Nursing Elites

1. During a paracentesis procedure on a client with abdominal ascites, into which position would the nurse assist the client?

• A. Supine
• B. Upright
• C. Left side-lying
• D. Right side-lying

Correct answer: B

Rationale: During a paracentesis procedure for a client with abdominal ascites, the nurse should assist the client into an upright position. Placing the client upright allows the intestines to float posteriorly, reducing the risk of intestinal laceration during catheter insertion. Choices A, C, and D are incorrect because a supine, left side-lying, or right side-lying position would not provide the same benefit of intestinal mobility and protection during the procedure.

2. A client with a chest tube attached to a closed drainage system has undergone a chest x-ray, which revealed that the affected lung is fully reexpanded. The nurse anticipates that the next assessment of the chest tube system will reveal:

• A. No fluctuation in the water seal chamber
• B. Continuous bubbling in the water seal chamber
• C. Increased drainage in the collection chamber
• D. Continuous gentle suction in the suction control chamber

Correct answer: A

Rationale: When the client's lung is fully reexpanded, the chest tube drainage system will no longer be actively draining, and there will be no fluctuation in the water seal chamber. Option B, continuous bubbling in the water seal chamber, indicates an air leak in the system, which is not expected when the lung is fully expanded. Option C, increased drainage in the collection chamber, would not be expected when the lung is reexpanded as there should be minimal to no drainage. Option D, continuous gentle suction in the suction control chamber, would not be appropriate when the lung is fully reexpanded and the chest tube is typically on a water seal system at this point to promote reexpansion and prevent air from entering the pleural space.

3. A client recently diagnosed with chronic kidney disease (CKD) is receiving discharge instructions from a nurse. Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)

• A. I need to ask for an antibiotic when scheduling a dental appointment.
• B. I’ll need to check my blood sugar often to prevent hypoglycemia.
• C. The dose of my pain medication may have to be adjusted.
• D. The need to watch for bleeding with anticoagulants.

Correct answer: A

Rationale: The correct statements indicating a proper understanding of the teaching include the need for antibiotics for dental work, the potential need to adjust pain medication doses, and the importance of monitoring blood sugar levels. The statement about watching for bleeding with anticoagulants is not directly related to CKD and discharge instructions for this condition. Therefore, option A is correct, as it addresses relevant concerns for a client with CKD, while the other options are either unrelated or not specifically mentioned in the scenario.

4. When a young client being taught to use an inhaler for asthma symptoms states the intention to use the inhaler but plans to continue smoking cigarettes, what is the best initial action by the nurse?

• A. Inform the healthcare provider of the client's statement.
• B. Explain that denial of illness can interfere with the treatment regimen.
• C. Revise the plan of care based on the client's plans to continue smoking.
• D. Review factors surrounding the client's beliefs about smoking cessation.

Correct answer: B

Rationale: The best initial action by the nurse when a client expresses plans to use an inhaler for asthma symptoms but continue smoking cigarettes is to address denial. By explaining that denial of illness can interfere with the treatment regimen, the nurse educates the client about the impact of smoking on asthma treatment. This approach helps the client understand the importance of smoking cessation in managing asthma symptoms. Informing the healthcare provider (Choice A) may be necessary but is not the initial action in this scenario. Revising the plan of care (Choice C) should be considered after addressing the client's denial and educating them. Reviewing factors surrounding the client's beliefs about smoking cessation (Choice D) is relevant but not the best initial action when denial is identified.

5. A client’s baseline vital signs are temperature 98°F oral, pulse 74 beats/min, respiratory rate 18 breaths/min, and blood pressure 124/76 mm Hg. The client suddenly spikes a fever to 103°F. Which of the following respiratory rates would the nurse anticipate as part of the body’s response to the change in client status?

• A. 12 breaths/min
• B. 16 breaths/min
• C. 18 breaths/min
• D. 22 breaths/min

Correct answer: D

Rationale: When a client experiences a fever, there is an increase in body temperature, leading to a higher metabolic rate and oxygen demand. As a result, the respiratory rate typically increases to meet the body's increased oxygen needs. Therefore, in response to the fever spike from 98°F to 103°F, the nurse would anticipate a higher respiratory rate. Choices A, B, and C are incorrect because a decrease in body temperature, not an increase as seen in fever, would lead to a decrease in respiratory rate to conserve energy and oxygen consumption.

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