A nurse is assessing a client who has pneumonia. Which of the following manifestations should the nurse expect?

Crackles.

Crepitus.

Stridor.

Decreased fremitus.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Crackles are adventitious lung sounds that can be heard on auscultation and are commonly associated with pneumonia. They are caused by the movement of air through fluid-filled or collapsed alveoli, indicating inflammation and infection in the lungs.

Choice B rationale:

Crepitus is a different respiratory finding and is not typically associated with pneumonia. Crepitus is a crackling or grating sensation that can be felt under the skin, often caused by subcutaneous emphysema or gas trapped in the tissues, not within the lungs.

Choice C rationale:

Stridor is a harsh, high-pitched sound heard during inspiration and is usually indicative of upper airway obstruction, not pneumonia. It can be caused by conditions such as croup or anaphylaxis.

Choice D rationale:

Decreased fremitus is not a specific manifestation of pneumonia. Fremitus is the vibration felt when the patient speaks and is transmitted through the chest wall. In pneumonia, increased fremitus may be observed due to the consolidation of lung tissue with fluid or pus, not decreased fremitus.

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Correct Answer is B

Explanation

Choice A rationale:
Providing a continuous passive motion (CPM) device is not necessary for a client following a total hip arthroplasty. CPM devices are more commonly used after knee arthroplasty to improve joint mobility.
Choice B rationale:
Ensuring the client has an elevated toilet seat at home is important following a total hip arthroplasty. The elevated seat reduces the amount of hip flexion required during toileting, which helps prevent hip dislocation and strain on the surgical site.
Choice C rationale:
Providing a trapeze bar is not essential for a client following a total hip arthroplasty. Trapeze bars are typically used to assist with repositioning in bed for clients with limited mobility, but they are not specific to hip arthroplasty recovery.
Choice D rationale:
Providing a compression garment is not necessary after total hip arthroplasty. Compression garments are often used for conditions like venous insufficiency or to manage swelling, but they are not routinely used for hip arthroplasty recovery.

A. "Administer this medication into your leg muscle.". B. "Expel the excess air in the syringe before you administer the medication.". C. "Insert the entire needle into your skin to administer medication completely.". D. "Take ibuprofen for fever following administration of this medication.".

Correct Answer is C

Explanation

Answer: C. "Insert the entire needle into your skin to administer medication completely."

Rationale:

A) "Administer this medication into your leg muscle."
Enoxaparin should be administered subcutaneously, typically in the abdominal area, not into a muscle. Injecting it intramuscularly can lead to unpredictable absorption and increase the risk of bleeding.

B) "Expel the excess air in the syringe before you administer the medication."
This statement is incorrect. For enoxaparin, it is recommended to retain the air bubble in the syringe. The air bubble helps ensure the entire dose is delivered and minimizes leakage at the injection site.

C) "Insert the entire needle into your skin to administer medication completely."
This is an appropriate instruction as it emphasizes the need to fully insert the needle for effective subcutaneous delivery of enoxaparin. Proper technique is essential to ensure the medication is administered as intended.

D) "Take ibuprofen for fever following administration of this medication."
This recommendation is not advisable because ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), can increase the risk of bleeding, especially when taken concurrently with enoxaparin. The client should consult their healthcare provider for safe alternatives for managing fever or pain.

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A nurse is assessing a client who has pneumonia. Which of the following manifestations should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

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Correct Answer is C

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