Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD expresses difficulty in bringing up bronchial secretions. Which action should the nurse take to help the client with tenacious bronchial secretions?

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

Correct answer: D

Rationale: Encouraging the client to drink eight glasses of water daily is the most appropriate action to help with tenacious bronchial secretions in COPD. Increased fluid intake can help in thinning the mucus, making it easier for the client to cough up and clear secretions. This addresses the client's difficulty in bringing up bronchial secretions. Maintaining a semi-Fowler's position can aid in breathing but does not directly address the issue of clearing secretions. Administering oxygen may be necessary for COPD, but it does not specifically target the tenacious secretions. Selecting a low-salt diet can be helpful in managing COPD in general, but it does not directly address the client's current concern of clearing bronchial secretions.

2. A client prescribed home oxygen therapy is receiving discharge teaching from a nurse. Which statement by the client indicates a need for further teaching?

• A. I will be able to tell the amount of oxygen being delivered by looking at the flowmeter.
• B. I should contact my doctor if I notice a decrease in my ability to concentrate.
• C. I will ensure that visitors smoke outside.
• D. I should see a frosty buildup on the tank when I refill my portable oxygen.

Correct answer: A

Rationale: The correct answer is A. The client's statement indicates a need for further teaching because the flowmeter indicates the flow rate of oxygen, not the total amount of oxygen being delivered. Choices B, C, and D demonstrate understanding of safety measures and indications for seeking medical attention in relation to home oxygen therapy, making them appropriate statements.

3. A nurse is caring for a client who came to the emergency department reporting chest pain. The provider suspects a myocardial infarction. While waiting for the laboratory to report the client's troponin levels, the client asks what this blood test will show. The nurse should explain that troponin is

• A. an enzyme that indicates damage to brain, heart, and skeletal muscle tissues.
• B. a protein whose levels reflect the risk for coronary artery disease.
• C. a heart muscle protein that appears in the bloodstream when there is damage to the heart.
• D. a protein that helps transport oxygen throughout the body.

Correct answer: C

Rationale: The correct answer is that troponin is a heart muscle protein that appears in the bloodstream when there is damage to the heart. Troponin is a specific marker for heart muscle damage, particularly seen in conditions like myocardial infarction. Choice A is incorrect as troponin is not an enzyme that indicates damage to brain and skeletal muscle tissues. Choice B is incorrect as troponin is not a protein whose levels reflect the risk for coronary artery disease; it indicates heart muscle damage. Choice D is incorrect as troponin is not a protein that helps transport oxygen throughout the body; its presence in the bloodstream is specific to heart muscle damage.

4. A client who is HIV-positive, has pneumonia and is not responding to antibiotic therapy may have active pulmonary tuberculosis (TB) due to exposure history and symptoms of night sweats and hemoptysis. Which test is the most reliable to confirm the diagnosis of active pulmonary TB?

• A. Chest x-ray
• B. Presence of bronchophony
• C. Mantoux test
• D. Sputum culture for acid-fast bacillus

Correct answer: D

Rationale: The correct answer is D: Sputum culture for acid-fast bacillus. The most reliable test to confirm the diagnosis of active pulmonary TB is the sputum culture for acid-fast bacillus. This test helps identify the presence of Mycobacterium tuberculosis, the causative agent of TB, in the sputum. Chest x-rays can show characteristic findings of TB but are not as reliable as sputum cultures for confirmation. Bronchophony is a test for assessing vocal resonance and is not specific for TB diagnosis. The Mantoux test is a screening test for TB exposure but cannot confirm active disease.

5. A client comes to the emergency department reporting chest pain that is sharp, knife-like, and localized to an area he points to with one finger. The nurse should document this chest pain as which of the following?

• A. Angina pectoris
• B. Cardiogenic pain
• C. Myocardial infarction
• D. Pleuritic pain

Correct answer: D

Rationale: The correct answer is 'Pleuritic pain.' Pleuritic pain is characterized by sharp, knife-like pain that worsens with deep breathing or coughing and is localized to a specific area. This type of pain is often associated with inflammation of the pleura. Choices A, B, and C are incorrect. Angina pectoris is a type of chest pain caused by reduced blood flow to the heart muscle. Cardiogenic pain refers to pain originating from the heart itself. Myocardial infarction is the medical term for a heart attack.

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