Nursing Elites

1. 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.

2. A client with chronic obstructive pulmonary disease (COPD) appears thin and disheveled. Which question should the nurse ask first?

• A. Do you have a strong support system?
• B. What do you understand about your disease?
• C. Do you experience shortness of breath with basic activities?
• D. What medications are you prescribed to take each day?

Correct answer: C

Rationale: In clients with severe COPD, shortness of breath can significantly impact their ability to perform basic activities like bathing and eating. Therefore, the nurse's priority should be to assess if shortness of breath is interfering with the client's basic activities, which can provide crucial information for planning and managing care.

3. A post-anesthesia care unit nurse is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give the highest priority to?

• A. Arterial blood gases
• B. Urinary output
• C. Chest tube drainage
• D. Pain level

Correct answer: A

Rationale: Arterial blood gases are crucial to assess postoperatively in a client who has undergone thoracotomy and lobectomy to monitor oxygenation and ventilation status. Changes in arterial blood gases can indicate respiratory complications or inadequate gas exchange, which are critical issues that need prompt intervention to prevent further complications. While urinary output, chest tube drainage, and pain level are important assessments, monitoring arterial blood gases takes precedence in this specific postoperative scenario to ensure optimal respiratory function and overall patient well-being.

4. A nurse collaborates with a respiratory therapist to complete pulmonary function tests (PFTs) for a client. Which statements should the nurse include in communications with the respiratory therapist prior to the tests? (SATA)

• A. I held the client's morning bronchodilator medication.
• B. The client is ready to go down to radiology for this examination.
• C. Physical therapy states the client can run on a treadmill.
• D. I advised the client not to smoke for 6 hours prior to the test.

Correct answer: B

Rationale: To ensure the PFTs are accurate, the therapist needs to know that no bronchodilators have been administered in the past 4 to 6 hours, the client did not smoke within 6 to 8 hours prior to the test and the client can follow basic commands, including different breathing maneuvers. The respiratory therapist can perform PFTs at the bedside. A treadmill is not used for this test.

5. A healthcare professional is caring for four clients on intravenous heparin therapy. Which lab value possibly indicates a serious side effect has occurred?

• A. Hemoglobin: 14.2 g/dL
• B. Platelet count: 82,000/µL
• C. RBC count: 4.8 x 10^6/µL
• D. WBC count: 8.7 x 10^3/µL

Correct answer: B

Rationale: A low platelet count, as seen in choice B, is concerning as it could indicate heparin-induced thrombocytopenia, a serious side effect of heparin therapy. Heparin-induced thrombocytopenia can lead to an increased risk of blood clotting, potentially causing severe complications. Monitoring platelet counts is crucial during heparin therapy to promptly identify and manage this adverse effect.

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