A charge nurse is planning a room assignment for a client who has a productive cough, a questionable chest x-ray, and a positive Mantoux test. Room 208 is a private, negative-pressure airflow room; room 212 is a semi-private, positive-pressure airflow room; 214 is a negative-pressure, semi-private room; and room 216 is a private, positive-pressure airflow room. To which of the following rooms should the nurse assign the client?

214

212

216

208

Answer and Explanation

The Correct Answer is D

A. 214: Although this is a negative-pressure room, it is semi-private, which is not ideal for clients with suspected tuberculosis or similar conditions requiring isolation due to airborne transmission.
B. 212: This is a positive-pressure room, which is not suitable for clients with suspected airborne infections, as it could potentially spread the infection to other areas.
C. 216: This is a private, positive-pressure airflow room, which is not appropriate for the client with suspected airborne infection due to potential cross-contamination risks.
D. 208: This is a private, negative-pressure airflow room, which is ideal for clients with suspected airborne infections, such as tuberculosis. Negative-pressure rooms prevent the spread of airborne pathogens to other areas.

Nursing Test Bank

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Correct Answer is C

Explanation

A. Acute pain manifested by client's report: This diagnosis is too general and does not address the specific issue of unknown etiology or the need for further investigation.
B. Acute pain related to psychosomatic condition: This diagnosis assumes a psychosomatic cause without sufficient evidence. The cause of the pain is not yet clear, so this may not be accurate.
C. Acute pain related to unknown etiology: This diagnosis accurately reflects the situation of pain with an unclear cause and is appropriate for guiding further assessment and investigation.
D. Acute pain related to unknown factors: This diagnosis is vague and less specific than "unknown etiology," which provides a clearer framework for understanding the cause of the pain.

A. Bronchial airway constriction B. Hypoglycemia C. Dilated pupils D. Decreased blood pressure

Correct Answer is C

Explanation

A. Bronchial airway constriction: During the fight-or-flight response, bronchial airways typically dilate to increase airflow to the lungs, not constrict.
B. Hypoglycemia: The fight-or-flight response typically increases blood glucose levels to provide quick energy, leading to hyperglycemia rather than hypoglycemia.
C. Dilated pupils: Pupils dilate during the fight-or-flight response to enhance vision and perception of potential threats. This is a correct manifestation of the stress response.
D. Decreased blood pressure: The fight-or-flight response usually causes an increase in blood pressure due to the release of adrenaline and other stress hormones that prepare the body for immediate action.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care to a client that has been having pain without a clear etiology. Which nursing diagnosis should the nurse write as most appropriate for this client?

Correct Answer is C

Explanation

A nurse is teaching a class about physical manifestations associated with the fight-or-flight response to stress. Which of the following manifestations should the nurse include?

Correct Answer is C

Explanation

A nurse is preparing a teaching plan for a client who is learning to walk with a cane. The nurse should identify that which of the following actions is a evaluation step of the teaching plan?

A nurse is teaching a class about stress. The nurse should include that which of the following is a manifestation of prolonged stress

A nurse is teaching a client how to walk using a walker. After showing the client the procedure, the nurse asks the client to perform the skill. Which of the following types of teaching strategies is the nurse utilizing?

The nurse working in the ER is admitting a toddler to the orthopedic unit. The parents and grandparents are at bedside. What should the nurse use as the best source of data for this client?

A nurse is preparing a teaching plan for a client who has diabetes mellitus. Which of the following actions should the nurse plan to take first?

Which of the following is essential when restraints are applied to a client?

36: A nurse is delegating care for a group of four clients. Which of the following tasks should the nurse delegate to an assistive person?

A nurse is about to perform postmortem care of a client. The family wishes to view the body. Which of the following actions should the nurse take? (Select All that Apply.)