Nursing Elites

1. When assessing a 75-year-old patient who has asthma, the nurse notes that the patient assumes a tripod position, leaning forward with arms braced on the chair. How would the nurse interpret these findings?

• A. Interpret that the patient is eager and interested in participating in the interview.
• B. Evaluate the patient for abdominal pain, which may be exacerbated in the sitting position.
• C. Interpret that the patient is having difficulty breathing and assist them to a supine position.
• D. Recognize that a tripod position is often used when a patient is having respiratory difficulties.

Correct answer: D

Rationale: Assuming a tripod position"?leaning forward with arms braced on chair arms"?occurs with chronic pulmonary diseases like asthma. This position helps improve breathing by allowing better use of respiratory muscles. Option A is incorrect because assuming the tripod position is not related to being eager or interested in participating in an interview. Option B is incorrect as abdominal pain is not typically associated with the tripod position in this context. Option C is incorrect as assisting the patient to a supine position would not address the underlying respiratory difficulty indicated by the tripod position. Therefore, the correct interpretation is to recognize that the patient is likely experiencing respiratory difficulties when assuming the tripod position.

2. A patient works with a nurse to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patient's best interest. What is the nurse's best action?

• A. Remain silent.
• B. Educate the patient that the outcome is not realistic.
• C. Explore with the patient possible consequences of the outcome.
• D. Formulate an appropriate outcome without the patient's input.

Correct answer: C

Rationale: In this scenario, the nurse should collaborate with the patient rather than impose personal opinions. While the nurse should respect the patient's autonomy, they also have a duty to provide guidance. By exploring possible consequences of the suggested outcome with the patient, the nurse can facilitate a discussion that helps the patient make an informed decision. This approach respects the patient's input while ensuring their well-being. Remaining silent (Choice A) may not address the issue, educating the patient unilaterally (Choice B) may be perceived as dismissive, and formulating an outcome without patient input (Choice D) disregards the patient's autonomy and preferences.

3. A healthcare professional is employed at a district health department and must spend several hours each day sitting at a desk. Which principle of ergonomics will most likely help them to reduce the risk of injury or pain in this situation?

• A. Adjust the chair height to keep the legs bent at the hips at a 90-degree angle
• B. Maintain the position of the computer monitor just below eye level
• C. Stand up and take a walk or stretch every 4 hours
• D. Rest wrists on the edge of the desk while typing

Correct answer: A

Rationale: When sitting for prolonged periods, it is important to adjust the height of the chair so that the legs are bent at the hips at a 90-degree angle. This position helps to reduce pressure on the back, legs, and feet, promoting better posture and reducing muscle fatigue. Standing up and moving around at least once every hour is crucial to support circulation and prevent stiffness. Maintaining the position of the computer monitor just below eye level helps reduce strain on the neck and eyes. Resting wrists on the edge of the desk while typing can lead to wrist strain and discomfort, so it is not an ergonomic recommendation for prolonged desk work.

4. Mrs. D is a pregnant client who is 33 weeks' gestation and is admitted for bright red vaginal bleeding. Her physician suspects placenta previa. All of the following nursing interventions are appropriate for this client except:

• A. Institute complete bed rest for the client
• B. Assess uterine tone to determine condition
• C. Perform a vaginal exam to assess cervical dilation
• D. Measure and record blood loss each shift

Correct answer: C

Rationale: A client with placenta previa has part of the placenta covering some or all of the cervical opening. Performing a vaginal exam for placenta previa may cause significant bleeding and should be avoided unless directed by a physician, and preparations are made for emergency delivery. **Choice A** is correct as complete bed rest is essential to decrease the risk of further bleeding. **Choice B** is appropriate as assessing uterine tone helps in determining the condition of the uterus and can provide important information for the healthcare team. **Choice D** is also a necessary intervention as monitoring and recording blood loss is crucial in assessing the client's condition and response to treatment.

5. During an examination of a patient's abdomen, the nurse notes that the abdomen is rounded and firm to the touch. During percussion, the nurse notes a drum-like quality of the sounds across the quadrants. How would the nurse interpret this type of sound?

• A. Constipation
• B. Air-filled areas
• C. Presence of a tumor
• D. Presence of dense organs

Correct answer: B

Rationale: A musical or drum-like sound (tympany) is heard when percussion occurs over an air-filled viscus, such as the stomach or intestines. This indicates the presence of air-filled areas. Constipation, choice A, does not produce specific percussion sounds and is related to bowel movements rather than the sound produced during percussion. The presence of a tumor, choice C, would not typically produce a drum-like sound but might result in dullness or decreased resonance. Dense organs, choice D, would produce a dull thud sound rather than a drum-like tympanic sound.

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