Nursing Elites

1. The purpose of chest percussion and vibration is to loosen secretions in the lungs. The difference between the procedures is:

• A. Percussion uses only one hand, while vibration uses both hands
• B. Percussion delivers cushioned blows to the chest with cupped palms, while vibration gently shakes secretions loose
• C. In both percussion and vibration, the hands are not on top of each other, and hand action is not in tune with the client's breath
• D. Percussion slaps the chest to loosen secretions, while vibration shakes the secretions along with the inhalation

Correct answer: D

Rationale: Chest percussion involves the use of rhythmic tapping to dislodge mucus from the lungs, facilitating its movement toward the larger airways where it can be expelled. This technique is particularly important in conditions where mucus retention is a significant risk factor for infection. The key difference between chest percussion and vibration is that percussion involves slapping the chest to loosen secretions, while vibration involves shaking the secretions along with the inhalation, aiding in moving the loosened secretions upwards for easier removal. Choices A, B, and C do not accurately describe the main difference between chest percussion and vibration, making them incorrect.

2. The component that should receive the highest priority before physical examination is the:

• A. Psychological preparation of the client
• B. Physical Preparation of the client
• C. Preparation of the Environment
• D. Preparation of the Equipments

Correct answer: C

Rationale: Effective nursing care involves comprehensive assessments that address all aspects of a patient's condition, ensuring that interventions are appropriately targeted and outcomes are optimized.

3. With which type of cancer is asbestos exposure most strongly associated?

• A. Liver cancer
• B. Peritoneal cancer
• C. Skin cancer
• D. Esophageal cancer

Correct answer: B

Rationale: Asbestos exposure is most strongly associated with peritoneal cancer, a type of cancer that affects the lining of the abdomen. While asbestos can potentially contribute to other types of cancer, there is a significant body of research indicating a robust correlation between asbestos exposure and peritoneal cancer. Asbestos exposure can also lead to mesothelioma, a cancer that affects the lining of the chest. The other options - liver cancer, skin cancer, and esophageal cancer - are not typically associated with asbestos exposure.

4. A factor contributing to the risk for dehydration in the older adult is that _____.

• A. drinking fluids causes loss of bladder control
• B. older adults do not seem to notice mouth dryness as readily as younger people
• C. increased fluid intake will decrease the intake of nutrient-dense foods
• D. changes in intestinal motility contribute to excess fluid loss

Correct answer: C

Rationale: Older adults may not notice mouth dryness as readily as younger individuals, increasing their risk for dehydration, especially if they do not consciously increase fluid intake.

5. What nursing diagnosis would be most appropriate for a patient with heart failure?

• A. risk for infection
• B. fluid volume excess
• C. impaired body temperature
• D. ineffective airway clearance

Correct answer: B

Rationale: The most appropriate nursing diagnosis for a patient with heart failure is 'fluid volume excess.' In heart failure, the heart's reduced pumping ability leads to fluid retention, causing an excess of fluid in the body. This can result in symptoms such as edema, shortness of breath, and weight gain. 'Risk for infection,' 'impaired body temperature,' and 'ineffective airway clearance' are not the most appropriate nursing diagnoses for a patient with heart failure as they do not directly relate to the pathophysiology and common issues seen in heart failure patients.

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