Nursing Elites

1. A nurse is planning care for a client who has pneumonia. Which of the following interventions should the nurse include to promote airway clearance?

• A. Encourage the client to increase fluid intake.
• B. Suction the client every 2 hours.
• C. Perform chest physiotherapy every 8 hours.
• D. Administer oxygen via nasal cannula.

Correct answer: A

Rationale: Encouraging the client to increase fluid intake is essential to promote airway clearance in pneumonia. Adequate hydration helps to thin respiratory secretions, making them easier to expectorate. Suctioning every 2 hours may be too frequent and can lead to airway trauma and irritation. Chest physiotherapy is not typically indicated for pneumonia unless there are specific complications. Administering oxygen via nasal cannula may be necessary to maintain oxygen saturation but does not directly promote airway clearance.

2. A nurse is assessing a client who is immediately postoperative following a subtotal thyroidectomy. Which of the following should the nurse expect to administer?

• A. Calcium gluconate
• B. Sodium bicarbonate
• C. Potassium chloride
• D. Sodium phosphate

Correct answer: A

Rationale: Calcium gluconate is the correct answer because it is administered to treat hypocalcemia, a common complication post-thyroidectomy. After a thyroidectomy, there is a risk of damaging the parathyroid glands, which can lead to a decrease in calcium levels. Administering calcium gluconate helps to raise calcium levels. Sodium bicarbonate (Choice B) is not typically indicated for immediate postoperative care following a subtotal thyroidectomy. Potassium chloride (Choice C) is not directly related to the common complications of this specific surgery. Sodium phosphate (Choice D) is not typically used to address immediate postoperative issues post-thyroidectomy.

3. A nurse is providing discharge instructions to a client who has tuberculosis and a new prescription for rifampin. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should have my vision checked regularly while taking this medication.
• B. This medication can cause my urine to turn reddish-orange.
• C. I need to wear sunscreen and protective clothing while taking this medication.
• D. I will discontinue this medication if I experience nausea.

Correct answer: B

Rationale: The correct answer is B. Rifampin can cause a harmless reddish-orange discoloration of body fluids, including urine. Choice A is not related to rifampin; vision changes are not a common side effect of the medication. Choice C is more relevant to medications that cause photosensitivity reactions, not specifically rifampin. Choice D is incorrect because nausea is a common side effect of rifampin, but it does not warrant immediate discontinuation of the medication.

4. A client with a new diagnosis of Graves' disease and a prescription for propylthiouracil (PTU) is receiving teaching from a nurse. Which of the following client statements indicates an understanding of the teaching?

• A. I should report a sore throat to my provider.
• B. I will need to take this medication for the rest of my life.
• C. This medication increases my risk for infection.
• D. This medication decreases my appetite.

Correct answer: C

Rationale: The correct answer is C because propylthiouracil (PTU) can increase the risk of infection. Therefore, the client should be aware that this medication may compromise their immune system, making them more susceptible to infections. Reporting any signs of infection promptly to the provider is crucial for timely intervention and management. Choices A, B, and D are incorrect because reporting a sore throat, assuming lifelong medication intake, or experiencing decreased appetite are not directly related to the medication's side effects or risks.

5. A client with osteoporosis is being taught by a nurse about preventing bone loss. Which of the following instructions should the nurse include?

• A. Take a calcium supplement once a day.
• B. Avoid weight-bearing exercises.
• C. Walk for 30 minutes 3 times per week.
• D. Increase intake of high-phosphorus foods.

Correct answer: C

Rationale: The correct answer is C: 'Walk for 30 minutes 3 times per week.' Walking is a weight-bearing exercise that helps prevent bone loss and improve overall health in clients with osteoporosis. Option A is incorrect because while calcium is essential for bone health, simply taking a supplement is not sufficient for preventing bone loss. Option B is incorrect because weight-bearing exercises are actually beneficial for improving bone density and strength. Option D is incorrect because high-phosphorus foods do not play a significant role in preventing bone loss in osteoporosis.

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