Nursing Elites

1. A client with chronic obstructive pulmonary disease (COPD) is being assessed by a nurse. Which finding indicates the condition is worsening?

• A. Increased shortness of breath
• B. Decreased wheezing
• C. Productive cough with green sputum
• D. Slight increase in fatigue

Correct answer: A

Rationale: The correct answer is A: Increased shortness of breath. In COPD, worsening symptoms often include increased shortness of breath due to impaired lung function. This indicates a decline in respiratory status and the need for prompt intervention. Choice B, decreased wheezing, is not indicative of worsening COPD as it could suggest better airflow. Choice C, productive cough with green sputum, may indicate an infection but not necessarily worsening COPD. Choice D, a slight increase in fatigue, is non-specific and may not directly correlate with the worsening of COPD.

2. A nurse is caring for a client who has heart failure and is prescribed furosemide. Which of the following outcomes indicates that the medication is effective?

• A. Improvement in visual acuity
• B. Decreased respiratory rate
• C. Weight loss of 1.36 kg (3 lb) in 24 hours
• D. Increased urinary output

Correct answer: D

Rationale: The correct answer is D. Increased urinary output is the desired outcome when administering furosemide to a client with heart failure. Furosemide is a diuretic that promotes the excretion of excess fluids from the body, which helps in reducing fluid overload, a common symptom of heart failure. Choices A, B, and C are not directly related to the action of furosemide in treating heart failure. Visual acuity improvement, decreased respiratory rate, and rapid weight loss are not typical indicators of furosemide effectiveness in managing heart failure.

3. A nurse is teaching a female client who is experiencing alcohol withdrawal about chlordiazepoxide. Which of the following information should the nurse include in the teaching?

• A. This medication may increase your blood pressure
• B. Breast tenderness may occur with this medication
• C. You can double the dose of medication if you feel anxious
• D. Notify the provider if pregnancy is desired or suspected

Correct answer: D

Rationale: Pregnancy can complicate alcohol withdrawal treatment, and the provider should be notified.

4. Which action by the nurse will help reduce the risk of venous thromboembolism (VTE) in a postoperative patient?

• A. Encourage early ambulation and leg exercises.
• B. Apply compression stockings to the patient's legs.
• C. Administer anticoagulants as prescribed.
• D. Elevate the patient's legs to promote circulation.

Correct answer: A

Rationale: The correct answer is to encourage early ambulation and leg exercises. By promoting early ambulation and leg exercises, blood flow is enhanced, reducing the risk of venous thromboembolism (VTE) in postoperative patients. Choice B, applying compression stockings, helps prevent VTE but is not as effective as early ambulation and exercises. Choice C, administering anticoagulants, is important in VTE prevention but does not directly address improving circulation through physical activity. Choice D, elevating the patient's legs, may be beneficial for circulation in specific cases but is not as effective in preventing VTE as early ambulation and leg exercises.

5. A newly licensed nurse tells a charge nurse that he is unsure about accepting telephone medication prescriptions. Which of the following providers should the charge nurse identify as having the legal ability to give telephone medication prescriptions?

• A. Anesthesiologists
• B. Physician assistants
• C. Hospital pharmacists
• D. Nurse practitioners

Correct answer: A

Rationale: The correct answer is A: Anesthesiologists. Anesthesiologists are licensed providers who have the legal authority to give telephone medication prescriptions. Physician assistants (choice B), hospital pharmacists (choice C), and nurse practitioners (choice D) do not typically have the legal ability to provide medication prescriptions over the phone. In this scenario, the charge nurse should inform the newly licensed nurse that anesthesiologists are one of the providers who can legally give telephone medication prescriptions.

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