Question

A Client has a medication available that is 20 mg/kg. The client weighs 176 lbs. How many mg will the client receive?

Answer 1

Correct Answers:

1600

Rationale :

🔶Step 1: Convert pounds to kilograms

🔶Weight in kg=Weight in lb /2.2

🔶176÷2.2=80 kg

🔶Step 2: Calculate the medication dose

🔶Dose=Ordered dose in mg/kg× Weight in kg

🔶20 mg/kg×80 kg

📍1,600 mg

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 2

Correct Answers:

Need for suctioning.

Rationale :

✅ Following a total laryngectomy, maintaining a patent airway is the highest priority because the client breathes exclusively through the permanent neck stoma.

✅ Postoperative edema, blood, and thick respiratory secretions can accumulate within the airway and cause partial or complete obstruction, making frequent airway assessment essential.

✅ The nurse should monitor for audible secretions, increased work of breathing, decreased oxygen saturation, ineffective coughing, and visible mucus within the stoma, which may indicate a need for suctioning.

✅ Suctioning should be performed when clinically indicated because excessive or routine unnecessary suctioning can cause mucosal trauma, bleeding, hypoxemia, and irritation.

✅ Using the airway-breathing-circulation priority framework, recognizing the need for suctioning takes precedence over dressing integrity, IV patency, and pain assessment when airway compromise is possible.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 3

Correct Answers:

Mask

Rationale :

➡️ Influenza is primarily transmitted through respiratory droplets generated when an infected person coughs, sneezes, talks, or has close contact with others.

➡️ Having the client wear a surgical or procedure mask provides source control by limiting the dispersal of infectious respiratory droplets into the surrounding environment.

➡️ A mask is particularly important when the client must leave the room for medically necessary transport or procedures.

➡️ Healthcare personnel caring for a client with influenza should follow droplet precautions in addition to standard precautions and use appropriate PPE based on anticipated exposure.

➡️ Therefore, among the options provided, a mask is the most appropriate item for the client to wear to reduce influenza transmission.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 4

Correct Answers:

Instruct the client to post "No Smoking" signs near the front door and bedroom and advise all household members and visitors to smoke outside.

Rationale :

↪️ Supplemental oxygen does not itself burn, but it strongly supports combustion, causing flammable materials to ignite more easily and burn more rapidly.

↪️ Smoking near an oxygen source creates a serious risk of fire, burns, explosion, and injury to the client and others in the home.

↪️ Posting clearly visible “No Smoking” signs reminds household members and visitors that smoking must never occur near oxygen equipment.

↪️ The client should also keep oxygen equipment away from open flames, candles, gas stoves, fireplaces, sparks, and other heat sources, and smoking should occur only well away from the oxygen system.

↪️ Because preventing ignition is essential during home oxygen therapy, strict smoking and fire-safety precautions are among the most important discharge instructions.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 5

Correct Answers:

Brush the client's teeth with a suction toothbrush every 12hr.

Rationale :

*️⃣ Ventilator-associated pneumonia develops partly because pathogenic microorganisms colonize the mouth and oropharynx and can be aspirated around the endotracheal tube into the lower respiratory tract.

*️⃣ Regular oral hygiene using a toothbrush and suction system helps remove dental plaque, oral secretions, and bacterial biofilm that can contribute to respiratory infection.

*️⃣ Suction during oral care is particularly important because an intubated client may have an impaired ability to swallow or clear secretions independently.

*️⃣ Oral care should be incorporated into a broader VAP-prevention strategy that includes measures such as head-of-bed elevation, appropriate suctioning, minimizing unnecessary sedation, and daily assessment for ventilator liberation when appropriate.

*️⃣ Therefore, brushing the client's teeth with a suction toothbrush every 12 hours is the best option listed for directly reducing oropharyngeal bacterial burden and aspiration risk.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 6

Correct Answers:

Attach a humidifier bottle to the base of the flow meter.

Rationale :

💠 Oxygen delivered by nasal cannula at 5 L/min can dry the nasal and upper-airway mucosa because the continuous gas flow increases evaporation from mucous membranes.

💠 Adding prescribed humidification introduces moisture into the oxygen stream and can improve comfort while reducing nasal dryness, irritation, and thickening of secretions.

💠 Humidification is especially useful when oxygen is delivered at higher nasal-cannula flow rates or for prolonged periods, because mucosal dryness becomes more likely.

💠 The humidifier bottle should be connected correctly to the oxygen flow system and maintained according to infection-control and equipment-safety procedures.

💠 Therefore, attaching a humidifier bottle to the flow meter is the most appropriate action among the listed options for a client receiving 5 L/min by nasal cannula.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 7

Correct Answers:

Submerge the distal end of the disconnected chest tube in sterile water to restore the water seal temporarily.

Rationale :

❇️ When a chest tube becomes disconnected from the drainage system, the immediate concern is preventing atmospheric air from entering the pleural space while maintaining a route for air to escape.

❇️ Placing the distal end of the chest tube approximately 2 cm below the surface of sterile water temporarily recreates a one-way water seal until a new sterile drainage system can be connected.

❇️ This intervention allows pleural air to exit during expiration while helping prevent outside air from being sucked back into the thoracic cavity during inspiration.

❇️ The nurse should then assess the client's respiratory status, oxygen saturation, breath sounds, tube integrity, and signs of worsening pneumothorax, while obtaining a replacement drainage system promptly.

❇️ Because the client is already becoming restless, tachypneic, and tachycardic, rapid restoration of the water seal is essential to limit further respiratory compromise.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 8

Correct Answers:

Influenza typically causes systemic symptoms like fever and muscle aches, while rhinitis usually involves localized nasal symptoms without fever.

