Nursing Elites

1. A healthcare professional auscultates a harsh hollow sound over a client's trachea & larynx. Which action should the healthcare professional take first?

• A. Document findings.
• B. Administer O2 therapy.
• C. Position client in high-Fowler's position.
• D. Administer prescribed albuterol.

Correct answer: A

Rationale: The healthcare professional has identified bronchial breath sounds, which are normal findings over the trachea & larynx, characterized by harsh, hollow, tubular, and blowing sounds. The appropriate initial action for the healthcare professional is to document these normal findings. Oxygen therapy, administering albuterol, or repositioning the client is unnecessary as this finding does not indicate a need for intervention.

2. A client is admitted with a pulmonary embolism (PE). The client is young, healthy, and active, and has no known risk factors for PE. What action by the nurse is most appropriate?

• A. Encourage the client to walk for 5 minutes each hour.
• B. Refer the client for smoking cessation classes.
• C. Teach the client about factor V Leiden testing.
• D. Explain to the client that sometimes no cause for the disease is found.

Correct answer: C

Rationale: The most appropriate action for the nurse in this scenario is to teach the client about factor V Leiden testing. Factor V Leiden is an inherited thrombophilia that can lead to abnormal clotting events, including pulmonary embolism (PE). In a case where a client has no known risk factors for PE, testing for this genetic disorder is crucial to determine if it is a contributing factor. Encouraging the client to walk or referring them to smoking cessation classes, while beneficial for overall health, are not directly relevant to the development of a PE in this specific case. While it is true that sometimes no cause for a disease is found, prematurely assuming this without appropriate investigations may lead to missed opportunities for preventive measures or treatments.

3. A nurse manager wishes to ensure that the nurses on the unit are practicing at their highest levels of competency. Which areas should the manager assess to determine if the nursing staff demonstrate competency according to the Institute of Medicine (IOM) report Health Professions Education: A Bridge to Quality? (Select ONE that does not apply)

• A. Collaborating with an interdisciplinary team
• B. Implementing evidence-based care
• C. Providing family-focused care
• D. Experimenting on patients

Correct answer: D

Rationale: The Institute of Medicine (IOM) report 'Health Professions Education: A Bridge to Quality' outlines five core competencies that healthcare providers should possess. These competencies include collaborating with an interdisciplinary team, implementing evidence-based care, providing family-focused care, using informatics in practice, and focusing on patient-centered care. Therefore, to ensure that nurses are practicing at their highest levels of competency as per the IOM report, the nurse manager should assess all of these areas.

4. A client with chronic obstructive pulmonary disease (COPD tells the nurse, 'I can feel the congestion in my lungs, and I certainly cough a lot, but I can't seem to bring anything up.' Which of the following actions should the nurse take to help this client with tenacious bronchial secretions?

• A. Maintaining a semi-Fowler's position as often as possible
• B. Administering oxygen via nasal cannula at 2 L/min
• C. Helping the client select a low-salt diet
• D. Encouraging the client to drink 2 to 3 L of water daily

Correct answer: D

Rationale: Encouraging the client to drink 2 to 3 liters of water daily helps to thin bronchial secretions, making them easier to expectorate. This can assist the client in coughing up the tenacious secretions. Maintaining a semi-Fowler's position can aid in improving lung expansion but may not directly address the issue of clearing the secretions. Administering oxygen via nasal cannula at 2 L/min can help improve oxygenation but does not specifically target the removal of bronchial secretions. Selecting a low-salt diet is important for overall health, but it does not directly address the client's immediate concern of clearing the bronchial secretions.

5. A client with emphysema is being cared for by a nurse. Which of the following findings should the nurse not expect to assess in this client?

• A. Dyspnea
• B. Bradycardia
• C. Barrel chest
• D. Clubbing of the fingers

Correct answer: B

Rationale: Emphysema is a chronic lung condition characterized by shortness of breath (dyspnea), a barrel-shaped chest due to hyperinflation of the lungs (barrel chest), and clubbing of the fingers (enlargement of fingertips). Bradycardia (slow heart rate) is not typically associated with emphysema. In emphysema, the primary focus is on respiratory complications rather than cardiac issues.

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