Question

The clinic nurse is caring for a client who came in to be tested for tuberculosis (TB). The client informs the nurse that they have received the bacille Calmette-Guérin (BCG) vaccine for TB in the past. Which initial test would be most appropriate?

Answer 1

Correct Answers:

QuantiFERON-TB Gold

Rationale :

✏️ QuantiFERON-TB Gold is an interferon-gamma release assay used to detect immune sensitization to Mycobacterium tuberculosis.

✏️ This blood test is preferred for a client who previously received the BCG vaccine because BCG does not cause a false-positive QuantiFERON result.

✏️ In contrast, the BCG vaccine can cause a false-positive Mantoux skin test, making the result more difficult to interpret.

✏️ QuantiFERON testing requires only one visit and does not require the client to return within 48 to 72 hours for interpretation.

✏️ A positive result indicates TB infection and requires additional evaluation to distinguish latent TB infection from active TB disease.

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Answer 2

Correct Answers:

Superior Vena Cava Syndrome (SVC)

Rationale :

♦️ Superior vena cava syndrome occurs when a tumor or thrombus compresses or obstructs the superior vena cava.

♦️ Obstruction prevents normal venous return from the head, neck, upper extremities, and upper chest to the heart.

♦️ Expected findings include distended jugular veins, facial or upper-extremity swelling, dyspnea, cough, headache, and engorged chest veins.

♦️ Respiratory distress may worsen rapidly because venous congestion can contribute to airway edema and impaired cerebral circulation.

♦️ The nurse should elevate the head of the bed, support oxygenation, and urgently notify the healthcare team because SVC syndrome is an oncologic emergency.

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Answer 3

Correct Answers:

Place in prone position

Rationale :

🖍️ Prone positioning is indicated for a mechanically ventilated client with severe ARDS and worsening hypoxemia despite increased oxygen and PEEP.

🖍️ Turning the client prone recruits previously collapsed dorsal alveoli and improves ventilation of lung regions that continue to receive substantial blood flow.

🖍️ This positioning improves ventilation-perfusion matching, decreases intrapulmonary shunting, and can improve oxygenation.

🖍️ Proning also distributes mechanical stress more evenly throughout the lungs, reducing ventilator-associated lung injury.

🖍️ Evidence supports prolonged prone sessions for appropriately selected clients with moderate-to-severe ARDS when performed by a trained critical care team.

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Answer 4

Correct Answers:

"This screening is used to detect new cancer early, even if you do not have symptoms."

Rationale :

🌹 A routine mammogram is a screening test designed to identify breast abnormalities before symptoms become apparent.

🌹 A history of ovarian cancer does not eliminate the possibility of developing a new primary breast cancer.

🌹 Certain inherited mutations, particularly BRCA1 and BRCA2, may increase the risks of both ovarian and breast cancers.

🌹 Early detection can allow treatment at a less advanced stage and may improve the range of available treatment options.

🌹 The response accurately explains the purpose of screening without falsely promising that the test will prevent cancer.

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Answer 5

Correct Answers:

"Fluticasone causes fewer systemic adverse reactions."

Rationale :

✍️ Fluticasone is an inhaled corticosteroid that delivers anti-inflammatory medication directly into the respiratory tract.

✍️ Local administration reduces airway inflammation, edema, mucus production, and bronchial hyperresponsiveness.

✍️ Because less medication reaches the systemic circulation than with oral or intravenous corticosteroids, it generally causes fewer systemic adverse effects.

✍️ The client must still rinse the mouth after inhalation to reduce the risk of oral candidiasis and dysphonia.

✍️ Fluticasone is used regularly for long-term control rather than for immediate relief of acute bronchospasm.

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Answer 6

Correct Answers:

New-onset shortness of breath with decreased oxygen saturation

Rationale :

⚽ New-onset dyspnea with decreased oxygen saturation indicates impaired gas exchange and requires immediate assessment and intervention.

⚽ Following thoracoscopy, this finding may signal pneumothorax, hemothorax, lung collapse, bleeding, or worsening pleural fluid accumulation.

