Nursing Elites

1. Which statement by the client with chronic obstructive lung disease indicates an understanding of the major reason for the use of occasional pursed-lip breathing?

• A. ''This action of my lips helps to keep my airway open.''
• B. ''I can expel more air when I pucker up my lips to breathe out.''
• C. ''My mouth doesn't get as dry when I breathe with pursed lips.''
• D. ''By prolonging breathing out with pursed lips, the smaller areas in my lungs don't collapse.''

Correct answer: D

Rationale: The correct answer is D. Clients with chronic obstructive pulmonary disease have difficulty exhaling fully due to the weak alveolar walls from the disease process. Pursed-lip breathing helps prevent alveolar collapse by maintaining positive pressure in the airways during exhalation. This is the major reason for using pursed-lip breathing in individuals with chronic obstructive lung disease. Choices A, B, and C are incorrect because they do not directly address the main purpose of pursed-lip breathing, which is to prevent alveolar collapse and improve exhalation in these patients.

2. Which principle of body mechanics may help to reduce the risk of a back injury?

• A. Maintain a wide base of support
• B. Bend from the knees, not the waist
• C. Keep the back straight while lifting
• D. Push or pull objects rather than lifting

Correct answer: C

Rationale: Proper body mechanics are crucial to prevent injuries, especially for professions involving lifting and moving objects. Keeping the back straight while lifting is essential to reduce the risk of back injuries as it helps maintain the spine's natural alignment and prevents excessive strain on the back muscles. Choosing choices A, B, and D would increase the risk of back injury. Maintaining a wide base of support provides stability, bending from the knees instead of the waist protects the lower back, and pushing or pulling objects reduces the strain on the back muscles, all contributing to preventing back injuries.

3. Which of the following is an example of a positive effect of exercise on a client?

• A. Decreased basal metabolic rate
• B. Decreased venous return
• C. Decreased work of breathing
• D. Decreased gastric motility

Correct answer: C

Rationale: The correct answer is 'Decreased work of breathing.' Exercise has numerous positive effects on clients, such as increasing metabolic rate, improving gastric motility, and enhancing venous return. When a client exercises regularly, their work of breathing decreases, meaning that everyday activities require less exertion. This is beneficial as it indicates improved cardiovascular and respiratory efficiency. Choices A, B, and D are incorrect because a decreased basal metabolic rate, decreased venous return, and decreased gastric motility are not typically considered positive effects of exercise. Instead, an increased basal metabolic rate, improved venous return, and optimal gastric motility are desired outcomes associated with physical activity.

4. The nurse is caring for a patient who has a right-sided chest tube after a right lower lobectomy. Which nursing action can the nurse delegate to the unlicensed assistive personnel (UAP)?

• A. Document the amount of drainage every eight hours
• B. Obtain samples of drainage for culture from the system
• C. Assess patient pain level associated with the chest tube
• D. Check the water-seal chamber for the correct fluid level

Correct answer: A

Rationale: The correct answer is to document the amount of drainage every eight hours. UAP education typically includes tasks related to documentation of intake and output. Obtaining samples of drainage for culture and assessing patient pain level are nursing responsibilities that require licensed nursing personnel's education and scope of practice. Checking the water-seal chamber for the correct fluid level also falls under the nursing role, as it involves monitoring and maintaining the chest tube system, which requires nursing knowledge and training.

5. You have been assigned to take an apical pulse for one of the patients on the nursing unit. How will you do this?

• A. You will place the stethoscope over the heart and listen for any irregular beats.
• B. You will place the stethoscope over the heart and count the beats per minute.
• C. You will place your fingertip over the patient's wrist and feel for any irregular beats.
• D. You will place your fingertip over the patient's wrist and count the beats per minute.

Correct answer: B

Rationale: To take an apical pulse accurately, you should place the stethoscope over the heart and count the number of beats per minute. This method provides a precise assessment of the heart rate. While listening for irregular beats is essential for assessing the heart's rhythm, the primary objective of taking an apical pulse is to determine the heart rate. Choices C and D are incorrect because the apical pulse is not taken at the wrist; instead, it is obtained by auscultating at the apex of the heart, usually at the point where the fifth intercostal space meets the midclavicular line.

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