Nursing Elites

1. A client reports gastrointestinal upset after taking oral tetracycline. Which snack should the nurse recommend?

• A. Yogurt with fruit
• B. Toast with jelly
• C. Crackers with peanut butter
• D. Oatmeal with raisins

Correct answer: B

Rationale: The correct answer is B: Toast with jelly. Tetracycline can cause gastrointestinal upset when taken with dairy products. Yogurt with fruit (Choice A) contains dairy, which can worsen the gastrointestinal upset. Crackers with peanut butter (Choice C) and oatmeal with raisins (Choice D) are also not the best choices as they may not be gentle enough on the stomach. Toast with jelly is a simple snack that does not contain dairy and is less likely to exacerbate the gastrointestinal upset.

2. A client with chronic obstructive pulmonary disease (COPD) is prescribed home oxygen therapy. What teaching should the nurse provide?

• A. Ensure that the client uses oxygen continuously at night.
• B. Instruct the client to avoid smoking and exposure to smoke.
• C. Teach the client how to clean and replace the oxygen tubing.
• D. Instruct the client to increase their fluid intake.

Correct answer: C

Rationale: The correct teaching for a client with COPD prescribed home oxygen therapy is to educate them on how to clean and replace the oxygen tubing. This is crucial to prevent infections and ensure the effectiveness of the oxygen delivery system. Option A is not necessary as oxygen therapy is usually prescribed as needed, not continuously at night. While smoking cessation and avoiding smoke exposure are important in COPD management, it is not directly related to home oxygen therapy. Increasing fluid intake is beneficial for some conditions but is not specifically related to home oxygen therapy for COPD.

3. What does the nurse's signature on the client’s surgical consent form signify?

• A. The client voluntarily grants permission for the procedure to be done
• B. The client is competent to sign the consent without impairment of judgment
• C. The client understands the risks and benefits associated with the procedure
• D. The client has signed the form freely and voluntarily

Correct answer: A

Rationale: The nurse's signature on a surgical consent form signifies that the client voluntarily grants permission for the procedure to be done. This is the correct answer because the nurse's signature does not imply the client's competence, understanding of risks and benefits, or that the client signed the form freely and voluntarily. The nurse's role is to verify that the client has made an informed decision and is providing consent for the procedure.

4. A client with a chest tube following a pneumothorax is complaining of increased shortness of breath. What is the nurse's first action?

• A. Check for kinks in the chest tube tubing.
• B. Assess the client's lung sounds.
• C. Elevate the head of the bed to 30 degrees.
• D. Prepare for chest tube replacement.

Correct answer: C

Rationale: The correct first action for a client with a chest tube experiencing increased shortness of breath is to elevate the head of the bed to 30 degrees. This position promotes lung expansion, improves oxygenation, and can help relieve shortness of breath. Checking for kinks in the chest tube tubing would be important but not the first action in this situation. Assessing the client's lung sounds is also important but not the initial priority. Preparing for chest tube replacement is not indicated based solely on the client's complaint of increased shortness of breath.

5. A male client admitted for schizophrenia is noted to be diaphoretic and pacing the hallway. What is the most important intervention?

• A. Take the client's temperature and blood pressure.
• B. Encourage the client to rest.
• C. Plan an activity involving physical exercise.
• D. Carefully observe the client throughout the shift.

Correct answer: D

Rationale: In this scenario, the most important intervention for a male client with schizophrenia who is diaphoretic and pacing the hallway is to carefully observe the client throughout the shift. Diaphoresis and pacing can be indicators of agitation or distress in clients with schizophrenia. Careful observation is crucial to monitor the client's safety, assess for any potential escalation of symptoms, and provide timely intervention if needed. Taking the client's temperature and blood pressure (Choice A) may not address the immediate need for safety and observation. Encouraging the client to rest (Choice B) may not be effective if the client is agitated. Planning an activity involving physical exercise (Choice C) could potentially exacerbate the situation rather than addressing the immediate need for observation and safety.

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