Nursing Elites

1. A client admitted with coronary artery disease (CAD) reports dyspnea at rest. What intervention should the nurse prioritize?

• A. Providing a walker to aid in ambulation
• B. Elevating the head of the bed to at least 45 degrees
• C. Performing continuous monitoring of oxygen saturation
• D. Placing an oxygen cannula at the bedside for use if needed

Correct answer: B

Rationale: In a client with coronary artery disease (CAD) experiencing dyspnea at rest, the priority intervention should be to elevate the head of the bed to at least 45 degrees. This position helps reduce the work of breathing, optimizes lung expansion, and can alleviate symptoms of dyspnea by improving oxygenation and ventilation. Providing a walker for ambulation, monitoring oxygen saturation, and having an oxygen cannula at the bedside are important interventions but not the priority when the client is experiencing dyspnea at rest. Elevating the head of the bed is crucial to improve respiratory function and should be prioritized in this situation.

2. A client has a new prescription for prednisone. Which of the following statements should the nurse include in teaching the client?

• A. You may experience weight gain.
• B. Increase your intake of vitamin K.
• C. Expect increased urinary output.
• D. You may have dark, tarry stools.

Correct answer: A

Rationale: The correct answer is A. Weight gain is a common side effect of prednisone. The nurse should educate the client about the possibility of weight gain and the need to monitor it closely during treatment with prednisone. Choice B is incorrect because increasing vitamin K intake is not specifically related to prednisone therapy. Choice C is incorrect as prednisone is more likely to cause fluid retention rather than increased urinary output. Choice D is incorrect as dark, tarry stools are not a common side effect of prednisone.

3. The client is starting therapy with digoxin (Lanoxin). What instruction should the nurse reinforce about the medication?

• A. Take the medication with meals.
• B. Avoid dairy products.
• C. Monitor for yellow or blurred vision.
• D. Increase potassium-rich foods in the diet.

Correct answer: C

Rationale: The correct answer is C: 'Monitor for yellow or blurred vision.' When a client is taking digoxin, it is crucial to monitor for signs of toxicity, such as yellow or blurred vision, as these can indicate an adverse reaction. Reporting these visual disturbances promptly to the healthcare provider is important for further evaluation and management to prevent potential complications. Choices A, B, and D are incorrect because taking digoxin with meals, avoiding dairy products, or increasing potassium-rich foods are not specific instructions related to monitoring for adverse effects of digoxin therapy.

4. A client with peptic ulcer disease is being taught about managing the disorder. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should take NSAIDs for pain relief.'
• B. 'I should avoid drinking alcohol.'
• C. 'I should eat small, frequent meals.'
• D. 'I should drink milk to coat my stomach.'

Correct answer: B

Rationale: The correct answer is B. Avoiding alcohol is crucial in managing peptic ulcer disease as it helps prevent irritation and further damage to the stomach lining. Alcohol can worsen symptoms and hinder the healing process in individuals with this condition. Choice A is incorrect because NSAIDs can worsen peptic ulcers by irritating the stomach lining. Choice C is a correct dietary recommendation for managing peptic ulcer disease as it helps reduce stomach acid secretion and promotes healing. Choice D is incorrect as milk may temporarily soothe ulcer pain, but it can stimulate acid production and worsen symptoms in the long run.

5. The LPN/LVN is assisting in the care of a client with chronic heart failure who is receiving furosemide (Lasix). Which instruction should the nurse reinforce with the client?

• A. Limit your fluid intake to avoid fluid overload.
• B. Increase your potassium intake by eating bananas and oranges.
• C. Weigh yourself once a week to monitor for fluid retention.
• D. Take the medication at night to avoid frequent urination during the day.

Correct answer: B

Rationale: The correct instruction for the nurse to reinforce with the client is to increase potassium intake by eating bananas and oranges. Furosemide can lead to potassium loss, potentially causing hypokalemia. By increasing potassium intake through diet, the client can help prevent this electrolyte imbalance and maintain overall health. Choices A, C, and D are incorrect. Limiting fluid intake is not the appropriate instruction, as furosemide is a diuretic that already helps in fluid management. Weighing once a week is not as crucial as monitoring potassium levels, and taking the medication at night does not impact potassium levels.

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