Nursing Elites

1. A nurse cares for a client with urinary incontinence. The client states, “I am so embarrassed. My bladder leaks like a young child’s bladder.” How should the nurse respond?

• A. I understand how you feel. I would be mortified.
• B. Incontinence pads will minimize leaks in public.
• C. I can teach you strategies to help control your incontinence.
• D. More women experience incontinence than you might think.

Correct answer: C

Rationale: The nurse should accept and acknowledge the client’s concerns, and assist the client to learn techniques that will allow control of urinary incontinence. The nurse should not diminish the client’s concerns with the use of pads or stating statistics about the occurrence of incontinence.

2. A client who has just undergone surgery suddenly experiences chest pain, dyspnea, and tachypnea. The nurse suspects that the client has a pulmonary embolism and immediately sets about:

• A. Preparing the client for a perfusion scan
• B. Attaching the client to a cardiac monitor
• C. Administering oxygen via nasal cannula
• D. Ensuring that the intravenous (IV) line is patent

Correct answer: C

Rationale: When a client who has just undergone surgery experiences sudden chest pain, dyspnea, and tachypnea, indicating possible pulmonary embolism, the immediate priority for the nurse is to administer oxygen via nasal cannula. This intervention aims to improve oxygenation and alleviate respiratory distress, which is crucial in the setting of a potential pulmonary embolism. Preparing the client for a perfusion scan is not the immediate priority as stabilizing the client's respiratory status comes first. While attaching the client to a cardiac monitor is important for monitoring, administering oxygen takes precedence in this situation. Ensuring IV line patency is relevant for overall client care but is not the priority when a client is experiencing respiratory distress requiring immediate intervention.

3. Following the diagnosis of angina pectoris, a client reports being unable to walk up two flights of stairs without pain. Which of the following measures would most likely help the client prevent this problem?

• A. Climb the stairs early in the day.
• B. Rest for at least an hour before climbing the stairs.
• C. Take a nitroglycerin tablet before climbing the stairs.
• D. Lie down after climbing the stairs.

Correct answer: C

Rationale: The correct answer is to take a nitroglycerin tablet before climbing the stairs. Nitroglycerin helps prevent angina by dilating the coronary arteries, which increases blood flow to the heart. This medication can help reduce the chest pain and discomfort experienced during physical exertion. Climing the stairs early in the day (Choice A) does not address the underlying issue of inadequate blood flow to the heart. Resting for at least an hour before climbing the stairs (Choice B) may not be as effective in preventing angina as taking nitroglycerin. Lying down after climbing the stairs (Choice D) does not offer a preventive measure for angina; it is more focused on post-activity rest rather than prevention.

4. The healthcare provider prescribes diagnostic tests for a client with pneumonia identified on a chest X-ray. Which diagnostic test should the nurse review for implementation to guide the most therapeutic treatment of pneumonia?

• A. Sputum culture and sensitivity
• B. Blood cultures
• C. Arterial blood gases (ABG)
• D. Computerized tomography (CT) of the chest

Correct answer: A

Rationale: Sputum culture and sensitivity is the most appropriate diagnostic test for pneumonia as it helps in identifying the causative organism, which is crucial for guiding the selection of the most effective antibiotic therapy. Blood cultures (choice B) are more useful in identifying systemic infections rather than pneumonia specifically. Arterial blood gases (ABG) (choice C) are helpful in assessing oxygenation but do not directly aid in identifying the causative organism. Computerized tomography (CT) of the chest (choice D) is useful for evaluating structural abnormalities in the lungs but is not the initial test of choice for diagnosing pneumonia.

5. A patient has a serum potassium level of 2.7 mEq/L. The patient’s provider has determined that the patient will need 200 mEq of potassium to replace serum losses. How will the nurse caring for this patient expect to administer the potassium?

• A. As a single-dose 200 mEq oral tablet
• B. As an intravenous bolus over 15 to 20 minutes
• C. In an intravenous solution at a rate of 10 mEq/hour
• D. In an intravenous solution at a rate of 45 mEq/hour

Correct answer: C

Rationale: For a patient with severe hypokalemia with a serum potassium level of 2.7 mEq/L requiring 200 mEq of potassium replacement, the appropriate route of administration would be intravenous. Potassium chloride should be administered slowly to prevent adverse effects; therefore, the correct option is to administer the potassium in an intravenous solution at a rate of 10 mEq/hour. Choices A and B are incorrect because potassium should not be given as a single-dose oral tablet or as an intravenous bolus over a short period of time due to the risk of adverse effects. Choice D is also incorrect as the rate of 45 mEq/hour exceeds the recommended maximum infusion rate for adults with a serum potassium level greater than 2.5 mEq/L, which is 10 mEq/hour.

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