health uses observation, not prompting, when the consequence of failure is a drug-resistant strain.

Correct Answer: It generates extreme negative pressure that can injure lung tissue

Stripping or milking the tubing can generate enormously negative intrathoracic pressure, with figures near four hundred centimeters of water cited. That force can traumatize lung tissue and cause a pneumothorax, so the practice is prohibited. Option b is incorrect because the water seal and gravity drainage prevent backflow toward the chest as long as the unit stays upright and below chest level. Retrograde flow is not the hazard here. Option c is incorrect because squeezing the outside of the tubing does not open the system or introduce organisms. The danger is mechanical, arising from the suction force transmitted back into the pleural space. Option d is incorrect because the suction control water column is unaffected by handling of the drainage tubing. Its level is set deliberately by the nurse and changes only through evaporation or refilling.

Correct Answer: Salmeterol is for maintenance, and albuterol is my rescue drug.

Long acting beta agonists are maintenance drugs whose onset is too slow for rescue, and the course prints that they are not for acute attacks. The short acting agent stays with the client for sudden symptoms. Option a is incorrect because relying on a long acting agent during sudden breathlessness delays relief that albuterol delivers within minutes. That delay can allow a treatable episode to progress into a severe exacerbation. Option b is incorrect because this class is never used alone in asthma. Without a steroid the drug masks worsening inflammation while the client feels well, and that pattern carries a documented risk of severe exacerbations and death. Option d is incorrect because exercise related symptoms are prevented with the short acting inhaler shortly beforehand, or with an oral leukotriene modifier taken at least two hours ahead. Extra maintenance doses simply add tremor and tachycardia.

Correct Answer: Reposition the client and provide oral care

Repositioning and oral hygiene are routine comfort measures within assistive personnel scope. Suctioning, changing the ties and evaluating the stoma all require sterile technique or nursing judgment and stay with the nurse. Option a is incorrect because tracheostomy suctioning is a sterile procedure carrying real risk of hypoxemia and vagal bradycardia. Deciding when it is needed also demands assessment that unlicensed staff cannot perform. Option b is incorrect because a tie change can dislodge the tube if the faceplate is not held securely, so licensed staff perform it with new ties applied before old ones come off. Option c is incorrect because inspecting a stoma means interpreting skin changes, drainage and odor against earlier findings. That judgment is an assessment and belongs to the registered nurse alone.

Correct Answer: Give one hundred percent oxygen before suctioning

Pre-oxygenating with one hundred percent oxygen for thirty to sixty seconds is the single most effective step against suction induced hypoxemia, which is the commonest and most dangerous complication of the procedure. Option b is incorrect because suction is applied only on the way out, intermittently, while the catheter rotates. Applying it during insertion strips air from the airway and tears the tracheal lining. Option c is incorrect because the mouth is suctioned last, or with separate equipment. Moving a catheter from the oral cavity into the trachea carries mouth organisms straight into the lower airway. Option d is incorrect because thirty seconds of continuous suction removes far too much air and oxygen. Each pass is held to ten seconds, with a rest of thirty seconds to a minute between passes.

Correct Answer: An interferon gamma release blood test

An interferon gamma release assay needs one visit, has no reader subjectivity, and is not made falsely positive by prior BCG vaccination. It is now preferred over the skin test in most situations. Option a is incorrect because prior BCG vaccination can produce a reaction that the skin test cannot distinguish from true infection. Repeating the reading does not resolve that ambiguity for this client. Option b is incorrect because sputum examination diagnoses active disease in someone with symptoms and an abnormal film. Asymptomatic workplace screening looks for infection, and an asymptomatic person cannot usually produce sputum anyway. Option d is incorrect because imaging follows a positive screening result rather than replacing it. A film is normal in latent infection, so using it first would miss every person who carries dormant bacilli.

Correct Answer: The oral mucosa and the conjunctivae

Pigmentation, skin thickness and room lighting make facial skin unreliable, so central cyanosis is best judged at mucous membranes and conjunctivae. Cyanosis is still a late sign and never the nurse's first warning. Option a is incorrect because pigmented facial skin masks the blue grey color change, and poor room lighting compounds the problem. Many clients are missed entirely when the face is used for this judgment. Option c is incorrect because the back has thick, heavily pigmented skin and no thin mucosal surface where capillary blood can be seen. Turning the client to look there also wastes time. Option d is incorrect because color change confined to the extremities usually reflects cold or sluggish peripheral flow rather than desaturated arterial blood. That peripheral pattern can occur with a normal saturation.

Correct Answer: Take the quick relief inhaler and remeasure

Fifty to eighty percent of personal best is the yellow zone, a caution band. The client takes quick relief medicine now, continues the controllers, measures again after treatment and contacts the provider if symptoms persist. Option a is incorrect because emergency transport belongs to the red zone, below half of personal best, or to danger signs such as blue lips or being unable to walk and talk. Option b is incorrect because controller therapy continues through every zone and is never withdrawn when control is slipping. Removing the anti inflammatory drug while symptoms are increasing invites a full exacerbation within days. Option c is incorrect because a client does not independently change a prescribed steroid dose, and an inhaled steroid takes days to act. The immediate need is bronchodilation, which only quick relief medicine delivers.

