Nursing Elites

1. A client with chronic obstructive pulmonary disease is being taught by a nurse about ways to facilitate eating. Which of the following statements indicates a need for further teaching?

• A. I will rest for at least 30 minutes before eating.
• B. I will take my bronchodilators after meals.
• C. I will eat five or six small meals each day.
• D. I will choose foods that are not gas-forming.

Correct answer: B

Rationale: Option B, 'I will take my bronchodilators after meals,' indicates a need for further teaching. Bronchodilators should be taken before meals to help open the airways and make breathing easier before eating. This statement suggests a misunderstanding of the timing for optimal bronchodilator effectiveness. Options A, C, and D are all appropriate strategies for facilitating eating for a client with chronic obstructive pulmonary disease.

2. A client has a newly inserted chest drainage system with a water seal. Which of the following actions should be taken?

• A. Clamp the tube when the client is ambulating.
• B. Keep the collection device below the level of the client's chest.
• C. Carefully coil the tubes to prevent kinking.
• D. Position the client flat to avoid leaks in the tubing.

Correct answer: B

Rationale: Keeping the collection device below the level of the client's chest ensures proper drainage and prevents backflow of fluid into the patient's chest. This position allows gravity to assist in the drainage process. Clamping the tube when the client is ambulating can cause a buildup of pressure in the chest drainage system, potentially leading to complications. Carefully coiling the tubes is important to prevent obstructions and kinks that could impede the flow of drainage. Positioning the client flat may not be ideal as it could hinder proper drainage and increase the risk of leaks in the tubing.

3. A client with chronic obstructive pulmonary disease (COPD) is being taught by a nurse. What nutrition information should the nurse include in the teaching?

• A. Avoid drinking fluids just before and during meals.
• B. Rest before meals if experiencing dyspnea.
• C. Consume about six small meals a day.
• D. Consume high-fiber foods to promote gastric emptying.

Correct answer: D

Rationale: While some of the other options may be helpful, the most appropriate advice for a client with COPD is to consume high-fiber foods to promote gastric emptying. Avoiding fluids just before and during meals can help prevent bloating, resting before meals can assist with dyspnea, and having several small meals a day can help reduce bloating. However, fibrous foods can lead to gas production, causing abdominal bloating and potentially worsening shortness of breath. Increasing calorie and protein intake is essential to prevent malnourishment. It is also important to avoid excessive carbohydrate intake, as it can increase carbon dioxide production and the risk of acidosis in COPD patients.

4. A client had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings?

• A. Poor impulse control
• B. Inability to discriminate words and letters
• C. Deficits in the right visual field
• D. Motor retardation

Correct answer: A

Rationale: A stroke affecting the right cerebral hemisphere can lead to poor impulse control due to the involvement of this area in regulating behavior and inhibiting impulses. Deficits in the right visual field are associated with stroke affecting the left cerebral hemisphere. Inability to discriminate words and letters may be seen in left cerebral hemisphere strokes. Motor retardation may be observed with strokes affecting motor areas in either hemisphere but is not the most specific finding related to a right cerebral hemisphere stroke.

5. A client is being treated for inhalational anthrax following bioterrorism exposure. Which of the following medications should NOT be expected as a common treatment for anthrax?

• A. Ciprofloxacin
• B. Doxycycline
• C. Amoxicillin
• D. Penicillin G

Correct answer: D

Rationale: Penicillin G is NOT commonly used to treat anthrax. Anthrax is typically treated with antibiotics such as ciprofloxacin and doxycycline due to penicillin's limited efficacy against anthrax bacteria. Amoxicillin is also not a preferred choice for anthrax treatment. Therefore, penicillin G would not be expected as a primary medication for anthrax treatment following bioterrorism exposure.

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