Nursing Elites

1. After an open lung biopsy, a nurse assesses a client. Which assessment finding is matched with the correct intervention?

• A. Client states he is dizzy. Nurse applies oxygen and pulse oximetry.
• B. Client's HR is 55 beats/min. Nurse withholds pain medication.
• C. Client has reduced breath sounds. Nurse calls the physician immediately.
• D. Client's RR is 18 breaths/min. Nurse decreases the oxygen flow rate.

Correct answer: C

Rationale: After an open lung biopsy, a potential complication is pneumothorax, often indicated by reduced or absent breath sounds. The nurse should promptly notify the physician to address this serious issue and ensure timely intervention.

2. A client who experienced a femur fracture 8 hr ago now reports sudden onset dyspnea and severe chest pain. Which of the following actions should the nurse take first?

• A. Provide high-flow oxygen.
• B. Check the client for a positive Chvostek's sign.
• C. Administer an IV vasopressor medication.
• D. Monitor the client for headache.

Correct answer: A

Rationale: In this situation, the priority action is to provide high-flow oxygen to the client. Sudden onset dyspnea and severe chest pain can be indicative of a pulmonary embolism, which is a life-threatening emergency. Oxygen therapy helps improve oxygenation and stabilizes the client's condition. Checking for Chvostek's sign, administering IV vasopressors, or monitoring for a headache are not the immediate priorities in this critical situation.

3. A healthcare professional is assessing a client with rheumatoid arthritis. Which assessment finding is most characteristic of this disease?

• A. Asymmetrical joint involvement
• B. Heberden's nodes
• C. Morning stiffness lasting more than 30 minutes
• D. Pain that worsens with activity

Correct answer: C

Rationale: Morning stiffness lasting more than 30 minutes is a hallmark symptom of rheumatoid arthritis. This prolonged morning stiffness is typically a distinguishing feature of rheumatoid arthritis compared to other types of arthritis, making it the most characteristic assessment finding for this disease.

4. A nurse is assessing a client who has COPD. The nurse should expect the client's chest to be which of the following shapes?

• A. Pigeon
• B. Funnel
• C. Kyphotic
• D. Barrel

Correct answer: D

Rationale:

5. A client is prescribed nicotine replacement therapy. Which statement should the nurse include in this client's teaching?

• A. Smoking while taking this medication will increase your risk of a stroke.
• B. Make a list of reasons why smoking is a bad habit.
• C. Stopping this medication suddenly increases your risk for a heart attack.
• D. Rise slowly when getting out of bed in the morning.

Correct answer: A

Rationale: When a client is prescribed nicotine replacement therapy, it is crucial to emphasize that smoking while using this therapy can increase the risk of a stroke. Smoking while on nicotine replacement therapy can lead to excessive nicotine levels in the body, elevating cardiovascular risks. Therefore, the nurse should educate the client on the importance of avoiding smoking while utilizing this medication. Choices B, C, and D are not relevant to the specific teaching required for a client on nicotine replacement therapy.

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