Rationale :

🌸 Influenza is an acute viral respiratory illness that commonly causes prominent systemic manifestations such as fever, chills, myalgia, headache, fatigue, and malaise, often with cough and sore throat.

🌸 Rhinitis primarily affects the nasal mucosa and more commonly causes nasal congestion, rhinorrhea, sneezing, nasal itching, and postnasal drainage.

🌸 Allergic rhinitis typically does not cause a significant fever or pronounced generalized muscle aches because it results from an IgE-mediated allergic inflammatory response rather than systemic viral infection.

🌸 Influenza symptoms often begin abruptly and can cause significant constitutional illness, whereas uncomplicated rhinitis is usually dominated by localized upper-airway complaints.

🌸 Therefore, recognizing the presence of system is a useful clinical clue favoring influenza over uncomplicated rhinitis.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 9

Correct Answers:

Inform the client to report any changes in vision promptly, as ethambutol can cause optic neuritis.

Rationale :

❣️ Ethambutol can cause optic neuritis, making visual assessment one of the most important safety considerations during therapy.

❣️ The client should immediately report blurred vision, decreased visual acuity, difficulty distinguishing red from green, or other changes in color perception.

❣️ Baseline and periodic visual-acuity and color-vision testing may be performed during treatment, particularly when therapy is prolonged.

❣️ Early recognition is important because continued exposure after visual toxicity develops can increase the risk of persistent visual impairment.

❣️ Promptly reporting changes in vision is therefore the highest-priority teaching for safe ethambutol therapy.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Answer 10

Correct Answers:

The client will need further assessment and testing to determine if they have latent or active tuberculosis

Rationale :

✳️ A positive PPD indicates TB infection or immune sensitization, but it does not by itself distinguish latent tuberculosis infection from active disease.

✳️ The client requires additional assessment, including symptom review and typically a chest radiograph, with sputum testing if active pulmonary TB is suspected.

✳️ Clients with latent TB are infected but do not have active disease manifestations and are generally not contagious.

✳️ Clients with active TB require multidrug therapy and appropriate infection-control measures, whereas latent TB is treated with a preventive regimen.

✳️ Further evaluation must therefore occur before determining the correct treatment plan.

Distractor Analysis :

Rationale for Incorrect Options to be Available Soon

Custom N331 Exam 2 FA26 Minton_Assessment

No.

1 :
A Client has a medication available that is 20 mg/kg. The client weighs 176 lbs. How many mg will the client receive?

2 :
A nurse is caring for a client following a total laryngectomy. Which of the following is the priority observation in the client's care?

3 :
A nurse is caring for a client who has influenza, Which of the following personal protective equipment (PPE) should the nurse instruct the client to wear?

4 :
A nurse is preparing to discharge a client with COPD who has been prescribed home oxygen therapy. Which of the following instructions should the nurse prioritize to ensure the client's safety and reduce the risk of fire-related accidents?

5 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia?

6 :
A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take?

8 :
A nurse is educating a client about the differences between influenza and rhinitis. Which statement by the client indicates a correct understanding of the differences between these two conditions?

9 :
A nurse is educating a client who has been prescribed ethambutol for tuberculosis. Which instruction should the nurse prioritize to ensure the client's safety and treatment effectiveness?

10 :
A client arrives at the clinic for follow up after being exposed to active tuberculosis from a neighbor. The PPD (purified protein derivative) skin test is positive. What education will the nurse provide next?

Connect With Us

Custom N331 Exam 2 FA26 Minton_Assessment

No.

1 : A Client has a medication available that is 20 mg/kg. The client weighs 176 lbs. How many mg will the client receive?

2 : A nurse is caring for a client following a total laryngectomy. Which of the following is the priority observation in the client's care?

3 : A nurse is caring for a client who has influenza, Which of the following personal protective equipment (PPE) should the nurse instruct the client to wear?

4 : A nurse is preparing to discharge a client with COPD who has been prescribed home oxygen therapy. Which of the following instructions should the nurse prioritize to ensure the client's safety and reduce the risk of fire-related accidents?

5 : A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia?

6 : A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take?

8 : A nurse is educating a client about the differences between influenza and rhinitis. Which statement by the client indicates a correct understanding of the differences between these two conditions?

9 : A nurse is educating a client who has been prescribed ethambutol for tuberculosis. Which instruction should the nurse prioritize to ensure the client's safety and treatment effectiveness?

10 : A client arrives at the clinic for follow up after being exposed to active tuberculosis from a neighbor. The PPD (purified protein derivative) skin test is positive. What education will the nurse provide next?

1 :
A Client has a medication available that is 20 mg/kg. The client weighs 176 lbs. How many mg will the client receive?

2 :
A nurse is caring for a client following a total laryngectomy. Which of the following is the priority observation in the client's care?

3 :
A nurse is caring for a client who has influenza, Which of the following personal protective equipment (PPE) should the nurse instruct the client to wear?

4 :
A nurse is preparing to discharge a client with COPD who has been prescribed home oxygen therapy. Which of the following instructions should the nurse prioritize to ensure the client's safety and reduce the risk of fire-related accidents?

5 :
A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following actions should the nurse take to reduce the risk of ventilator-associated pneumonia?

6 :
A nurse is caring for a client who has pneumonia and a prescription for oxygen therapy at 5 L/min via nasal cannula. Which of the following actions should the nurse take?

8 :
A nurse is educating a client about the differences between influenza and rhinitis. Which statement by the client indicates a correct understanding of the differences between these two conditions?

9 :
A nurse is educating a client who has been prescribed ethambutol for tuberculosis. Which instruction should the nurse prioritize to ensure the client's safety and treatment effectiveness?

10 :
A client arrives at the clinic for follow up after being exposed to active tuberculosis from a neighbor. The PPD (purified protein derivative) skin test is positive. What education will the nurse provide next?