Nursing Elites

1. A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

• A. Pigeon
• B. Funnel
• C. Kyphotic
• D. Barrel

Correct answer: D

Rationale: When assessing a client with COPD, the nurse should expect the client's chest to be barrel-shaped. This shape is a classic characteristic of COPD due to hyperinflation of the lungs. A 'Pigeon' chest shape is associated with pectus carinatum, a deformity of the chest wall. A 'Funnel' chest shape is seen in conditions like pectus excavatum. 'Kyphotic' refers to an exaggerated outward curvature of the thoracic spine. Therefore, the correct answer is 'Barrel' as it is the expected chest shape in clients with COPD.

2. A client who is HIV-positive, has pneumonia and is not responding to antibiotic therapy may have active pulmonary tuberculosis (TB) due to exposure history and symptoms of night sweats and hemoptysis. Which test is the most reliable to confirm the diagnosis of active pulmonary TB?

• A. Chest x-ray
• B. Presence of bronchophony
• C. Mantoux test
• D. Sputum culture for acid-fast bacillus

Correct answer: D

Rationale: The correct answer is D: Sputum culture for acid-fast bacillus. The most reliable test to confirm the diagnosis of active pulmonary TB is the sputum culture for acid-fast bacillus. This test helps identify the presence of Mycobacterium tuberculosis, the causative agent of TB, in the sputum. Chest x-rays can show characteristic findings of TB but are not as reliable as sputum cultures for confirmation. Bronchophony is a test for assessing vocal resonance and is not specific for TB diagnosis. The Mantoux test is a screening test for TB exposure but cannot confirm active disease.

3. A client with chronic obstructive pulmonary disease (COPD expresses difficulty in bringing up bronchial secretions. Which action should the nurse take to help the client with tenacious bronchial secretions?

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

Correct answer: D

Rationale: Encouraging the client to drink eight glasses of water daily is the most appropriate action to help with tenacious bronchial secretions in COPD. Increased fluid intake can help in thinning the mucus, making it easier for the client to cough up and clear secretions. This addresses the client's difficulty in bringing up bronchial secretions. Maintaining a semi-Fowler's position can aid in breathing but does not directly address the issue of clearing secretions. Administering oxygen may be necessary for COPD, but it does not specifically target the tenacious secretions. Selecting a low-salt diet can be helpful in managing COPD in general, but it does not directly address the client's current concern of clearing bronchial secretions.

4. A client hospitalized with deep vein thrombosis has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?

• A. The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.
• B. I will call the provider to get a prescription for discontinuing the IV heparin today
• C. Both heparin and Coumadin work together to dissolve the clots.
• D. The IV heparin increases the effects of the Coumadin and decreases the length of your hospital stay.

Correct answer: A

Rationale: The correct answer is, 'The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level.' Warfarin (Coumadin) is an oral anticoagulant that takes time to reach its full effect, typically a few days. In the meantime, IV heparin is used to provide immediate anticoagulation until the Coumadin levels become therapeutic. Option B is incorrect because discontinuing the IV heparin abruptly without reaching a therapeutic level with Coumadin can increase the risk of clot formation. Option C is incorrect because heparin and Coumadin do not work together to dissolve clots; they both have anticoagulant effects but work differently. Option D is incorrect because IV heparin does not directly increase the effects of Coumadin; they have different mechanisms of action.

5. When caring for a client with COPD, which intervention should the nurse include in the care plan?

• A. Restrict the client's fluid intake to less than 2 L/day.
• B. Encourage the client to use the upper chest for respiration.
• C. Have the client use the early-morning hours for exercise and activity.
• D. Instruct the client to use pursed-lip breathing.

Correct answer: D

Rationale: The correct answer is to instruct the client to use pursed-lip breathing. This technique helps improve breathing efficiency by keeping the airways open during exhalation and reducing air trapping. Restricting fluid intake to less than 2 L/day is not appropriate for a client with COPD, as they need adequate hydration. Using the upper chest for respiration is incorrect as it promotes shallow breathing, which is not ideal for COPD patients. While exercise is beneficial, early-morning hours may not be the best time for clients with COPD due to increased respiratory distress in the morning.

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