Nursing Elites

1. A client with a tracheostomy is being cared for by a nurse. The client's partner has been taught to perform suctioning. Which of the following actions by the partner should indicate to the nurse a readiness for the client's discharge?

• A. Attending a class on tracheostomy care
• B. Verbally explaining all steps in the procedure
• C. Performing the procedure independently
• D. Asking relevant questions about suctioning

Correct answer: C

Rationale: When the partner can independently perform the suctioning procedure, it demonstrates a readiness for the client's discharge. This indicates that the partner has acquired the necessary skills and knowledge to provide safe care for the client at home without the direct supervision of healthcare professionals.

2. What question should a nurse ask a client who has an anteroposterior (AP) chest diameter equal to the lateral chest diameter?

• A. Are you taking any medications or herbal supplements?
• B. Do you have any chronic breathing problems?
• C. How often do you perform aerobic exercise?
• D. What is your occupation and what are your hobbies?

Correct answer: B

Rationale: The correct answer is B. A nurse should ask the client if they have any chronic breathing problems when the anteroposterior (AP) chest diameter is the same as the lateral chest diameter. This finding indicates a barrel chest, which can be associated with chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD) or emphysema. Assessing for chronic breathing problems can help the nurse further evaluate the client's respiratory status and provide appropriate care.

3. A client in a clinic presents with an acute asthma exacerbation. Which of the following medications should reduce the symptoms?

• A. Cromolyn via a metered-dose inhaler
• B. Montelukast orally
• C. Budesonide via a dry-powder inhaler
• D. Albuterol via a jet nebulizer

Correct answer: D

Rationale: During an acute asthma exacerbation, the preferred medication for symptom relief is a short-acting beta-agonist like albuterol, typically delivered via a jet nebulizer for quick onset and efficacy. Cromolyn, montelukast, and budesonide are not as effective for immediate symptom relief in acute exacerbations and are more commonly used for prevention or long-term management of asthma symptoms.

4. A client is prescribed albuterol (Proventil) via a metered-dose inhaler. Which action should the nurse take to ensure effective use of this medication?

• A. Instruct the client to inhale quickly while administering the medication.
• B. Have the client hold their breath for 10 seconds after inhaling the medication.
• C. Tell the client to exhale immediately after inhaling the medication.
• D. Encourage the client to use the inhaler as needed only when experiencing symptoms.

Correct answer: B

Rationale: To ensure effective use of albuterol via a metered-dose inhaler, the nurse should have the client hold their breath for 10 seconds after inhaling the medication. This action allows the medication to reach deeper into the airways. Inhaling slowly and deeply, not quickly, is recommended for optimal drug delivery. Exhaling immediately after inhaling the medication would expel it before it can take effect. It's essential for the client to follow the prescribed regimen of medication usage, not just using the inhaler when symptoms are present.

5. 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.

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