Nursing Elites

1. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

2. A patient has come into the emergency room after an injury at work in which their upper body was pinned between two pieces of equipment. The nurse notes bruising in the upper abdomen and chest. The patient is complaining of sharp chest pain, having difficulty breathing, and their trachea is deviated to the left side. Which of the following conditions are these symptoms most closely associated with?

• A. Left-sided pneumothorax
• B. Pleural effusion
• C. Atelectasis
• D. Right-sided pneumothorax

Correct answer: D

Rationale: The patient is most likely suffering from a right-sided pneumothorax. Symptoms of a pneumothorax include sharp chest pain, difficulties with breathing, decreased vocal fremitus, absent breath sounds, and tracheal shift to the opposite of the affected side. In this case, the patient's trachea is deviated to the left side, indicating a right-sided pneumothorax. Choices A, B, and C can be eliminated as they do not present with the specific symptoms described in the scenario. Left-sided pneumothorax would not cause tracheal deviation to the left side. Pleural effusion typically presents with dull chest pain and decreased breath sounds, not sharp chest pain and tracheal deviation. Atelectasis would not cause tracheal deviation and is more associated with lung collapse rather than air accumulation in the pleural space.

3. A healthcare provider calls a physician with the concern that a patient has developed a pulmonary embolism. Which of the following symptoms has the healthcare provider most likely observed?

• A. The patient is somnolent with decreased response to stimuli.
• B. The patient suddenly complains of chest pain and shortness of breath.
• C. The patient has developed a wet cough and the healthcare provider hears crackles on auscultation of the lungs.
• D. The patient has a fever, chills, and loss of appetite.

Correct answer: B

Rationale: The correct answer is 'The patient suddenly complains of chest pain and shortness of breath.' Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician should be notified immediately. Clinical signs and symptoms for pulmonary embolism are nonspecific; therefore, patients suspected of having pulmonary embolism"?because of unexplained dyspnea, tachypnea, or chest pain or the presence of risk factors for pulmonary embolism"?must undergo diagnostic tests until the diagnosis is ascertained or eliminated or an alternative diagnosis is confirmed. Choices A, C, and D describe symptoms that are not typically associated with a pulmonary embolism, making them incorrect.

4. A client is undergoing radiation therapy for treatment of thyroid cancer. Following the radiation, the client develops xerostomia. Which of the following best describes this condition?

• A. Cracks in the corners of the mouth
• B. Peeling skin from the tongue and gums
• C. Increased dental caries
• D. Dry mouth

Correct answer: D

Rationale: Xerostomia, also known as dry mouth, is a common side effect of radiation therapy in the head and neck region. It occurs when the salivary glands are damaged during treatment, reducing saliva production and causing a dry sensation in the mouth. The correct answer is 'Dry mouth' (option D). Choice A, 'Cracks in the corners of the mouth,' describes angular cheilitis, a condition linked to nutritional deficiencies or candida infection. Choice B, 'Peeling skin from the tongue and gums,' is more indicative of conditions like oral thrush or mucositis. Choice C, 'Increased dental caries,' is a consequence of reduced saliva flow but does not specifically describe xerostomia.

5. In which part of the plan of care should a nurse record the item 'Encourage patient to attend one psychoeducational group daily'?

• A. Assessment
• B. Analysis
• C. Planning
• D. Implementation

Correct answer: D

Rationale: The correct answer is 'Implementation.' In the nursing process, implementation involves carrying out the planned interventions to meet the patient's goals. Encouraging the patient to attend a psychoeducational group daily is an intervention aimed at building social skills. Assessment (choice A) is the phase where data about the patient's condition is collected. Analysis (choice B) involves interpreting the gathered data. Planning (choice C) is where the nurse decides on the interventions to address the patient's needs. Therefore, in this scenario, recording the item 'Encourage patient to attend one psychoeducational group daily' would be part of the implementation phase.

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