Nursing Elites

1. The nurse administers prescribed therapies for a patient with cor pulmonale and right-sided heart failure. Which assessment would best evaluate the effectiveness of the therapies?

• A. Observe for distended neck veins.
• B. Auscultate for crackles in the lungs.
• C. Palpate for heaves or thrills over the heart.
• D. Review hemoglobin and hematocrit values.

Correct answer: A

Rationale: To evaluate the effectiveness of therapies for cor pulmonale and right-sided heart failure, observing for distended neck veins would be the most appropriate assessment. Cor pulmonale is characterized by right ventricular failure due to pulmonary hypertension, leading to clinical manifestations such as peripheral edema, jugular venous distention, and right upper-quadrant abdominal tenderness. These signs indicate increased central venous pressure and right heart strain, which can be assessed by observing for distended neck veins. Auscultating for crackles in the lungs is more indicative of left-sided heart failure rather than right-sided heart failure. Heaves or thrills over the heart are not typically associated with cor pulmonale. Reviewing hemoglobin and hematocrit values may show elevations due to chronic hypoxemia and polycythemia in cor pulmonale, but these values alone do not directly evaluate the immediate effectiveness of the prescribed therapies on the patient's condition.

2. The nurse assesses the chest of a patient with pneumococcal pneumonia. Which finding would the nurse expect?

• A. Increased tactile fremitus
• B. Dry, nonproductive cough
• C. Hyperresonance to percussion
• D. A grating sound on auscultation

Correct answer: A

Rationale: Increased tactile fremitus over the area of pulmonary consolidation is expected with bacterial pneumonias, such as pneumococcal pneumonia. Dullness to percussion would be expected due to consolidation. Pneumococcal pneumonia typically presents with a loose, productive cough rather than a dry, nonproductive cough. Hyperresonance to percussion is not a typical finding in pneumonia and may suggest conditions like emphysema. Adventitious breath sounds such as crackles and wheezes are typical in pneumonia, but a grating sound on auscultation is more representative of a pleural friction rub rather than pneumonia.

3. An 80-year-old patient is admitted with dyspnea, dependent edema, rales, and distended neck veins. As the nurse monitors the patient, he becomes increasingly short of breath and begins to have cardiac dysrhythmias. The most critical intervention for this patient is to:

• A. Ensure his airway is open and unobstructed.
• B. Apply oxygen to maintain his oxygen saturation above 94%.
• C. Administer Dobutamine to increase cardiac output.
• D. Start an IV for monitoring fluid intake.

Correct answer: A

Rationale: In a patient presenting with dyspnea, dependent edema, rales, distended neck veins, and developing cardiac dysrhythmias, the priority intervention is to ensure the airway is open and unobstructed. Maintaining an open airway is crucial for adequate ventilation and oxygenation, especially in a patient showing signs of impending respiratory distress and cardiac compromise. While applying oxygen to maintain oxygen saturation is important, ensuring airway patency takes precedence as it directly impacts the patient's ability to breathe. Administering Dobutamine may be necessary to improve cardiac output; however, addressing the airway first is essential to prevent further respiratory distress and worsening dysrhythmias. Starting an IV for monitoring fluid intake is not the most critical intervention in this scenario compared to ensuring airway patency and oxygenation.

4. A client is in the post-anesthesia care unit (PACU) shivering despite being covered with several layers of blankets. What is the nurse's next action?

• A. Turn the client to the prone position
• B. Assist the client in breathing deeply
• C. Administer meperidine as ordered
• D. None of the above

Correct answer: C

Rationale: In the post-anesthesia care unit, clients may experience shivering or chills due to a drop in body temperature after surgery. Meperidine (Demerol) can be prescribed to alleviate shivering in cold clients. The prone position (lying face down) and deep breathing exercises are not interventions specifically indicated for addressing shivering due to low body temperature. Therefore, administering meperidine as ordered is the most appropriate action to manage the client's shivering in this scenario.

5. In which of the following conditions would a healthcare provider not administer erythromycin?

• A. Campylobacteriosis infection
• B. Legionnaires disease
• C. Pneumonia
• D. Multiple Sclerosis

Correct answer: D

Rationale: Erythromycin is an antibiotic used to treat bacterial infections. Multiple sclerosis (MS) is an autoimmune disease affecting the central nervous system, involving the brain and spinal cord. Since MS is not caused by bacteria, administering erythromycin would not be appropriate. Campylobacteriosis infection, Legionnaires disease, and pneumonia are bacterial infections that can be treated with erythromycin, making them incorrect choices for conditions where erythromycin would not be administered.

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