Nursing Elites

1. A client who had a subtotal parathyroidectomy two days ago is now preparing for discharge. Which assessment finding requires immediate provider notification?

• A. Afebrile with a normal pulse.
• B. No bowel movement since surgery.
• C. No appetite for breakfast.
• D. A positive Chvostek's sign.

Correct answer: D

Rationale: A positive Chvostek's sign suggests hypocalcemia, which is a post-parathyroidectomy complication and requires prompt treatment. The other options are less urgent: being afebrile with a normal pulse is expected, no bowel movement since surgery can be managed with interventions like early ambulation and stool softeners, and no appetite for breakfast is common postoperatively and can be addressed without immediate provider notification.

2. A client with a tracheostomy develops copious, thick secretions. What is the nurse's priority action?

• A. Increase the client's fluid intake.
• B. Perform tracheal suctioning.
• C. Administer a mucolytic agent.
• D. Increase the humidity of the oxygen source.

Correct answer: D

Rationale: The correct answer is to increase the humidity of the oxygen source. This action helps thin thick secretions, making them easier to clear from the tracheostomy tube. Increasing fluid intake (Choice A) can be beneficial in some cases but addressing humidity is more specific to managing thick secretions in a client with a tracheostomy. Tracheal suctioning (Choice B) should be done after attempting to thin the secretions with increased humidity. Administering a mucolytic agent (Choice C) is a possible intervention but typically comes after addressing humidity and before resorting to suctioning to avoid unnecessary invasiveness.

3. A male client with heart failure becomes short of breath, anxious, and has pink frothy sputum. What is the first action the nurse should take?

• A. Consult the charge nurse about administering morphine.
• B. Administer the morphine sulfate as prescribed.
• C. Withhold the morphine until the dyspnea resolves.
• D. Review the need for the morphine prescription with the provider.

Correct answer: B

Rationale: The correct answer is B: Administer the morphine sulfate as prescribed. In this situation, the client is experiencing symptoms of acute pulmonary edema, a complication of heart failure. Morphine is indicated as it helps reduce anxiety and respiratory distress by decreasing preload and afterload. It dilates blood vessels, reducing the workload of the heart and improving oxygenation. The priority is to administer the morphine promptly to alleviate the client's distress and improve oxygenation. Consulting the charge nurse (A) or reviewing the need for the morphine prescription with the provider (D) would cause a delay in providing essential treatment. Withholding the morphine (C) would not be appropriate as it is indicated for this condition.

4. A client is prescribed an inhaled corticosteroid for asthma management. Which instruction should the nurse provide to the client regarding the use of this medication?

• A. Rinse your mouth after using the inhaler
• B. Hold your breath for 5 seconds after inhaling the medication
• C. Use the inhaler during an acute asthma attack
• D. Take the medication only when symptoms occur

Correct answer: A

Rationale: The correct instruction for a client using an inhaled corticosteroid for asthma management is to rinse the mouth after using the inhaler. This helps prevent oral thrush, a common side effect of corticosteroid inhalers. Holding the breath for 5 seconds after inhaling the medication (Choice B) is not necessary for corticosteroid inhalers. Using the inhaler during an acute asthma attack (Choice C) is not the purpose of corticosteroids, which are used for long-term asthma management. Taking the medication only when symptoms occur (Choice D) is not correct as corticosteroids are typically used regularly to control asthma symptoms.

5. Which client is at greatest risk for developing delirium?

• A. An adult client who cannot sleep due to pain.
• B. An older client who attempted suicide 1 month ago.
• C. A young adult taking antipsychotic medications twice daily.
• D. A middle-aged woman using supplemental oxygen.

Correct answer: B

Rationale: The correct answer is B. Older adults who have attempted suicide are at higher risk for developing delirium, especially in the context of underlying mental health conditions. Choice A is incorrect as sleep disturbances due to pain may lead to discomfort but not necessarily delirium. Choice C is incorrect as taking antipsychotic medications, if managed well, does not inherently increase the risk of delirium. Choice D is incorrect as using supplemental oxygen alone does not significantly increase the risk of developing delirium.

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