Nursing Elites

1. A nurse in the PACU is assessing a client who has an endotracheal tube (ET) in place and observes the absence of left-sided chest wall expansion upon respiration. Which of the following complications should the nurse suspect?

• A. Blockage of the ET tube by the client's tongue
• B. Passage of the ET tube into the esophagus
• C. Movement of the ET tube into the right main bronchus
• D. Infection of the vocal cords

Correct answer: C

Rationale: When the nurse observes the absence of left-sided chest wall expansion upon respiration, it indicates that the endotracheal tube (ET) may have migrated into the right main bronchus, leading to uneven chest expansion. This can result in inadequate ventilation to the left lung, causing respiratory compromise. The other options, such as blockage of the ET tube by the client's tongue, passage of the ET tube into the esophagus, and infection of the vocal cords, do not directly explain the observed chest wall asymmetry and respiratory distress.

2. When working as a professional nurse, what is the priority for a new nurse working on an inpatient medical-surgical unit with a preceptor?

• A. Attending to holistic client needs
• B. Ensuring client safety
• C. Avoiding medication errors
• D. Providing client-focused care

Correct answer: B

Rationale: The priority for a nurse working on an inpatient medical-surgical unit is to ensure client safety. This is crucial as errors in hospital care can lead to preventable deaths. While attending to holistic client needs and providing client-focused care are important aspects of nursing, ensuring client safety takes precedence to prevent harm and promote positive patient outcomes.

3. A client with chronic obstructive pulmonary disease (COPD) is being taught by a nurse. What nutrition information should the nurse include in the teaching?

• A. Avoid drinking fluids just before and during meals.
• B. Rest before meals if experiencing dyspnea.
• C. Consume about six small meals a day.
• D. Consume high-fiber foods to promote gastric emptying.

Correct answer: D

Rationale: While some of the other options may be helpful, the most appropriate advice for a client with COPD is to consume high-fiber foods to promote gastric emptying. Avoiding fluids just before and during meals can help prevent bloating, resting before meals can assist with dyspnea, and having several small meals a day can help reduce bloating. However, fibrous foods can lead to gas production, causing abdominal bloating and potentially worsening shortness of breath. Increasing calorie and protein intake is essential to prevent malnourishment. It is also important to avoid excessive carbohydrate intake, as it can increase carbon dioxide production and the risk of acidosis in COPD patients.

4. A client with chronic obstructive pulmonary disease (COPD) appears thin and disheveled. Which question should the nurse ask first?

• A. Do you have a strong support system?
• B. What do you understand about your disease?
• C. Do you experience shortness of breath with basic activities?
• D. What medications are you prescribed to take each day?

Correct answer: C

Rationale: In clients with severe COPD, shortness of breath can significantly impact their ability to perform basic activities like bathing and eating. Therefore, the nurse's priority should be to assess if shortness of breath is interfering with the client's basic activities, which can provide crucial information for planning and managing care.

5. The client is prescribed a long-acting beta2 agonist and expresses concerns about the cost, stating they only use the inhaler during asthma attacks. How should the nurse respond?

• A. Explain the importance of using the inhaler daily to prevent asthma attacks.
• B. Suggest identifying community services to help with the cost and encourage daily use of the inhaler.
• C. Explore the client's fears regarding breathlessness.
• D. Emphasize the necessity of using this inhaler daily and discuss potential community services for financial assistance.

Correct answer: B

Rationale: The correct response should address the client's concern about the cost of using the inhaler daily. While emphasizing the importance of daily use is crucial, it is also essential to acknowledge and offer support for the financial burden. Identifying community resources can help the client access affordable medications. Exploring fears related to breathlessness does not directly address the client's financial concerns.

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