Nursing Elites

1. A nurse is providing discharge instructions to a client with oxygen therapy. What should the nurse emphasize?

• A. Avoid keeping oxygen tanks in an upright position
• B. Keep oxygen equipment at least 6 feet away from heat sources
• C. Allow family members to smoke in designated areas
• D. Restrict fluid intake while using oxygen therapy

Correct answer: B

Rationale: The correct answer is B: 'Keep oxygen equipment at least 6 feet away from heat sources.' It is crucial to keep oxygen equipment away from heat sources to prevent fire hazards. Option A is incorrect as oxygen tanks should be stored in an upright position. Option C is wrong because smoking near oxygen equipment poses a significant fire risk. Option D is also incorrect as fluid intake should not be restricted while using oxygen therapy; in fact, it is important to maintain adequate hydration.

2. The nurse is caring for a manic client in the seclusion room, and it is time for lunch. It is MOST appropriate for the nurse to take which of the following actions?

• A. Take the client to the dining room with 1:1 supervision
• B. Inform the client they may go to the dining room when they control their behavior
• C. Hold the meal until the client is able to come out of seclusion
• D. Serve the meal to the client in the seclusion room

Correct answer: D

Rationale: In the scenario described, the manic client is in the seclusion room, and it is most appropriate for the nurse to serve the meal to the client in the seclusion room. This action helps maintain the client's nutritional needs while managing their behavior. Taking the client to the dining room with 1:1 supervision (Choice A) may pose safety risks both for the client and others. Informing the client they may go to the dining room when they control their behavior (Choice B) may not be feasible in a manic state. Holding the meal until the client is able to come out of seclusion (Choice C) can lead to nutritional deficiencies and does not address the immediate need for nutrition during the episode of mania.

3. A nurse is reviewing the record of a client with dementia. Which of the following findings should the nurse prioritize?

• A. Wandering at night
• B. A serum albumin level of 3.5 g/dL
• C. Urinary incontinence
• D. Restlessness and agitation

Correct answer: D

Rationale: Restlessness and agitation in clients with dementia could indicate a worsening condition and should be prioritized. While wandering at night and urinary incontinence are common issues in dementia patients, restlessness and agitation can signal acute distress or an unmet need, requiring immediate attention. Monitoring serum albumin levels is important for overall health but would not be the priority when assessing a client with dementia.

4. What are the key considerations for managing a patient with COPD?

• A. Bronchodilators
• B. Smoking cessation
• C. Pulmonary rehabilitation
• D. Oxygen therapy

Correct answer: D

Rationale: The key considerations for managing a patient with COPD include oxygen therapy, which is essential to maintain adequate oxygen saturation levels. While bronchodilators are commonly used to manage COPD symptoms, they are not the primary consideration. Smoking cessation is crucial in preventing further damage but is not a direct management consideration. Pulmonary rehabilitation is beneficial for improving exercise capacity and quality of life but is not as crucial as ensuring adequate oxygen therapy.

5. What are the early signs of heart failure in a patient?

• A. Shortness of breath and weight gain
• B. Fatigue and chest pain
• C. Nausea and vomiting
• D. Cough and elevated blood pressure

Correct answer: A

Rationale: The correct answer is A: Shortness of breath and weight gain. Early signs of heart failure typically manifest as shortness of breath due to fluid accumulation in the lungs and weight gain due to fluid retention in the body. Choices B, C, and D are incorrect. Fatigue and chest pain are symptoms commonly associated with heart conditions but are not specific early signs of heart failure. Nausea and vomiting are not typically early signs of heart failure. Cough can be a symptom of heart failure, but it is usually associated with other symptoms like shortness of breath rather than being an isolated early sign. Elevated blood pressure is not an early sign of heart failure; in fact, heart failure is more commonly associated with low blood pressure.

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