Nursing Elites

1. A client with a pleural effusion is being assessed by a nurse. Which clinical manifestation does the nurse expect to find?

• A. Decreased breath sounds on the affected side
• B. Hyperresonance on percussion of the affected side
• C. Increased tactile fremitus on the affected side
• D. Tracheal deviation toward the affected side

Correct answer: A

Rationale: In a client with pleural effusion, decreased breath sounds on the affected side are common due to the presence of fluid in the pleural space. Hyperresonance is not expected; dullness on percussion is more likely. Tactile fremitus is typically decreased, not increased, in pleural effusion cases. Tracheal deviation away from the affected side, not toward it, can be seen with large effusions.

2. A client is hospitalized with a second episode of pulmonary embolism (PE). Recent genetic testing reveals the client has an alteration in the gene CYP2C19. What action by the nurse is best?

• A. Instruct the client to eliminate all vitamin K from the diet.
• B. Prepare preoperative teaching for an inferior vena cava (IVC) filter.
• C. Refer the client to a chronic illness support group.
• D. Teach the client to use a soft-bristled toothbrush.

Correct answer: B

Rationale: Clients with an alteration in the CYP2C19 gene do not metabolize warfarin (Coumadin) well, leading to higher blood levels and more side effects. As this client is a poor candidate for warfarin therapy, the prescriber will most likely recommend the implantation of an inferior vena cava (IVC) filter. This device helps prevent blood clots from reaching the lungs, reducing the risk of pulmonary embolism.

3. What comfort measure may the nurse delegate to unlicensed assistive personnel (UAP) for a client receiving O2 at 4 liters per nasal cannula?

• A. Apply water-soluble ointment to nares and lips.
• B. Periodically adjust the oxygen flow rate.
• C. Remove the tubing from the client's nose.
• D. Turn the client every 2 hours or as needed.

Correct answer: A

Rationale: When a client is receiving oxygen at a high flow rate, it can cause drying of the nasal passages and lips. Therefore, a comfort measure that can be delegated to unlicensed assistive personnel (UAP) is applying water-soluble ointment to the client's nares and lips. Adjusting the oxygen flow rate should be done by licensed nursing staff, not UAP. Removing the tubing can disrupt the oxygen delivery and should be performed by trained personnel. Turning the client every 2 hours is a general comfort measure but is not specific to addressing the drying effects of oxygen therapy.

4. A client with hypertension is being taught about lifestyle modifications. Which statement by the client indicates a need for further teaching?

• A. I will reduce my sodium intake to help control my blood pressure.
• B. I need to start walking at least 30 minutes most days of the week.
• C. I can continue drinking alcohol as long as it is not in excess.
• D. I will check my blood pressure regularly at home.

Correct answer: C

Rationale: In hypertension management, it is crucial for clients to limit or avoid alcohol consumption, not just refrain from excess. Alcohol can raise blood pressure and interfere with the effectiveness of antihypertensive medications, making it a key lifestyle modification for individuals with hypertension.

5. The provider requests the nurse to start an infusion of an inotropic agent on a client. How should the nurse explain the action of these drugs to the client and spouse?

• A. It constricts vessels, improving blood flow.
• B. It dilates vessels, which lessens the work of the heart.
• C. It increases the force of the heart's contractions.
• D. It slows the heart rate down for better filling.

Correct answer: C

Rationale: An inotropic agent is a medication that increases the force of the heart's contractions, which helps improve cardiac output. Choice A and B are incorrect as inotropic agents do not constrict or dilate vessels. Choice D is also incorrect as inotropic agents do not slow down the heart rate but rather enhance the heart's contractility.

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