Nursing Elites

1. A nurse is assessing a client with pneumonia. Which of the following findings should the nurse expect?

• A. Bradycardia
• B. Increased respiratory rate
• C. Decreased temperature
• D. Elevated blood pressure

Correct answer: B

Rationale: The correct answer is B: Increased respiratory rate. In pneumonia, the body tries to compensate for the reduced ability to oxygenate the blood by increasing the respiratory rate. This helps to improve oxygen exchange. Bradycardia (Choice A) is not typically associated with pneumonia, as an increased heart rate is more common due to the stress on the body. Decreased temperature (Choice C) is not a typical finding in pneumonia, as infections usually cause a fever. Elevated blood pressure (Choice D) is not a common finding in pneumonia unless there are complications such as sepsis.

2. A healthcare provider is among the first responders to a mass-casualty incident and does not know what type of personal protective equipment (PPE) is needed. Which of the following actions should the healthcare provider take?

• A. Use basic gloves and a mask.
• B. Choose the highest level of protection equipment available.
• C. Use only respiratory protection.
• D. Ask a colleague for advice.

Correct answer: B

Rationale: In situations where the type of hazard is unknown, the healthcare provider should choose the highest level of protection equipment available. This helps ensure adequate protection against any potential hazards that may be present. Using only basic gloves and a mask (Choice A) may not provide sufficient protection if the hazard is more severe. Opting for respiratory protection only (Choice C) may leave other areas of the body vulnerable to exposure. While asking a colleague for advice (Choice D) is good practice in general, in urgent situations like mass-casualty incidents with unknown hazards, it is crucial to prioritize immediate protection by selecting the highest level of PPE.

3. A nurse is assessing a client who has a femur fracture and is in skeletal traction. Which of the following findings should the nurse report to the provider?

• A. Clear fluid drainage from the pin sites
• B. Client reporting intermittent muscle spasms
• C. Client reporting severe pain despite receiving analgesics
• D. The traction weights are hanging freely

Correct answer: C

Rationale: The correct answer is C. Severe pain that is not relieved by analgesics may indicate neurovascular compromise or other complications and requires immediate attention by the provider. Choices A, B, and D are incorrect because clear fluid drainage from the pin sites is expected in skeletal traction, intermittent muscle spasms are common in this situation, and traction weights hanging freely indicate proper traction alignment.

4. A nurse is checking laboratory results for a client. Which of the following laboratory findings indicates hypervolemia?

• A. Serum sodium 138 mEq/L
• B. Urine specific gravity 1.001
• C. Serum calcium 10 mg/dL
• D. Urine pH 6

Correct answer: B

Rationale: The correct answer is B. A urine specific gravity of 1.001 is low and indicates dilute urine, which is a sign of fluid overload (hypervolemia). Choice A, serum sodium 138 mEq/L, is within the normal range and does not indicate hypervolemia. Choice C, serum calcium 10 mg/dL, is not typically used to diagnose hypervolemia. Choice D, urine pH 6, is also not a specific indicator of hypervolemia.

5. A laboring client received meperidine IV one hour prior to delivery. Which of the following medications should the nurse have available to counteract the effects of this medication on the newborn?

• A. Naloxone
• B. Epinephrine
• C. Atropine
• D. Diazepam

Correct answer: A

Rationale: Meperidine is an opioid analgesic that can cross the placenta and cause respiratory depression in the newborn. Naloxone is an opioid antagonist that is administered to reverse the effects of opioids. It is critical to have Naloxone available when opioids are administered during labor, especially close to delivery. Epinephrine is not used to counteract the effects of opioids but rather for managing severe allergic reactions or cardiac arrest. Atropine is used for specific conditions like bradycardia, not to counteract opioid effects. Diazepam is a benzodiazepine used for anxiety, seizures, and muscle spasms, not for reversing opioid effects.

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