Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which assessment finding is most concerning?

• A. Oxygen saturation of 90%
• B. Respiratory rate of 24 breaths per minute
• C. Use of accessory muscles
• D. Inspiratory crackles

Correct answer: C

Rationale: The correct answer is C. Use of accessory muscles is the most concerning finding in a client with COPD experiencing an exacerbation. This indicates increased work of breathing and can be a sign of respiratory failure, requiring immediate intervention. Oxygen saturation of 90% is low but not as concerning as the increased work of breathing. A respiratory rate of 24 breaths per minute can be within normal limits. Inspiratory crackles may be present in COPD due to airway inflammation but are not as concerning as the use of accessory muscles.

2. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which intervention should the nurse implement first?

• A. Administer a bronchodilator as prescribed.
• B. Assess the client's respiratory rate.
• C. Assess the client's oxygen saturation.
• D. Elevate the head of the bed.

Correct answer: C

Rationale: Assessing the client's oxygen saturation is crucial in a client with COPD receiving supplemental oxygen to ensure adequate oxygenation. This assessment helps determine if the current oxygen therapy is effective or if adjustments are necessary. While administering a bronchodilator is important in managing COPD, assessing oxygen saturation takes precedence to address the client's immediate oxygen needs. Assessing the respiratory rate is also important but evaluating oxygen saturation provides more direct information about the client's oxygen status. Elevating the head of the bed can improve ventilation but is not the priority when assessing oxygen saturation in a client with COPD receiving supplemental oxygen.

3. A male client with hypertension, who received new antihypertensive prescriptions at his last visit, returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106, and he admits that he has not been taking the prescribed medication because the drugs make him 'feel bad'. In explaining the need for hypertension control, the nurse should stress that an elevated BP places the client at risk for which pathophysiological condition?

• A. Blindness due to cataracts
• B. Acute kidney injury due to glomerular damage
• C. Stroke secondary to hemorrhage
• D. Heart block due to myocardial damage

Correct answer: C

Rationale: The correct answer is C, 'Stroke secondary to hemorrhage.' Uncontrolled hypertension can lead to the weakening of blood vessels in the brain, increasing the risk of a stroke due to hemorrhage. This can result in serious neurological deficits or even death. Choices A, B, and D are incorrect because while hypertension can have various complications including vision changes, kidney damage, and heart problems, the most immediate and severe risk associated with uncontrolled hypertension is a stroke from cerebral hemorrhage.

4. A client's subjective data includes dysuria, urgency, and urinary frequency. What action should the nurse implement next?

• A. Collect a clean-catch specimen
• B. Administer prescribed antibiotics
• C. Perform a bladder scan
• D. Increase the client's fluid intake

Correct answer: A

Rationale: The correct action for the nurse to implement next is to collect a clean-catch specimen. This is essential to diagnose the cause of the client's symptoms accurately before initiating any treatment. Administering antibiotics (Choice B) without confirming the diagnosis through a specimen collection can be inappropriate and potentially harmful. Performing a bladder scan (Choice C) may not provide the necessary information to identify the specific cause of the symptoms. Increasing the client's fluid intake (Choice D) is a general recommendation and may not address the underlying issue causing the symptoms.

5. A client with newly diagnosed peptic ulcer disease is being taught about lifestyle modifications. Which client statement indicates that further teaching is needed?

• A. ‘I should avoid eating spicy foods to prevent irritation of my ulcer.’
• B. ‘I should take my antacids regularly, even if I don’t have symptoms.’
• C. ‘I should avoid smoking to prevent exacerbation of my symptoms.’
• D. ‘I should avoid drinking alcohol to prevent irritation of my ulcer.’

Correct answer: D

Rationale: The corrected question assesses the client's understanding of lifestyle modifications for peptic ulcer disease. Choice D, 'I should avoid drinking alcohol to prevent irritation of my ulcer,' is the correct answer. This statement demonstrates that the client has a good grasp of the teaching provided, as alcohol can indeed irritate peptic ulcers. Choices A, B, and C are all accurate statements that reflect appropriate understanding of managing peptic ulcer disease and do not indicate a need for further teaching.

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