Nursing Elites

1. A nurse is caring for a client who is in the early stages of hypovolemic shock. Which of the following findings should the nurse expect?

• A. Heart rate 60/min
• B. Increased urinary output
• C. Increased respiratory rate
• D. Hypothermia

Correct answer: C

Rationale: In the early stages of hypovolemic shock, the body initiates compensatory mechanisms to maintain perfusion. One of these mechanisms is an increased respiratory rate to improve oxygen delivery. This helps to offset the decreased circulating blood volume. A heart rate of 60/min (choice A) is not expected in hypovolemic shock; instead, tachycardia is a common finding due to the body's attempt to maintain cardiac output. Increased urinary output (choice B) is not typically seen in hypovolemic shock as the body tries to conserve fluid. Hypothermia (choice D) is usually a late sign of shock when the body's compensatory mechanisms are failing, and perfusion is severely compromised.

2. A nurse is maintaining droplet precautions for a client who has meningitis. Which of the following actions should the nurse take?

• A. Wear a gown within 3 feet of the client
• B. Maintain a distance of 6 feet from the client
• C. Wear a surgical mask within 3 feet of the client
• D. Remove gloves before leaving the room

Correct answer: C

Rationale: The correct action for the nurse to take when maintaining droplet precautions for a client with meningitis is to wear a surgical mask within 3 feet of the client. This is essential to prevent the transmission of meningitis via respiratory droplets. Choice A is incorrect because wearing a gown is not specifically required for droplet precautions. Choice B suggests maintaining a distance of 6 feet, which is more applicable to airborne precautions, not droplet precautions. Choice D is incorrect as gloves should be removed and disposed of properly, but it is not related to droplet precautions specifically.

3. What are the complications of untreated DVT?

• A. Pulmonary embolism and stroke
• B. Infection and kidney failure
• C. Hypertension and vision loss
• D. Dehydration and electrolyte imbalance

Correct answer: A

Rationale: The correct answer is A: Pulmonary embolism and stroke. Untreated DVT can result in these serious complications, emphasizing the importance of timely intervention. Choices B, C, and D are incorrect because they do not represent common complications associated with untreated deep vein thrombosis. Infection and kidney failure, hypertension and vision loss, as well as dehydration and electrolyte imbalance are not typically direct consequences of untreated DVT.

4. A healthcare professional is reviewing the medical history of a client with dementia. Which of the following findings should be addressed immediately?

• A. Frequent episodes of wandering at night
• B. Restlessness and agitation
• C. Mild confusion during the day
• D. Incontinence

Correct answer: B

Rationale: Restlessness and agitation in clients with dementia should be addressed immediately as they can indicate underlying causes such as pain, discomfort, or unmet needs. Addressing these symptoms promptly can help prevent the escalation of behavioral issues and improve the client's quality of life. While frequent episodes of wandering at night, mild confusion during the day, and incontinence are also important issues to address in clients with dementia, restlessness and agitation usually require immediate attention to ensure the safety and well-being of the client.

5. A client with asthma and a new prescription for an ipratropium inhaler is being taught by a nurse. Which statement by the client indicates an understanding of the teaching?

• A. I will rinse my mouth after each use
• B. I should wait 5 minutes before taking a second puff
• C. I should take this medication when I wake up
• D. I should wait 1 minute before taking a second puff

Correct answer: D

Rationale: The correct answer is D because waiting 1 minute between puffs ensures proper absorption of the medication. Choice A is incorrect as rinsing the mouth is not a specific instruction related to using the inhaler. Choice B is incorrect as waiting 5 minutes between puffs is longer than necessary. Choice C is incorrect as the timing of medication administration is not specified in the question.

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