Nursing Elites

1. 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.

2. A client is receiving oxygen therapy via a nasal cannula. The nurse should explain that this method of oxygen delivery does which of the following?

• A. Delivers a specific concentration of oxygen constantly
• B. Delivers a high concentration of oxygen
• C. Delivers a low concentration of oxygen
• D. Restricts the client's ability to eat, speak, or drink

Correct answer: A

Rationale: A nasal cannula is a device used for delivering supplemental oxygen to patients. It delivers a specific concentration of oxygen constantly, typically ranging from 1-6 liters per minute. This method is effective for patients who require low to moderate levels of oxygen. Choices B and C are incorrect because a nasal cannula does not deliver a high concentration of oxygen and is not considered a low concentration delivery method. Choice D is incorrect because a nasal cannula does not restrict the client's ability to eat, speak, or drink; it allows them to perform these activities while receiving oxygen therapy.

3. In preparation for the discharge of a client with peripheral arterial disease (PAD), the nurse should include which of the following instructions?

• A. Apply a heating pad on a low setting to help relieve leg pain.
• B. Adjust the thermostat so that the environment is warm.
• C. Wear antiembolic stockings during the day.
• D. Rest with the legs above heart level.

Correct answer: D

Rationale: Resting with the legs above heart level is important for clients with peripheral arterial disease (PAD) to promote better circulation and reduce leg pain. Applying a heating pad on a low setting can actually worsen symptoms by causing burns or increasing blood flow to the area, which is not recommended for PAD. While keeping the environment warm is generally beneficial, it is not a specific instruction for managing PAD. Antiembolic stockings are typically used for preventing blood clots in hospitalized patients and may not be directly related to managing PAD at home.

4. A client with angina pectoris is being taught about starting therapy with nitroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication

• A. after each meal and at bedtime.
• B. every 15 minutes during an acute attack.
• C. at the first indication of chest pain.
• D. with 8 oz of water.

Correct answer: C

Rationale: Nitroglycerin (Nitrostat) tablets are used to relieve chest pain associated with angina. The client should take the medication at the first indication of chest pain to help dilate blood vessels and improve blood flow to the heart muscle. Choice A is incorrect because nitroglycerin should not be scheduled after each meal or at bedtime. Choice B is incorrect as taking the medication every 15 minutes during an acute attack is excessive and not recommended. Choice D is incorrect because while it is important to take nitroglycerin with water, the timing of water intake is not as critical as taking the medication at the first sign of chest pain.

5. A provider is discharging a client with a prescription for home oxygen therapy. Client and family teaching by the nurse should include all of the following instructions except?

• A. Cleanse the mask or collar with soapy water every other day.
• B. Ensure that the straps on the mask are secure but not too tight.
• C. Apply petroleum jelly around and inside the nares.
• D. Post 'no smoking' warning signs at home in a prominent location.

Correct answer: C

Rationale: When providing instructions for home oxygen therapy, it is important to ensure safety and proper care. Choices A, B, and D are all essential instructions for the client and family. Choice C, 'Apply petroleum jelly around and inside the nares,' is incorrect. Petroleum jelly should not be used near oxygen sources as it is flammable and can increase the risk of fire hazard. Therefore, this instruction should not be included in the teaching.

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