Nursing Elites

1. A nurse in a long-term care facility is auscultating the lung sounds of a client who reports shortness of breath and increased fatigue. The nurse should report which of the following to the provider after hearing this sound?

• A. Fine crackles
• B. Rhonchi
• C. Wheezing
• D. Stridor

Correct answer: A

Rationale: The correct answer is A: Fine crackles. Fine crackles suggest fluid in the lungs, which could indicate a serious respiratory issue like pulmonary edema. This sound should be reported to the provider for further evaluation and possible intervention. Rhonchi (choice B) are low-pitched wheezing sounds often caused by secretions in the larger airways, wheezing (choice C) is a high-pitched whistling sound usually caused by narrowed airways, and stridor (choice D) is a high-pitched sound heard on inspiration that indicates upper airway obstruction. While these sounds also require attention, fine crackles are more indicative of fluid accumulation in the lungs, making them the priority for reporting in this scenario.

2. What are the primary differences between left-sided and right-sided heart failure?

• A. Left-sided: Pulmonary congestion; Right-sided: Systemic edema
• B. Right-sided: Pulmonary congestion; Left-sided: Systemic edema
• C. Left-sided: Systemic edema; Right-sided: Pulmonary congestion
• D. Right-sided: Pulmonary congestion; Left-sided: Heart failure

Correct answer: A

Rationale: The correct answer is A: "Left-sided: Pulmonary congestion; Right-sided: Systemic edema." Left-sided heart failure primarily affects the lungs, leading to pulmonary congestion, which manifests as symptoms like shortness of breath and cough. On the other hand, right-sided heart failure causes systemic congestion and edema, often presenting as swelling in the legs and abdomen due to fluid retention. Choice B is incorrect because it swaps the features of left-sided and right-sided heart failure. Choice C is incorrect as it also incorrectly switches the characteristics of the two types of heart failure. Choice D is incorrect because it inaccurately associates left-sided heart failure with pulmonary congestion and right-sided heart failure with heart failure itself, which is not a distinguishing feature.

3. Which of the following techniques should the nurse use when performing nasotracheal suctioning for a client?

• A. Insert the suction catheter while the client is swallowing
• B. Apply intermittent suction when withdrawing the catheter
• C. Place the catheter in a clean, dry location for later use
• D. Hold the suction catheter with the non-dominant hand

Correct answer: B

Rationale: The correct technique when performing nasotracheal suctioning is to apply intermittent suction when withdrawing the catheter. This method helps reduce trauma to the mucosa by preventing prolonged suctioning. Choice A is incorrect because inserting the suction catheter while the client is swallowing may increase the risk of aspiration. Choice C is incorrect as placing the catheter in a clean, dry location for later use is not a safe practice as it can lead to contamination. Choice D is incorrect since it does not address the proper technique involved in nasotracheal suctioning.

4. What is the appropriate action for a healthcare professional when administering a blood transfusion?

• A. Verify the patient's identity
• B. Monitor vital signs
• C. Stay with the patient during the first 15 minutes
• D. Stop the transfusion if a reaction occurs

Correct answer: A

Rationale: The appropriate action for a healthcare professional when administering a blood transfusion is to verify the patient's identity. This step is essential to ensure that the correct blood product is given to the right patient, preventing any errors or adverse reactions. While monitoring vital signs and staying with the patient during the initial phase of the transfusion are also important steps, the primary action of verifying the patient's identity takes precedence to uphold patient safety and prevent any potential harm.

5. A client with COPD is being cared for by a nurse. Which of the following interventions should the nurse include in the plan of care?

• A. Administer oxygen at 2 L/min via nasal cannula
• B. Encourage pursed-lip breathing
• C. Position the client in high Fowler's position
• D. Encourage deep breathing and coughing

Correct answer: B

Rationale: The correct intervention for a client with COPD is to encourage pursed-lip breathing. Pursed-lip breathing helps maintain airway patency by preventing the collapse of small airways during exhalation, improving breathing efficiency. Administering oxygen at 2 L/min via nasal cannula may be appropriate for some COPD patients but is not the priority intervention. Positioning the client in high Fowler's position may help improve breathing but is not as specific as pursed-lip breathing for COPD. Encouraging deep breathing and coughing may be beneficial in other respiratory conditions, but it is not the most effective intervention for COPD.

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