A nurse in an emergency department (ED) is admitting a client.
Exhibits
Select 4 findings in the client's medical record that place them at risk for pneumonia.
Pneumococcal vaccine
Level of consciousness
Influenza vaccine
Health history
Fluid intake
Age
Smoking history
Correct Answer : A,C,E,F
A. The client has not received pneumococcal vaccine, which increases susceptibility to pneumococcal pneumonia.
B. The client is oriented to time place and person which is normal.
C. The client has not received influenza vaccine, which increases susceptibility to pneumococcal pneumonia.
D. The client has no significant health history other than the primary concern.
E. The client's fluid intake seems to be reduced, as indicated by their decreased urination and reports of not drinking much water due to a sore throat, which can contribute to the risk of infection.
F. Being 70 years old increases susceptibility to respiratory infections like pneumonia.
G. No history of smoking reduces risk compared to smokers, but is still a risk factor in pneumonia development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Dismissing the client's feelings does not address the client's anxiety.
B. Comparing the client to others does not address her individual concerns and may feel dismissive.
C. Asking "why" questions can come across as judgmental and may not encourage open communication.
D. Encouraging the client to express her concerns is a therapeutic communication technique that validates her feelings and can help reduce anxiety.
Correct Answer is ["B","C","E"]
Explanation
A. Providing information on medication effects is within the nurse's scope of practice and does not typically require social work involvement.
B. Client B, who is hospitalized and wishes to keep up with school assignments, may need assistance with educational continuity plans.
C. Securing an emergency notification system involves social services to assess and arrange appropriate services.
D. Providing breastfeeding instructions is part of nursing care and does not typically require social work involvement.
E. Placement in an assisted living facility requires social work assistance to coordinate appropriate care and transition.
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