Nursing Elites

1. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which instruction should the LPN/LVN reinforce to the client to help manage their condition?

• A. Increase fluid intake to thin secretions.
• B. Practice pursed-lip breathing to improve oxygenation.
• C. Avoid physical activity to prevent dyspnea.
• D. Use a peak flow meter to monitor lung function.

Correct answer: B

Rationale: Practicing pursed-lip breathing is an essential technique to help manage COPD as it can improve oxygenation by promoting better gas exchange. This technique helps to keep the airways open longer during exhalation, preventing air trapping and improving breathing efficiency. Increasing fluid intake can help thin secretions, which is beneficial, but it is not the primary instruction for managing COPD. Avoiding physical activity is not recommended as it can lead to deconditioning and worsen dyspnea in COPD patients. Using a peak flow meter is more commonly associated with monitoring asthma rather than COPD, so it is not the most relevant instruction for managing COPD.

2. Which statement made by a client indicates to the nurse that they may have a thought disorder?

• A. 'I'm so angry about this. Wait until my partner hears about this.'
• B. 'I'm a little confused. What time is it?'
• C. 'I can't find my missing shoes. Have you seen them?'
• D. 'I'm fine. It's my daughter who has the problem.'

Correct answer: C

Rationale: The statement 'I can't find my missing shoes. Have you seen them?' displays disorganized thinking or speech, which is characteristic of a thought disorder. The mention of 'missing shoes' in a context that does not make logical sense suggests a disturbance in thought processes. Choices A, B, and D do not demonstrate disorganized thinking typical of thought disorders. Option A reflects emotional expression, option B indicates mild confusion, and option D shows a redirection of focus to someone else's problem.

3. A client has an indwelling urinary catheter. Which of the following assessment findings indicates that the catheter requires irrigation?

• A. Bladder scan shows 525 mL of urine
• B. Urine has a strong odor
• C. The client reports abdominal discomfort
• D. The catheter is blocked or not draining

Correct answer: D

Rationale: The correct answer is D because if the catheter is blocked or not draining, it may need irrigation to restore proper flow. Option A, 'Bladder scan shows 525 mL of urine,' does not necessarily indicate the need for irrigation as it could be within the expected range for catheter drainage. Option B, 'Urine has a strong odor,' may indicate a urinary tract infection but does not directly correlate with the need for catheter irrigation. Option C, 'The client reports abdominal discomfort,' could indicate various issues but does not specifically suggest the need for catheter irrigation.

4. A client reports abdominal pain. An assessment by the nurse reveals a temperature of 39.2 degrees C (102 degrees F), heart rate of 105/min, a soft tender abdomen, and menses overdue by 2 days. Which of the following findings should be the nurse's priority?

• A. Temperature
• B. Heart rate
• C. Abdominal tenderness
• D. Overdue menses

Correct answer: A

Rationale: The nurse's priority should be the client's temperature. A high temperature of 39.2 degrees C (102 degrees F) indicates a potential infection or inflammation that requires immediate attention. While heart rate and abdominal tenderness are important assessments, the temperature takes precedence as it signals a more urgent issue. Overdue menses, although significant, are not the priority in this scenario when compared to the possibility of an acute infection or inflammatory process.

5. A client has a new prescription for a home oxygen concentrator. Which of the following instructions should the nurse provide to the client and their family?

• A. Check the cord routinely for frays or tearing
• B. Use oxygen around open flames
• C. Store oxygen concentrator in a closet
• D. Wear synthetic clothing to prevent static electricity

Correct answer: A

Rationale: The correct answer is to instruct the client and their family to check the cord routinely for frays or tearing. This is crucial to ensure the safety and proper function of the oxygen concentrator. Choice B is incorrect because oxygen should never be used around open flames due to the risk of fire. Choice C is also incorrect as oxygen cylinders or concentrators should not be stored in a closet due to ventilation and safety concerns. Choice D is incorrect because synthetic clothing can generate static electricity, which could pose a risk around oxygen equipment.

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