Nursing Elites

1. A mother brings her child, who has a history of asthma, to the emergency room. The child is wheezing and speaking one word between each breath. The child is anxious, tachycardic, and has labored respirations. Which assessment is most important for the nurse to obtain?

• A. Type of inhaler the child typically uses on a regular basis
• B. Frequency of rescue inhaler use during the week
• C. Last dose and type of rescue inhaler used by the child
• D. Type of allergen exposure or trigger for the current episode

Correct answer: C

Rationale: The correct answer is C because knowing the last dose and type of rescue inhaler used helps assess if the child has received adequate treatment and if further intervention is needed. This information is crucial in managing an acute asthma exacerbation. Choice A, the type of inhaler the child typically uses, is less critical during an emergency. Choice B, the frequency of rescue inhaler use during the week, is important for general asthma management but does not provide immediate guidance in the acute situation. Choice D, the type of allergen exposure or trigger, is more relevant for preventive strategies and does not directly impact the immediate treatment of the child's acute asthma attack.

2. A client with a large pleural effusion undergoes a thoracentesis. Following the procedure, which assessment finding warrants immediate intervention by the nurse?

• A. The client has asymmetrical chest wall expansion
• B. The client complains of pain at the insertion site
• C. The client's chest x-ray indicates decreased pleural effusion
• D. The client's arterial blood gases show pH 7.35, PaO2 85, PaCO2 35, HCO3 26

Correct answer: A

Rationale: Asymmetrical chest wall expansion is a critical finding post-thoracentesis as it may suggest a pneumothorax, requiring immediate intervention to prevent further complications. The other options, such as pain at the insertion site (Choice B), decreased pleural effusion on chest x-ray (Choice C), and normal arterial blood gases within acceptable ranges (Choice D) do not indicate an immediate need for intervention like asymmetrical chest wall expansion does.

3. A female client with fibromyalgia asks the nurse to arrange for hospice care to help her manage the severe, chronic pain. Which interdisciplinary team member should the nurse consult to assist the client?

• A. Contact a hospice nurse for an evaluation
• B. Arrange an appointment with a pain specialist
• C. Ask for a consultation with a psychologist
• D. Form an interdisciplinary team for evaluation

Correct answer: A

Rationale: In this scenario, the most appropriate interdisciplinary team member for the nurse to consult is a hospice nurse. Hospice nurses specialize in managing pain and symptom control, which aligns with the client's needs for managing severe chronic pain. While pain specialists (choice B) focus on pain management, in this case, the client specifically requested hospice care for pain management. Consulting a psychologist (choice C) may be beneficial for addressing psychological aspects, but the client's immediate need is pain management. Forming an interdisciplinary team (choice D) is not as specific as consulting a hospice nurse, who has the specialized skills required to address the client's pain effectively.

4. A female client has been taking a high dose of prednisone, a corticosteroid, for several months. After stopping the medication abruptly, the client reports feeling very tired. Which nursing intervention is most important for the nurse to implement?

• A. Measure vital signs
• B. Auscultate breath sounds
• C. Palpate the abdomen
• D. Observe the skin for bruising

Correct answer: A

Rationale: Discontinuing prednisone abruptly can lead to adrenal insufficiency, which may result in symptoms such as fatigue. Monitoring vital signs is crucial in this situation to assess for potential complications like hypotension, which can be a sign of adrenal insufficiency. Auscultating breath sounds (choice B) is important but not the priority when considering the risk of adrenal insufficiency. Palpating the abdomen (choice C) and observing the skin for bruising (choice D) are not directly related to the potential complications of abruptly stopping prednisone.

5. Parents who have one male child with sickle cell anemia are concerned about having more children with the disease. What client teaching should the nurse provide?

• A. All future children will be carriers, but will not necessarily have the disease
• B. There is a chance that each future child will have the disease
• C. Only male children cannot inherit the sickle cell disease trait
• D. Only one out of four of their children will definitely manifest the disease

Correct answer: B

Rationale: The correct answer is B. Each child has a 25% chance of having sickle cell anemia if both parents are carriers of the trait. Choice A is incorrect because not all future children will be carriers; some may have the disease. Choice C is incorrect as both male and female children can inherit the sickle cell disease trait. Choice D is incorrect as the chance is not fixed at one out of four; each child has an independent 25% chance of having the disease.

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