⚽ The nurse should promptly assess respiratory effort, breath sounds, oxygen saturation, chest symmetry, and any chest drainage system.

⚽ Supplemental oxygen should be provided as prescribed while the healthcare provider or rapid response team is notified.

⚽ Airway and breathing take priority because untreated postoperative respiratory compromise can rapidly become life-threatening.

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Answer 7

Correct Answers:

Slow down the blood transfusion rate.

Rationale :

🧿 Dyspnea, hypertension, and pulmonary crackles during a transfusion strongly suggest transfusion-associated circulatory overload, which causes cardiogenic pulmonary edema.

🧿 Among the listed choices, slowing the transfusion most directly reduces the ongoing rate of circulatory volume administration.

🧿 The nurse should position the client upright, provide oxygen, assess vital signs, and anticipate prescribed diuretic therapy.

🧿 The healthcare provider and blood bank must also be notified so that the reaction can be evaluated and documented.

🧿 Clinically, the transfusion should be stopped immediately rather than merely slowed, making the question’s available responses imperfect; stopping the transfusion is the accepted first action for suspected TACO.

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Answer 8

Correct Answers:

Provide continuous pain management

Rationale :

🍊 The primary goal of hospice care is to maximize comfort and quality of life rather than cure the terminal illness.

🍊 Intermittent discomfort should be prevented and controlled through regularly scheduled analgesics, breakthrough medication, and ongoing reassessment.

🍊 Continuous pain management maintains a stable therapeutic medication level and reduces cycles of severe pain followed by delayed relief.

🍊 The nurse should individualize care according to the client’s reported symptoms, preferences, alertness, and desired level of activity.

🍊 Effective symptom control supports dignity and allows the client to use available energy for meaningful interactions and personal priorities.

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Answer 9

Correct Answers:

"I should not get into a hot tub while wearing the patch."

Rationale :

🏵️ External heat can increase blood flow to the skin and accelerate the release and absorption of transdermal fentanyl.

🏵️ Excessive absorption can cause profound sedation, respiratory depression, overdose, and death.

🏵️ The client should avoid hot tubs, saunas, heating pads, electric blankets, heat lamps, and very hot baths while wearing the patch.

🏵️ Fever should also be reported because elevated body temperature may increase fentanyl absorption.

🏵️ Avoiding a hot tub demonstrates correct understanding of a critical fentanyl patch safety precaution.

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Answer 10

Correct Answers:

Allergy

Rationale :

🌸 A Type I hypersensitivity reaction is an immediate allergic reaction mediated primarily by immunoglobulin E.

🌸 Initial exposure stimulates the production of IgE antibodies, which attach to mast cells and basophils.

🌸 Re-exposure causes these cells to release histamine and other inflammatory mediators.

🌸 Histamine produces vasodilation and increased capillary permeability, resulting in urticaria, itching, redness, and localized swelling.

🌸 Severe systemic Type I reactions may progress to angioedema, bronchospasm, hypotension, and anaphylaxis.

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QLexNursing

1 :
The clinic nurse is caring for a client who came in to be tested for tuberculosis (TB). The client informs the nurse that they have received the bacille Calmette-Guérin (BCG) vaccine for TB in the past. Which initial test would be most appropriate?

2 :
The nurse enters the room of a client with advanced-stage breast cancer to find the client with distended jugular veins and is struggling to breathe. The nurse knows that these symptoms indicate the development of what oncologic emergency?

4 :
A client with a history of ovarian cancer is scheduled for a routine mammogram. The client asks the nurse, "Why do I still need cancer screenings if I already had cancer before?" Which response by the nurse is most appropriate?

5 :
The nurse is completing teaching on a client being discharged on fluticasone. Which statement by the nurse explains the advantage fluticasone has over other corticosteroids?

6 :
A nurse is caring for a client who underwent a thoracoscopy earlier in the day for management of a pleural effusion. The client now reports increasing discomfort at the procedure site. Which assessment finding requires the nurse's immediate priority attention?

