Nursing Elites

1. A nurse cares for a female client who has a family history of cystic fibrosis. The client asks, Will my children have cystic fibrosis? How should the nurse respond?

• A. Since many of your family members are carriers, your children will also be carriers of the gene.
• B. Cystic fibrosis is an autosomal recessive disorder. If you are a carrier, your children will have the disorder.
• C. Since you have a family history of cystic fibrosis, I would encourage you & your partner to be tested.
• D. Cystic fibrosis is caused by a protein that controls the movement of chloride. Adjusting your diet will decrease the spread of this disorder.

Correct answer: C

Rationale: Cystic fibrosis is an autosomal recessive disorder in which both gene alleles must be mutated for the disorder to be expressed. The nurse should encourage both the client & partner to be tested for the abnormal gene. The other statements are not true.

2. A client with chronic obstructive pulmonary disease (COPD tells the nurse, 'I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up.' Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

• A. Maintaining a semi-Fowler's position as often as possible
• B. Administering oxygen via nasal cannula at 2 L/min
• C. Helping the client select a low-salt diet
• D. Encouraging the client to drink 2 to 3 L of water daily

Correct answer: D

Rationale: Encouraging the client to drink 2 to 3 liters of water daily helps to thin bronchial secretions, making them easier to expectorate. This can assist the client in coughing up the tenacious secretions. Maintaining a semi-Fowler's position can aid in improving lung expansion but may not directly address the issue of clearing the secretions. Administering oxygen via nasal cannula at 2 L/min can help improve oxygenation but does not specifically target the removal of bronchial secretions. Selecting a low-salt diet is important for overall health, but it does not directly address the client's immediate concern of clearing the bronchial secretions.

3. A healthcare provider assesses a client with pneumonia. Which clinical manifestation should the provider expect to find?

• A. Fremitus
• B. Hyperresonance
• C. Dullness on percussion
• D. Decreased tactile fremitus

Correct answer: C

Rationale: Pneumonia often leads to the consolidation of lung tissue, resulting in dullness on percussion. This occurs due to the presence of fluid or inflammatory material in the alveoli. Fremitus and decreased tactile fremitus are more indicative of conditions like pleural effusion or pneumothorax, where there is an increase in the density of the pleural space or air in the pleural cavity. Hyperresonance, on the other hand, is typically associated with conditions causing air trapping, such as emphysema, where there is increased air in the alveoli.

4. A student is practicing suctioning a tracheostomy in the skills laboratory. What action by the student demonstrates that more teaching is needed?

• A. Applying suction while withdrawing the catheter
• B. Preoxygenating the client before suctioning
• C. Suctioning up to three times if necessary
• D. Suctioning for a duration of 10 to 15 seconds each time

Correct answer: A

Rationale: The correct technique for suctioning a tracheostomy involves applying suction while withdrawing the catheter to avoid damaging the tracheal mucosa. Therefore, the student applying suction while inserting the catheter indicates a need for further teaching. Preoxygenating the client, suctioning up to three times if necessary, and limiting suctioning to 10 to 15 seconds each time are all appropriate actions in tracheostomy suctioning.

5. A client with hypertension is being taught about lifestyle modifications. Which statement by the client indicates a need for further teaching?

• A. I will reduce my sodium intake to help control my blood pressure.
• B. I need to start walking at least 30 minutes most days of the week.
• C. I can continue drinking alcohol as long as it is not in excess.
• D. I will check my blood pressure regularly at home.

Correct answer: C

Rationale: In hypertension management, it is crucial for clients to limit or avoid alcohol consumption, not just refrain from excess. Alcohol can raise blood pressure and interfere with the effectiveness of antihypertensive medications, making it a key lifestyle modification for individuals with hypertension.

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