Nursing Elites

1. A healthcare provider is assessing a client immediately after the removal of the endotracheal tube. Which of the following findings should the provider report to the healthcare provider?

• A. Stridor
• B. Copious oral secretions
• C. Hoarseness
• D. Sore throat

Correct answer: A

Rationale: Stridor is a high-pitched, harsh respiratory sound that can indicate airway obstruction. It is a serious finding that requires immediate attention as it may lead to respiratory compromise. Copious oral secretions, hoarseness, and sore throat are common but expected findings after endotracheal tube removal and do not typically require urgent intervention.

2. A client with asthma is being taught about peak flow meter use. Which statement by the client indicates understanding of the teaching?

• A. I will use my peak flow meter every morning.
• B. I will use my peak flow meter when I feel short of breath.
• C. I will use my peak flow meter before using my inhaler.
• D. I will use my peak flow meter after using my inhaler.

Correct answer: A

Rationale: The correct answer is A. Using the peak flow meter every morning is crucial for monitoring asthma control and making timely treatment adjustments. While using the meter when feeling short of breath or before using an inhaler can also be beneficial, the daily morning routine helps in consistent management of asthma symptoms.

3. A client learns about pursed-lip breathing. Which statement by the client indicates teaching has been effective?

• A. I will breathe in quickly through my mouth and out through my nose.
• B. I will breathe in slowly through my nose and out through pursed lips.
• C. I will hold my breath for 10 seconds before exhaling.
• D. I will breathe in and out through pursed lips.

Correct answer: B

Rationale: The correct technique for pursed-lip breathing involves inhaling slowly through the nose and exhaling slowly through pursed lips. This technique helps improve expiration and reduce air trapping. Breathing in quickly, holding the breath, or breathing in and out through pursed lips does not align with the correct method of pursed-lip breathing.

4. A client with chronic obstructive pulmonary disease is being taught by a nurse. Which nutritional information should the nurse include in the teaching? (SATA)

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

Correct answer: D

Rationale: In chronic obstructive pulmonary disease, it's important to consider the impact of nutrition on respiratory function. Eating high-fiber foods can lead to increased gas production, causing abdominal bloating and potentially worsening shortness of breath. Therefore, it is advisable for clients with COPD to avoid high-fiber foods to prevent these issues. Resting before meals can help manage dyspnea, and having smaller, more frequent meals can prevent bloating. Increasing calorie and protein intake is essential to prevent malnourishment in COPD patients. Additionally, limiting carbohydrate intake is crucial as it can increase carbon dioxide production, leading to a higher risk of acidosis in these individuals.

5. 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.

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