Nursing Elites

1. A client is experiencing an acute exacerbation of asthma. Which medication should the nurse administer first?

• A. Albuterol (Proventil)
• B. Ipratropium (Atrovent)
• C. Salmeterol (Serevent)
• D. Fluticasone (Flovent)

Correct answer: A

Rationale: During an acute exacerbation of asthma, the priority is to administer a short-acting beta2-agonist like Albuterol (Proventil) first. Albuterol acts quickly to dilate the airways and provide immediate relief of bronchospasm. Ipratropium (Atrovent) is an anticholinergic that can be used as an adjunct therapy. Salmeterol (Serevent) is a long-acting beta2-agonist intended for maintenance therapy, not for acute exacerbations. Fluticasone (Flovent) is a corticosteroid used for long-term asthma control and should not be the initial medication given during an acute exacerbation.

2. A client developed fat embolism syndrome (FES) following a fracture. Which of the following laboratory findings should the nurse expect?

• A. Decreased serum calcium level
• B. Decreased level of serum lipids
• C. Decreased erythrocyte sedimentation rate (ESR)
• D. Increased platelet count

Correct answer: A

Rationale: In fat embolism syndrome (FES), fat globules enter the bloodstream and can lead to various complications, including a decrease in serum calcium levels. This occurs due to the formation of fat emboli in the vessels, which can interfere with calcium metabolism. Therefore, a decreased serum calcium level is an expected laboratory finding in a client with fat embolism syndrome.

3. A client who is interested in smoking cessation receives teaching from a nurse. Which statements should the nurse include in this teaching? (Select ONE that does not apply)

• A. Find an activity that you enjoy and that will keep your hands busy.
• B. Keep healthy snacks on hand to nibble on.
• C. Identify reasons for quitting smoking.
• D. Make a list of reasons for quitting smoking.

Correct answer: C

Rationale: When teaching a client interested in smoking cessation, the nurse should include advice to find an activity that keeps hands busy to help distract from smoking urges, keep healthy snacks on hand to manage oral cravings, and drink at least 8 glasses of water daily to aid in flushing out toxins. Making a list of reasons for quitting smoking is also beneficial to reinforce motivation. It is important to avoid punitive measures or punishments for relapses as this can negatively impact the client's progress.

4. A healthcare professional is caring for four clients on intravenous heparin therapy. Which lab value possibly indicates a serious side effect has occurred?

• A. Hemoglobin: 14.2 g/dL
• B. Platelet count: 82,000/µL
• C. RBC count: 4.8 x 10^6/µL
• D. WBC count: 8.7 x 10^3/µL

Correct answer: B

Rationale: A low platelet count, as seen in choice B, is concerning as it could indicate heparin-induced thrombocytopenia, a serious side effect of heparin therapy. Heparin-induced thrombocytopenia can lead to an increased risk of blood clotting, potentially causing severe complications. Monitoring platelet counts is crucial during heparin therapy to promptly identify and manage this adverse effect.

5. A client with chronic obstructive pulmonary disease is being taught by a nurse about ways to facilitate eating. Which of the following statements indicates a need for further teaching?

• A. I will rest for at least 30 minutes before eating.
• B. I will take my bronchodilators after meals.
• C. I will eat five or six small meals each day.
• D. I will choose foods that are not gas-forming.

Correct answer: B

Rationale: Option B, 'I will take my bronchodilators after meals,' indicates a need for further teaching. Bronchodilators should be taken before meals to help open the airways and make breathing easier before eating. This statement suggests a misunderstanding of the timing for optimal bronchodilator effectiveness. Options A, C, and D are all appropriate strategies for facilitating eating for a client with chronic obstructive pulmonary disease.

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