Nursing Elites

1. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. Which laboratory value requires immediate intervention?

• A. Arterial blood gas (ABG) values
• B. Serum potassium level
• C. Serum sodium level
• D. Blood glucose level

Correct answer: A

Rationale: The correct answer is A: Arterial blood gas (ABG) values. In a client with COPD and pneumonia, ABG values are crucial as they provide essential information about the client's respiratory status, including oxygenation and acid-base balance. Immediate intervention may be required to optimize respiratory function based on ABG results. Serum potassium, sodium, and blood glucose levels are important parameters to monitor in various conditions but are not as directly related to the respiratory status in a client with COPD and pneumonia. Therefore, they do not require immediate intervention compared to ABG values.

2. Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the circulating nurse if a 3-minute surgical hand scrub is adequate preparation for this client. Which response should the circulating nurse provide?

• A. Ask a more experienced nurse to perform that scrub since it is the first time of the day
• B. Validate the nurse is implementing the OR policy for surgical hand scrub
• C. Inform the nurse that hand scrubs should be 3 minutes between cases.
• D. Direct the nurse to continue the surgical hand scrub for a 5-minute duration.

Correct answer: D

Rationale: The correct answer is to direct the nurse to continue the surgical hand scrub for a 5-minute duration. Surgical hand scrubs should last for 5 to 10 minutes, ensuring thorough cleaning and disinfection. Choice A is incorrect because the nurse should be guided to complete the scrub properly rather than having someone else do it. Choice B is incorrect as it does not address the duration of the hand scrub. Choice C is incorrect as it suggests a 3-minute hand scrub is sufficient, which is inadequate for proper preparation before surgery.

3. During the initial visit, which intervention is most important for the nurse to implement?

• A. Determine how the client is cared for when the caregiver is not present.
• B. Develop a client needs assessment and review it with the caregiver.
• C. Evaluate the caregiver's ability to care for the client's needs.
• D. Review with the caregiver the interventions provided each day.

Correct answer: A

Rationale: The most important intervention for the nurse to implement during the initial visit is to determine how the client is cared for when the caregiver is not present. This is crucial for ensuring continuous and adequate care, especially for a bed-bound client with multiple sclerosis who relies heavily on the caregiver. While developing a client needs assessment (choice B) and evaluating the caregiver's ability (choice C) are important, understanding the care plan in the caregiver's absence takes precedence. Reviewing daily interventions with the caregiver (choice D) is valuable but not as critical as knowing the care plan during the caregiver's absence.

4. Following discharge teaching, a male client with a duodenal ulcer tells the nurse he will drink plenty of dairy products to help coat and protect his ulcer. What is the best follow-up action by the nurse?

• A. Remind the client that it is also important to switch to decaffeinated coffee and tea.
• B. Suggest that the client also plans to eat frequent small meals to reduce discomfort.
• C. Review with the client the need to avoid foods that are rich in milk and cream.
• D. Reinforce this teaching by asking the client to list a dairy food that he might select.

Correct answer: C

Rationale: The correct answer is C because diets rich in milk and cream stimulate gastric acid secretion, which can exacerbate a duodenal ulcer. Therefore, it is essential to avoid foods that are rich in milk and cream. Choice A is incorrect because switching to decaffeinated coffee and tea does not address the issue of avoiding milk and cream products. Choice B is incorrect because while eating frequent small meals can help with discomfort, it does not address the specific issue of avoiding milk and cream. Choice D is incorrect as it does not address the need to avoid milk and cream products.

5. A woman with an anxiety disorder calls her obstetrician's office and tells the nurse of increased anxiety since the normal vaginal delivery of her son three weeks ago. Since she is breastfeeding, she stopped taking her antianxiety medications, but thinks she may need to start taking them again because of her increased anxiety. What response is best for the nurse to provide this woman?

• A. Describe the transmission of drugs to the infant through breast milk
• B. Encourage her to use stress-relieving alternatives, such as deep breathing exercises
• C. Inform her that some antianxiety medications are safe to take while breastfeeding
• D. Explain that anxiety is a normal response for the mother of a 3-week-old.

Correct answer: C

Rationale: There are several antianxiety medications that are not contraindicated for breastfeeding mothers, so it is important to inform her of this option.

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