7 :
A nurse is monitoring a client who is receiving a blood transfusion. The client suddenly develops dyspnea, increased blood pressure, and crackles in the lungs. Which action should the nurse take first in response to these symptoms?

8 :
A client receiving hospice services after terminating cancer treatment reports intermittent discomfort and varying energy levels. When planning care, which nursing intervention should the nurse identify as the priority?

9 :
The nurse is teaching a patient with cancer about the fentanyl patch. Which statement by the patient indicates understanding of the teaching?

10 :
A client presents to the emergency department stating that they developed hives overnight. The nurse's inspection confirms the presence of urticaria. The nurse knows that this is a Type 1 hypersensitivity. (One word)

QLexNursing

1 : The clinic nurse is caring for a client who came in to be tested for tuberculosis (TB). The client informs the nurse that they have received the bacille Calmette-Guérin (BCG) vaccine for TB in the past. Which initial test would be most appropriate?

2 : The nurse enters the room of a client with advanced-stage breast cancer to find the client with distended jugular veins and is struggling to breathe. The nurse knows that these symptoms indicate the development of what oncologic emergency?

4 : A client with a history of ovarian cancer is scheduled for a routine mammogram. The client asks the nurse, "Why do I still need cancer screenings if I already had cancer before?" Which response by the nurse is most appropriate?

5 : The nurse is completing teaching on a client being discharged on fluticasone. Which statement by the nurse explains the advantage fluticasone has over other corticosteroids?

6 : A nurse is caring for a client who underwent a thoracoscopy earlier in the day for management of a pleural effusion. The client now reports increasing discomfort at the procedure site. Which assessment finding requires the nurse's immediate priority attention?

7 : A nurse is monitoring a client who is receiving a blood transfusion. The client suddenly develops dyspnea, increased blood pressure, and crackles in the lungs. Which action should the nurse take first in response to these symptoms?

8 : A client receiving hospice services after terminating cancer treatment reports intermittent discomfort and varying energy levels. When planning care, which nursing intervention should the nurse identify as the priority?

9 : The nurse is teaching a patient with cancer about the fentanyl patch. Which statement by the patient indicates understanding of the teaching?

10 : A client presents to the emergency department stating that they developed hives overnight. The nurse's inspection confirms the presence of urticaria. The nurse knows that this is a Type 1 hypersensitivity. (One word)

1 :
The clinic nurse is caring for a client who came in to be tested for tuberculosis (TB). The client informs the nurse that they have received the bacille Calmette-Guérin (BCG) vaccine for TB in the past. Which initial test would be most appropriate?

2 :
The nurse enters the room of a client with advanced-stage breast cancer to find the client with distended jugular veins and is struggling to breathe. The nurse knows that these symptoms indicate the development of what oncologic emergency?

4 :
A client with a history of ovarian cancer is scheduled for a routine mammogram. The client asks the nurse, "Why do I still need cancer screenings if I already had cancer before?" Which response by the nurse is most appropriate?

5 :
The nurse is completing teaching on a client being discharged on fluticasone. Which statement by the nurse explains the advantage fluticasone has over other corticosteroids?

6 :
A nurse is caring for a client who underwent a thoracoscopy earlier in the day for management of a pleural effusion. The client now reports increasing discomfort at the procedure site. Which assessment finding requires the nurse's immediate priority attention?

7 :
A nurse is monitoring a client who is receiving a blood transfusion. The client suddenly develops dyspnea, increased blood pressure, and crackles in the lungs. Which action should the nurse take first in response to these symptoms?

8 :
A client receiving hospice services after terminating cancer treatment reports intermittent discomfort and varying energy levels. When planning care, which nursing intervention should the nurse identify as the priority?

9 :
The nurse is teaching a patient with cancer about the fentanyl patch. Which statement by the patient indicates understanding of the teaching?

10 :
A client presents to the emergency department stating that they developed hives overnight. The nurse's inspection confirms the presence of urticaria. The nurse knows that this is a Type 1 hypersensitivity. (One word)