Nursing Elites

1. When caring for a client with COPD, which intervention should the nurse include in the care plan?

• A. Restrict the client's fluid intake to less than 2 L/day.
• B. Encourage the client to use the upper chest for respiration.
• C. Have the client use the early-morning hours for exercise and activity.
• D. Instruct the client to use pursed-lip breathing.

Correct answer: D

Rationale: The correct answer is to instruct the client to use pursed-lip breathing. This technique helps improve breathing efficiency by keeping the airways open during exhalation and reducing air trapping. Restricting fluid intake to less than 2 L/day is not appropriate for a client with COPD, as they need adequate hydration. Using the upper chest for respiration is incorrect as it promotes shallow breathing, which is not ideal for COPD patients. While exercise is beneficial, early-morning hours may not be the best time for clients with COPD due to increased respiratory distress in the morning.

2. A client with angina pectoris is being taught about starting therapy with nitroglycerin (Nitrostat) tablets. The nurse should instruct the client to take the medication

• A. after each meal and at bedtime.
• B. every 15 minutes during an acute attack.
• C. at the first indication of chest pain.
• D. with 8 oz of water.

Correct answer: C

Rationale: Nitroglycerin (Nitrostat) tablets are used to relieve chest pain associated with angina. The client should take the medication at the first indication of chest pain to help dilate blood vessels and improve blood flow to the heart muscle. Choice A is incorrect because nitroglycerin should not be scheduled after each meal or at bedtime. Choice B is incorrect as taking the medication every 15 minutes during an acute attack is excessive and not recommended. Choice D is incorrect because while it is important to take nitroglycerin with water, the timing of water intake is not as critical as taking the medication at the first sign of chest pain.

3. During a home visit, a nurse sees a client with COPD receiving oxygen at 2 L/min through a nasal cannula. The client reports difficulty breathing. What is the priority nursing action at this time?

• A. Increase the oxygen flow to 3 L/min.
• B. Evaluate the client's respiratory status.
• C. Call emergency services for the client.
• D. Instruct the client to cough and clear secretions.

Correct answer: B

Rationale: The priority nursing action in this situation is to evaluate the client's respiratory status. When a client with COPD on oxygen therapy experiences difficulty breathing, the nurse should first assess the client's respiratory status to determine the severity of the situation. Increasing the oxygen flow without proper assessment can be harmful if not clinically indicated. While calling emergency services may eventually be necessary, it should not be the immediate action without assessing the client first. Instructing the client to cough and clear secretions is not appropriate as the nurse needs to evaluate the respiratory status before proceeding with interventions.

4. A client with peripheral arterial disease (PAD) is experiencing muscle pain or cramping during physical activity that resolves with rest. Which of the following symptoms is typically the initial reason clients with PAD seek medical attention?

• A. Intermittent claudication
• B. Dependent rubor
• C. Rest pain
• D. Foot ulcers

Correct answer: A

Rationale: The correct answer is Intermittent claudication. Intermittent claudication, which manifests as muscle pain or cramping during physical activity that improves with rest, is typically the initial reason clients with PAD seek medical attention. Dependent rubor, rest pain, and foot ulcers are more advanced symptoms of PAD and are not usually the initial reasons for seeking medical care.

5. 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: When assessing a client with COPD, the nurse should expect the client's chest to be barrel-shaped. This shape is a classic characteristic of COPD due to hyperinflation of the lungs. A 'Pigeon' chest shape is associated with pectus carinatum, a deformity of the chest wall. A 'Funnel' chest shape is seen in conditions like pectus excavatum. 'Kyphotic' refers to an exaggerated outward curvature of the thoracic spine. Therefore, the correct answer is 'Barrel' as it is the expected chest shape in clients with COPD.

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