Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is prescribed a metered-dose inhaler (MDI) with a spacer. Which instruction should the nurse reinforce to ensure correct use?

• A. Inhale deeply and slowly after activating the MDI.
• B. Hold the breath for 5 seconds after inhaling the medication.
• C. Rinse the mouth immediately after using the MDI.
• D. Exhale fully before placing the mouthpiece in the mouth.

Correct answer: A

Rationale: Inhaling deeply and slowly after activating the MDI is the correct instruction to ensure effective delivery of the medication to the lungs. This technique helps the medication reach the lower airways where it can be most beneficial in managing COPD symptoms. Inhaling too quickly or not deeply enough may result in improper drug delivery and reduce the effectiveness of the treatment. Holding the breath for 5 seconds after inhaling the medication (Choice B) may not be necessary and could cause discomfort without additional benefits. Rinsing the mouth immediately after using the MDI (Choice C) is not necessary unless specified by the healthcare provider. Exhaling fully before placing the mouthpiece in the mouth (Choice D) is not ideal as it may result in inadequate medication delivery to the lungs.

2. A client who has a new prescription for warfarin is being educated by a healthcare professional about monitoring for adverse effects. Which of the following statements by the client indicates an understanding of the teaching?

• A. 'I should use a soft toothbrush to brush my teeth.'
• B. 'I will double my dose if I miss one.'
• C. 'I should increase my intake of leafy green vegetables.'
• D. 'I will contact my doctor if I notice any unusual bleeding or bruising.'

Correct answer: D

Rationale: The correct answer is D: 'I will contact my doctor if I notice any unusual bleeding or bruising.' This statement indicates a good understanding of the teaching regarding warfarin. Warfarin is an anticoagulant medication that increases the risk of bleeding. Contacting the doctor if unusual bleeding or bruising is noticed is essential as it can help prevent serious complications. Choices A, B, and C are incorrect. Using a soft toothbrush is generally recommended for oral hygiene but is not directly related to monitoring for adverse effects of warfarin. Doubling the dose of warfarin if a dose is missed is dangerous and can increase the risk of bleeding. Increasing the intake of leafy green vegetables can interfere with warfarin's effectiveness as they contain vitamin K, which antagonizes warfarin's anticoagulant effects.

3. The client needs instruction on using a metered-dose inhaler (MDI). Which instruction should be given?

• A. Inhale the medication and then exhale immediately
• B. Exhale fully, then place the inhaler in your mouth and inhale deeply while pressing the canister
• C. Take two short breaths before inhaling the medication
• D. Hold your breath for 5 seconds after inhaling the medication

Correct answer: B

Rationale: The correct technique for using a metered-dose inhaler (MDI) involves exhaling fully before inhaling deeply while pressing the canister to ensure effective delivery of the medication. Choice A is incorrect as exhaling should precede inhaling. Choice C is incorrect as taking two short breaths is not part of the correct technique. Choice D is incorrect as there is no need to hold the breath for a specific time after inhaling the medication.

4. A healthcare professional is assessing a client who has been taking levodopa/carbidopa for Parkinson's disease. Which of the following findings should the healthcare professional report to the provider?

• A. Dry mouth
• B. Urinary retention
• C. Bradykinesia
• D. Dizziness

Correct answer: C

Rationale: Bradykinesia is a cardinal symptom of Parkinson's disease characterized by slowness of movement. An increase in bradykinesia may indicate a decline in the client's condition and the need for adjustments in their medication regimen. Therefore, the healthcare professional should promptly report this finding to the provider for further evaluation and management. Choices A, B, and D are not directly related to the client's Parkinson's disease or the medication levodopa/carbidopa. Dry mouth is a common side effect of many medications, including anticholinergics, but not specifically levodopa/carbidopa. Urinary retention and dizziness are also not typically associated with levodopa/carbidopa use for Parkinson's disease.

5. The nurse is reinforcing instructions to a client with coronary artery disease who is prescribed a low-cholesterol diet. The nurse should advise the client to choose which food item?

• A. Eggs and bacon
• B. Oatmeal with fresh fruit
• C. Cream of chicken soup
• D. Grilled cheese sandwich

Correct answer: B

Rationale: Oatmeal with fresh fruit is a suitable choice for a client with coronary artery disease on a low-cholesterol diet as it is low in cholesterol and provides heart-healthy benefits. Eggs and bacon, cream of chicken soup, and grilled cheese sandwich are higher in cholesterol and may not be as heart-healthy for this client. Eggs and bacon are high in cholesterol, cream of chicken soup may contain saturated fats, and a grilled cheese sandwich typically contains high amounts of fat and cholesterol, making them less suitable choices for a client with coronary artery disease on a low-cholesterol diet.

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