Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is receiving supplemental oxygen. The client reports feeling short of breath and has a respiratory rate of 28 breaths per minute. What should the nurse do first?

• A. Increase the oxygen flow rate
• B. Notify the healthcare provider
• C. Administer a bronchodilator
• D. Elevate the head of the bed

Correct answer: D

Rationale: Elevating the head of the bed promotes lung expansion and improves oxygenation, making it the priority intervention for a client with shortness of breath. This position helps in maximizing lung expansion and aiding ventilation-perfusion matching in patients with COPD. Increasing the oxygen flow rate may be necessary but should come after optimizing the client's positioning. Notifying the healthcare provider and administering a bronchodilator are not the initial interventions for addressing shortness of breath in a client with COPD.

2. A client with diabetes mellitus is scheduled for surgery, and their blood glucose level is 280 mg/dL. What is the nurse's priority action?

• A. Administer insulin as prescribed.
• B. Delay surgery until the blood glucose is below 180 mg/dL.
• C. Check the client’s hemoglobin A1C level.
• D. Administer IV fluids to flush excess glucose.

Correct answer: A

Rationale: The correct answer is A: Administer insulin as prescribed. In clients with diabetes, high blood glucose levels can increase the risk of infection and impair healing after surgery. Administering insulin as prescribed helps reduce blood glucose to a safer level before surgery, preventing complications. Choice B is incorrect because delaying surgery without addressing the high blood glucose level does not address the immediate issue. Choice C is incorrect as checking the client's hemoglobin A1C level is not the priority when dealing with acute high blood glucose levels before surgery. Choice D is incorrect as administering IV fluids may help with hydration but does not directly address the high blood glucose level that needs immediate attention.

3. A client with pheochromocytoma is admitted to the hospital. Which intervention has the highest priority?

• A. Monitor blood pressure frequently
• B. Start intravenous fluids at a fast rate
• C. Administer pain medication to reduce discomfort
• D. Give antihypertensive medications as prescribed

Correct answer: B

Rationale: The correct answer is B: Start intravenous fluids at a fast rate. In a client with pheochromocytoma, the highest priority intervention is to ensure adequate intravascular volume before initiating any other treatment. This helps prevent a sudden drop in blood pressure that can occur due to the release of catecholamines during tumor manipulation. While monitoring blood pressure frequently is essential, ensuring adequate intravascular volume takes precedence. Administering pain medication and antihypertensive medications are important but are not the highest priority in the initial management of pheochromocytoma.

4. A client is receiving IV antibiotic therapy for sepsis. Which assessment finding indicates that the client's condition is improving?

• A. Urine output increases to 25 mL/hour
• B. Client reports feeling less fatigued
• C. Heart rate decreases from 120 to 110 beats per minute
• D. White blood cell count decreases from 15,000 to 9,000/mm3

Correct answer: D

Rationale: The correct answer is D. A decrease in white blood cell count indicates that the infection is responding to treatment, making this the most objective indicator of improvement in a client with sepsis. Choices A, B, and C are subjective indicators and may not always directly correlate with the resolution of the underlying infection. While an increase in urine output, a client reporting feeling less fatigued, and a decrease in heart rate are positive signs, they are not as specific or directly related to the resolution of the infection as a decrease in white blood cell count.

5. The nurse is caring for a client post-surgery with an order to ambulate the client every 2 hours. Which of the following tasks could be safely delegated to an unlicensed assistive personnel (UAP)?

• A. Assessing the client's ability to ambulate safely
• B. Documenting the client's tolerance of ambulation
• C. Assisting the client with ambulation
• D. Evaluating the client's pain level after ambulation

Correct answer: C

Rationale: Assisting with ambulation is a task that can be safely delegated to a UAP as it is a supportive activity that does not require clinical judgment. Choices A, B, and D involve assessments, documentation, and evaluation, which require nursing knowledge and clinical judgment, making them tasks that should be performed by a licensed nurse.

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