Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) who is beginning oxygen therapy asks the nurse why the flow rate cannot be increased to more than 2 L/min. The nurse responds that this would be harmful because it could:

• A. Be drying to nasal passages
• B. Decrease the client’s oxygen-based respiratory drive
• C. Increase the risk of pneumonia due to drier air passages
• D. Decrease the client’s carbon dioxide–based respiratory drive

Correct answer: B

Rationale: Increasing the oxygen flow rate beyond 2 L/min for a client with COPD can decrease the client's oxygen-based respiratory drive. In clients with COPD, the natural respiratory drive is based on the level of oxygen instead of carbon dioxide, as seen in healthy individuals. Increasing the oxygen level independently can suppress the drive to breathe, leading to respiratory failure. Choices A, C, and D are incorrect because drying of nasal passages, increased risk of pneumonia due to drier air passages, and decreasing the carbon dioxide-based respiratory drive are not the primary concerns associated with increasing the oxygen flow rate in a client with COPD.

2. A marathon runner comes into the clinic and states, 'I have not urinated very much in the last few days.' The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?

• A. Give the client a bottle of water immediately.
• B. Start an intravenous line for fluids.
• C. Teach the client to drink 2 to 3 liters of water daily.
• D. Perform an electrocardiogram.

Correct answer: A

Rationale: The priority action for the nurse is to give the client a bottle of water immediately. The athlete's symptoms of decreased urination, along with a heart rate of 110 beats/min and low blood pressure of 86/58 mm Hg, indicate mild dehydration. Rehydration should begin promptly to address the dehydration. Teaching the client to drink 2 to 3 liters of water daily is a good long-term strategy but not the immediate priority. Starting an intravenous line for fluids may be necessary if oral hydration is insufficient or if the degree of dehydration is severe. Performing an electrocardiogram is not indicated at this time as the priority is addressing the dehydration.

3. A female client taking oral contraceptives reports to the nurse that she is experiencing calf pain. What action should the nurse implement?

• A. Determine if the client has also experienced breast tenderness and weight gain.
• B. Encourage the client to begin a regular, daily program of walking and exercise.
• C. Advise the client to notify the healthcare provider for immediate medical attention.
• D. Tell the client to stop taking the medication for a week to see if symptoms subside.

Correct answer: C

Rationale: Calf pain is indicative of thrombophlebitis, a serious, life-threatening complication associated with the use of oral contraceptives which requires further assessment and possibly immediate medical intervention.

4. After checking the client’s gag reflex following an esophagogastroduodenoscopy (EGD), which action should the nurse take?

• A. Taking the client’s vital signs
• B. Giving the client a drink of water
• C. Monitoring the client for a sore throat
• D. Being alert to complaints of heartburn

Correct answer: A

Rationale: After an esophagogastroduodenoscopy (EGD), the nurse's priority is to assess the client's airway by checking the gag reflex. Once this assessment is done, the next step is to take the client's vital signs to monitor for any signs of complications such as bleeding or changes in respiratory status. Giving the client water immediately after the procedure may not be appropriate, as the client may still have a compromised gag reflex and is at risk for aspiration. Monitoring for a sore throat is important but not the immediate priority post-procedure. Being alert to complaints of heartburn is relevant for assessing the client's symptoms but is not the priority immediately after checking the gag reflex.

5. What is the primary purpose of administering anticoagulants to a patient with atrial fibrillation?

• A. To reduce blood pressure.
• B. To prevent clot formation.
• C. To prevent arrhythmias.
• D. To reduce inflammation.

Correct answer: B

Rationale: The primary purpose of administering anticoagulants to a patient with atrial fibrillation is to prevent clot formation. Patients with atrial fibrillation are at an increased risk of forming blood clots in the heart, which can lead to stroke if they travel to the brain. Anticoagulants help to reduce this risk by inhibiting the clotting process. Therefore, choices A, C, and D are incorrect because anticoagulants do not primarily aim to reduce blood pressure, prevent arrhythmias, or reduce inflammation in patients with atrial fibrillation.

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