Posted: January 10th, 2017

Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

An elderly client has been ill with the flu, experiencing headache, fever, and chills. After 3 days, she develops a cough productive of yellow sputum. The nurse auscultates her lungs and hears diffuse crackles. How would the nurse best interpret these assessment findings?

1. It is likely that the client is developing a secondary bacterial pneumonia.
2. The assessment findings are consistent with influenza and are to be expected.
3. The client is getting dehydrated and needs to increase her fluid intake to decrease secretions.
4. The client has not been taking her decongestants and bronchodilators as prescribed.

63.  Guaifenesin 300 mg four times daily has been ordered as an expectorant. The dosage strength of the liquid is 200mg/5ml. How many mL should the nurse administer each dose?

1. 5.0 ml
2. 7.5 ml
3. 9.5 ml
4. 10 ml

64.  Pseudoephedrine (Sudafed) has been ordered as a nasal decongestant. Which of the following is a possible side effect of this drug?

1. Constipation
2. Bradycardia
3. Diplopia
4. Restlessness

65.  A client with COPD reports steady weight loss and being “too tired from just breathing to eat.” Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client?

1. Altered nutrition: Less than body requirements related to fatigue.
2. Activity intolerance related to dyspnea.
3. Weight loss related to COPD.
4. Ineffective breathing pattern related to alveolar hypoventilation.