Nursing Elites

1. A nurse is caring for a client who is receiving continuous cardiac monitoring. The client's heart rate is 69/min, and the PR interval is 0.24 seconds. What cardiac rhythm should the nurse interpret this finding as?

• A. First-degree AV block.
• B. Premature ventricular contraction.
• C. Sinus bradycardia.
• D. Atrial fibrillation.

Correct answer: A

Rationale: The correct answer is A: First-degree AV block. A PR interval of 0.24 seconds indicates a prolonged PR interval, which is characteristic of first-degree AV block. This rhythm is considered benign and often does not require treatment. Choice B, premature ventricular contraction, is characterized by early, abnormal ventricular contractions and would not be indicated by the findings provided. Choice C, sinus bradycardia, would present with a normal PR interval but a heart rate less than 60 beats per minute. Choice D, atrial fibrillation, is characterized by an irregularly irregular rhythm with no identifiable P waves, which does not align with the findings of a prolonged PR interval in this scenario.

2. A charge nurse is teaching a group of nurses about delegation. Which task should the nurse delegate to assistive personnel (AP)?

• A. Teaching a new mother how to breastfeed.
• B. Assisting a client with ambulation post-surgery.
• C. Helping with medication administration.
• D. Delegating IV medication administration.

Correct answer: B

Rationale: The correct answer is B. Assisting a client with ambulation post-surgery is a task that can be appropriately delegated to assistive personnel (AP) as it falls within their scope of duties. Teaching a new mother how to breastfeed and helping with medication administration involve assessments and critical thinking that are typically within the scope of licensed nursing staff, not AP. Delegating IV medication administration involves a higher level of skill and knowledge that should be performed by licensed nursing staff.

3. A client is preparing advance directives. Which of the following statements by the client indicates an understanding of advance directives?

• A. I cannot change my instructions once I have signed them.
• B. My doctor will need to approve my advance directives.
• C. I need a witness to sign my advance directives.
• D. I have the right to refuse treatment.

Correct answer: D

Rationale: The correct answer is D: 'I have the right to refuse treatment.' This statement shows an understanding of advance directives because they allow individuals to specify their treatment preferences in advance, including the right to refuse treatment. Choices A, B, and C are incorrect. Choice A is inaccurate as individuals can update or change their advance directives at any time. Choice B is incorrect because while a doctor may discuss advance directives with the client, approval is not required for the directives to be valid. Choice C is also incorrect as a witness is typically required to verify the client's signature, not the other way around.

4. When collecting a sputum specimen from a client with tuberculosis, what action should the nurse take?

• A. Obtain the specimen immediately upon the client waking up.
• B. Wait one day to collect the specimen if the client cannot provide sputum.
• C. Ask the client to provide 15 to 20 ml of sputum.
• D. Wear sterile gloves when collecting the specimen.

Correct answer: A

Rationale: The correct answer is to obtain the specimen immediately upon the client waking up. Collecting sputum early in the morning provides the best sample for tuberculosis testing. Option B is incorrect because waiting a day can decrease the accuracy of the specimen. Option C is incorrect as it does not specify the optimal timing for specimen collection. Option D is incorrect as sterile gloves should be worn for infection control but do not specifically relate to the timing of specimen collection.

5. When caring for a client with asthma experiencing an acute exacerbation, which medication should the nurse administer first?

• A. Montelukast
• B. Salmeterol
• C. Albuterol
• D. Fluticasone

Correct answer: C

Rationale: During an acute asthma exacerbation, the priority is to quickly relieve bronchoconstriction and improve airflow. Albuterol is a short-acting bronchodilator that acts rapidly to dilate the airways, making it the first-line medication for acute symptom relief. Montelukast is a leukotriene receptor antagonist used for long-term asthma control, not for immediate relief. Salmeterol is a long-acting bronchodilator used for maintenance therapy, not for acute exacerbations. Fluticasone is an inhaled corticosteroid that reduces airway inflammation and is also used for long-term control, not for immediate relief during an exacerbation.

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