Correct Answer: Collect the sputum specimen before the antibiotic

A culture drawn after antibiotics may be sterile and useless for identifying the organism. Because this client can cough and is stable, collecting the specimen first costs no time and does not delay therapy. Option b is incorrect because reversing the order sacrifices the only chance to identify the pathogen and later narrow the regimen. Antibiotics come first only when collecting the specimen would genuinely delay treatment. Option c is incorrect because saliva is not sputum and yields a worthless result. The client should rinse the mouth, take several deep breaths and cough deeply from the chest to raise a true specimen. Option d is incorrect because empiric treatment begins promptly once pneumonia is suspected and is never held pending imaging. Postponing both the culture and the drug leaves an infected client untreated for no benefit.

Correct Answer: Blood is passing alveoli that are filled with exudate

Consolidated alveoli are perfused but not ventilated, which is a shunt. Blood flows past fluid filled sacs and never contacts the added oxygen, so raising the flow rate alone does not correct the saturation. Option a is incorrect because a faulty probe signal produces an erratic or absent tracing rather than a stable number that persists through repeated flow changes. The clinical picture here matches the lung, not the device. Option b is incorrect because dead space means alveoli are ventilated but not perfused, the pattern seen in pulmonary embolism. Pneumonia does the opposite by filling air sacs while blood flow continues past them. Option d is incorrect because carbon dioxide narcosis causes drowsiness, flushing and a falling respiratory rate in a client who retains carbon dioxide. This client is alert and breathing comfortably without those findings.

Correct Answer: Support the position and encourage the breathing technique

Pursed lip breathing creates back pressure that splints collapsing airways open and slows exhalation, and the tripod position gives accessory muscles a fixed point. Both are effective self management and should be supported. Option b is incorrect because lying flat lets abdominal contents push the diaphragm upward and makes lung expansion mechanically harder. A client with airflow obstruction will become more breathless within moments of being laid down. Option c is incorrect because faster breathing shortens expiration and traps more air behind narrowed airways, worsening hyperinflation. The whole value of the technique lies in the prolonged, slow breath out. Option d is incorrect because nothing in this visit indicates hypoxemia or distress, and a high concentration mask is not the answer to a coping strategy that is already working well.

Correct Answer: Call the rapid response team and give oxygen

Loss of responsiveness with a falling heart rate means compensation has failed and the client is close to arrest. Emergency help and oxygen are needed now, before any further assessment is completed. Option a is incorrect because reducing oxygen to a client in late hypoxia removes the only support keeping tissue alive. This client has pneumonia without any stated history of carbon dioxide retention. Option b is incorrect because the quiet the nurse is seeing is not rest, it is a brain that has run out of oxygen. Delay here leads directly to respiratory and cardiac arrest. Option d is incorrect because a sedating medication would deepen the very depression of consciousness and heart rate that signals impending arrest. Drowsiness in this setting is a symptom, never an indication.

Correct Answer: Keep the client nothing by mouth

Nothing by mouth, not even water or oral medication, is the rule until a swallow screen is passed after a stroke. A wet sounding voice is a bedside cue of aspiration risk. Option a is incorrect because straws deliver a fast, poorly controlled bolus and are avoided in clients with impaired swallowing. Sips of thin water are among the most easily aspirated substances offered. Option b is incorrect because thickened liquids are prescribed by speech-language pathology after a formal swallow evaluation. A nurse cannot select a diet consistency for an unscreened client on the basis of a wet voice. Option c is incorrect because ice chips melt into thin liquid and carry the same aspiration hazard as water. Oral moisture can be supplied safely with sponge swabs and mouth care instead.

Correct Answer: Cover the site with a sterile dressing taped on three sides

A sterile occlusive dressing taped on three sides acts as a flutter valve. Air trapped in the pleural space escapes under the open edge on expiration, while atmospheric air cannot be drawn in on inspiration. Option a is incorrect because the provider is notified only after the site is covered. Leaving an open chest wound unsealed even briefly lets atmospheric air enter the pleural space with every breath. Option c is incorrect because a dressing sealed on all four sides traps air with no route of escape. Pressure then builds with each breath and can convert the injury into a tension pneumothorax. Option d is incorrect because submerging the tube end belongs to a different emergency, one where the tubing separates from the drainage unit. Here the tube is no longer in the client at all.

Correct Answer: Reduce the flow to hold the target saturation

The saturation is far above the eighty eight to ninety two percent target, so the oxygen is excessive. Flow is lowered to the minimum that holds that range while the nurse stays, obtains a blood gas and escalates. Option b is incorrect because stripping the oxygen away entirely swings the client from excess into hypoxemia. The correction is a controlled reduction to the lowest flow that maintains the target, with continuous observation of responsiveness. Option c is incorrect because drowsiness here comes from retained carbon dioxide, not from a lack of oxygen. Adding more would deepen the narcosis, and the flushed skin with a falling respiratory rate points to the same cause. Option d is incorrect because a client who cannot be roused is not simply asleep. Rising carbon dioxide produces exactly this picture, and delay allows progression toward respiratory arrest while the pulse oximeter still looks reassuring.

Correct Answer: It creates back pressure that splints airways open

Pursed lips raise pressure inside the airway during exhalation. That positive pressure holds floppy small airways open from within, preventing dynamic collapse, so more air leaves the lung and trapping, respiratory rate and panic all fall. Option a is incorrect because the technique is an exhalation maneuver and builds no inspiratory muscle strength. Diaphragmatic breathing retraining is the separate skill aimed at recruiting the diaphragm, and it is taught while the client is calm. Option b is incorrect because slow exhalation is what is coached, taking roughly twice as long to breathe out as to breathe in. Forcing air out quickly collapses the very airways this maneuver keeps open. Option d is incorrect because warming and humidifying inspired air is done by the nose and upper airway. Nothing about exhaling through narrowed lips conditions incoming gas, and the benefit described occurs entirely during expiration.