A client arrives with an upper respiratory infection and complains of otalgia, malaise, and nasal drainage. The client's temperature is 100.7 F. Which of the following will the nurse anticipate providing to the client?
Education about mastoidectomy
A referral for a hearing test
Education on administration of oral antibiotics
A prescription for an antifungal cream
The Correct Answer is C
Choice A reason: This is incorrect because education about mastoidectomy is not relevant for a client with an upper respiratory infection. Mastoidectomy is a surgical procedure that removes part or all of the mastoid bone behind the ear, which can become infected or inflamed due to chronic or recurrent middle ear infections. The nurse should assess the client's ear for signs of mastoiditis, such as swelling, tenderness, or redness behind the ear, but mastoidectomy is not a common or first-line treatment for upper respiratory infection.
Choice B reason: This is incorrect because a referral for a hearing test is not necessary for a client with an upper respiratory infection. Hearing test is a diagnostic tool that measures how well a person can hear different sounds at different frequencies and intensities. The nurse should ask the client about any changes in hearing or tinnitus, which are possible complications of upper respiratory infection, but a hearing test is not a routine or urgent intervention for this condition.
Choice C reason: This is correct because education on the administration of oral antibiotics can help treat an upper respiratory infection. Antibiotics are drugs that kill or inhibit bacteria that cause infections. Upper respiratory infections can be caused by various pathogens, such as viruses, bacteria, or fungi, but bacterial infections are more likely to cause fever, otalgia, or purulent nasal drainage. The nurse should instruct the client on how to take antibiotics as prescribed, such as dosage, frequency, duration, side effects, and interactions.
Choice D reason: This is incorrect because a prescription for an antifungal cream is not appropriate for a client
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
Choice A Reason: A distended bladder is one of the most common triggers of autonomic dysreflexia, which is a life-threatening condition that occurs in clients with spinal cord injuries above T-6. The bladder becomes overfilled and stimulates the sympathetic nervous system, causing vasoconstriction and hypertension.
Choice B Reason: A severe headache is one of the most common symptoms of autonomic dysreflexia, caused by the increased blood pressure in the brain. The headache may be accompanied by blurred vision, sweating, flushing, or anxiety.
Choice C Reason: An elevated blood pressure is the hallmark sign of autonomic dysreflexia, which can reach dangerously high levels and cause stroke, seizure, or death. The blood pressure may rise up to 300/160 mmHg or higher.
Choice D Reason: Nasal congestion is another possible trigger of autonomic dysreflexia, as it stimulates the nasal mucosa and activates the sympathetic nervous system. Other potential triggers include bowel impaction, skin irritation, tight clothing, or temperature changes.
Correct Answer is C
Explanation
Choice A Reason: This choice is incorrect. Inability to read is not a finding that the nurse should expect in a client who has meningitis, but rather a possible finding in a client who has a stroke or a brain tumor. Meningitis does not affect the language or cognitive functions, but rather the meninges or the membranes that cover the brain and spinal cord.
Choice B Reason: This choice is incorrect. Bruising around the eyes is not a finding that the nurse should expect in a client who has meningitis, but rather a possible finding in a client who has a basilar skull fracture or a head trauma. Meningitis does not cause bleeding or bruising, but rather inflammation and infection of the meninges.
Choice C Reason: This is the correct choice. A throbbing headache is a finding that the nurse should expect in a client who has meningitis, as it is one of the most common and characteristic symptoms. A throbbing headache is caused by increased intracranial pressure and irritation of the meninges due to inflammation and infection.
Choice D Reason: This choice is incorrect. A heart rate of 50 is not a finding that the nurse should expect in a client who has meningitis, but rather a possible finding in a client who has bradycardia or a slow heart rate. Meningitis does not affect the heart rate, but rather the temperature and blood pressure. The nurse should expect to see fever and hypotension in a client who has meningitis.
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