Nursing Elites

1. 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:

2. A healthcare professional is monitoring a client following a thoracentesis. The healthcare professional should identify which of the following manifestations as a complication and contact the provider immediately?

• A. Serosanguineous drainage from the puncture site
• B. Discomfort at the puncture site
• C. Increased heart rate
• D. Decreased temperature

Correct answer: C

Rationale: Following a thoracentesis, it is crucial for healthcare professionals to monitor for potential complications. Increased heart rate can indicate hypovolemia or other serious issues, such as bleeding or pneumothorax, and requires immediate attention to prevent further complications. Serosanguineous drainage from the puncture site is a common expected finding post-procedure. Discomfort at the puncture site is also common and can be managed with appropriate interventions. Decreased temperature is not typically associated with complications following a thoracentesis. Therefore, the correct answer is increased heart rate as it signifies a potential serious complication that needs prompt medical evaluation.

3. A client tests positive for alpha1-antitrypsin (AAT) deficiency and asks the nurse, What does this mean? How should the nurse respond?

• A. Your children may be at high risk for developing chronic obstructive pulmonary disease.
• B. I will arrange for a genetic counselor to discuss your condition.
• C. Your risk for chronic obstructive pulmonary disease is higher, particularly if you smoke.
• D. This is a recessive gene that should not affect your health.

Correct answer: C

Rationale: Alpha1-antitrypsin (AAT) deficiency is associated with a higher risk of chronic obstructive pulmonary disease (COPD), especially if the individual smokes. This condition is caused by a recessive gene. Individuals with one allele typically produce enough AAT to prevent COPD unless they smoke. However, those with two alleles are at high risk for COPD even without exposure to smoke or other irritants. Being a carrier of AAT deficiency does not guarantee that one's children will develop the disease; it depends on the AAT levels of the partner. While involving a genetic counselor may be beneficial in the long run, the immediate concern of the client's question should be addressed first.

4. A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. Which finding should the nurse expect?

• A. Increased anterior-posterior (AP) chest diameter
• B. Decreased respiratory rate
• C. Weight gain
• D. Productive cough with yellow sputum

Correct answer: A

Rationale: In COPD, the client often develops a barrel chest, characterized by an increased anterior-posterior diameter of the chest. This change is due to air trapping and hyperinflation of the lungs. Decreased respiratory rate, weight gain, and productive cough with yellow sputum are not typically associated with COPD. Weight loss is more common due to increased work of breathing and decreased energy expenditure in individuals with COPD.

5. During an assessment, an older adult client's son reports that the client has been sick with a respiratory illness for the past 6 days. Which of the following assessment findings is a manifestation of pneumonia in the older adult client?

• A. Bradycardia
• B. Night sweats
• C. Confusion
• D. Narrowed pulse pressure

Correct answer: C

Rationale: Confusion is a common manifestation of pneumonia in older adults. It can result from inadequate oxygenation to the brain due to respiratory compromise. Bradycardia, night sweats, and narrowed pulse pressure are not typically specific findings associated with pneumonia and should be further assessed or monitored, but confusion is a key indicator that warrants immediate attention.

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