Nursing Elites

1. A client with chronic obstructive pulmonary disease is receiving dietary teaching from a nurse. Which of the following instructions should the nurse include?

• A. Eat 3 balanced meals each day.
• B. Limit fluid intake with meals.
• C. Reduce sodium intake.
• D. Take a bronchodilator 1 hour before eating.

Correct answer: B

Rationale: In clients with chronic obstructive pulmonary disease, limiting fluid intake with meals can help reduce the risk of bloating and feeling too full, which can make breathing more difficult due to increased pressure on the diaphragm. It is important to encourage a balanced diet with appropriate fluid intake between meals to maintain hydration and proper nutrition. Options A, C, and D are not specifically related to dietary recommendations for clients with chronic obstructive pulmonary disease.

2. When assessing a client with pneumonia, which clinical manifestation should the nurse expect to find?

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

Correct answer: C

Rationale: In pneumonia, lung tissue consolidation occurs, leading to dullness on percussion. This is a typical finding in pneumonia. Fremitus and decreased tactile fremitus are more commonly associated with conditions like pleural effusion or pneumothorax. Hyperresonance is typically seen in conditions causing air trapping, such as emphysema.

3. While assessing a client with a tracheostomy, a nurse notes that the tracheostomy tube is pulsing with the heartbeat during a pulse check. No other abnormal findings are noted. What action should the nurse take?

• A. Notify the operating room of a potential emergency case.
• B. No action is required at this time; this pulsation can be a normal finding in some clients.
• C. Remove the tracheostomy tube and ventilate the client using a bag-valve-mask.
• D. Stay with the client and ask someone else to contact the provider immediately.

Correct answer: D

Rationale: The pulsation of the tracheostomy tube with the heartbeat may indicate a tracheoinnominate artery fistula, which can lead to life-threatening hemorrhage if the artery is breached. In this scenario, as there is no active bleeding yet, the nurse should remain with the client and have another person notify the provider immediately. If the client starts to hemorrhage, the nurse should remove the tracheostomy tube and apply pressure at the bleeding site, preparing the client for urgent surgical intervention.

4. A client with chronic obstructive pulmonary disease (COPD) is being taught by a healthcare provider. Which statement by the client indicates a need for further teaching?

• A. I will avoid smoking to prevent further damage to my lungs.
• B. I will eat smaller, more frequent meals to avoid feeling bloated.
• C. I will exercise every day to improve my strength and endurance.
• D. I will drink plenty of fluids to help thin my mucus.

Correct answer: C

Rationale: The correct answer is C. While exercise is important for clients with COPD, daily exercise may be too strenuous. Clients should be encouraged to exercise regularly but should be advised to avoid overexertion. Statements A, B, and D demonstrate appropriate understanding and management of COPD symptoms.

5. A client in the intensive care unit is receiving teaching before removal of an endotracheal tube. Which of the following instructions should the nurse include in the teaching?

• A. Rest in a side-lying position after the tube is removed.
• B. Use the incentive spirometer every 4 hours after the tube is removed.
• C. Avoid speaking for extended periods.
• D. Vital signs will be monitored by a nurse every 15 minutes in the first hour after the tube is removed.

Correct answer: C

Rationale: It is essential to advise the client to avoid speaking for extended periods after the removal of the endotracheal tube to prevent strain on the vocal cords and allow the airway to recover. Speaking for prolonged periods can lead to irritation and potentially affect the healing process. The other options are also important post-extubation instructions, such as using the incentive spirometer to maintain lung function, positioning in a side-lying position for comfort, and frequent monitoring of vital signs to ensure the client's stability.

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