A patient, who is on complete bed rest following extensive surgery, begins to complain of chest pain and shortness of breath with hemoptysis.

His SO2 measures 90%. The nurse recognizes that the patient is most likely exhibiting signs and symptoms of which condition?

Deep vein thrombosis (DVT).

Pulmonary embolus (PE).

Anemia.

Right heart failure (RHF).

Answer and Explanation

The Correct Answer is B

Choice A rationale
Deep vein thrombosis (DVT) can lead to pulmonary embolism but does not directly cause chest pain and shortness of breath.
Choice B rationale
Pulmonary embolus (PE) is characterized by chest pain, shortness of breath, and hemoptysis (coughing up blood), especially in patients on bed rest.
Choice C rationale
Anemia can cause fatigue and shortness of breath but not typically chest pain and hemoptysis.
Choice D rationale
Right heart failure can cause shortness of breath and edema but not typically chest pain and hemoptysis.

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Correct Answer is A

Explanation

Choice A rationale
A respiratory rate of 28 breaths per minute indicates tachypnea, which is a sign of respiratory distress. Immediate intervention is needed to address the underlying cause and prevent further deterioration of the patient’s condition.
Choice B rationale
A temperature of 38°C (100.4°F) indicates a fever, which may suggest an infection. While this requires medical attention, it is not as immediately critical as respiratory distress.
Choice C rationale
A blood pressure of 140/90 mmHg is considered high, but it does not indicate an immediate need for intervention in the context of COPD. Hypertension should be managed, but it is not an acute emergency.
Choice D rationale
A heart rate of 90 beats per minute is within the normal range and does not indicate an immediate need for intervention. Monitoring the patient’s heart rate is important, but it is not an urgent concern in this scenario.

A. It takes about 14 days to develop antibodies and immunity to the disease after vaccine administration. B. The laboratory ran out of blood specimen tubes and is unable to perform the test today. C. It takes about 14 days to develop antigens and immunity to the disease after vaccine administration. D. After receiving the vaccine, you might transmit the communicable disease to the laboratory.

Correct Answer is A

Explanation

Choice A rationale
It takes about 14 days to develop antibodies and immunity to the disease after vaccine administration. This is why the patient is asked to return in 2 to 3 weeks for an antibody titer. The immune system needs time to respond to the vaccine and produce detectable levels of antibodies.
Choice B rationale
The laboratory running out of blood specimen tubes is not a valid reason for delaying the antibody titer. This choice does not provide an accurate explanation for the patient.
Choice C rationale
It takes about 14 days to develop antibodies, not antigens, and immunity to the disease after vaccine administration. This choice contains incorrect information about the immune response.
Choice D rationale
After receiving the vaccine, the patient is not likely to transmit the communicable disease to the laboratory. This choice does not provide a valid reason for delaying the antibody titer.

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A patient, who is on complete bed rest following extensive surgery, begins to complain of chest pain and shortness of breath with hemoptysis. His SO2 measures 90%. The nurse recognizes that the patient is most likely exhibiting signs and symptoms of which condition?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client with chronic obstructive pulmonary disease (COPD). Which of the following findings would indicate the need for immediate intervention?

Correct Answer is A

Explanation

After receiving a vaccination for a communicable disease, the patient was asked to return in 2 to 3 weeks to get an antibody titer and asks why blood testing can’t be done immediately.How should the RN (registered nurse) respond?

Correct Answer is A

Explanation

A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with increased shortness of breath and a productive cough. The nurse notes the client’s oxygen saturation is 88% on room air. Which of the following interventions should the nurse implement first?

A client with heart failure is experiencing shortness of breath and swelling in the lower extremities. Which of the following interventions should the nurse implement first?

A nurse is assessing a client with a temperature of 39°C (102.2°F) and a blood pressure of 90/60 mmHg. Which condition is the client most likely experiencing?

A patient with cerebral ischemia has signs and symptoms of right homonymous hemianopia and inability to move the right arm. This is indicative of increased intracranial pressure that is most probably due to a lesion in the:

A patient presents to his healthcare provider with complaints of severe epigastric pain. His lab work reveals high amylase and lipase levels. His diagnosis is most likely which condition?

A registered nurse (RN) would expect to find which sign and symptom (S&S) in the patient whose blood glucose level is 43 mg/dL?

A registered nurse (RN) is providing strategies for “better breathing” to a patient with emphysema. Successful teaching of this topic would be identified when the patient states that he will:

Which assessment data would indicate to the nurse that pharmacologic treatment with antibiotics and antacids has been effective for the patient diagnosed with peptic ulcer disease (PUD) secondary to H. pylori?

A patient, who is on complete bed rest following extensive surgery, begins to complain of chest pain and shortness of breath with hemoptysis.

His SO2 measures 90%. The nurse recognizes that the patient is most likely exhibiting signs and symptoms of which condition?