Nursing Elites

1. A client with asthma is prescribed a metered-dose inhaler (MDI) with albuterol. Which instruction is essential for the nurse to provide?

• A. Use the inhaler only before bedtime
• B. Shake the inhaler well before use
• C. Exhale fully before inhaling the medication
• D. Take two puffs every hour

Correct answer: B

Rationale: The correct answer is to 'Shake the inhaler well before use.' This instruction is crucial as shaking the inhaler ensures the proper mixing of the medication, which is essential for its effective delivery. Option A is incorrect because using the inhaler only before bedtime may not provide adequate relief during the day. Option C is incorrect as exhaling fully is a good practice but not the most essential instruction. Option D is incorrect as taking two puffs every hour may exceed the recommended dosage and lead to adverse effects.

2. During the initial assessment of an older male client with obesity and diabetes who develops intermittent claudication, which additional information obtained by the nurse is most significant?

• A. Smokes 1.5 packs of cigarettes daily.
• B. Exercises regularly.
• C. Has a high-fat diet.
• D. Consumes alcohol daily.

Correct answer: A

Rationale: The correct answer is A: 'Smokes 1.5 packs of cigarettes daily.' Smoking is a significant risk factor for peripheral arterial disease, a condition that can lead to intermittent claudication. The nicotine and other chemicals in cigarettes can damage blood vessels, leading to reduced blood flow and increased risk of developing circulation problems. Choices B, C, and D are less significant in the context of intermittent claudication. Regular exercise, a high-fat diet, and daily alcohol consumption may have health implications, but they are not as directly linked to the development of intermittent claudication in the presence of obesity, diabetes, and smoking.

3. The nurse is recording a history for a child who has been diagnosed with recurrent abdominal pain (RAP). What is a finding that is characteristic of this disorder?

• A. Morning headaches
• B. Pain for 3 consecutive months
• C. Febrile episodes in the late afternoon
• D. Diaphoresis when attacks occur

Correct answer: B

Rationale: The correct answer is B: Pain for 3 consecutive months. Recurrent abdominal pain (RAP) is characterized by abdominal pain that occurs at least once per week for at least 2 months before diagnosis. Choosing option A is incorrect since morning headaches are not a common characteristic of RAP. Option C is incorrect because febrile episodes in the late afternoon are not typically associated with RAP. Option D is incorrect as diaphoresis (excessive sweating) when attacks occur is not a common finding in RAP.

4. What is the major criterion for diagnosing cognitive impairment in a child?

• A. An IQ of 75 or less
• B. Subaverage functioning
• C. An IQ of 70 or less
• D. Onset before 18

Correct answer: C

Rationale: The correct criterion for diagnosing cognitive impairment in a child is having an IQ of 70 or less. This range is typically used to define cognitive impairment in children. Choice A ('An IQ of 75 or less') is incorrect as the threshold is generally set at 70 or below. Choice B ('Subaverage functioning') is vague and does not specifically address the IQ criterion. Choice D ('Onset before 18') is unrelated to the primary criterion of IQ level used in diagnosing cognitive impairment in children.

5. A client who was discharged 8 months ago with cirrhosis and ascites is admitted with anorexia and recent hemoptysis. The client is drowsy but responds to verbal stimuli. The nurse programs a blood pressure monitor to take readings every 15 minutes. Which assessment should the nurse implement first?

• A. Evaluate distal capillary refill for delayed perfusion
• B. Check the extremities for bruising and petechiae
• C. Examine the peritibial regions for pitting edema
• D. Palpate the abdomen for tenderness and rigidity

Correct answer: D

Rationale: In a client with a history of cirrhosis and ascites presenting with anorexia and recent hemoptysis, palpating the abdomen for tenderness and rigidity is crucial as it helps in identifying signs of complications related to these conditions. Assessing for abdominal tenderness and rigidity can provide valuable information about the presence of internal bleeding, ascites complications, or liver enlargement. Evaluating distal capillary refill, checking for bruising and petechiae, or examining peritibial regions for pitting edema are important assessments but are not the priority in this case, given the client's history and current symptoms.

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