Nursing Elites

1. The client was asked to read the Snellen chart. Which of the following is being tested?

• A. Optic
• B. Olfactory
• C. Oculomotor
• D. Trochlear

Correct answer: A

Rationale: The correct answer is A: Optic. The Snellen chart is used to test visual acuity, which assesses the function of the optic nerve responsible for vision. Choices B, C, and D are incorrect. Olfactory relates to the sense of smell, oculomotor controls eye movement, and trochlear controls certain eye muscles. Therefore, the only option related to vision testing in this context is the optic nerve.

2. A client is receiving brachytherapy for treatment of prostate cancer. Which of the following actions should the nurse take?

• A. Cleanse equipment before removal from the client's room.
• B. Limit the client's visitors to 30 minutes per day.
• C. Discard the client's linens in a double bag.
• D. Discard the radioactive source in a biohazard bag

Correct answer: D

Rationale: When caring for a client receiving brachytherapy, it is crucial to handle radioactive sources appropriately. Discarding the radioactive source in a biohazard bag is essential to prevent exposure to radiation. Cleaning equipment before removal, limiting client's visitors, or discarding linens in a double bag are not specific to the management of radioactive sources in brachytherapy.

3. During the removal of a chest tube, what should the nurse instruct the client to do?

• A. Lie on their left side.
• B. Use the incentive spirometer.
• C. Cough at regular intervals.
• D. Perform the Valsalva maneuver.

Correct answer: D

Rationale: During the removal of a chest tube, instructing the client to perform the Valsalva maneuver is essential. This maneuver involves holding the breath and bearing down, which helps prevent air from entering the pleural space during tube removal, reducing the risk of pneumothorax. Instructing the client to lie on their left side, use the incentive spirometer, or cough at regular intervals is not appropriate during the chest tube removal process.

4. In which of the following organs does the exchange of gases take place?

• A. Kidneys
• B. Lungs
• C. Liver
• D. Heart

Correct answer: B

Rationale: The exchange of gases, specifically oxygen and carbon dioxide, occurs in the lungs. In the lungs, oxygen from the air we breathe enters the bloodstream, while carbon dioxide is removed from the bloodstream and exhaled. This process is essential for respiration and supplying the body with oxygen for energy production. The kidneys filter waste from the blood to produce urine and regulate fluid balance (Choice A). The liver is involved in detoxification, protein synthesis, and producing bile (Choice C). The heart is responsible for pumping blood throughout the body to deliver oxygen and nutrients (Choice D).

5. What is the most appropriate nursing order for a patient who develops dyspnea and shortness of breath?

• A. Maintain the patient on strict bed rest at all times
• B. Maintain the patient in an orthopneic position as needed
• C. Administer high-flow oxygen immediately
• D. Encourage the patient to engage in vigorous physical activity

Correct answer: B

Rationale: Maintaining the patient in an orthopneic position as needed is the most appropriate nursing order for a patient experiencing dyspnea and shortness of breath. This position helps to optimize lung expansion, improve oxygenation, and alleviate breathing difficulties. It is a strategic intervention to enhance respiratory function in patients with respiratory distress. Choice A is incorrect because strict bed rest may not address the underlying respiratory issue effectively. Choice C is premature as administering high-flow oxygen should be based on a comprehensive assessment. Choice D is inappropriate as encouraging vigorous physical activity can exacerbate breathing problems in a patient experiencing dyspnea.

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