Nursing Elites

1. When educating a client who experienced a pneumothorax, which of the following statements should the nurse use?

• A. Notify the provider if you experience weakness.
• B. You should be able to return to work in 1 week.
• C. You need to wear a mask when in crowded areas.
• D. Notify your provider if you experience a productive cough.

Correct answer: D

Rationale: After experiencing a pneumothorax, it is crucial for the client to be educated on potential complications. A productive cough can indicate infection or another issue, requiring prompt medical attention. Weakness, returning to work, and wearing a mask in crowded areas are important considerations but not as critical as monitoring for respiratory symptoms post-pneumothorax.

2. When is sterile technique used?

• A. During strict isolation procedures
• B. After terminal disinfection is performed
• C. For invasive procedures
• D. When protective isolation is necessary

Correct answer: C

Rationale: Sterile technique is utilized during invasive procedures to prevent the introduction of pathogens, minimizing the risk of infections. This strict approach ensures that the procedure is performed in a sterile environment, reducing the chances of contamination and subsequent complications.

3. When caring for a client who is to have a line placed for hemodynamic monitoring, which statement by the newly licensed nurse indicates effectiveness of the teaching?

• A. Air should be instilled into the monitoring system after the procedure.
• B. The client should be positioned on the left side after the procedure.
• C. The transducer should be level with the second intercostal space after the line is placed.
• D. A chest x-ray is needed to verify placement after the procedure.

Correct answer: D

Rationale: After a line is placed for hemodynamic monitoring, it is crucial to confirm its correct placement. The definitive way to verify the placement is through a chest x-ray. This ensures that the line is appropriately positioned without complications. Options A, B, and C do not address the essential step of confirming the line's placement, making them incorrect choices.

4. A client with vision loss is under the care of a nurse. Which of the following actions should the nurse AVOID?

• A. Keep objects in the client's room in the same place
• B. Ensure there is high-wattage lighting in the client's room
• C. Approach the client from the side
• D. Allow extra time for the client to perform tasks

Correct answer: C

Rationale: Approaching a client with vision loss from the side can startle them and may lead to accidents or discomfort. It is important to approach them from the front so they are aware of your presence. Keeping objects in the same place aids in familiarity and reduces the risk of falls. High-wattage lighting enhances visibility for the client. Allowing extra time for tasks accommodates the client's potential slower pace and ensures they can perform tasks safely.

5. During the assessment of a client receiving packed RBCs, which finding indicates fluid overload?

• A. Low back pain.
• B. Dyspnea.
• C. Hypotension.
• D. Thready pulse.

Correct answer: B

Rationale: Dyspnea is a key finding indicating fluid overload in a client receiving packed RBCs. Fluid overload can lead to pulmonary edema, causing difficulty breathing or shortness of breath (dyspnea). Low back pain is not typically associated with fluid overload but can be more related to musculoskeletal issues. Hypotension and thready pulse are more indicative of hypovolemia (low fluid volume), not fluid overload.

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