Nursing Elites

1. The nurse prepares a patient with a left-sided pleural effusion for a thoracentesis. How should the nurse position the patient?

• A. Supine with the head of the bed elevated 30 degrees
• B. In a high-Fowler's position with the left arm extended
• C. On the right side with the left arm extended above the head
• D. Sitting upright with the arms supported on an overbed table

Correct answer: D

Rationale: The correct position for a patient with a left-sided pleural effusion undergoing thoracentesis is sitting upright with the arms supported on an overbed table. This position helps increase lung expansion, allows fluid to collect at the lung bases, and expands the intercostal space making access to the pleural space easier. Placing the patient supine, in a high-Fowler's position, or on the right side with the left arm extended above the head could increase the work of breathing for the patient and complicate the thoracentesis procedure for the healthcare provider.

2. The nurse is taking the health history of a patient being treated for Emphysema and Chronic Bronchitis. After being told the patient has been smoking cigarettes for 30 years, the nurse expects to note which assessment finding?

• A. Increase in Forced Vital Capacity (FVC)
• B. A widened chest cavity
• C. Clubbed fingers
• D. An increased risk of cardiac failure

Correct answer: C

Rationale: 1. Increase in Forced Vital Capacity (FVC): Forced Vital Capacity is the volume of air exhaled from full inhalation to full exhalation. A patient with COPD would have a decrease in FVC. Therefore, this choice is incorrect. 2. A widened chest cavity: A patient with COPD often presents with a 'barrel chest,' which is seen as a widened chest cavity. Hence, a narrowed chest cavity is not an expected finding. 3. Clubbed fingers - CORRECT: Clubbed fingers are a sign of a long-term, or chronic, decrease in oxygen levels, which is commonly seen in patients with chronic respiratory conditions like Emphysema and Chronic Bronchitis. 4. An increased risk of cardiac failure: Although a patient with these conditions would indeed be at an increased risk for cardiac failure, this is a potential complication and not an assessment finding, making it an incorrect choice.

3. Mr. B is recovering from a surgical procedure that was performed four days ago. The nurse's assessment finds this client coughing up rust-colored sputum; his respiratory rate is 28/minute with expiratory grunting, and his lung sounds have coarse crackles on auscultation. Which of the following conditions is the most likely cause of these symptoms?

• A. Tuberculosis
• B. Pulmonary edema
• C. Pneumonia
• D. Histoplasmosis

Correct answer: C

Rationale: In this scenario, the client's presentation of coughing up rust-colored sputum, increased respiratory rate, expiratory grunting, and coarse crackles on lung auscultation suggests the development of pneumonia. Pneumonia is characterized by lung tissue inflammation or infection, often caused by various organisms. Symptoms may include productive cough, dyspnea, and abnormal breath sounds. Tuberculosis (Choice A) typically presents with a chronic cough, weight loss, and night sweats and is less likely in this acute post-operative setting. Pulmonary edema (Choice B) is characterized by pink, frothy sputum, crackles throughout the lungs, and typically occurs in the context of heart failure. Histoplasmosis (Choice D) is a fungal infection that usually presents with flu-like symptoms and is less likely to manifest with the specific respiratory findings described in this case.

4. A client complained of nausea, a metallic taste in her mouth, and fine hand tremors 2 hours after her first dose of lithium carbonate (Lithane). What is the nurse's best explanation of these findings?

• A. These side effects are common and should subside in a few days.
• B. The client is probably having an allergic reaction and should discontinue the drug.
• C. Taking the lithium on an empty stomach should decrease these symptoms.
• D. Decreasing dietary intake of sodium and fluids should minimize the side effects.

Correct answer: A

Rationale: The correct answer is, 'These side effects are common and should subside in a few days.' Nausea, metallic taste, and fine hand tremors are common side effects of lithium carbonate (Lithane) and typically diminish within a few days as the body adjusts to the medication. Option B is incorrect because these symptoms are not indicative of an allergic reaction. Option C is incorrect as taking lithium on an empty stomach does not directly address or decrease these specific side effects. Option D is also incorrect as reducing sodium and fluid intake is not the recommended approach to managing these particular side effects of lithium.

5. A client is being assessed for risks of a pressure ulcer by a healthcare professional. What is the best description of what may be found with an early pressure ulcer in an African American client?

• A. Skin has a purple/bluish color
• B. Capillary refill is 1 second
• C. Skin appears blanched at the pressure site
• D. Tenting appears when checking skin turgor

Correct answer: A

Rationale: When assessing for signs of developing pressure ulcers in a client with dark skin, traditional signs like blanching may not be evident. In individuals with darker skin tones, the skin of an early pressure ulcer may present with a purple or bluish hue. This discoloration can be a crucial indicator of compromised circulation and tissue damage. Capillary refill, blanching, and tenting are more commonly used in the assessment of skin integrity and hydration levels but may not be as reliable in individuals with darker skin tones, making the purple/bluish color a key finding in this context.

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